House Season3 EP17

Fetal Position

Episode 317 : 2007-04-03

Famous celebrity photographer Emma Sloan is five months pregnant. She arrives late for a shoot with a band member from All-American Rejects. She complains that the words on the backdrop are jumbled even though they are correct. Emma panics and shouts for somebody to call 911 because she's having a stroke.

House ambles into Emma's hospital room with a quick order to hold her arms out with palms up. Her right arm begins to droop. House asks if her ob gyn cleared her and her fetus. Emma affirms this and House calls him an idiot for missing the pronator drift. House examines Emma's eyes and notices an issue with vessels. He thinks her microaneurysm is a predictor of future strokes. In the conversation, House learns that Emma was artificially inseminated with a donation from a gay neurologist. He also notices that Emma's catheter bag is half-filled with blood.

The team later reports that a urinalysis revealed that there was excessive protein and red blood cells. A chem panel showed a creatinine level over 2.5. After the stroke, Emma's kidneys have been shutting down. Cameron wonders if the kidney problem came first and threw off a clot that caused the stroke. House thinks the heart is much more likely to throw off a clot and mentions the six cases of strep in Emma's history. Untreated strep leads to Rheumatic fever, which leads to mitral valve stenosis, which leads to the team exiting the office to go check Emma's heart.

While Emma lays in a CT scanner, Chase and Cameron discuss House catching them in the supply closet. Chase doesn't think it's a big deal, but Cameron worries that House has some secret plan in the works. Chase wonders if Cameron is simply annoyed that House caught them and doesn't care. He then notices a calcified mitral valve in Emma's heart.

Emma is put in surgery so that Chase and Cameron can insert a balloon into her narrowed valve. They believe this will solve her problems as long as she finishes her prescribed antibiotics the next time she gets strep. But before they start, Cuddy enters. With a smile, she starts giving Cameron and Chase orders on how to approach the procedure they've done numerous times in the past.

The team finds House in his office making vacation plans with a direct flight to Phnom Penh. They tell him about Cuddy, which House brushes off. They go on to explain that Emma's kidneys are still failing. House figures that means they screwed up the procedure, but Cameron counters that maybe House screwed up the diagnosis. Considering the pregnancy, the doctors mention pre-eclampsia, proteinuria, low platelets. They also bring up hypoperfusion, a condition in which a fetus acts like a parasite and steals crucial nutrients and blood from the mother. Foreman, mentioning the pregnancy could be irrelevant, wonders about sepsis or HUS/TTP. House sends them off to check for everything.

All of Emma's tests come back clean. The doctors are baffled. Everything that screws with the kidneys is something they considered. House approaches Emma and informs her that they've eliminated all possibilities for her body. But the other body -- the fetus -- isn't performing so well.

House convenes his team in the office and explains Maternal Mirror Syndrome to them. In short, the creation of a new system inside a functioning body goes wrong. As the fetus slowly dies, rather than miscarry or become a stillbirth, it kills the mother's body as well. The good news is if they fix the fetus, Emma will get better. The bad news is that this syndrome rarely turns out favorably. House suggests they start with a look at the fetus's heart. Unfortunately, it's nearly impossible to get an accurate scan on a fetal heart because the fetus doesn't stop moving. Yet House has a solution. He's going to paralyze the fetus.

Cuddy catches wind of this scheme and tries to stop House. House is quickly able to talk her into it. And together, they're able to talk Emma into the procedure. Everything is a success and the fetal heart is structurally sound according to the MRI. However, the bladder is four times the normal size. It's so engorged that it's squeezing out the other organs, not allowing space for the lungs to develop. Cuddy informs Cameron that it's a lower urinary tract obstruction that can be fixed by inserting a shunt. Cameron asks if Cuddy is taking over this case, and Cuddy replies that House won't care now that the diagnosis is in. Cuddy then warns Cameron that dating Chase can only end in one of two ways: marriage and happiness, or a breakup that leads to Cuddy having to fire one of them because they can no longer work together. Cameron knows that House told Cuddy about them.

Cuddy informs Emma of their plan to insert the shunt, which should solve the problems. They will have to check the fetal kidneys first to make sure they function properly. If they're too damaged, there's nothing the doctors can do.

Cuddy finds House in her office. He happily explains to her that her kidney test will be inconclusive. The urine is stale, and she'll need to do at least three kidney taps before she can find fresh urine. Then he asks Cuddy why she's so interested in this case. Perhaps Emma is basically Cuddy, a single woman in her 40s who is using in vitro. He wonders whether Cuddy wants Emma to succeed to give herself some hope. Cuddy thinks on this, and agrees. She gives the case back to House.

