Changes: Histories

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Foreman: "I’ve known a lot more homeless people than you have."

Wilson: "Yes, you’ve got that going for you. How could I have doubted your medical opinion."

―Histories

Histories is a first season episode of House which first aired on February 8, 2005. Wilson is convinced a homeless Jane Doe in the emergency room has a real illness, but Foreman is convinced she’s faking symptoms to stay in the hospital. House takes the case just to spite Foreman, but even when they find who she is and what’s wrong with her, the treatment makes her worse.

Recap

The woman begs to be taken into a rave party, but doesn't have the money. She pleads to find a man named James, and the doorman agrees. She is confused by the flashing lights, repeatedly calling James. A woman helps her find him, but kisses her. Another woman pushes her aside and police raid the party. She knocks over the policeman arresting the woman who pushed the gay woman aside, and falls to the floor, having a seizure. She is taken to Princeton-Plainsboro where she is admitted as a Jane Doe.

Wilson tells Foreman that although they suspected her condition was a drug overdose, her tox screen was clean. Foreman believes she might have a mental illness. They examine the patient and Foreman feels that she is faking symptoms. The patient has a seizure which turns out to be the result of low blood sugar. She is also displaying a twitch and can't remember who she is. Foreman still feels that she's faking it and wants to discharge her.

Wilson goes to House to tell him that he thinks the patient has a real problem. House wonders why Wilson is so interested in the patient and takes the case. The team does a differential, and Foreman still thinks she's faking it. House believes it's important to find out who she is. He starts going through her meagre possessions. He also points out that without memories, she can't give them a medical history. By looking at her possessions, House feels she might have an electrolyte imbalance. House tells Foreman he's taking the case because Foreman doesn't want him to.

The patient is making drawings of the doctors. Chase speaks to the patient and tells her Foreman doesn't like him either. She goes into a rage while Chase treats her and bites Foreman. Chase notes she's negative for HIV and Hepatitis C. Foreman tries to bump another patient to give the patient an MRI so he can discharge her, but Cuddy finds out about the attempt. Cuddy points out that the CT scan showed the patient has a metal pin in her arm and can't undergo an MRI. She agrees to let them remove the pin because House tells her Foreman believes it is a brain tumor.

Foreman goes out to look for where the patient was living. He trades his jacket to a homeless man to find out, and finds the patient's tent filled with bats. He also finds some papers.

The MRI is negative, but House admits he only took out the pin so that he could identify the patient (the pins have serial numbers that are tied to the patient‘s name). Most of the papers found are drawings made by the patient. The patient's name is Victoria Madsen. Her medical records start coming in, the first of which shows she’s allergic to the anemia medication they are giving her.

The patient suffers a severe allergic reaction. They inject her with epinephrine. However, they still can't determine what might be wrong with her despite finding her old hospital records. Wilson thinks that they might have been looking for ovarian cancer. House notes that paraneoplastic syndrome might account for the twitch and orders them to scan her ovaries.

House dodges clinic duty by faking a cold.

House discusses with Foreman why he doesn't like homeless people. He also asks Wilson why he cares so much about the patient.

Cuddy gets back at House for dodging clinic duty by assigning him two students to teach them about medical histories. House sends them to interview the patient they've been assigned to.

House still wonders why Foreman doesn't like homeless people. Wilson wonders why House cares.

They find a mass on her ovary. If it is cancer, the patient will not live. House tells them to treat for tuberculosis on the off-chance that it’s a tuberculoma - they can't do anything for ovarian cancer.

Foreman apologizes to the patient for not believing she was ill. She apologizes too - she took too much insulin to get into hospital. The patient starts complaining that the lights are too bright. She also has a fever of 105F. She spits out the water she is given, complaining it tastes like poison.

Foreman wants to rule out tuberculosis as the treatment isn't working, but the biopsy shows that the mass is a tuberculoma, confirming tuberculosis. House wonders why the diagnosis is right and the treatment for it is making her worse. Chase, Wilson and Foreman start arguing. House orders a chest x-ray and they put the patient in an ice bath to reduce her fever. However, the patient is still terrified of the water.

Meanwhile, the students report back to House. One says the patient hurt her wrist when she fell off her horse. The other says that she did it when she fell off her porch. House asks what the patient's weight is and what color her nose is. The patient is either under 90 pounds or has a red nose. The students realize that House knows whats wrong and ask him what it is. He hands them a huge neurology textbook and tells them it starts with "C".

The team has discovered she has an infection, most likely meningitis. House orders treatment for it. However, they find the patient, who was sedated, is not in her room.

Wilson thinks Foreman screwed up and didn‘t properly sedate the patient. Cuddy tells them to phone the police.

The students report back to House. They are guessing. House talks to the patient, a slight young teenager. She tells him he hurt her wrist when she swung at a bird but hit a ferris wheel. House tells the students its Korsakoff's syndrome. The patient is using clues to try to fill in gaps in her memory, but can't actually remember what happened. The students point out that Korsakoff starts with a "K". House tells them to treat everyone like they have it, as everybody lies. He tells them to put her on thiamine and give her some food.

