The entire thread can be read at Google Groups: Subject: HOUSE, M.D.: 4. "Maternity" From: MDuPree@theworld.com.snip.to.reply (Micky DuPree) Newsgroups: rec.arts.tv,alt.tv.house-md Date: Sun, 8 Jan 2006 22:44:33 +0000 (UTC) Organization: The World : www.TheWorld.com : Since 1989 Message-ID: Lines: 737 If you consider letting it slip that a minor set prop is introduced in a later episode to be a spoiler, then there are spoilers below beyond this episode, but no big stuff. Elapsed time numbers are for the DVD copy. PROLOGUE I'm not a big fan of babies in the main (nothing against them, but they're no fun until they can talk), but I was rooting for Baby Girl Hartig. The baby they found to play her looked like she was trying her best to understand what was going on even though the odds were against her. KAREN: She hasn't even eaten anything. Why is she spitting up? I'll revisit this point below. LIM: You lived underwater for nine months, you'd have a lot to spit up too. One of the offending teddy bears was in the first scene. ACT I 2:17 The windows led me to suspect that the obstetrics lounge was actually Cuddy's office redressed. HOUSE: It's amnesia. You don't have to be a doctor to figure that one out after an accident in a soap opera. Since the "Soap Doctor" and "Soap Patient" were listed in the closing credits, this must have been the point at which the producers decided it would be cheaper to shoot their own fake soap footage than to pay for real-world soap clips. House seems to notice everything that's going on around him even when he's trying to pay attention to something else, like when he heard what the obstetricians were saying in the lounge while he was trying to watch TV. Almost every single encounter House has had with the other doctors in the hospital, besides the regular characters, has been abrasive at best, outright antagonistic at worst. HOUSE: Exhibit A: Baby Girl Hartig. Term baby, forty-two hours old. Went into seizure six hours ago, brought into the intensive care, diagnosed with obstruction of the small bowel. I think this was an arithmetic glitch. If Baby Girl Hartig didn't start seizing until she was 36 hours old, then wasn't that awfully late (barring complications) for her to be about to start feeding for the first time? And if the mother meant merely that the baby hadn't eaten anything yet *for this feeding session*, then wasn't that a bit late for the obstetrician to be explaining it away as, "You lived underwater for nine months, you'd have a lot to spit up too"? And isn't any baby over a day old really too old to be involving the obstetrician? Maybe there's some finer medical point that I missed, but I suspect the writers should have made the babies at least twelve hours younger, unless that wouldn't have been enough time for them to start showing symptoms, in which case the dialogue needed tweaking to make the numbers work. WILSON: I'm still amazed you're actually in the same room with a patient. HOUSE: People don't bug me until they get teeth. I would have thought that people bugged House when they were old enough to complain, which is pretty much immediately. But I guess babies can't lie to you. HOUSE: What does "bowel obstruction" on a chart indicate? WILSON: Well, normally, I'd say it indicates a patient's bowel is obstructed, but I'm pretty sure you have some deeper truth to impart. Hee. Actually, Wilson and Cuddy did start off sounding like the reasonable ones, but that didn't last long. HOUSE: It means that some random doctor of indeterminate skill THINKS that the patient's bowel is obstructed. I think one of the reasons why House goes over well with the audience is that he has contempt not only for patients, but also for other doctors. CUDDY: You're finding a cluster because you think it's interesting to find a cluster. Two plain old sick babies would bore you. Which, from what we've seen, is certainly true. HOUSE: See, this is why I don't waste money on shrinks, `cause you give me all these really great insights for free. CUDDY: Shrink ... If you would consider going to a shrink, I would pay for it myself. The hospital would hold a bake sale, for God's sake. Heh. If I try to imagine House with a shrink, I come up with House distracting the shrink by diagnosing all sorts of real and concocted maladies for the shrink. CUDDY: Two sick babies is very sad, but it doesn't prove an epidemic. [Exits.] HOUSE: How many do? Three. Or at least that was the standard answer we were told in math class as to how many data points do you need to establish a series. But when it comes to contagious