- Foreman: "Of course you had a choice!"
- Cuddy: "Regulations are clear."
- Foreman: "And the punishment for violating those regulations, is it death? Because frankly, I’m okay, if you get a fine, a suspension, hell you can spend a couple of years in jail if it saves my life!"
- — Euphoria
Euphoria Part 2 is a 2nd season episode of House which first aired on May 3rd, 2006, the day after Euphoria (Part 1). After their previous patient dies, the rest of the team rushes to diagnose what is wrong with Foreman and realize that the disease is progressing faster in him than in the deceased patient. Meanwhile, Cuddy refuses to authorize an autopsy on the previous patient on the grounds that whatever he had may spread through the hospital.
House wants a bone saw to take a sample of the dead patient's brain, but Cuddy refuses on the grounds that if the dead patient is contagious, they don’t have the right equipment, and that they could release something to the rest of the hospital. The CDC has been called in, but they won't be on the scene for three days. House points out that Foreman will be dead by then and the disease may not even be contagious.
Instead, House asks Foreman to perform an ice pick lobotomy on the dead patient - an old procedure that Foreman has only read about. However, when Foreman tries, he biopsies the mattress instead. House realizes that Foreman is blind and doesn't realize it - the same symptom that the dead patient had, only Foreman's symptoms have developed faster.
House rules out meningitis because they would all be sick. It can't be a toxic mold or Cameron would be sick too. House instructs the team to treat Foreman for everything. When the team points out that this could be toxic, House screams that the better idea would be to autopsy the dead patient, but he's not allowed to do so.
Foreman is given a range of medication, and can identify them by touch and realizes he is being treated for every possible diagnosis. Foreman thinks House is desperate, but takes the pills anyway. House goes back to the cop's apartment and calls Foreman on the phone to retrace his steps. He is exposing Steve McQueen to the same environment Foreman was in hoping that Steve will show signs of giddiness. Foreman calls his father to advise him of his condition.
Wilson finds House looking at a webcam of Steve McQueen in House's kitchen. Wilson is appalled that House is using their pet rat as a guinea pig, but House says he needs a healthy specimen. They wonder how they will know when Steve is showing symptoms of euphoria.
Cuddy finds House, atypically working hard in the clinic. She thinks he's avoiding Foreman's case.
Cameron goes to treat Foreman, and she is not showing symptoms. Foreman has regained his sight. House tells Cameron to start withdrawing his meds one by one until they find out which one works. However, Chase comes in with bad news - the medications are already starting to affect Foreman's pancreas.
Foreman is nauseous from the medication. House tells Foreman that he has no more than 14 hours to live, but only 4 if he keeps taking the meds. He agrees to go off the medication. At that moment, Foreman's father Rodney shows up. House rushes him away and takes him to see Cuddy to see if he can convince her to do the autopsy on the dead patient. Cuddy falls back on public health protocols although she realizes that Foreman may die. She says that doing the autopsy may put other people at risk of a contagious deadly infection. Surprisingly, Rodney agrees with Cuddy.
Rodney goes to see Eric. Eric is suffering from loss of motion control. Rodney asks if the disease is going to hurt. Eric lies that the other patient wasn't in much pain before he died.
Steve McQueen is not suffering symptoms either. The dead patient is in a locked room under guard to keep him away from House, who has been staking out the morgue to get an opportunity to do an autopsy.
Foreman's brother hasn't been told about the illness. Foreman would like to speak to his mother, but his father says that his mother is "not the woman she used to be", and reminds him that his she can't travel and that she wouldn't remember anyway - it would just make her upset for a few minutes because of her dementia before she forgets it. Rodney hopes that his son will go to heaven, but Foreman is not comforted by this fact. Foreman wonders what he should be afraid of if he isn't afraid of dying, and admits to his father that he no longer shares his faith. Rodney says he will pray for his son, and he suggests that Foreman do the same.
The CDC collects the body, depriving the team of any chance to do the autopsy.
Chase reports that Foreman has gone blind again and that he is in severe pain. House thinks that the faster progression of the symptoms may point to the underlying cause. Finally, House realizes that the dead patient had Legionnaires' disease, and that this may have slowed the progress of the brain infection.
