1. He is not sick.Copy !req
2. Dr. Riley is throwing up.
He obviously can't lecture.Copy !req
3. You witnessed the spew?
Or you just have his word for it?Copy !req
4. I think I'm coming down
with a little bit of the clap.
I may have to go home for a few days.Copy !req
5. Dr. Riley doesn't have a history
of lying to me.Copy !req
6. You said this is the fifth time
he's missed a class this year.Copy !req
7. - Either he's dying or he's lying.
- I'll give you two hours off clinic duty.Copy !req
8. Fine. I'll have Cameron do it.
She loves inspiring the inspired.Copy !req
9. - You'll do it.
- Why is it always me?Copy !req
10. Because the world hates you.
Or because it's a class on diagnostics.Copy !req
11. Pick whichever reason
feeds your narcissism better.Copy !req
12. I'm not doing it.Copy !req
13. You're supposed to stop me.
Renegotiate.Copy !req
14. And you were supposed
to keep on walking.Copy !req
15. Sorry. Guess we both screwed up.
Go on. Do it again.Copy !req
16. I'll do the lecture
for four hours off clinic.Copy !req
17. Two. I know you'd rather
spend a couple of hours...Copy !req
18. listening to yourself
than listening to patients.Copy !req
19. - Class starts in 20 minutes.Copy !req
20. - Dr. House, there's a patient.
- I'm outta here. Take it up with Cuddy.Copy !req
21. Greg.Copy !req
22. Hi, Stacy.Copy !req
23. How ya doin'?Copy !req
24. How am I doing?Copy !req
25. The last five years have been like-Copy !req
26. You ever see those
Girls Gone Wild videos?Copy !req
27. Your life's been like that?
Or your life's been spent watching them?Copy !req
28. I have missed you.Copy !req
29. Is that why you're here?Copy !req
30. I need your help.Copy !req
31. Who am I looking at?
My husband.Copy !req
32. Who is suffering abdominal pain
and fainting spells.Copy !req
33. No sign of tumors, no vasculitis.Copy !req
34. Could be indigestion.Copy !req
35. Or maybe a kidney stone.
Little one can pack a lot of wallop.Copy !req
36. Did you think I wasn't
going to get married?Copy !req
37. Not to someone so poorly endowed.Copy !req
38. This guy's pancreas is pathetic.Copy !req
39. There is no kidney stone,
no indigestion.Copy !req
40. Three hospitals, five doctors-
Not one of them found anything.Copy !req
41. Maybe there's nothing to be found.Copy !req
42. Right. You suddenly trust doctors,
love puppies and long walks in the rain.Copy !req
43. Walks are out.Copy !req
44. I was around you long enough
to know when something's not right.Copy !req
45. Mark's had personality changes.
He's acting strange, disconnected.Copy !req
46. Interesting.Copy !req
47. Means there's either a neurological
component, or he's having an affair.Copy !req
48. No affair. No nothing. He's sick.Copy !req
49. I know you're not too busy.
You avoid work like the plague.Copy !req
50. Unless it actually is the plague.Copy !req
51. I'm asking you a favor.
I'm not too busy.Copy !req
52. But I'm not sure I want him to live.Copy !req
53. It's good seeing you again.Copy !req
54. Three guys walk into a clinic.Copy !req
55. Their legs hurt.
What's wrong with them?Copy !req
56. I'm not gonna like you, am I?Copy !req
57. The most likely cause of leg pain
is muscle strain.Copy !req
58. Apply heat
and rest affected areas.Copy !req
59. Statistically, you're right.
Very good.Copy !req
60. My experience, over half ofleg pain
is musculoskeletal,Copy !req
61. generally from excessive exercise,Copy !req
62. Twelve percent is varicose veins
brought on by pregnancy,Copy !req
63. and most of the rest is the result
of vehicular accidents.Copy !req
64. I said three people.
That's six legs.Copy !req
65. So you've got three hurt jogging, two
in collisions, and one of the legs is pregnant.Copy !req
66. - What were they doing when pain presented?Copy !req
67. - I have no idea.
- You didn't ask? You didn't take a history?Copy !req
68. Of course. But all that told us
is what they said happened.Copy !req
69. Person "A," farmer,
says he was fixing a fence.Copy !req
70. Tightness in the ankle,
loss of muscle control.Copy !req
71. Person "B," volleyball practice.Copy !req
72. - Coach figured it was a pulled muscle.Copy !req
73. And "C," we've got Carmen Electra golfing.Copy !req
74. - Yes!
