House (2004–2012): Season 1, Episode 7 - Fidelity - full transcript

So now the plan is either find ourselves a new counselor,

stick it out with the old one but go more often,

or resign ourselves to the fact that she's never gonna be happy

no matter what I do, so let's just take the money we're wasting

and put it towards a membership at Lakeview, you know?

I'm guessing the last option obviously formally present her.

Yeah... Jeez what's with you?

It usually takes about half speed to stay with me.

I didn't get a lot of sleep last night.

How are things with Elise?

Great.



Great?

Yeah.

Simple answers. You're either out of breath or you're lying to me.

Yeah... we have our moments,
but they usually work out.

Can I get some water?

Yeah...

So how do you work things out?

Talk, someone apologizes.

Man I shouldn't have drank last night.

Hey, you mean you apologize.

Yeah, I guess.

How often do you guys have sex?

Enough...

You do it this morning?



You did, you did it this morning,

maybe that's why you can't stand up. Come on!

Elise!

Honey, I'm dehydrated.

We have anything with electrolytes?

Sleeping beauty, wake up,
this is an emergency.

The fridge is empty.

Come on, it's almost four!

Elise, sweetie...

Call Jacques, tell him I'm not feeling well.

It's Saturday.

You haven't been to work in three days, remember?

Just let me sleep.

Come on. You haven't been out of bed since Wednesday.

Leave me alone...

Come on, lets go.

I SAID LEVE ME ALONE!!!!

I think there's something wrong with me.

1X07: FIDELITY

Original Airdate on FOX: December 28, 2004

She's been averaging 18 hours of sleep a day since her admission.

Clinical depression.
Incredibly contagious.

Every time I'm around one of them I get blue.

It's not clinical depression.

Great, you got it all figured out.
You don't need me.

Three ER doctors, two neurologists
and a radiologist have all figured out what its not,

we need to figure out what it IS.

Well, maybe if above mentioned doctors
were interested in my opinion
they would have asked for it.

None of them are willing to subject themselves to you.

No pain no gain.

The blood work showed no signs of inflammation,

and no one can figure out what's actually the cause of--

Huh.

What?

Husband described her
as being unusually irritable recently.

And?

I didn't know it was possible for a woman
to be "unusually" irritable.

Nice try, but you're a misanthrope, not a masochist.

What's the first thing you ask a doctor who's referring a patient?

Are you questioning my ability to take a history?

"What's the primary"--

Not "what?". "Why?"

Diseases don't have motives.

No, but doctors do.

Why this patient, what interests you?

Give me the chart.

Why?

I find your interest interesting.

She's irritable, sleeping 18 hours a day.

What's interesting about that?

Hypersomnia is usually accompanied
by irritability in depressed patients.

True, but not relevant.
She's not depressed.

Hello! She's sleeping 18 hours a day!

Fever.

Clinical depression does not cause fever.

She could be sick and depressed?

She's sick! Dammit,
why didn't I think of that?

Yeah, that's what I mean...

Elevated SED rate indicates inflammation.

Hypersomnia and personality changes point toward the brain.

Not the spleen.

Thank goodness we hired a neurologist!

Brain symptoms... hmm, could this be a brain problem?

No other systemic signs of inflammation, probably not vasculitis.

What about parasites? Malaria, chagas?

Patient's never been outside the United States, especially the tropics.

You mean she claims she's never been outside the U.S.

Very good.

Doesn't matter, blood and c-sub smears show no sign of parasites.

Has to be a tumor then.

A tumor sitting directly on top of the brain stem.

That three ER doctors, two neurologists, and a radiologist missed?

Partridge in a pear tree missed it too.

Redo the blood work and get a new MRI with 2 millimeter cuts through the mesodiencephalic.

And check for evil stepmothers.

This much sleep usually indicates poisoned apples.

Anything else beside the shortness of breath?

Not really, its actually just kind of a tightness.

You smoke?

No, never.

Exercise?

Eight hours a day.

I teach preschool.

Sounds fun.

Any history of heart disease in your family?

Not that I know of.

Take a deep breath.

Been under a lot of stress lately?

None more than usual.

You're probably just a little anemic,

but I'm going to do an EKG just to make sure.

Do I need to take this off?

No, you can just pull that down in front.

