- I was riding a city bike the other day and
someone screamed, "Dr. Mike, we want more House M.D."
Here we go, House M.D. Number Three.
Bee-whoop!
(soft beat music)
- [Lady] Oh, God.
- [Boy] Is the baby coming? I don't know how to do this.
- [Dr. Mike] Aww.
- You okay, Ian?
- Yeah, sure.
- Uh-oh.
- [Lady] I don't think you are.
- Are they both going to be patients in this episode?
- You're bleeding.
- Wow, that's a lot of blood.
Hmm, a little poker.
- Dr. Cuddy, I've got one of your patients in the E.R.
Ian Austin, six years old.
- Oh, I know him.
What's the problem?
I'm all in.
- Bloody diarrhea, hemodynamically stable,
but he's been developing some coordination problems.
- Sounds like gastroenteritis and dehydration.
Order fluids and I'll take it on my service.
Bets to you House.
- Did they scan his head?
- No, why would they scan his -
- Don't play games.
You gonna call?
- How's the heart rate?
- Stable.
- [Cuddy] I'm sorry.
House, it's gastroenteritis.
I'm not going anywhere.
Put the order in and someone tell Allen and Sarah
that I'll be up when I'm done.
- I hope that's an nonalcoholic beverage in her hand.
If you're on-call and you're going to
be admitting patients to your service,
you probably shouldn't be drinking alcohol, just saying.
- [Cuddy] Stone cold bluff!
You might wanna spend a little more time paying
attention to your cards and a little less time
starring at my breasts.
- They don't match either.
- I used to play poker semi-professionally
during my college days.
I would play it online before it was banned
and I would make some money, not a lot of money.
It was more about a learning experience,
but the friends that I played with,
we constantly used poker as an analogy
for everything we did in life,
whether it was medicine, talking to girls,
relationships with our friends,
we would always somehow relate it back to poker.
And I feel like that's what's gonna happen in this episode.
Everything that's gonna happen with this patient
is somehow gonna turn into a poker hand.
What's interesting about poker
is that it's a lot like life.
Making a difficult decision, you're not always
gonna have all your information available
at your disposal, right?
Because life is crazy and things change all the time,
there's variables.
So there's a lot of luck involved in life.
That's the same thing that happens in poker.
Skill can only take you so far.
There's a huge luck component.
If your opponent only has one card that will beat you,
despite the fact that every other card
is gonna work in your favor, they may win.
And if they win, it doesn't mean that they out played you.
It means that they got lucky.
The same thing that can happen in life.
You can make a great decision with
all the information available at your disposal,
and yet you can still lose or have a bad outcome.
- Follow my finger with your eyes.
- Nystagmus.
- How much longer will Dr. Cuddy be?
- Well given the number of mojitos she's knocking
back at a party, I'd say it's gonna be a least
three hours before she's even conscious.
- [Mother] Weren't you at the same party?
- I don't drink.
- I just pop pills!
- I want you to reach out and grab my cane.
(suspenseful music)
- What's wrong?
- Abnormal proprioception.
- Your son's brain is losing control of his muscles.
- Dr. Cuddy's message said it was
just dehydration from diarrhea.
- She's wrong.
- I love House, but the way that he jumps
to knowing that there's something more sinister
happening with this child from hearing the basic story,
it's a little extra.
Some children, when they have diarrhea,
especially bloody diarrhea, with stable vital signs,
stable labs, can act a little bit strange
and then as time goes on, they improve.
By him taking a special interest in this story,
just from hearing that story, it's a little unrealistic.
- Two cases, same symptoms.
What do six year olds and 70 year olds have in common?
- [Foreman] This kid doesn't have kidney failure.
- [House] He will.
I was treating a 73 year old woman
who went through this progression of symptoms,
the last of which was -
And in case any of you missed that class in med school,
that one's untreatable.
Do a colonoscopy.
- On a six year old kid who probably has
nothing worse than some food poisoning?
- If you happen to find any purple papules,
do me a favor and grab a slice.
I wanna check for Erdheim-Chester.
- How does he know what that is?
I've never even heard of it.
I don't know how you justify doing a colonoscopy
on a child with a single episode of bloody diarrhea
and a stomach ache, with normal vital signs, normal labs,
just off of the fear that there could be a rare,
potentially life-threatening condition
that hasn't yet presented itself in any other way
outside of ataxia and bloody diarrhea.
Doing a colonoscopy, while it's a common procedure,
it's a benign procedure, things can go wrong.
You can rupture the colon, you can have an infection.
I mean if something negative happens as a result
of the colonoscopy and you find nothing,
that's horrible!
You did that to the child.
- You know how people see the Virgin Mary
in danishes and stuff?
Someone died 12 years ago and House doesn't know why.
House sees that case now in paint peeling and clouds.
- I agree with him.
And yes, like I said before,
residents don't do all the procedures.
You would get a gastroenterologist to do the colonoscopy.
Internal medicine residents don't
just do colonoscopies on their own.
This is crazy.
Why am I getting so upset about this?
It's just a show.
- Negative for Erdheim-Chester.
- Let me see.
- Still don't know what that is.
(suspenseful music)
- It's not Erdheim-Chester.
- It's exactly what we said before,
a gun variety gastroenteritis.
Can we go back to the party?
- Do a kidney biopsy.
- What?