- Whoa. You treated the Baywatch chick?Copy !req
75. The Baywatch thespian.
And no.Copy !req
76. I gotta disguise the identity
of each of the patients,Copy !req
77. and I got tired
of using the middle-aged man.Copy !req
78. Carmen seemed like a pleasant alternative.Copy !req
79. Also, she's apparently quite the golfer.Copy !req
80. In less than two hours,
one of these three...Copy !req
81. will be tossed out of the hospital because
they were faking it to score narcotics,Copy !req
82. and one will be very close to death.Copy !req
83. Any guesses on which is which?Copy !req
84. Okay, I say we start with the farmer.Copy !req
85. Did you hike to the fence,
and how far?Copy !req
86. Yes. It's about a half a mile
from my farmhouse.Copy !req
87. Where is the pain localized?Copy !req
88. It started just above my ankle,
and it's radiating up.Copy !req
89. So, what should we do first?Copy !req
90. Family history?Copy !req
91. Indicative of leg pain?
That's a very short list.Copy !req
92. Any history of bone cancer, osteogenesis
imperfecta or multiple myeloma?Copy !req
93. Could be a blood issue.Copy !req
94. We should run a C.B.C.
And a D-Dimer.
And get an M.R.I.Copy !req
95. M.R.I. Or a PET scan?
If the problem's vascular,
he's better off-Copy !req
96. Sorry. Thanks for playin'.
Patient's dead. You killed him.Copy !req
97. We had no time to run any tests.
There was nothing we could do.Copy !req
98. You had time to look at the leg.Copy !req
99. I thought we were starting
with the farmer's case first.Copy !req
100. We are. But if we're
gonna look at a leg-Copy !req
101. I need you to take off your pants.Copy !req
102. Puncture.Copy !req
103. Snakebite.
That would be my guess.Copy !req
104. Farmer didn't know
he'd been bitten by a snake?
That's what he said.Copy !req
105. Sudden shooting pain, tall grass.
Never saw a thing.Copy !req
106. - What kind of snake?
- You want me to tell you what kind of snake
it was from the shape of the hole in the leg?Copy !req
107. How are we to know
what kind of antivenom to use
if we don't know what kind of snake it is?Copy !req
108. Oh, there are people
to find those things out.Copy !req
109. Shouldn't we wait
for the Humane Society or something?Copy !req
110. - Guy might only have a couple of hours.Copy !req
111. And while we wait
for the Humane Society to show up,Copy !req
112. what say we check in
on the volleyball player.Copy !req
113. You have tendinitis.Copy !req
114. How old is this person?Copy !req
115. I mean, it's not really a 40-year-old man
on a girls' volleyball team, right?Copy !req
116. It's a leg.
A leg is a leg is a leg.Copy !req
117. - Well, I was just worried that-
- Would you worry about her more
if she was younger?Copy !req
118. Obviously, we should care about all
our patients, no matter what age-Copy !req
119. Yeah, right. I saw the way
you were looking at Carmen.Copy !req
120. She's mine. Stay away.Copy !req
121. - Would you operate on your mother?
- Of course not.Copy !req
122. I'd be too nervous.
Couldn't be objective.Copy !req
123. Then why are you so anxious
to treat every patient like they're family?Copy !req
124. The actual patient is 16.Copy !req
125. Here's what happens
when doctors care too much.Copy !req
126. I need to know everything about you.Copy !req
127. I went back three generations.Copy !req
128. No history of cancer, Parkinson's
or any other degenerative condition.Copy !req
129. But there's this boy at school,
and he's on the boys' volleyball team.Copy !req
130. They made out at a party,
and now he won't call her back.Copy !req
131. And this friend of hers at school
said this boy didn't like her
and never did.Copy !req
132. You got all this
from an examination of the knee?Copy !req
133. I think she's depressed.
She doesn't have tendinitis?Copy !req
134. She has tendinitis.
She's depressed
about having tendinitis?Copy !req
135. She's depressed for the same
reason that she has tendinitis.
