Subject: HOUSE, M.D.: 40. "Sleeping Dogs Lie"
From: MDuPree@theworld.com.snip.to.reply (Micky DuPree)
Newsgroups: rec.arts.tv,alt.tv.house-md
Date: Sat, 17 Jun 2006 17:29:31 +0000 (UTC)
Organization: The World : www.TheWorld.com : Since 1989
Message-ID: <e71e5r$h7m$1@pcls6.std.com>
Lines: 2061

Years in the making, a cast of thousands ...

Spoilers for "Sleeping Dogs Lie," 4/18/06 (the one with the sleepless
lesbian).  To preempt other entries in the State-the-Obvious Contest,
yes, this is almost two months behind.  It's also really long and mostly
negative.  If you can't stand the heat, don't read the article.



This was worse than "Distractions."  Not a lot to recommend the human
race in this episode, and not a lot to recommend the writing.  The
characterization of three of the characters was an unqualified mess.

Being way behind means that I've had a chance to sample general opinion
this time, and the feeling seemed to run pretty strongly against
Cameron.  In particular, the episode recap at Television without Pity
was medically ignorant, ethically amoral, and emotionally vituperative
simply because the recapper didn't like Cameron.  See, this is what's
wrong with the American jury system.  People vote not for the side
that's in the right, but for the person they find the most likable, the
person they'd most like to go have a beer with.  I've never liked
Cameron.  She's the weakest, most annoying character on the show, and
yet she maddeningly gets more screen time than anyone else except House. 
But Jesus H., the way House, Cuddy, and Foreman treated her in this
episode was despicable.  Princeton Plainsboro Teaching Hospital
resembled part of a zoo, specifically the reptile house.

There were five major character problems that crippled this episode to
me.

1) In "Role Model," House *agonized* over putting his name and his
professional reputation on unsound medical information.  He actually
said it was unethical.  In the end, he couldn't do it, and was willing
to lose his job and the jobs of his subordinates over the issue.  Even
if the writers strip away everything that was good about House in his
personal demeanor, the central defining feature of the character was how
much medicine and his job meant to him.  In "Sleeping Dogs Lie," House
signed a medical article without even reading it.  He's let things like
clinic duty slide, but he's always taken what he considers to be serious
medicine seriously.  If you put your name to something like that, the
contents are your professional responsibility.  First-season House
wouldn't have taken the risk that he had signed off on an article with a
mistake in it.

2) The reason why House even considered putting his name behind Vogler's
fraudulent drug was because House was fighting as hard as he could on
behalf of his subordinates' jobs.  He was never a hand-holder, but he
used to give a damn about them professionally.  It is true that he has
maintained the posture all along that doctors aren't on the job to make
friends or serve as emotional surrogates.  House resisted Foreman's
desire to make him into an older friend, like Foreman had done with his
last boss.  House drew a hard line between himself and Cameron once
Cameron started trying to turn him into an older lover.  House kept
Chase at arm's length when it was obvious that Chase was hungry for a
father figure (although given what a cold fish his real father was,
maybe Chase has felt right at home with House).  By extension, it makes
sense that House would want the fellows to realize that they're not
there to make friends with one another either.  Certainly he didn't seem
to approve of Chase sleeping with Cameron, and House led by example on
that issue.

But ever since "DNR," the reason why has seemed to me to be that
emotional attachments between doctors interfere with their objectivity. 
People are more reluctant to disagree with people they're fond of, as
Foreman was when it came to declining to undercut his beloved former
boss in "DNR."  To have colleagues fighting with one another, stealing
paper topics away from one another, and resentful of one another
interferes with their objectivity as well.  People are more reluctant to
agree with people they see as antagonists.  I get that House has wanted
to toughen up the fellows where he's seen weakness, but encouraging
amoral internecine attacks within the *same department* is just as
potentially damaging to their collegial collaborative effectiveness (as
we saw in "Sleeping Dogs Lie") as personal bonds.

I also get that House put the fellows in direct zero-sum competition in
"Heavy" when Vogler was forcing him to get rid of one of them.  But in
that case, House seemed to be looking for a way to diagnose his problem
and make a choice.  When he finally ran out of options, he didn't reward
the fellow who had acted unethically.  Instead, he spared the two who
had tried to spare the other two.  Plus, by the very nature of the
problem, the fellow who ended up the loser of the competition wouldn't
be still hanging around with their resentment after being fired, whereas
when colleagues seemingly steal articles from one another and then have
to work together in the weeks to come, how are they supposed to remain
objective in the face of that?

3) Foreman explicitly called Cameron a friend in "Love Hurts" and on
that basis, took it upon himself to tell House not to hurt her when they
went on The Date.  Foreman was pissed as all hell with House in "Babies
& Bathwater" when he thought that Cameron had been fired because of
House's refusal to play Vogler's game.  He was also pissed at Chase for
not being similarly pissed with House over the same issue.  If Foreman
conceived of the job as nothing more than a dogfighting ring, he
wouldn't have gotten pissed off, but would have simply felt relief that 
he was one of the ones who had dodged the bullet.  He similarly wouldn't 
have gotten pissed off at Chase, since he would have thought that Chase 
would have been right to feel the same way.

So now we've learned that Foreman does not consider Cameron to be a
friend at all.  This is soap opera, where what happened in the past
doesn't really matter to present story lines if it's inconvenient.

4) Foreman had previously been the wisest of the fellows about
preserving a smooth workplace atmosphere.  Yeah, he stumbled in "DNR,"
but he also warned Chase and Cameron about the dangers of colleagues
getting romantically involved in "Occam's Razor."  He resisted mightily
House's attempt to pit them one against the other in "Heavy."  He
wouldn't even put forth a candidate for firing until House threatened to
make it him (and that candidate was Chase, by the way, not Cameron). 
Now Foreman doesn't give a shit about personally antagonizing someone
he's supposed to work with every day?  Once again, this is soap opera.

5) Cuddy used to complain about ethical violations.  Now she shrugs them
off.

Every time the writers have actually done something that I've wished for
in the second season, they've made me regret it.  A Cuddy-centric
episode?  Only if it makes her incompetent.  More Wilson?  Only if he
turns into an overwrought ninny.  Info on how the protagonists publish? 
Only if it turns PPTH into a snakepit.

Finally, it's bad enough that they've been dragging House down into the
mud this season and made him into a gratuitously amoral slug, but they
seem to be determined to do the same to Foreman now, too.  The only one
who's represented as "moral" is Cameron, who is usually depicted instead
as insufferably trying to run other people's lives, which isn't
morality, though it often paints itself as such.  There is no moral
compass on this show now at all, and I have to wonder if the writers
have one themselves.


Elapsed time numbers refer to a videotape copy of the original broadcast
with the commercials left in.



PROLOGUE


On the bottle that Hannah emptied:

  SLEEPING
  CAPSULES

The hand that reached for the bottle looked a lot older than Max's 27
years.


Most people would be at the doctor's office after five days without
sleep.  A truly loving partner would insist that you go to the doctor
after seven days without sleep.  But then, most of House's patients are
deeply stupid, so I guess I shouldn't have been surprised that both
Hannah and Max preferred to let it get to the life-threatening, take-a-
whole-bottle-of-pills stage before they sought medical treatment.


ACT I
5:01


On the cover of the magazine on House's face as he slept in exam room
one:

   Midwest Journal of
  Experimental Medicine


They've remodeled exam room one.  Wherever does PPTH find the money?


  HOUSE:  I'm a night owl.  Wilson's an early bird.  We're
          different species.

I would have originally pegged House as a night owl, too, but he told
the fellows in "Autopsy," "Don't worry.  I don't sleep in."

For someone who had been worried enough about Cuddy's reaction to hide
his clinic-shirking from her in "Paternity," House was awfully cavalier
about being caught sleeping on the job here.  It was, however, in
keeping with the second-season approach the writers have taken to make
Cuddy roll over for House and make House act accordingly.  He's gone
from being the _enfant terrible_ of PPTH, pulling stunts behind Cuddy's
back until he got called to the principal's office, to being its
_monstre sacre'_, mostly doing whatever he feels like out in the open
with impunity, without any acknowledgement of this change in his status
or in his relationship with Cuddy.  It was a lot funnier and more
believable when House was forced to try to hide his antics from Cuddy.


  CUDDY:  Twenty-five-year-old female with sleep issues.
  HOUSE:  I'm guessing she's -- what's the medical term?  Upset. 
          These twenty-five-year-old females are usually completely
          rational.  They're rocks, really.  Uhh, my theory seems
          to be supported by the fact that she swallowed a bottle
          of sleeping pills.  Get her a shrink.  I need some
          shuteye.
  CUDDY:  She's a little bit more than upset.  She hasn't slept in
          ten days.
  HOUSE:  She's lying.  Without REM sleep, your neurons stop
          regenerating.  The brain shuts down lobe by lobe.  She'd
          be insane after five days, dead by ten.

Oh, for shame, repeating widely circulated medical myths.  The bit about
dying after ten days awake has been circulated since around the '60s, I
think, and it's untrue.  The bit about insanity after five sleepless
days reportedly originated with a radio disc jockey in the late '50s,
whose coherence degenerated during a widely publicized marathon stunt of
on-air wakefulness.  However, controlled experiments yielded mixed
results.

In fact, Hannah seemed to be in great shape for someone who supposedly
hadn't slept in ten days.  She wasn't beset by hallucinations.  She
could speak fairly normally and remember what was said to her.

  CUDDY:  [To House]  Give me a little credit.  I know what gets 
          you off.

Give the audience some credit for seeing this pattern repeated so often,
too.  By now, House should know that Cuddy knows how to pitch a zebra to
him.  His response in "Cursed" was perfect.  She baited him, he knew she
was baiting him, she knew he knew, he still resisted, and yet he finally
gave in when she pretended to give up.


  CUDDY:  And the longest anyone has ever survived without sleep is
          eleven days.  Which gives you about twenty-two hours.

The record for an otherwise healthy person staying awake is actually 18
days, and the recordholder reportedly recovered her healthy status after
getting some sleep.  Rats in laboratories have died after experimenters
deprived them of sleep for 21 days, but I don't think there are any
documented cases of any normal human beings dying from lack of sleep.   
For some reason, no one suggested that Hannah could have been an 
atypical presentation of fatal familial insomnia or sporadic fatal 
insomnia.  People suffering from FFI do die of it, but it can take 
months without sleep for death to occur, and scientists don't even think 
that the cause of death is the lack of sleep per se.