The police recover the patient, who has collapsed and has heart arhythmia. House thinks it is still meningitis. The police tell House that she was lying on the grass. House figures out that the police used their taser on her, which caused the arhythmia.

Despite the treatment, the patient is getting worse. House also notes that the patient didn't respond to the first taser shot to her thigh. She turns out not to have any sensation there. Foreman thinks its diabetes mellitus. However, House jabs a needle where the patient bit Foreman, and Foreman doesn't show any reaction until he sees the needle.

The numbness, paranoia, ineffectiveness of sedatives, hydrophobia, disorientation and sensitivity to light point to only one thing - rabies, most likely from bats. The disease has progressed too far and there is nothing they can do. However, Foreman needs to have immediate treatment.

Foreman and Wilson go out to look for the man the patient was referring to - James. They find her old apartment, now abandoned. They discover that “Mr. Fury” in her comic books was her husband Paul Furia. James was her son, who died along with her husband during the car crash where she received her surgical pin. It becomes obvious that after the car crash she couldn't cope and became homeless. Foreman returns to Victoria and tells her that her husband and James forgive her. She dies peacefully.

House once again confronts Wilson about why he fought so hard for the patient. He finds out for the first time that Wilson has a brother who is homeless and he hasn't seen in nine years.

Title

Goofs

"Hydrophobia" is a frequently misunderstood term, and this episode doesn't help. Before it was called "rabies", the most common name for the disorder was "hydrophobia" as in the disease's late stages, the patient has difficulty swallowing and even taking a sip of water causes very painful spasmsl. To avoid the pain, the patient avoids drinking water and even becomes agitated when water is offered to them (the same way a person with an ulcer avoids eating because it usually brings on the symptoms, even when they should be starving). As the disease progresses further, even the thought of drinking causes a spasm in the throat that is very painful. However, the rabies virus is also transmitted through saliva and, as a result, salivary production is increased. The spasms in the throat prevent the patient from swallowing their saliva, so in both humans and other infected animals, you get the typical "foaming at the mouth".
When they suspect Victoria has bacterial meningitis, they should have acted more urgently as this can be immediately fatal. She should have received a lumbar puncture to test her cerebro-spinal fluid.
When Foreman is treated for rabies, the shot is given in his abdomen, an incredibly painful procedure. Although this was once the way rabies vaccine were given, nowadays rabies vaccine consists of one shot in the posterior and five in the muscle of the upper arm. Done carefully, the procedure is painless.
Had Foreman actually been far enough along in the disease's progression to not be feeling sensation at the site of the bite injury, the disease would most likely have been untreatable. In any event, the disease would have been progressing too quickly. Rabies is still asymptomatic after two days - it has an incubation period of at least ten days before any symptoms manifest.
All patients who are even suspected of having tuberculosis are immediately isolated and put on airborne precautions. If they are suspected of having bacterial meningitis, they are put on contact precautions. These diseases were not only suspected but confirmed, yet nobody in the patient's room wore any kind of PPE.
The Taser(TM) sequence doesn't make a lot of sense. Firstly, Tasers are illegal in New Jersey and although a police officer can get permission to use one, it's not routine for police to carry them. In addition, a police grade Taser uses two electrodes (meaning two burn marks, not one) and the voltage causes the muscles to involuntarily contract, usually resulting in the target collapsing due to lack of muscle control. Pain isn't a factor - even if Victoria's leg had been numb, the muscle still would have been effective. Moreover, it's pointless for the police officer to lie - a police grade Taser also shoots a series of ID tags that imbed in the target which identify the weapon used. .
On the $100 bill House tries to use to bribe the cop, the portrait of Benjamin Franklin is facing the wrong way. Franklin's portrait on a genuine bill faces the holder's right.
When they need to give Victoria epinephrine, they give her an intramuscular injection even though she's on an IV bag. In a situation like that, the drug can be added directly to the IV line - it's faster and safer. Minutes later, they give her haldol in the IV line.
The CA-125 test is not used to screen for or diagnose ovarian cancer - it's expensive and not definitive. It's only used for tracking a patient's progress. Moreover, as Polite Dissent pointed out, many doctors often have to talk patients out of the test because of this very problem and this episode merely perpetuates the myth of its effectiveness.
Polite Dissent specifically pointed out a common issue throughout the series - the doctors often perform all the procedures themselves. In a typical hospital setting, diagnostic procedures are usually performed by specialists. For example, Foreman does a biopsy of the ovaries, but as a neurologist, it's unlikely he would have had any training on locating the ovaries, let alone doing a biopsy.

Zebra Factor 7/10

In 2005, there was only 1 human case of rabies in the United States. During 1980--2004, a total of 56 cases of human rabies were reported in the United States. Among the 55 cases for which rabies-virus variants were obtained, 35 (64%) were associated with insectivorous bats.

However, by coincidence, New Jersey was having a rabies epidemic at about the same time the episode aired, although this was due to an outbreak in the raccoon population. A doctor in the area would have been on the lookout for possible symptoms of the disease, so in reality even this rare disease should have been caught in the emergency room.

Worldwide, the World Health Organization estimates that approximately 55,000 people die from rabies each year - mostly in Africa and Asia, and mostly from dog rabies.

