House, M.D./Damned If You Do
Damned If You Do is the fifth episode of the first season of House, M.D..
At Christmas, Sister Mary Augustine checks into the clinic with a rash and bleeding hands, for which House prescribes antihistamines. When she has an allergic reaction to those, he gives her an injection which puts her into cardiac arrest. Cuddy believes House gave her too high a dose and threatens to report it as an error on his part. When House puts Sister Augustine on a dangerous treatment, Foreman goes to Cuddy, who takes him off the case. As Cuddy and House's staff treat Sister Augustine, House learns the tea she drank caused her cardiac arrest, so her other symptoms are the result of an allergic reaction. Sister Augustine is put in a clean room away from allergens, where she has a crisis of faith, but Chase - a former seminary student - counsels her. Even in the clean room, she has another reaction. An off-hand remark by Wilson inspires House to look inside her for the allergen, and he finds an outdated birth control device - the product of her reckless adolescence. The device is removed, and she gets better in time for Christmas.
- Sister Mary Augustine: She starts off as a clinic patient complaining of an allergic reaction causing a rash on her hands and arms.
- Marvin: A department store Santa Claus whose inflammatory bowel syndrome does not respond to steroids or other treatments. House writes an unorthodox prescription: "Cigarettes. One twice a day. No more, no less." Marvin protests that cigarettes are "addictive and dangerous." House says, "Pretty much all the drugs I prescribe are addictive and dangerous. The only difference with this one is it's completely legal."
This is the first time in the series - and one of the rare instances overall - in which House or any of the other lead characters appear in the cold open of the show.
(See the Medical Dictionary for all definitions.)
- House diagnoses Sister Mary Augustine's rash as contact dermatitis and prescribes the antihistamine called diphenhydramine and over-the-counter cortisone. When Sister Augustine has a respiratory reaction, House calls it an asthma attack, for which he gives her epinephrine. He prescribes steroids and says her heart beating fast is the result of adrenaline.
- As House and his staff discuss Sister Augustine's cardiac arrest, Cameron hypothesizes cellulitis, which could explain the tachycardia, but Foreman says that does not match the CBC results. Cameron then hypothesizes an allergic reaction based in part on elevated eosinophil count. House dismisses that and suggests vasculitis, which Foreman says wouldn't cause an elevated eosinophil count. House counters that it could be Churg-Strauss vasculitis. He orders a chest CT on Chase's suggestion and prescribes prednisone.
- In the clinic, House examines a department store Santa Claus whose inflammatory bowel did not respond to sulfasalzine, corticosteroids, 5-ASA or 6-mercaptopurine.
- Sister Augustine's tests prove she does not have Churg-Strauss vasculitis, so Foreman wants to believe House screwed up, but Cameron says it could be "thyrotoxicosis or a carcinoid." They pull Sister Augustine out of the machine, but she has a religious vision, so Foreman orders Ativan, saying her temporal lobe is swelling.
- After Sister Augustine's seizure, Foreman says she "tested positive for herpetic encephalitis," which Cameron says means her "immune system is severely compromised." Cuddy points out the prednisone could have caused that. Chase hypothesizes mixed connective tissue disease, but Foreman objects, saying, "Her ANA was normal." Nonetheless, House orders that she be placed in a hyperbaric oxygen chamber. As Chase and Cameron leave, Foreman warns House that the chamber can cause oxygen toxicity.
- When Cuddy takes over Sister Augustine's case, she ascribes the labored breathing to pneumonitis. Chase also says Sister Augustine's BUN, creatinine, ALT and AST are high. Cuddy suspects these are results of the hypotensive episode.
- After House proves Sister Augustine's illness is an allergic reaction, Foreman hypothesizes it is to the tea which caused her arrhythmia.
- As Sister Augustine seizes in the clean room, Chase says, "She's in anaphylactic shock."
- As House and Wilson discuss the riddle of Sister Augustine's clean room allergic reaction, Wilson hypothesizes that mast cell leukemia may have caused the anaphylaxis. House dismisses that, eosinophilia and idiopathic anaphylaxis.
- House's staff performs a full body scan on Sister Augustine to find an allergen inside her and finds a copper IUD embedded in her endometrial tissue.
- "Rudolph the Red Nosed Reindeer" by John Denver: Wilson and House work in the clinic.
- "The Twelve Days of Christmas" by Paul and Brenda Neal: The second scene in the clinic lobby, after House has treated Sister Mary Augustine.
- "Silent Night" by Hugh Laurie: House plays the piano over the montage showing how each of the characters in the episode spends Christmas.
- House and Wilson: Wilson spends Christmas with House rather than with his wife, whom he says is "used to being alone." House doubts this explanation, but Wilson refuses to talk about it.
- Chase: Several important clues about Chase's past are revealed. Chase says that his mother has "been dead for ten years." When Sister Mary Augustine has a crisis of faith, he says he went to seminary. He quotes 1 Peter 1:7, about a crisis of faith. She asks why he left seminary. He replies, "That test. You passed. I didn't."
Behind the Scenes
Allusions and References
- The Divine Comedy: As House and Wilson work in the clinic, they have this exchange:
House: We are condemned to useless labor.
Wilson: Fourth circle of Hell. Charting goes a lot faster when you eliminate all classic poetry.
House: Writing down what we already know to be read by nobody. I'm pretty sure Dante would agree that qualifies as useless.
