Changes: House's Head

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"Your legs are not your biggest problem. Your biggest problem is …I don’t know what your biggest problem is."

―House’s Head

House's Head is a 4th season episode of House which first aired on May 12, 2008. House suffers a concussion in a horrendous bus accident and loses his memory of the events just before the crash. However, as he starts to recover his memory, he becomes sure that one of his fellow passengers was suffering a life-threatening illness and risks his own recovery in order to prove that he was right.

This episode finished 8th in Facebook's poll of the best episodes of the series completed in April, 2012.

Recap

House is at a strip club, but he is having flashbacks about injured people. He thinks he's drunk and starts testing his memory with one of the strippers giving him random animal names. He then notices he's bleeding, but he can't find a wound. However, he has blood all over him. The stripper sees a wound on his head and House realizes he has a concussion and retrograde amnesia. He thinks he‘s been mugged but the stripper tells him he paid for his dance with a $20 bill. When he closes his eyes he sees someone he's seen who is seriously ill and is going to die, but he can't remember who. He leaves the club and finds himself at the scene of a huge accident, an overturned bus.

House is at the emergency room being treated for his concussion. He's talking to Wilson with Cameron suturing his head wound. His team comes and he orders them to take a medical history from everyone in the ER to find the person with the mystery symptom. His cane and motorcycle are missing too, and he tells Kutner to find it. He starts to think it might be the bus driver.

They find the bus driver. House thinks he has signs of leukemia, but it's just the bruise from his seat belt. The driver said he hit a garbage truck. House doesn't want anyone from the ER to leave, so he claims one of the patients has meningitis.

House is trying to reconstruct what he did after he left the hospital the previous night. The team has tracked down all the bus passengers, and the only things wrong with them are from the accident. The team goes back to the ER and Kutner tells House to relax. Kutner suggests medical hypnosis. Chase and Wilson help House to relax so he can recover his memory. Just as House is about to quit, he visualizes the bus. He remembers he was at a bar getting drunk. Wilson wants to know why he was getting drunk without him. House remembers some people at the bar. Amber starts to impinge on his vision, and Chase manages to get House to force Wilson and Amber out of his consciousness. House remembers the bartender, who seems fine. He remembers the bartender took his keys, so he had to take the bus. He remembers a pretty girl,and a young man coughing and picking his nose.

He finds the young man and tells him he has a brain tumor. He manages to examine the patient, but he can't find any symptoms - he's fine. Cuddy wants to admit House. All of a sudden, the bus driver finds he can't move his legs.

House and his team start to do a differential on the bus driver's sudden onset paralysis. House wants to concentrate on diagnoses that would have had visible symptoms that he could have seen. When smelling coffee brings back a memory of someone on the bus drinking it. House goes to smell stuff from the bus to recover his memories. Foreman decides to give the patient antibiotics. All House can smell is exploding bus, but he takes more Vicodin and dives into the clothing. He finds himself back on the bus. The bus driver tells him he's hallucinating and he should have a CT Scan. House sees a woman who wouldn't be on the bus. Wilson revives House and gives him an MRI. The MRI shows he has a longitudinal fracture of the temporal bone which is why he has a concussion. Wilson and House start talking about why House was thinking of Amber. House says he was thinking of seeing her naked. However, Wilson realizes House has feelings for Amber instead of treating her like a sex object.

Cuddy wants House to go home and rest. Wilson wants to know why House is risking his life for this patient. House just goes to the cafeteria. He keeps working and develops severe headaches.

The bus driver starts to improve - the antibiotics appear to have worked. However, the patient's stomach starts to hurt. House thinks it might be Addison's Disease, but Foreman rules it out. Foreman notices House's ear is bleeding.

S04E15 House Chase and wilson at the bar — At the bar

House decides to go into a sensory deprivation tank. He sees Cuddy on the bus. House starts fantasizing about her, but she's also talking about the patient's symptoms. When stripper Cuddy figures out she’s distracting him, she goes back to her usual clothing. The bus driver confronts him about his own symptoms. All of a sudden, the wealthy woman who shouldn’t be on the bus shows up again, and House sees the driver help someone into the bus. House notices the driver is shuffling his feet, indicating Parkinson's disease. He gets out of the tank and announces it, but he suddenly vomits and collapses.