Trivia & Cultural References

Mental illness is one of the major contributing factors to homelessness.
When Foreman replies that the treatment for advanced ovarian cancer is a “pine box”, he is referring to an inexpensive type of casket, often used to bury the destitute.
The massive textbook House hands the medical students is Adams and Victor’s Principles of Neurology by Allan Ropper and Robert Brown. It is a genuine medical text.
One of the businesses in Victoria's sketches is named "Kaplow's Pawn Shop"
A Taser is a weapon that delivers an electric shock that causes loss of voluntary muscle control.
House mentions he likes The O.C. (Which also was broadcast on Fox)
Victoria was the first adult patient on the series to die. The first patient to die was Baby Boy Chen-Lupino in Maternity.
The Alien movies are a series of eight sci-fi/horror movies - four main films, two spin-offs and two prequels. A common theme in the movies is a monster bursting from a person's chest.
Rabies cannot be detected in lab tests. The only way to confirm a diagnosis is by post-mortem examination of the brain.
Baby It's Cold Outside is a well known duet by Frank Loesser. It was first performed in the 1949 film "Neptune's Daughter".
When hearing that Foreman's parents have been married for forty years, Wilson exclaims "mazel tov", literally "good star" but more figuratively "congratulations". Many non-Jews are at a loss to respond, but not House, who replies in Yiddish "kein ayin hara" or "no evil eye".
The real Swedish word for "friend" is "vän".

Reviews

IMDB users rated the episode an 8.6 with 29.5% of users rating it a 10. It rated best with females age 18-29 (9.1) and worst with IMDB staff (7.5)
TV.com users rated the episode an 8.7. They voted Hugh Laurie as their Most Valuable Performer.
Polite Dissent thought the medicine was average (C through B+) and didn't comment on the dramatic plot.

Medical Ethics

Quotes

House: "Unless it's not cancer. "

Chase: "You've got to be joking."

House: " Well, hard not to. Nothing funnier than cancer."

House to Foreman:

"Go check out the 'hood, dog.'"

―Histories

Foreman: "A tuberculoma doesn't give you a temperature of 105."

Chase: "Then it's a tuberculoma and something else."

— Histories

Wilson: "The 'something else' is going to melt her brain."

House: "Poach. Better metaphor."

— Histories

Major Events

We find out about Foreman’s family for the first time - that his mother and father are still married and have been for forty years.
Wilson tells House that he has two brothers, one of whom is homeless and who he hasn't seen in nearly nine years.

Cast

Hugh Laurie as Dr. Gregory House
Lisa Edelstein as Dr. Lisa Cuddy
Omar Epps as Dr. Eric Foreman
Robert Sean Leonard as Dr. James Wilson
Jennifer Morrison as Dr. Allison Cameron
Jesse Spencer as Dr. Robert Chase
Leslie Hope as Victoria Madsen
Larry Clarke as Officer Gilmar
Smith Cho as Julia
Ogy Durham as Chris Dewey
Brandon Brocato as Phil
Suzanne Ford as Mrs. Whitney
Farrah Skyler Greye as Nurse
Leslie Karpman as Jodi
Graciella Evelina Martinez as Tall Girl
Kevin Moon as EMT
Patty Onagan as Girlfriend
Bonnie Perlman as Shelly Diamond
Troy Robinson as Cop One
Paul Sklar as Cop Two
Charles C. Stevenson Jr. as Walter

Music

Trip Like I Do by The Crystal Method
On Fire Like This by Mutayor at the rave.

Release Dates

United States - February 5, 2005 on Fox
Canada - February 5, 2005 on Global
Estonia - February 17, 2006
Hungary - May 24, 2006
Germany - July 11, 2006
Finland - November 23, 2006

In Other Languages

Links

Previous episode:
DNR

Histories

Next episode:
Detox

@@ Line 66: / Line 66: @@
 ==Goofs==
+* "Hydrophobia" is a frequently misunderstood term, and this episode doesn't help. Before it was called "rabies", the most common name for the disorder was "hydrophobia" as in the disease's late stages, the patient has difficulty swallowing and even taking a sip of water causes very painful spasmsl. To avoid the pain, the patient avoids drinking water and even becomes agitated when water is offered to them (the same way a person with an ulcer avoids eating because it usually brings on the symptoms, even when they should be starving). As the disease progresses further, even the thought of drinking causes a spasm in the throat that is very painful. However, the rabies virus is also transmitted through [[saliva]] and, as a result, salivary production is increased. The spasms in the throat prevent the patient from swallowing their saliva, so in both humans and other infected animals, you get the typical "foaming at the mouth".
 * When they suspect Victoria has bacterial meningitis, they should have acted more urgently as this can be immediately fatal. She should have received a [[lumbar puncture]] to test her [[cerebro-spinal fluid]].
 * When Foreman is treated for rabies, the shot is given in his abdomen, an incredibly painful procedure. Although this was once the way rabies vaccine were given, nowadays rabies vaccine consists of one shot in the posterior and five in the muscle of the upper arm. Done carefully, the procedure is painless.