Chase breaks the news to Emma that the fetus's kidneys aren't damaged. They're going to insert the shunt and everything should turn around. Surgery for the shunt is a success and the fetal bladder starts to decompress. Emma complains of abdominal pain and when Cameron checks her eyes, they're yellow. Cameron and Chase let House know that Emma's liver is now failing. House begins to wonder what the fetus is hiding. Maternal Mirror Syndrome has one surefire cure: delivery. However, a fetus isn't viable at 21 weeks. Who gets to tell Emma?

Emma asks about putting the fetus on ventilators, but the fetus is at least two weeks away from being viable. The catch is, her liver isn't going to last two more days. Emma refuses an abortion, so House points out that either the fetus dies or they both die. There is no chance of her dying and the baby surviving. Emma declares she won't consent to an abortion and tells House he has two days to figure it out.

House wants Cuddy to order an abortion, but Cuddy refuses. He claims the fetus is nothing more than a parasite at this point, but Cuddy says they need to exhaust every avenue before aborting. Cuddy gathers the team to run a differential, asking if their original assumption could be wrong. Desperate for a possible solution, Cuddy asks if the liver problems could have developed after they cured the urinary blockage. Cameron and Chase mention acute fatty liver, viral hepatitis and HELLP Syndrome as possible causes. Foreman points out that Emma's platelets are too low. If they biopsy the liver, they won't be able to stop the bleeding. Cuddy mentions transjugular hepatic biopsy. If they go into the liver from above and it does start to bleed, then the blood will go right back into her veins. Impressed, the team heads out.

Chase and Foreman thread a needle through Emma's veins. When they pierce the liver, her heart rate and blood pressure spike. The fetal heart rate explodes to 185 and contractions begin pre-term labor. Later, the doctors tell Cuddy they were able to control the pre-term labor with tocolytics. But the liver biopsy was negative, which means it is definitely Mirror Syndrome. The doctors insist that there's no solution outside of termination. Cuddy suggests overloading the fetus with corticosteroids in an effort to speed up the lung development. Then they can look at the lungs in search of a problem. The doctors rattle off a long list of developmental and practical problems a corticosteroid bath would create, but Cuddy is undeterred. She rushes out to perform it herself.

During the procedure, Emma develops a pulmonary edema, just as the doctors predicted. Wilson enters at the behest of the team. He also advises termination. All Cuddy has done is turn Emma into an incubator for a dead fetus. Cuddy tells Wilson to get out.

The next morning, Cuddy shuffles into Wilson's office with an admission that they were all right. Emma is getting worse faster than the baby is getting better. Cuddy asks Wilson what House would do in this situation. Suddenly, she has a revelation. Since Emma is already on a respirator, it doesn't matter what Cuddy does to her lungs and she can actually increase the corticosteroids. It also sounds like a risky flight of fancy that House would attempt.

The gamble works and Cuddy gets a viable MRI of the fetus' lungs, which she rushes over to House's apartment. The MRI presents many possibilities. House blows off his airport cab for vacation and returns to the hospital. The problem facing the team is that all of the normal lung tests -- transesophageal echo, high-res CT scan, ventilation perfusion -- are impossible to perform on a fetus. Frustrated, Chase blurts out that what they would normally do if stuck is perform exploratory surgery. House thinks that sounds like a good idea.

House plans to open the uterus, then open the fetus itself to take a look around. Despite Cuddy's warning that this procedure is incredibly dangerous, Emma sees a real-time 4D scan of her fetus and emotionally consents. The observation deck is packed for the surgery. When House cuts into the uterus, the fetus's arm emerges, tenderly grabbing House's finger. House freezes, staring at the tiny hand in awe. Despite his earlier insistence that this is a fetus and not a baby, he seems moved by the moment.

Later in the surgery, the fetal surgeon spots three lesions in the lungs and pronounces it to be C-CAM. He thinks he can reset them. Suddenly, Emma begins to crash. Cuddy tries to shock her back to life. House declares that the surgery isn't crashing Emma. It's the fetus. He grabs a pair of scissors and heads to the womb. Cuddy orders him to step back or get electrocuted. House continues working, but sees Cuddy isn't bluffing. He jumps back right before she delivers another shock. Finally, Emma's heart rate returns to normal.

The surgery is a success. House performs a follow up exam on Emma and everything is just fine. Emma thanks him, but House admits that the pregnancy would've been terminated if he had his way.