Good. Lord. Are those real?

Do they look real?

They look... pretty damn good.

They were a present for my husband's 40th.

I figured he'd enjoy them more than a sweater.

That's so sweet.

I'm afraid the cause of your problem could be staring us right in the face.

Actually I guess I'm the one doing the staring.

Of course I can't be sure,
I'd like to consult a colleague.

He's actually somewhat of an expert in these matters.

Can I get a page on Dr. Wilson?

A tumor?

We don't know, we're checking just to be safe.

They already checked for that.

The previous MRI had a broader view.

Some tumors are almost impossible to see unless we know exactly where to look.

That means it would be small, right?

Yes.

So you'd be able to operate? Take it out?

If it is a tumor, there are a variety of treatment options,

but there are variables other than just size.

Don't worry...

Too late.

Try to remain as still as possible.

The less distortion there is,
the more we'll be able to see.

Ok.

Well. That's what breasts look like.

Is a lie a lie if everybody knows it's a lie?

Well, if a tree pretends to fall in a forest...

House, come on, they're breasts.

They're a birthday present,
not a philosophical treatise.

Lie number one,

she did not do that for her husband,
she did that for herself.

She thinks if she looks different, she'll be different.

No, she thinks if she looks different,
she'll be more attractive, which, I have to say...

Not to her husband.

Cosmetic surgery is so that everyone else will look at us differently.

Same reason you're wearing that tie.

Well exactly, that was going to be my next point.

Last three months, same five ties.

Thursday should be that paisley thing.

It's a gift from my wife.

No its not. Julie hates green.
You bought that yourself.

You want to look pretty. At work.

Wilson's got a girlfriend...

Stop! Stop. I don't.

It takes TWO department heads to treat shortness of breath?

What, do the complications increase exponentially with cup size?

I want an EKG and blood tests including tox screen on Mrs....

Exam Room 1.

You're ordering tests to cover your lechery.

Interesting.

Very tricky case.

You love everybody.
That's your pathology.

There were no lesions and no mass effect that we could see.

What does that mean?

It means we're still not sure what's causing your neurological problems.

I know some thing are hard to cure,

but what I just don't get is
why it's taking so long to figure out
what's wrong with her.

I know you're scared, I would be too.

I don't feel good...

You feeling nauseous?

Honey? You all right?

She's seizing!

Get her on her side.
I need some Ativan!

I'll get it!

What's happening?

She's having a seizure.

She's aspirating, suction!

Elise!

Come on Elise!

The MRI reveals nothing.

That we were able to detect.

It's not a tumor.

A small glioma could hide from contrast.
We could do a PET scan.

Yes, that's how a responsible doctor would waste his time in the situation.

Suddenly tests and radiologists aren't capable of error?

A glioma not presenting on a contrast MRI would have to be smaller than a grain of sand,

which does not a gravely ill person make.

It could be just postictal disorientation.

We would have seen improvement by now.

Late stage Lyme Disease can cause seizures.

Does the husband care about her?

He hasn't left her bedside.

No way... it also means she doesn't have Lyme Disease.

What? Love conquers all?

Lyme Disease initially presents with a rash.

Mr. Clingy would have noticed.

We've looked at everything else.

Did you look at her breasts?

Pff. Men.

Could be paraneoplastic.

She have any family history of breast cancer?

Her mother died of it.

The brain, but not the brain. Clever, huh?

How can breast cancer cause problems in her brain?

There are molecular similarities between brain cells and tumor cells.

Paraneoplastic Syndrome causes the body's own antibodies to get thrown off track.

They end up attacking the brain instead of the tumor.

So if you do find the tumor, what do you do?

We treat the underlying malignancy.

Once there's no tumor to attack,
there's nothing for the antibodies
to get confused about.

If the tumor's treatable.

Exactly.

OW!

I'm sorry, I know it's uncomfortable.

The tighter we go,
the better the image will be.

Least it'll keep me awake.

Don't worry, it's almost over.

I wish people would stop telling me not to worry.

I'm sorry.

My mom was the same age.

We've been trying to get pregnant for over a year.

I guess we're lucky we didn't.

A lot has changed since your mom died.

Don't worr...

Don't give up.

No tumor?

The MRI and mammogram only showed a few benign calcifications.

