House, M.D./The Socratic Method
The Socratic Method is the sixth 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)
Lucy Palermo, a schizophrenic woman cared for by her son Luke (who claims to be 18) feels a pain in her leg and collapses. House believes Lucy's doctor is dismissing her as an alcoholic too easily. He takes Lucy off all meds, but Foreman gives her a sedative. When she vomits blood, House deduces she has a vitamin K deficiency, which a check of her apartment proves correct. As House learns Luke is underage but afraid of being sent to a social home, Chase and Cameron learn Lucy has liver cancer. Because they can't get surgery to remove the tumor, House and Wilson shrink it to trick the surgeon. Cuddy finds out but does not stop the surgery. Social services take Luke away, and he believes House made the call. House realizes Lucy herself made the call - the act of a rational woman, not a schizophrenic. A check of her medical history reveals she is suffering from a rare genetic disorder. Treatment clears up her physical and psychological symptoms, and she is sent home with Luke, but House still accepts the blame for turning Luke in.
- Wendy: A chubby girl whose mother Terri brings her in on the false pretense of checking for strep throat, but really wants House to convince her to accept a sugar-free cake for her birthday. House berates Terri and tells her "get the kid a damned ice cream cake."
- Clark: An adult male with an unstoppable case of hiccups. One of the remedies Clark has tried is slapping himself. House asks him to demonstrate. Clark does twice. When Cuddy calls House away, he tells Clark to hit himself harder while he's gone.
(See the Medical Dictionary for all definitions.)
- Dr. Wells tells Luke Palermo that Lucy had a pulmonary embolism. He attributes the leg pain to a deep-vein thrombosis. Luke reveals Lucy is schizophrenic. When Wells dismisses Lucy as an alcoholic, House sarcastically says that Wells is a professional doctor who would have "scoped for varices."
- House asks for a differential [diagnosis] for Lucy. Foreman suggests a number of probable factors, including diabetes, and recommends Heparin. House dismisses these and says the paranoia from her schizophrenia "keeps her limber," but he excludes this from the diagnosis, because, "Abnormal dopaminergic pathways in the brain do not cause blood clots."
- After his conversation with Lucy, House orders blood tests for "PT, PTT, factor five, protein C and S, the whole shebang."
- When Lucy struggles and spits in his face, Foreman orders of Haldol.
- House's clinic patient Wendy has been brought in by her mother Terri on the pretense of checking her for strep. In actuality, Terri wants House to talk Wendy out of wanting a sugary birthday cake. House tells the girl that sugar causes appendicitis and athlete's foot.
- Lucy's vomiting blood leads House to diagnose a vitamin K deficiency. Cameron hypothesizes a reaction between two drugs, such as Heparin and ampicillin. Chase hypothesizes scurvy, the plague or cirrhosis from alcoholism.
- In the Palermos' apartment, Foreman finds trifluoperazine, Thorazine and Clozaril. He also finds a full bottle of ampicillin.
- House claims to deduce Luke's age by viewing an X-ray of his epiphyseal plate.
- When Lucy's chances of a liver transplant seem improbable, House recommends "surgery to resect the tumor." Chase says hospital surgeon Dr. Bergin uses a gamma knife.
- To trick Bergin into performing surgery, House and Wilson inject ethanol into the tumor to shrink it.
- After Lucy sends Luke away, House says her diagnosis of schizophrenia was the result of an internist sending her to a shrink.
- To make a point to his staff, House uses a hypothetical situation in which he has a headache and goes to three doctors, each sharing a specialty with the members of his staff. "The neurologist", he says, referring to Foreman, "tells me it's an aneurysm. The immunologist [Cameron] says I got hay fever. The intensivist [Chase] can't be bothered." He asks what else could be Lucy's problem. Cameron hypothesizes porphyria and Wilson's disease. House likes this latter idea as it matches with Lucy's appointment with an ophthalmologist. He says she had an appointment with him because Wilson's causes cataracts as well as cirrhosis.
- To test House's hypothesis of Wilson's disease, Foreman checks Lucy for Kayser-Fleischer rings around her corneas.
- "Happy Birthday to You" by Hugh Laurie: At the piano, House taps out a few bars of this tune.
- Chase: Chase believes Lucy must be an alcoholic and is angry. Foreman and House deduce this is a clue to Chase's past.
- House's Painkillers: For the first time in the series, House is not shown taking Vicodin. He does, however, drink alcohol while playing the piano. Later episodes will suggest he is also an alcoholic.
- House's Birthday: Several references are made to it being House's birthday, but the date is never stated. The previous episode, 1x05 - Damned If You Do, took place on Christmas, four days after this episode's airdate of December 21. The only other clue is the establishing shot of the hospital, which shows either a warm winter or an early spring. This episode can therefore be assumed to take place some time between December 26 and April 15 or so.
- Faux Chopin: The classical music House plays is in the style and manner of the Romantic composer Frederic Chopin. This is not a real Chopin piece but rather an imitation produced for the show.
Behind the Scenes
- House's English Accent: While trying to get a hold of Lucy's medical information in the wee small hours of the morning, House fakes an English accent and pretends to be a British doctor unaware of the time in America. Of course, actor Hugh Laurie is English, and this is not a faked accent, but rather his normal one.
Allusions and References
- Pablo Picasso: Wilson compares House's fascination with a simple blood clot to "Picasso deciding to whitewash a fence." Spanish painter and sculptor Pablo Ruiz Picasso was one of the most revered figures in 20th century art, who pioneered the movement called Cubism. He is considered to be the greatest artist of his century, and like fellow artists Leonardo da Vinci, Michelangelo and Vincent Van Gogh, his name is synonymous with great artists.
