House Season1 EP18

Babies and Bathwater

Episode 118 : 2005-04-19

Pregnant Naomi Randolph is in the driver's seat with her slightly intoxicated husband, Sean, as a passenger. Suddenly, she goes limp and the car swerves into oncoming traffic. Sean quickly grabs the wheel and pulls the car over. A police officer arrives. When Naomi slurs her words, he asks her to get out of the car. She mindlessly sways to the back of the car, then collapses.

At the hospital, Foreman tells the Randolphs that there is no sign of stroke but the bloodwork shows that her kidneys and liver are struggling. Naomi nervously declares that she's 39 and has miscarried three times already. Foreman and Chase track down House, who's napping. He takes Naomi's file and becomes interested when he sees she has three miscarriages. Foreman reports that her B.U.N. and creatinine are up and her LFTs are slightly elevated. Yet he thinks that, with three miscarriages, there's some underlying physiology. House muses that it could be pregnancy-related autoimmunity where the body becomes allergic to the baby. House also informs them in passing that Cameron quit. Foreman and Chase are shocked, but House merely asks for a blood test, an MRI, a sonogram and a round of magnesium in case it is pre-eclampsia.

The ultrasound shows no sign of fetal distress. Naomi swallows a bit of food, but begins choking on it. They cannot perform the Heimlich maneuver, so Foreman dives in with the forceps. Naomi can't swallow. An MRI shows no signs of vasculitis. Naomi begins cramping up during the exam. Foreman and Chase recognize the pre-term labor and administer medicines to prevent it.

House sneaks around the hospital, trying to avoid Vogler. Vogler corners House in his office anyway. House tries to say he cut Cameron to make things even, but Vogler declares that tomorrow morning House will announce his resignation and make a public apology. If not, Vogler will destroy him.

Chase and Foreman tell House that Naomi's contractions are under control and she might make it to full term. Chase affirms that it's pre-eclampsia. Foreman suggests myasthenia, which would explain the muscle loss and choking incident. House counters that choking on a soft, wet pear is well past the point of mere muscle weakness. House orders them to administer an endoscopy and check her eyelids. Wilson pulls House away to inform him that the board met this morning about his future. House feels very confident about his status, because his tenure needs a unanimous vote to be revoked and his contract is still current. Wilson thinks Vogler will find a way to get to him.

House then checks in with another patient. Two young parents named Joel and Rachel Kaplan have a baby that developed pneumonia and malnourishment after the parents put the child on a raw food vegan diet. House reports that the baby is improving, but they need to give her a real diet, which they gladly agree to do. At that moment, Social Services bursts in, seizes the child and arrests the Kaplans for child endangerment. House confronts Cuddy, wondering if this is how Vogler will get him. Cuddy calmly explains that the nurses were concerned and made the call. House took a big legal risk in not reporting the abuse. She warns him not to give Vogler an excuse to dump him.

Foreman and Chase examine Naomi's eyelids and notice some drooping. Chase peers at her esophagus and notices swelling. An X-ray reveals a three centimeter mass in the right upper lobe. Foreman hopes it's a granuloma, but House points out that there's no calcification. Wilson tells the Naomi that she has small cell lung cancer. It has spread, so they cannot operate. The antibodies her body was making to fight the tumor got sidetracked, which explains the brain and kidney problems. She suffers from Lambert-Eaton syndrome. Wilson plainly informs Naomi that the five year survival rate is only ten to fifteen percent, so they have to start chemo and radiation right away. Naomi asks about the baby. They will be forced to perform a C-section before starting treatment, and the child has an 80% chance of surviving the early birth. Naomi refuses the treatment. With only a 15% chance of surviving, she'd rather protect the baby.

Vogler sums up some of House's recent actions to the hospital board. He has violated a DNR, was charged with assault, he spit on a surgeon and he accepted a gift from a known mafia member. Wilson leaps to House's defense, citing that he has saved hundreds of lives. Vogler calls House a drug addict, a disgrace and an embarrassment. Vogler makes it simple: either House is fired or Vogler leaves with his hundred million dollars. Vogler calls for a vote. All of the board members -- including Cuddy - approve termination. Wilson is opposed, and House is saved because it wasn't unanimous. Vogler immediately calls a vote on dismissing Dr. Wilson from the board.

House meets with Chase and Foreman to discuss Naomi's refusal of treatment. House thinks they need to raise her odds of survival in order to convince her to agree to the treatment. He walks off to look for Wilson, but is stopped by the Kaplans. They plead with him for help, claiming that they fed their baby enough and a nutritionist advised them that this diet was safe. Intrigued, House calls Foreman and asks for a CT scan on Olive Kaplan. House finds Wilson, who's packing up his office. He decided to resign after being dumped off the board. Wilson angrily complains that only two things matter to him -- his job and his friendship with House. Yet House didn't care enough about either to give one lousy speech. House feebly tries to apologize, then asks about some clinical trials for Naomi's sake. Later, House tries to confront Cuddy, but she quickly ends the conversation by declaring that he may be a great doctor but he is not worth $100 million.