第17集（S3EP17:Fetal Postition）
這集裡面小鴨子們看大叔照片的樣子好搞笑呀...^^b
1.Fetal Position
標題Fetal Position 一語雙關。首先可以翻譯為“胎兒的地位”，說明胎兒是本集的主要焦點所在。其次可以作為專業術語翻譯為“胎方位",胎方位是指胎兒先露部的指示點與母體骨盆的關係。胎方位在整個妊娠和生產中的地位很重要。——感謝網友maxe.doc的補充

2.All-american rejects & Rockwell
36秒的時候，本集的病例Emma給搖滾歌星拍照前說："All-american rejects.Juxtaposing a classic image of americana with modern pop culture, you."（所有美國人都反對，把代表流行文化的你，和一張代表傳統美國文化的經典照片弄到一起）。我們在後面知道Emma拍攝的照片都是那種黑白老照片感覺的，而緊接著的對話也說明這位元歌星的歌迷大都出生在90年代。事實上這裡的"All-american rejects"算的上是一語三關。首先，它是“所有美國人都反對”的意思；其次，它是1999年成立於美國奧克拉荷馬州的All-American Rejects樂隊的名字；再次，在本集中客串搖滾明星的就是All-American Rejects樂隊的主唱兼貝司手Tyson Ritter。
而緊接下來53秒所說的"Love the rockwell thing."（喜歡Rockwell的東西）我個人認為也是雙關語。首先Rockwell=Rock well，符合搖滾歌星身份。其次Rockwell應該是指20世紀著名的美國插圖畫家Norman Rockwell，他的畫恰恰又多是描寫美國傳統生活的。

3.The mnemonic FAST
1分23秒病例Emma開始叨咕的記憶法也許有些人看的會一知半解吧。首先，中風會導致記憶障礙，所以Emma在懷疑自己中風的時候叨咕"FAST"（快）來看自己是否記憶出現問題。這個FAST（快）其實每個字母都是有含義的，分別為Face（臉，看是否笑容會有扭曲），Arms（胳膊，看是否能舉起胳膊），Speech（講話，口齒是否不清），Time（時間，如果中風病人能夠在3小時內得到及時救治，那麼他的大腦受損的概率就會降低）。Emma正是在記憶FAST代表的具體含義（測試記憶力）同時，分別測試了自己的F，A，S...方面，才判斷出自己中風的。

4.Who are the Jews in this metaphor?
“這個比喻裡猶太人指誰？”——Chase
本集Cuddy從一開始就表現出了對病例的“過分”關心（片頭就說這是一個“重要”病人）。而House當然察覺到了這點。在10分44秒，House用德國鐵路系統來比喻母體。這個比喻中一切都有所指，唯獨猶太人大叔沒有明說指誰。Chase於是問道"Who are the Jews in this metaphor?"（這個比喻裡猶太人指誰？），這個猶太人指的就是Cuddy。

5.House: Sorry. Just realized I forgot to Tivo Alien.
HOUSE：抱歉，我只是想起忘記錄《異形》了。
36分13秒大叔所說的這句“忘記錄《異形》”有2個所指。對於《異形》（"Alien"）這個系列的電影，相信並不需要多說什麼。胎兒從子宮中伸出小手的畫面，類似異形從母體破體而出的場景。而Tivo則是美國數位錄影機的著名品牌，用戶可以通過Tivo牌錄影機將數位電視節目錄到內置的硬碟中，以便後來觀看。而正如施樂（Xerox）成為複印的代名詞，邦迪（Band-Aid）成為創口帖的代名詞，Post-it成為便簽的代名詞，Google成為搜索的代名詞一樣，Tivo也成為錄播數位電視節目的代名詞了。
而35分45秒開始的本集中這最動人的一幕（胎兒的小手伸出與大叔親密接觸），我要告訴你這一幕其實現實中是存在的（驚訝吧^^b）。這個胎兒名叫Samuel Armas，當時只有21周大的他因患上胎兒脊髓病變，必需開刀為胎兒醫治。通常在這種胎兒先天有疾病的情況下，父母都會選擇流產，但Samuel Armas的父母選擇了在懷孕期間為其治療。手術在Vanderbilt大學醫療中心進行，其實這已經是該醫療中心進行的第54例胎兒手術了（他們發明了一項能夠在懷孕期間打開子宮為胎兒作手術的技術）。然而在手術的過程中，子宮中竟然伸出了一隻嬰兒的小手，並且緊緊握住了醫生的大手！手術最後很成功，而Samuel Armas也於1999年12月2日順利降生。而這張手術時的照片也被是世界多家媒體所轉載。而這一幕不單只出現在House一劇中，在《實習醫生風雲》（"Scrubs"）一劇的My Road to Nowhere一集中，Donald Faison飾演的Christopher Duncan Turk醫生給Jordan的胎兒做手術時，也出現了這一幕。
另外順帶提一下，《實習醫生風雲》裡很多場景和House太像了，2部劇的“病人”們也是跑來跑去的，所以2部劇比較著看也挺有意思的。