Cuddy goes to see Foreman. Foreman realizes that Cuddy couldn't change her mind because his father asks, but gets angry at her for making a decision that will kill him just to possibly avoid some jail time - he's not going to forgive her just because she came by to say she was sorry. At that moment, House comes along and exposes Foreman to Legionnaires' disease on the theory that it will slow the progression of whatever Foreman has. Foreman would prefer to be in an induced coma, but House exposes him anyway by shattering a glass vial of the legionella in the isolation chamber.
Foreman starts suffering from Legionnaire's disease. He's being very curt to Cameron. However, his temperature is dropping. His pain isn't getting worse.
When Steve stays healthy, House asks Cameron what diseases affect humans but not rats. It's clear the disease isn't bloodborne, or Cameron would have it. He then asks what diseases Foreman could have but test negative for. He points out that if the infection didn't get the immune system riled up, the immune response to Legionnaires' would kill the infection anyway. One infection that fits the bill would be listeria, and House wants to start treating Foreman for it. Foreman asks for a white matter brain biopsy, a deeper brain biopsy that has a very high risk of severe brain damage. However, House refuses to agree to it. Foreman doesn't want the listeria treatment because it will kill the Legionnaire’s too and bring back the pain. House promises to do the biopsy if he has to and Foreman agrees to the listeria antibiotics.
House goes to see Rodney in the chapel. He tells him that Foreman will have to be put in a coma if he gets in too much pain and that Rodney will have to make some medical decisions for Eric. Rodney is aware of how manipulative House is, but he agrees to let House have a free hand because Foreman has also told him that House is the best doctor that he has ever worked with. Cameron goes to discuss putting Foreman into an induced coma, but he wants to draft a will and appoint Cameron as his medical proxy because he's afraid that House will be able to manipulate his father. He apologizes for exposing Cameron. She agrees to be his proxy, but doesn't forgive him for exposing her to the infection or stealing her article and won't accept his apology until he gets better.
Foreman isn't improving, and Cameron suggests the deep brain biopsy, but House wants to wait. Chase goes to tell Rodney that Eric is being put in a coma and that this will be his last chance to talk to him if he doesn't come out it. Rodney doesn't know what to say, and Chase tells Rodney to tell Eric he loves him. Rodney goes to see Eric to tell him it's going to be alright and, breaking into tears, tells him he doesn't want to lose him. Cameron tells Eric that she accepts his apology. They put Eric into a coma.
Wilson comes in to tell House to do the biopsy. House thinks there is more time and the procedure is dangerous. However, Wilson says if it was some other patient, House would have done it already. Cameron comes in and demands the brain biopsy, waving her medical proxy. Cuddy backs Cameron and tells House that if he doesn't like it, he can get a lawyer. Cameron points out that they wouldn't have to do the biopsy if Cuddy would agree to the autopsy. House begs for an hour to go back to find a dead animal at the apartment. Cameron tells him that he has until Foreman's oxygen saturation level reaches 90. House heads off without an isolation suit, figuring either he or Cameron will come up with the right answer.
Chase prepares for the brain biopsy.
House finds a blind pigeon, but he can't capture it. However, House does notice a water leak. He finds an irrigation system working in the grow room that was only active when Foreman was there. Cameron says she checked the water, but House realizes that the water isn't coming from the city water supply when he sees supply pipes leading to the roof. He climbs on to the roof and finds a cistern of rain water that contains Naegleria fowleri, a parasitic amoeba that feeds on brain cells and has resulted in primary amoebic meningoencephalitis. He calls Cameron with the news, but she already knows - she performed the brain biopsy.
They start treatment for the parasite. Cameron tells Rodney that although there will be no lasting damage from the parasite, the brain biopsy may have caused damage that they won't know about until Eric wakes up from his coma.
Foreman comes out of his coma and he is responsive to questions. He is not in pain, nor does he feel numb. He is able to follow House's finger with his eyes and identify everyone at his bedside, including the "manipulative bastard". However, his lobes appear to be crossed: when asked to wiggle his left toes, his right toes can be seen moving under the blanket, and when attempting to move his right arm, his left arm moves instead.
- With Joe now dead, Cuddy forbids House from doing an autopsy on the grounds that it could cause a Public Health crisis and she also tells him that the CDC will be here in three days.
- Foreman's father, Rodney Foreman is introduced.
- Cameron becomes Foreman's medical proxy.
- To stop the worst of the pain, Foreman is put into a chemically-induced coma.
