Monday, November 9, 2009

Pardon the Interruption: House 6.6 - Known Unknowns

Overall Rating: 8.7

Maddening (a good sign) twists and turns for House and Cuddy as the writers string us along for an entire episode before breaking our (and House's) hearts. The moral dilemma faced by Wilson deserves discussion and I'm sure my sister, who is very strongly opposed to euthanasia will counter my own words eloquently.

Cut for SPoilers

Plot Synopsis:

The Patient: A girl named Jordan - after what she claims is a wild night partying with a popular band - presents to the hospital with severe edema in her legs and hands - a classic sign of anaphylaxis - but House thinks there's something more going on. He makes a quick (inaccurate, obviously) diagnosis and intends to discharge the patient until it becomes obvious that she's not telling the truth about her night out. House urges his team to get an accurate history and they diagnose first food allergies then an overdose of the date rape drug (based only on Cameron's suspicion that all men are evil adulterers). House eventually realizes during a conversation with Wilson that many of her symptoms (internal bleeding, the compulsive lying she does, and the unstable blood pressure) are the direct result of her many blood transfusions and diagnoses a lethal combination of a common bacterial infection found in the oysters she'd eaten the night before and Hemachromatosis.

House/Cuddy: After initially resisting Wilson's request that he accompany him to a dull sounding medical conference, House learns that Cuddy is coming too and this changes his mind. He is beginning to realize just how much he wants to be with her and hsa finally decided to make an effort to make that happen. Wilson encourages him to go for it and in a rare moment of personal vulnerability, House confesses to Cuddy that he's wanted her for as long as he's known her. She responds by freaking out and disappearing. Wilson talks to Cuddy and learns that she is looking for someone who will be a dependable father to her child and doesn't believe she can trust House to live up to that standard. He convinces House that he should offer to babysit, but when he does, he discovers that his former private investigator is already there and that Cuddy and Lucas are apparently an item. His heart undoubtedly broken, he nonetheless decides she is probably better off with Lucas than with him.

House/Wilson: Meanwhile, Wilson begins the episode treating a patient who is terminally ill with stage four cancer and whose pain has gone far beyond manageable levels. Wilson has promised to be with the dying man until the end but he does not make good on his promise because he has reached the point where he can't stand watching him suffer so badly on his own and gives his patient the chance to commit suicide. He can't be there when it happens for his own protection. This decision makes him feel incredibly guilty and he decides to make his lecture at the conference a self-sacrificing confession to his crime. House, in a bold and unbelievably generous move, drugs Wilson and gives his speech for him, taking all the blame. Wilson, at first, is furious that House did this without consulting him, and House calls him on his self-delusion (it was never about telling the story and getting euthanasia was always about needing personal vindication from his peers). In the end, Wilson thanks House for offering him some kind words about all he does to fight for patients.

Chase/Cameron: Chase, still feeling guilty about having killed Dibala (and still unwilling to confess this fact to his wife - his justification for keeping that information from her was a load of crap and I'm hoping other viewers got that point too), is feeling the heat from everyone aroud him now. Cameron has him followed and confirms that he is going exactly where he says he will - evidence that he's not having an affair. She still doesn't trust him and tries to get information from Foreman, who continues to insist that they need to talk to each other and not drag him into the middle. When she starts seeing deception in an innocent man, Chase calls her on it, accusing her of taking her anger at Chase out on someone else and endangering their patient. Finally, she decides that she should trust her husband and apologizes for being so suspicious. Then and only then is he ready to confess to murder.

Writing: 8.0

Thematically, this episode is very well crafted and some of the cinematography and directing choices made helped increase the emotional response for at least this particular viewer. Choosing to highlight Cuddy's shameless flirting with House in an early (amusing) scene, showing their undeniable chemistry on at least three different occasions...all before ripping away our hopes for the two of them so suddenly made House's plight all the more painful to watch and made his incredible show of support and friendship for Wilson all the more impressive as a sign that he really is making progress. Unfortunately, the dialogue doesn't really sparkle like it usually does in a great House episode and it removes some of the luster from what could have been a feature-worthy story. The patient's case was, unfortunately, rather boring - though I did enough that House totally bitch-smacked this poor kid's selfish neglectful parents. The progress in Chase and Cameron's saga was minor but important and will be more heavily featured in the next episode.

Acting: 9.0

Lisa Edelstein and Hugh Laurie absolutely sparkle (and spark!) as usual in their scenes together and the big three (Cuddy, Wilson and House) are on top of the craft this week. It was feature-worthy acting all around with the exception of the patient, her best friend and Foreman, who seemed to be rather uninterested in his role this week (and who can blame him...he barely even appeared on screen!).

