House, M.D./Babies & Bathwater

Babies & Bathwater
Season 1, Episode 18
Airdate	April 19, 2005
Production Number	118
Teleplay by	Peter Blake & David Shore
Story by	Peter Blake
Directed by	Bill Johnson
Stream
← 1x17 Role Model	1x19 → Kids
House, M.D. — Season One

Babies & Bathwater is the eighteenth episode of the first season of House, M.D..

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) (credit only), Jesse Spencer (Dr. Robert Chase)

Guest Starring: Marin Hinkle (Naomi Randolph), Michael Goorjian (Sean Randolph), Michael Simpson (Joel Kaplan), Natalie Shaw (Rachel Kaplan), Ron Perkins (Dr. Simpson), Kenneth Choi (Dr. Lim)

and Chi McBride (Edward Vogler)

Co-Starring: John Berg (Dr. Prather), S.E. Perry (Officer Davis), Guy Camilleri (Hayden Brown), Kevin Brief (Officer Angle), Diane Sellers (Gail Friedman), Veronica Brown (Female Boardmember), Reggie Jordan (Anesthesiologist)

Plot Overview

When, in the last weeks of her pregnancy, Naomi Randolph faints, she worries she will have a fourth miscarriage. Meanwhile, Cameron has quit, and Vogler holds a board meeting and says either House is fired or he leaves and takes his donation with him, but the decision requires a unanimous vote. Naomi has lung cancer, but she chooses to hold off on treatment until she is sure her baby is safe. Meanwhile, Wilson is the lone dissenting vote to keep House, so Vogler fires Wilson. House gets an experimental treatment for Naomi, but to get the treatment, he has to lie about a C-section she is having. At first Naomi refuses even this, but when House realizes she has had a baby before who died at a young age, he convinces her to take the risk. Vogler learns of House's maneuvering and cancels the treatment. With Naomi's condition worsening, her husband Sean must choose between his wife and the baby, and he chooses his wife. However, when complications in surgery means she and the baby will both die, House convinces him to sacrifice Naomi for her child. Vogler votes again to fire House, but Cuddy dissents and convinces the board to oust Vogler and reinstate Wilson.

Clinic Patients

• Olive Kaplan: An infant with pneumonia whose vegan parents Joel and Rachel Kaplan have her on a raw foods diet, which House suspects is the cause of Olive's rapid weight loss. He orders antibiotics and nutrients, but after Olive seems to be getting better, Cuddy has Joel and Rachel arrested. House is furious, but Cuddy says she is protecting House from Vogler's wrath. The Kaplans return to the hospital to plead their case to House. When they say Olive's diet was approved by a professional nutritionist, House orders more tests. These tests show Olive's weight loss is due to a genetic glandular disorder. House presents the results to Cuddy just as she is about to vote again on whether or not House should be fired. The news makes Cuddy realize she cannot fire House and exonerates the Kaplans.

• Hayden Brown: (Note: Cuddy's patient.) A man with rectal bleeding, but Cuddy assures him it is hemorrhoids, not cancer.

Notes

Medical Terms

(See the Medical Dictionary for all definitions.)

• When Naomi Randolph hears Foreman's test results, she worries she has preeclampsia. She says her pregnancy is in vitro.

• In his dream, House tells Vogler cancer has metastasized to his liver, but the experimental 8C12 offers hope.

• Foreman says Naomi was on oxybutynin for incontinence and her "BUN and creatinine are up. LFT's slightly elevated." Chase thinks it is preeclampsia and recommends calling an OB-GYN. Foreman says her BP is normal. House orders an MRA to check for vasculitis and prescribes magnesium for preeclampsia.

• After her ultrasound, Chase tells Naomi they are prescribing potassium and magnesium.

• House's first diagnosis of Joel and Rachel Kaplan's baby Olive is pneumonia.

• When Naomi starts to go into early labor during her MRA, Chase orders terbutaline.

• After Naomi's early labor, Chase is convinced his diagnosis of preeclampsia was correct. Foreman says that does not explain her myasthenia, demonstrated by her inability to swallow a bite of pear. House orders an upper endoscopy to investigate the swallowing problem. Chase asks if House thinks "there's something obstructing her esophagus."

