The first scene of this week’s episode opens up on a sheet metal factory floor. The lungs of a female foreman fill up with fluid and she starts frothing at the mouth. What could be causing such a young woman to grab her chest and drown in her own body?
Wilson greets House in the elevator on the way to his office in the morning and is met with a defensive grumble before he even gets to ask about his pursuit of Cuddy. Rather than pursue the topic further, Wilson lets it go and House is suspicious.
The Drowning Girl is an emancipated 16 year old whose parents died last year; to avoid foster care, she obtained her GED, a very impressive job, and her own place. Taub generalizes that since she’s a factory worker, she could’ve caught the cooties from recent immigrants. Foreman stereotypes her as well, this time based on age and gender, by claiming she’s probably suffering from pregnancy-induced pulmonary edema. Kutner strongly defends her and addresses the fact that her history lists her as not sexually active. However, die-hard House fans know his mantra often rings true: people lie. When Thirteen adds drug use to the mix, Kutner really takes offense – I feel a personal story coming on.
House sends Thirteen and Taub to search Drowning Girl’s apartment for toxins and drugs, while Foreman and Kutner are ordered to perform an EKG. Foreman follows House to his office and asks permission to participate in a clinical trial. House refuses and reminds him he already has work to do. Way to knock him down to size – he’s not House’s lackey anymore… or is he?
Kutner performs the EKG alone and tries to bond with Drowning Girl. He tells her he was orphaned at an even younger age than she, so he gets her story of loss and survival.
Thirteen and Taub search through Drowning Girl’s spotless apartment, admiring her balanced checkbook and homemade wooden furniture. Thirteen expresses her annoyance at Kutner’s need to see the best in people, not necessarily a bad trait but Thirteen’s turned into a bit of a cranky bitch since episode 5 (“Lucky Thirteen”). I guess having your sexual orientation and health status outed would make anyone pissed. In the midst of grumbling about Kutner, Thirteen finds a bong under Drowning Girl’s desk. Guess you really can’t trust her.
Back at Princeton Plainsboro, Kutner dismisses the discovery of the bong as irrelevant since they haven’t found anything wrong with the patient’s heart anyway. House explains that a lack of structural damage doesn’t mean that there still isn’t something wrong with the heart; for instance, drugs could’ve caused intermittent tachycardia (abnormally rapid heartbeat). Kutner thinks vasculitis (inflammation of the blood vessels) makes more sense. House ignores him and instructs Foreman specifically to start the patient on beta blockers.
Kutner starts Drowning Girl on beta blockers. He tells her they found the bong and she insists she doesn’t do drugs; the bong belonged to her ex-boyfriend. Kutner tells her about the possibility of vasculitis and switches her treatment to a course of steroids.
Cuddy catches Foreman in the clinic and finds out from him that House won’t let him do clinical trials. Cuddy refuses to override House’s decision but does hand Foreman a case file that will allow him to prove his worth and break free of boss man: a young boy with stomach cramps has been vomiting blood for four days. He visits his new patient, Jonah, the boy’s mother, and his precocious big brother, Evan, who suggests his kid bro might just need a poop (don’t know about you, but that usually works for me). Instead of being a House clone, Foreman is compassionate and attentive. I like where this storyline is heading – Foreman has always been a diagnostic genius almost on par with House but has been deathly afraid of becoming the misanthropic asshole his mentor has always been, and now here’s his chance to go head-to-head and serve as some nice competition at the hospital.
Okay, steroids might not have been such a good idea. A nurse adjusts Drowning Girl’s IV and she becomes angry and delirious. Lab tests show no metabolic cause. House tries to blame Foreman for Kutner’s bad decision, but Kutner interrupts and tells him Drowning Girl wasn’t on steroids long enough for it to be the reason for the psychotic break – it must be a new symptom. So, what causes delirium and lung issues? Foreman suggests Prinzmetal’s angina (chest pain due to severe coronary artery spasm) affecting the brain. House orders Foreman specifically to perform an fMRI and give the girl ergonovine. As soon as House walks out the room, Foreman tells the team to set everything up and page him when ready.
Meanwhile, Foreman returns to Jonah’s bedside where he tries to persuade the boy to swallow a tiny camera disguised as a giant pill that will let them more fully explore his gastrointestinal tract. At first, Jonah refuses (yeah, I don’t like horse pills either, kid) but Evan cleverly convinces him that the camera is like a vitamin that will make his muscles grow. Jonah swallows the pill and instantly breaks into a fit of giggles – another symptom. Foreman asks Chase and Cameron for help. Before they can accept or refuse, he gets paged.
Foreman joins Kutner for the fMRI. While asking Drowning Girl questions about her dead parents, Kutner notices something very interesting: the limbic region of her brain (the part associated with imagination) keeps lighting up on the scan. After being confronted, Drowning Girl admits that her parents are not dead – she emancipated herself because her father raped her and her mother pretended it never happened.
Taub thinks rape could mean she has an STD that’s causing her symptoms. Kutner, no longer able to trust her, believes Drowning Girl may even be lying about the rape. House says stress could be a contributing factor and tells Thirteen to give her diazepam.
