The entire thread can be read at Google Groups: Subject: HOUSE, M.D.: 1. "Pilot" From: MDuPree@theworld.com.snip.to.reply (Micky DuPree) Newsgroups: rec.arts.tv,alt.tv.house-md Date: Sat, 10 Dec 2005 16:15:45 +0000 (UTC) Organization: The World : www.TheWorld.com : Since 1989 Message-ID: Lines: 805 Since _House_ was preempted this week, I thought I'd start over from the beginning. I don't think I've included any episode-specific spoilers beyond the pilot, but I do take advantage of a general knowledge of the series through the early second season, which the purists would indeed consider to be spoiling information. This is an expanded version of something I did for Television without Pity, but TwoP has a 7500-character limit per post, which meant that I was doomed never to be a good fit there. SAM: I can't unleash my full potential in a two-page summary. -- _The West Wing_, "The Lame Duck Congress" Elapsed time numbers are for the DVD copy. PROLOGUE I read a lot of fans complaining about the orange tint to the pilot and didn't know what they meant until I saw the DVD copy. The orange patient was only in the advanced stages of what all the other characters seemed to have. The copy I first saw wasn't that bad. I loved the music in the pilot. Except for the occasionally sappy commercial song choice, I did like the music in the rest of the first season, but there was something special and cinematic about the music in the pilot. I wonder where they found a pedestrian overpass in L.A. (or was that Vancouver?), because they did manage to make me think it was in the northeast. I suppose Robin Tunney is now better recognized as the woman running from the conspirators on _Prison Break_. ACT I 2:59 Princeton-Plainsboro Teaching Hospital has the busiest, most crowded hospital corridors I've ever seen, and yet since the Diagnostics Dept. works almost entirely in isolation, never bringing anyone in for a consult except Wilson, the hospital nevertheless feels radically understaffed. I loved the film noir look to the lighting in the early days. It took me a long time to reconcile myself to House's permanent stubble. It's perfectly in character that House can't be bothered to put in the time required to shave. However, in real life, it takes time and maintenance to keep stubble at the same length day in and day out. It looks like a Don Johnson 1980s affectation (which would not be in character for House). But finally I realized I had to cut them some slack for production purposes. Since they shoot scenes out of sequence, they can't afford for House to start off clean-shaven at the beginning of an episode and then have a week's worth of beard at the end. The fastest, easiest, and cheapest solution to maintaining visual continuity throughout is to artificially keep the same level of stubble all the time. WILSON: Twenty-nine-year-old female, first seizure one month ago, lost the ability to speak. They must have sent Rebecca home for a while, though, because the ham that Foreman ate wasn't a month old. HOUSE: See that? They all assume that I'm a patient because of this cane. WILSON: So put on a white coat like the rest of us. HOUSE: I don't want them to think I'm a doctor. WILSON: You see where the administration might have a problem with that attitude. HOUSE: Eh, people don't want a sick doctor. The pilot was the only time I've caught House caring about what other people think of him (in the first season, anyway). My theory is that David Shore was still experimenting with where he wanted to go with the show in general and with the character in particular. It was also a little strange that House would wait several years after he started walking with the cane to make this observation to his only friend, but obviously he said it for the audience's benefit more than for Wilson's. WILSON: No wonder you're such a renowned diagnostician. You don't need to actually know anything to figure out what's wrong. Evidence of House's reputation, albeit backhanded. HOUSE: That's an HMO lab. You might as well have sent it to a high-school kid with a chemistry set. Heh. WILSON: No family history. HOUSE: I thought your uncle died of cancer. WILSON: Other side. Implying it was a paternal uncle, or House would have caught the discrepancy in the surnames. WILSON: And she's not responding to radiation treatment. How did they know where to aim the radiation if they couldn't find a tumor? Did they just assume that the undefined "lesion" that Foreman noted was a tumor? Or is there a type