It's most likely a small cell tumor,

its no surprise we're having trouble finding it.

We should do a PET scan.

Start with her lungs, and maybe her bones...

Sometimes it presents with no tumor at all.

How can a disease caused by a tumor present if there's no tumor?

It happens. Twelve percent of cases.

And how do you treat it if there's no tumor?

You don't. Those twelve percent have no treatment.

They were too busy looking for the tumor,

right till they put the patient in the ground.

What choice do we have?

Treat the symptoms.
IV Immunoglobulin.

So we're just going to ignore the tumor?

Eventually it'll get bigger.
Then it'll be really easy to find.

One of you needs to check out where she works.

Why?

Cause the husband's not sick.

Meaning?

If it's not paraneoplastic and
it is a reaction to some kind of toxic,
it's obviously not coming from their home.

Foreman, you do it.

Why are you riding me?

It's what I do... has it gotten worse lately?

Yeah. Seems to me.

Really. Well that rules out the race thing.

Cause you were just as black last week.

How long has Elise worked here?

Three years, she's my best rotisseur.

What's that?

The rotisseur prepares the roasted meats and gravies.

How do you clean your grill?

They say elbow grease.

Do you use chemical cleaners?

Ah, no. Absolutely no, our chefs don't do the cleaning, anyway.

What about pesticides?

You must spray for roaches and that sort of thing?

Nope, my kitchen is clean. No roaches.

I need to get back to work.

And the fact that I'm here asking you these questions, it doesn't worry you?

Look at me. I'm here 18 hours a day.

That guy practically lives here,
he does live here...

I use the same detergents for 15 years
and everyone is healthy as a horse.

Whatever Elise has she didn't get here.

Tell her I hope she feels better,
and I had to get a new rotisseur.

Where's Ed?

He went down to the gift shop to buy a shirt.

I told him I'd stay up here in case you woke up.

You must have better things to do.

I send my laundry out.

You're not married?

No.

Waiting for the perfect guy?

Let me guess.

You've already found him.

He threw my towels out the window.

What?

It's how we met.

Freshman year, he came to a party my roommate and I threw.

He spent most of the night on the bathroom floor.

He figured I wouldn't notice vomit on the towels if I didn't have any towels.

I'm assuming he came back the next day to apologize?

No way. We had to track him down.

Conflict resolution has never been one of Ed's strong points.

Nobody's perfect, right?

I guess.

Oh my neck hurts.

You've been in this bed for a really long time.

We're gonna do the same test we did last night, ok?

Do you know what day it is?

My arm itches.

It's probably just a mild skin irritation,

I'll get you some hydrocortisone in a minute.

Do you know what day it is?

Tuesday. It really itches.

How about get you that cream right now.

Oh my God! Get them off! Someone! Get them off of me!

Elise calm down.

Elise calm down.

I need some Haldol, 5 milligrams.

Elise, what's wrong?

Get them off! Get them off! Get them off!

There's nothing there, Elise.
There's nothing there!

We had to sedate her.

You gave sedatives to a patient who's already sleeping 18 hours a day?

It was better than letting her scratch all the skin off her arms.

Or supposed to be.

Creepy-crawlies are consistent with paraneoplastic syndrome.

Onset immediately after IVIG isn't.

There is a simple explanation. Maybe she really has bugs under her skin.

Infection?

That's what the worsening of symptoms after immunotherapy would suggest.

Blood cultures and the timeline rule out most bacteria.

If a patient throws up on your shoes do you clean up "most" of it?

The symptoms rule out the rest.

Serology rules out viruses,
CSS smears rule out parasites.

In the final stage of African Trypanosomiasis almost all the parasites are inside the brain.

It's possible they wouldn't show on smears.

But it's not possible for a patient who's never been to Africa to have African Sleeping Sickness.

I'm just saying it fits the symptoms.

She could have got it from a transfusion.

Or I'm just saying she could have got it from a transfusion.

Which she never had.

Okay...

What about toxins?

No, the kitchen she works in is cleaner than some hospitals.

But they do serve rabbit.
Rabbit Fever fits her symptoms.

Tularemia initially presents with a rash or ulcer near the infection site.

Not if she inhaled it.

Chopping the meat with a cleaver could easily aerosolize the bacteria.