House regains consciousness. He's in his apartment with a nurse and a security guard. House realizes that the patient doesn't have Parkinson's. The team finds out House has a small skull fracture. House calls his team, who have already realized Parkinson's was the wrong diagnosis. He orders a test where the patient eats bagels on a treadmill as the nurse grabs his cell phone. House manages to dodge the nurse to call Kutner again on the nurse‘s cell phone. He listens to the patient's labored breathing. All of a sudden, the patient collapses and is wheezing. House realizes the test was pointless; he doesn't have what they were testing for.

Cuddy gives in and allows House back to the hospital. His team think it‘s a clot. As they take the patient to the operating room, House thinks that an air bubble got under his dental caps. That would have caused a myoclonic jerk which House saw. House manages to isolate himself, Thirteen and the patient in a locked room. Cuddy refers to her as "Dr. Hadley" and tells her to open the door, but House replies that "Cuddy doesn't even know your name." Thirteen trusts him and grabs a syringe. She finds the air bubble and the patient improves immediately.

Cuddy orders House to get some sleep. He dreams about the wealthy woman who wouldn't have been on the bus. He realizes that he's missed something. He sees a necklace that appears to have a stone with a mosquito in it. He finds a tourniquet in his hand. He ties it around the woman's leg. She says she's cold. House tells her to stay with him - something he would normally say to someone he was treating who was suffering from shock. House wakes up Cuddy to tell her he saved the wrong person.

House realizes the crash caused the air bubble to dislodge, so he couldn't have seen it before the accident. Cuddy takes House's vital signs.

House grabs a bunch of volunteers and puts them on a bus. House starts to remember things, having taken Alzheimer's drugs to improve his memory. He starts having another vision and he sees the woman too wealthy to be on the bus. He can't figure out who she is. He sees her necklace is made of a resin, but eventually realizes what it really signifies - amber. He remembers Amber was on the bus with him. He remembers that Amber was hurt and was going into shock when her thigh was impaled. Her purse was thrown clear in the crash, which is why she didn't have any identification. House tied a tourniquet around her leg and realized she was going into shock. However, he passed out and when he awoke, he saw someone carrying her off the bus. He got out of the bus by himself, disoriented by memory loss, and wound up at the strip club.

We see reality and they are giving House CPR. He tells them he remembers Amber was on the bus. Wilson realizes that he hasn't heard from her in hours, and House quickly realizes that she was one of the Jane Doe patients sent to Princeton General, and the one who is dying.

Major Events

Princeton Plainsboro becomes overwhelmed with victims from a horrific bus crash.
House becomes focused on finding out what happened before the crash and why he's missing four hours of the previous night.
Wilson gives House an MRI and learns that House is suffering from a cracked skull.
House has a vision about a young woman dressed in black who keeps asking him what her necklace is made of.
Thirteen's surname is revealed to be Hadley when Cuddy refers to her by name.
Is revealed that Thirteen was born after 1980.
House eventually realizes that the person he saw dying is none other than Amber Volakis, Wilson's girlfriend.

Zebra Factor 6/10

Air emboli are rare as physicians and dentists take great care to avoid injecting air into a vein or artery because of the risk of an embolism.

Trivia & Cultural References

The Beer brand beer is - on one hand - a presentation of House's brain not focusing on the details, such as the brand of the beer he was drinking. On the other hand, because of licensing problems, Beer brand beer is the common brand referred to in movies and television shows.
Altered States is a 1980 movie about a scientist who experiments with mind altering drugs while in a sensory deprivation tank.
MADD (Mothers Against Drunk Driving) is a non-profit organization that seeks stricter laws against drinking and driving.
This episode was ranked number 71 in The Ringer's 100 Best TV Episodes of the Century.

