House, M.D./Occam's Razor
Occam's Razor is the third 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), Jesse Spencer (Dr. Robert Chase)
and Faith Prince (Becky Merrell)
Co-Starring: Lauren Cohn (Jodi Matthews), Marco Pelaez (Hospital Pharmacist), Jason Stuart (Adam Brown), Ben Campbell (Jerry Morris), John Kelly (Robert Merrell), Joshua Wolf Coleman (Suburban Pharmacist), Beth Hall (Shelly Lever)
A college kid, Brandon Merrell, has rough sex with his fiancée and passes out. Wilson convinces House to take his case, but no disease explains all the symptoms, and antibiotics seem to make the problem worse. House suggests two diseases at once are the problem, but Foreman doubts this. Brandon seems to improve on House's treatment, but Foreman finds his immune system is shutting down, so he is quarantined. A pharmacy mix-up over his own pills suggests to House that Brandon may have taken the wrong pills for his cough due to pharmacist error, and the worsening of his condition is because his mother brought him his cough medication. A check of the pharmacy, however, seems to disprove House's theory. To find the problem, House orders surgery, but the risky procedure nearly kills Brandon. Pain in his fingers, however, tells House that his theory was correct, and that Brandon took a gout medication which he may have obtained through his use of ecstasy. As Brandon recovers thanks to House's treatment, House obsessively checks every version of the gout medication until he finds the one that proves his original theory correct.
- Jody Matthews: An adult female who checks in because she coughed up mucus a week ago who even brings a color sample for precision. House deduces she is about to get fired from her job and is trying to use her health insurance while she still can. When she says, "I just don't like being told what to do," he sympathizes with her position and offers a full body scan.
- Adam Brown: An adult male with a simple sore throat whom House leaves waiting while he plays a video game to wait for Cuddy to arrive so he can annoy her and punish her for forcing him to do clinic duty (no doubt inspired by Jody Matthews' use of health insurance). Cuddy confirms the diagnosis is simple and tells Brown to "go home. Drink some hot tea." House confirms this is "excellent counsel."
- Shelly Lever: An adult female whose "leg hurts after running six miles." Again, House plays video games with her while waiting on a consult from Cuddy. Cuddy disappoints House by sending Wilson instead.
- Jerry Morris: A young adult male whose problem House doesn't even inquire about as he complains about having to kiss Cuddy's butt. When Morris tries to leave, House tells him he has already deduced that the problem is Morris has swallowed something humiliating. Morris confesses the object is an MP3 player. House waits a few minutes until his clinic duty is over, so he can refer Morris to Cuddy.
(See the Medical Dictionary for definitions.)
- During the first differential diagnosis, House goes over the tests which showed nothing, including a CBC and CT scan. Chase hypothesizes a Yersinia infection, but Foreman shoots that down and hypothesizes arthritis causing vasculitis, which Cameron shoots down. Chase hypothesizes carcinoid, and as Foreman's shooting that down, House throws a medical dictionary in front of him and says, "Foreman, if you're gonna list all the things it's not, might be quicker to do it alphabetically. Let's see now... Absidia! Excellent! Doesn't account for any of the symptoms!" House orders his team to treat Brandon Merrell for sepsis and requests a Cort-stim test and an echocardiogram.
- As he administers the Cort-stim test, Foreman tells Brandon that it is to test his pituitary and adrenal glands.
- While addressing the patients in the clinic, House declares his two specialties as infectious disease medicine and nephrology. He also shows off his Vicodin.
- One of the danger signs which tells Foreman he should take Brandon off antibiotics is that his "creatinine is rising."
- With kidney failure added to the symptoms, Foreman offers a theory which he says explains, among other symptoms, cardiomyopathy. House then repeats all the theories offered thus far, circling the symptoms they would cause on his board, and adds to them hyperthyroidism. When this leads him to believe Brandon is suffering from hyperthyroidism and a sinus infection, he prescribes Unasyn and Levothyroxin.
- As Foreman tries to convince Chase and Cameron not to accept House's diagnosis of two simultaneous diseases, he says, "We've been here long enough to have Stockholm syndrome."
- In the lab, as they discuss Cameron's attractiveness, Foreman tests for Coxsackie B virus and Chase for Epstein-Barr virus.
- In a later scene in the lab, as Foreman and House confront Cameron over her effect on Chase, Cameron tests for parvovirus B19.
- After extensive lab tests, Foreman tells House he found interstitial nephritis, confirming House's theory.
- Foreman bursts in on House at the clinic, where he is waiting with a patient with a sore leg, and says he ran a test on Brandon's TSH.
- To calm Brandon as he takes a sample of his bone marrow, Foreman tells him one of the problems they may find is fibrosis.
- After spending all night pondering Brandon's problem, House walks out to his staff and announces simply, "Gout." He explains that Brandon received the wrong medicine for his cough, and instead received colchicine, which blocked cellular mitosis.
- After colchicine poisoning seems to have been ruled out as a possibility, Wilson hypothesizes lymphoma. House objects that his "CT scan showed no adenopathy," but Wilson suggests House "screw the tests. Do an exploratory laparotomy."
- During Brandon's laparotomy, Chase warns that the procedure is causing ectopy. When Foreman dismisses it, Chase says, "He can't tolerate any cardiac arrhythmia."