of radiation therapy that isn't directly aimed? The point at which House was on the verge of taking the case was one of the few times you could actually see a Vicodin pill in his hand. I wouldn't be surprised if Laurie usually just mimes taking it. WILSON: Come on! Why leave all the fun for the coroner? I just like that line. WILSON: What's the point of putting together a team if you're not going to use them? You've got three overqualified doctors working for you, getting bored. A pattern of slacking. FOREMAN: Shouldn't we be speaking to the patient before we start diagnosing? HOUSE: Is she a doctor? FOREMAN: No, but -- HOUSE: Everybody lies. CAMERON: [To Foreman] Doctor House doesn't like dealing with patients. FOREMAN: Isn't treating patients why we became doctors? HOUSE: No, treating illnesses is why we became doctors. Treating patients is what makes most doctors miserable. FOREMAN: So you're trying to eliminate the humanity from the practice of medicine. Strongly implying that Foreman was very new to the team at this point and that this was the first case they had taken on since he got there, while Cameron had been there long enough to know House's quirks with respect to patients. FOREMAN: First year of medical school, if you hear hoofbeats, you think horses, not zebras. HOUSE: Are you in first year medical school? No. First of all, there's nothing on the CAT scan. Second of all, if this is a horse, then her kindly family doctor in Trenton makes the obvious diagnosis and it never gets near this office. Establishing the premise that the Diagnostics Dept. would be dealing strictly with 99.9th percentile cases in the A plots. Also reinforcing the implication that Foreman was new to the team if he had to have the exclusivity of zebras explained to him. CHASE: Mad cow? HOUSE: Mad zebra. Snerk. HOUSE: No, blood thiamine level was normal. Laurie pronounced it THIGH-a-meen, one of the very few times on the show when I've gotten a sense of a British accent off of him. Brits are the only ones I've ever heard pronounce it that way. (On the other hand, someone I know from Philly claims that's the way he's always heard it.) FOREMAN: I assume it's a corollary, if people lie, that people screw up. Quick study. :) Also establishing a pattern that the Diagnostics Dept. tends to distrust outside test results. Cameron's hair was so dark in the pilot it was almost black. HOUSE: I have tenure. That must have been either a minor miracle (Cuddy alone couldn't have managed that), or else House used to make more concessions to convention before he got tenure. HOUSE: I'm here from nine to five. To be fair, when House has a time-critical case, he's been known to pull an all-nighter. Ought to count for something. CUDDY: Your billings are practically nonexistent. HOUSE: Rough year. As another character would later describe House's department: a financial black hole. I wonder if House just loses billing paperwork on purpose for patients without insurance or if this was just indicative of the low number of patients he treats. CUDDY: You ignore requests for consults. HOUSE: I call back. Sometimes I misdial. This seemed stranger to me. You'd think that if other doctors are already baffled, that would increase the odds that they've got some interesting zebras for House to look at. Or does he just get Cameron to screen out the horses with dye jobs? CUDDY: You're six years behind on your obligation to this clinic. [....] Six years times three weeks -- you owe me better than four months. You'd think that Cuddy would have brought this up six years ago, but again, this was mostly for the audience's benefit. So House had been at Princeton-Plainsboro Teaching Hospital for at least six years. Someone else would later say House had been working at PPTH for eight years. Maybe House got tenure after two years and then stopped working clinic duty on the assumption that he could no longer be fired? 