Some people in the manic phase of bipolar affective disorder have done 
marathon wakefulness sessions without significant permanent damage.  Of 
course, they also have a mental illness, but it was unfathomable that 
the Diagnostics Dept. briefly considered schizophrenia for Hannah, and 
yet bipolar disorder was never even suggested during the differential in 
this episode.


On the cover of the magazine that Cameron slapped down in front of
Foreman:

   Midwest Journal of
  Experimental Medicine

Meaning House was sleeping under the same journal, but still hadn't read
Foreman's article.

Wow.  Having to find out about Foreman's article by reading it in the
journal.  He couldn't even bother to give Cameron a heads-up that it was
accepted by the journal.  He may as well have told her she was less than
shit to him, and the rest of their colleagues rubber-stamped that.


  CAMERON:  You stole my article.
  FOREMAN:  I wouldn't do that.
  CAMERON:  I wrote up the case where we induced hypothermic
            cardiac arrest in the terminal cancer girl.
  FOREMAN:  I wrote my own.  I didn't steal yours.
  CAMERON:  You knew I was writing one!  You gave me notes!

Right off the bat, we were faced with an unbelievable story postulate:
that the publication of any article at all on a given medical case
automatically precludes anyone else from ever publishing any other
article about the same case, regardless of what other aspects of the
case it may describe and regardless of what other vantage or discipline
may be involved.  It doesn't work that way in the real world, but none
of the rest of this plot line could be gotten to make sense unless we
swallowed this postulate whole.  Therefore, as we would learn, though
Foreman was technically correct to say that he didn't steal Cameron's
exact article or even her angle of approach, every single regular
character acted as if the publication of Foreman's article had
irrevocably blocked Cameron (and anyone else) from ever publishing 
any other article whatsoever about the same medical case.  So in effect, 
he did steal her idea to publish about the case without so much as a 
warning that he was entering the race as well.


  CAMERON:  I assume the E.R. tried giving her some sedatives.  We
            should up the dosage.
  FOREMAN:  Sedation isn't the same as sleep.

No shit, but sedatives and sedating doses of antidepressants are often
what American doctors prescribe when they're faced with sleepless
patients that they want to get rid of.

Why couldn't the Diagnostics Dept. have induced a coma to sort of keep
Hannah on hold while they ran tests?  It wouldn't have been normal sleep
either, but people can spend years in a coma without dying from lack of
"normal" sleep.  (Yeah, eventually they would have had her bleeding and
liver failure to contend with, but they were ignorant of that at this
point.)

  CAMERON:  Thanks for your insight.  For someone who hasn't slept
            in ten days, sedation is a great start.

Where some American doctors are too quick to reach for the prescription
pad without an adequate sleeplessness diagnosis, though, others will
dole out only a few pills at a time, if they're willing to dole out any
at all, even in the face of dysfunctional suffering, because of a "just
say no" conviction that insomniacs are really just addicts in disguise.


  CAMERON:  You've had my article on your desk for the last four
            months!
    HOUSE:  I'm a very slow reader.

For what it's worth, I've always figured House for a page reader.

    HOUSE:  No fever, no white count, means no infection.

"Everybody lies," including TV writers.  At this early point in the
episode, House knew about the steroids and knew about the normal white
blood cell count.  He's a genius infectious disease specialist who knows
that steroids suppress the immune system, and yet it took him until the
last ten minutes of the hour to realize that "normal isn't normal."  The
writers once again retarded House's powers of deduction so that he
wouldn't reach the right answer too soon.

    CHASE:  Schizophrenia?
    HOUSE:  No delusions.

And yet no one suggested the manic phase of bipolar affective disorder,
which would have been much more likely.

  CAMERON:  You read his.
    HOUSE:  Signed it.  Didn't read it.

That was a terribly sour character note for me.  House sure as hell read
the report on Vogler's drug Viopril before he put his name to an
endorsement of it.  The use of his professional name mattered so much to
House that he was willing to throw away everything he professionally
cared about to do the right thing professionally, on behalf of nameless
faceless sick people that he was never going to meet and who weren't
even his patients.  God, I miss that House, gone and never to return.


  CAMERON:  When did you get his article?
    HOUSE:  Uhh, about three weeks ago.

I'm not sure about the medical profession, but that would be
breathtakingly fast publication in academia.


  FOREMAN:  Sleep is initially controlled by external light cues.
    CHASE:  And if her brain can't interpret those cues ...
  CAMERON:  Optic-nerve disease.

Unfortunately, they picked a medical problem that I actually know a
little about this time: sleep disorders.  Or at least I know what it's
like to be processed by the medical system for a sleep complaint.  It is
extremely difficult to get diagnosed and treated for rare sleep
disturbances, because the protocol is to check for a host of other, more
common sources of sleep disturbance first.  The only thing that rang
true to me about House's approach to the problem was, "She's upset,"
because mood disturbances and mood disorders are always the first
suspects, and a psych referral is usually the first order of business,
especially if the patient isn't overweight.  An exhaustive history is
taken with respect to mood disorders and lifestyle, because the
automatic assumptions are that you're either manic, depressed, or
bringing your troubles on yourself with caffeine, nicotine, and poor
bedtime habits.  Never does the suspicion jump from "upset" to optic
nerve disorders in a single step.  Most sleep specialists, who aren't
called in until after the psych disorders are ruled out, won't even jump
first to circadian disorders.  Half of them are just spotting apnea and
narcolepsy and aren't even well versed in circadian disorders.  Before
they test your eyes, they're going to order a sleep study, and we know
that PPTH has a sleep lab, because they used it to diagnose night
terrors in "Paternity," and House sent the sexsomniac in "Role Model"
down to the lab to have her brain waves examined.

The claim that you haven't slept in over five days will not be taken
seriously unless the doctors can see it with their own eyes, because the
assumption will be that you are getting at least short incidents of
sleep ("microsleep") without knowing it (as indeed appeared to be the
case in this episode).


    HOUSE:  I'm sensing another article.

Because in this fictional universe, it was now out of the question for
Cameron to submit her previous article anywhere.  Besides, House didn't
indicate that he would sign her next article either.


  FOREMAN:  Need a hand?
  CAMERON:  No.
  FOREMAN:  We're never going to work together again?

That thought didn't even occur to Foreman when he wrote the article? 
And to say this in front of a patient just compounded his
unprofessionalism.


  CAMERON:  She's asleep.
  FOREMAN:  Normal stage one brain waves.
  CAMERON:  Maybe she's -- better?
   HANNAH:  [Opens her eyes.]  Still blurry.
  FOREMAN:  You fell asleep.
   HANNAH:  No, I didn't.

At which point real-world doctors would generally become suspicious
about the reliability of the patient's original report of nonstop
sleeplessness (and therefore about the validity of the imposed deadline
to cure the patient).


  FOREMAN:  The brain is often unaware of stage one sleep.

Very true.  Sometimes the only way I know I'm asleep is if I realize
that what I'm thinking about is way too peculiar to be a daydream.

  FOREMAN:  CT showed no tumors, no clots, no seizure disorder.

I thought you needed an EEG to detect seizure disorders.  Well, that or
a seizure.


I think that the Vicodin-laced Reuben sandwich was the first time we've
seen House take his usual pain meds in any other way than popping the
pill.  I couldn't see where sprinkling it on food would be any faster,
though, since he had to eat the whole thing in bites to be sure of
getting it all down.  Why not crush it and dissolve it in a beverage
that he gulps down?  He could make those up ahead of time so that some
already dissolved Vicodin is ready and waiting to get into his
bloodstream when he wants it.


    HOUSE:  Where's Cameron?
  FOREMAN:  She felt I could deliver the news on my own.
    HOUSE:  Oh, this is going to work out great.

And the master diagnostician of human relationships couldn't have seen
this coming?


    HOUSE:  [To Cameron and Foreman]  If you two guys can't play
            nice together, I'm taking away your toys.  I don't care
            whose fault this is.

Yeah, that's the clever way to run a department on which people are
staking their lives.

  CAMERON:  If YOU hadn't --
    HOUSE:  Especially don't care if it's my fault.

Because it's up to House's subordinates to do House's job for him. 
Nice.


    CHASE:  You want us to make her sicker?
    HOUSE:  Yes.  I want to stress her body.  Specifically her
            brain.  Keep her awake.
  CAMERON:  Depriving her of even the few minutes of sleep she does
            have, it's torture.
    HOUSE:  So's cutting people with knives, but you can totally
            get away with that if you have a doctor coat on.
  FOREMAN:  House, those few seconds of sleep are maybe the only
            reason she's still alive.
    HOUSE:  The more symptoms we can force out of her, the more
            tests we can do.  The more tests we do, the more
            information we get, the quicker we make a diagnosis.

The writers act like clinical medicine is binary: either you make the 
diagnosis and cure the disease, or you don't.  Therefore by making the 
symptoms worse here, House would be able to solve the case and make the 
patient all better.  Problem is, with some illnesses, if you don't  
control the symptoms, you increase the risk of permanent damage or even
accelerated death.  Some illnesses are diagnosable, but have no cure. 
Exacerbating a patient's symptoms may hasten not only their diagnosis, 
but also their demise.

On the other hand, while I personally didn't think that Hannah would 
have died if she hadn't slept for another day, I also didn't see what 
House hoped to find out by taking this risk either.  Admittedly, it's 
not a subtopic I'm well read in, but I've never heard of an instance of 
forcing someone to stay awake that yielded symptoms diagnostic of 
anything other than lack of sleep.

    HOUSE:  See how much more fun it is when you guys get along? 
            [Points at Cameron and Foreman.]  You two take the
            first four hours.  [Chase smirks.]

The best thing about this episode was watching Jesse Spencer do silent
facial expressions while the storm went on around him.  He's good at
that, always "on" even when he isn't the center of attention.

The steadicam operator really gets in there and dances around the actors
sometimes.


At least Cameron pulled Foreman away from the civilians to argue with
him about sticking the patient with a needle to keep her awake (and also
about sticking Cameron on the article).


  CAMERON:  We've got rectal bleeding.
    HOUSE:  What, all of you?

It's been a recurring theme this season.

    HOUSE:  So the monster is peeking out from under the bed. 
            Which either means she has a clotting disorder, or she
            has a tumor in her colon.

Since when does either of those conditions account for nonstop
sleeplessness?  Why didn't they do a proper differential diagnosis on
the whiteboard this time?


  CAMERON:  You have to sedate a patient to do a colonoscopy.
    HOUSE:  Why?  Just because of the pain?  [Takes a Vicodin.]  If
            you find a tumor in her colon, you can knock her out. 
            If you don't, she stays awake.

They did a virtual CAT scan colonoscopy on Carly in "Control."  It was
said to be expensive, but they didn't even offer Hannah that option
here.

