Fetal Position

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Cuddy: Do you think I'm an idiot?

House: You're not objective. But you're not an idiot.

―Fetal Position

Fetal Position is a third season episode of House that first aired on April 3, 2007. House treats a famous forty-two-year-old photographer who suffers a stroke in the middle of her pregnancy. House quickly diagnoses what's wrong but it appears the only way to save the patient is to terminate the pregnancy. However, when the patient presses for another answer, Cuddy throws House off the case and starts treatments so dangerous that even House's team realizes House wouldn't try the same thing no matter what the stakes. Even Wilson fails to get Cuddy to play it safe. However, when Cuddy must turn back to House for help and with an even crazier idea proposed by Chase, they come up with a "Hail Mary" that could almost certainly result in the death of both the patient and her unborn son.

Recap[]

A pregnant 42-year-old photographer arrives at a photo shoot and realizes she is suffering the symptoms of a stroke. She collapses right after telling everyone to call 911.

The photographer is taken to Princeton-Plainsboro, where she is admitted and is met by House. He tells her that although her symptoms have disappeared, it might happen again unless he can figure out the underlying cause. She tells House she was artificially inseminated. House looks at the blood in her urine and realizes that her kidneys are failing.

House finds the team looking at a photo of him taken by the photographer. He takes down the photo and starts the differential. Cameron thinks that the kidney problems started before the stroke, but House thinks it is unlikely. House starts talking about his vacation plans to the Galapagos Islands. He thinks it more likely to be a heart problem brought about by a strep throat, since most strep patients fail to take all their medication, allowing the illness to lie in wait.

Cameron and Chase are doing an MRI and discussing what to do now that House knows about their relationship. They find a small problem with the patient's mitral valve and start a procedure to treat her. The procedure goes well.

Meanwhile, House is arranging a vacation flight, this time to Cambodia. The team comes in to say the treatment of the patient's mitral valve hasn't helped her kidneys. They come up with five possible diagnoses and House tells them to narrow it down to one. However, none of the diagnoses turn out to be correct. House comes up with the only possible conclusion—the patient is healthy but her unborn child is ill.

The patient has maternal mirror syndrome. A fetus in distress can kill the mother, but treating the fetus will cure the mother. It's difficult to diagnose the problem, although there are only a few things that cause mirror syndrome and they're all treatable. House suggests paralyzing the fetus to take a better MRI.

Cuddy hears about the procedure and objects, but House convinces her it's the only way to save the fetus. He also tells Cuddy about Cameron and Chase having a relationship. Cuddy and House both convince the patient it's the only way to proceed. The patient consents and House starts the procedure. Unfortunately, the problem isn't with the fetus' heart, but its bladder. After Cameron informs Cuddy, Cuddy wants to do surgery to correct the problem. She then warns Cameron against having a relationship with Chase, telling her she will either end up hurt or possibly fired.

Cameron finds House in the hyperbaric chamber and confronts him about telling Cuddy about her relationship with Chase. House is in the chamber because he now says he is going to climb a mountain and will save time if he adjusts his red blood cell content with low pressure. Cameron questions House's ability to climb, but he replies that he will hire guides who will carry him up the mountain.

Cuddy tells the patient about the procedure, which carries risks. She advises the patient that she can try again in the future to have a baby. The patient resists losing the baby because she is 42 and has already had two miscarriages.

House challenges Cuddy's conclusions and tells her she will have to do three bladder taps on the fetus before she obtains urine fresh enough to predict if the procedure will work. He tells Cuddy she's not being objective because the patient, like Cuddy, is a single woman in her forties who wants to have a baby. She tells House he can't go on vacation until he's done treating the patient.

Chase tells the patient that they can proceed, although the baby will need surgery after it is born. The patient knows about his feelings for Cameron, having seen the way he looks at her. She takes a photo of him examining a picture of Cameron.

They proceed with the shunt, which appears to relieve the pressure on the fetus' bladder. Cameron and Chase once again discuss their relationship. The patient starts complaining of stomach pain and Cameron notices she is jaundiced, meaning her liver is shutting down. House realizes the blocked urinary tract may not have been the only problem. He recommends to the patient that she terminate the pregnancy. However, the patient wants to wait two more weeks until the fetus is viable. House tells her she's already on dialysis and her liver is shutting down—she won't live more than two days. She still insists on not terminating the pregnancy. House tells her that this isn't the choice—either the fetus dies or they both die. She still won't agree to the termination.

House tries to convince Cuddy of the need terminate the pregnancy. Cuddy is not sympathetic and backs the patient's position. She starts her own differential using House's team, but they agree with House—it's mirror syndrome. Cuddy gets desperate and suggests the liver problem is unrelated to the mirror syndrome. The team gives some possible diagnoses, but House shoots them down. Cuddy suggests a liver biopsy, but the patient is so weak that the only way to do it is to go down from her jugular vein. When House shows contempt, she tells him to go on vacation.

The team starts the biopsy. Foreman and Chase talk about Chase's relationship with Cameron. During the procedure, the patient goes into preterm labor, but the team stops it. The biopsy is negative. The team comes back unanimous that it's mirror syndrome and suggest termination. Cuddy insists on trying to treat the patient, but the team supports House. Cuddy gives the fetus extra doses of steroids to help develop its lungs. The team realizes she is out of control, but their usual course of action when House is out of control, telling Cuddy, won't work. They need someone to be Cuddy's "Cuddy", and turn to Wilson, who also tells Cuddy to terminate when she nearly kills the patient by giving her the steroids. She throws him out of the room.

