Human Error

Episodes • 1 • 2 • 3 • 4 • 5 • 6 • 7 • 8

House: "My patient has no heartbeat. It stopped when we inserted a catheter during a routine angiogram. Anyone tells me why her heart stopped gets an A in Dr. Cuddy’s class"

Student: "Human Error?"

House: "Yeah. I’m polling first-year medical students because I hadn’t considered human error."

— Human Error

Human Error is the 3rd season finale episode of House which first aired on May 29, 2007. A pair of Cubans make a dangerous attempt to escape Cuba merely so that they can meet House to diagnose the wife’s illness, which has stumped the Cuban doctors. When the patient suffers a huge reversal and it seems the only cause could be Foreman screwing up, House refuses to accept it and desperately looks for another cause. However, when the patient makes a seemingly miraculous recovery, House must instead convince the patient and her husband to let him keep looking.

Meanwhile, House’s team falls apart. When Chase challenges House’s refusal to make any effort to keep Foreman on the team, House responds by firing Chase. When House does finally make a stab at keeping Foreman on the team, Cameron finds herself making big decisions instead.

Recap

A pair of Cuban refugees are rescued in a storm. The rescuers can't understand why the husband refused to abandon his suitcase, but he explains it contained his wife's medical records. At first, the rescuers believe that the Cubans want to go home, but they explain that they want to see Dr. House.

Meanwhile, House is lying low at the hospital until Wilson finds him and tells him about the Cuban woman, who risked a treacherous sea voyage just to see him. He also reminds House to do something about keeping Foreman, but House doesn't see what he can do. Wilson tells him that Foreman doesn't want to become like House, and tells House that Foreman has a skewed view of House's real personality.

The team does a differential. Chase believes it is either an infectious disease or parasite. However, House knows that Cuban doctors are competent and would have ruled that out. However, Cubans don't have expensive scanning technology so House orders a series of tests.

Chase examines the husband while Cameron examines the wife. The husband is upset that House isn't examining his wife, but Chase tells him that House doesn't care about patients.

House seems to be acting particularly nice to Foreman and agrees to let him treat the wife for multiple sclerosis. The husband objects because he figures the Cuban doctors would have found that. Sure enough, when they do treat her, her pain gets worse. When Foreman checks her range of motion, he accidentally breaks her forearm.

House is surprised by the new symptom, but continues to be supportive of Foreman. The most likely explanation seems to be bone cancer. Chase is enraged - he tells House that he can't expect to be nice to Foreman for a few hours to get him to change his mind. House orders a PET scan.

Chase goes to see House to apologize, but instead House fires him, ostensibly because he's been on the team too long.

Foreman and Cameron are doing a PET scan on the wife. Chase comes in and tells them he's been fired. His colleagues are shocked, but Chase manages to spot something on the scan.

Foreman and Cameron confront House about firing Chase. Then Wilson and Cuddy come in and confront House as well. House wants to know how the PET scan turned out. Cuddy orders House to re-hire Chase, but House refuses and instead leaves a message for Chase to tell him about the PET scan. Chase phones back and House manages to find out the wife has a blood clot in her arm. He still tells Chase he's fired. House orders an angiogram of the patient.

The husband is angry that House hasn't found out what's wrong. To get back at House, Foreman gives the husband House's home phone number, and tells him to keep calling until House answers.

Foreman and Cameron prepare for the angiogram. As they perform it, House bursts in and asks who gave the husband his phone number. At that moment, the wife's heart stops beating, although she can still speak. As the patient goes into cardiac arrest and finally loses consciousness, he orders his team to keep her alive until he can figure out why her heart stopped.

House goes to interrupt Wilson in surgery to ask what could stop a heart during an angiogram. The only thing that Wilson can think of is human error, but House rules that out.

Cameron and Foreman get help to continue to do CPR, but plan to put the patient on bypass as soon as possible. However, they can’t get in touch with House.

Next, House confronts Cuddy and the students she's leading through rounds with the same question. One student suggests human error and House shoots her down. However, they can't come up with an answer either. Cuddy finds out that the wife is still not on heart-lung bypass and orders House to get her on despite the risk of clotting.

The husband finds out about his wife and confronts House, asking him how he can fix something without looking at it. As a result, House goes to the wife, who is being put on bypass. He asks the surgeon to defibrilate the heart. The surgeon does so several times and pronounces the patient dead because her heart won‘t start again.

Cameron tells Foreman she will miss him, and Foreman admits he will miss Cameron as well. Cameron gives Foreman a framed copy of the article that they had previously argued over. House goes to his team and tells them they still need to find out why her heart stopped. They can't see the point.

Cameron goes to find Chase in a bar. She tells him she will miss him. Chase admits it was stupid for him to tell Cameron that he liked her every Tuesday. Cameron turns down Chase's invitation to sit down for a drink.

Cuddy visits House in his office. House is afraid that once they do an autopsy, it will be obvious why the patient’s heart stopped. Cuddy tells him to face facts and tell the husband nothing more can be done.