disease, even coincidences should be investigated. I think that Chase's alarm clock was a _Physician's Desk Reference_. Oof. HOUSE: We're going hunting. FOREMAN: For what? HOUSE: Wabbits. Ha. Zebras wearing wabbit suits. HOUSE: Overflow rooms, third floor. I think there have been two functions of the third floor that we've been told about to date, maternity overflow and psych ward. (And for the hell of it, the first-floor directory also lists "SENIOR SERVICES" and "SAME DAY ADMISSION UNIT" for the third floor. Love the zoom button.) FOREMAN: [To Cameron and Chase] This imaginary infection has spread to the next floor? Explicitly from this and by implication from the lights above the elevator doors, the maternity ward is on the second floor. This was one instance where House and company really should have been wearing gloves. If they were going to go from room to room picking up babies because of a suspected infectious agent in the hospital, they really shouldn't have been handling the babies without changing gloves between babies. Even I know that. Visual continuity glitch: As we saw Cuddy's POV of the expectant couple being wheeled down the hall, there were three people over by the spindly chairs on her right. When we reversed to the POV of the couple watching Cuddy come down the hall towards them, the three extras by the chairs suddenly vanished. I'm sure there are all sorts of problems that routinely crop up when an editor is trying to match shots of extras in the background from different takes, but it's not usually so drastic that I notice people disappearing. CUDDY: Happy now? HOUSE: No. But I am interested. Geez, shoot the messenger, Cuddy. It's not like House caused the epidemic rather than contained it. ACT II 7:43 HOUSE: Because the hospital is her baby, and her baby's sick. If she doesn't solve this soon, her head's going to explode, and I don't want to get any on me. Probably the best read on Cuddy we'll ever get. CAMERON: Maybe contaminated food or water source? Pseudomonas. Baby Girl Hartig hadn't eaten yet. Were we supposed to assume she was given water before her first feeding? Dolly-in/zoom-out on Karen Hartig and her separated baby. I'm actually kind of tired of that technique, just in general. Judy Lupino was holding another teddy bear. JUDY: Well, how, um, how bad is that? CAMERON: [Pauses.] Uh ... FOREMAN: [Steps forward.] It's, it's low. The heart needs to circulate the blood. If it's weak, the oxygen isn't getting to the liver, the kidneys, the brain. Making Foreman the first to bail Cameron out. JUDY: Um, I had a cold last month, and I told the doctors about it, and -- KIM: Honey, this has nothing to do with you. CAMERON: Kim's right. Your son was born healthy. He caught the infection after his birth. There's no reason to think that he caught it from you. JUDY: But you don't know. I mean, you don't know how he got sick. My first wild-ass layman's guess was that the culprit was going to be a bug or a toxin that one of the mothers was carrying, which did not pass through the placenta (I was given to understand that some things don't), but was introduced upon postnatal contact, and that it was carried by Judy, who was trying to tell Cameron and Foreman about it but got shushed (making it Cameron and Foreman's fault for not taking a complete environmental history). I don't know if that was a deliberate red herring or not given that Cameron and Foreman shot it down so quickly and completely. CAMERON: What they need to know is the future. You got a Magic Eight-Ball? Now I'm wondering when they introduced House's Magic Eight-Ball. (I remember when they first called attention to it, but it could have been there for months before that.) FOREMAN: No, just eight years of medical training. Which would have put Foreman at around 30 in the beginning. HOUSE: You have a parasite. Not a flattering way to refer to a pregnancy. House did his own sonogram, which was even stranger than getting a fellow to do one. This particular one looked way too far along to be a four-month pregnancy, but I suppose they wanted something clear-cut to show the audience. CHASE: They have the same disease. You want to give them different treatments? FOREMAN: What the hell are you doing? HOUSE: Therapeutic trial, to find the cause of the infection. FOREMAN: That's wrong. HOUSE: We have four sick kids at least. Who knows how many more haven't started showing symptoms yet? FOREMAN: We have a duty to these two! HOUSE: If these two have different reactions, we'll know how to save the rest. FOREMAN: So you're condemning one of these kids to die