Cuddy later goes to Wilson to apologize and to consult on what House would do. The patient is getting worse. Wilson reminds Cuddy that House would terminate the pregnancy and be objective about the patient's life. Still resistant to terminating the pregnancy, Cuddy decides to put the patient back on steroids because the patient is already on a respirator, so it doesn't matter if she is unable to breath on her own. It works and the fetus' lungs start to expand. Cuddy returns to House for help. He tells her she's not being objective, but admits she's not an idiot. They take a look at a new scan of the fetus' lungs, noticing tissue buds in them that, after a few suggestions, lead House to believe it be Congenital cystic adenomatoid malformation AKA CCAM. House returns to the hospital to do a new differential. Chase suggests doing exploratory surgery on the fetus, and House surprisingly agrees. He and Cuddy go to the patient to get consent. Cuddy tells her that the procedure is incredibly dangerous to her and the fetus but it's the only remaining option. The patient agrees to the procedure.

The surgery proceeds to a standing room only crowd in the operating theater. The fetus reaches out and grabs House's finger during the surgery, causing him to take an uncharacteristic pause for a more than a few seconds and enter into deep thought. He jokes that he forgot to TiVo "Alien" in order to recover from his pause. The surgeon confirms the fetus to have CCAM by finding lesions that he can correct, but the mother goes into ventricular fibrillation. House says the only way to save the mother is to take out the fetus, but Cuddy strongly insists on shocking the heart and forced House to back off. After numerous tries the patient's heart starts beating again, and Cuddy tells the surgeon to complete the surgery.

The patient and fetus recover. House starts calling the fetus a baby. The patient thanks House, but he reminds her he wanted to kill the fetus.

Cameron finds the picture of Chase that was taken when he was thinking about her. Cameron says the picture makes him look like he's glowing, but he says he always looks like that.

Cuddy catches House as he's leaving and gives him a first class ticket to Vancouver Island. She boasts she saved two lives, but House reminds her that she wasn't being objective, and 99 times out of 100, both mother and fetus would have died. She tells him to go on vacation and be happy.

House goes home and tears up the plane ticket. He takes his phone off the hook and sits down to watch travel videos on the Galápagos Islands.

Months later, we see the patient hanging up photos of the hospital staff in her apartment and taking care of her new baby boy. House's picture is conspicuous by its absence.

Major Events[]

House starts planning his vacation.
House reveals to Cuddy and Foreman that Chase and Cameron are sleeping together.
Cuddy confronts Cameron over her relationship with Chase.
Cuddy takes over as the Attending for Emma Sloan, the photographer experiencing problems with her baby. In the progress, Cuddy also develops an obsession with saving Sloan's unborn baby.
House puts his vacation plans on hold to help Cuddy and his team.

Zebra Factor 5/10[]

Maternal mirror syndrome is somewhat rare, occurring in only about 1 in 40,000 pregnancies. The conditions that caused it here are somewhat more common, but can usually be treated post-partum as they don't always cause mirror syndrome as well.

Goofs[]

The building Emma is seen caring for her baby in at the end of the episode is the exact same location as the photo shoot at the beginning of the episode. It's possible she brought her newborn into her professional photo studio, but it looks decorated with personal belongings including her 'visual memory book' of her pregnancy, a bike and PC. Unless she was biking into work with her baby, it's more likely the location was reused in hopes the audience wouldn't notice.

Trivia & Cultural References[]

The baby Cuddy is looking at in the nursery while she ponders the case is named Arthur, a reference to Sir Arthur Conan Doyle the author of Sherlock Holmes who House is based on.
Tyson Ritter of The All-American Rejects appears as himself.
Norman Rockwell is an American illustrator who is best known for his drawings of Americana for the covers of the Saturday Evening Post.
Scarlett Johansson is an American actress.
The Galápagos Islands are a group of islands in the Pacific Ocean off the shore of Ecuador. They are best known for hosting the naturalist Charles Darwin during his trip around the world on the Beagle.
More about Frankfurt, Germany, Taipei, Taiwan, Singapore, and London, Ontario, Canada (Birthplace of creator David Shore, and also harbouring a board certified nephrologist named Dr. House)
Phnom Penh, is the capital city of Cambodia.
More about the Mekong giant catfish.
wikipedia:Aconcagua Aconcagua is the highest mountain in the Americas and the highest outside of Asia, rising to 22,841 ft. above sea level.
The Mocoví are a group of native Americans who reside in the Gran Chaco area divided between Bolivia, Paraguay, and Argentina.
The Johnstone Strait separates Vancouver Island from the mainland of British Columbia.
TiVo is a brand of hard drive video recorder that has its own subscription service.
Alien is a 1979 horror-science fiction film that spawned three sequels and one prequel.
The scene in which the fetus grabs House's finger during surgery is based upon the real-life story of Samuel Armas whose own in-utero surgery for spina bifida was immortalized by a photographer who captured his hand being pushed back into the womb by the surgeon. (According to the surgeon.)
When House walks into Emma's room, he says, "Me again, your friendly neighborhood belly squirter." This is a reference to Marvel Comics superhero Spider-Man, who is known as "Your friendly neighborhood Spider-Man!"

Cast[]

Links[]

Helpful hints[]

At the beginning of the episode, the patient realizes she is suffering from visual aphasia, and recites a mnemonic "FAST" to determine if she is suffering from a stroke that was taught to her by her baby's biological father, a neurologist.

Face: She asks if her smile is crooked, as often the first symptom is often loss of muscle control on the left side of the face.
Arms: She holds her arms out straight in front of her, but cannot maintain them at the same level.
Speech: She realizes her speech is slurring.
Time: She realizes that she will recover if she is treated right away and tells the people around her to call 911.

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Top Secret

Fetal Position

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Airborne