- Cuddy: "Question is, is this a bad agenda or a good one. Either you’re trying to screw with me, or you’re trying to show me you’ve really changed"
- House: "So which is it? I’m dying to know!"
- ―Ignorance is Bliss
Ignorance is Bliss is a 6th season episode of House which first aired on November 23, 2009. On the eve of Thanksgiving, House and the team take on the case of James Sidas , an exceptionally brilliant physicist and author who traded his successful career for a job as a courier. For the ailing patient, intelligence is a miserable burden that has prompted depression and addiction, and this, coupled with a myriad of strange symptoms, nearly stumps the team. Meanwhile, the doctors at Princeton-Plainsboro Teaching Hospital wrestle with strained personal relationships. House will say that he loves Cuddy. This will be the first episode where Cameron is gone from the show, and after House compares Chase to Cameron he loses it and punches House.
A book store owner recognizes famous physicist James Sidas when he makes a delivery to his store. He asks him to sign one of Sidas's books. Sidas tries to comply, but has trouble using his hands and becomes disoriented.
House is trying to get the cafeteria cashier Daria to charge Wilson for his bagel. Cuddy comes by and pays for House. Cuddy gives him Sidas’s case. He describes Sidas's case to his team. Thirteen thinks it is an infection, but that appears to be ruled out. Taub thinks it is sickle-cell anemia, even though Sidas is Caucasian. Foreman thinks it is Thrombotic thrombocytopenic purpura and when Thirteen and Chase agree, House orders tests for it. He pages Wilson, but gets no response.
Taub and Thirteen meet the patient, who is with his wife. They ask why he isn't working in a better job given his reputation. Sidas says he doesn't like thinking so much and having so much anticipation for him. He says he is happy in his new job as a courier and he likes being happy better than being smart.
Foreman talks to Chase about Cameron, but Chase says it's over. He turns aside Foreman's offer of help.
Taub talks to Thirteen as to why the patient, with such a high IQ, seems so normal. They talk about why they returned to work for House. They confirm TTP and Taub wonders why House took the case if it was so easy. However, Taub thinks it is a test. He suggests to House they do a splenectomy because plasmapheresis has been ruled out. House agrees and assures Taub he is not just testing them. He says he took the case, even though it's easy, because he wants to find out about Sidas. House is looking for Wilson in the men’s washroom, but still can’t find him.
Wilson arrives late after a dental appointment and House asks why he hasn't been answering his pages. Wilson knew the pages were about Cuddy. House is planning to break up Lucas and Cuddy by crashing Cuddy's Thanksgiving dinner with her sister. However, House doesn't know where the sister lives and Wilson says he doesn't know either.
Sidas shows signs of improvement, but all of a sudden, it appears he is delerious. Chase realizes he is having a stroke.
They manage to treat the stroke and the patient suffers no brain damage. They realize it isn't TTP because the removal of the spleen would have improved it. Taub thinks it is a form of vasculitis, but nothing showed on the CT Scan. House is trying to find Cuddy's sister by phoning people in the phone book with Cuddy’s sister’s name in the phone book. They finally decide to test for rare toxins and do an environmental scan. Taub and Chase go to the patient's apartment and Taub asks Chase for Thanksgiving dinner. Chase figures it's just because Taub thinks he is lonely and politely declines. Taub finds a lot of Sidas's notebooks. They realize he was working on physics in high school even though he wasn't part of his homework. Chase finds hidden alcohol.
Cuddy finds House doing voluntary clinic duty. She figures he is up to something, either screwing with her or trying to show he's changed. She invites him to Thanksgiving dinner. House goes to Wilson. Wilson suggests it might be a trick, but House has checked out the address even though it is a three hour drive away.
The team reports to House that they found alcohol but no toxins. Chase thinks it is liver failure and tells House to wear a less flashy tie to dinner. Everyone seems to think it is alcoholism and Foreman wants to go for Thanksgiving and do the biopsy when they get back. House lets Foreman and Chase leave, but orders Taub and Thirteen to do the biopsy as soon as possible just in case they're wrong.
The patient denies being an alcoholic, but his wife wonders when he started drinking at all. They argue about how much he must be drinking. Taub does the biopsy.