- Moments before he passes out, Cameron tells Foreman that she accepts his apology.
- House puts off the white-matter brain biopsy, claiming that there's more time left before the pain hits Foreman any further.
- House and Mr Foreman learn that Cameron is officially Foreman's medical proxy.
- Realizing there might be more victims, House returns to Joe's flat to look for more corpses and finds a blind pigeon. However, he fails to capture it. (Note: The blind pigeon House spots and pursues is a Blue-bar. However, the cornered pigeon, just before flying off, is a Check/Checkered.)
- Eventually, House discovers the real disease (Amoebic Meningitis caused by Naegleria Fowleri) but learns that Cameron went ahead with the biopsy.
- Foreman awakens from his coma but when he's asked to curl his right toes, he curls his left toes instead. (In the beginning of the next episode "Forever", Foreman states that his right/left reversal is back to normal.)
- House [to Cuddy]: I need a bone saw.
- Cuddy: I’m sorry.
- House: You said you would…
- Cuddy: I wish I could
- House: I just want a little tiny slice of this guy’s brain, that’s all I need, just enough to tell me what’s killing Foreman.
- Cuddy: A thin slice of Joe’s brain could also cause a public health crisis.
- House: It’s not a good idea to scream “fire” every time someone lights a match.
- Cuddy: Don’t downplay this, House. You put both of them in isolation for a reason. Joe’s death elevates the situation to a biosafety level 3.
- House: [shivering] Oooh. Level 3. We should call Jack Bauer.
- Foreman [to House]: What’s going on? When are they doing the autopsy?
- House: You’re doing it. Now. Ever study how they used to do ice-pick lobotomies?
- Foreman: Read about it in med school. Why would I….
- House: Shove an ice-pick into the eye socket just above the tear duct. Bang it a couple of times with the hammer, get a sample.
- Foreman: What’s going on, House?
- Cuddy: [walking up to House] Foreman, you can’t do it! You’d be in violation of…
- House: Can’t do the time if you’re not alive.
- [When Foreman tries to do the biopsy, but he ends up doing it on the bed instead of Joe]
- Foreman: That didn’t feel right.
- Cuddy: He’s blind.
- House: He thinks he can see, same as the cop.
- Foreman: We need something to bag the sample.
- House: Forget it. You just biopsied a mattress.
- Cameron: If it was toxic mold, I’d be sick.
- House: How do we know you’re not sick?
- Cameron: Do I seem happy to you?
- House: Never. [Chase guffaws]
- Chase: It was funny.
- Cameron [to House]: Where are you going?
- House: To see if I can find another brain to biopsy.
- [When House infects his rat, Steve McQueen with the mold sample from Joe’s apartment]
- Wilson: You infected Steve?! Why didn’t you just get a rat from the pet store?
- House: Because I needed one with a clean medical history. Who knows what kind of antibiotics they gave those rats.
- Wilson: So this is your plan, just sit here and watch your rat all day?
- House: Eh, it shouldn’t take long. Got the AC blasting, I soaked the floor of his cage…. [Wilson looks disgusted] As soon as he gets sick, I do an autopsy.
- Wilson: As soon as he’s dead.
- House: Right after he gets sick, there’s a good chance he’ll get hit in the head with a cane-shaped object.
- Wilson: Normally you just use your patients as lab rats. It’s a nice change. [pulls up a chair]
- House: First symptom is euphoria.
- Wilson: How do you know if a rat’s euphoric?
- House: He doesn’t usually climb on his water bottle like that, does he?
- [While House is treating a little girl in the clinic]
- House: You mix rocking, grunting, sweating, and dystonia with concerned parents and you get an amateur diagnosis of epilepsy. In actuality, all your little girl is doing is saying “yoo hoo” to the hoo-hoo.
- Mother: She’s what?
- House: “Marching the penguin.” “Ya-ya-ing the sisterhood.” “Finding Nemo.” [The little girl laughs]
- Little Girl: That was funny.
- House: It’s called gratification disorder. Sort of a misnomer – if one was unable to gratify oneself…that would be a disorder.
- Mother: [covers her daughter’s ears] Are you saying she’s masturbating?
- House: I was trying to be discreet – there’s a child in the room!
- Cuddy [to House]: One afternoon and you’re on pace to set the record for most patients seen in a month.
- House: You’re upset that I’m doing clinic hours? Wow, that is so like rain on your wedding day.