based on random chance. HOUSE: [Pauses.] I guess I am. I was impressed that House didn't wimp out of saying that he was going to let a baby die. The story did allow him to dodge being a direct cause of death, but I suppose that was necessary because otherwise he probably would have had his license pulled and we'd have no more show. If they had wanted to sugar-coat it, they could have had House point out that he was giving each of the first two babies the exact same expected chance at survival, fifty-fifty, as if he had put them both on the same medication. Only this way, he fully expected that one of the two babies would draw a short straw instead of both ending up dead or both ending up alive. Plus, unless they got lucky the first time out of the gate, they'd be at a disadvantage for saving the other four babies, because putting both of the first two on the same medication would have yielded less information. So they could have honestly said that without actually improving the odds for either of the first two babies, following protocol would have lessened the odds for the other four babies. But they chose not to sugar-coat it, which was way off the beaten track for an American broadcast network show. ACT III 16:23 CUDDY: So, you're going to flip a coin? That's how you decide which baby lives? HOUSE: Can I borrow a quarter? If House could have decided which baby would live, he wouldn't have needed the quarter. CUDDY: [To House] Do what you think is best. This is probably the biggest reason why House can bring himself to work for Cuddy. Foreman and Cameron telling the two sets of parents what they were going to do was the first intercut of parallel conversations that I could remember them using, and to good effect. It wouldn't be the last. CAMERON: If their son dies tomorrow, do you think they'll give a damn what I said to them today? Absolutely. If it makes the doctors look like they were clueless as to how serious things were, it can make all the difference in whether the parents think the doctors did everything possible or dropped the ball. For some people, it can mean the difference between feeling it was an unavoidable act of God or a mismanaged act of Man. For Catholics, it can mean giving the last rites before death actually occurs. For anyone, it can mean taking the remaining time to gather other family members together before death actually occurs. Hell yeah, it can make a difference. It can undercut whether the loved ones feel they can trust anything the doctors have said to them. CHARLIE: I can't have mono. I, I don't even feel sick or anything. HOUSE: That's very often the first sign. [To Jill] Call my office in the morning. I'll schedule him for blood tests. Despite House's personal willingness to participate in his own dictum, "Everybody lies," he seems to be willing to support other people's efforts not to lie, and to that end, he's sometimes willing to collude in what seems to be the lesser of two lies (in this case, "I need to test you for mono," versus, "The child you've raised isn't your biological offspring after all"). It implies an intricate set of contingencies for ethics. Signage glitch. The wall signage across from the elevator on the same floor as House's office: second flo[...] <- PEDIATRICS <- PULMONARY LABORATORY <- ULTRASOUND PAT[...] But we know from numerous other episodes that House's office is on the fourth floor. They apparently forgot or were too rushed to switch the signs back for the scene where Jill brought Charlie to meet House. The more I pay attention to the early 4th-floor/2nd-floor set, the more I realize just how small it was and just how clever they (usually) were about disguising that fact. I think it was basically just one bisected rectangle, but if you swapped some rooms around, swapped some signs around, slapped some extra wood paneling over some glass, and didn't let your camera angles linger on any fixed landmarks, voila: you got a completely different hospital floor with an indeterminate number of branching corridors. WILSON: Find anything yet? CUDDY: No, just some baby formula being stored under a sink with a dripping faucet. WILSON: Tap water contamination. You thinking Pseudomonas infection? CUDDY: I was. I wasted a couple of hours chasing it down, but of course the formula hasn't been anywhere near the babies. Well, duh. The Hartig baby hadn't eaten yet when she got sick. The whole Pseudomonas line of investigation seemed suspect to me. HOUSE: Time of death: six fifty-seven p.m. I think it was a bit gutsy for a broadcast show to give House his first loss of the