Bombshells

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Episodes • 1 • 2 • 3 • 4 • 5 • 6 • 7 • 8

"Good thing I brought my axe cane."

―Bombshells

"Bombshells" is a 7th season episode of House which first aired on March 7, 2011. It is directed by Greg Yaitanes. This episode took a rather different approach through use of dream sequences and choreographed scenes.[1] Among the styles copied were 50's television sitcoms, modern westerns, and zombie movies.

House treats a teenager who coughs up blood during a basketball game, but he's distracted when Cuddy has symptoms of her own and has to go through her own diagnosis. The character's hopes, fears and aspirations start playing out as fantasies and dreams. When Cuddy’s prognosis gets worse, House can‘t bring himself to face her until he turns to an "old friend."

Recap

Cuddy wakes up to an empty bed and goes to look for House. Suddenly, she feels someone grab for her leg, but it’s just House, who has gotten up early and hid under the bed just to scare her. She’s amused and they start making out, but she has to go and pee. House grabs a book. Cuddy calls for him - she tells him there is blood in her urine.

House accompanies Cuddy to the urologist for her exam, but brings his team along because they have a patient who spit up blood at a basketball game. The team starts a differential and Cuddy sends them out of the room. House calls at them to use a pill camera and check for angiodysplasia.

Taub explains the pill camera to the patient. The patient has lost weight over the year, and his father said it started after he quit the swim team. The patient says he quit because he had to get up too early. Taub sends the parents out of the room to talk to the patient about sexual activity, but when they leave, he asks the patient how long he has been self-cutting. The patient says the scars on his abdomen are from a fall from a skateboard, but Taub gets him to admit to sleep disturbances, loss of appetite and quitting something he used to enjoy. He asks the patient how long he has been depressed.

Taub reports the patient admits to depression and marijuana use. Taub thinks the marijuana was laced with toxins. House pays off a technician for test results and orders tests for lead poisoning and intravenous fluids.

House comes to Cuddy and starts reading from what appears to be her lab results. Cuddy wants to know where he got them, but he shows her a blank piece of paper - he realized from her behavior that all the tests were normal. Cuddy is afraid the blood is coming from her kidneys, but House accuses her of worrying too much, just like her mom. Cuddy agrees and House offers to buy her lunch in the cafeteria. However, after he leaves, Cuddy schedules an ultrasound.

Taub admits to the patient he lied to his parents and said they had no idea how he was exposed to toxins. The patient wants to know how Taub figured out he was depressed when he’s been hiding it from everyone for months. Taub tells him that’s his job. Taub suggests he talk to his parents about it, but the patient says they would blame themselves. Taub tells him that in med school, he felt he was the only one who couldn’t deal with the pressure. He says he hurt himself as a result. However, Taub soon notices red spots in the patient’s sclera that weren’t there before.

Wilson does the ultrasound on Cuddy. She sees Wilson get worried and asks him what he sees. He says there is a mass on her kidney.

The patient’s symptoms point to a clotting problem. However, Chase thinks it’s an infection. House agrees and starts the patient on antibiotics.

House finds Cuddy with her lawyer drafting her will. House tells her she’s freaking out about nothing. He tells her that she should get a biopsy, but she says it’s scheduled the next day. House knows she can get someone to get her a biopsy right now. She says she can’t knock other patients off their schedule. House says she’s more important, but she counters that he said she isn’t sick. He agrees to drop it.

A teenager is in the patient’s room and he’s angry about something. Taub asks him about it and it turns out that the patient sold some medication to the teenager. The teenager paid, but the patient got sick before delivery. Taub gives him the $80 to give back to the teenager.

Cuddy is meeting with her sister Julia, who is agreeing to act as Rachel’s guardian if Cuddy dies. Julia wonders why Cuddy didn’t ask House and she reminds her that they’ve only been dating a few months. Julia reminds Cuddy that she’s been talking to her about House for ten years, if only to tell her how much she wanted to smash his mouth in sometimes. Cuddy tells her that people change.