Why did no one mention the possibility of spinal anaesthesia instead of
general anaesthesia?  I had a spinal once.  I recommend it to all my
friends.  No grogginess, no nausea, faster recovery, and if the doctors
make a mistake, they're less able to cover it up.

One of the reasons why it's necessary for the plot to have most of the
zebras be at death's door, especially these days, is because in real
life, when patients are treated the way House treats them, a lot of them
go shopping for a different doctor, regardless of the first doctor's
reputation.  A relatively quick drive up the New Jersey Turnpike and
House's patients would be in New York City, where they could find hordes
of specialists with good reps.


  CAMERON:  [To Hannah]  Keep breathing, nice and steady.  [To
            Chase]  How am I supposed to work with him?

Oh great.  Cameron caught the "Let's air our dirty laundry in front of
civilians" bug.


  CAMERON:  Is that what you told him?  I'm hysterical, and I need
            to relax my anus?
    CHASE:  I told him, "How many cases do we work up in a year? 
            They're all weird."  He could have written up any one 
            of them.

An excellent point.  House's department should be a never ending gold
mine for someone interested in medical publishing.


ACT II
17:41


  FOREMAN:  Rat poison mixed with some sort of neurogenic toxin
            could cause bleeding and sleep disturbances.

To give Foreman his due, he seemed to be the only one in the department, 
including House, strangely enough, who finally buckled down and tried to 
explain all the symptoms at one go by this point.


  CAMERON:  Do you have any idea what it feels like to have a six-
            foot-long hose shoved into your large intestine?
    HOUSE:  No, but I now have a much greater respect for whichever
            basketball player you dated in college.

Sometimes they seem to be pushing the censors to see just how much
crudeness they can get away with.  It makes me wonder what on earth they
put in as censor-bait that they traded away so that they could keep
lines like this.  The problem with this approach is that the writers
seem to yearn for cable's freedom, but House will never sound like a
cable character as long as he has to make do with 'crap' and 'pee' (and
you know that in real life, no one like House would tiptoe around
profanity).


    HOUSE:  Rash plus nosebleed plus sleep disturbance equals
            Wegener's granulomatosis.  Start corticosteroid
            treatment.

In "DNR," the patient was already on steroids for pneumonia when House
decided to switch to a diagnosis of Wegener's granulomatosis.  House
treated the patient with Cytoxan.


  HOUSE:  [To Anne]  Judging by the redness around your mom's 
          nostrils and the tissue she's got conveniently stashed in 
          her wristband, I'd say her problem is more likely a URI 
          than a PMS.

Except that these symptoms could also have been explained by crying. 
Conveniently, though, it would turn out that House understood part of
what Mrs. Ling was saying, which allowed us to gloss over what was
probably sloppy writing and not a deliberate signal to the audience that
House wasn't really making his diagnosis based on the ambiguous clues he
told Anne about here.

Unfortunately for Stupid American Child, some big hospitals with a rep.
might actually scrounge up a Mandarin translator (or Spanish, French,
Portuguese, Haitian Creole, Vietnamese, to name just some of the ones
provided at my hospital) to avoid such problems as this.  (I thought
that Mandarin was an educated lingua franca kind of dialect, not a
mother-tongue dialect spoken in the home between family members, but
maybe I was misinformed.)


That was a really perfunctory first-time introduction to birth control
pills, too.  No stressing of how important it is to take one every day. 
No advising Anne that if there were any problems, a different
formulation might work better for her.  No warning that pills do not
protect against STDs.  And especially no warning that another method of
contraception must be used for one cycle before the pills would have her
covered.  All that's usually on the package insert, but House took pains
to establish for us that he knew he was dealing with Stupid American
Child, who, from the sound of it, was twelve years old and a complete
newbie to contraception.  ("You were going to exchange the birth control
pills for some over-the-counter decongestants in the hope that your
mom's cold lasts another six years?")


The thematic connection between the A, B, and C plots this time was
(surprise) "Everybody's (mis)using somebody else for his or her own
gain.  Except for Cameron, who needs to get with the program."


There are a lot of zebra cases that aren't life-threatening.  I realize
that for dramatic purposes, they're going to make most A-plot zebras
require House's services in order to avoid dying in a matter of days,
but for variety, I'd like to see some of the clinic patients replaced by
minor, but bizarre zebra referrals.  Sometimes zebras just happen to
walk into the clinic and get House by the luck of the draw, but that's
not statistically believable on a regular basis.


  CAMERON:  Was this just one of your experiments?  You just wanted
            to see how I'd react to being screwed over by Foreman?
    HOUSE:  Nice idea, but no.  This was just good old-fashioned
            laziness.  Gotta hand it to Foreman, though.  He knew
            that you're a suck-up, and I don't give a crap.  He
            successfully exploited us both.

Actually, it's been Chase that they've represented as the suck-up. 
Cameron has given both House and Foreman an argument from time to time,
but I wouldn't expect the writers to keep track anymore.

House used to care almost fanatically about what medical information he
put his name to.  He also used to care about the people in his
department being able to work together well.  Late second-season House
is almost unrecognizable from his first-season version (and has even
deteriorated from earlier in the second season) apart from the surface
presentation of "asshole doctor."

House's motives here were completely opaque.  There was no reason given
for why he would sign one fellow's paper in an expedited manner and
simply ignore the other's.  After all, the stated motivation of
"laziness" would indicate that he not sign either paper.  What did it
matter that Cameron was supposedly a suck-up and Foreman knew House
supposedly didn't give a crap?  How did that lead to different results? 
I can think of plenty of reasons they could have given or hinted at --
House didn't like Cameron's paper, he deliberately abused his authority
to "teach her a lesson" about being more cynical (which he said he
didn't do), he simply forgot about Cameron's paper, or even that he
refuses to speak in a publication on the subject of medical ethics --
but no reason at all was a huge hole in that plot line.  It was never
even stated what it was that Cameron was supposed to do differently the
next time in order to get the result that Foreman got this time.

  CAMERON:  Right.  We're both victims.  A simple heads-up, that's
            all I needed.  Maybe between your incredibly witty
            remarks about anal sex and Cuddy's breasts, you could
            have tipped me off.
    HOUSE:  Yeah.  Then I'd have Foreman pissed at me.  And as
            annoying as you could be, at least I know you're not
            going to pop a cap in my ass.  Witty, huh?

Oh, right.  House has always quaked in his boots over the wrath of
Foreman.  

    HOUSE:  You, on the other hand, continue to be flabbergasted
            every time someone actually acts like a human being. 
            Foreman did what he did because it worked out best that
            way for him.

Cameron just sounded angry to me, which was entirely reasonable.  She
didn't seem flabbergasted about the article business until Foreman told
her off at the very end of the episode.

What was flabbergasting to me was the specific personality makeover they
did on Foreman from an extremely by-the-book doctor and all-round nice
guy to a viciously cutthroat amoral scumbag.  They used to base plot
points and character points precisely on how difficult it was to get
Foreman to color outside the lines.  Now violating boundaries is
supposed to be his everyday personality, and it's been retconned to have 
always been this way.  Once upon a time, House would have been alarmed, 
not only because Foreman was being unprofessional and trying to throw 
his department into disarray, but also because it was an anomaly in his 
standard behavior pattern, and House used to hate anomalies.

    HOUSE:  That's what everyone does.

Doublethink: by enacting inferior behavior, that somehow entitles you to
strike a superior pose.

  CAMERON:  That is not the definition of being human.  That's the
            definition of being an ass.

It seems to be what the writers these days think is universal.

House has Alzheimer's, not only about the characterization of first-
season Foreman, but also about some people he's met along the way.  He's
completely forgotten about Senator Wright from "Role Model."  And
screwed up though Dr. Charles was, the TB doctor from "TB or Not TB" was
going to die to make a point, and this has also completely dropped from
House's memory.  House conveniently forgot about offering to take a one-
third cut in his pay to retain all of the fellows in "Heavy," even the
one whom he suspected of double-crossing him.  Both House and Cameron
have amnesia about House throwing everything away in order not to
support the sham of Vogler's drug in "Role Model."

This version of House doesn't even square with the earlier second-season
version of House, which, in a dazed and confused way, allowed for
individual morality, which isn't quite the same thing as narrowly
defined self-interest.  From "Acceptance":

  STACY:  I had to do what I thought was right.
  HOUSE:  It's the only reason anyone does anything.

The second season has also introduced a de facto double standard.  In
"Damned If You Do," House praised Foreman for standing up for what he
believed in and criticized Cameron for not doing the same:

  HOUSE:  [To Cameron]  Take a lesson from Foreman: stand up for
          what you believe.

In "Control," House belittled Wilson for not standing up for what he
believed:

  HOUSE:  [To Wilson]  Oh, geez.  Have some backbone.  If you think
          I'm wrong, do something.

But here House was hammering Cameron for sticking up for what she
believed in.  Does independence of mind look good only on male doctors?


  FOREMAN:  So you think I was out of line?

Great, back to airing dirty laundry and talking about absent colleagues
in front of civilians.

    CHASE:  That article would've sat on House's desk for the next
            six years.

Chase seemed to be trying to mollify all sides, which actually fits for
a kid who grew up the way he did.  But as far as revisionist House goes,
Chase didn't say anything untrue to either Cameron or Foreman, just not
the whole truth.  Chase sidestepped Foreman's question here.

  FOREMAN:  I could've told her.

Foreman could say this to Chase, but not to Cameron?

    CHASE:  You could have written it for her too.

Except that that was unnecessary, since Cameron had written hers first.

    CHASE:  She knows House as well as any of us.  She should have
            known she was waiting for him to do something he was
            never going to do.

The writers seemed to be completely unaware of the fact that they never
once bothered to say what it was that Cameron did differently from
Foreman, if anything.  If there was supposed to be some great amoral
_Lord of the Flies_ lesson here about how to get ahead in life, they
never actually said what it was.  For all we know, House put on a
blindfold one day, picked a piece of paper on his desk at random, and
signed it.  How was Cameron supposed to wise up and exploit that lesson
in the future?  House may as well have just told Cameron, "I like
Foreman, and I don't like you," because it resulted in the same thing.


  FOREMAN:  Looks like REM.
      MAX:  What's that?
    CHASE:  Rapid eye movements.  It's what your eyes do when
            you're sleeping.
      MAX:  But she's awake.
  FOREMAN:  Hannah!  Hannah, can you hear me?
   HANNAH:  [Comes to.]  Yeah, of course.

Except that some people can sleep with their eyes open.