Not the boy?Copy !req
136. No, the boy's a jerk. She knows that,
and yet she's depressed.Copy !req
137. I found a nodule.Copy !req
138. Ahh. Problems with the thyroid gland-
causes depressed mental state...Copy !req
139. can cause inflammation
of the tendons.Copy !req
140. I'll run the tests.Copy !req
141. So because she took
such an extreme interest,Copy !req
142. she found out that the person
had a thyroid condition.Copy !req
143. No. Because she took such an interest,
she discovered a tiny nodule...Copy !req
144. which in reality signified nothing
but gave us no choice...Copy !req
145. but to put a person with tendinitis
through an expensive and painful test.Copy !req
146. Here's how a well-adjusted
doctor handles a case.Copy !req
147. Can I put my pants back on now?
I'd rather you didn't.Copy !req
148. Which Carmen Electra is this?Copy !req
149. The first one. The golfer.Copy !req
150. Then why isn't she wearing pants?Copy !req
151. You have decreased reflexes
in your patellar tendon.Copy !req
152. - Anyone?
- Slipped disc.Copy !req
153. Could be. How bad does it hurt?Copy !req
154. - It hurts really, really bad.
- Yeah?Copy !req
155. It doesn't seem real.
Is she the one faking?Copy !req
156. Oh, for God's sake.
She's here to play into my fantasy,
not 'cause she's Meryl Streep.Copy !req
157. Fine.Copy !req
158. What the hell is wrong with me!Copy !req
159. Do something!Copy !req
160. Too much pain to be a slipped disc.
Could be herniated
and impinging the nerve root.Copy !req
161. Or it could be referred pain
from his groin.Copy !req
162. Sir, are you getting pain
anywhere else?Copy !req
163. - He's curling. It's not the back.
- Sir, where are you getting pain?Copy !req
164. - Help me.!
- He's not gonna tell us anything
if we don't get him out of pain.Copy !req
165. - Give him 50 milligrams of Demerol.
- We have no history. He could be allergic.Copy !req
166. - What do I do?
- We can't diagnose him while he screams.Copy !req
167. Better than killing him
with painkillers. That-Copy !req
168. Apparently he's not allergic.Copy !req
169. Thank you. I feel a lot better now.Copy !req
170. We screwed up.Copy !req
171. No. You did exactly
what his attending did.Copy !req
172. And that was the proper way
to handle the case?
Yeah.Copy !req
173. The guy used him as a dealer.Copy !req
174. You're gonna see a lot of drug-seeking
behavior in your practice.Copy !req
175. There's a reason- It works.Copy !req
176. Meanwhile, back on the farm-Copy !req
177. Yeah. Timber rattlesnake.Copy !req
178. Four vials of the CroFab antivenom.Copy !req
179. - Hey, how ya doin'?
- All right.Copy !req
180. Thank you. This will start making you
feel better really fast.Copy !req
181. He's having an allergic reaction. Bag.Copy !req
182. Paddles and epi.Copy !req
183. His heart's fine.
It's not gonna stay that way.Copy !req
184. - Paddles!Copy !req
185. What say we take five,Copy !req
186. get some coffee, go pee.Copy !req
187. You didn't think
she was gonna get married?Copy !req
188. She asked me the same question.Copy !req
189. And... what?
You're not gonna treat him?Copy !req
190. There's probably nothing wrong with him.Copy !req
191. Oh, sure, that makes sense.
She's just using the old
sick husband routine...Copy !req
192. as an excuse to get
back in touch with you.Copy !req
193. You think this is easy for her?Copy !req
194. The only reason she'd be anywhere
near you is if she was desperate.Copy !req
195. So I should help her
because she hates me?Copy !req
196. She doesn't hate you.
She loves you.Copy !req
197. She just... can't stand
to be around you.Copy !req
198. Uh, Dr. House?Copy !req
199. It's been almost six minutes.Copy !req
200. Found him.Copy !req
201. The volleyball player...Copy !req
202. was responding to the anti-inflammatories
as you'd expect in a case of tendinitis.Copy !req
203. Whoa, whoa, whoa, whoa, whoa.
What about the snakebite guy?Copy !req
204. I don't really care
about the volleyball player.Copy !req
205. What if I told you the volleyball player
had a sudden massive stroke?Copy !req
206. - Really?
- No.Copy !req
207. But that would make you interested, right?
What if her T-4 came back low?Copy !req
208. It's not quite as interesting,
but it has the benefit ofbeing true.Copy !req
209. You said the thyroid biopsy
was a wasted test.Copy !req
210. No, I didn't. I said
she put a person with tendinitis
through an expensive and painful test.Copy !req
211. Apparently, the patient had tendinitis
and a thyroid condition.Copy !req
212. We're gonna start you on thyroxine.
It'll make you feel better
and level your moods.Copy !req
213. Thank you.Copy !req
214. - So that's it?