Goofs

At the end of the episode, Wilson and Cuddy are seen resuscitating House. During CPR, for air to reach the lungs, a person must perform mouth-to-mouth on a patient. The patient's nostrils must be pressed shut so air does not escape through their nose, and can instead enter their lungs. While Cuddy performs CPR on House, she does not pinch his nose shut. In a real situation that requires CPR, this method would be ineffective, as the air would escape through the nose without ever reaching the lungs.

After Cuddy takes House's pulse for approximately ten seconds, she tells him his heart rate is 127. To get the BPM from a short duration, a doctor could mentally multiply the count by the fraction of a minute corresponding to the duration. For example, 10 seconds is 1/6th of a minute, so one would multiply the count by 6 to get BPM, making it a multiple by 6. But 127 could not have been produced in any similar easy way because it is a prime number and not a multiple of any other number.

Cast

Notes

This episode is similar to No Reason as House has multiple hallucinations due to injuries he sustained at the beginning of the episode. House uses his own injuries to help diagnose a patient.

Limp Bizkit front man Fred Durst guest starred as the bartender

Also see the article The Bus Crash which breaks down those individual scenes.

Video

Previous episode:
Living The Dream

House's Head

Next episode:
Wilson's Heart

@@ Line 45: / Line 45: @@
 House realizes the crash caused the air bubble to dislodge, so he couldn't have seen it before the accident. Cuddy takes House's [[vital signs]].
-House grabs a bunch of volunteers and puts them on a bus. House starts to remember things, having taken [[Alzheimer's disease|Alzheimer's]] drugs to improve his memory. He starts having another vision and he sees the woman too wealthy to be on the bus. He can't figure out who she is. He sees her necklace is made of a resin, but eventually realizes what it really signifies - amber. He remembers [[Amber Volakis|Amber]] was on the bus with him. He remembers that Amber was hurt and was going into shock when her thigh was impaled. Her purse was thrown clear in the crash, which is why she didn't have any identification. House tied a tourniquet around her leg and realized she was going into shock. However, he passed out and when he awoke she was gone. He got out of the bus by himself, disoriented by memory loss, and wound up at the strip club.
+House grabs a bunch of volunteers and puts them on a bus. House starts to remember things, having taken [[Alzheimer's disease|Alzheimer's]] drugs to improve his memory. He starts having another vision and he sees the woman too wealthy to be on the bus. He can't figure out who she is. He sees her necklace is made of a resin, but eventually realizes what it really signifies - amber. He remembers [[Amber Volakis|Amber]] was on the bus with him. He remembers that Amber was hurt and was going into shock when her thigh was impaled. Her purse was thrown clear in the crash, which is why she didn't have any identification. House tied a tourniquet around her leg and realized she was going into shock. However, he passed out and when he awoke, he saw someone carrying her off the bus. He got out of the bus by himself, disoriented by memory loss, and wound up at the strip club.
 We see reality and they are giving House [[cardiopulmonary resuscitation|CPR]]. He tells them he remembers Amber was on the bus. Wilson realizes that he hasn't heard from her in hours, and House quickly realizes that she was one of the Jane Doe patients sent to [[Princeton General]], and the one who is dying.
@@ Line 71: / Line 71: @@
 * At the end of the episode, Wilson and Cuddy are seen resuscitating House. During CPR, for air to reach the lungs, a person must perform mouth-to-mouth on a patient. The patient's nostrils must be pressed shut so air does not escape through their nose, and can instead enter their lungs. While Cuddy performs CPR on House, she does not pinch his nose shut. In a real situation that requires CPR, this method would be ineffective, as the air would escape through the nose without ever reaching the lungs.
+* After Cuddy takes House's pulse for approximately ten seconds, she tells him his heart rate is 127. To get the BPM from a short duration, a  doctor could mentally multiply the count by the fraction of a minute corresponding to the duration. For example, 10 seconds is 1/6th of a minute, so one would multiply the count by 6 to get BPM, making it a multiple by 6. But 127 could not have been produced in any similar easy way because it is a prime number and not a multiple of any other number.
-* Cuddy tells House that his heart rate is 127 after taking pulse for approximately ten seconds, a prime number. BPM can not be extrapolated from a reading that is a fraction of a minute.
 ==Cast==