No, then she'd have respiratory symptoms.

Maybe she ignored it,
figured she had a cold.

We rejected Lyme Disease because the couple would have noticed a rash,

but a wet hacking cough is just going to slip right by.

Hey, it's either that or she missed her exit on the turnpike and wound up in Africa.

Ok. Two lousy ideas.

Unfortunately they're better than all the other ideas.

Tularemia. Bizarre.

Very nice.

That's why I ride you.

Did he just turn on the TV?

He needs to think.

So this should tell us whether or not she's got rabbit fever?

For a diagnosis of Tularemia you need a four-fold increase in serum antibody levels.

To measure an increase you need a before, all we have is an after.

A single titer over 160 would be a big clue.

"That's why I ride you."
What does that mean?

Even when I have a good idea it's because of him?

Actually I think he said your idea was a lousy idea.

It has to be one of these two conditions.

I say we take our best guess and just start treatment. Or treat both.

The treatment for Tularemia can cause aplastic anemia.

How come he doesn't ride you guys?

He's got a crush on you.
He just doesn't know how to show it.

Get over it, he rides everybody.

And the treatment for sleeping sickness kills one in ten patients.

So we start with the safer treatment.

By "safer" you mean the one that's slightly less likely to kill her?

Foreman got the gang testing for Tularemia?

Yep.

Probably inconclusive, but worth doing.

So what's her name?
When do I get to meet her?

There's nobody.
Give it up.

Your lips say no,
your shoes say yes.

Well they're French.
You can't trust a word they say.

Solid, yet stylish.

A professional woman would be impressed.

I'm thinking accountant, actuary, maybe.

It's somebody in the hospital.

Patient?

No, chemo's not sexy.
Daughter of the patient?

She would certainly have the neediness you need.

I'm not gonna date a patient's daughter.

Very ethical.

Of course, most married men would say they don't date at all.

There was no date!

I had lunch with one of the nurses.

It's her first time in an oncology unit
and she's having a tough time,

emotionally.

Perfect.

I wanted to be nice.
That's all. I mean it.

You always do.
It's part of your charm.

Hi boys.

Mrs. Campbell's test results.

Oh, you remember her, the preschool teacher with the heart of silicon.

Nope, doesn't ring a bell.

They came in yesterday, I figured
you guys would have been all over them.

I know how concerned you are.

She's all upset because we paid more attention to the other girl.

You check out her ass,
I've got the chest.

The tests were normal.

'Cause that's just my opinion,
you may want to call a couple of guys
from maintenance in for a consult.

You check her EKG results before she left the other day?

You ordered it.

You're the responsible one.

What's wrong? They look normal to me.

Where is she?

Waiting downstairs, why?

I was right.

Do I have to get rid of the implants?

Surprisingly, no.

But your EKG shows a slightly decreased heart rate.

Is that a problem?

You told me you hadn't changed your diet or exercise, were you lying?

Lying?

Does your husband have high blood pressure?

My husband?

Yeah.. see, if you're gonna repeat everything I say this conversation is gonna take twice as long.

Yes, he was diagnosed six moths ago...

He do a lot of cooking at home?

Not really, other than oatmeal in the morning.

Did you happen to notice a slightly odd taste to the oatmeal lately?

Wait, are you saying that...

That it looks like your husband stirred in some of his blood pressure medication along with brown sugar.

You think my husbands trying to poison me?!

No, nothing like that.

He just doesn't want to have sex with you.

Decreased sex drive is one of the most common side effects of the beta blockers he's been taking.

I'm guessing he figured if you're both frigid, no harm no foul.

You should have gotten him the sweater.

That's ridiculous.

Fine.

But if you're still concerned about the shortness of breath, I'd start making your own breakfast.

Wait!

What should I do?

If you care about your husband at all,

I'd do the responsible thing:

buy yourself some condoms,
go to a bar, find...

Lab tests inconclusive?

Not surprisingly.

No. Too bad.
Luckily, I have the answer.

To what?

Thanks for asking.
The life itself. Sex.

Anything that can be transmitted via the blood can be transmitted through sex.

Sleeping sickness from sex?

It's not without precedent.

I'm pretty sure it is.

Unless you're talking about going to Africa and having sex with the tse tse fly.