Later, when House and Wilson are again in the clinic on Christmas, House describes the sixth circle of Hell as being "confined in a sweat box with a bloody nose, and all the tissues are soggy." House and Wilson argue over whether this is the sixth or seventh circle. These are references to the 14th century epic poem The Divine Comedy by Dante Alighieri - specifically the first cantica, "Inferno." In the poem, Dante travels to Hell, which has been broken up into multiple circles, each offering unique punishments to specific types of sinners. In the fourth circle, the greedy and the indulgent are punished for eternity by pushing giant stones in opposite directions. House's description of the sixth circle - reserved for heretics - is essentially accurate. The seventh circle holds several punishments for those whose crimes are described as "violent."
- The Sound of Music: After House initially treats Sister Mary Augustine, he says to Wilson, "How do you solve a problem like dermatitis?" This is a reference to the song "How Do You Solve a Problem Like Maria?" from the 1959 musical play The Sound of Music, about an Austrian nun in the 1930s who goes to live with a noble family as their governess and eventually flees the Nazis with them.
- Biblical Verses: There are several references to the Bible and Biblical verses in this episode, including:
- Jonah 2:7: During her CT scan, Foreman tries to calm Sister Augustine, but she says, "As Jonah said from inside the whale, 'When I had lost all hope, I turned my thoughts to the Lord.'" The Book of Jonah tells the story of a Jewish prophet chosen by God to preach in the city Nineveh and convert the people to Judaism. Jonah flees to a ship at sea. When the ship is threatened by a deadly storm, he convinces the sailors to throw him overboard, and the storm calms. Jonah is swallowed by a big fish. Inside its belly, he prays for forgiveness, so the fish vomits him out to land so he can complete his quest. The verse Sister Augustine quotes is from Jonah 2:7 - "When my soul fainted within me I remembered the LORD: and my prayer came in unto thee, into thine holy temple."
- 1 Peter 1:7: As Sister Augustine has her crisis of faith, Chase says his favorite verse from seminary, 1 Peter 1:7, which they recite together as: "These trials only test your faith to see whether or not it is strong and pure. Your faith is being tested, as fire tests gold and purifies it. ... And your faith is far more precious to the Lord than mere gold. So if your faith remains strong after being tested, it will bring you much praise and glory and honor on the day of his return." The Book of 1 Peter is a letter written by the Apostle Peter to the Christians in the Middle East and Greece in the days of the early Christian church, when they were persecuted by the Romans, non-Christian Jews and others. The exact wording of 1 Peter 1:7 in the King James Version is: "That the trial of your faith, being much more precious than of gold that perisheth, though it be tried with fire, might be found unto praise and honour and glory at the appearing of Jesus Christ."
- Luke 15:32: After Chase tells Sister Augustine they have found what is causing her allergic reaction, she tells him her favorite Biblical verse: "Celebrate and be glad, because your brother was dead and is alive again." Chase recognizes this as being from the story of the Prodigal Son. The story, a parable told by Jesus of the value of those who find their faith after losing it, tells of a man with two sons. The elder son is faithful, but the younger son travels and spends all his money. When the younger son returns to his father and humbles himself, the father holds a celebration. The elder son complains of the preferential treatment, but his father replies, "It was meet that we should make merry, and be glad: for this thy brother was dead, and is alive again; and was lost, and is found."
- The Hippocratic Oath: Foreman reminds House of the Hippocratic Oath. House says, "The one that starts, 'First, do no harm,' then goes on to tell us no abortions, no seductions and definitely no cutting of those who labor beneath the stone." The Hippocratic Oath is taken by many physicians, traditionally ascribed to the 4th and 5th century BCE Greek physician Hippocrates. The popular misquoting of the opening phrase is, "First, do no harm" ("Primum non nocere"), although some wording translates to, "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone." It includes injunctions against performing abortions and seducing patients. The phrase regarding "those who labor beneath the stone" is translated as: "I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art." It refers to performing surgery to remove kidney stones or gall stones, instead leaving that for surgeons to do.
- North Shore: The TV show House is watching while he is in chapel is North Shore, a FOX Network soap opera about events in and around the Grand Waimea Hotel in Hawaii.
- In the chapel, Sister Mary Eucharist complains to House of Sister Mary Augustine being a hypochondriac and receiving special treatment for it from Mother Superior. House offers her chocolate, which she devours. He then asks her if she reads people well, and she says she does. House says, "So we've got pride, anger, envy, gluttony. That's four out of seven deadly sins in under two minutes. Do you people keep records of these things? Is there a Cathlympics?" Sister Eucharist says she thinks he uses his intelligence and humor to hide behind his true feelings. He replies, "You know, from the way you're looking at me right now, I'd say you just hit number five: Lust."
- Mother Superior: Well, becoming a nun doesn't make you a saint.
House: Becoming a doctor doesn't make you a healer.
- Cameron: I just wanted to say that I know that you did everything you could.
House: I don't need verification from you to know that I'm doing my job well. That's your problem, not mine.
Cameron: I was just being nice.
House: Yeah, well, you don't need to always do that.
- Sister Mary Augustine: When I was 15, I was on every kind of birth control known to man, hhh, and I still got pregnant. I blamed God. I hated Him for ruining my life. But then I realized something: You can't be angry with God and not believe in Him at the same time. No one can. Not even you, Dr. House.