    HOUSE:  Was she sitting up or lying down?
    CHASE:  Sitting up.
    HOUSE:  Then it wasn't REM.
  CAMERON:  Chase says her eyes were moving the exact way --
    HOUSE:  You start her on the steroids?
    CHASE:  Not yet.  We were still doing the --
    HOUSE:  Then she wasn't sleeping.
    CHASE:  How do you know?
    HOUSE:  Because we haven't done anything yet.  She may be able
            to sleep with her eyes open, but unless you also
            discover that she's got two extra teats and hooves for
            feet, there's no way she'd be able to maintain enough
            muscle tensity during REM sleep to sit upright.

Never ever ever?  One of the things that bugs me about the depiction of
House's methods is that he ends up treating the human body and its
ailments as pretty much a completely mapped out territory.  All he has
to do is find the latitude and longitude of what's ailing you, and he's
got it nailed.  And yet many, perhaps most of the conditions recognized
as being medical zebras today started out as unrecognized, and therefore
as undocumented, at least in respectable scientific journals.  At some
point, someone who thought outside the box had to say, "Wait a minute. 
Something that everyone says shouldn't happen is nevertheless happening, 
and we can't explain it away in a rigorous scientific manner, except to
allow that there exists a condition that was previously thought not to
exist."  But since a bunch of TV writers can't produce convincing new
medical discoveries, House can't go there without venturing into science
fiction.  That's unfortunate, since I'd expect a real House to trip over
previously undocumented phenomena every so often and to be 
epistemologically rigorous enough not to misdiagnose them as just quirky
versions of already known illnesses.  (And the third option, admitting 
that there are some things that medicine simply hasn't figured out yet, 
isn't permitted on the show because that would make House look less than 
omniscient, and we can't have that.)

Anyway, a normal person couldn't maintain upright muscle tensity during
REM sleep, but Hannah wouldn't have been House's patient if she had been
normal, duh.  No one suggested REMSBD, rapid eye movement sleep behavior
disorder.  It's not common, but it's more common than bubonic plague in
the U.S.  Plus, I suspect it's underdiagnosed because unless the sleeper
gets violent enough to make treatment an urgent priority, people would
tend to shrug it off as garden-variety (NREM) sleepwalking.

    CHASE:  Rabies could cause muscle spasms, malaise, anxiety, and
            wakefulness.
  CAMERON:  Pretty unlikely she'd forget being bitten by a crazed
            animal.

It managed to slip by last season.


  HOUSE:  If her birthday was a month ago, she would've still been
          on steroids for the poison ivy.  And those meds would
          have suppressed any reaction she might have had to the
          dog, which means she lied about being allergic.  Dog's a
          commitment.  You pretend to be allergic, because you
          don't want to tell your girlfriend that you're not
          planning on being around that long.

Or the lie could have been in the courtship phase, where non-dog-person
Hannah lied to dog-person Max about being a dog person in order to get
more in Max's good graces.  Once Hannah was asked to back it up, rather
than get caught in the first lie, she just lied about being allergic. 
Oh, too bad.

Or the dose of steroids for the poison ivy might not have been high
enough to completely suppress a really strong allergic reaction to the
dog.  These things aren't binary (as House himself noted when he said
that you'd need a much stronger dose of steroids for Wegener's
granulomatosis than for poison ivy).


  CAMERON:  Well, we could either base our diagnosis on your
            admittedly keen understanding of lesbian relationships,
            or we could do a scratch test.
    HOUSE:  Do a scratch test.

I appreciated that House was willing to back up his hypothesis with a
test, but of course, he had to be right because there are never too many
variables in life to be beyond his ability to calculate.  What if Hannah
had simply lied about taking the full course of steroids because they 
were making her gain weight?  What if there was some lie or mistaken 
impression behind the poison ivy?  There are times when I think they 
take "Everybody lies" too far on this show, and other times when I think 
they don't take it far enough, because House blindly trusts some 
information and yet distrusts other information with about as much
foundation.


There was an irreconcilable time line contradiction.  Max gave Hannah a
dog "about a month ago."  Hannah successfully feigned an allergic
reaction, so they got rid of the dog:

    HOUSE:  When did she get rid of the dog?
  CAMERON:  About a month ago.

Hannah was supposed to be already on steroids for poison ivy at the time
of the dog incident, so she supposedly couldn't have gotten allergic
symptoms.  Therefore the poison ivy attack was at least a month ago as
well:

    HOUSE:  If her birthday was a month ago, she would've still
            been on steroids for the poison ivy.

Ten days prior to admission to PPTH, Hannah was hit with insomnia:

    CUDDY:  She hasn't slept in ten days.

And yet at one point, House claimed that the poison ivy symptoms didn't
show up until the same time as the insomnia:

    HOUSE:  What if the poison ivy wasn't poison ivy?  She got the
            rash that was diagnosed as poison ivy around the same
            time the insomnia started.

So there were conflicting claims that the poison ivy and the steroids 
started at least a month ago vs. only ten days ago, a contradiction that 
was never acknowledged by the characters.  Ordinarily, I'd just note it 
as a minor glitch and move on, but the writers were the ones who made 
the timing of the steroids into a plot point leading to the revelation 
about Hannah intending to leave Max, and the whole magilla about the 
ethics of informed consent followed from that.


  HANNAH:  She's a good person.  We've just been together so long,
           I ...  I'm tired of her.

What, were they high-school sweethearts?  Hannah's 25th birthday was
only a month ago.


  CAMERON:  She has massive internal bleeding.

I don't know why they didn't pursue clotting disorders or cancer more
vigorously in the beginning (or beat themselves up for not having done
so once they discovered the internal bleeding).  House mentioned them as
possibilities when Hannah started bleeding rectally, but after the 
nosebleed, they just assumed that that explained the rectal bleeding as 
well without bothering to exclude the differential.


  CAMERON:  Drugs or alcohol can mess with the sleeping and
            compromise the liver.

But House specifically said that the tox screen was negative except for 
the sleeping pills.  Argh.  If the writers wanted Cameron to suggest 
something more exotic than a garden-variety tox screen would cover, they 
shouldn't have included garden-variety "alcohol" in this line.


  FOREMAN:  Liver's not compromised.  It's dead.  She doesn't need
            a diagnosis.  She needs a new liver.
    HOUSE:  She's not getting a new liver unless we can figure out
            what's wrong with her.
  FOREMAN:  Test for cirrhosis: twelve hours.  Test for hepatitis:
            eight.  Her liver's not going to last another six.

Two problems here.  1) Ever since they used a pig for liver filtration
in "Mob Rules," I haven't been able to figure out why none of the
doctors has ever suggested doing it again, even if they were to come up
with reasons why they couldn't.  It just looks so damn odd, as if the
pig trick had been just a one-off wish from a genie that they could
never repeat.

2) As I foresaw, House did not have Cameron comb through impending
hospital deaths looking for a suboptimal transplant donor like he had
her do in "Sex Kills."  And yet, since they did it once, I had to wonder
why they didn't even consider doing it the next time they needed an
organ.  Sure, they could have come up with reasons why not, but we
didn't even hear a peep about the possibility of trying, much less the
obstacles.

I can shrug off some real-world medical inaccuracies, but the internal
inconsistencies in the _House_ world really grate, since they may as
well be making up fake illnesses and fake cures out of whole cloth if
none of the medical stuff matters anyway.  It's hard to give a damn
about a character who's supposedly rational and observant if there's
nothing genuinely rational about what he does, and there's nothing 
really there to observe.


Max was *amazingly* prompt with all the exact questions, suggestions,
and demands that House wanted to hear re organ donation.  How many 
laymen would know to say all those things in exactly the right order?  
House is far, far luckier than he has any right to be.


ACT III
33:01


    HOUSE:  Differential diagnosis: which monster eats your liver,
            screws up your sleep, and causes bleeding?

If the patient were Prometheus, I'd say vultures.  In this case, I had
to wonder if maybe the sleeping pills were what boxed Hannah's liver
while the sleeplessness was a separate problem.  But I guess it was 
necessary for the plot that no one thought to check for those pesky 
liver function numbers after the overdose just to make sure the pills 
hadn't clobbered her liver, or else they would have presumably seen that 
something was fishy with that liver all the way back when she got there, 
and they'd have a little more than SIX HOURS to procure an organ and 
complete a transplant.


  CAMERON:  If she knew, there's no way she'd go through with this.
    HOUSE:  And if you didn't have a pathological need to create a
            close personal relationship with every dying person you
            meet, we would be blissfully ignorant of any ethical
            dilemmas and might actually be able to concentrate on
            the differential.

The writers are reducing their genius protagonist to babbling idiot 
nonsense.  Ordinarily, House thinks it's great to know every conceivable 
thing about the patient, up to and including what the family cat died 
of.  At the point when Cameron queried Hannah on the dog issue, they 
didn't know about the liver problem yet, nor about the potential need 
for a transplant, so even by House's own standards of inquiry, Cameron 
didn't do anything wrong.  All she did was confirm House's guess that 
there was a lie in the patient's medical history, a verification 
exercise that House usually heartily approves of.  In fact, the person 
on whose behalf Cameron was lobbying wasn't even the dying partner (with 
whom Cameron had not developed a "close personal relationship"), but the 
healthy partner (with whom Cameron had not developed much of a 
relationship at all).

There's a unfortunate ripple effect whenever they write one of these 
supposedly intelligent characters as stupid, too, because the other 
characters look stupid for not noticing the first character's stupidity.  
Even Cameron should have been smart enough to point House's non sequitur 
out to him, but they're all being written by dull-witted people now.  
This whole episode seemed to be nothing more than one big nonsensical 
excuse to dump on doing the right thing medically and to dump on not 
being a doormat professionally.  Cameron was just chosen to be the 
vessel to receive the dumping.


  CAMERON:  We're withholding information relevant to her decision
            to risk her life.  How is that not an ethical dilemma?
    HOUSE:  It's not medical information.
  CAMERON:  Who cares?
    HOUSE:  The AMA.

Actually, that was bullshit (and since when did House care about AMA
guidelines anyway?).  Live organ donors are usually required to undergo
extensive preoperative counseling.  No, I don't think doctors are
allowed to simply tell patient B what patient A has revealed, at least
not without patient A's permission, but the counseling would indeed
revolve around the relationship as much as around the physiological
risks involved in the procedure.  Since the doctors were almost
completely dispensing with the preoperative counseling, and they knew
that they would be dispensing with it, they damn well did have an
ethical dilemma.

Foreman and Chase were blithely ignoring the ethical discussion.  And
yet Foreman was the first fellow to stop House from injecting Mark
Warner without his permission in "Honeymoon," and eventually the other
two joined in.  Now Foreman and Chase don't give a damn about informed
consent.