6 years x 3 weeks standard clinic duty/year = 18 weeks backlogged clinic duty x 40 hours/week = 720 hours backlogged clinic duty. HOUSE: It's five o'clock. I'm going home. CUDDY: To what? HOUSE: Nice. House never gets mad at personal digs. But it's also a valid question. If House lives for his work, but all but the most challenging cases bore him, then what does he do to keep from getting bored at home? CUDDY: Look, Doctor House, the only reason why I don't fire you is because your reputation is still worth something to this hospital. More evidence of House's reputation. CUDDY: The clinic is part of your job. It's been a great conceit for the series, forcing House to work the clinic, but it's still a conceit. I can't see a major cost-conscious public hospital putting renowned and expensive specialists to work doing what amounts to primary-care intake. In a lot of places, you'd have two nurse practitioners or physicians' assistants overseen by one primary- care physician doing that job. There was what looked like a female secretary in the outer chamber of Cuddy's office when House came barging in. HOUSE: [To Cuddy] You showed me disrespect. You embarrassed me. And as long as I work here you have no legal -- Once again, this was the only (first-season) episode in which I could remember House seeming to care what others thought of him (House embarrassed?), although in this particular instance, I could see him going on about all that more to light a fire under Cuddy than to salve his pride. CUDDY: That's scary, but I'm pretty sure I can outrun you. House never gets mad at cripple digs. He did take a Vicodin, though. And I loved the way Cuddy calmly talked him down. HOUSE: I've gotta do four hours a week in this clinic until I make up the time I've missed. Two thousand fifty-four. I'll be caught up in two thousand fifty-four. 3 weeks standard clinic duty/year x 40 hours/week = 120 hours standard clinic duty/year. 1.7 hours/week extra clinic duty = 423.5 weeks or 8.1 years until backlogged clinic duty is worked off. Either House was exaggerating for effect, or there's something I'm missing about the math. That business of background:green/foreground:white in the MRI room dates back to the pilot. I just didn't notice it until the second season. There was a technician present in the MRI room, but she had only one line during the first attempt, and she was mostly out of shot during the second attempt. In a lot of later episodes, there would be no technician present at all. Rebecca had the first of many allergic reactions, seizures, etc. to make an MRI or other test or treatment unfeasible and complicate the plot. If story time paralleled real time, then Rebecca was deprived of oxygen for 1:13 minutes. ACT II 13:20 House took another Vicodin while waiting for the fellows to finish up with Rebecca. HOUSE: Can't get a picture, gonna have to get a thousand words. Is gadolinium the only contrast medium you can use with an MRI? HOUSE: Twelve fifty-two p.m., Doctor House checks in. Please write that down. Do you have cable TV here somewhere? _General Hospital_ starts in eight minutes. According to my schedule, _General Hospital_ is on at 3 PM ET. House took another Vicodin while listening to Orange Guy. HOUSE: Your wife is having an affair. What if Orange Guy's wife had been blind? Or totally color-blind? Or out of town for work? Or if Orange Guy was an ex-husband or a widower who sentimentally never took off his wedding ring? There are differential diagnoses for visual inattentiveness. HOUSE: But the steroids ... the steroids ... stop the inflammation. The more often this happens ... Lesser _satori_. (Actually, in this case, false _satori_, since it wasn't vasculitis.) CHASE: You should have told her the truth. It's a long-shot guess. CAMERON: [....] If House is right, no harm. If he's wrong, we've given a dying woman a couple days' hope. CHASE: False hope. CAMERON: If there was any other type available, I would have given her that. Interesting how Cameron would have a problem with lying later, but she was cool with simply concealing the truth as long as it was an unpleasant truth. FOREMAN: Do you have any pets in this class? SYDNEY: No, but we used to have a gerbil, but Carly L. dropped a book on it. At this stage, I originally thought the gerbil was going to end up being the disease transmitter. I've been told that the footage on the cafeteria TV was from _All My Children_. I wouldn't know. _General Hospital_ was acknowledged in the closing credits while AMC wasn't. FOREMAN: Parrots are the primary source of psittacosis. HOUSE: It's not the parrot. FOREMAN: Psittacosis can lead to nerve problems and neurological complications. HOUSE: How many kids were in the class? FOREMAN: Twenty. HOUSE: How many are home sick? FOREMAN: None, but -- HOUSE: None. But you figured that five-year-olds are more serious about bird hygiene than their teacher. Wouldn't it be more likely that the care of the parrot was entrusted to another adult, not to the students? And people can't have allergic or other individual reactions to parrots? HOUSE: The lady back