- Wilson: "We can't smoke in here."
- House: "We also can't summon people to the clinic based on a lie motivated by a petty bet. And yet it happens. It's an imperfect world."
- — Better Half
Better Half is a Season 8 episode of House which first aired on January 23, 2012. It was the mid-season premiere. It was written by Kath Ligenfelter and directed by Greg Yaitanes.
While in the hospital for an Alzheimer's disease drug trial, the patient starts suffering from severe vomiting and increasingly explosive temper. As the case proceeds, it becomes clear to the team that there is more conflict in the patient's marriage than either spouse is willing to let on. Meanwhile, Wilson treats a woman who claims to be in a chaste marriage and House becomes obsessed with proving her lack of interest in sex has an organic cause. House and Foreman literally play mind games over House‘s case and the subject of House‘s ankle monitor.
Andres Tavares, a patient with Alzheimer's disease, is being tested for signs of dementia when he loses his temper. His wife, Natalie tells him to be calm and he regains his temper. Dr. Banerjee tells them that he’s eligible for a clinical trial, but all of a sudden Andres starts coughing violently, and coughs up blood.
Foreman is presenting the case to House’s team when House arrives. Taub is away taking care of one of his daughters. House says he denied Taub the personal day, but Foreman reminds him that he approved it. House asks Adams to get an envelope from beneath her chair that predicts Foreman would pull rank on House sooner or later. They start a differential diagnosis and House orders them to discontinue the anti-emetics and do an upper endoscopy.
Chase speaks to Foreman, who assures Chase that, although he and House have had issues in the past, his judgment and objectivity won’t be affected by that. Foreman also has to decide whether to have House’s ankle monitor removed. Chase advises him to stay out of the diagnostic office.
Natalie reassures Andres while they perform the endoscopy. All of a sudden, a man called Joseph comes in. Park tells him only family is allowed in the room during procedures. Natalie says he’s a good friend who helps with Andres, but Park is insistent and Chase suggests that Natalie show him where the lounge is. Chase chides Park for being undiplomatic, and states that he thinks Joseph is probably Natalie’s lover. However, Chase finds a tear that’s the cause of the bleeding.
Wilson tells House about the asexual patient. Wilson says she’s perfectly healthy except for a routine bladder infection. House bets $100 he can find a medical reason she doesn’t want to have sex. Wilson doesn’t want to let House anywhere near her, and House agrees to diagnose her from her file and any remaining blood and fluid samples that might be left. Wilson agrees.
House comes to see Foreman’s office with the results of the endoscopy. Foreman reluctantly agrees to drop what he’s doing. They figure the tear was the result of the vomiting. Foreman suggests steatohepatitis and House agrees to treat for it. However, House wants to do a biopsy under anasthetic to confirm. Foreman thinks that an ultrasound would be less invasive, but realizes he’s trying to overrule House again and says it was just an observation. House mocks him and goes to leave, but Foreman stops him, realizing that House is just trying to break Foreman’s confidence in himself and reverses House by ordering the ultrasound.
On their way to the patient, Foreman intercepts Chase and Adams, accusing them of using the ultrasound machine they’re so obviously taking to the patient to guide the biopsy. He goes to look for a biopsy kit, but just finds a card from House predicting that Foreman will waste his afternoon following his fellows. Chase warns Foreman not to play mind games with House over this. Natalie comes and tells them Andres has started vomiting again. When she offers him a pan to vomit in, he violently attacks her. Foreman rushes in to sedate him. They notice that he has urinated and that it’s tinged with blood.
The team discusses why Andres attacked his wife. They discuss whether a person in Natalie’s position should remain faithful. They run into Foreman, who reminds them that he was right not to take him off the anti-emetics. He blames House for the attack on the wife. House reminds him that taking Andres off the anti-emetics gave them a new symptom. House also reminds Foreman that he wanted to put the patient under anasthetic, which would have prevented the attack. Foreman says he’s just rationalizing after the fact. House gets Park to get a card from under another chair, which says the patient was going to punch his wife, and pulls out another saying Foreman would accuse him of faking the first card by making it up after the fact. It’s obvious Foreman was right. Adams thinks it’s thrombotic thrombocytopenic purpura. House orders plasmapheresis and asks Foreman if that’s okay. Foreman just glares at him.
