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House Explained. Season 1, Episode 11.
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Detox.
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Dr. Gregory House, a brilliant but abrasive diagnostician addicted to Vicodin,
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leads a three-person team at Princeton-Plainsboro Teaching Hospital:
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neurologist Eric Foreman, immunologist Allison Cameron,
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and intensivist Robert Chase.
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His boss is Dean of Medicine Lisa Cuddy,
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and his only real friend is oncologist James Wilson.
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When a sixteen-year-old boy won't stop bleeding and no one can figure out why,
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House takes the case,
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while simultaneously accepting a bet to go a week without painkillers.
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This episode runs two crises at once.
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Keith Foster, a sixteen-year-old,
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has been bleeding internally for three weeks after a car accident,
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his girlfriend was driving his dad's Porsche when he started coughing blood,
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and every test comes back negative.
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Meanwhile, Cuddy bets House he can't go a week without Vicodin,
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and he takes the deal for a month off clinic duty.
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So from the very first scene,
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every medical decision House makes has this question hanging over it,
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is this his genius talking,
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or is withdrawal messing with his judgment?
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His team can't tell either.
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Keith loses vision in one eye.
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A blood clot.
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In a patient who's bleeding everywhere?
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Opposing processes.
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Chase drains fluid from the eye to give the clot room to dissolve,
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creative fix, it works, Keith can see again.
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But they still don't know what's causing any of this,
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and then Keith's liver starts shutting down.
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Cameron argues it's lupus,
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three diagnostic criteria lined up,
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but House pushes back,
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says it's moving too fast for lupus.
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He suspects hepatitis E instead,
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incredibly rare domestically, but Keith's been traveling internationally.
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Here's where it gets uncomfortable,
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there's no treatment for hep E,
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so House's plan is to give Keith a drug that will make him slightly worse if it IS hep E,
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just enough to confirm the diagnosis.
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He tells Cameron to lie to Mr. Foster,
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Keith's father, about what they're doing.
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Chase backs him, the only one.
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But House is deteriorating.
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He deliberately breaks his own fingers to trigger an endorphin response that overrides the leg pain.
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Then Cameron breaks too.
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She tells Mr. Foster she thinks it's lupus,
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not hepatitis.
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And you understand why Foster resists House's plan,
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this is a widower whose wife died of pancreatic cancer after doctors promised aggressive treatment would extend her life,
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and she was gone in three weeks.
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He does not trust medical gambles.
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But Keith is too sick to transfer,
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the father has no alternative, so he caves.
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And then before treatment can even start,
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Keith hallucinates, screaming about someone named Jules,
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then starts bleeding from the rectum.
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Hypovolemic shock.
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Cameron says psychosis is the fourth criterion.
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It's lupus. Transplant list.
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House is vomiting from withdrawal.
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Foreman walks in and hands him his Vicodin,
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says he's covering his own ass, not helping.
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Does House take them?
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No. But House fixates on one detail.
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Who is Jules?
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The family cat, dead about a month.
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House argues that Keith was reliving a real memory of a real animal,
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not hallucinating something imaginary,
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so that's not psychosis,
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and the fourth criterion for lupus falls apart.
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If the cat died recently with no obvious cause,
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maybe it died of the same thing killing Keith.
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House has Foreman and Chase dig up the cat in frozen ground,
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autopsies it himself, and finds massive naphthalene poisoning,
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a chemical termites produce to protect their nests.
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Meanwhile a donor liver arrives.
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Keith is on the table.
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House bursts into the OR and spits to break the sterile field.
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The naphthalene is fat-soluble,
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stored in Keith's fat cells from a termite nest inside his bedroom walls.
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When he stopped eating hospital food and lost fourteen pounds,
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his body burned fat and the poison flooded his system.
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So getting away from the source of the poison is what poisoned him.
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The father punches House, but the logic holds,
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a new liver would just get poisoned too.
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They feed Keith to stop the fat-burning,
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find a massive termite nest in his bedroom walls,
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and he recovers. Then House sits down with Wilson and admits he's an addict.
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But says it's not a problem,
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the pills let him do his job and take away his pain.
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Wilson has no counter-argument.
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House solved the case in withdrawal,
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broke his own body to cope,
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and still came out right.
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And then we learn the whole bet was Wilson's idea,
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he put Cuddy up to it.
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Last episode Wilson revealed he has a homeless brother he hasn't seen in nine years.
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He can't save his brother,
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so he's trying to save House.
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And it didn't work.
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House admitted addiction and went straight back on the pills.
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Wilson's bet failed. The dosage keeps climbing.