there, who made your egg-salad sandwich. Her eyes look glassy. Did you notice that? Sweet, a triple rack focus, extreme background to extreme foreground to close-middle ground. HOUSE: Now hospital policy is to stay home if you're sick, but if you're making eight dollars an hour, then you kind of need the eight dollars an hour, right? Nice of House to notice. FOREMAN: Oh, I can't just break into someone's house. HOUSE: Isn't that how you got into the Felkers' home? [Off Foreman's look.] Yeah, I know. Court records are sealed. You were sixteen. It was a stupid mistake. But your old gym teacher has a big mouth. Should write a thank-you note. FOREMAN: I should thank him? HOUSE: Well, I needed somebody around here with street smarts. O.K.? Who knows when they're being conned, knows how to con. Hmp. I think Foreman's only selectively wise to cons. FOREMAN: I should sue you! HOUSE: I'm pretty sure you can't sue somebody for wrongful hiring. FOREMAN: But I'm pretty sure I can sue if you fire me for not breaking into some lady's house. [Takes a pointed bite of his sandwich.] Foreman defiantly eating that last bit of sandwich cracked me up. The cover of the magazine that House was reading in exam room two: Goss[ip] SPRING'[S] HOTTEST PEOPLE [...]ver 100 pages of the most intriguing, most famous and most sought after CUDDY: Why are you giving Adler steroids? I wonder what put Cuddy on to House's case in the first place. CUDDY: You don't prescribe medicine based on guesses. At least we don't since Tuskegee and Mengele. HOUSE: You're comparing me to a Nazi? Nice. House doesn't even get mad at professional digs (which I would have expected to mean more to him). He just brushes those off too. (In "Humpty Dumpty," I think it will be important to look back at this reference to the Tuskegee study.) HOUSE: There's never any proof. Five different doctors come up with five different diagnoses based on the same evidence. Ain't that the truth. REBECCA: Am I ever gonna meet Doctor House? WILSON: Well, you might run into him at the movies or on a bus. Seriously, House takes the bus with all that hoi polloi around him? Or was Wilson kidding? ACT III 24:55 FOREMAN: When you break into someone's house, it's always better to have a white chick with you. LOL. You would not BELIEVE the shitstorm that got kicked up on the official Fox _House_ forum because fibromyalgia sufferers mistook the portrayal of the hypochondriac diagnosing himself with fibromyalgia for a portrayal of fibro sufferers as hypochondriacs. There were people complaining who hadn't even seen the episode, because some sort of call to action was circulated on some support-group network. HOUSE: I need thirty-six Vicodin and change for a dollar. No normal pharmacist would dispense narcotics without a prescription, and we would later see it confirmed that a doctor can't just prescribe narcotics for himself, so I don't know what they were thinking here. I find it hard to believe that a pharmacist would leave a bottle of 36 narcotic pills unlabeled and sitting on an unattended counter in a public place. They don't usually give that stuff up without a police escort and an armband to identify you as an addict in the making. Plus, the pills that the pharmacist gave House as "Vicodin" were small and round, not large and elongated like House's later Vicodin. CAMERON: [To Foreman] House doesn't believe in pretense. Figures life's too short and too painful. So he just says what he thinks. I guess they were setting Cameron up to idealize House pretty early, since this line came immediately after House prescribed placebos for the hypochondriac. It was also another indication of how new Foreman was to the team, with Cameron continuing to explain the lay of the land to him. CAMERON: Well, if you wanted to be judged for your medical prowess only, maybe you shouldn't have broken into someone's home. FOREMAN: I was sixteen! [....] CAMERON: I managed to make it to seventeen without a criminal record. FOREMAN: Yeah? Well, you obviously didn't grow up in my neighborhood. A lot of fans seem to think this meant that Cameron got a criminal record when she was 18, but it just seemed like sarcasm to me, because if she had a criminal record at all, especially as an adult, she wouldn't have been able to criticize Foreman's juvie record from her moral high ground. FOREMAN: You know what, after centuries of slavery, decades of civil rights marches, and more significantly, living like a monk, never getting less then a four-point-oh GPA, you