• Foreman asks if the mass on Naomi's lung could be a granuloma, but Wilson and House confirm it is cancer.

• Wilson presents the diagnosis of lung cancer to Naomi and says her brain, kidney, liver and eyelid problems are the result of a paraneoplastic syndrome called Lambert-Eaton syndrome. He says she will need a C-section before she starts cancer treatment.

• House tries to devise a plan to save Naomi and her child. House says, "Where the hell is Wilson? He's the oncologist."

• Joel and Rachel say Olive's diet was approved by a nutritionist. House orders a CT scan on her for abscesses or occult infections.

• Cuddy says Hayden Brown's rectal bleeding is due to hemorrhoids and not cancer.

• When House and Dr. Pather discuss a trial treatment for Naomi, House says her tumor cells have a "mutation at codon fifty-five."

• House explains the experimental cancer treatment, which involves angiogenesis inhibitors, to Naomi and Sean. He says he has scheduled a C-section and assures her "our Pediatrics Department has the best neonatal ICU in the state." When Naomi refuses, House gets her to admit she had a child who suffered from infantile Alexander's disease and died at age two.

• Chase asks if Naomi's respiratory distress might be a pulmonary edema, but Foreman finds a pulmonary embolus.

• During surgery, Foreman orders more streptokinase for Naomi's hemodynamic compromise. Chase starts bolusing as her blood pressure drops. Another doctor suggests pressors, but there is no time. As Foreman states her systolic blood pressure, Chase removes the clot. When her pressure drops again, Chase orders dopamine and asks if she is septic.

• After Chase and Foreman deliver Naomi's baby, her heart monitor starts beeping, and Dr. Lim says she is going into V-fib.

• House stops Cuddy on her way into the second board meeting to show her the results of the Kaplan baby's CT scan, whose thymus gland shows signs of DiGeorge syndrome. House recommends immunoglobulin replacement therapy.

Music

• "Happiness" by Grant Lee Buffalo: The closing montage, in which the characters are reunited with their respective "babies."

Arc Advancement

Happenings

• Edward Vogler is ousted as Chairman of the Board of Princeton-Plainsboro Hospital.

Referbacks

• 1x09 - DNR: At the board, Vogler lists House's crimes. "He violated a DNR and was charged with assault" happened in that episode.

• 1x11 - Detox: Vogler says House "brought a termite into the OR and spat on a surgeon," and, "he is a drug addict who flaunts his addiction and refuses to get treatment." The incident and House's admission of his Vicodin addiction are in that episode.

• 1x14 - Control: Vogler threatens to leave and take the hundred million dollars he donated to the hospital with him. Later, Cuddy and House talk about the donation. The donation was made - and Vogler became Chairman of the Board - in that episode.

• 1x15 - Mob Rules: Vogler says House "accepted a Corvette from a patient who was a known member of the New Jersey Mafia," a moment from that episode.

• 1x17 - Role Model: Several references are made to a speech House was supposed to give promoting a drug released by Vogler's company, but in which House instead bashed the drug, which was the climax of that episode. Also, Foreman and Chase learn Cameron has quit, as she did in the final moments of that episode. In that episode, Vogler had told House that he either had to fire a member of his staff or give the speech, and when Vogler finds House in this episode, House says he has fired Cameron.

Trivia

The Show

• Final Appearance: This is the final appearance of Edward Vogler.

• Recurring Characters: Dr. Simpson - an orthopedic surgeon played by Ron Perkins - appears as a board member who presents only token resistance to Vogler in discussing the issue of whether or not to fire House. He previously appeared in 1x14 - Control as a doctor whom House had questioned about a clinic patient's puzzling case. Also, Dr. Lim - a maternal care doctor played by Kenneth Choi - appears as a doctor who performs surgery on Naomi Randolph. He previously appeared in 1x04 - Maternity as the maternity doctor who discovered the first sick infant.

Behind the Scenes

• Crew Name Homage: House's vegan clinic patients are the Kaplans, whose name is an homage to series producer Marcy G. Kaplan.