  CAMERON:  This is immoral.
    HOUSE:  Look, let's say you're right.  We tell.  She changes
            her mind.  Our patient dies.  How is that moral?

The difference was that it would be unlucky, not immoral.  No, it wasn't
cosmically fair that Hannah was on the road to death.  It sucked to be
Hannah.  But no one has the right to redress the bad luck of one by
cutting into another without informed consent.  House's high horse about
how it wouldn't be "moral" to let Hannah die, even if saving her was at
Max's expense, was specious, and even Cameron should have been smart
enough to call him on it.

As far as the spirit of medical ethics went, Cameron was in the right. 
Issues about how each patient felt about their relationship would have
been explored in preoperative counseling.  Given what Max really felt,
it probably wouldn't have changed the transplant one bit, but that
decision was Max's to make in consultation with Hannah and a counselor. 
The decision did not belong to the doctors involved in the medical side
of Hannah's (and only Hannah's) case, but House made that decision
anyway and then hid behind technical aspects of medical ethics, as if
suddenly he were Dr. Straight N. Narrow.  


    CHASE:  She's not 'shrooming.  She's a sports nut.

Yeah, that baseball player in "Sports Medicine" and that cyclist in
"Spin" wouldn't have dreamed of doing drugs either.  I suppose the days
when Chase was the first to suspect drug abuse because his mom was an
alcoholic are long over.  Now the writers seem to be content with the
retconned stereotype of the naive sheltered rich kid (despite his 
alcoholic mother and absent father) who's always the last to suspect 
drug abuse rather than the first.


    HOUSE:  If anyone says anything to Max, they're fired.
  CAMERON:  We have to.
    HOUSE:  We have to not.  Because she's not our patient.

Specious again.  Maybe they couldn't just blurt out to Max what Hannah
confessed to Cameron, but there are medical ethics covering the informed
consent of those you harvest from, even if they're "not your patient." 
It is immoral to save one person at the uninformed expense of another. 
Otherwise, why not just do that urban legend of kidnapping people and
taking their organs without their consent, period?  After all, those
people "aren't your patient" either.  Hannah and Max weren't in the
position of being two sick candidates for the same donated organ, may
the luckiest patient win.  For all the doctors knew at this point, they
were tricking a healthy person into sacrificing herself to save a sick
person simply because the sick one was "their patient" while the healthy
one wasn't.


  CUDDY:  You don't have a diagnosis.
  HOUSE:  The transplant buys me time.
  CUDDY:  Let's just skip the part where I say this is insane.

Instead of saying skip it, Cuddy should have made her first protest
about the potential for ethical violations and hospital liability right
here.  That was what she used to do in the past, anyway.


  CUDDY:  If she wants to be an idiot, it's her call.  You don't
          need me.

On the contrary, I would have thought they would need Cuddy to approve 
the accelerated procedure.  She should have been insisting on inserting 
herself into the process at this point, if only to cover the hospital's 
ass, not brushing House aside.

  CUDDY:  Have one of your team walk her through the process.
  HOUSE:  The donor and the donee sort of have opposing interests,
          right?  We can't really advise them both.
  CUDDY:  You're concerned about the ethics of this?

This didn't scan at all.  Cuddy used to be the one concerned with
following ethical guidelines and keeping the hospital out of trouble,
and yet it was House who had to remind her that the two patients had
opposing interests.  Why did Cuddy cavalierly tell House at first that
his team could handle both patients?  Even if she wanted them to go
through with the transplant, she still shouldn't have told House to have
one of his team "walk her through the process," if only from a
liability-limitation standpoint.  The more i's crossed and t's dotted,
the less the hospital would have been exposed to a potential lawsuit.

  CUDDY:  What's going on?  What do you know?
  HOUSE:  Nothing medically relevant.
  CUDDY:  But you know something.  And it is relevant.
  HOUSE:  If I can't tell her, I can't really tell you, can I?  And
          if you're advising her ...

This seemed all wrong and illogical too.  It shouldn't have been the
hospital administrator who was advising a patient who had potentially
opposing interests with another patient.  Cuddy is responsible for all
the hospital's patients as best she can be without taking sides.  She
should have read the file, and if she felt like proceeding, she should
have appointed a third physician, preferably a shrink with experience in
transplants, to advise and advocate for Max.  If an impaired Max (or
Max's family, if Max had died) decided to sue the hospital after the
surgery, Cuddy's willful failure to supervise House when there was
already a whiff of ethical impropriety would have opened the hospital
wide to paying a large settlement or award.  And if I were on the board
of directors, I'd vote to fire both Cuddy and House.

  CUDDY:  I'm assuming this information is in the medical file.
  HOUSE:  My patient's confidential file.
  CUDDY:  This hospital's file.
  HOUSE:  You can either satisfy your curiosity, or you can remain
          ignorant, do nothing ethically wrong, and my patient
          doesn't die in three hours.

This part should have had Cuddy's ethics and liability radar beeping
like crazy, but instead, she was House's lap dog again.  "Oh, it's what
House wants, so I just have to trust that everything will work out all
right in the end."


  CUDDY:  [To Max]  These tests and the counseling normally happen
          over weeks, sometimes months.

Bingo.


    MAX:  I don't want to change my mind.
  CUDDY:  Not now, but with time and perspective, maybe we learn
          things --

Could you vague that up a little more?


  CUDDY:  Either I sign off on this, or it doesn't happen.

Bingo.

  CUDDY:  So I need you to listen to me.  Because there's a chance
          that you will die on that table.

But Cuddy knew House's team would have been willing and required to tell
Max that much.  (The anesthesiologist would have been required to tell 
her that much.)  So Cuddy also knew that couldn't have been what House
had been so cagey about.

    MAX:  I just want me and Hannah to be able to lie in bed
          together, as old ladies.  Compare scars.

Since that was what Max wanted to get out of all this, then even if
House hadn't left a trail of unethical breadcrumbs with his talk about
the patients having "opposing interests," Cuddy should have probed the
question of the various ways in which Max might not get what she wanted
out of all this and how it would affect her attitude towards the
transplant.  In addition to, "What if you die?" other outcomes that
could bar Max from achieving her transplant goals should have been put
before her: "How do you think it will make Hannah feel if she lives but
you die?  What if Hannah dies anyway?  What if Hannah gets tired of you? 
What if you get tired of Hannah?  What if Hannah ends up permanently
incapacitated?  What if *you* end up permanently incapacitated from the
operation, and Hannah leaves you?  What if Hannah feels forced into
taking care of you?  What if a still sick Hannah feels forced into
taking care of you?"  And actively preventing the patients from talking
between themselves was unconscionable.  It was their lives and their
bodies.


   HANNAH:  You'd really tell?
  CAMERON:  Yeah.
   HANNAH:  You'd die?

That would pretty much depend on the reaction of the donor.  But yeah,
some people need to wrap their minds around the idea that not everyone
is willing to live by cheating other people.


On the spine of the book under House's head as he napped on the floor of
his office:

   GRAY'S   The Classic Collector's Edition
  ANATOMY


On the cover of the magazine that Wilson tossed at House:

   Midwest Journal of
  Experimental Medicine


  WILSON:  [Drops journal next to House.  House wakes up.]  Take it
           you've seen that?
   HOUSE:  [Looks at journal.]  Seen it, digested it, watched it
           blow up my entire department.

Yeah, it was too bad for House that he was powerless to head that off at
the pass.  Oh, wait.

Both House and Foreman used to care about keeping the work environment
in such a state that colleagues could at least work together without
getting too hung up on personal issues.

  WILSON:  You read Cameron's version?
   HOUSE:  Didn't read either.

If House thought it was bad, he should have rejected it.  If he was
refusing to sign off on it, he should have handed it back.  If, for any
number of reasons, he has a thing about never putting his name on a
ethics paper, he should have said so up front.  He had a professional
obligation to respond in some way to Cameron's paper.  Publishing is
part and parcel of their jobs.  She wasn't asking for special
consideration or for anything outside of his job description or
responsibilities.  She wasn't asking for any more consideration than he
himself was shown when he was coming up through the ranks.  House was
way, WAY out of line.

  WILSON:  It was good.
   HOUSE:  Better than Foreman's?
  WILSON:  Maybe.  He was more analytical about the diagnostic
           procedures.  She concentrated more on the ethical
           dilemmas of informed consent: how any patient can really
           be informed without a medical degree.
   HOUSE:  Same old party lines.
  WILSON:  Foreman should have told her.

I know it's possible to write up the same research or experiment from
different angles and for the various articles to still be considered
ethically and scientifically valid, so everyone's attitude here seemed
bogus to me, because the presumption was that publishing on a single
medical experiment was a one-time-only possibility.  Therefore if you
publish an article about, for example, the unusual approach to radiology
taken during the event, that precludes you or anyone else going on to
publish about the unusual approach to blood management or lab work or
pharmacology or physical rehabilitation etc. taken on the same case. 
That's just not true.  The ethics of informed consent and the analysis
of the procedures in a live autopsy are so well out of each other's way
that I think the writers went far astray on this portrayal in their
eagerness to paint professional life as being as morally stunted as the
artificially constrained eat-your-neighbor reality series on TV.

In real life, Cameron and Foreman could have critiqued each other's
articles, given each other lesser coauthor credit, and both ended up
with *two* more articles on their CVs without either being considered
professionally the lesser for it.  Double-publishing could have been
win-win for both of them in the real world.  Yeah, people sometimes
screw one another in academia, particularly in the race for one research
*group* to publish before another research *group*, but this idea that
you can advance in medicine only by trampling your own teammates, whom
you'll have to work with the next day, is social darwinist bullshit.

Maybe this is how it works in the field of television writing.  You
shoot the breeze to a friend about a story idea, and the next thing you
know, said "friend" has written the story without giving you even a
"story by" credit, and you have no recourse unless you can produce proof
of prior authorship.  But it doesn't usually work that way in academia,
research, and, I'm pretty sure, medicine.

In fact, in theory, there should have been plenty of other material to
go around so that Chase, Wilson, and some of the other doctors could
publish on the same case as well if they wanted to.  Considering the 
groundbreaking nature of the autopsy, it was surprising that none of the 
rest of the nameless team that helped out on Andie's case wasn't already 
working on an article of their own about it from some angle or the 
other.

We were obviously supposed to get the idea that House doesn't care about 
publishing once a case is solved.  It left open the question of how he 
got published enough to get tenure, though.  It doesn't matter how 
brilliant you are.  If you haven't published, you don't get tenure.

