HOUSE: Season Finale

Spoiler Alert: Stay away if you haven't watched the complete two-episode finale! This post is loaded with spoilers!

The writers' strike-shortened fourth season of House has ended and labor unrest was only one unexpected twist to have affected the series. Since all three of House's previous fellows had left the team at the end of Season 3, House launched a 'Survivor' style elimination protocol to identify three new proteges from the unruly horde of applicants. That seemed so long ago. Much of the first 4 or 5 episodes were devoted to the competitors - House himself often seemed like a footnote.

Things progressed in predictable House fashion until Amber was eliminated. Amber, the cutthroat, throw-anybody-under-the-bus physician with absent scruples and conscience that rivaled Dr. House's worst behavior. How could they get rid of Amber? She's a perfect foil!

Surprise! By the time the strike was settled Amber was back at Princeton-Plainsboro still competing with House. This time, however, it was for the affections of oncologist sidekick Dr. James Wilson. Very clever; the writers kept her in the story but mostly as a sideshow attraction. In the climax of Episode 416, 'Wilson's Heart', Amber becomes the hub for the entire season.

It appears that besides Dr. House, Amber was also riding that ill-fated bus that crashed in the previous episode. She was escorting the drunken doctor back to his house in place of on-call Wilson. Amber sustains severe internal trauma, coma, arrhythmia and eventual irreversible multi-organ failure. They lower her body temperature to buy valuable time (at least 60 minutes, right?) Searching for answers, House continues to journey in-and-out of his foggy memories and foggier fantasies related to that tragic evening. Wilson becomes suspicious that House and Amber were secretly involved behind his back. Does he also suspect that House will let Amber die to hide the affair and to restore their buddy status? Nobody ever accuses anybody but you can definitely feel the tension.

If House can accurately reconstruct what happened to Amber he may be able to save her!

Deep brain stimulation is applied to further jostle House's fragmented memories. I may employ the technology next time I cannot locate my car keys! House collects the final clues which explain Amber's deterioration. Minutes before the bus crash Amber consumed the prescription drug amantadine to ward-off early flu symptoms. Her severe kidney injuries kept the drug from being metabolized so, in essence, she overdosed by taking just two pills. For the record, she only needed to take one. Once House shares his discovery, he suffers a seizure and lapses into coma. Darn that deep brain shish kabob!

House's team cannot save Amber by performing dialysis because the drug binds to albumin and will not be filtered-out. Maybe so, but wouldn't an exchange transfusion or emergent kidney transplant solve the problem? C'mon, find some spine! She was already receiving heart-lung bypass. At what point do you stop suspending disbelief?!?

Amber is aroused just long enough for her weepy boyfriend to say goodbye. Wilson then personally shuts-off the the bypass equipment (So long, dear, I'll miss you!). Everybody else reacts in their own way regarding the loss of a former colleague/competitor. House worries that Wilson will remain angry at him. Most of the cast succumb to their emotions - except for Kutner who enjoys a late night bowl of cereal and some TV. Hmmm...maybe he's watching a rerun of House.

Reruns are all that we get until Season 5 premieres in the fall. Pass the milk, please.

Related Topics:

• WebMD Video: Deep Brain Stimulation
• Implant Aids Man With Brain Injury

Technorati Tags: House, TV, Hugh Laurie

HOUSE: Jarred Memories

The fourth season of House concluded with a two-part finale. The first part (Episode 415, House's Head) has an amnesic Dr. House retracing his steps after realizing he had survived a bus crash four hours earlier. Many passengers sustained severe injuries. House is convinced that, moments before the crash, he recognized a person with diagnostic features for a life-threatening illness. But, which passenger and what illness?

House himself sustained a bone fracture involving the base of his skull with cerebral edema, yet he was able to mobilize his team and begin assembling clues. Most skull fracture survivors take to their bed and stay there. House underwent hypnosis in an effort to illuminate his misplaced memories and resolve his amnesia. Clever editing combined hypnotherapy and Vicodin-induced hallucinations. It was often hard to distinguish which events were recollections and which were fantasies.

A lot of time and energy was devoted to the bus driver. House theorized perhaps it was the bus driver who had an occult health condition that caused him to temporarily blackout. By the end of the episode House flushed the bus driver scenario - the passenger in greatest danger remained unidentified. Can you say 'cliffhanger'?

Now, don't worry about any spoilers because none are divulged in this blog post. Who knows what trivial plot details in this week's episode become the pillars of next week's closer?

