House, M.D./Autopsy

Autopsy
Season 2, Episode 2
Airdate	September 20, 2005
Production Number	202
Written by	Lawrence Kaplow
Directed by	Deran Sarafian
Stream
← 2x01 Acceptance	2x03 → Humpty Dumpty
House, M.D. — Season Two

Autopsy is the second episode of the second season of House, M.D., and the twenty-fourth episode overall.

Starring: Hugh Laurie (Dr. Gregory House), Lisa Edelstein (Dr. Lisa Cuddy), Omar Epps (Dr. Eric Foreman), Robert Sean Leonard (Dr. James Wilson), Jennifer Morrison (Dr. Allison Cameron), Jesse Spencer (Dr. Robert Chase)

Guest Starring: Sasha Pieterse (Andie), Jewel Christian (Pam), Randall Park (Brad), Stephanie Venditto (Nurse Brenda Previn)

Co-Starring: Eamon Hunt (Neurosurgeon), William Jones (Dr. Murphy), Hira Ambrosino (Anesthesiologist), Gwen Holloway (Neurosurgeon #2), Jonathan Fraser (Salesperson)

Plot Overview

In this episode, House is trying to extend the life of a 9 year old girl who suffers from cancer and some other mysterious ailments as well. Meanwhile, he is trying to treat his own severe allergies.

Transcript

Show opens with a young bald girl, Andie, obviously a cancer victim, going through her morning routine in her bathroom, which includes a cup full of different pills and at least one self-injection. Suddenly the girl imagines that there's an earthquake and the walls are collapsing around her, the mirror shattering. When she comes to, her mother's there and her hand is bloody from where 9-year-old Andie shattered the mirror herself. It was all an hallucination.

House is trying to head home and take a sick day due to his severe sneezing and sinus congestion when Wilson interrupts with Andie's case. Andie had lung cancer, has had a wide variety of treatments, including 14 chemotherapies. It will likely recure and kill her within a year. House blames the cancer for the hallucinations, it must have spread to the brain. Wilson shows him the tests indicating the cancer is in remission. House agrees to stay and check out the case.

House has his team check for signs of brain infection. Nothing comes up. During the CT scan Andie convinces Chase to give her a kiss, as she doesn't want to die without kissing a boy.

House reluctantly sees a patient in Emergency who insists on a male doctor. Turns out the patient's girlfriend had never been with a man who wasn't circumcised and so found the man's privates disconcerting. The man took a boxcutter to himself to remove the offending extra skin. House calls in a plastic surgeon for this bozo.

Andie's tests come back negative. No sign of infection. Foreman suggests one relevant type of infection they didn't test for - neural syphilis. However, that's only scene in 9-year olds when they've been molested, which makes Chase very uncomfortable. House doesn't discount it since Andie is unusually mature and slightly manipulative for her age - behaviour which can be associated with molestation victims.

Cameron performs a rape kit - it comes back negative. Andie has never been molested (thank goodness).

Andie's oxygen saturation is on the low side of normal and dropping slightly. House suspects another lung impairment, probably a tumour, but Wilson won't go for exploratory surgery. It's too unlikely for one child to have two different lung tumours.

House makes his team listen to the ultrasounds of Andie's chest again and Cameron notices what House already has - one of Andie's heart/lung valves doesn't quite sound right. With this evidence Wilson goes for the surgery and convinces Andie's mother.

Chase is in the operating room observing and the operation finds a very thin tumour, too thin to be seen on the MRI and CAT scans, growing along Andie's lung and into her heart. The surgeon removes the tumour and repairs her heart using bovine tissue, but Chase notices a bleed in Andie's eye.

Now everyone is both freaked and confused. What else could be wrong with Andie? The cancer tests were all negative after all. House opines that the new tumour was benign, thus the negative tests, but that it threw off a blood clot before the surgery. Just bad luck. The clot must be somewhere in her brain, but there is no way of knowing where.

House talks to Wilson and theorizes that Andie's extraordinary bravery and fortitude through her cancer and this new ordeal are not natural. The blood clot must be near the emotion centers of her brain, screwing with Andie's thoughts processes and making her unnaturally brave. Wilson is skeptical, believes House is just trying to impugn Andie's admirable bravery, and anyway that part of the brain is too big and important to just go probing about.

However, this means that Andie is doomed. Sooner or later, likely within the week, the mysterious clot will cause a deadly cranial bleed.

House comes up with new procedure, base on an idea from Foreman. They will put Andie into hypothermic cardiac arrest by lowering her body temperature, thus limiting damage to her brain and organs, then quickly drain off 2 litres of blood and pump it right back in. While the blood is returning they will do a simultaneous MRI of the brain and see where the returning blood flow is momentarily slowed, thus locating the clot. House gets Cuddy to authorize it, since Andie is doomed anyway.

Wilson convinces Andie's mother to sign off on the procedure, but House believes that if Andie really is as brave and mature as she seems, it should be her decision. House talks to Andie and tells her that it should be her choice whether to try for another year of a miserable life, and if she doesn't want to go through the pain then he'll make up an excuse to cancel the procedure and cover for her. Andie realizes what's involved but loves her mother too much to just give up and cause such emotional pain.

House assembles a team that practices the procedure, but it doesn't go well until Foreman suggests bolting Andie's head to the operating table to keep it steady enough for an accurate MRI. They do the real procedure, including Foreman drilling the bolt into the top of Andie's skull, and it doesn't go well. No sign of the clot. At the last moment Foreman sees a brief fluctuation in blood flow.

They do the exploratory surgery on her brain and although the surgeon is skeptical, the blood clot does turn out to be near where Foreman saw it.

The clot location turns out to be nowhere hear Andie's emotional centers. Her bravery, and enjoyment of what little life has to offer her, are natural. Wilson points out that Andie's attitude suggests that this young cancer patient, likely to die and constantly subjected to painful medical procedures, has a healthier attitude towards life than House. House doesn't much like this obvious truth about himself.

Andie checks out of the hospital, to House's admiration. House, apparently inspired by Andie, tries not to be so miserable and takes a motorcycle for a test drive.

Trivia

Allusions and References

In the bathroom scene, House listens to the aria Nessun dorma from Giacomo Puccini's opera Turandot. Puccini died while composing this opera. He had undergone an operation for cancer of the throat and died from a heart failure he developed as a complication.

Quotes

• Wilson: So... the little kid dying of cancer; I shouldn't like her?

House: If you're dying, suddenly everyone loves you.

Wilson: You have a cane; nobody even likes you.

House: I'm not terminal; merely pathetic. You wouldn't believe the crap people let me get away with.

• Wilson: We can't do exploratory surgery on her brain!

House: Are you sure you're not a neurologist?

• House: Well the clot's not gonna go away quietly; it could go at any time. Are you going to let them know?

Wilson: I guess so.
House: Can I come with?

Wilson: To tell Andie she's going to die? That's very un-you.

House: "She's such a brave girl." I want to see how brave she is when you tell her she's going to die.

Wilson: ...Go to hell.

• House: Is it still illegal to perform an autopsy on a living person?

Cuddy: Are you high?

House: It's Tuesday; I'm wasted.

Cuddy: [exasperated] It's Wednesday.