- You were right the first time.Copy !req
215. Snakebite guy's way more interesting.
Gross, actually.Copy !req
216. The patient responded to epinephrine,
and the allergic reaction was arrested.Copy !req
217. Unfortunately, the patient
continues to deteriorate.Copy !req
218. Maybe the snake wrangler
was wrong about the type we caught.Copy !req
219. He faxed us the venom test.
Confirmed. It's a timber rattlesnake.Copy !req
220. No, it's not. Notice the volume?Copy !req
221. I skimmed over that
and the gender and the coloring.
Jumped right to the name of the snake.Copy !req
222. Two hundred milligrams.
Our guy got bit less than four hours ago.Copy !req
223. There's no way a snake regenerates
that much venom that quickly.Copy !req
224. - We're supposed to know how fast
snakes make their venom?
- No.Copy !req
225. Unless you've got a patient bit by one.
Then it might be helpful.
So what do we do now?Copy !req
226. He must have been bitten by a different
snake. We go back and find it.Copy !req
227. Or you go online, and you find
there's only three poisonous snakes
common in New Jersey:Copy !req
228. The copperhead, timber rattler
and the coral.Copy !req
229. Copperhead and timber rattler both respond
to the antivenoms we gave the guy.Copy !req
230. - So we give him the antivenom
for the other one?
- Is that a question?Copy !req
231. We can't just blindly give him
another antivenom, especially
after the first one almost killed him.Copy !req
232. You said only three types of poisonous
snakes commonly found in New Jersey.Copy !req
233. - Well, what if this is an uncommon one?
- Very good.Copy !req
234. - We gotta find the right snake.
- No need.Copy !req
235. Odds are by the time you get back,
the autopsy results will tell you
what kind of snake it was.Copy !req
236. - But you said-
- So we do give him the antivenom
for the other one?Copy !req
237. Again, was that a question?
I asked what you would do.Copy !req
238. It seems unfair for you to ask me
what you would do.Copy !req
239. Who gives the guy
the other antivenom?Copy !req
240. And who goes looking for the snake?Copy !req
241. I assume that one choice kills him,
the other one saves him.Copy !req
242. That's usually the way it works
at the leg-turning-black stage.Copy !req
243. So half of us killed him,
and half of us saved his life.Copy !req
244. - Yeah.
- We can't be blamed for-Copy !req
245. I'm sure this goes against
everything you've been taught,
but right and wrong do exist.Copy !req
246. Just because you don't know
what the right answer is-Copy !req
247. maybe there's even no way you
could know what the right answer is-Copy !req
248. doesn't make your answer right
or even okay.Copy !req
249. It's much simpler than that.
It's just plain wrong.Copy !req
250. We gave the guy the antivenom.
What if I'm allergic again?Copy !req
251. That's why these people are here.Copy !req
252. If you have a reaction,
we're ready to do whatever's necessary...Copy !req
253. to ensure your airways stay open
and your heart keeps beating.Copy !req
254. My wife's on her way in.
Can't this wait?Copy !req
255. I'm sorry. It can't.Copy !req
256. It hurts again.
He came back?Copy !req
257. On average,
drug addicts are stupid.Copy !req
258. - I'd call the cops.
- Good for you.Copy !req
259. A lot of doctors wouldn't risk
their careers on a hunch.Copy !req
260. It's not a hunch.
I mean, I know he wants drugs.Copy !req
261. Well, even drug addicts get sick.Copy !req
262. Actually, for some reason,
they tend to get sick more often
than non-drug addicts.Copy !req
263. Luckily, you don't
have to play your hunch.Copy !req
264. There's a faster way.
Actually, there are several.Copy !req
265. My preference is urine testing.Copy !req
266. - But you already know
he has drugs in his system.
- That's not what I'm testing for.Copy !req
267. We're gonna put this hard rubber tube
up your urethra and into your bladder.Copy !req
268. - It may be a little uncomfortable.
- Shouldn't I be getting
some sort of anesthetic?Copy !req
269. We're concerned
about allergic reactions today.Copy !req
270. If the guy can handle a rod in his penis
for half an hour, he's really sick.Copy !req
271. Or he's really jonesing.Copy !req
272. There's easier ways
to get ahold of drugs.Copy !req
273. Other hospitals, for example.Copy !req
274. The volleyball player
is not responding to treatment.Copy !req
275. At least we think it's not working...Copy !req
276. on account of the fact
that she's getting worse.Copy !req
277. - Can you still hear me?
- No.Copy !req
278. A little!
Not really!Copy !req
279. Well, if you can't hear me,
how do you know what I asked?Copy !req
280. - Ow!