House goes to the husband and tells him that although his wife's brain appears to be fine, there is nothing they can do for her heart. The husband agrees to take her off bypass, and they shut off the machine. However, the wife still has a heartbeat, and she starts speaking again. House turns the heart monitor back on and it shows a normal sinus rhythm and heart rate. House is dumbfounded.

The wife remains stable and her other symptoms disappear. While everyone is convinced it is a miracle, House is convinced there is an underlying condition that will most likely recur if it isn't treated, perhaps a congenital heart defect. He manages to convince the couple to let him try the angiogram again despite the risk.

House performs the angiogram and all goes well. House finds that the patient has a third coronary ostium at the root of her aorta. The ostium is doing nothing but serving as a site for infection. It can be corrected with surgery.

Cameron arrives at Chase's house and asks him to tell her that he likes her. He says it's only Monday. She tells him she couldn't wait.

House finally meets with Foreman to talk to him about staying. They get into an argument about their respective philosophies about dealing with patients, not just diseases. House lashes out at Foreman and Foreman leaves.

Cameron comes in with a letter of resignation, saying she's learned all she can. House reacts with a joke, which is exactly what she expected.

House shares a cigar with the husband. The husband asks House how he feels about losing his entire staff. House tells him he doesn't feel anything about it, but he thinks he’s okay. However, he has no idea what he is going to do.

At the end, we see House opening a large box which has arrived at his home. It is a new guitar to replace the one he has been playing since he was thirteen. It appears to signal House's ability to change things and people in his life, and his acceptance of letting Foreman, Chase and Cameron go.

Zebra Factor 10/10

In normal anatomy, there are only two coronary ostia at the root of the aorta, one for each of the two coronary arteries. Anatomic variation/congenital heart defect can change the location and number of these openings: a third, fourth, or even fifth coronary ostium is not unheard of, however, they are still rather rare. In most cases, the defects are caught soon after birth, but individuals who live to adulthood are usually asymptomatic or their first clinical sign is sudden death.[1] [2]

Major Events

The hospital holds a farewell party for Foreman.
House fires Chase, telling him it's time for a change.
Foreman, Cameron, Wilson and Cuddy confront House over his sacking of Chase.
Chase and Cameron rekindle their relationship.
House finally admits to Foreman that he wants him to stay but Foreman declines.
Cameron resigns from the team as well.
With Chase, Cameron and Foreman now gone, House is left without a Diagnostics team to help him.

Trivia & Cultural References

More about Healthcare in Cuba
The journal that Cameron gives to Foreman, containing the article he stole from her the previous season, is the fictional “Midwest Journal of Experimental Medicine”. His article is entitled “Cerebral Magnetic Resonance Angiography Enhanced by Rapid Auto-Transfusion During Hypothermic Circulatory Arrest”. The journal appears to be based on the real life Journal of Experimental Medicine
House is correct that Estaban can’t get American cigars in Cuba. Due to the United States embargo against Cuba, trade in most items between the two nations is completely restricted. As a result, Cuban cigars and other goods are similarly illegal in the United States even if they are imported from a third country.
When the wife wakes up, she asks if she is in heaven, to which House responds that it's New Jersey. His response parodies the film Field of Dreams where a similar exchange takes place regarding Iowa.
After Wilson tells him he had another satisfied customer, House replies with "One more and I get a set of steak knives," the same line uttered by Tom Cruise's character in A Few Good Men

Goofs

At one point, Wilson mentions that House drives a ten-year-old car. In fact, in 2007, House's car would have been at least seventeen.

In real life

Human error in a dye injection catheterization actually led to a great medical breakthrough in 1958. Dr. F. Mason Sones was performing a routine dye injection which, at that time, meant injecting the dye into aortic valve because too much dye anywhere else would reduce the flow of blood, resulting in the death of the patient. By accident, Dr. Sones injected the dye into the right coronary artery instead. The patient's heart immediately stopped, but the patient inexplicably remained conscious. Dr. Sones told the patient to cough and, when he did, the heart started beating again. In addition, the dye went entirely throughout the heart, giving the doctors a perfect image of all the blood vessels in the heart. The technique, with a little adjustment to reduce the amount of the dye, is now a standard diagnostic practice.

Cast

Hugh Laurie as Gregory House
Lisa Edelstein as Lisa Cuddy
Omar Epps as Eric Foreman
Robert Sean Leonard as James Wilson
Jennifer Morrison as Allison Cameron
Jesse Spencer as Robert Chase
Omar Avila as Esteban Hernandez
Mercedes Renard as Marina Hernandez
Stephen Markle as Dr. Gooding
Tiya Sircar as Student One
John Bobek as Student Two
Kathryn Adams as Number 23 (Credited as "Pretty Student #3")
Ken Luckey as Ken Sowinski
Lucas Ford as Pilot
Eltony Williams as Co-pilot
Helena Apothaker as Nurse Ellen Hoffner (Credited as "Nurse #3")

Links

Previous episode:
The Jerk

Human Error

Next episode:
Alone