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HOUSE: Near-Death and Beyond
This week's episode of House featured the usual multifaceted wild goose chase (more details to follow) set against the backdrop of end-of-life decisions.
When does life-sustaining medical treatment violate a patient's choice to refuse further intervention?
It all begins with a paralyzed young man suffering with a longstanding progressive neurodegenerative condition. He is admitted for a fainting spell and swallowing difficulties. Within minutes the a diagnosis is established (Strongyloides parasitic infestation acquired during a trip to Thailand, see photo). The patient is prescribed pills to eliminate the worm but fails to improve. The chase is on for other conditions. At one point House is convinced the patient has uveal melanoma, a malignant eye tumor. When are those scriptwriters going to begin consulting WebMD? I was screaming at the TV set - maybe you heard me:
- 'The patient is far too young!' (average age is 60)
- 'Uveal melanoma is treated with enucleation, not orbital exenteration!' (a radical procedure - think Phantom of the Opera)
- 'Widespread metastasis from uveal melanoma is very rare at the time of initial diagnosis!'
- 'Even if it were a rare case of youthful, metastatic uveal melanoma it would nearly always spread first to the liver, not the lungs!'
ARRGHHH! Chill, Dr. Bill, it's only TV.
Down the hall a motor vehicle trauma patient describes his heavenly near-death experience to House, the atheist. House refutes any notion of the afterlife and immortality. This patient is so convinced of the experience he jams a knife into an electrical socket to attempt a second "free ride," knowing that the hospital staff will revive him.
Meanwhile, House's original patient continues to spiral and is giving up hope for any recovery. House recommends radical surgery to remove the eye tumor and extend the patient's life. Say, doesn't Princeton Plainsboro Hospital have an Ophthalmology Department? And, by the way, didn't any of those hotshot fellowship candidates perform an eye exam at the time of admission? (yeah, I'm quibbling again!)
The paralyzed patient's condition deteriorates rapidly and he is no longer interested in trying to salvage his wretched life and his worn-out body. Here's another patient of House that suspects there must be something better after death. He refuses to have his eye removed and an ethical dilemma ensues.
So, can a hospital force a seriously ill patient to consent to radical surgery? Well, if death is imminent (often defined as within 14 days), and it certainly was in this case, the patient has the right to refuse treatment. That is very different than, let's say, a newly diagnosed low-grade lymphoma patient who contracts pneumonia. Treating the lung infection is appropriate because the pneumonia will respond to antibiotics and the patient will likely live years afterward.
Surgery is cancelled and the patient expires within 24 hours. An autopsy is performed. The body is riddled with parasitic worms. Surprise! House discovers that, days earlier, the patient never took the antiparasite medication. He threw the pills away because he was sick of being sick. The original diagnosis was correct but untreated.
Let's recap: Two young men embrace the afterlife for different reasons, House insists our earthly existence is all we've got, House is unqualified to practice ophthalmology, and to quote Former Surgeon General C. Everett Koop, "Drugs don't work when patients don't take them."
This episode of House reminds all that in this country we have the right to make informed choices about our health care. This same episode also reminds us that are free to change the channel!
Related Topics: Technorati Tags: House, TV, end of life, health and wellness