On a separate note, though evidently the writers didn't mean for us to
go there, I had to wonder if maybe House avoided Cameron's article
because it was, completely unbeknownst to her, woefully incomplete. 
There was an entire dimension to "informed consent" in Andie the
hypothermic cancer kid's case that presumably remains a secret known
only to House and Andie, and it was by far the best and most important
dimension to that episode.  In House's shoes, I'd have had difficulty
signing off on Cameron's article too, and I wouldn't have wanted to tell
her why either, but I didn't get the impression that the writers
remembered any of that, nor that we were supposed to remember any of
that, nor that it was supposed to be a motive for House.  I think the
writers were feeling all clever about how "informed consent" related to
this episode, but what jumped out at me was how it related to the case
in the article, where I think House was morally right to emancipate and
seek informed consent from a nine-year-old, but was unable to discuss it 
for fear of professional and legal repercussions.

Tangential mini-rant.  It's been 25 years since Stephen Bochco broke the
barriers and enabled prime-time American creators after him to refer
back to what they had done many episodes prior by saying, "Previously on
_Hill Street Blues_."  For TV creators in 2006 to throw that potential
away is to consciously choose a stunted format.

Anyway, how cool would it have been for this episode to open with Hugh
Laurie's voice saying, "Previously on _House, M.D._," followed by the
clip from "Autopsy" of House asking Andie if she wanted it all to be
over?  They wouldn't have had to change anything else about the body of
the episode, but it would have added a huge extra dimension to it.


  WILSON:  If you allow this sort of thing in your department,
           you're basically saying it's O.K.
   HOUSE:  No, I'm saying that I don't care what they do as long as
           my life isn't interrupted by pointless conversations
           like this one.

But that is the same thing as saying that backstabbing is just as O.K.
as not backstabbing, and that House will allow the rewards to accrue to
the backstabber.  Last season, pitting subordinates against one another
was a Vogler move, not a House move.  (And in just the last episode, 
House said that it was healthy for subordinates to disagree with him all 
they liked.)  Even if we accept revisionist House as the one true House, 
in this very episode, he went on and on to Cameron about how everyone 
does what's in his own (narrowly defined) interest, and yet House did 
not do what would give him the most peace and the least work.  He had to
actively do something (sign one article) in order to land in this
situation, when he could have done nothing at all (not sign either
article) and avoid this.

  WILSON:  They won't trust each other, and they won't trust you.
   HOUSE:  They shouldn't.

House asked Chase point blank how he could continue to work with Chase
after Chase confessed to being Vogler's snitch in "Role Model."  These
people used to give a shit about the quality of their work
relationships, even if they didn't necessarily want to socialize after
hours.  If nothing else, House used to see emotionally charged work
relationships, regardless of whether the emotions were positive or
negative, as interfering with professional objectivity, which used to be
one of his watchwords.

  WILSON:  Deception like this is just one step removed from
           actively sabotaging one another.  Then what would you
           do?

Or from sabotaging House himself.

   HOUSE:  I could be the kindest, gentlest boss in the world, and
           Foreman would still have done what he did, because
           that's who he is.

Huh???  The writers acted like they had no concept of the working
hierarchy of their own characters, nor of academic/scientific
publishing.  I don't know how much Foreman's article would have been
worth if House hadn't signed off on it, but certainly a whole lot less,
and if House wanted to contest authorship, no respectable journal would
have touched it with a ten-foot pole.  Even the mighty Vogler wanted the
weight of House's name behind him.  Foreman COULDN'T have done what he
did if House had simply DONE NOTHING.

This was supposed to be the same Foreman whom House practically had to
beat into naming a candidate for firing during the Vogler arc?  Oh yeah,
that's Foreman all right: first to chuck people out of the lifeboat. 
Soap opera reversal?  You're soaking in it.

I'd be open to a plot line in which Foreman *became* a backstabber
because he was disillusioned by the way he was treated when he was used
and abused as the puppet head of department by Cuddy.  But the fact that
House and the rest of the gang saw no difference, no anomalies between
first-season Foreman and this Foreman, demonstrated that this was a
retcon, and probably an unconscious one by sloppy writers.

   HOUSE:  We can only hope that Cameron has learned something.

House acted like everyone in general and Foreman in particular were
impervious to censure and to the establishment of professional
standards, *except* for Cameron, who House was hoping would soak up this
(un)professional standard he was laying down.  But since when did House
bow down before the unstoppable might of Foreman's ambition?  Certainly
not a few months ago when Foreman was nominally House's boss, so why
here when House was fully back in charge?  It was downright bizarre for
House to act like he had no power or influence over Foreman at all. 
(All House had to do to prevent this particular problem was simply not
sign either article, although not signing any articles ever would cause
different problems over time.)

At the most extreme, House would have been completely within his rights
to fire Foreman.  Less extreme but more damaging in the long run, he
could give Foreman lousy letters of reference from there on out.  (House
would be completely justified in saying that this revisionist version of
Foreman is not a team player, although at this point, the writers' 
conception of House's handling of that managerial duty is completely up 
in the air.)  Less extreme still, he could cut Foreman out of the 
interesting work, like when House made Chase do penance for the Vogler 
incident.  Even less extreme, he could scold Foreman, because Foreman 
does listen to House even when he pretends not to.  This "oh, I'm 
helpless to put the brakes on unprofessional amorality in my own
department" shit was disingenuous shirking on the part of both House as
a character and his writers.

House sounds like the naive one if he thinks that local mores and
professional standards have no effect on individual behavior.  Yeah, a
lot of people do cheat, but a lot of people also do respond to the
rules, the local standards, and the example set by those in charge. 
(And Foreman used to be the epitome of the doctor who was a stickler for
the rules.)  That's why when individuals are caught acting in accordance
with a culture of corruption, the standard response is usually, "But
everyone else was doing it."  It's one thing to teach proteges to guard
their work from being stolen, but it's quite another to reward theft and
call it the same lesson.  I don't think that either the characters or
the writers have any real sense of the difference anymore.  It's not
just repulsive.  It's also a non sequitur.  They're painting House not
only as scum, but also as incompetent and unobservant.  Yeah, right, the
man who notices everything (including who in his department has slept
with whom) was completely oblivious to the blowup that was cruising
along in his direction.  Very convenient for this plot, but completely
unbelievable as characterization.

  WILSON:  Right.  Because you're all about the teaching.

Teaching used to come second only to patient care for House.


On House's t-shirt:

    DEATH VALLEY

  SOUND SYSTEM
    ???? BEATS


  CAMERON:  [To transplant team]  Maybe we should give these two a 
            minute together before the surgery.
      MAX:  You ready, honey?
   HANNAH:  Max.
      MAX:  It's O.K.  I'm right here.
   HANNAH:  I need you to know something.
      MAX:  I know.  I love you too.  [House enters.]
   HANNAH:  I don't know how to say this.
    HOUSE:  Good lord.
      MAX:  You can tell me anything.
    HOUSE:  She hasn't slept in eleven days.  You people trying to
            torture her?  [Injects something into Hannah's IV. 
            Hannah falls unconscious.]  Ding ding, let's go.

Ordinarily, I'd say that Cameron was on very thin ice with respect to
advocating for a patient that wasn't technically hers.  However,
ordinarily, both parties in a live-donor transplant would undergo much
more extensive preoperative counseling and screening, partly to protect
them and partly, I suspect, to protect the doctors and hospitals from
postoperative lawsuits.  Since almost all of that was dispensed with
because of the archetypal EXTREME TIME PRESSURE on _House_, I really
couldn't see Cameron trying to simply *allow* the case to gravitate
towards Max's fully informed consent as being anywhere near a violation
of the letter or the spirit of medical ethics, unlike the clear
violation of the letter of the law that House committed when he extended
fully informed consent to Andie in "Autopsy."  Giving a nine-year-old
the right to die without parental veto was a clear violation of
statutory law and medical guidelines.  Letting two lovers talk about
major aspects of their relationship before engaging in risky surgery
together wasn't even mildly shady.  On the other hand, House forcibly
*preventing* two lovers from voluntarily talking together for what might
be the last time ever was an ethical violation, and was the most
egregious form of doctor paternalism, deciding from on high what was to
be done with the lives of patients.


    HOUSE:  Oh, she could have the best prefrontal cortex in the
            history of mankind, but given the choice of life versus
            death, those bad, bad people are going to choose life.

The series itself has had examples of people who were willing to risk
death for the ones they loved.  Hannah told Cameron that she wasn't
leaving Max because she didn't love Max, and she obviously had some
positive feeling for Max.  Besides, Max may have still been willing to 
donate to Hannah after the latter's confession.  The second season even 
had an example of someone who was willing to die for masses of people 
("TB or Not TB"), and all of these examples were known to Cameron as 
well as to House, so blanket statements between them here just didn't 
make sense.

  CAMERON:  Then why'd you sedate her?  If she wasn't gonna tell,
            if she was never gonna to do the right thing, why
            bother knocking her out?

Cameron's question deserved an answer, or at least more consequences. 
It didn't look like a slam dunk that Hannah was willing to sacrifice Max
to save her own life.  It looked more like House was willing to
sacrifice Max to keep his own stats stellar.  House mouthed off in this
episode about how it was impossible to get people to do the right thing,
but he took active steps in both the A plot and the publishing plot to
make sure that the wrong thing would take place between other people. 
It was like he was campaigning to prevent people from doing the right
thing.

  CAMERON:  This isn't about them.  If she talks, if she does the
            decent thing, then you don't get to solve your puzzle,
            your game's over, you lose.
    HOUSE:  Yeah.  I want to save her.  I'm morally bankrupt.

By sacrificing someone else?  Yeah, he is.  When is House going to start
harvesting the coma patient's organs when no one's looking?  The coma
patient isn't House's patient either, so presumably he's fair game.


  CAMERON:  You read Foreman's article?
    CUDDY:  It was good.
  CAMERON:  He basically stole it from me.
    CUDDY:  So?
  CAMERON:  You're on his side?
    CUDDY:  Sides?  No, this isn't dodge ball.

God, this was bizarrely dismissive of Cuddy.  That was an incredibly
serious, potentially career-wrecking charge Cameron made.  As Dean of
Medicine, Cuddy should have been asking for more details in order to
ascertain whether formal discipline hearings or even job termination was
in order for Foreman.  That wouldn't have been taking sides.  That would
have been simply doing her job and meeting her responsibilities. 
Intellectual theft isn't tolerated at well-run institutions.  This
wasn't even a messy, inconclusive case of he said/she said.  Foreman
actually admitted to all the facts of the case.  House acknowledged the
facts of the case.  Cuddy just wasn't the least bit concerned about
establishing the facts of the case.  Again, I had to wonder if the
authors were projecting the hazy attitude of the scriptwriting world
towards pilfering ideas onto the more rigorous world of academic
publishing.