The scene shifts to a parody of Two and a Half Men, with Wilson playing the role of Alan and House as Charlie. An eight-year-old Rachel shows up at the door with a police officer. Wilson scolds her for being late, but she blames the cop for not running red lights. The cop wonders where Rachel got her bad language, and House walks in. He denies doing anything wrong. Rachel had been shoplifting. House tells the cop Rachel’s mom is dead and Rachel is his “favourite tax write-off”. He assures the cop it won’t happen again because Rachel won’t get caught. He high-fives Rachel. They all hug.

Cuddy wakes up from her nightmare.

Masters is pleased Taub believed the patient. The patient comes out of the bathroom telling the doctors there is blood in his urine.

The blood rules out an infection and points to a kidney problem, probably a mass. However, Chase points out a kidney mass wouldn’t explain the coughing blood or blood in his eyes. Chase finally figures House is talking about Cuddy, who does have a kidney mass. Foreman reassures House that Cuddy’s biopsy will be back soon. Taub suggests heroin use by the patient, but there are no withdrawal symptoms. House goes with Chase’s idea of anti-phospholipid syndrome. He orders plasmapheresis. He also lets Taub do an environmental scan.

House wonders why Wilson isn’t with Cuddy, keeping her company before her biopsy. Wilson thinks he’s worried, but House feels he would just make Cuddy feel worse because he’s bad at companionship. Wilson tells him to practice. House says he will be there for her once there is something to worry about, but Wilson tells him he should be there merely because Cuddy is worried, even if there is nothing to worry about. House agrees, but sends Chase to keep Cuddy company. Chase offers to read from 1st Corinthians, but Cuddy points out that’s from the New Testament and she’s Jewish. Chase tells her she doesn’t know what she’s missing. Chase assures Cuddy that House will show up. Cuddy tells Chase he can’t possibly believe that, but she hopes House will show up too. She finds it ironic that House usually couldn’t go 15 minutes without bothering her and now he’s afraid to come into the same room. Chase quotes from the Bible anyway “Love hopes all things.”

Foreman and Taub do the environmental scan and Foreman asks why Taub is interested in the patient. Foreman feels that Taub thinks helping the patient will improve his own life. Foreman gets a call that the patient has lost all feeling in his right arm. He starts to head out, but Taub finds a yearbook filled with violent imagery.

The scene shifts to what appears to be a hospital in ruins, with House looking for Chase to see how Cuddy is. He finds Chase, who has turned into a zombie and attacks him. House manages to fight him off with his cane, which he then turns into an axe to decapitate him. He hears Cuddy crying for help. The cane turns into a shotgun, which is used to dispatch zombie Taub and zombie Masters. However, he finally turns to face zombie Foreman, who is dispatched with three shots to the chest. The cane next turns into a high powered flashlight which House uses to look for Cuddy in the ruins. He sees Cuddy being eaten by zombies, but then wakes up from his nightmare. Masters and Chase ask him if he’s okay. He says he was sleeping.

The arm paralysis while on steroids rules out an autoimmune disease. House is figuring out how Cuddy hid her biopsy results from him. Foreman suggests an angiogram to look for clotting. They finally get House’s attention and he agrees to the angiogram. He tells Masters to look through all the recent biopsy slides to find Cuddy’s.

Taub is worried about the violent imagery, but Chase says fantasizing about killing people is normal teenage behavior. Even Masters says she fantasized about torturing her classmates - and House. Taub agrees it might not be a big deal, but Chase starts to think - he remembers someone actually shot House once.

Wilson finds House hiding and tells him he has to be with Cuddy. House says Chase did a fine job and Cuddy is fine. Masters bursts in. As Wilson goes to leave, he tells House not to screw it up. Masters tells him she figured out which biopsy was Cuddy’s, but it was inconclusive because the mass was at the center of her kidney and they couldn’t get a proper sample. House realizes they will have to remove it surgically. Masters tells House they are doing imaging now.

Foreman comes home to find House in his apartment playing videogames. He tells House they found a clot in one of the patient’s cranial arteries and he’s been started on blood thinners. Foreman tells House the same thing as Wilson - even if House thinks he won’t be a good companion for Cuddy, it will be even worse if he’s not there. He then sits down and starts playing videogames with him.