don't, you don't think it's kind of disgusting I get one of the top jobs in the country because I'm a delinquent? Which was an indication of the prestige of Foreman's fellowship, probably of all their fellowships to a greater or lesser degree, and indirectly an indication of House's reputation again. CAMERON: You went to Hopkins, right? FOREMAN: Yep. CAMERON: So, you went to a better school than I did, got better grades than I did. FOREMAN: [Laughs.] So how'd you get the job? Did you stab a guy in a bar fight? LOL! FOREMAN: I had ham at her apartment! And the greater _satori_ was set in motion. Text of the open medical book in House's office. Note especially the name of the physician on an earlier similar case. :) [...]n of a common tapeworm [...]with a short trial of Albenda- [...]ays. Side effects of this drug [...]condition known as hotdog [...]ute hunger, diarrhea, vomiting [...] cases where tapeworms have [...]and migrated through the body. [...]omenon originate in the United [...]own diagnosis was made by Dr. [...]ian in the Dales country. Word of [...]ad for over twenty years due to the [...] local patois, but in 1948 a similar [...]the very young Marcus Welby, MD in [...] confirmation of the diagnosis was [...]atments were slowly perfected to kill [...]nywhere within the body in length to the entire length of the intes[...] more. These parasites rely on specialised hooks o[...] (SCOLEX) that help them attach to the intestines and absorb digested nutrients. In some cases the worm can compete with the host for absorption of food, resulting in weight loss. [caption] Taenia saginata (Tapeworm) 400x Magnification The symptoms of tapeworm infection generally begin to appear 10 days after egg in- gestion, but some people [...]tice any symp- [...]ction [....] A quick google says that Taenia Saginata is beef tapeworm, not pork tapeworm. ACT IV 33:16 HOUSE: [To Rebecca] When you're all better, I'll show you my diplomas. Unwarranted arrogance, since other doctors have diplomas too, but that doesn't mean that House would trust them on that basis. But it would be nice if we could get a look at House's diplomas. REBECCA: You were sure I had vasculitis, too. Actually, for once, House wasn't sure. He just thought that vasculitis was worth a shot. REBECCA: I just want to die with a little dignity. HOUSE: There's no such thing. Our bodies break down, sometimes when we're ninety, sometimes before we're even born, but it always happens and there's never any dignity in it. I don't care if you can walk, see, wipe your own ass. It's always ugly, always! We can live with dignity. We can't die with it. Great speech, pure House, a revelation of something he's passionate and sincere about, rather than the glib sarcasm he routinely surrounds himself with. It was the earliest glimpse we got that while the thrill of the mystery is what hooks him on any given case, there's more to his professional motivation than just the intellectual exercise. HOUSE: No treatment. FOREMAN: Maybe we can get a court order, uh, override her wishes, claim she doesn't have the capacity to make this decision. HOUSE: But she does. CAMERON: But we could claim that the illness made her mentally incompetent, right? FOREMAN: Pretty common result. HOUSE: That didn't happen here. Another point on which the characterization felt experimental. Here, it was Foreman and Cameron who were suggesting violating patient autonomy without batting an eye while House categorically refused. This was the only time I could remember these characters taking these respective stands on the issue. WILSON: He's not gonna do it. She's not just a file to him anymore. He respects her. Another line that seemed to be for the benefit of the audience. And it ain't necessarily true of the rest of the series. HOUSE: Patients always want proof. We're not making cars here. We don't give guarantees. More of an art than a science, as Cameron would later admit. Actually, I've heard of experiments to computerize medical diagnostics by combining vast databases of symptoms with AI that unfortunately performed so well that M.D.s felt threatened. But the M.D.s did like a modified version that offered up alternatives for the doctors to choose from instead of directly competing with the doctors. Why insurance companies haven't rammed such programs down doctors' throats yet I don't know. CHASE: I think we can prove it's a worm. And it was Chase who came up with the bright idea. Chase and Foreman were sitting in the x-ray control