series that early on and to make that loss a baby. It wasn't that there was a censorship issue, but merely that the mainstream audience expects more feel-good television than a cable audience. HOUSE: Cameron, tell the parents. Tell them their child probably saved five lives. CAMERON: But Chase should -- HOUSE: Chase is busy. CAMERON: You're the attending. HOUSE: [To Wilson] Make sure she does her job. Why was Wilson there at all, except out of curiosity once House roped him into being his sounding board? And more importantly, why wasn't it House's job, and not Wilson's, to make sure Cameron did her job? I know it set up certain other dialogue exchanges later, but what was the pretext? I can fanwank that House went to make arrangements to do the autopsy later on, but there was nothing in the episode to indicate where he went after he gave this instruction to Wilson. Judy was clutching the death bear when she got the news. I suppose that was deliberate. When Cameron froze up as she was supposed to tell the parents their baby had died, it finally revealed the fact that this problem was never really about giving hope to patients and their loved ones. It was about Cameron finding it too personally unpleasant to deliver bad news to bite the bullet herself. At this point, for example, there was no more hope left, false or real, to give the parents. They needed to get on with their lives. But Cameron still froze up. She's probably the kind of person who'll decide she wants to break up with her boyfriend, but then strings him along for another six months because she "can't bear to hurt his feelings." If memory serves, the elimination of the dialogue from the soundtrack when Wilson told the parents, "I'm sorry," was not reflected in the original closed captions. It now says "[No Audible Dialogue]" in the DVD subtitles, and I think they made a good choice taking the dialogue out. HOUSE: I asked you to make sure she does her job, not do it for her. WILSON: She froze up. HOUSE: She felt sorry for the parents, so she shut up. You felt sorry for her, so you opened your mouth. WILSON: She has a problem. HOUSE: Yeah. She needs to deal with it. If you hadn't bailed her out, she would have done it. Great contrast. House wasn't going to coddle Cameron, as did the more chivalrous but ultimately misguided Wilson and Foreman. That ultimately made the stereotypically emotional and overwrought Cameron bearable: the fact that House saw this as a problem and demanded better from her. WILSON: Great. Then she wouldn't have slept for two weeks. Maybe she should be thinking about different specialty. Lab work? Research? Really not a bad idea. HOUSE: This is our fault. Doctors overprescribing antibiotics. Got a cold? Take some penicillin. Sniffles? No problem. Have some azithromycin. Is that not working anymore? Well, got your Levaquin. Antibacterial soaps in every bathroom. We'll be adding vancomycin to the water supply soon. We bred these superbugs. They're our babies. Now they're all grown up and they've got body piercings and a lot of anger. Great rant, in no small part because House turned his anger inward on his own profession. It's not all doctors' fault. Yeah, they overprescribe antibiotics, but patients pressure doctors for antibiotics and then don't take the full course of treatment. ("But I feel better now.") Antibiotics are routinely fed to livestock. Madison Avenue fuels the modern mania for living in antiseptic homes. (A product that "kills 99.9% of all germs on contact" should scare most parents, not reassure them.) But House reserved his anger for doctors and used the first-person plural. HOUSE: Baby Boy Chen-Lupino. Time of death: six fifty-seven p.m., Thursday, December second, two thousand four. One of the best examples I've ever seen of how to do feeling without sentimentality. Time line note. One of the few firm dates for the series (not that it won't be undercut before the end of the episode). ACT IV 28:33 CAMERON: We could run gels, antibody tests. FOREMAN: A thousand of them? The kids don't have enough blood. HOUSE: Chase, you're the intensivist. How many could we do before we risk exsanguinating the kids? CHASE: You're talking vials, not stick tests? [House nods.] I wouldn't take more than five or six. HOUSE: O.K., so we have to narrow the thousand viruses down to six. Arithmetic glitch: The dialogue made it sound like the doctors were going to take "five or six" vials of blood per each remaining baby. As a friend of mine pointed out, if they were THAT convinced that all the babies had the same ailment and they were THAT pressed