The scene shifts to a 50s sitcom. House has cooked dinner and cured all his patients early so he could spend time with Rachel. Rachel boasts she got 100% on her spelling test, and she aced her law school admission test. House tells Cuddy he’s been studying with Rachel and it was supposed to be a surprise. Wilson shows up with Cuddy’s 29th birthday cake. She realizes something is wrong and wakes up. She hears someone knocking at her door - it’s Wilson with her imaging. She calls House. Foreman asks what the problem is. House tells him what the scans show and Foreman realizes that it indicates metastisized kidney cancer. House realizes she’s terminal.

The patient is shown in a video complaining how seat belts keep idiots alive, slowing the progress of evolution. He then sets off a small pipe bomb. Taub wants to tell the police about the video, but Foreman and Chase remind him that he stole the video from the patient’s flash drive in his house. Masters comes in to tell them the patient isn’t responding well to the blood thinners and the damage will soon be irreversible. They realize they may have to remove the clot surgically. Foreman figures House is with Cuddy, but Masters had just spoken to Cuddy and she doesn’t know where House is.

Foreman goes to Wilson’s office looking for House. Wilson says he is worried about House, but Cuddy is his patient and if he goes after House, it will be all about him instead of Cuddy. He tells Foreman that Cuddy thinks that House is still going to show up.

They explain the procedure to remove the clot to the parents. He also tells them about the pipe bombs and threats. The mother says the patient will never hurt anyone, and the father is worried about him being expelled if it comes out. He tells Taub to focus on keeping the patient alive.

Taub and Masters discuss Taub’s dilemma. Masters assures him that teenagers rarely follow through on threats. She then tells him that if his own view of that part of his life is skewed, he is likely to be overprotective. When Taub tells her she sucks at giving advice, she tells him to blame the statistics, not the statistician.

Foreman and Chase find the clot. However, when they go to remove it, it disintegrates immediately.

House and Cuddy are facing the entire Bolivian Army in the last scene from Butch Cassidy and the Sundance Kid. They talk about going to an Australian karaoke bar. Cuddy realizes she’s in a dream. She was hoping House would figure out how to handle it, but he can’t because he’s still a child. He says he can change, but it might be too late. Cuddy runs out guns blazing, but realizes House isn’t with her as she wakes up.

However, when she does wake up, she sees House waiting outside the room. He apologizes for not being there. She says she knew he’d come.

The team is wondering what it was that appeared to be a clot. The patient’s liver is now failing and the prognosis is that he won’t last more than a day. Masters suggests they page House, but Chase says he’s busy. House is with Cuddy. Masters says that House can’t help Cuddy, but the others ignore her.

House tells Cuddy if she doesn’t survive surgery, he won’t sleep with anyone else for a month. She tells him to make it two months. He calls her a bitch and she smiles as they take her away for surgery.

The team keeps up the differential. The surgical team prepare Cuddy for surgery. She sees House in the observation room just before they anesthetize her.

Doctor_House_-_Get_Happy — Doctor House - Get Happy

As Cuddy goes under, she hears House singing “Get Happy” and sees him dressed as a cabaret magician in a musical. Cuddy joins in the singing too. However, she soon finds herself alone on a gurney. She regains consciousness to find House by her side. He tells her neither of them have cancer - the tumor was benign. The masses in her lungs were merely an allergic reaction to the antibiotics she was given when they thought she had a urinary tract infection. House makes her a present of her tumor. Cuddy starts to open up to House. She’s afraid of so many things she manages to keep hidden, but when this happened, all her fears came out. However, she looks at House and realizes he’s figured out what was wrong with his patient. She tells him to go.

House tells his team to take the patient off all the medication. The patient has a simple staphylococcus infection. The parents protest that they treated him for it and he didn’t get better. House tells them that the antibiotics only killed the bacteria in the open, and let out a whole bunch of other bacteria that were hiding. Masters realizes House is talking about an abcess. They just have to find it. Taub realizes that if the scars on his stomach are from little pieces of the bombs he’s blowing up, the plastic he was using wouldn’t show up on scans, but would be a perfect breeding ground for bacteria. When they treated him with antibiotics, pieces of the abcess would break off, lodging in the kidney, liver and brain and look like clots. He just needed exploratory surgery to remove the plastic pieces.

Julia is nursing Cuddy at home. Julia promises not to tell their mother about her surgery to keep her from coming over. She also tells Cuddy she moved the sleeping pills back to the medicine cabinet.