room, but there was a nameless technician actually aiming the x-ray machine. HOUSE: [To Cameron] Does it make a difference what I think? I'm a jerk. The only thing that matters is what you think. Can you do the job? It should make a difference what House thinks. His judgment and experience are supposed to be better than Cameron's. Otherwise, why should she bother studying under him? HOUSE: [To Cameron] Would that upset you, really, to think that you were hired because of some genetic gift of beauty instead of some genetic gift of intelligence? Well, the latter is more substantive and relevant to Cameron's chosen career. CUDDY: [To ex-Orange Guy] Either your wife is having an affair, or she's not having an affair and you have come here because you rightly think I should fire him. But I can't, even if it costs me your money. The son of a bitch is the best doctor we have. Another reason Cuddy is reluctant to fire House. But we would later learn that Cuddy can manage to place an upper dollar figure on him. The class' greeting card: We Miss You! We're happy you're not dead, miss Rebecca I imagine that getting parental permission for such a field trip in real life would be a nightmare, but it gave us that Kodak moment between teacher and students. REBECCA: I wanted to thank Doctor House, but he never visited again. CAMERON: He cured you; you didn't cure him. Another line that seemed to be predominantly for the benefit of the audience. TV: Because we're doctors. If we make mistakes, people die. I've been told that the clip that House and Wilson were watching in the exam room at the end was actually from _General Hospital_. Again, I wouldn't know, but that surprised me. Since everyone was masked up on the screen and the dialogue just conveniently happened to echo an earlier line of Cuddy's, I originally assumed that this footage was shot just for _House_. Some of the location footage might have been shot in Canada. I recognized one of the casting people from some Canadian-based productions. _House_ suffers a little from time compression. It can often seem like a patient starts out in perfect health, falls down, is at death's door, and gets cured, all in a day or two. While the timetable is obviously speeded up for dramatic effect, it's not usually quite as bad as it seems. They just don't bother to call attention to the passing of time. Often the only clue that a day has passed between adjacent scenes is that the characters have changed clothes. Sometimes the only clue that even more time has passed is a quick mention in the dialogue, a suggestive montage, or even just the implication that time must have passed. Based on the wardrobe changes, the action in the pilot took place on six distinct days. The first day was a month before the others, when Rebecca first seized. The last day could easily have been several weeks after the middle days, once Rebecca had recovered enough to receive visitors. Plus, Orange Guy had flushed the excess vitamins out of his system and Hypochondriac Guy had had time to use up all his placebos. All in all, I found the pilot mediocre by the high standards set by the rest of the first season (but superior by and large to the second season). I didn't dislike it, but I felt it suffered from an evident pressure to hit the ground running in establishing who these characters were and what their relationships were to one another. Hence the characters would sometimes make pointed pronouncements about House in particular to make sure we didn't miss things, like, "Caring's a good motivator. He's found something else," and, "She's not just a file to him anymore. He respects her," and, "He cured you; you didn't cure him." Vicodin count: 4 Medical synopsis A plot: aphasia preceding a seizure mildly elevated sed rate initial diagnosis of undetectable brain tumor unresponsive to radiation differential diagnosis: aneurysm, stroke, or some other ischemic syndrome; Creutzfeldt-Jakob disease (mad cow); Wernicke's encephalopathy complication: allergic reaction to gadolinium (no contrast MRIs) tracheostomy diagnosis of cerebral vasculitis responded well to prednisone, then got worse temporary blindness, seizure, cardiac arrest intermittent neurological dysfunction nonambulatory loss of control of bladder function, bowel function, or both final diagnosis: pork tapeworm in the brain (neurocysticercosis) treated with albendazole Clinic patients: 1) megadosing with niacin and vitamin A 2) asthmatic not using inhaler 3) self-diagnosing hypochondriac