for time, then they didn't have to test each baby for each viral candidate. If they could take six vials from each of the five remaining babies, then they should have been able to test for thirty different viruses. It would have made more sense (at least to this layman; can't speak for anyone else) if Chase had said that since the babies' blood pressure was already dangerously low, they shouldn't risk taking more than one vial per kid. That would have made the numbers come out closer to what the writers wanted for the plot. I also couldn't help wondering if the doctors could have gotten accurate blood tests off the dead baby, which would have upped their chances considerably. I know some viruses don't remain viable after the death of the host, but some do. Despite potential medical glitches, the viral diagnostic brainstorming session in this episode remains the strongest one in the entire series, partly because all the regulars were throwing in their two cents, even Cuddy, partly because of the way the writing and acting managed to inject high drama into the intellectual elegance of reducing 1000 possibilities to eight probabilities, and partly because I could actually believe in House firing up the troops when the troops were few in number and they all had faith in his abilities. They reused some footage when they swung into the short diagnostic montage. You could lipread Cuddy saying "influenza A" a second time, and I think that Chase was saying "vials, not stick tests?" again (which they cut away from for House's nod the first time). Not that I'm throwing bricks. It was economical, which was all to the good. It's a game, like spotting crew reflections in the glass. HOUSE: Th-the, the kids on the floor who didn't get sick -- are any of them still in the hospital? WILSON: They got moved to the fifth floor. This is the only admission I can remember that there even is a fifth floor at PPTH. FOREMAN: But what's weirder, the healthy kid we tested, he's positive for echovirus eleven and CMV antibodies as well. Which should have been a clue that the culprit was one of those two. FOREMAN: Echovirus eleven. It's an enterovirus. It lodges in the intestinal tract. CAMERON: Enteroviruses cause diarrhea and flu-like symptoms in adults, maybe a rash, but for newborns it can be deadly. Since the sick kids' mothers didn't have antibodies for echovirus 11, why didn't any of them get the abovementioned diarrhea, flu-like symptoms, or a rash? Judy Lupino was handling one of the infected teddy bears. FOREMAN: There's a company in Pennsylvania developing an antiviral. It got positive results in a lab setting and we managed to get our hands on it. It would be nice to think that everyone had access to cutting-edge medications. Since the elevators on the set don't actually work (per Lisa Edelstein's demonstration on the DVD set tour), I assume that the illusion of people emerging from a working elevator must be accomplished largely by sound and light cues. They shoot through an open elevator door, have _Star Trek_ lights go up or down to indicate the passage of floors, put the sound of an opening elevator door on the soundtrack, roll an extra "outside" light on the actors, start up the sounds of busy people in a hospital, and give the extras a signal to start shuffling around. HOUSE: How's Cameron? FOREMAN: Doctor Cameron? HOUSE: Sure. Let's start with her and then move on to all the other Camerons we know. FOREMAN: I'm sorry. I'm just not used to you asking about someone's well-being. HOUSE: I can understand how the question would surprise you. I don't quite get how it would confuse you. FOREMAN: Why do you want to know? HOUSE: Why do you want to know why I want to know? FOREMAN: I-- Just curious. HOUSE: Me too. FOREMAN: You don't get curious. HOUSE: I'm the most curious man in the world. Got that right. FOREMAN: Not about trivialities. HOUSE: Well, then, this must not be trivial. How is Cameron handling everything? FOREMAN: Just fine. HOUSE: Great. Glad we talked. I could understand the desire to cover for a fellow employee, but in Foreman's place, after an inquiry like this, I would have been running back to Cameron to tell her she needed to get her act together because the boss was trying to sniff out weakness. Simply covering for her and picking up her slack for her was misplaced chivalry and not doing her (or her patients) any favors in the long run. HOUSE: You look tired. CAMERON: Thanks. HOUSE: It's no wonder. You had a hard time the last couple of days. CAMERON: And you haven't? HOUSE: Not like you. Anyone who's that awkward either