  CAMERON:  What am I supposed to do?  Just sit back and take it?
    CUDDY:  No, write another article.

Except that not one person ever explained what it was that Cameron was
supposed to do to get the next article signed by House that she didn't
do for the previous article.  She can't do House's job for him.  Once
again, Cuddy was portrayed as House's yes-man, even though she was the
one who had blasted him on his ethics in the past.

    CUDDY:  Kick ass until you're sitting behind some big expensive
            desk, and someone from Johns Hopkins calls and says,
            "We're thinking about hiring Eric Foreman as our head
            of neurology."  And you can say whatever you want.
  CAMERON:  Lovely.  Revenge as motive for success.
    CUDDY:  Well, doesn't have to be the motive.  But it sure
            tastes good.

Wow.  We hadn't seen managerial bungling this bad since Cuddy
deliberately jerked Foreman around and fostered internecine discontent
in the Diagnostics Dept. during the month the disciplinary committee was
rapping House's knuckles.  No reasonable person would want to work in
the environment fostered by Cuddy and House in this episode.

It also illustrates the fairy-tale naivete of the "suck it up"
philosophy.  "Kick ass and you'll triumph in the end because cheaters
never prosper."  By all accounts, both Foreman and Cameron are very
talented and worked extremely hard to get where they are, and they're
still working hard now.  The tie-breaker in any competition between them
could well be the immoral advantage given to one over the other by their
superiors for no good reason.  Cameron can't force House and Cuddy to do
their jobs like they're supposed to.  If that's the approach they're
going to take, there's every likelihood that Foreman will be the first
one to get behind some big expensive desk someday because he published
more and published earlier, and when Johns Hopkins calls for a reference
for Cameron, he makes sure to scuttle someone who could validly say bad
things about him.


I also want to point out that Cameron didn't go behind Foreman's back
and file a formal complaint with the hospital, but instead aired her
grievance informally and directly with Foreman himself.  When he took no
responsibility for the harm he had caused, she still didn't lodge a
formal complaint, but went informally to their supervisor.  When House
blew her off, she still didn't file a formal complaint about either
Foreman or House, but went informally to her boss' boss, at which point
she was basically told by Cuddy that in no way, shape, or form would
anyone in a position of power do anything to curb the abuses they were
allowing to flourish on their watch.  Apart from airing dirty laundry in
front of a patient (which Foreman did as well), Cameron didn't put a
single step wrong and tried to work things out person to person without
wrecking Foreman's or House's career.  Except for the complaint in front
of a patient, she was the only one of the principals to behave in a
mature, professional manner, and yet the writers, the other principals,
and the fans alike were acting like she was the one doing something
wrong.

If Cameron hadn't complained, she would have been accurately accused of
being a doormat, for which the "cure" would have been to speak out on
her own behalf.  Look, I dislike the character too, but the general
attitudes toward morality on this show are well into doublethink at this
point and usually boil down to which characters are the most well liked,
not to what's right and what's wrong.

In the end, though, after doing everything right, Cameron did lie down
and become a doormat.  She already quit the job once because her heart
was going pitter-pat for House, but she's going to continue to hang
around after he's retarded her career and shown no sign that he won't do
it again?  Refusing to allow her to publish (and especially
preferentially refusing to allow her to publish) is more than sufficient
grounds for her finding better pastures elsewhere.


ACT IV
47:26


   WILSON:  Which cancer were you looking for?
    HOUSE:  Any of them.
  CAMERON:  We ran blood tests for ovarian, lung, and lymphomas.
   WILSON:  Not going to tell you much.  Her blood was taken after
            she was given immunosuppressants.  They fight
            rejection.  They also mess up our ability to get any
            clear readings.

That seemed awfully convenient for a plot complication.  They didn't
take sufficient early blood samples to test the "clean" samples for
cancer before they came up with the transplant idea?  And if they were
looking for tumors and they were desperate -- which they patently
were -- then why didn't they do a full-body scan on Hannah like they did
on Senator Wright in "Role Model"?

They've also touched on this before: in hindsight, the antirejection
drugs should have made the plague steamroll over Hannah's immune system
at this point.


  HANNAH:  If Max wakes up, I want to talk to her.

Nice gesture.  I wish we had been allowed to hear that conversation.


It seemed strange to me that with the clock tick-ticking on Hannah,
House didn't appeal to Cuddy to let him out of clinic duty until Hannah
was either dead or cured.


   ANNE:  [To House]  Her boobs are bigger.

Since House saw the mother-daughter pair in the clinic the second
morning after Hannah came to PPTH, and it was only the next day when
they showed up again, that was very fast work for today's low-dose birth
control pills, which were probably the starter pills House prescribed.


   ANNE:  You speak Mandarin?

I think that having House speak any dialect of Chinese without a
specific reason (like his dad was stationed at some embassy when he was
a boy) was laying it on a bit thick.  He's starting to come off like
Batman, talented at everything.  The Marine brat angle would be a good
one, though: the idea that House Jr. picked up enough phrase-book lingo
in every place they lived for him to ask where the bathrooms were and be
a pain.

  HOUSE:  [To Anne]  I can count to ten, ask to go to the bathroom,
          and --  [To Mrs. Ling]  _Gung shi ni quai dung zu mu la_.

Best approximation.

   ANNE:  I'm not pregnant!  We haven't even done it yet!

Errr, what was that House was saying about the ethics of violating
patient confidentiality?  "But on me it looks good"?  The writers just
don't give a shit what House has done in the selfsame episode, never
mind what he's done in past episodes.  "Wouldn't it be cool if House
outted the daughter?" was all the justification they needed to do it.


  CAMERON:  Her white count is normal.
    HOUSE:  Normal is not normal.  She's been on steroids.

But House knew about the steroids and the normal white count all along. 
He should have been able to see this from the beginning.  Plus, it made
him look like he couldn't learn from experience.  Normal not being
normal has come up at least twice before that we know of, though not
because of steroids in particular, I don't think.  In "Deception," the
administration first of ACTH, then of antibiotics, and later of
colchicine suppressed the white count in a patient with a bacterial
infection.  In "Spin," the patient's prior self-treatment altered
current symptoms as well.  I'd expect House to be looking for that sort
of thing now, asking himself, "What about this case could conceivably
look different if X (in this case, steroids) were not in the picture?" 
Especially considering that he's an infectious disease specialist and a
genius at that, he should have at least wondered if the steroids could
have been suppressing a reaction to infection.  This part of the
differential should have taken place soon after the Diagnostics Dept.
took the case.

    HOUSE:  Transplant team gave her a cocktail of
            immunosuppressants.

In hindsight, I had to wonder why the clue as to the infection wouldn't
have been that Hannah seemed to be doing almost as bad after the
transplant as she was before, because the immunosuppressants clobbered
her body's remaining ability to fight the plague.  Logically, some
system functions should have gotten temporarily better once they took
her off the immunosuppressants, even though she was rejecting her new
liver.

    HOUSE:  She hasn't slept in over a week.  Her white count
            should be in the tank.

Then shouldn't the normal white blood count when Hannah first arrived
have sent up exactly the same red flag owing to the steroids and the
lack of sleep?  I didn't see why they had to wait for the addition of
immunosuppressants to notice something unless it was just another plot
contrivance, a need to retard the discovery of the problem.  In fact,
the whole issue of keeping the doctors from noticing anything even
remotely like a symptom of bacterial infection seemed highly suspicious.

Hannah and Max got rid of the dog "about a month ago."  The incubation
period for bubonic plague is supposed to be about two to seven days at
the outside, and it usually takes only about four more days after that 
for death to occur in cases that take a turn for the worst.  Twenty days 
for the first symptom to manifest in Hannah and another eleven days to 
kill her seemed a bit leisurely when she was supposed to be *more* 
vulnerable to infection, not less, because of the steroids.  I'm just 
saying.

And what happened to the dog?  Was it returned to the breeder?  Wouldn't
a potentially sick dog imply the possibility of other sick dogs as well
as people and other animals in contact with them?  Was Hannah the only
organism infected by this flea?


    CHASE:  We should start broad-spectrum antibiotics.
    HOUSE:  Yeah, you might want to add some chicken soup.  Be just
            as useless, but it's got chicken.  We need to know
            exactly what kind of infection we're dealing with.

O.K., now they're just making things up.  House hasn't regarded
speculative treatment with broad-spectrum antibiotics as useless in the
past, nor would it have been useless in this case in the real world.  He
has certainly ordered broad-spectrum antibiotics in other episodes as a
kitchen-sink approach when faced with a possible infection of unknown
origin (including in "Spin," when normal was also not normal).  Given
that he didn't know what he was looking at at this point, why would he
proclaim with such certainty that broad-spectrum antibiotics would be
useless?  Especially since many of the drugs of choice for treating
bubonic plague are broad-spectrum antibiotics, such as tetracycline. 
This passage made absolutely no sense to me, except possibly as the
writers wanting the [flourish of trumpets] dramatic save to be House's
incisive diagnosis of the medieval zebra, rather than have the fellows
go ahead and start Hannah on the antibiotics just in case, only to
realize after the correct diagnosis was made that they were already on
the road to curing her (which would therefore be an anticlimax). 
Unfortunately, in order to make House posture in a heroically dashing
manner, they had to make him sound stone stupid and inconsistent even
with his earlier second-season self.


    CHASE:  What about tularemia?
  CAMERON:  Chest was clear.  Tularemia doesn't cause movement
            disorders.
  FOREMAN:  It would if she developed meningitis.
  CAMERON:  There was no ulcerations on the skin.

What if Hannah mistook such a skin problem for another sign of the
poison ivy?  The last time they went ahead and treated for tularemia, in
"Fidelity," the chest was also clear and there were no ulcerations on
the skin.  Of course, that patient was sleeping too much, not too
little, not that it matters.

And I realize that nitpicking the grammar in spoken dialogue is a bit
much since people don't speak in formal English, but I'm tired of
supposedly hypereducated characters displaying these little telltale
signs of authorial ignorance.  "There was no ulcerations"?


    HOUSE:  Imagine an idyllic river of bacteria.  Yeah, it's not
            idyllic for her, but it serves my purposes.  The
            steroids and the immunosuppressants acted like a big
            honkin' dam across the river.  Physics one oh one: put
            a dam up in front of a raging river; the river rises. 
            By stopping the immunosuppressants, we blew up the dam,
            and a hundred-foot wall of bacteria flooded her lymph
            nodes.

