Brant Macklin was the army private who leaked intelligence to the media and became the patient in the Season 8 episode Blowing the Whistle. He is the younger brother of Hayes Macklin, the brother-in-law of Joni Macklin, and the uncle of Evan Macklin. He was portrayed by actor Arlen Escarpeta.
The character is loosely based on Chelsea Manning, an army intelligence analyst who leaked documents to Wikileaks. The massacre of civilians may be a reference to the Kandahar massacre on March 11, 2012, where army sergeant Robert Bales killed seventeen Muslim civilians and wounded five others.
Medical History[]
The patient had recently returned from Afghanistan, where he was serving as a junior intelligence clerk, interacting with the local population.
Case History[]
Brant was in army custody because of charges of treason when he collapsed while being escorted through an airport. He continued to suffer a series of tonic-clonic seizures. The patient had negative scans for structural abnormalities, and his EEG was normal. The case was assigned to Dr. House.
Dr. Chase started the differential diagnosis with typhus. However, Dr. House noted the patient had shaved his head and was unlikely to have the lice which act as the vector for the disease. Dr. Adams suggested leishmaniasis, but Dr. Park noted the patient had no fever. She believed that the patient faked the seizures. This would explain the normal EEG. Dr. House instructed his team to give the patient a placebo to see if the symptoms disappeared.
Dr. Adams explained to the patient that they thought he may have developed a deep vein thrombosis while flying back from Afghanistan and gave him a placebo. She then told him that if he developed numbness in his leg, that would confirm it and he would need a lengthy hospitalization. They started talking about his father, who had passed away, and Adams wondered if the father's death could be related to Brant's illness. However, his brother told them that the father had died in a car accident. However, it was clear that Brant did not believe that because his father's service record had been redacted. He had joined the army to get access to his father's file. He then complained he couldn't feel his leg. Adams went to discharge him and Park explained that they had given him a placebo to see if he would fake the numbness. However, his brother told the doctors that it would be totally out of character for Brant to be faking symptoms. Brant then began to complain that his stomach hurt as well. Dr. Adams examined him and found a large bruise covering his abdomen. She realized Brant wasn't faking the symptoms.
Although Dr. Chase agreed the rash was a real symptom, he argued that the numbness still could have been faked. However, Dr. Adams disagreed because Brant had already agreed to plead guilty to treason. She thought it was adicoesophageal rupture leading to compartment syndrome. However, Dr. Taub pointed out the patient had no pain while swallowing. He thought it was a ruptured abdominal aortic aneurysm, but Dr. Park noted that wouldn't explain the seizures. Dr. Chase thought it was more prosaic - pancreatitis from gallstones obstructing the pancreatic duct. Dr. Chase went to do an ultrasound.
Dr. Chase performed the ultrasound, but couldn't find any obstructions. However, his spleen was enlarged and Dr. Chase also noticed there was blood in his urine. They also noticed he was bleeding from other sites as well. Dr. Chase ordered a transfusion. Brant started bleeding from his eyes as well and Dr. Chase realized that all of Brant's platelets were being sequestered in his enlarged spleen. They realized a platelet infusion would take too long to stop the bleeding and they had to squeeze his spleen to release the platelets. Dr. Chase called for an emergency operating room.
Dr. Chase performed surgery. Dr. Taub noted the patient's blood pressure had dropped to 70/40 and he was hypovolemic. The nurse pushed saline to bring up the blood volume. Dr. Chase finally got to the spleen to release the platelets. Brant's blood pressure started to rise and his blood started to clot. However, Dr. Chase also noticed the spleen was lumpy.
A CT scan confirmed nodules on the spleen. They started a new differential. Dr. Taub suggested extramedullary hematopoiesis, but the patient had no history of anemia. He next suggested tuberculosis, but the PPT test was negative. Dr. Taub next suggested brucellosis, but Dr. House pointed out there was no rash or back pain. Dr. Taub next suggested lymphoma, but Dr. Adams pointed out there were no cerebral masses on his CT scan. However, Dr. Taub finally realized the nodules could be granulomas indicating sarcoidosis. Dr. House agreed and ordered steroids.
However, Brant refused treatment. Dr. Taub warned the patient he could suffer a fatal arrhythmia, but the patient was insisting on being allowed a live television interview.
Major Mathewson refused to consider allowing the interview. As a result, Dr. Chase suggested to Brant's brother that they go to court saying that Brant was suffering from narcissism so that the brother could act as his medical proxy. Dr. Chase pointed out that both the leaking of the tape and refusing treatment supported that diagnosis. However, they needed the brother to support their application. The brother thought his brother was a fool, but refused to say he was crazy and would not cooperate.