Chase goes to explain the procedure to Natalie and Joseph. He asks about her eye injury from Andres’ attack. She asks Joseph to leave and when he does (after kissing her goodbye), she denies having an affair although she admits she has talked to him about it. Chase advises her to go home and get a good night’s sleep.
House enlists Adams and Park to help him diagnose the asexual woman. However, the clinic patient’s hormone levels are normal. Adams wonders what the big deal is, and House tells them it’s a primary biological function. Park suggests the woman has a spinal cord injury which blocks the sensation from her genitals. Adams thinks it might be psychological, and when House rejects that because of her close relationship with her husband, Adams suggests that she might be lacking a brain chemical that helps women build relationships. Park shoots down this theory because of her own experience - she’s had sex with men without wanting to bond with them. Adams suggests she must be lying, but House rejects that - after 10 years she would have left her husband. However, this makes House think of something.
Natalie comes back refreshed. However, when they go to see Andres, he’s not in his room. It soon turns out he’s left the hospital. Foreman apologizes, but the nurses were all busy with codes the previous night and weren’t there to monitor him. He’s called the police and has his security staff searching for him. Chase apologizes for suggesting it was okay for Natalie to leave. She says she has to go look for him, but when she turns to leave, House stops her. He realizes that she finally did have sex with Joseph and she’s feeling guilty, not angry. He tells her that she has to sit, focus, and answer their questions. House and Foreman realize that Andres is probably confused and has reverted to old patterns. His reminder board says it’s Saturday, so they ask what he usually did on Saturdays before he got sick. She lists a few things and Chase realizes that the patient‘s soccer trophy is missing. Natalie tells them the practice field is nearby. The team goes to the field and wonder where he would have waited for children to arrive. They finds him, cold and unconscious, nearby. They start CPR.
Adams starts wondering if the patient was trying to run away, but Chase thought she was talking about the patient wanting to commit suicide. They argue about what a person should do if they become a burden to their loved ones. All of a sudden, Andres starts showing activity on the EEG. Chase tells him that when his dad left, he had to split his time between his baby sister and his alcoholic mother. His mother soon died with Chase hating her, and his sister became an alcoholic and hated Chase because he was then to busy to help her. He admits he wishes her mom had killed herself with a gun instead. Andres heart starts beating. They get the defibrillator ready and Chase manages to shock him back into sinus rhythm. Foreman tells Natalie they still have a long way to go.
To keep to the terms of the bet, House calls in the asexual husband on the pretext of a free flu shot. Wilson confronts House, but House reminds him that only his patient was off limits. Wilson also reminds him that the bet was about why the woman doesn’t want sex, but House’s theory is that only the husband is asexual and the wife is lying about it because she loves him and wants to be with him. Wilson reminds House about the medical ethics of testing a patient on a pretext. When House counters that he’s doing both of them a favor, Wilson calls him out and says he knows it’s all about the bet. He accuses House of trying to destroy the relationship of two happy people. House tells Wilson he’s only assumed they’re happy and goes back to the husband.
Foreman tries to start a new differential with fever, but House tells him that the fever could be nothing more than an adverse reaction to nearly freezing to death. Chase supports House - the fever could be from necrosis set off by the freezing. House wants to restart plasmapheresis, but Foreman wants to add other neurological symptoms - loss of language and aggression. However, House puts those down to Alzheimer’s. Foreman starts to question the Alzheimer’s diagnosis and reminds House that the symptoms only started after he was admitted. Foreman makes a good case for encephalitis and House concedes, ordering interferon.
Chase explains the new diagnosis to Natalie, but also admits that they’re not sure. She says she can’t take care of him anymore.
House comes to Wilson in triumph - the asexual husband has high prolactin levels and has partial color blindness. This points to a tumor in the pituitary gland. This would have lowered his libido and caused erectile dysfunction. He only needs dopamine antagonists and his sex drive will be restored. Wilson realizes that this will probably change the husband’s whole life and accuses House of being unable to leave things alone. House counters by telling Wilson that Wilson must have known that House would not drop the matter once Wilson told him about it.
Foreman starts reviewing something else - a petition to remove House’s ankle monitor. Foreman goes to sign it and thinks of something. He goes to House and says that the whole fight over the patient wasn’t about the patient at all - it was about the ankle monitor. He accuses House of letting him win in order to build up his confidence so he would feel in control of House and wouldn’t worry about the monitor any more. House admits it and asks him to take off the monitor anyway. House notes he wins either way - either Foreman would have fallen for it and signed the forms, or would have realized House was playing him, thus proving he had House under enough control to give up on the monitor. Foreman tears up the form.