House finally approaches Wilson to admit that he tried to ask Cuddy out but ended up falling flat on his face. Wils remains quiet as he scrubs in for surgery. House is annoyed – I wonder why? Maybe because Wilson’s acting just like him, even capping off the non-conversation with an, “Interesting…”
Chase dives into helping Foreman with his solo case, offering up meningitis, thyroid problems, and stomach cancer as possibilities. Altered mental status makes Foreman think porphyria, so he decides to test for both it and cancer. Cameron is wary: she’s either offended at being drafted onto a team serving her former peer or she’s worried he shouldn’t be juggling both cases.
It’s Thirteen’s turn to empathize with the patient, and she encourages her to turn her father in to the cops. Drowning Girl refuses. Then her urine turns brown, ruling out stress. Lab tests show the discoloration is due to shredded red blood cells. Kutner thinks E. Coli could be the culprit, but Foreman points Legionnaire’s disease is a better guess. House asks about Drowning Girl’s homemade furniture: if it was pressure treated, tiny holes would be present; burning or sawing the pieces would release arsenic. Thirteen says arsenic didn’t show on any of the blood tests. In the process of giving one of his convoluted metaphorical clues, Foreman interrupts with the clear-cut answer: arsenic is absorbed by the internal organs and doesn’t show up on tests; they should test her hair instead of her blood. Then his pager goes off and he’s gone.
Chase tells Foreman there’s no sign of cancer or porphyria in Jonah. Maybe it’s time to talk to House about this case. Foreman refuses. Jonah crashes. Yeah, maybe it’s time to talk to House.
Drowning Girl’s hair test reveals the presence of arsenic. Thirteen treats her with blood chelation (removing heavy metals from the bloodstream) which seems to work until the girl starts to seize. A new MRI shows several brain lesions that have developed over three days. Taub thinks it could be an infection like MRSA, but Thirteen points out that the white blood cell count would be much higher. House is the consummate rebel doctor by proposing they give her back her arsenic – what other physician would think of poisoning his patient in order to cure her? Apparently, some others do – I’m surprised to find out that syphilis used to be treated with arsenic before the discovery of penicillin, and Acute Promyelocytic Leukemia (APL) is still treated with it. APL explains the lesions, but even with the poison treatment Drowning Girl will need a bone marrow transplant. House orders the team to biopsy her brain.
Foreman approaches House with his tail tucked, but House already suspects that there’s a mystery case with which he needs help. Standard House practice is to let patients teeter on the brink of death just to prove a point, so he refuses to lend assistance. He’s still hung up on Wilson’s silence so he leaves Foreman and barges into his friend’s office and accuses him of using reverse psychology to influence his actions with Cuddy. Seems to be working, or at the very least is getting under his skin enough to keep a Cuddy romance on his mind.
Drowning Girl is strongly against having rapist marrow in her bones, so she refuses to have the team seek out her parents for testing. During the biopsy, Taub claims to have Huntingdon’s disease to convince the girl to do everything within her power to survive. Doesn’t quite work, especially when Drowning Girl asks him if he’s ever been raped. After the procedure, Thirteen lambasts Taub for stealing her life and lying to the patient. Taub argues back that she should’ve taken the opportunity to use her own personal story to get the girl to want to live. Their fight disturbs House who’s trying to nap at his desk. Taub tells House that the biopsy confirms APL. Against House’s orders to search the donor banks, Thirteen decides to find Drowning Girl’s parents.
Foreman meets Chase and Cameron to continue their differential of Jonah’s case. Chase suggests Munchausen by proxy, but Foreman tells him that Evan would’ve noticed if his mother was feeding her baby boy Draino. Well, what if it’s big brother who’s doing the poisoning? Foreman shakes his head – no, Evan is ultra-protective of his kid brother, helping him with everything like making sure he eats and brushing his teeth… Eureka! Jonah is suffering an iron overdose from too many children’s vitamins care of his loving big brother.
Thirteen visits Drowning Girl’s parents’ home and speaks with her father. She tells him that they’re treating his daughter for leukemia and need to test his bone marrow. He looks puzzled. We see why when he’s joined at the door by a teenage girl claiming to be his only daughter. Back at Princeton Plainsboro, Thirteen confronts Drowning Girl, who admits she stole the other girl’s identity and forged her emancipation papers. What is she really running from? Now the team will need to find her real parents to get their consent before treating the patient further. The girl gets stubborn and wickedly smart: if she lets herself get sick enough, they’ll be forced to treat her even without contacting her parents.
Drowning Girl continues to deteriorate. House’s interest is piqued by the news that she refuses her parents’ bone marrow because she wants to deny them the satisfaction of saving her life – this is too rational an explanation for what should be an emotional reaction. What is she really running from? What could be worse than rape and incest to make her lie about it? The show continues with the theme of brotherly love when House finds out that Drowning Girl caused the accidental drowning death of her baby brother in the bath tub. House convinces her to call her folks so she doesn’t end up killing their other child.
Foreman is done with asking for permission, so he tells House he’s going to do clinical trials whether he accepts or not. House is satisfied – it’s just what he wanted. At the end of the day, House and Wilson meet in the elevator and both agree that they can’t switch roles or play the same kind of games that House played with Foreman. Though their lips are sealed, I know they’re both still all ado about Cuddy.
Next Week: A very sick man holds Princeton Plainsboro hostage to get a diagnosis. This is the second gun to enter this hospital – shouldn’t they install metal detectors? It is Jersey, after all.
