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.

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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...

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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?

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

HOUSE: Misleading Lab Results

Well, the television writers are back at their word processors, the actors are back on set, and so now I've got to get back to work and share my impressions about this latest episode of House titled "No More Mr. Nice Guy."

Just as a quick aside, I couldn't help notice that the opening scene involved striking nurses with picket signs hauntingly similar to the Writers' Guild of America placards - coincidence?

This week's puzzle involves an overly friendly guy named Jeff. He works around lots of cleaners and solvents. House discovers him in the Emergency Room. He has been sitting patiently for hours for a fainting evaluation. Jeff also has a history of dysgeusia (impaired taste) wherein everything he eats taste likes lemon meringue pie.

House is convinced that Jeff's peaceful, noncomplaining demeanor indicates occult pathology. In short, healthy people are not so placid. Since House is a lumper (tends to attribute most of a patient's symptoms to one central disorder) Jeff's demeanor and unusual taste phenomenon share a common cause.

Untreated syphilis becomes a central diagnostic consideration. If the bacterium involves the brain (neurosyphilis) there can be changes to mood, mentation, and motor skills. Blood is drawn and Jeff's serology tests are positive for syphilis. Shortly thereafter a tube of House's blood is inexplicably tested and it, too, is positive for syphilis.

We can skip the moral outrage concerning unauthorized testing of co-workers. Hey! This team performs routine home invasions of its patients to search for clues. "Mrs. Kettle, have you met Mrs. Pot?"

It's good to see that the writers have not lost their stride, pacing Jeff's various ICU crashes to precede each jumbo commercial block. Eventually it is discovered that House's sample was not his blood (meaning someone is still roaming Princeton with undiagnosed syphilis!) Jeff becomes hostile and mean-spirited while his overall medical condition continues to deteriorate. Repeat brain imaging reveals new lesions suggestive for a different kind of infection, a bug that could generate positive syphilis serology. We call this finding a false positive (tests confirms presence of syphilis where there is none).

Lots of medical conditions can generate a false positive syphilis test. Alternate testing like PCR (gene amplification) and selective immunoassays can help clinicians get to the truth. In Jeff's situation, he had contracted Chagas' Disease (a bloodborne protozoan that favors the heart and brain) while living in Central America many years earlier. It remained undetected for over a decade and insidiously caused his mood and taste abnormalities. Antiparasite medical therapy will eliminate the infection and hopefully normalize his central nervous system.

Here's a helpful take-away point: Whenever a physician informs you of unexpected lab results don't hesitate to ask if a second round of confirmative tests or alternative studies would be beneficial. It is never wise to base important health care decisions on a single tube of blood, especially when it might not even be your blood!

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Technorati Tags: TV, House, Hugh Laurie, lab results, misdiagnosis

The Biggest Loser - Couples: A Finale of Just Desserts

Well, it's over. We made it. And in the end, it was worth the weight! (You know we can never resist a good pun.)

In a season marked by overt sexism, blatant conspiracies and macho madness, the fact that "The Biggest Loser" was a woman, for the first time ever, was justice served. "1, 2, 3, PRIDE." Not so much.

The first few minutes of last night's finale was devoted to revealing whether Mark or Roger would be the third contestant in the running for the grand prize. Remember, "America Voted", and in another blow to Mark's fragile ego, Roger won the vote. Mark was relegated to the larger group of eliminated contestants, awaiting a lesser prize. Roger was a nicer person, and also a greater threat to win the prize. Mark didn't cry; we were very grateful.

We watched in amazement at the parade of contestants, their pounds having been shed both on screen and off, as they took to the scale for the final time. In addition to the grand prize of $250,000 and the the title of "The Biggest Loser", a secondary prize is awarded to a contestant who had been voted off but who achieves nonetheless the greatest percentage of weight loss among other ousted contestants. Again, justice was served, as Bernie won. Bernie, you may recall, was part of the duo of Bernie and Brittany, the two that did not know each other when the show began. And when it was crunch time, Bernie gave Brittany the opportunity to stay on campus rather than himself. He was sweet and supportive and clearly a fan favorite. And the taste of Bernie's victory was that much sweeter because he beat Mark, the ring leader of the macho blue team, by a single pound.

Bernie was one of Jillian's charges. Score one for Jillian.

Some of the contestants looked great; some less so, but all of them demonstrated some measure of change and we applaud them all for their efforts.

But in the end, Ali, once a champion synchronized swimmer, reclaimed her athletic soul, and pushed herself to achieve extraordinary results. She lost an amazing 112 pounds, 47.86% of her weight. She looked like the woman who was trapped inside the person who arrived nearly six months ago, and her transformation clearly took place on the inside as well as the outside. And Ali was also one of Jillian's people.

It was a victorious night on many levels. But the kudos go to Ali for her strength, character, and persistence. And oh yes, for kicking the butts of the macho men who worked all season to eliminate the women, one by one.

Go Ali. Go Jillian.

Wonder if those "Pride" tattoos can be removed?

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(c) NBC Universal.

Technorati Tags: weight, loss, success, biggestloser, NBC

The Biggest Loser--Couples: The Weight is Almost Over

OK, last night was pretty good again. Still way too long, hence very dragged-out scenes with the remaining four contestants reliving their "journeys" from fat to fit. But seeing the transformations is really quite incredible and there is little to do but applaud their determination and their progress. All four: Ali, Kelly, Mark, and Roger have reason to be so proud.