House and Foreman get paged. Andres is having a heart attack. House uses the defibrillator and nearly shocks Foreman in the process. However, Andres is back into sinus rhythm.
The heart attack rules out encephalitis, but Foreman still thinks the aggression and language loss are important symptoms. House starts thinking about toxins and orders an environmental scan. However, Foreman overrules him - he thinks it’s meningitis and the patient’s mental state has hidden the neurological symptoms He orders a test of the cerebro-spinal fluid. Foreman then admits that he couldn’t resist overruling one of House’s diagnoses, just like House predicted.
Forbidden from doing an environmental scan, House starts talking to Natalie about possible toxins. He starts to ask her to ask Joseph to collect samples, but then overhears the patient talking Portuguese and starts a conversation with him. The patient keeps saying “blue shack” and House asks Natalie about it. She says its where they had their first date. The patient keeps talking and, although House says it’s not medically relevant, she asks that she tell her anyway. He’s talking about their first date and how much he wanted to marry her. However, Andres doesn’t recognize her. House asks that she get Joseph to get samples.
Wilson is breaking the news to the asexual couple. He tells them as the tumor shrinks, the husband is likely to regain his sex drive. He asks what would happen if he wasn’t treated. She says he needs treatment and says they will work through it. She then breaks the news she has had sex before and enjoyed it.
Foreman is meeting with some donors when he looks over at some flowers he received a week ago that are still fresh. He excuses himself. He goes to House in triumph - it’s Reye's syndrome. House says it’s rare in adults and the wife kept all the medicine under lock and key. However, Foreman has realized that Natalie was an ex-florist who most likely used aspirin to extend the life of flowers for the few orders she still worked on. The patient probably had flu, which presented with a sore throat. He saw aspirin and started taking them and, because he forgot he took them, he probably took several. Foreman has already started the patient on steroids.
Andres regains consciousness, starts speaking English again and recognizes her again. He asks what happened to her eye and kisses her hand.
Wilson tells House that he was right about the tumor. He concedes the bet. House tells him to be glad - they saved the husband’s life and got the couple back on track to a healthy sex life. Wilson still thinks they were happy the way they were, even though the wife was lying about her lack of sexual desire. House sets the $100 bill on fire to light his cigar. Wilson reminds him that smoking isn’t permitted, and House says neither is calling in patients on a pretext. Wilson joins House with a cigar of his own. All of a sudden, a man comes in. House hides his cigar and asks what he wants. He says he has an order to remove his ankle monitor.
Chase calls his sister for the first time in several years.
House goes to Foreman. Foreman knows why he’s there and tells him that things work faster without training wheels. He then throws him out because he has a lot of work to do. House “accidentally” knocks over Foreman’s pencil holder as he leaves.
- Park admits to sleeping with about 30 men in college, then admits to lying about it, but then won’t say if the actual number was higher or lower.
- Foreman agrees to have House’s ankle monitor removed.
Zebra Factor 9/10
Reye’s is getting increasingly rare in the United States as studies have confirmed the correlation between Reye’s, aspirin use, and viral diseases such as influenza and varicella. Public information and drug warnings have largely eliminated aspirin as a drug used for childhood fever. In 1994, there were only two reported cases. In addition, it is very rare in adults - the median age of a Reye’s patient is six.
Trivia & Cultural References
- The start of the episode takes place on a Friday, and Adams is wearing her Osler Scarf from Johns Hopkins Medical School. The Osler Scarf (or the Osler Tie for men) is given to all Hopkins residents and is traditionally worn each Friday.
- Soccer is the most popular sport in the world, and is the top sport in Brazil
- House using last Tuesday's newspaper to fake a prediction is a parody of the storytelling trope of Authentication by Newspaper
- Taub does not appear in this episode, and it is discussed in the beginning that he got a personal day. Since the episode stretches over at least a couple of days, why he doesn't appear the next day remains a mystery.
- Episode page at IMDB
- Episode page at House MD Guide
- Episode guide at Ace Showbiz
- Episode transcript at Clinic Duty
- A review of the medicine at Polite Dissent
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