- LeRoy Neiman: House replies to Wilson's Picasso statement by saying he is a bigger fan of LeRoy Neiman. LeRoy Neiman is an American painter of the 20th and 21st centuries best known for his abstract portraits of athletes. Despite his popularity, he is often dismissed by art critics as a pop culture illustrator and not a serious artist.
- The Nobel Prize: In regards to the blood clot, Wilson says to House, "Solve this one and you're on your way to Stockholm." The inference is that House will win a Nobel Prize in Physiology or Medicine - the highest honor which can be bestowed upon any medical scientist - which is awarded each year in Stockholm, Sweden.
- Galen: House tells Wilson that Galen treated schizophrenics through "fumigation of the vagina." Second century Greek physician Claudius Galenus of Pergamum's studies dominated Western medical science for over a thousand years. He believed the mind was controlled by what he called pneuma, which translates literally to "air" or "breath," but for which modern translators use the word "soul." Due to this flawed theory, he believed mental illnesses were caused by bad air, particularly in women.
- Marcus Welby: House calls Galen "the Marcus Welby of ancient Greece." Marcus Welby was the hero of the 70s medical drama Marcus Welby, M.D., one of the biggest hit medical dramas in television history. Dr. Welby was known for his soothing bedside manner and for treating patients as individuals. It is for this reason that House - who views patients as puzzles and despises people - can in many ways be seen as a sort of anti-Welby.
- Famous Schizophrenics: In justifying to Wilson taking Lucy Palermo's case, House lists famous schizophrenics, including:
- Socrates: Fifth century BCE Greek philosopher Socrates' students - including Plato - attributed much of their writings to him. He invented the Socratic Method, a dialectical method of inquiry which forms the basis of Western ethics.
- Isaac Newton: The late 17th and early 18th century English scientist Sir Isaac Newton is considered the greatest scientific mind in history. His laws of gravity and motion gave birth to the modern study of physics.
- Syd Barrett: The 1960s and '70s English band Pink Floyd was one of the most influential post-Beatles rock bands. They were founded and fronted by guitarist Syd Barrett, whose schizophrenia forced him out of the band before they hit their greatest success in the 1970s with such albums as The Dark Side of the Moon, Wish You Were Here and The Wall.
- The New York Mets: When House first asks Lucy about her "meds," she replies, "Baseball! I like baseball." House says, "Not 'Mets.' Meds, medicine." After the conversation, he returns to Wilson and his staff and says he learned that "the Mets suck." Later, as social services arrive to take Luke away, Lucy says, "When the Mets lost, you remember?" The New York Mets are a Major League Baseball team in the National League who play in Shea Stadium in Queens.
- "Her Praise": At the start of the scene which ends with Lucy vomiting blood, Luke reads a poem, which she knows by heart. After Luke is sent away, House reads from the same poem. The poem is "Her Praise" by the late 19th and early 20th century Irish poet William Butler Yeats, from his 1919 collection The Wild Swans at Coole. The lines read are the last four, which are:
- If there be rags enough he will know her name
- And be well pleased in remembering it, for in the old days,
- Though she had young men's praise and old men's blame,
- Among the poor both old and young gave her praise.
- Mickey Mantle: After Lucy's liver tumor is found, House says she will never get a transplant because of her presumed alcoholism. Foreman says, "Mickey Mantle had a whole bar named after him. He got a transplant." House replies, "Yeah, well, Lucy can't switch-hit." Mickey Charles Mantle was a baseball player in the 1950s and '60s who played for the New York Yankees and was known for his many home runs and high batting average. Off the field, he was known for his hard drinking and womanizing, which necessitated him receiving a liver transplant in 1995, mere months before his death at the age of sixty-three.
- The Madness of King George: When Cameron hypothesizes porphyria, Chase says, "The Madness of King George." This is the title of a 1994 film based on the play The Madness of George III by Alan Bennett. It is about King George III of Great Britain and Ireland - best known as the king against whom the colonists rebelled in the American Revolution. After the Revolution, King George suffered from bouts of insanity, which scientists now theorize were the result of the genetic disease porphyria. The film dramatizes his first bout of insanity, which began in the autumn of 1788 and lasted into February of the following year.
- Cuddy confronts House and says, "You should know by now, my doctors have no secrets from me." Believing she is referring to his conning of the surgeon to remove Lucy Palermo's tumor, House asks, "Who came running to Mommy?" This leads Cuddy - who does not know about House's trick - to deduce he has done something wrong. To throw her off the scent, House claims he thought Cameron told Cuddy about it being House's birthday, "and I'd have to stand here and smile while you gave me a sweatshirt or a fruit basket. You know, made me feel that deep sense of belonging." Cuddy claims she was referring to House owing her clinic hours. As House walks away, Cuddy makes a call to find out what House did wrong, but she throws away a birthday card.
- Luke: It's not the alcohol. It's gotta be something else.
- House: (Overhearing.) Of course it's the alcohol! Hello! This guy's a professional doctor! Plays golf and everything, I bet. He's not gonna tell you your mom's an alcoholic without proof. I'm sure he scoped for varices, checked her esophagus, ran all kinds of blood tests. Doctors like this, th-th-they don't make assumptions. They do the work!
- Chase: He likes crazy people. He likes the way they think.
- Foreman: They think badly. That's the definition of crazy. Why would he like...?
- Chase: They're not boring. He likes that.
- House: Look, I have a cane, and I know how to use it.
- House: Good morning, Dr. Cuddy. Love that outfit. It says, "I'm professional, but I'm still a woman." Actually, it sorta yells the second part.
- Cuddy: Yeah, and your big cane is real subtle, too.