A Portuguese man was diagnosed three years ago with CNS affected sleeping sickness.

His only connection with Africa was through a girlfriend who served under the military in Angola.

Oi, where'd you find that?

The journal de Instituto de Higina y Medicina Tropical.

You don't read Portuguese?

You do?

I'm pretty sure that's what it said.

Either that or it was an ad for sunglasses.

Her husband has never been to Africa either.

Ooh, stymied again.
Your logic is bulletproof.

I think ignoring respiratory symptoms is more likely than cheating.

Because?

They're completely devoted to each other.

Because?

They love each other.

Or?

They're overcompensating for guilt.

Find out which it is.

You want me to ask a man whose wife is about to die if he cheated on her?

No, I want you to be polite and let her die.

Actually, I don't want you to ask her anything.

Foreman take the husband,
Chase take the wife.

You don't trust me to do my job?

We all formulate questions based on the answers we want to hear.

And how exactly do you re-formulate
"Have you screwed around?"

Did you know she's been trying to get pregnant?

Yes.

After you got so freaked about the sick babies a while ago I figured that was your thing.

But you've never been prescribed folic acid,

and you can't lose a baby if you've never been pregnant.

You pulled my medical records?

You coughed the other day,
I was concerned.

You were curious.

Like an eight-year old boy with a puzzle that's just a little to grown-up for him to figure out.

To-MAY-to, to-MAH-to...

So... it's either sleeping sickness or this rabbit thing.

They're both fatal without treatment.

And unfortunately the treatment for both is extremely dangerous.

Are there test you can do?

Not at this stage.

But each condition has a unique history.

We're hoping your answers to a few questions will help us.

Sure. Whatever you need to know.

Before the sleeping problems,
did you have any trouble breathing,

a cough that wouldn't go away,
anything like that?

No.

Are you certain?

Absolutely.

I've never been away from her
for more than a night,

if she had breathing troubles,
I would have noticed.

[sighs]

The other condition is significantly more likely if...

if you've had an affair.

Have you ever had an affair?

Of course not.

You sure?

I think I'd remember cheating on my wife.

You might be reluctant to admit it...

No.

I just want to be perfectly clear.

If your wife has sleeping sickness
and we don't treat her, she'll die.

I would never do that to Ed.

I love him.

Absolutely not.

I love her.

Alright then.

They say no cheating,
we cross of sleeping sickness.

Any new ideas?

Ok, we go with Foreman's Tularemia.

Start her on IV-Chloramphenicol 25 milligrams per kilogram four times a day.

Good night.

Where's Ed?

Right next to you.
Two down, two to go.

Two days?

No, doses.

You have about twenty more days of this fun.

What time is it?

About four a.m.
I pulled the short straw.

Flow rate looks good.

No rash or flushing...

What time is it?

4 a.m.

Do you not remember just asking?

I don't know...

Elise...?

Elise? Elise? Elise!

What are you doing?

Trying to wake her.

She fall asleep again?

In the middle of a sentence.

Elise!

Elise!

What's happening?

Patient's not responding.

Pulse is fine, airways open.

Check her blood pressure.

Pupils are reactive.

Elise wake up.
You gotta wake up.

What does that mean?
What are you doing?

She's not responsive to pain.

Come on Elise!

Is she dying?

I don't know.

She's in a coma.

There's only one way a Tularemia patient goes into a coma while on IV-Chloramphenicol.

The patient doesn't have Tularemia.

And then there was one.

Patient comes in because she's sleeping too much.

It takes ten doctors and a coma to diagnose sleeping sickness.

And then there was none.

We still have the problem of explaining
how a white chick from Jersey
who's never traveled south of D.C.

Well, the obvious explanation?

I made it clear.

If this guy's lying about sleeping around,
he knows he's murdering his wife.

Does seem unlikely...

Go away.

What are you doing?

Checking for lymphadenopothy.
And waiting for you.

Who are you?

I'm Dr. House.

Your wife has human African Trypanosomiasis.

Sleeping sickness.

You mean its not Tularemia.
A virus, tumor or- or cancer.

Nope.

I've never had an affair.

I believe you.

And I trust Elise.

The treatment for this disease is a drug that's... fatal on its own ten percent of the time.

Which is why I need your written consent before I can legally prescribe it.