- Cuddy [to House]: Go to your office, play with your ball, write on your whiteboard, insult your team, do whatever it is you do to figure things out.
- House: Feeling guilty? It’s not too late to change your mind. Go call the CDC, tell them you were just joshin’.
- Cuddy: Keep avoiding Foreman’s case until he dies. Then I’ll drown in guilt.
- House [to Foreman]: Philosophical question: how do you want to die?
- Foreman: Old age.
- House: Your choice is currently between four hours from now and 14 hours from now, so I’m assuming that means you want the latter.
- Wilson: You’ve got to stop blaming Cuddy for this.
- House: Given that it is her fault, it seems appropriate.
- Wilson: That part is her fault. The part where somebody wasted his time in a basement plotting the overthrow of a government agency, that one’s on you.
- House: The only thing I can do is think. You can pretty much do that anywhere. As long as no one’s bugging me.
- Rodney Foreman [to Foreman]: I still know you’re going to a better place.
- Foreman: It’s easy for you, isn’t it? As long as you believe I’m going to a better place, dying ain’t so bad.
- Rodney Foreman: I don’t want you to be afraid.
- Foreman: If I’m not afraid to die, then what the hell should I be afraid of, Dad?
- Rodney Foreman: I thought you believed.
- Foreman: I did. Not so sure anymore.
- Rodney Foreman: I’m going to pray for you, son. I suggest you do the same.
- Cameron: Are you feeling any better?
- Foreman: I can’t breathe, I’m dizzy, and I can barely hear anything over the sounds of my lungs crackling.
- Cameron: That’s the legionella.
- Foreman: Oh. You figure that out from the symptoms or from the vial House tossed into my room?
- Cameron: I’m trying to be professional here. There’s no reason to be nasty.
- Foreman: I’m in pain.
- Cameron: So is House.
- Foreman: And he’s a delight!
- House: Cameron, what kind of illnesses affect humans but not rats?
- Cameron: Why are you asking me that?
- House: Because I’m sure you spent the first twelve years of your life dreaming of being a vet.
- Foreman: I’d rather be disabled than dead.
- House: Sure, I make it look oh-so-sexy. It’s actually not as glamorous as you may think.
- House [to Rodney Foreman]: I’ve started your son on a new course of treatment. If it works, he’ll get better. If it doesn’t, he won’t. While he’s not getting better, he’s going to experience so much pain that we’ll have to put him in a chemically-induced coma while we figure out what to do next.
- Rodney Foreman: My son says you’re a manipulative bastard.
- House: It’s a pet name. I call him Dr. Bling.
- Foreman [to Cameron]: I need your help.
- Cameron: There’s nothing I can give you for the pain.
- Foreman: I wanna be put out.
- Cameron: I can have a nurse in here in five minutes.
- Foreman: No, once I’m out, I might not come back. I’ve never done a will.
- Cameron: I’ll call a lawyer for you.
- Foreman: I want you to be my medical proxy. All the things that piss me off about you in House’s office: too emotional, too caring, too cautious… they’re all good things on this floor.
- Cameron: Your dad is...
- Foreman: No.
- Cameron: He cares about you.
- Foreman: So do you.
- Cameron: I can’t do this.
- Foreman: We expect family members to make decisions about their loved ones after a ten minute briefing that we’re agonizing over even with years of medical experience.
- Cameron: That’s from my article.
- Foreman: I’m sorry, Allison. I shouldn’t have stolen your article, I shouldn’t have exposed you. You are a friend, I need to know that we’re okay.
- Cameron: No. I’ll be your proxy, but we’re not okay. You’re scared, you’re dying, but that’s the only reason you wanna set things right. We’re gonna get you better first, and then, if you still want to apologize, I’ll be around. I’ll call that lawyer.
- Wilson [to House]: Why weren’t you with Foreman?
- House: I hang out in the basement, you rag on me. I stay in my office, you rag on me. Honky just can’t buy a break.
- Cameron [to House about Foreman’s condition]: He’s out. The EEG shows he’s still in pain, the antibiotics have had more than enough time, we’re doing the brain biopsy.
- House: Not unless you people can’t come up with something clever in the next three hours.
- Cameron: Now, we’re doing it now!
- House: Well, who died and made you boss?
- Cameron: Foreman.