House meets with another oncologist and shows him a slide of Naomi's cancer cells with hopes to getting her into the doctor's clinical trial. She is eligible if she can be ready to begin in two days. House schedules a C-section for Naomi, but Foreman and Chase argue that this is against hospital regulations. Clinical trials cannot be conducted until at least a month after a major surgery. Why give Vogler any help in firing House?

House lays everything out for Naomi, but she resists. Sean begs House to convince Naomi to agree. After Sean leaves the room, Naomi asks about her incontinence which is rare for a woman of her age. House questions whether this is really her first child. Naomi confesses that she bore a girl when she was eighteen, but the baby suffered from infantile Alexander's disease. The child died and Naomi separated from her husband. She wanted to start her life over. House accuses her of being selfish and ignoring what Sean truly wants, which is for Naomi to fight the cancer. She tearfully agrees to the C-section.

Naomi is put under for the operation, but a call comes into the OR and the surgeons end the procedure before starting. Vogler has nixed it. House confronts Vogler in the lobby and indicts him for killing Naomi. Vogler says that he needs to protect the study, protect the numbers and protect the protocol from the FDA. Vogler tells House to calm down because there is another board meeting that night.

Chase and Foreman lay out the situation for Naomi and Sean. Naomi begins gasping for air. Chase slides an ET tube down her throat and Foreman kicks on the ultrasound. They spot a blood clot, which needs to be removed immediately. Foreman tells Sean it requires his permission to begin the procedure, but that it's not that simple. The best course for the baby would be an immediate C-section to prevent any damage from a lack of oxygen. In her current condition, there's a real chance that Naomi won't survive the C-section. Sean opts to avoid the C-section and save his wife.

In the OR, Foreman pushes for streptokinase. It is not enough, and they are forced to suck out the clot. Chase inserts a special embolecetomy catheter into Naomi's IV line and draws out the clot. House checks Naomi's printout. Her BP drops again and House realizes that she's bleeding into her abdomen. There is no way to stop it. House tells Sean that he needs to okay the C-section because Naomi is likely to die either way. House explains that he must make a decision to save the baby. Sean relents.

The baby is removed and the doctors wait for it to take a breath. Naomi goes into cardiac arrest and they try to shock her back to life. As they work, the baby screams. It is alive. Outside, House catches Cuddy on her way to the board meeting. He hands Cuddy the CT scan for Olive Kaplan. Cuddy notices the thymus gland indicates DiGeorge Syndrome, a genetic condition which explains the lack of weight gain. House tells Cuddy to start Olive on immunoglobin replacement because he assumes that he won't be around long enough to do it himself.

The meeting gets underway and Vogler conducts the vote. This time, only Cuddy is opposed. Vogler can't believe that she would change her mind since yesterday. She argues that he might have saved another life. Cuddy points out that Vogler is responsible to no one and that if the board rolls over for this, then Vogler will completely own them without any dissenting voices. She leaves them to their vote.

Later, House and his staff celebrate the fact that Cuddy's speech convinced four board members to give up Vogler's money. Cuddy says that she voted to get rid of the lesser of two evils. Losing $100 million is no victory for anybody.

 

第18集（S1EP18:Babies & Bathwater）
1.HOUSE: Technically, Alexander Fleming. He developed antibiotics.
House: 技術上說，（應該謝謝）Alexander Fleming。他研發的抗生素。
12分25秒，在治癒門診病人，那個小baby後，母親Rachel Kaplan說了一句“感謝上帝”。House回答說應該謝謝Alexander Fleming。蘇格蘭生物學家亞歷山大.弗萊明（Alexander Fleming），青黴素的發現者。1928年發明的青黴素，二戰期間挽救了無數生命，並對西方醫學產生了巨大的影響。他也因此獲得了諾貝爾醫學和生理學獎。

2.HOUSE: You know, there’s a new biography of Quisling, I think you might like it...Uh, Norwegian guy, World War II, traitor.
Vogler讓House的門診病人，嬰兒的父母Joel和Rachel因為涉嫌虐待兒童而被拘留。大叔很惱火，他問Cuddy，“你知道麼，最近有本關於賣國賊的新書，你可能會喜歡的。”（13分22秒），“呃，是個挪威人，二戰時候的，賣國賊。”（13分26秒）。
Quisling這個詞本來並不是賣國賊的意思，然而在二戰期間，挪威的佔領政府總理Vidkun Abraham Lauritz Jonsson Quisling（這鳥名字真長）向納粹稱臣並對其給予援助，因此他的名字Quisling後來被當成是賣國者的同義詞。

3.HOUSE: In evolutionary terms, the needs of the next generation are more important.
在得知本集的主要病人Naomi Randolph決定要停止自己的治療以抱住胎兒的時候，House，Foreman，Chase有一個討論（21分12秒處）。Foreman認為犧牲自己是違反人類本能的，然後House卻用進化論的觀點反駁了他“按照進化論，下一代永遠是更重要的”。
達爾文（Charles Robert Darwin）的進化論就不用多說了，這裏提一點，按照進化論的理論，繁衍是生物最主要的本能之一。因此父母經常會本能的犧牲自己而保全下一代。這也許就是父愛和母愛的理論依據吧。