What interested me most about this episode was the recognition that physicians often continue working despite illness or injury. Is it professional duty or fear of lost revenues? In my opinion it is a devotion to patient care that drives most physicians beyond their own sickness - even beyond the point of good judgment. I believe this is part of the reason why doctors make the worst patients. Watching the progressively disoriented House carry-on after sustaining serious head trauma, my wife quietly remarked, "...reminds me of February 1984".

Ouch, that hurt!

In February 1984 I was Ophthalmology Chief Resident: lots of patients, lots of surgery, lots of responsibility, not much money. For three days I kept working around the clock despite fever and abdominal pain. My wife repeatedly warned me that I needed to get help. I reassured her that I'd felt worse before. Denial reigns supreme! On the fourth day I collapsed from peritonitis due to my untreated ruptured appendix. Finally, I saw a doctor, had long-overdue surgery, and spent 10 days in a hospital bed hooked up to IV antibiotics. Had I gotten help sooner I never would have made myself so sick. Looking back at that experience I recall several hospitalized patients telling me, "Doc, you should be in this bed. You look worse than me!"

Professional journalists would howl that I have inserted myself into this story, which is supposed to be about House. What can I say? House's behavior is not unlike other doctors. You know, other doctors like me! It's great that I am not a professional journalist - just a medical blogger.

I dare not spill any beans regarding storyline specifics. Let's wait until Part 2 airs and we can wrap the entire season finale with one big ribbon (or head bandage!) TO BE CONTINUED...

Related Topics:

• All Ears: Doctors DO Get Sick!
• WebMD Video: Getting Men to See the Doctor

Technorati Tags: House, TV, amnesia, health and wellness

HOUSE: Judgment Day for Princeton-Plainsboro

The portfolio of unpunished felonies continues to pile up for Doctor House. In addition to the routinely scheduled residential break-ins, Episode 414, 'Living the Dream,' opens with House perpetrating a kidnapping in order to confirm his suspicions that a popular soap opera actor has a brain tumor. The unsuspecting actor ends up in Princeton-Plainsboro and endures a lengthy series of invasive tests and near-death medical emergencies: cardiac arrest, kidney failure, extreme fever, coma, etc. Spoiler alert: dude had a rare allergy that was previously used in an ancient episode of Murder, She Wrote.

Do not despair. Even without Angela Lansbury this episode still had some entertaining drama.

For those in the medical community, the real plotline involved Dr. Cuddy's efforts to guide the hospital through its reaccreditation inspection. Every time House behaved at his worst the inspector was a witness.

Reaccreditation is a lengthy, expensive, time-consuming show-and-tell. The agency in charge (typically JCAHO - Joint Commission for Accreditation of Health Care Organizations) inspects every hospital with announced and unannounced visits. Ostensibly, the reaccreditation process is promoted to improve patient care delivery but, ironically, an upcoming inspection cycle often distracts many hospital employees from their real responsibility...helping patients. The reality is that most health care professionals see reaccreditation as a colossal waste of time.

Nurses and administrators maintain underground communications with their counterparts at other recently inspected hospitals to discover upcoming key areas of scrutiny. For example, one year such advance 'intelligence' warned that inspectors were particularly concerned about hospital staff knowledge regarding steps to take in the event of a fire. Sounds reasonable, right?

Many thousands of manhours were devoted to briefing (and rebriefing) employees, printing clip-on cheat cards, and mounting laminated signs on both sides of every door and approximately every 10 feet along both sides of the corridors. Good news! If you can just crawl 10 feet away from that blaze you will find laminated instructions that will help you escape...so long as they haven't melted! Every experienced clinician has 2 or 3 wild reaccreditation inspection stories to share. On inspection day nobody was asked anything about fires, but the outdated anesthetic ventilation system in the operating rooms took a big hit. Ooops!

Back to the show, the unyielding inspector learned about House's radical (read hair-trigger) approach to patient care: treat first, diagnose later. The soap-opera patient survived but it had no impact on the inspector's evaluation. Cuddy's hospital was cited and got socked with a fine but House got to keep his job and survive to violate his Hippocratic Oath one more time.

Hmmm, how often should prime time fictional medical dramas get reaccredited?

Related Topics:

• Choosing a Hospital
• Taking Charge of Your Hospital Stay

Technorati Tags: House, TV, hospital, accreditation, JCAHO