- I'm sorry. What did I do?Copy !req
281. I don't know.
It really hurts.
I promise to be very careful.Copy !req
282. - Susan-
- Not her real name.Copy !req
283. - Susan, I barely touched you.Copy !req
284. It hurts so much!
I'm sorry. I have to get
this blood. Just hold on.Copy !req
285. Hypersensitivity to touch.Copy !req
286. - Her calcium up?
- Lab over 16.Copy !req
287. - Question is why. Likely suspects.
- Parathyroid adenoma.Copy !req
288. - Kidney problems.
- Vit "D" intoxication.
- Hyperthyroid.Copy !req
289. - Caused by our treatment?
- Whoa, whoa.Copy !req
290. Can you please slow down?Copy !req
291. The adenoma is most likely.Copy !req
292. Check her P. T.H., phosphorus...Copy !req
293. and ionized calcium.Copy !req
294. And do a technetium sestamibi.Copy !req
295. Okay, that's enough
about the volleyball player.Copy !req
296. - What's up with the farmer?
- What farmer?Copy !req
297. Snakebite guy.Copy !req
298. Oh, right. You guys
don't know about him.Copy !req
299. He doesn't get bitten until three months
after we treat the volleyball player.Copy !req
300. Luckily, it's been well established
that time is not a fixed construct.Copy !req
301. His condition is not improving.
Double the dosage.Copy !req
302. - Already did.
- There's another antivenom.Copy !req
303. - It's not as effective, but-
- Already tried it.Copy !req
304. - The first stuff, the stuff he was allergic to.
- Gave it to him with high-dose steroids.Copy !req
305. - Nothing's working.
- What does it all mean?Copy !req
306. - Wrong snake?
- We tried every other antivenom we had.Copy !req
307. - We're too late?
- Yep. He's dying. His wife's here.Copy !req
308. Finally found a babysitter.
Who wants to let 'em know?Copy !req
309. - Actually, I'm kidding.
- He's not dying?Copy !req
310. Oh, yeah, he's dying.
But there's no wife and kid.Copy !req
311. Which is great.Copy !req
312. Makes the breaking-the-news
thing way easier.Copy !req
313. Oh, yeah.
One more piece of news.Copy !req
314. The drug addict is peeing blood.Copy !req
315. How do they teach you how
to tell someone that they're dying?Copy !req
316. It's kind of like teaching architects
how to explain why their building fell down.Copy !req
317. Do you role-play and stuff?Copy !req
318. Yeah. One of us gives the bad news,
and one of us gets the bad news.Copy !req
319. What do you have to do to get an "A"
in You're Dying 101?Copy !req
320. They grade you on gentleness
and supportiveness?Copy !req
321. Is there a scale
for measuring compassion?Copy !req
322. This buddy of mine-Copy !req
323. I gotta give him 10 bucks
every time someone says thank you.Copy !req
324. Imagine that.
This guy's so good,Copy !req
325. people thank him for telling 'em
that they're dying.Copy !req
326. Needs brown.Copy !req
327. I don't get thanked that often.Copy !req
328. You're dying.Copy !req
329. In a few hours.Copy !req
330. There's nothing we can do
except deal with the pain.Copy !req
331. Well, I need to go home.Copy !req
332. You're not going home.Copy !req
333. But my dog.
What will happen to my dog?Copy !req
334. Her neck looks clean.
No adenoma.Copy !req
335. Wait, wait, wait. The guy's dying,
and all he cares about is his dog?Copy !req
336. Any of you guys go the dog route
in your improv sessions?Copy !req
337. It's a basic truth of the human condition
that everybody lies.Copy !req
338. The only variable is about what.Copy !req
339. The great thing about telling
someone they're dying...Copy !req
340. is that it tends to focus their priorities.Copy !req
341. You find out what matters to them.Copy !req
342. What they're willing to die for.Copy !req
343. What they're willing to lie for.Copy !req
344. You must have a neighbor who-
Neighbors don't like him.Copy !req
345. So the Humane Society will
take him in and find him a home.