Message: 9.0

OK...I am now bracing for a debate on this one. This is a subject where my co-author and I disagree rather strongly. Euthanasia - is it ever justified? The Catholic position is clear - any doctor who assists a patient in hastening their death is playing God. There are legitimate social reasons not to be pleased with a broad acceptance of euthanasia as a valid medical treatment - not the least of which would be the potential for patients to feel pressured to end their lives before they want to die, the philosophical message it sends that there are lives not worth fighting for, and the risk of doctors reaching for the termination switch to save money long before any such actions are needed (or...just as bad...getting lazy in their attempts to diagnose and treat patients and making mistakes that lead people to needlessly early deaths). I recognize the inherent dangers. And yet, I do believe there are times when death is preferable to life and when it's downright immoral not to offer someone a way out of intractable pain. The decision to euthanize someone should *never* come lightly and should *always* be a clear pact between a doctor and their patient, just as Wilson demonstrated in this episode. I think there should be a way for doctors to seek the support of their colleagues in these types of lose-lose situations without spreading the message that euthanasia is ever the preferred solution to a medical condition. In this regard, I agree wholeheartedly with Wilson's speech (given by House) and with House's editorial remarks.

It was also a relief to see Chase take some responsibility for his actions in the Dibala case - he may not have come forward to the police, but he did something even more difficult. He came forward to the one person in this world in whose eyes he wanted to be perfect. Add on to that House's continued baby steps toward being functional in relationships and his obvious desire to do right by his friends and his patients and you have one happy reviewer.


CUDDY: Tell me why you're here, House.
HOUSE: I have a legitimate medical reason.
CUDDY: Well good. Let's hear it (leaning over her desk to give House a really long juicy shot of her impressive cleavage)
HOUSE: Actually, I forgot what it was. Now I'm just here to check out Patty and Selma.
CUDDY: You should be hurt, House. I never bothered to name your testicles.
HOUSE: It's a compliment! 'Cause they're always somkin'!
CUDDY: Well, unless you have some other reason...(still showing off her breasts and now blushing a bit, I think)
HOUSE: You know, I think you've set an all-time personal low for the cut of your top. (Cuddy bends over to pick up her briefcase and kind of lingers with her butt sticking right in House's face for a few extra seconds) And your luggage (said suggestively) is at least twice as full as normal! Are you going somewhere special?
CUDDY: Medical conference...
HOUSE: You're going too?
CUDDY: Wilson said...
HOUSE: That I had a case? Yeah...I just remembered why I was here. I need you to sign her discharge papers. Hence why I'm holding this file. (and so the pursuit begins...LOL)

GEEKY DOC: Care to dance?
HOUSE: Actually, sorry, we were just about to hit the dance floor ourselves.
CUDDY: Thank you...(they walk out ot the floor and House looks around awkwardly) gonna be OK?
HOUSE: long as you don't expect rhythm. (he makes a really lame attempt to fast-dance and is saved by the music changing to a much more manageable classic 80s love song - they embrace and move into a very slow dance) How are you enjoying the party?
CUDDY: Oh this takes me back...
HOUSE: Remember when we first met? Med school...endocrinology?
HOUSE: You sat next to me...we talked about...
CUDDY: I meant we met once before that. It was in the book store. You walked right up to me, took one look at my course schedule and said 'You're a perfectionist with something to prove...and you know how to party.'
HOUSE: I forgot you knew how to party...
CUDDY: I think I accused you of making it all up and you said...
HOUSE: (explains how he knew all of the above)
CUDDY: I sought you out in endocrinology.
HOUSE: And one thing led to another...
CUDDY: And then it didn't.
HOUSE: I was going to call you the next day...
CUDDY: No! Don't do that. I had no expectations; you don't have to...
HOUSE: I was going to call you...and the next day I got expelled from my first medical school and I didn't see the point. I sought you out in endocrinology. (Cuddy exits abruptly, House looks confused and hurt)

WILSON: Yes, hello! I don't know what department I'm in. I'm supposed giving a lecture five minutes ago! I need...(long pause while he searches for words)...pants! (ROTFL!!)

HOUSE: Euthanasia! Let's be honest. We all do it...we just can't talk about it. There was a patient - with terminal cancer - he was maxed out on his morphine and begging for more. I gave him the button for the morphine drip and told him when he needed more, he could just press it. I warned him too much could be fatal but said it was OK because the machine would only give so much. I told him that to override the safety protocol required an access code. When I left his room, I handed his chart to the on call nurse and said 'the code is 308.' I said it loud. When he first came to me, I promised I would be there with him every step of the way. I didn't keep my promise. To cover my own ass...I failed him.

(long pause as Wilson enters looking very angry)

HOUSE: I was wrong when I wrote that. I know...I did everything I could for that man. I am incapable of backing away from a responsibility. There's not a doctor around who sacrifices more of himself for the people in his life. My friends...all too often take advantage of this. These are not decisions any doctor should have to face alone.