Did I miss something?  This analogy didn't make sense to me.  The
steroids and immunosuppressants should have permitted the bacteria to
flourish.  How was that like damming the bacteria up?  And since the
diagnostic action all took place in the space of two days, why didn't
simply stopping the steroids lead to the exact same reaction and the
exact same appearance of the bubo before they went to all the trouble of
the transplant?  Why did it take putting Hannah on the
immunosuppressants for a few hours and then taking her off of them for a
few hours to lead to a classically identifiable symptom of bubonic
plague?


  FOREMAN:  We better find out where that dog is now.

Given that House wanted to know what the family cat died of in "Detox,"
it was a little surprising that they didn't do a telephone follow-up
earlier to find out about the health of the dog and that of the other
people who had had contact with it.

    HOUSE:  After we restart the immunosuppressants and fill her up
            to the eyeballs with streptomycin sulfate, gentamicin,
            and tetracycline.

The latter two of which are broad-spectrum antibiotics, which House
confidently declared to be "useless" just a short time before.


    HOUSE:  [To the fellows]  Get yourselves some prophylactic 
            treatments as well.

How about Max and everyone else who came in contact with Hannah without
the full range of protective gear?

   HANNAH:  I've got the plague?
    HOUSE:  Don't worry, it's treatable.  Being a bitch, though --
            nothing we can do about that.

This was the guy who was practically singing the praises of every-man-
for-himself earlier.  Here House sounded like vintage Cameron,
pronouncing his personal judgment where it wasn't medically relevant. 
He treated a mafioso in "Mob Rules" and a convicted murderer in
"Acceptance" without marching into their rooms and pronouncing moral
judgment on them, but not someone who was just too timid to leave her
lover and too scared to leave her life?  If he wouldn't have done the
same thing in Hannah's shoes, then he was the one who sounded bitchy
earlier when he pissed all over Cameron for her disapproval of Hannah's
silence.  Either House is scum or he's a hypocrite about being scum,
which is a loser-loser proposition.


      MAX:  She can't leave me now.
  CAMERON:  You really want her to stay out of guilt?  That's not
            going to make either of you happy.
      MAX:  You don't know that.  I love her.  I just want her to
            stay.

The surprise twist with Max being just as manipulative as Hannah wasn't
a surprise at all, because that was the moral universe the writers had
set up here.  I was waiting for it ever since Cameron put them together
before the surgery and House interrupted.  Since the story never
followed up on why House sedated Hannah before she could talk, the real
story reason for preventing them from talking was to "surprise" us with
Max's deception.  But it made Max sound as naive as vintage Cameron. 
Hannah was 25 years old and already had restless feet?  I could see her
hanging around a little longer than she otherwise would have because of
her debt to Max, but as long as Max made a healthy recovery, I thought
it was unlikely that Hannah would hang around forever.  (Unrealistic
goals for surgery sound like a good reason for preoperative counseling
to me.)

I could see a general argument that one in a thousand people in Hannah's
shoes would think that they'd never find another partner more devoted
than Max, and fall in love all over again.  But since Hannah already
thought of Max as a "good person," and yet still wanted to leave, I
don't think in this case that the grand gesture would produce a lifetime
commitment.

On the other hand, if my S.O. had surprised me with a pet without asking
me ahead of time (it's not as bad as a child, but pets are
responsibilities), and the pet turned out to give me a life-threatening
disease, I'd be doubly pissed off at the S.O.  In Hannah's place, I
would have told Max the truth, but if Max had still come through, I
personally wouldn't have had any trouble leaving Max afterwards.  It was
Max's fault Hannah lost her liver and almost lost her life.

I could also see the possibility that even if Hannah had confessed to
Max prior to the operation, Max would have still wanted to go through 
with it because she couldn't stand the thought of Hannah dying while she 
stood by and did nothing.  But that wasn't the doctors' call to make.

The desired emotional impact of Max's revelation on the audience,
though, was to bail House out of any lingering moral disapproval via
sheer serendipity, since the episode wasn't really about ethics at all,
but about rooting for ill fortune for the characters the audience
disliked.  Since it turned out that Max had less than pure motives, that
suddenly made it O.K. in a lot of viewers' minds that the hospital in
general and Hannah, House, and Cuddy in particular did not respect Max's
rights in their breathless rush to keep their mortality stats down.

The bail-out-the-regulars resolution can get old even when used
sparingly.  It underscores the weaknesses and limitations of broadcast
commercial American TV.  It practically shouts that the writers want
unpleasant characters like on cable, but they don't want them to do
things that have consequences that are too unpleasant, as you can have
in cable series.  The unsavory turns that House, Cuddy, and Foreman in
particular have taken this season would be easier to swallow in a more
realistic cable-TV story environment, rather than one in which House
pulls all sorts of shit and then is represented as a hero for it.


The writers want these characters all over the map for the convenience
of any given week's plot.  They had Cameron say, "The more devoted, the
more reason to lie," in "Failure to Communicate," but then they had her
be completely nonplussed by another instance of same in this episode. 
They claim it's a character-oriented show, but it's neither that nor
plot-driven anymore.  It's driven by soap: the desire to jerk the
audience first one way, then another.


It's a longstanding truism in American medical dramas that the doctors
are expected to cure the patients' personal problems as well as their
medical ones.  M.D.s are revered as shamans, as if they went to medical
school to gain wisdom as well as knowledge and skill, and only very
slowly are they losing their godlike status in American society.  Since
the writers had Cameron get a rude awakening to the fact that she was 
not omniscient about patients' personal lives, I might have been able to 
see this episode as tackling that issue if only House wasn't made to be 
seen as godlike in his judgment of the situation after all.


  CAMERON:  If we want this not to get in the way of our
            friendship, I think we both have to apologize and put
            it behind us.

I don't think it's ever wise to demand an apology from someone, at least
not for yourself, not even if you deserve one.  Demanding an apology
just makes you look needy and controlling, and you learn a lot more
about people by waiting to see who steps up and does the right thing on
their own and who doesn't.

  FOREMAN:  I like you.  Really.  We have a good time working
            together.  But ten years from now, we're not going to
            be hanging out and having dinners.

You can be friends only with people you'll be seeing every day for the
rest of your lives?  Pretty limited definition.  Besides, for most
people, bonds forged under life-or-death stress make a lasting
impression.  A lot of people in combat wouldn't have been friends with
their squad mates in civilian life, but there can still be something
there after they leave the service.


  FOREMAN:  [To Cameron]  We're not friends.  We're colleagues.

This would have made more sense if Foreman had said that they weren't
friends *anymore*, for whatever reason was rubbing him the wrong way.

  FOREMAN:  And I don't have anything to apologize for.

Good lord.  I don't care if you never even nod to each other in the
hallways.  Colleagues in the same academic department or research group
do not do that to one another anywhere that professional standards are
maintained.  Unfortunately, vertical leeching is tolerated.  A lazy and
unnurturing head of the group or department sometimes puts his name as
primary author on papers coming out of his department that he didn't
have much to do with, while excluding some of the people who did
contribute.  But one junior colleague simply undercutting another junior
colleague at the same level?  Not if you want to get work reliably done
in the department afterwards.


Based on a combination of lighting changes and clothing changes (the
fellows didn't go home for at least two days and two nights), the story
took place on five separate calendar days, starting at 11:35 p.m. on Day
1 and chugging along contiguously until diagnosis at 9:18 a.m. on Day 4. 
The time from Hannah's arrival at PPTH to diagnosis was roughly 48
hours, depending on how long it took for the ambulance to get her there. 
Day 5 could have been the very next day after Day 4.  Max was still on
an IV and got tired after short walks.  Hannah looked better, but was
still in bed.


"Sleeping Dogs Lie": A more clever title than some of the ones they've
had in 2006.  Hannah was one sleeping bitch once they cured her. 
Cameron wasn't allowed to tell Max that the dog didn't really make
Hannah allergic.  Hannah and Max, bitches both, were lying to each
other.  Everyone was trying to get Cameron to just drop the matter of
the article conflict with Foreman.  And I guess as a cute throwaway bit,
House needed his beauty sleep.


Cameron and Foreman are still on fellowships, and therefore still
officially under mentorship.  It's not enough to just say, "Shitheads
happen, get over it," as if it had been Cameron's fault rather than
Foreman's.  Maybe House is impervious to the opinions of others, but
he's by far and away the exception, not the rule.  We already know that
Foreman values the opinions of his superiors (e.g., Dr. Hamilton in
"DNR") and he at least used to value a smooth working environment.  I
expect that he'd think twice in response to the verbal disapproval of
others, if not in the present, then at least the next time such a
situation presented itself.  For sure, giving Foreman a free pass
guarantees that he'll do the same thing again in a heartbeat, and it
encourages Chase and Cameron herself to follow his example.  That's a
terribly irresponsible work environment to foster.  House and Cuddy were
both derelict as managers to put the problem all on Cameron when Foreman
is under their direct chain of command, is their responsibility, and
it's entirely within their power and their purview to dress Foreman
down.  Even if House is going to be written as completely uncaring about
unprofessionalism in his department, I had a hard time believing that
Cuddy would foster the attitude that Foreman's behavior gets a pass in
her hospital.  And Cuddy, not Wilson, should have been the one to dress
House down for his failure to supervise and mentor properly (although
Wilson's two cents were appreciated, especially since the patient in
both articles was also his).

Essentially, we ended up with a portrait of two terrible bosses (though
I suspect the writers didn't see it that way) and one rotten subordinate
(though I suspect the writers felt that way about Cameron rather than
Foreman).  Chase (who put in his bid for World's Worst Subordinate last
season) tried to stay on the fence, and Wilson (who dates nurses in his
dept. when he's married) just wagged his finger ineffectually.


Some of my favorite TV series feature amoral protagonists, notably _The
Sopranos_, _Deadwood_, and _The Shield_.  But much like some of the more
detailed 19th century European novels, they paint an intricate picture
of an entire subculture, warts and all.  They're about the web of
social, economic, and (para)military relationships in the milieu.  A
creator can afford to do that with an American cable series.

_House, M.D._ is on an American broadcast network (even if that network
is Fox), and it uses the structure, devices, and ingrained expectations
and revelations of heroic fiction.  Greg House isn't merely a
protagonist.  He isn't even an antihero the way the screwed-up Detective
McNulty on _The Wire_ is an antihero.  By the very nature of the
storytelling, House is made out to be a hero.  But in the second season,
he isn't a hero by any rational measure.  He does one thing that has
utilitarian value to society, but in the second season, he has not
consistently behaved in a moral manner.  In the first season, he did act
by a firm, consistent, if idiosyncratic code of ethics, but those days
are long gone.