Allusions and References

• Alexander Fleming: When House cures her baby, Rachel Kaplan says, "Thank God." House says, "Technically, Alexander Fleming. He developed antibiotics." Scottish biologist Sir Alexander Fleming became famous in the early 20th century with his discovery of bacteria-killing mold. Although not Fleming's first discovery of antibiotic agents, nor the first discovery of antibiotic fungi, Fleming developed the mold into the antibiotic penicillin, which had a tremendous impact on the advance of Western medicine.

• Vidkun Quisling: As House argues with Cuddy over having Joel and Rachel Kaplan arrested, he says, "Y'know, there's a new biography of Quisling. I think you might like it." Cuddy does not know who Quisling is, so House says, "Uh... Norwegian guy, World War II, traitor." As Minister President of occupied Norway during World War II, Vidkun Abraham Lauritz Jonsson Quisling assisted and complied with the Nazis. His name has become synonymous with collaborationists.

• Charles Darwin: As Foreman, Chase and House discuss Naomi Randolph's decision to withhold cancer treatment until her baby can survive a C-section, Foreman says Naomi is acting against her baser instincts. House counters her motives are biological, because, "In evolutionary terms, the needs of the next generation are more important." Chase asks if House thinks Naomi is "making the right call," and House answers, "Darwin is. I'm not." Nineteenth-century British naturalist Charles Robert Darwin was the founder of the modern theory of evolution. According to his theory, the primary biological instinct is to reproduce and pass on one's traits to future generations. Parental instinct, therefore, is a parent's willingness to sacrifice his or her own life to preserve the offspring.

• Game Boy: Vogler ends his argument with House by suggesting House "play some Game Boy." Game Boy is a line of handheld video game consoles produced by Japanese video game giant Nintendo. House has been seen playing video games on a Game Boy console in several episodes, beginning with 1x03 - Occam's Razor.

Memorable Moments

• House tells Vogler he has cancer, and only an experimental drug can save him. Vogler thanks House and apologizes for mistreating him. House says, "[There is] always [hope]. But just in case, I special-ordered an extra-jumbo-sized coffin. ... Don't thank me. It's just who I am." Vogler shouts, "Hey!" House wakes up to see Foreman calling him out of his wonderful dream.

• At the first board meeting, Vogler reads a list of House's recent rules violations and says either House is fired, or he will leave and take his donation with him. Cuddy asks if Vogler is willing to walk away from the work he intended to do "because of one doctor." Vogler answers, "Gregory House is a symbol of everything wrong with the health care industry: Waste, insubordination, doctors preening like they're kings and the hospital is their own private fiefdom. Health care is a business. I'm gonna run it like one." He calls for a vote. One by one, every board member - including, reluctantly, Cuddy - votes in favor except Wilson, who dissents. Vogler asks Wilson to leave the room for another vote. Wilson says, "Well, first of all, you can't void my vote by making me stand in the hallway, and second, you should check the bylaws. You need notice and at least one business day before you can reconsider any matter." Vogler says, "We're voting on a different matter, which you are conflicted out of. ... This vote is whether to dismiss Dr. James Wilson."

Quotes

• Foreman: When a dog dumps on the floor, do you pat its head and call it a genius? No. You smack it in the nose with a newspaper!

Chase: Dogs can learn things. House can't!

• Vogler: In the morning, I expect you in my office with your letter of resignation and plans for a public apology. Otherwise I'll destroy you.

House: So that's a no on us being squared away.

• Wilson: Vogler's smart. He's got some plan to get you.

House: Does it involve candy? 'Cause I'm a sucker for chocolates.

• House: This is how Vogler's gonna destroy me?

Cuddy: What did he do, grease your cane?

• Vogler: He is a drug addict who flaunts his addiction and refuses to get treatment! He is a disgrace and an embarrassment to this hospital! Now, I'd go on, but it gets kind of mean.

• Wilson: I got sacked.

House: Did you make a pass at Cuddy? I told you. She only has thighs for me.

• Wilson: I got no kids. My marriage sucks. I only had two things that worked for me: This job and this stupid screwed up friendship.

• Cuddy: If you think House deserves to go, if... if you think I deserve to go, Wilson deserved to go, then vote yes. But if you're doing this because you're afraid of losing his money, then he's right. He does own you. You have a choice. Maybe the last real one you'll have here.