has no experience with death or too much, and I'm pretty sure it's not the former. Chase told me about that idea you had, the parents holding the baby. Where'd you get that? Did you lose someone? Did you lose a baby? CAMERON: You can be a real bastard. [Exits.] It's true, House can be a real bastard. However, in this particular instance, he didn't really go beyond nosiness. He didn't taunt Cameron or belittle her for anything. And since her issues had interfered with her work, House wasn't even being nosy outside of professional boundaries. He would have been derelict if he hadn't tried to get her to confront her deficiency somehow. They gave us a longer than usual montage of exterior shots of the hospital, perhaps to suggest the passage of some days? WILSON: Unfinished business? HOUSE: I'm in the haystack. WILSON: Ah, because now you know you're looking for a needle. HOUSE: Right. WILSON: If I tell you to let it go, it won't make any difference, will it? I should hope not. HOUSE: And the babies didn't share any common personnel. That's what's weird. WILSON: Yeah, yeah. THAT'S what's weird. I found it hard to believe that Cuddy could have missed the "Gray Lady" (do they still call elderly volunteers that?) since Cuddy was already resorting to cutting neckties and swabbing under the sinks (not swabbing bears?), but I guess this was supposed to be a variation on the truism of the janitor being the invisible man. It was also a little surprising that Wilson wasn't more supportive of House's obsessiveness this time. Unlike the case with an accidental colchicine overdose, if they couldn't pin down the source of the virus, they could have ended up with another round of sick babies. I'd guess that House marched the deadly grandma into Cuddy's office and left the matter in Cuddy's hands. Not only was it Cuddy's problem, but also Cuddy would have probably been a lot harsher than House would have been, and it would have been therapeutic for her to close the chapter on the threat to the hospital. It would have been educational for Cuddy too. Having overlooked a volunteer during one infectious outbreak, she'd certainly never make that mistake again. LIM: Hey, seriously, man. You're not supposed to be here. HOUSE: I'm performing a delivery. KUBISAK: YOU are? HOUSE: Patient whose prenatal care I've been handling. Just took her on a couple of minutes ago. 'Course, I'll need one of you two guys to supervise. LIM: When's she due? HOUSE: Late March. KUBISAK: That's five months from now. HOUSE: Thank God these chairs are comfortable. Arithmetic glitch. Since the autopsy took place on Dec. 2, 2004 and House said Jill was due in five months, she should have been due around the first of May, not in March. I wonder if Cuddy's ever considered offering House a Tivo in his office if he would attend faculty symposiums. There was no big "aha!" moment in this ep., just some heavy slogging through "the usual suspects." There was a thematic tie-in of maternity between the A and B plots, but it was pretty much there for a humorous full circle so that House got the reward of the obstetrics lounge after all despite being its unwelcome hero. Based on wardrobe changes and dialogue, the action took place on five distinct days, the first four being continuous and the last possibly being a few days later. Vicodin count: 0 And I was really surprised at that, as I never noticed the first time around that House didn't take any pills. Perhaps they felt they would have been skating too close to a perception that doctors who lose a baby shouldn't be doing drugs. However, the more I think about it, the more it would have felt like pure House if he had taken a pill right after spinning the quarter. Medical synopsis: A plot spitting up, lethargic, fever, seizing falling blood pressure acyclovir, ribavirin, broad-spectrum antibiotics Differential diagnosis: MRSA (methicillin-resistant Staphylococcus aureus), Pseudomonas, VRE (vancomycin-resistant Enterococcus), H. flu (Haemophilus influenzae type B) vancomycin, aztreonam, MRIs (negative) kidney failure urine tests (negative) cessation of vancomycin/cessation of aztreonam Levophed, two other pressors, defibrillation one death one skin rash myocardial fibrosis and lymphocytic infiltrates Differential diagnosis: CMV (cytomegalovirus), echovirus 11, influenza A, coxsacchie, robovirus, Epstein-Barr, parvovirus B19, RSV (respiratory syncytial virus) antibody tests control group antibody tests maternal antibody tests Final diagnosis: echovirus 11 targeted antiviral Clinic patient unplanned pregnancy, stealth paternity test --