Cuddy goes to confront House. She thinks he took Vicodin before he came to see her in the hospital, and thinks he was stoned when he showed up. House admits it, but tells her it was only a one time thing and he stopped taking them again. However, Cuddy thinks he used the Vicodin to avoid feeling the pain, like he does with everything else he does. She tells him if you care about people, you can’t avoid feeling pain. She says he wasn’t really with her, but he tells her he wanted to be. She says it’s not enough. He says he can do better. She doesn’t think he can. He begs her not to leave him, but she walks off.

Taub drops a package directed to the Trenton Police in the mailbox.

Cuddy is commiserating with Julia.

House is in his bathroom with two Vicodin in his hand. He quickly swallows them.

Major Events

Cuddy has bloody urine, which is eventually traced to a benign kidney tumor which caused a cancer scare.
House avoids Cuddy while she’s sick, but eventually takes Vicodin in order to go and see her.
Cuddy realizes House took Vicodin and breaks up with him.

Title

Zebra Factor 1/10

Staphylococcus is a very common bacteria in the environment and is the most common opportunistic infection. It readily infects any untreated open wound. Chase came up with this as a diagnosis at the first instance.

Trivia & Cultural References

This episode won an Emmy Award for Outstanding Sound Mixing for a Comedy or Drama Series (One-Hour)
The episode had no opening title sequence
In Cuddy’s first three dreams, House is always seen with some kind of candy, a clue given to her by her subconscious to warn her about House's need for vicodin.
A Corn dog is a hot dog on a stick, dipped in cornmeal batter and deep fried.
Emo is a modern style of rock music characterized by a focus on melody and expressive lyrics.
A bonobo is a great ape closely related to the chimpanzee
Mel Gibson is an American-born Australian actor who has been criticized for some of his verbal outbursts. On the other hand, Nelson Mandela was a South African lawyer and politician who is known for bringing South Africa peacefully out of apartheid and into a multi-racial democracy.
House's outfit in the first dream sequence is based on the clothes worn by Charlie Sheen's character in the sitcom Two and a Half Men.
The model airplane House is carrying in the '80s sitcom is a Supermarine Spitfire, a World War II British fighter, and likely a reference to Hugh Laurie's nationality.
A ninja is a covert mercenary active in feudal Japan
Tom Cruise is the most successful movie actor in the world, based on his box-office performance.
1st Corinthians is one of the most quotable books of the New Testament. Chase’s quote (actually paraphrasing) is from 1st Corinthians 13:7, "Love bears all things, believes all things, hopes all things, endures all things."
Classic Doctor Who generally refers to the run of the program from 1963-1989, covering the first seven Doctors.
A Zombie is a corpse that has been animated by supernatural means. They have been a fixture of popular culture since the late 19th century. They have been regularly depicted in movies since the 1930s.
In the Zombie dream sequence, when Zombie Taub is shot, the famous "Wilhelm scream" can be heard.
The video game is, once again Savagescape 2; the game being developed in Epic Fail
Little Rachel’s score of 170 on the Law School Admission Test would put her in the top 2% of test takers.
Butch Cassidy and the Sundance Kid was a 1969 Western starring Paul Newman and Robert Redford in their first film together. It was the top grossing film that year.
Newark is the largest city in New Jersey
Karaoke is a form of entertainment where members of the audience sing popular songs to pre-recorded background instrumentals
More about those terrific Australian acts Midnight Oil, Men at Work and Olivia Newton-John
Physical was a #1 hit for ten weeks.It was Olivia Newton-John's biggest American hit
Get Happy was first performed in 1930, but the most popular version is Judy Garland’s 1950 version from Summer Stock.
The dream sequences as well as the performance of Get Happy, had striking similarities to the Bob Fosse musical All That Jazz
The last scene deliberately follows the same pattern as the last scene in Help Me with House alone in his bathroom contemplating whether to take Vicodin. Without Cuddy to save him, he gives into temptation.