Subjecting a child to this many procedures
that are not benign on a whim is crazy.
There's no proof that this is what's happening.
You have to monitor the child,
watch the symptoms, act clinically.
Ego, check it.
- [Dr. Chase] The colonoscopy was clean
and the biopsy was negative for Erdheim-Chester.
- So he's gonna be all right,
it was just some sort of virus.
- What's that?
- Urine.
- But it's brown.
- His kidneys are shutting down.
- Still think it's not the same case?
- Now you can start thinking that it's something else.
- Doctor had a patient a while back who
exhibits the same symptoms as your son.
- Then, you know what's wrong.
- No.
- So, what do you know?
- We know the likely course the disease will take.
- [Father] Which is?
- She had multiple system failures -
- What happened to her?
- She died 24 hours after her admission.
- Look, telling patients information once you know it,
is really important because you want to honor
the idea of autonomy where a patient has the ability
to act upon their own body with the
best information possible.
In this case, it'd be the patients parents
because the child can't make decisions for himself.
However, if you have incomplete information
and that information is very worrisome
and is not gonna bring any value to the patient
and only gonna bring anxiety,
maybe best leave that information out
until you have a more concrete plan or answer.
Otherwise, we're just creating a lot of anxiety,
a lot of worry and essentially telling
these parents your child might die today
because we don't know what we're doing.
- [Cameron] The base of his brain has been
infiltrated by a small mass.
We think -
- Pituitary?
- Looks that way.
- Explains the low blood pressure.
- Pretty much confirms the lymphoma.
If we'd started Ester on prednisone -
- Uh, did anyone see the lymphoma?
- [Cameron] No, we saw a mass.
The location was consistent with -
- Didn't see any in the blood either.
White blood cells show no spindling
or abnormal nuclei, nothing on immunochemistries either.
It's not lymphoma.
- Can't breathe.
- Uh-oh.
- Chase!
*monitors beeping*
- [Mother] What's happening?
- Sounds like he's having an anaphylactic
reaction to something and his throats closing up.
- [Mother] Ian, come on.
Honey, just relax.
Ian breathe.
- [Chase] Look at the right atrium.
- That's not kawasakis.
- No.
It's small, but it's there.
- [Foreman] Ester didn't have a mass in her heart.
- Ian's younger.
He can take more of a pounding.
Ester died before the disease reached her heart.
The disease made a mass and made it fast.
- Could be bacteria.
- Muscle.
- Connective tissue.
- [House] The kid can't take anymore theories.
Only thing we know is that whatever that mass is,
that's what he's got.
We need a piece of it.
I'm doing a biopsy.
- You're gonna do a biopsy on the kid's heart!
Come on, House!
- And out again.
*monitors beeping*
- Cardiac arrest.
Code blue.
- Code blue.
- Come on, paddles!
Chest compressions, chest compressions,
chest compressions, before you shock!
*shock*
- [House] Again.
*shock*
- So when you shock, you right away go back to
chest compressions, chest compressions, chest compressions.
All this time without chest compressions
is the blood not circulating.
Can someone do some chest compressions?
- Wait, I've got something.
- He's back.
- [Wilson] He can't stand it, he goes all in.
He's sure he's won.
I call, I flip 'em.
Oo!
- Pocket aces.
- I nailed his ass.
(suspenseful music)
- What did he get from that story?
God, you gotta love this.
- The aces were hiding all along.
- Oh, the aces were hiding, duh.
- Test him for Erdheim-Chester disease.
*Dr. Mike laughs*
- All right, I'm pausing it.
I'm looking up what Erdheim-Chester is
because this is ridiculous.
Erdheim-Chester Disease.
It's a rare type of slow growing blood cancer.
In Erdheim-Chester the excess production of histiocytes,
AKA histiocytosis, leads to inflammation that can
damage organs and tissues throughout the body
causing them to be thick and dense, scared fibrotic,
and this tissue damage may lead to organ failure.
I thought they tested for this and if they did
a kidney biopsy, they would have found this.
I don't know where he's going with this.
This is a disease that probably happens
one in a million, kind of appropriate for a House episode.
- He tested negative.
- So did Ester.
- The disease lied.
- [Cameron] Yeah, the tumors got it in for you.
Diseases don't lie.
- Fine, it didn't lie.
It slow played us.
We biopsied the colon, it hadn't reached the GI tract yet.
It's there now.
It's in his liver, his lungs.
- You want it to be there,
because then you didn't screw up 12 years ago.
- We can't waste our one test on the
one disease we know it's not.
(suspenseful music)
- Run the test.
- Why didn't they do the kidney biopsy?
(suspenseful music)
- Take your time and say it loud.
- They turn red.
- CD68 positive.
*House hits wall*
*Dr. Mike laughs*
- It's so dramatic.
I feel like -
- Start the treatment.
- This is how the US National Library
of Medicine describes it.
It's a rare type of slow growing blood cancer.
How is this child dying in 48 hours?
I don't know.
Something about this seems shady.
Had they'd just followed regular protocol,
consulted the proper physicians,
instead of having House run a muck with this case,
this would have been solved so much quicker,
so much simpler, without the child suffering
these side effects.
- So Ester can rest peaceful now, huh?
- Yeah.
- House M.D.'s awesome, but check out
these hilarious two videos.
I know you're gonna love them.
And stay happy and healthy.
(soft beat music)