And everything about this episode was designed to make them fully face their transformations and embrace their new selves. Even the final challenge of the season--putting on a fat suit that replicated exactly their original size and shape and running a foot race--made them all feel they were leaving behind the worst of themselves forever. They all vowed never again to be the people they were when they arrived. And they all discussed their transformation not only from a weight loss and fitness standpoint, but equally important from the point of view of the emotional weight they dropped as well.

Side Note: Speaking of emotions, Mark acknowledged what we all have been observing for some time now--that his emotions are a bit out of control. In Mark's case, his weight was blocking his emotions (and tear ducts!) and having unlocked that part of him, he has been some sort of human geyser, overflowing with tears and emotions each week. We also suspect that Mark has a little guilt over his brother Jay falling on the sword for him last week. Even Mark's wife, remember, told him to "Snap out of it." Mark should have an interesting homecoming.

Back to the show.

As with every episode, there is some sort of gratuitous product placement. The gum was replaced last night by Rocco DiSpirito, who is clearly being groomed as some sort of Biggest Loser chef in residence. He returned to transform each of the contestants' former favorite meal item into a healthier version of that very meal. Everything from pepper steak to ice cream. This was useful and fun information and it teed up the new "Biggest Loser Meal Plan". There is even a home delivery option. Second product placement plug.

Back to last night. Mark, of course, won the challenge, racing up that hill for the last time carrying a flag that read...well..."Mark." His prize was that when he gets home, he'll be provided with the "Biggest Loser Meal Plan" home delivery so all of his meals will be carefully created for maximum health and weight control. He also got $10,000. This gives Mark a decided advantage for the finale...except for one little problem: he was below the yellow line and therefore marked for elimination.

In fact, in what could only be characterized as the final irony of this season, Ali and Kelly were the two contestants to make it into the finale. Ali won the weigh-in again--that's four in a row--and Kelly was second. Both Roger and Mark, feeling fairly cocky as always about their "numbers" were shocked to realize that they were both below the dreaded yellow line. Truth is, all of the contestants put up great numbers, and they worked all week without their trainers.

But here's the twist: instead of Kelly and Ali determining Mark and Roger's fate...we will! America will vote, online, at The Biggest Loser, and that vote will determine whether Mark or Roger joins Kelly and Ali in the season finale. The results will be announced live in the first five minutes of the season finale next week. For all that Blue Team bravado, all those shouts of "1, 2, 3 PRIDE!", all that conspiratorial plotting against "the girls", look who's lobbying for votes now!

The show ended, as they do every season at this time, with each contestant saying goodbye to their trainers, alone in the weigh-in room, face to face with a cardboard cut-out of themselves as they looked when they arrived on campus. Standing side by side with their former selves, it's hard not to jump up off the couch and yell, "1, 2, 3, PRIDE!"

Remember to vote online and tune in next Tuesday to see if Ali or Kelly can become the first female Biggest Loser in the history of the show.

(c) NBC Universal.

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The Biggest Loser--Couples: Down Under

Without being overly optimistic about the future of this show, last night's episode was much more like what we remember fondly from seasons past--a focus on exercise and weight loss, genuine teamwork and interesting challenges. We think the contestants liked it better too--they seemed proud and engaged and determined. What a nice change!

The remaining five contestants spent a week in Australia with their trainers. Turns out Jillian and Bob are the trainers for the show in Australia so they were very familiar with the territory. Many of our fine now-slender friends had never left their home states, let alone traveled to the other side of the world. There was great excitement and anticipation and for once, it was not met with disappointment. They all had a great time. The stunning beauty of Sydney figured prominently in their experience and they learned very handy survival techniques for staying on a healthy course while traveling. Going to local farmer's markets to find fresh, healthy and inexpensive food to keep in their rooms; eating fish and vegetables when dining out; even dancing to burn a few extra calories. All of these options were presented in a very welcoming way and the show, as a result, was one of the most successful of the season.

The challenge was a modified triathlon, which all of the contestants completed. This made them feel like the champions they are, and we were impressed with their performances. But perhaps the most impressive moment last night came when Mark, who along with Ali is the most competitive and successful contestant, was just about to win the challenge. He has made it up that final flight of stairs, with only a few steps to go to reach the finish. In what can only be termed "uncharacteristic", he waited for Ali, who was very close behind, so they could cross the finish line together. In fact, Ali carried Mark piggy back over the line! It was miraculous--a real change of personality for Mark. And he talked about the difference in himself. The whole experience had more meaning for him because he finished with Ali. Is this the Mark who conspired to eliminate the "girls", one by one each week? The Mark whose only alliance was with the "guys" on Bob's blue team? You know, "1, 2, 3, PRIDE!"

Well, whatever caused this change in Mark, it was a welcome relief and it really did elevate the experience for Mark, for Ali, and for the audience as well. In sharing the glory, Mark also shared the prize--a sunrise seaplane ride, a brunch by the beach, and a call home.

Side note: Mark cried, of course, when he called his wife. You remember, he's the big crier. Maybe even The Biggest Crier. We were amused when his wife said, "Are you crying again? You've got to toughen up. Snap out of it!" We agree.

In the end, Jay, Mark's younger brother, and Mark both fell below the yellow line, each of them having gained a pound. In another embarrassingly tearful scene, Jay fell on the sword for his brother and went home, leaving four strong, competitive contestants to go on.

Next week the contestants will work without their trainers. Should actually be interesting. Two weeks in a row that are interesting? Fingers crossed.

(c) NBC Universal

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Technorati Tags: Biggest Loser, weight, diet, exercise, fitness, healthy living