Music

Come On Get Happy - by Hugh Laurie and Lisa Edelstein, during the dream sequence
Dazzled by You - by Bob Geldhoff

Reviews

IMDB users rated the episode an 8.7, with 37.5% of voters giving it a "10" rating. The episode did best with Females under the age of 18 (9.3 average of 3 votes) and worst with males under the age of 18 (6.9 average of 8 votes).
Polite Dissent gave the medical mystery a B-, but didn't like the solution, which required the abscesses to be both "walled off" and "breaking off pieces". He gave the solution and the medicine a C-. However, he praised the soap opera plot as inventive and moving the entire story arc along and gave it a B+.
The AV Club gave the episode a B+. The reviewer was presently surprised by the strength of the episode and its ending even given the dream sequences.

Medical Ethics

Goofs

The team starts Ryan on sodium benzoate on the suspicion his ammonia levels are high. Ammonia levels can be tested quickly and easily so they should have tested before starting treatment.
If Ryan is bleeding and clotting at the same time, that narrows down the differential diagnosis to a few conditions. Disseminated intravascular coagulation is the most obvious choice.
Streptokinase is a really bad choice for a stroke patient. It's a very old drug and it's efficacy in stroke cases is questionable at best - it's not even FDA approved for the condition. Foreman, a neurologist, would be aware of this. In addition, it's contra-indicated if the patient has had recent bleeding disorders. Finally, if a patient doesn't improve on the recommended dose of streptokinase, the right procedure is to try another anti-coagulant, not to increase the dose.
Taub is right that PVC pipe will not show up on an x-ray. However, it does show up on an ultrasound, and abscesses do show up on x-rays.
In most cases, if intravenous antibiotics can't reach an abcess (which are often located behind a blood-proof barrier) they also won't break off pieces that will float through the bloodstream.
Cuddy's sleeping medication, Zolpidem (aka Ambien(TM)), comes in 5mg and 10mg pills. Her pill bottle shows the dose of each pill to be 200mg.
Antiphospholipid syndrome causes clotting, but not bleeding. In any case, plasmapheresis isn't the appropriate initial treatment
The team never considers a blood culture, which would clearly show staph
Depressed people generally don't participate in voluntary sports activities, like a pick-up basketball game.
This one is on the art department - in the Yearbook, the word "Achievements" is misspelled.

Quotes

Dream Sequences

There was a lot of discussion about which films and movies were being referenced in the dream sequences.

50's style sitcom - Most likely based on Leave It to Beaver
Modern sitcom - Most likely Two and a Half Men. House is wearing Charlie's shirt, and Wilson hugs Rachel like Alan would
Zombie movie - Most likely Army of Darkness. Both Ash and House are disabled and prefer a shotgun as a weapon
Western - Certainly Butch Cassidy and the Sundance Kid - the scene where the duo is surrounded by the Bolivian army.

Cast

Hugh Laurie as Gregory House
Lisa Edelstein as Lisa Cuddy
Omar Epps as Eric Foreman
Robert Sean Leonard as James Wilson
Jesse Spencer as Robert Chase
Peter Jacobson as Chris Taub
Amber Tamblyn as Martha M. Masters
Paula Marshall as Julia Cuddy
Brett DelBuono as Ryan
Lesley Fera as Kay
Ken Garito as Todd
Emily Hahn as Eight Year Old Rachel Cuddy
Beau Dremann as Police Officer
Lee Simpson as Hayes
Liz Benoit as Nurse Anne
Chuck McCollum as Urologist
Kai Schmoll as Lawyer
Bobbin Bergstrom as Nurse
Martha Nichols as Dancer One
Noelle Marsh as Dancer Two
Allison Holker as Dancer Three
Dominic Chaiduang as Dancer Four
Katie Schaar as Dancer Five
Ryan Ramirez as Dancer Six
Chaz Buzan as Dancer Seven
Scott Myrick as Dancer Eight
Billy Bell as Dancer Nine
William Wingfield as Dancer Ten

Release Dates

United States - March 7, 2011 on Fox
Canada - March 7, 2011 on Global
Finland - April 19, 2011
Hungary - September 7, 2011
Netherlands - September 15, 2011
Germany - October 18, 2011
Japan - April 2, 2013

In Other Languages

Links

Videos

1_Bombshells — 1 Bombshells

Multitasking

2_Bombshells — 2 Bombshells

House's next patient

3_Bombshells — 3 Bombshells

Leave it to Cuddy!

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Bombshells

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Out of the Chute