MOTHER: Jordan was bleeding internally. They gave her blood to keep her pressure up...
HOUSE: (over the phone) Is that the mother? I have a great comeback if it is!
HOUSE: I'm your daughter's doctor, so I can tell you that the blood transfusions are what's killing her. Now you can go back to neglecting her. (ouch!)


  1. If I understand you correctly, you don't support large-scale legalization of euthanasia, but do support a kind of amnesty for physicians who sometimes practice it with their clearly suffering terminally ill patients. Assuming I've read your comments accurately, I believe your view and mine have more common ground than you think.

    The Catholic view, according to the Congregation of the Doctrine of the Faith (I looked it up just be certain I fairly present the Church's view), is this:

    1) Deliberate euthanasia is an intrinsically grave sin. Deliberate euthanasia is when the doctor administers a lethal dose of medication or omits an ordinary treatment with the clear intent of terminating a patient's life. This includes assisted suicide, though patients are considered to have less subjective moral culpability because the Church recognizes that pain can lead to desperation.

    2) Patients are, however, allowed to request that all extraordinary measures to extend their lives be terminated. Extraordinary measures are those measures - such as experimental medications, dangerous surgeries, or repeated resuscitations - that are not a part of the ordinary maintenance of a patient. It is okay for a terminal cancer patient to stop chemotherapy and go into hospice to die; it is not okay to, say, remove a patient's feeding tube, as food and water are ordinary measures.

    3) And here, I think, it the most important statement: Doctors are permitted to use any and all measures short of deliberate killing to relieve a patient's pain. If a patient requires levels of narcotic medication so high that administering such a dose has the potential to shorten his life, the Catholic Church says it is still permissible to give him that medication. This is because the Church recognizes the principle of double effect. According to this ethical principle, if an act has the unintended side effect of bringing about a normally impermissible result, it may still be permissible depending on the circumstance. If a woman has uterine or ovarian cancer, it is permissible to perform a hysterectomy, even if this results in the woman's artificial sterilization, because the woman's life takes precedence. Similarly, if sincerely treating a patient's pain causes that patient to die a little sooner, the doctor is not considered to be at fault. Let me repeat: As long as the intent is to relieve pain and not to euthanize, high doses of pain meds are permitted.

    Wilson gave his patient the code to his morphine drip with intent to euthanize, so the Catholic Church would consider his act a morally grave sin. If, however, he had instructed the nurses to give the patient whatever he needed to stay reasonably comfortable, and the patient died as an unintended result, the Catholic Church would have accepted his approach. I think this is a reasonable position that avoids the inherent dangers of legalized euthanasia that you acknowledge in your own statements.

    By the way, the dangers of widespread legalized euthanasia are not simply theoretical - they're real. In Oregon, where assisted suicide has been legalized, the state health plan (upon which Obamacare is somewhat based) has already denied terminal cancer patients coverage for chemotherapy that they've requested to minimally extend their lives. In the Netherlands, where certain forms of euthanasia have been legalized for years, hundreds of patients have been euthanized without their consent. Such a reality should give us pause.

  2. I guess the point where i disagree with the Catholic position is on Wilson's act being a grave sin. I can't conceive of what he did as anything but a blessing. He gave the man a with the pain if he wanted to do so...or take enough drugs to stop the pain, consequences be damned (including death). I think that's the best any doctor can do in that situation. It's not in the hands of the's not in the hands of anyone but a trained professional and his dying patient.

  3. Well, remember that when the Catholic Church says "sin," that is not a final judgment, nor is it meant to cast aspersions on people like Wilson who are driven by their emotion and basic kindness to make the choices that they do. A lot of people hear "you're a sinner" and think we mean to say "you're a bad person, and you're going to hell," but that is certainly not the case.

    Consider, for example, how many centers for "healing after abortion" the Church has founded - two of those centers are advertised at my parish, as a matter of fact. Abortion, as you know, is also considered a grave sin - on a level with Euthanasia - but the Church understands the desperate circumstances - and the lies of the culture - that drive women (and men) to it and has responded with compassion, not judgment or punishment.

    In short: our rules may be strict - and yes, we recognize that they are sometimes difficult for non-Christians to understand - but our response to their violation is one of forgiveness. As a matter of fact, I'm willing to bet that if a doctor responsible for end-of-life care came to the Church and confessed that he has assisted in a patient's suicide, the Church would probably respond - if it hasn't already - by creating something similar to the physician support groups you're looking for. Granted, a Church-run group would not condone euthanasia, but it would certainly offer the psychological and prayer support that we absolutely realize is necessary to understand the mystery of suffering.

    I respect your position on Wilson. I imagine anyone who does not have an explicitly Christian worldview is going to have a lot of trouble comprehending why people should not be permitted to privately terminate their lives if they are terminally and painfully ill. After all, if you are not Christian, you do not believe in a God who came down to Earth in a physical Incarnation to suffer great torment in His Passion - or that our suffering is a way by which we can share in that Passion.