Dr. Chase went back to the team and suggested lacing the sponge bath water with steroids. However, Dr. Park noted it would take too long for the drugs to reach the bloodstream. Dr. Adams suggested filling the room with aerosolized steroids. However, Dr. House rejected that suggestion because it would be too difficult to get the concentration right. He realized that they would have to get the patient something he wanted more than an interview.
They spoke to Major Mathewson, who agreed to release the missing pages from the service record of Brant's father. However, it would take two days. Brant didn't trust the army, but his brother said he would ensure the army followed through. Brant agreed to treatment.
However, after treatment was started, Brant's left foot became cyanotic. This ruled out sarcoidosis.
They started a new differential. Dr. House suggested cholesterol embolization, but Dr. Adams pointed out that there was no sedimentation in the arteries. Dr. Park suggested a dissolved clot could have resulted in a vasospasm and DIC could have been caused by Bernard-Soulier syndrome. Dr. House ordered heparin.
Dr. House spoke to the patient and, as they spoke, the patient explained due to the stress of having to log in the tape of the massacre, his hair went grey in three days. Dr. House realized loss of hair color usually indicated an autoimmune condition, most likely Graves' disease. The hyperthyroidism led to a hypercoagulable state and thrombosis. He ordered antithyroid drugs. However, Dr. Taub argued that the loss of hair color could simply be a reaction to the stress the patient was under. Dr. Adams pointed out that the antithyroids could lower his blood pressure and suppress his breathing. After Dr. House left, Dr. Chase convinced the rest of the team not to administer the antithyroids.
Dr. Chase and Dr. Adams went to check on the patient, who was complaining he was starting to feel cold. Dr. Adams checked his body temperature, which was 104°F. This ruled out Bernard Soulier.
Dr. House found out about the team's refusal to give the patient antithyroids. However, Dr. Adams had run blood tests which had ruled out Graves' disease in any event. Dr. Foreman came in to tell Dr. House that until he agreed to be tested for hepatic encephalopathy, he would be approving all treatment orders. Dr. Adams got back to the differential and noted that the patient's white blood cell count was now high, so the infections they had ruled out had to be reconsidered. Dr. Park suggested legionellosis, but Dr. Chase noted there was no pneumonia. Dr. Taub suggested Dengue fever, but Dr. Foreman noted that condition causes a great deal more pain that what the patient had complained of. Dr. House thought it was malaria, but Dr. Adams noted the army routinely issues anti-malaria medication. Dr. House countered the drugs the army used were at least ten years out of date and the patient probably had a resistant strain. Dr. Foreman agreed and ordered treatment for abdominal sepsis and malaria.
However, Brant had started rejecting medication again because the army had not yet delivered his father's file. His brother tried to convince him it was just delayed, but Brant thought the army was just stalling.
The brother approached Dr. Taub and Dr. Park and asked if was too late to be appointed the patient's medical proxy. Dr. Taub assured him it wasn't and agreed to start the necessary paperwork.
Dr. Adams found out about the brother's change of heart and wondered about it. Dr. Taub thought it was just because the brother knew Brant was near death. However, Dr. Adams pointed out that Brant was near death the last time too. She found it odd that the brother would change his mind at this point. Dr. Taub realized something. He called the army and found they had released the file to the brother. Dr. Taub obtained another copy and he went to confront the brother about it. He admitted the deception, but said he had a reason. Dr. Taub sympathized, but said he was going to tell Brant so he could treat him.
Dr. Taub went to see Brant, but the brother followed him in and broke the news to Brant. Their father had been driving drunk and that's what caused his fatal accident. The father had also killed a pedestrian in the same accident. The brother had always known that and had tried to keep Brant from finding out because Brant had always looked up to their father. The redaction of the file was his idea. Brant agreed to treatment.
However, Brant did not improve. His fever stayed high, his white count continued to climb, and his kidney function declined. Dr. Adams suggested it might be gonorrhea which had spread to his heart. However, an echocardiogram showed his heart valves looked fine. However, Dr. House thought of something and went to see the patient.
He realized that the patient had visited Afghanis in their home, and their furniture may have harbored the lice that carry typhus. They had ruled it out earlier because he had shaved his hair, which is usually where the lice hide. He also told the patient that typhus affects people's behavior, and that may be why he felt compelled to leak the tape.
Brant improved with treatment and was released back into the custody of the army.