Why would she lie if she knew it could kill her?

I don't ask why patients lie,
I just assume they all do.

But why?

To protect you, because she didn't think it mattered.

It just seemed easier because...

that's what people do.

Now, If you're absolutely certain that your wife has never had sex with anyone but you

since you've been married,
then I'm wrong.

But if you think there's a possibility that just one time she wasn't perfect...

one weekend you're out of town...

one fight when she ran to a friend,
one stupid Christmas party...

then you need to allow me to start treatment.

Because if we don't...

she's gonna be dead by tomorrow morning.

Do you trust your wife that much?

I don't know...

I'll start the treatment.

Glass syringes?

And special IV tubing.

Why do we need this stuff?

Because Melarsoprol melts plastic.

This stuff's supposedly arsenic mixed with antifreeze.

What doesn't kill us makes us stronger, huh?

At least you wouldn't have been so glib if you'd been prescribed Melarsoprol.

Can cause vomiting, abdominal pain, blood toxicity, neural damage, cardiac arrhythmia...

Forgot to say it's gonna hurt like all hell.

She's lucky she's in a coma.

How long before we know its working?

It's tough to say.

It's a good sign that she hasn't gotten any worse.

Does she even know I'm here?

She knows you're always there for her.

Yeah...

If she gets better it means she wasn't always there for me.

It means she made a mistake.

I can't help it.

Part of me, a big part of me...
can't handle that.

Doesn't want her to get better.

Does that make me a terrible person?

Yes.

So we're treating her for African sleeping sickness

because you don't think it's possible for someone to be faithful in a relationship?

And you do?

Yes.

And you need to tell me that?

Look, I'm not having an affair.

I had lunch, with someone I work with, at work. Once.

I believe you.

What I don't believe is that it'll be just once.

I love my wife.

You certainly love saying it.

I'm sorry. I know you love your wife.

You loved all your wives.
Probably still do.

In fact, you probably still love all the women you ever loved who weren't your wives.

You can be a real jerk sometimes, you know that?

Yeah. And you're the good guy.

At least I try.

As long as you're trying to be good,
you can do whatever you want.

And as long as you're not trying,
you can say whatever you want.

So between us, we can do anything.
We can rule the world!

Mixing up some margaritas?

Mines a double, Senorita.

That's Portuguese, you know.

Spanish.

Uh-oh.

What's going on?

I'm re-calibrating the centrifuge.

Turn around.

It's a very sad thing,

an un-calibrated centrifuge.
It makes me cry too.

I'm not crying.

Ok.

I told the husband he was a jerk.

Why?

When I was in college, I...

I fell in love, and I got married. And...

At that age the chances of a marriage lasting...

It lasted six months.

Thyroid cancer metastasized to his brain.

There was nothing they could do.

I was 21, and... I watched my husband die.

I'm sorry...

But that's not the whole story.

It's a symptom, not your illness.

Thyroid cancer would have been diagnosed at least a year before his death,

you knew he was dying when you married him.

Must have been when you first met him.

And you married him anyway.

You can't be that good a person and well adjusted.

Why?

Because you wind up crying over centrifuges.

Or hating people.

Fever spiked at 104.
Echo shows global hyperkinesis.

Blood pressure?

Barely 90 over 40.

You give her gilpamine?

Started 270 micrograms per minute ten minutes ago, still no change.

Killing her parasites isn't gonna do much good
if we kill her heart at the same time.

A heart can be replaced, a brain can't.

Right now were killing both.

If she's gonna die, we should at least let her do it without that acid flowing through her veins.

What's happening?

We would have expected your wife's condition to show some improvement by now,

but it hasn't. It's going the other way.

Please don't die...

please don't die...

She's awake!

Hey. She's gonna be ok.

Yeah, sure.

What are you gonna do?

Were you always honest with her?

Do you know how lucky you are?
Your wife is alive, she loves you!

What she did...

you can't love a person and do that to them.

She LOVES you.

I need to know who you had the affair with.

He has to be notified so he can get treatment as well.

Why did you lie to us?

You knew your life was at stake.

He's not coming back, is he?

We all make mistakes,
and we all pay a price.

I need that name.

Hi, there...

How you doing?

Fine.

Do you know where your dad is?

Can I help you?