- From a clinic patient's clearly anal problem and his "high tolerance for humiliation," House surmises that his problem is not hemorrhoids.
- When Cameron informs House of the surgery complications, she recommends doubling Brandon's dose of G-CSF.
- Once House's diagnosis of colchicine poisoning has been confirmed, he predicts the path of the toxin. After damage to the bone marrow comes neuropathy. Once he finishes his rundown, he orders that Brandon be put on FAB fragments.
- "One" by Three Dog Night: House checks every type of colchicine until he finds one similar to the cough medicine Brandon Merrell was supposed to take.
- Foreman and Chase and Cameron: Cameron makes a remark about sex. Later, Foreman claims Cameron's remark made Chase uncomfortable. Still later, House and Foreman bring this to Cameron's attention, and later still, Cameron uses it to mess with Chase's head. This is the first time - outside of House's reference to it in 1x01 - Pilot - when Cameron's sexuality becomes an issue in the series.
- Graphic Warning: In the original airing of the episode, it opened with a warning which read: "The opening scene of tonight's episode contains a depiction of a sexual encounter. Parental discretion is advised." In repeat broadcasts, the warning was issued, but the scene was cut.
Behind the Scenes
Allusions and References
- Occam's Razor: When House first suggests Brandon Merrell may be the victim of two diseases, Foreman says, "Occam's Razor. The simplest explanation is always the best." Later, when House hypothesizes Brandon's condition is caused by a wrong prescription filled, he says, "Occam's Razor. The simplest explanation is almost always that somebody screwed up." Named for the English logician and friar William of Ockham, who first stated it, the original Latin statement translates to, "Multiples should never be used if not necessary." More common translations are, "Given two equally predictive theories, choose the simpler," and, "The simplest answer is usually the correct answer."
- "Metroid: Zero Mission": The video game which House plays to kill time in the clinic while waiting on unnecessary consults from Cuddy is "Metroid: Zero Mission", a remake of the original 1986 game "Metroid" about the alien-fighting heroine Samus Aran. The game was released for the GameBoy Advance SP, a popular console from Nintendo. (NOTE: Many viewers have pointed out that the video game sound effects are not from "Metroid: Zero Mission." This is most likely an issue with music rights necessitating a change.)
- The Great Wall of China: When Wilson suggests House may have an attraction to Cuddy, House responds, "There is not a thin line between love and hate. There is, in fact, a Great Wall of China, with armed sentries posted every 20 feet between love and hate." Built between 1368 and 1804, the Great Wall of China stretches nearly 4000 miles, separating China from what were traditionally barbarian peoples to the north.
- The Recording Industry Association of America: When House turns over a patient who has swallowed an MP3 player to Cuddy, he tells the nurse, "The RIAA wants her to check for illegal downloads." The Recording Industry Association of America represents the recording industry. It gained notoriety in the early part of the 21st century for suing teens and computer users who illegally downloaded music MP3s off the Internet.
- House addresses the patients sitting in the waiting room of the clinic and introduces himself and Cuddy. He announces that he is "the only doctor currently employed at this clinic who is forced to be here against his will. ... But not to worry! Because for most of you, this job could be done by a monkey with a bottle of Motrin." He then shows the patients his Vicodin and says, "It's mine. You can't have any. And, no, I do not have a pain management problem. I have a pain problem. But who knows? Maybe I'm wrong. Maybe I'm too stoned to tell." He concludes by asking the patients which of them want to be treated by him. None of them raise their hands. When he asks who would rather have one of the other two doctors, they all raise their hands.
- Seeing Chase distracted by her earlier comment about sex, Cameron distracts him further by talking in great detail about the effects of sex on the body. By the time she is done, Chase is absolutely speechless.
- House: There are about a billion sick people on the planet. Why this one?
- Wilson: Because this one's in our emergency room.
- House: Ah, so it's a proximity issue. If somebody was sick in the third-floor stairwell, that's who we'd be talking about.
- Wilson: Yes. I checked the stairwell. It's clear.
- House: So how are we doing on cotton swabs today? If there's an acute shortage, I could run home....
- Cuddy: No, you couldn't.
- House: Nice.
- Wilson: That smugness of yours really is an attractive quality.
- House: Thank you. It was either that or get my hair highlighted. Smugness is easier to maintain.
- Cuddy: It's not gonna work. You know why? Because this is fun. You think of something to make me miserable, I think of something to make you miserable... it's a game! And I'm gonna win. Because I got a head start. You are already miserable.
- House: It was so perfect. It was beautiful.
- Wilson: Beauty often seduces us on the road to truth.
- House: And triteness kicks us in the nuts.
- Wilson: So true.
- House: This doesn’t bother you?
- Wilson: That you were wrong? I try to work through the pain...
- House: I was not wrong. Everything I said was true. It fit. It was elegant.
- Wilson: So... reality was wrong?
- House: Reality is almost always wrong.
- House: What would you want? A doctor who holds your hand while you die, or a doctor who ignores you while you get better? I guess it would particularly suck to have a doctor who ignores you while you die.
- House: Make a note: I should never doubt myself.
- Wilson: I think you'll remember. You know, it wouldn't hurt you to be wrong every now and then.
- House: What, you don't care about these people?
- Wilson: You know what? I'm not interested.
- House: You're not curious?
- Wilson: No. Because I'm well-adjusted.