- Cuddy [about Foreman’s proxy]: It’s legal.
- House: He’s out of his mind! Yesterday he was giggling about a hole in a guy’s head.
- Cuddy: Then hire a laywer and challenge it. In the mean time, Cameron’s in charge.
- Rodney Foreman: Why would he sign that?
- Cameron: It’s nothing personal, Mr. Foreman.
- Rodney Foreman: My son doesn’t trust me. How exactly is that not personal?
- Cameron: I’m sorry.
- House: You’re sorry? You’re talking about this man’s son. You’re denying him the right to be a part of..
- Cuddy: Oh, shut up, House. If you want to do the biopsy, do the biopsy. If House tries to interfere, let me know and I will take care of it.
- Cameron: Yeah, you’re a hero. If it wasn’t for you, we’d be cutting into a dead guy’s head instead of Foreman’s. Sorry. Thanks.
- Foreman: I'm sorry House tried to use my dad to manipulate you. You've got integrity. You aren't going to change your mind just because you're confronted by my father.
- Cuddy: Thank you.
- Foreman: Just like I'm not going to forgive you just because you come by and ask how I'm feeling.
- Cuddy: You know I've had no choice...
- Foreman: Of course you've had a choice!
- Cuddy: Regulations are clear--
- Foreman: And the punishment for violating those regulations?! Is it death? Hmm? Because, frankly, I'm okay if you get a fine, a suspension...hell, you can spend a couple years in jail if it saves my life!
Zebra Factor 8/10
Primary Amoebic Meningoencephalitis is incredibly rare and most times fatal, although there have been four well-documented survivors in North America. According to the Centers for Disease Control, there have only been a total of 30 confirmed cases in the United States between the years 2000 and 2009. As of 2010, there have only been a total of 58 confirmed cases of N. fowleri-induced PAM since its discovery as an infectious parasite in 1965. It takes 15 days for symptoms to appear and another 2 weeks until death, also symptoms do not include giggling or euphoria.
Cuddy refuses to allow House to cut into a deceased Joe's infected brain after he passes away in "Euphoria Part 1" citing that it could cause a public health crisis, but allows House to cut into Foreman's "live" infected brain.
When House diagnoses Foreman to be having listeria infection he gives him "Amp and gent" (Ampicillin and gentamycin) tablets. Gentamycin is an aminoglycoside group of antibiotic that is not absorbed enterically. So it is always given by injection. A similar error was made in TB or Not TB episode.
Trivia and Cultural References
- House has to use four euphemisms for “masturbation” with the clinic mom before she understands what he’s talking about. He uses “hoohoo“ (itself a euphemism for vagina that was used in another episode), March of the Penguins, Divine Secrets of the Ya-Ya Sisterhood and Finding Nemo. Finding Nemo was also referenced in Safe
- In the summer of 2011, there were several cases of nægleria in the south-eastern United States, resulting in three deaths. https://web.archive.org/web/20111013123239/http://news.yahoo.com/3-die-rare-brain-infection-amoeba-water-001505888.html
- While talking to Cuddy, House references Jack Bauer, who is the main character on the hit TV series 24, played by Kiefer Sutherland.
- Though Nægleria fowleri is a common freshwater amoeba, infection is extremely rare. This is primarily due to two aspects of the parasite. First, the amoeba is only infectious in its amoeboid or flagellated forms, which it assumes in very warm environments, which is why infection is most common in warm climates. Secondly, contaminated water must be present very far up in the nasal passages to cause infection, as it must attach itself to the olfactory nerve and migrate to the frontal lobe of the cerebral cortex. Thus, the likelihood of Joe or Foreman being infected by aerosol from Joe's marijuana irrigation system in upstate New Jersey is next to nil.
- Nægleria fowleri infectionshave an exceptionally high mortality rate (~98%), even when diagnosed and treated early. Therefore, the odds of Foreman surviving would have been very low, particularly considering how advanced the disease had progressed prior to treatment.
A mother comes in with her young daughter believing her daughter is exhibiting the symptoms of epilepsy. However, House cannot induce a seizure. House notes that the little girl doesn't mind having the seizure. He diagnoses her with gratification disorder - she's been masturbating. When the mother is horrified, House tells her that epilepsy would be the horrifying diagnosis and to teach her daughter about privacy.
Euphoria (Part 1)
Euphoria (Part 2)