No, they won't.Copy !req
346. Yeah, but maybe my aunt-Copy !req
347. It wasn't a snakebite, was it?Copy !req
348. I said I don't remember bein' bit.Copy !req
349. Sure you do. Just not by a snake.Copy !req
350. I assume that Cujo bit
one of your neighbors a while back.Copy !req
351. You tell me that he bit you,
and I gotta report it.Copy !req
352. Cujo's got a record.
He gets the chair.Copy !req
353. The good news is you might just live.
The bad news is your dog's gonna die.Copy !req
354. - Guy risked his life to save this thing?Copy !req
355. I'll hold him.
You swab the mouth.Copy !req
356. I think I've got a better grip here.
You go for the mouth.Copy !req
357. All right. I'm odds.Copy !req
358. You serious?
One, two, three!Copy !req
359. Damn.Copy !req
360. I don't care if he's scratching
your nads off, you don't let go.Copy !req
361. Just do it!Copy !req
362. I say we let the guy die.Copy !req
363. - I got his head. Just do it.
- Got it.Copy !req
364. What would you call that?Copy !req
365. It's tea-colored, right?Copy !req
366. The guy we thought
was just after the drugs-Copy !req
367. What's the differential diagnosis
for urine that's tea-colored?Copy !req
368. Kidney stone.Copy !req
369. Kidney stones would cause what?Copy !req
370. - Blood in urine.
- What color is your pee?Copy !req
371. - Yellow.
- What color is your blood?Copy !req
372. - Red.
- What colors did I use?Copy !req
373. Red, yellow and brown.Copy !req
374. - And brown. What causes brown?
- Waste.Copy !req
375. - Which means the kidneys
are shutting down. Why?
- Trauma.Copy !req
376. - None that his history would indicate.
- Could be damage done
by the self-injection of the Demerol.Copy !req
377. - Treatment?
- Heat and rest-Copy !req
378. - Other possible causes?
- Infection.Copy !req
379. Start him on antibiotics. What else?Copy !req
380. Come on! Come on!
L-I don't know.Copy !req
381. You're useless.
But at least you know it.Copy !req
382. Blood tests show elevated creatine kinase.Copy !req
383. - What does that tell you?
- The trauma diagnosis was right.Copy !req
384. - He takes it easy
for a few days, he'll be fine.
- You sure?Copy !req
385. - The elevated C.K. Rules out infection-
- You know what's worse than useless?Copy !req
386. Useless and oblivious.Copy !req
387. What are they missing?Copy !req
388. It's kind of hard to think
when you're in our face like-Copy !req
389. Yeah? You think it's gonna be easier
when you got a real patient really dying?Copy !req
390. What are you missing?Copy !req
391. Muscle death.Copy !req
392. - Not your case.
- Nothing wrong with a consult.Copy !req
393. Dying muscle leaks myoglobin.
It's toxic to the kidneys.Copy !req
394. Brilliant.Copy !req
395. M.R.I. His leg.
See what's killing it.Copy !req
396. - Why is the girl getting the M.R.I.?
- Because the neck scan revealed nothing,Copy !req
397. and her doctor's way more obsessive
than she thinks she is.Copy !req
398. - But you said the guy needed the M.R.I.
- Because Dr. Cameron back there
said muscle death.Copy !req
399. Not one of you said it.
Not one of this guy's doctors said it.Copy !req
400. They gave him bed rest and antibiotics,
just like you guys would have.Copy !req
401. - Did he get better?
- No.Copy !req
402. - How long-
- Three days.Copy !req
403. It is in the nature of medicine
that you are gonna screw up.Copy !req
404. You are gonna kill someone.Copy !req
405. If you can't handle that reality,
pick another profession.Copy !req
406. Or finish medical school and teach.Copy !req
407. Three days before they thought
it might have been muscle death?Copy !req
408. No, three days before the patient
suggested it might have been muscle death.Copy !req
409. The M.R.I. Revealed an osteosarcoma.Copy !req
410. A cancerous tumor on your femur.
It needs to be removed surgically.Copy !req
411. With chemo, she has
an excellent chance of survival.Copy !req
412. But I have to warn you-
depending on how large the tumor is
and how ingrained it is,Copy !req
413. the surgeon may need
to amputate your leg.Copy !req
414. I'm sorry.Copy !req
415. It's okay.Copy !req
416. Dogs' mouths are pretty filthy,Copy !req
417. but they have natural antibodies
to fight off most of the stuff.Copy !req
418. We don't. That's why
dog bites can be so nasty.Copy !req
419. Lab tests of your dog's saliva
revealed a type of strep bacteria.Copy !req
420. It's commonly known
as the flesh-eating disease.Copy !req
421. We need to operate immediately
to remove the damaged tissue.Copy !req
422. We may need to remove the leg.Copy !req
423. The M.R.I. Revealed a problem.
No kidding.Copy !req
424. I'm sorry none of your doctors
found it earlier.Copy !req
425. I am personally gonna oversee
your treatment from now on.