House arrives for dinner at the address gave him, but finds that Cuddy has misdirected him to another relative a sister who is having vacation in Hawaii. The house sitter offers him a turkey sandwich on Cuddy's direction. Cuddy and Lucas are enjoying Thanksgiving with Cuddy's family.
The biopsy shows no scarring or other signs of cirrhosis, but the blood tests show an elevated albumen level. Taub thinks it might be kidney failure. It would explain everything except the stroke, but that could be explained by a related condition. They realize they have to biopsy his kidney to find out.
Lucas arrives home to find that House, having broken in, is waiting for him and having some wine. They discuss Cuddy. House figures Cuddy is trying to figure out if he's willing to change, and he realizes she always has given him a chance, but he used up too many of them. Lucas offers a coffee, but House stands up, says he's pathetic and doesn't deserve Cuddy, and collapses on the floor. He tells Lucas he loves Cuddy.
The kidney biopsy confirms kidney failure. House has called in sick and the rest of the team tries to work it out themselves. Chase denies he had a bad time on Thanksgiving. He starts to focus on the patient's recent cough. Foreman suggests immunosuppresants and dialysis to treat the kidney failure. The rest of the team think he's trying to be in charge again, but he agrees to the treatment.
Sidas asks how long he has to be hooked up for dialysis. The wife is concerned about the changing diagnosis.
Thirteen speaks to Chase about Cameron and suggests counselling, but Chase just wants to be left alone.
Cuddy goes to confront House about what he said to Lucas last night as Lucas has broken up with her. Lucas told her he didn't realize how much there was between her and House. House can't remember much of last night or even how he got home, but admits he was drunk. Cuddy admits that she started feeling bad about giving him the wrong address, but has now realized House didn't deserve her sympathy. She tells him that there was never anything between them.
House is jubilant and brags to Wilson that he got Cuddy and Lucas to split up by lying to Lucas. Wilson says Cuddy probably hates him. When Wilson notes sarcastically that it's Lucas's fault for being so stupid, House thinks of something.
House goes to Sidas and tells him that he's stupid. He's realized that the cough syrup was his real addiction - dextromethorphan. Taken constantly, it lowers IQ. Although he's still smarter than average, he's a lot dumber than he used to be. However, dextromethorpan would also cause permanent brain damage, unless the patient used alcohol in moderation. He figures that Sidas was intentionally lowering his intelligence while maintaining his brain. Sidas admits that this was his plan - not being as smart made him less miserable. Dextromethorphan abuse explains all of his symptoms, even the coughing - a rebound effect. House orders a bowel lavage and activated charcoal to clean the drug from his system. When Sidas says he can't live without it, House tells him its surprising what you can live without.
Sidas improves quickly and starts making physics drawings again. He tries to explain them to his wife, but he realizes it’s too advanced for her. He asks for juice to get his wife out of the room and confides in Foreman that his wife is now so much less intelligent than him it's like having sex with a monkey and he wishes his wife could at least spell "applied physics". Foreman asks if he would be happier without her. Sidas admits that he wouldn't, and that he owes her everything, but being as smart as he is makes him a jerk who doesn't really feel like he wants to be with her.
Silas's wife realizes he is treating her differently. Foreman tells her not to worry, but all of a sudden Silas cries out - he has no feeling in his legs.
Taub is discussing his decision to work for House with his wife. He says he can always make money, but he won't always have the opportunity to work with someone of House's calibre. Rachel denies it's about the money or his decision to work for House again without asking her. Her real problem is that he went from being the boss to doing grunt work for House. That's what he did when they first got married (he was an intern), and she only put up with it because she knew it would lead to something better. Now, House makes Taub miss Thanksgiving dinner. Taub gets paged.
Thirteen thinks Silas has Vitamin B-12 deficiency, but that wouldn't cause a stroke. Foreman suggests a problem with the bone marrow, but that wouldn't explain the schistocytes they mistook as a symptom of TTP. Taub suggest lupus, but the ANA was negative. When Chase has no suggestions, House threatens to call Cameron. Foreman tries to stop House, but he's gone to far - Chase slowly walks over to House and punches him in the face. House hits the floor, still conscious, and Chase leaves the room.
