Gary H. Wright was the african-american senator who was running for president in the epiosde Role Model. The character is loosely based on the then junior U.S. Senator from Illinois, Barack Obama.
Medical History
Gary had had seizures due to childhood epilepsy. During one seizure, he bit through his [[tongue]. However, the seizures stopped when he was 6, and he hadn't taken medication for them since he was 8. He did not disclose his epilepsy to the medical team and explained the tongue scar as a childhood injury.
Case History
Gary was giving a speech to a large crowd when he started feeling nauseous and disoriented. His assistant finished the speech for him. He assured his assistant he was fine. As he left the dias, someone started talking to him, and he developed double vision and felt dizzy. He threw-up on the person he was talking to. He was taken to Princeton-Plainsboro Teaching Hospital.
The chairman of the board of directors brought the case to House. House thought that it was just food poisoning, the most likely diagnosis for nausea headache and mental confusion. However, Mr. Vogler insisted that he examine the patient.
After dismissing the media and the patient's staff , Dr. Foreman performed the examination with Dr. House observing. No one else at the fundraiser had been ill, and the patient put his symptoms down to travelling a lot. The patient had a scar on his tongue and told Dr. Foreman that when he was 6, he fell off the swing and bit his tongue. Foreman tested his reflexes, but there was no response. Dr. House tested the reflex himself and also found no response. This appeared to indicate a problem with the patient's brain. House told Foreman to give the patient an MRI and a lumbar puncture.
The LP showed no sign of infection and the MRI was fairly clean. There was a small lesion in the patient's Broca's area, which Dr. Chase put down to background noise. However, Dr. House thought that it might have been an infection or a tumor. Dr. House wanted to do a brain biopsy. However, Dr. Cuddy didn't want him to proceed merely on the basis of a small spot because the biopsy could cause permanent neurological damage. However, Dr. House pointed out the danger of a tumor. They decided to let Gary decide and both of them went to argue their side to the patient. Dr. Cuddy thought the symptoms were merely the result of a transient iscemic attack and recommended observation. The patient was concerned about the publicity over the brain biopsy and how it would affect voters' opinion of him. House told him that it could leave him brain damaged. Hoewver, the patient agreed to the biopsy.
The lesion wasn't a tumor or a bacterial infection. Dr. Wilson told them that it was toxoplasmosis, a fungus. This could only mean that Gary had full-blown AIDS. Dr. Foreman told Gary about the toxoplasmosis being in the brain meant he had AIDS, although the toxoplasmosis was easily treated. Foreman told him that people with HIV could live a long time. Gary asked what else could cause it. Dr. Foreman said there were certain cancers that could cause the same symptoms, but Dr. House argued that it was definitely AIDS. Gary told them that he didn't use drugs and he hadn't had sex for some time. Gary refused to take the anti-retrovirals until he was tested for HIV under a false name, give him the drugs for the toxo only and test him for cancer. However, Dr. House warned that treating the toxo without treating the AIDS would most likely kill him. Dr. House ordered his team to rush the HIV test and check for cancer.
Dr. Foreman did a bone marrow biopsy to check for bone cancer. Foreman asked if he wanted to wait until the HIV test came back to do the biopsy. Gary told him he didn't want to wait and insisted he wasn't lying about his life history.
Dr. House gave Gary the results, they were positive for HIV. The patient took the anti-retrovirals. His T-cell count was eight which meant that there was a good chance he would die. House alson needed to contact his sexual partners. The patient once again told House he had only had two girlfriends and consistently used condoms. Dr. House insisted that the patient stop lying, but Gary called House a coward who is scared to take chances. Gary told him that he believed in people, he would rather think that people are good and be disappointed once and again. He asked Dr. House to believe him. Dr. House ran the HIV test again.
Gary tried to get out of the bed, but couldn't move his legs. Dr. Cuddy wondered why the patient wasn't responding to the anti-retrovirals. Dr. House discontinued the antiretrovirals when the second test came back negative. Dr. House told him that he didn't have AIDS, but he was still dying. However, Dr. House did not know what the problem was.
Gary continued to get worse, with loss of control of the muscles on the right side of his body, he was losing the ability to concentrate and his T-cell count was still very low. Dr. House re-checked the HIV test and it was negative again. Dr. Chase thought it might be an immunoglobulin deficiency, but there was no history of respiratory problems. Dr. Cameron thought it might be ideopathic T-cell deficiency, but Dr. House pointed out that this only meant that they couldn't explain the cause for the deficiency. Dr. House finally told them to do a whole body scan, despite the fact that they are usually useless. However, they had no other course of action.
As expected, the scan showed numerous small abnormalities like a slightly enlarged lymph nodes in his left armpit, neck and groin and liver cysts that exhibited spontaneous bleeding - a sign they were benign. The biopsied them all and found that they were all benign. The only interesting result was signes of CBLM antibodies, but not enough to indicate lymphoma. Dr. House suggested hairy-cell leukemia, but this would have shown up in all the lymph nodes, and Dr. Chase pointed out the patient's spleen wasn't enlarged. Dr. House wanted to biopsy Gary's spleen despite the risk of him bleeding to death or developing sepsis, because that was could confirm hairy-cell. Dr. Foreman pointed out the patient's brain was continuing to deteriorate. Cuddy was opposed, but agreed.
Dr. Foreman went to Gary to seek consent for the spleen biopsy. However, the patient was having trouble breathing. Gary wanted to consent, but Dr. Foreman realized they couldn't do the biopsy with him in this condition - the patient's 02 stats were at 89 and a stain showed he had developed pneumocystic cardii pneumonia from another fungus. The second fungal infection was consistent with hairy cell, but his platelet clot had dropped to 20 which meant a spleen biopsy would definitely cause him to bleed to death. The previous bone marrow biopsy was inconclusive. Hairy cell leukemia was the most likely diagnosis, but there was no way to test for it. However, Dr. House suggested they look for other viruses such as HTLV and ATLV which accompany hairy-cell.
However, all the tests were negative, ruling out hairy cell. The only virus the patient was positive for was Epstein-Barr virus, but that doesn't indicate hairy cell leukemia. Dr. House rushed to the patient's room and realized he didn't damage his tongue in an accident, he must have had an epileptic seizure. Dr. House removed the patient's oxygen, but he insisted he bit his tongue when he was six. He denied being on medication for seizures since he was ten, but Dr. House got himn to admit he had taken fenetoyne. Together with the Epstein-Barr virus, it caused common variable immunodeficiency disease, which causes a deficiency in T-cells, B-cells, immunoglobulin and antibodies. Dr. Chase points out he guessed the patient had an immunoglobulin deficiency earlier, but Dr. House rejected it based on the fact it is generally a childhood disease. However, the patient got the disease as a child, but it didn't manifest itself until he was under the stress of campaigning. However, Dr. Cameron pointed out that the diagnosis was still unlikely. He orders them to treat him for it despite how unlikely it might be and ordered immunoglobulin. Over the next week, the patient starts improving until his speech and reflexes return to normal, and his T-cell count rises above 100 and his white blood cell count returns to normal. Although the condition can't be cured, it can be treated with medication he will have to take for the rest of his life. They tell him he can continue to run for office and that Kennedy had Addison's disease and Franklin Roosevelt had polio. He admits that he won't win, but says that House is wrong about always having to win.