You're gonna cut me open, aren't you?Copy !req
426. We may need to remove the leg.Copy !req
427. His M.R.I. Showed that the leg pain
wasn't caused by the self-injection.Copy !req
428. It wasn't caused by an infection.Copy !req
429. It was an aneurysm that clotted...Copy !req
430. leading to an infarction.Copy !req
431. My God, you were right.
It's House.Copy !req
432. We have to do the surgery.Copy !req
433. The necrotic tissue has to be removed.
If there's too much-Copy !req
434. I don't care what you find.Copy !req
435. It may become necessary
in order to save your life.Copy !req
436. I like my leg.Copy !req
437. I've had it for as long as I can remember.Copy !req
438. Greg, I love your leg
as much as you do.
They're not cutting it off.Copy !req
439. The patient made the right choice.Copy !req
440. Tell a surgeon that
it's okay to cut a leg off,Copy !req
441. and he's gonna spend the night
polishing his good hacksaw.Copy !req
442. Right. Surgeons could care less
about saving limbs.Copy !req
443. Of course they care about their patients.
They just care about themselves more,Copy !req
444. which is not an unreasonable position.Copy !req
445. Trying to maximize the tissue you save...Copy !req
446. also maximizes the chances
of something going wrong,Copy !req
447. which means you've gotta be extra careful,
which is such a pain in the ass.Copy !req
448. Amazing advances have been made.
Kids with prosthetic legs...Copy !req
449. are running the hundred-meter dash
in 12 seconds.Copy !req
450. Yeah, they're just not as pretty.Copy !req
451. Do a bypass.
Restore the circulation.Copy !req
452. - Amputation is safer.
- For you or me?Copy !req
453. - The blockage of blood flow-
- Four-day blockage.Copy !req
454. Yes. It caused muscle cell death.Copy !req
455. When those cells die,
they release cytokines and potassium.Copy !req
456. And if you restore the blood flow
instead of just lopping it all off,Copy !req
457. then all that crap gets washed
back into my system.Copy !req
458. The cytokines could cause organ failure.
The potassium could cause cardiac arrest.Copy !req
459. On the other hand,
I may just get the use of my leg back.Copy !req
460. The postoperative pain alone will-
I'll get through it.Copy !req
461. I understand the risks. You're
in the clear. Go schedule an O.R.Copy !req
462. - God, you're an idiot.
- I think I'm more of a jerk.Copy !req
463. I'm not being glib,
and I'm not being cute.Copy !req
464. I don't want you to kill yourself.Copy !req
465. I'm not gonna die.Copy !req
466. Oh, I feel completely reassured.Copy !req
467. More suction.Copy !req
468. Inserting now.Copy !req
469. They gotta up the morphine.Copy !req
470. - Doctors say they can't.
- Doctors recommended
bed rest and antibiotics.Copy !req
471. - They screwed up.
It doesn't mean they're wrong this time.
- Sure doesn't mean they're right.Copy !req
472. - Morphine will kill you.
- I can handle it.Copy !req
473. - You're in pain.
You're not thinking right.
- That's why I need the damn morphine!Copy !req
474. - I'll talk to them.Copy !req
475. Oh, my God. How much longer
is the pain gonna last?Copy !req
476. It depends on how much
muscle cell death there was.Copy !req
477. He could be right.
He could come out of this
with almost full use of his leg.Copy !req
478. Or?Copy !req
479. He could be in pain
for the rest of his life.Copy !req
480. There's a third option...
surgically.Copy !req
481. A middle ground between
what we did and amputation.Copy !req
482. He's not big on middle ground.Copy !req
483. Yeah.Copy !req
484. Nurse? Nurse!Copy !req
485. - I need more calcium gluconate.
- You just had five m.I.'s.Copy !req
486. The Q. R.S. Is getting wider.
My potassium is rising.Copy !req
487. - I'll talk to your doctor.
- Well, you better make it fast,Copy !req
488. 'cause I'm about to go
into cardiac arrest.Copy !req
489. You give me the dose, or I go
into wide complex tachycardia.Copy !req
490. - I could get in trouble-
- Listen, it's not a narcotic!Copy !req
491. I'm not looking for a buzz.
You got about 20 seconds.Copy !req
492. I was wrong.Copy !req
493. What do you got?
Wide complex tachycardia.Copy !req
494. You diagnosed-
He did.Copy !req
495. Defibrillator.
Paddles.Copy !req
496. Charge.
Clear.Copy !req
497. The patient was technically dead
for over a minute.Copy !req
498. He's back.Copy !req
499. Do you think he was dead?Copy !req
500. Do you think
those experiences were real?Copy !req
501. Define "real."
They were real experiences.Copy !req
502. What they meant-Copy !req
503. Personally, I choose to believe
that the white light people sometimes see,Copy !req
504. the visions this patient saw,Copy !req
505. they're all just chemical reactions
that take place while the brain shuts down.Copy !req
506. - You choose to believe that?
