Afsoun Hamidi was the performance artist patient in the episode Moving On. She was awarded a MacArthur Genius Grant for her work. She was portrayed by actress Shohreh Aghdashloo. The character was possibly based on real-life performance artist Marina Abramović.
Medical History[]
The patient's mother committed suicide. She was abused by her stepfather.
Case History[]
Hamidi collapsed during a performance piece after being doused in paint thinner and threatened with a match. Her assistant, Luca intervened against her directions. She was taken to the emergency room of Princeton-Plainsboro Teaching Hospital, where she was found to have an arrhythmia, low hematocrit and inconsistent heart rate variability. Dr. Foreman thought the patient had a mental illness and wanted to run a fMRI to look for increased activity in the dorsal nexus. However, Dr. House disagreed. Dr. Hadley though the paint thinner had set off an allergy, but Dr. Chase noted they would have seen bronchospasm. Dr. Taub noted that there was a space heater in the room and it could be carbon monoxide poisoning. Dr. House agreed and ordered that Hamidi be put in a hyperbaric chamber.
Luca was blaming himself for not ensuring the gallery was well ventilated. Dr. Foreman asked Hamidi if she was going to let the man set her on fire, but she dodged the question. Luca assured them the incident was not staged. During the treatment, Hamidi vomited. Dr. Hadley removed her from the chamber and asked Luca to hand her the oxygen mask, but he didn't respond.
Dr. Foreman reported that Hamidi's symptoms grew worse in the hyperbaric chamber, ruling out carbon monoxide poisoning. Dr. Hadley thought it might be an infection and thought Luca should be tested too because he seemed to be in a daze when she asked him for the oxygen mask. However, Dr. Foreman thought that Luca was in love with Hamidi and was just overwhelmed. Dr. House was curious and asked if Luca had brought anything from the patient's room to the treatment room. Dr. Foreman said he had brought along a handbag, some flowers and a stuffed elephant. Dr. House wondered why Hamidi would need a stuffed animal - she seemed perfectly capable of dealing with distress without such comforts. Dr. House called Dr. Hadley on her cellphone (even though she was in the room) and directed her to go to the patient's room. When she arrived, he told her to go to the elephant. She examined the elephant and found a camera. Dr. House had correctly surmised that Luca had been told not to intervene in Hamidi's treatment, just like he was told not to intervene at the gallery. Hamidi had made the doctors her latest performance piece.
Dr. Hadley quickly surmised that Luca had been taking notes, recording the treatments on the camera, and collecting physical material used in treatment for a gallery installation. An ultrasound had shown a cyst on her pancreas, and it was drained. Dr. Taub was upset they had been set up, and Dr. Foreman wasn't even sure she was really sick. However, Dr. Hadley argued that faking an illness didn't fit in with her artistic vision of honesty. Dr. House noted that if the patient induced pancreatitis and a heart attack, she was suicidal. Since she risked her life all the time, she would be dead, not sick. Dr. House thought it was coxsackie B and also ordered a CT Scan of her biliary tree to rule out gallstones. Dr. House insisted on doing the CT Scan with Dr. Foreman as he knew Dr. Foreman would take the opportunity to scan the lungs as well to find fibrosis to prove the patient inhaled paint thinner to make herself sick.
Dr. House and Dr. Foreman did the CT Scan and ruled out fibrosis. The patient complained of dizziness. Dr. Foreman examined her and found her pale, arthritic, tachycardia, and with low blood pressure. He thought it might be internal bleeding, and Dr. House ordered a colonoscopy.
The colonoscopy was negative, so Dr. Chase started an abdominal scope of the liver. Hamidi insisted that Luca document the procedure, but Dr. Foreman took away his camera. They found no blood and no swelling or asymmetry. However, Dr. Foreman grew suspicious and examined the patient's feet. He found evidence that Hamidi had been blood doping.
Dr. Foreman returned to Dr. House and noted that blood doping explained the symptoms. It would cause the arrhythmia and when her hematocrit returned to normal, it was mistaken for bleeding. Dr. Foreman had also checked out her laptop's browser history and found research about blood doping and Dr. House. Dr. Foreman believed that Hamidi had set up Dr. House to give him a seemingly interesting diagnostic puzzle so she could make art out of it.
Dr. House confronted Hamidi about her deception. However, although she admitted to the blood doping to get him intrigued, she told him she was ill before she started doing it. She admitted she knew what was wrong with her, but refused to tell him. She wanted his game and her art to continue. She refused to answer why she chose him, but pointed out she was the perfect case for him - a patient with real, fake, and concealed symptoms. He agreed to keep working on the case.
Dr. House started a new differential over his team's objections and ordered blood cultures for parasites and bacteria. Dr. Hadley and Dr. Chase agreed to assist.
During the blood draw, Hamidi complained of nausea and had earlier had back pain that rated a 5 out of 10. Dr. Chase was sceptical, but Dr. Hadley examined the patient and found Turner's sign. The patient's pancreas was releasing enzymes that would eventually destroy the surrounding organs. Dr. Hadley pressed Hamidi to tell them what was wrong with her. Luca pressed her as well, but she still refused and told Luca to trust her judgment.
Dr. Hadley reported the pancreatic cyst had returned. Dr. House asked Dr. Hadley if she thought Hamidi was suicidal, but although Dr. Hadley considered it, Hamidi's tox screen was clean and there was no way to deliberately induce the cyst. Dr. House decided to focus on diagnoses that were terminal, which was why Hamidi didn't care about being treated.
Dr. House realized that when Hamidi shaved her head for a performance piece four months ago, she was trying to hide the effects of cancer treatment. He did a CT Scan and found that Hamidi had primary CMS lymphoma, a terminal cancer, in her brain. The rest of her symptoms were explained by paraneoplastic syndrome. Hamidi confirmed that was the prior diagnosis. She had sought treatment when she had vision and balance problems and was diagnosed with it at that time. The tumor was too close to the brain stem to do surgery. She had radiation therapy, but it had no effect. Hamidi thanked Dr. House for taking the matter personally, but he denied that he had. He also accused Hamidi of hoping the diagnosis would be different this time. He made arrangements to have Hamidi discharged.
However, Dr. House noted Hamidi was still in her room. She said she was waiting for a nurse to bring her something for her eczema. However, Dr. House realized it wasn't eczema or cancer. He ordered a biopsy which confirmed granulomatosis with polyangiitis. The swelling of the blood vessels below her skin typical of the disease were mistaken for eczema. The "tumor" was merely a granuloma. It also explained the pancreatitis. She needed steroids and more radiation therapy. However, Hamidi complained the radiation made it difficult to work. She wanted to just take the steroids despite the fact they would be less effective without the radiation. Luca tried to convince her to take the radiation to have a better chance of saving her life, but she refused because she was more concerned about her art. Luca decided to leave. However, Dr. House supported her decision.
However, Dr. Hadley spoke to Hamidi as well. Dr. Hadley reminded her that she pushed Luca away after her first diagnosis and that she could still have him with her now. Hamidi agreed to have radiation. Dr. House went to confront her about her decision, but she said that some things were more important. He confronted her that her art was all she lived for and that Luca would just leave her again. She asked him why he was doing this and he left. He saw Hamidi and Luca embrace.