Cuddy finds House in her office and asks if he's going to press charges, but he claims he tripped over an ottoman. House asks Cuddy to dinner, but she says there are witnesses to the assault. House writes it off as mass hysteria. When Cuddy says doctors can't punch each other out, House asks who got punched. When Cuddy asks if Chase needs help, House says Chase couldn't have punched anyone as he was with Chase when he tripped over the ottoman. He asks Cuddy to a movie, but she says she's not going to play his game because it isn't fun. She tells him to just do his job.
House goes to Silas, who asks about his face. He says that he wants to ask Silas for a differential diagnosis. Silas doubts it will work given his lack of medical knowledge, but House says he has no-one else to ask anyway. Silas talks about how smart they are and how lonely it is. He admits that he started abusing drugs when he unsuccessfully tried to commit suicide by jumping and he was put on narcotics for his injuries. He started to feel more normal and less isolated. He met his wife at the hospital and fell in love with her when he was high on drugs. House gives him more dextromethorphan. However, House then thinks of something - he asks which ribs he broke in the fall - it was the bottom 3 on the left side, but that was 12 years ago.
House arranges an MRI with ferrous oxide contrast. Taub says this better be important because his wife is now ready to leave him. When Chase arrives, House uses Taub as a human shield. House explains that, in a normal patient, ferrous oxide is absorbed by the spleen, unless the patient doesn't have one, in which case it is absorbed by the liver and is toxic. Chase has already removed the spleen and wonders if House thinks he missed it. The scan shows that the patient has several spleens throughout his torso. When the patient broke his ribs, the spleen ruptured, but then broke off and travelled to different parts of his body. It was TTP all along, but Chase didn't remove all of the spleens so the splenectomy was ineffective. They schedule more surgery.
Chase chases down House in the hall, and apologizes for doing so much damage. Chase says it wasn't about what House said, it was about everyone asking if he was okay about Cameron. He figured by hitting House, it would keep everyone else from talking to him about it.
Silas recovers from surgery and plans to return to a life with his wife in it - back to dextromethorphan and being a courier. Taub wonders why House is okay with the patient's decision, and House tells him ignorance is bliss. Taub takes a picture of House's broken nose, saying he's going to put them on T-shirts and mugs. Instead, he shows the picture to his wife and says he did it himself. Rachel wonders if he is going to be fired or arrested, but he tells her not to worry. They make up.
House catches Cuddy leaving the hospital and asks if they can still be civil to each other. He offers her tickets to a carnival so she can take Rachel Cuddy. He says he bought them off a nurse, but she turns them down anyway.
House realizes that Cuddy hasn't really split up with Lucas. House tells Wilson that he's realized she just said they did so he would back off. House says he hasn't got anything else planned and that he's okay with that.
Cuddy tells Lucas that she knows that House figured out they didn't break up. When Lucas asks how she knows, she says she just knows. Lucas says maybe House isn't so bad after all. Cuddy admits that would be nice.
House starts asking about the patient's symptoms, which are vague, and all the patient's reactions are normal. The patient asks if he's always this rude and what he thinks she has. He asks, as an insurance company spy, if she shouldn't have a better job. She denies it, but he notes that the handwriting in her medical records is way too neat to be from real doctors, she's asking more questions than she's answering, and he's already searched her purse (he was looking for gum) and found the list of questions she was supposed to have memorized. He buys her silence and a show that she’s pleased with $20 so he can impress Cuddy. However, Cuddy has left for the day and the patient runs out when House looks like he wants his money back.
Zebra Factor 7/10
TTP is a very rare disease, with an incidence of about 1 in a million. It is more common in pregnant females (see Kids) but almost unknown in white Caucasian males.
Trivia & Cultural References
- The title of this episode comes from the phrase from the poem Ode on a Distant Prospect of Eton College by Thomas Gray. It may refer to the following:
- The patient prefers to dumb himself down because he is happier when he is not intelligent.
- Cuddy prefers not to know if House has changed or whether he is trying to do something mean.
- Thanksgiving is an annual holiday in the United States, celebrated on the fourth Thursday of November. Like many holidays around the world held at harvest time, it is often when extended families get back together.
- Nurse Jeffrey appears for the first time.
- House: "Sorry, I can’t remember if I mocked you yet for being a male nurse"
- Jeffrey: "I think this counts"
- ―Opening salvo
- An Ottoman is a type of upholstered stool used as furniture, that usually matches the couch. It is named after the Ottoman Empire, where the concept originated.
Ignorance is Bliss