- There's no conclusive science.Copy !req
507. My choice has no practical
relevance to my life.Copy !req
508. I choose the outcome
I find more comforting.Copy !req
509. You find it more comforting
to believe that this is it?Copy !req
510. Lfind it more comforting to believe
that this... isn't simply a test.Copy !req
511. - How bad is the pain right now?Copy !req
512. It's bad.Copy !req
513. It's not getting any better.
If you were right,
the pain would be subsiding.Copy !req
514. You'd be getting better.
It's just taking longer.Copy !req
515. No, it's not.Copy !req
516. We've gotta let 'em
cut the leg off.Copy !req
517. It's my leg. It's my life.Copy !req
518. Would you give up your leg
to save my life?Copy !req
519. Of course I would.Copy !req
520. Why do you think your life
is worth less than mine?Copy !req
521. If this were any other patient,
what would you tell them to do?Copy !req
522. I would say it's their choice.
Not a chance.Copy !req
523. You'd browbeat them
until they made the choice
you knew was right.Copy !req
524. You'd shove it in their face
that it's just a damn leg.Copy !req
525. You don't think you deserve to live?Copy !req
526. You don't think you deserve to be happy?Copy !req
527. Now let them cut off your leg.Copy !req
528. [Panting, Stammering]
I can't. I can't.Copy !req
529. I'm sorry.Copy !req
530. The pain alone is gonna kill you.Copy !req
531. I know. I know.Copy !req
532. I need you to talk to the doctor.Copy !req
533. He change his mind?Copy !req
534. No.Copy !req
535. He's asked to be put
in a chemically induced coma...Copy !req
536. so that he can sleep through
the worst part of the pain.Copy !req
537. We can do that.Copy !req
538. What happens after he's in the coma?Copy !req
539. We'll obviously monitor
his condition closely,Copy !req
540. and if he can get through
the next 48 hours without
another cardiac incident-Copy !req
541. I meant, I'm his health care proxy.
I get to make medical decisions for him
if he's not able to.Copy !req
542. You should talk to him
about what he wants to do.Copy !req
543. I know what he wants.
But if he's out, it's my call, right?Copy !req
544. You'll be out in less than a minute.Copy !req
545. Thank you.Copy !req
546. - Hey.
- Hey.Copy !req
547. I'll see you when I wake up.Copy !req
548. - We'll go golfing.Copy !req
549. I love you.Copy !req
550. I love you too.Copy !req
551. I'm sorry.Copy !req
552. You've got nothing to be sorry about.Copy !req
553. The middle ground you were talking about-Copy !req
554. We go in, take out the dead muscle.Copy !req
555. There's still some risk
of reperfusion injury, but-Copy !req
556. Give me the forms you need signed.Copy !req
557. You're saving his life.Copy !req
558. He won't see it that way.Copy !req
559. Because of the extent
of the muscle removed,Copy !req
560. the utility of the patient's leg
was severely compromised.Copy !req
561. Because of the time delay
in making the diagnosis,Copy !req
562. the patient continues
to experience chronic pain.Copy !req
563. She had no right to do that.Copy !req
564. - She had the proxy.
- She knew he didn't want the surgery.Copy !req
565. - She saved his life.
- We don't know that.
Maybe he would've been fine.Copy !req
566. - It doesn't matter. It's the patient's call.
- The patient's an idiot.Copy !req
567. They usually are.Copy !req
568. Do you have a buzzer or something?
What time does this class end?Copy !req
569. Twenty minutes ago.Copy !req
570. I'm not doing this again.Copy !req
571. And this guy is not the world's
greatest dad. Not even ranked.Copy !req
572. Who the hell lets their kids
play with lead-based paint?
That's why he's always sick.Copy !req
573. Find him some plastic cups,
and the class is all his again.Copy !req
574. Stacy, it's Greg.Copy !req
575. I've got an opening in my calendar
for 10:00 tomorrow morning.Copy !req
576. Make sure your husband isn't late.Copy !req
577. That's some bad hat, Harry.Copy !req