Changes: Ignorance is Bliss

Revision as of 02:32, 14 July 2016

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Cuddy: "Question is, is this a bad agenda or a good one. Either you’re trying to screw with me, or you’re trying to show me you’ve really changed"

House: "So which is it? I’m dying to know!"

―Ignorance is Bliss

Ignorance is Bliss is a 6th season episode of House which first aired on November 23, 2009. On the eve of Thanksgiving, House and the team take on the case of James Sidas, an exceptionally brilliant physicist and author who traded his successful career for a job as a courier. For the ailing patient, intelligence is a miserable burden that has prompted depression and addiction, and this, coupled with a myriad of strange symptoms, nearly stumps the team. Meanwhile, the doctors at Princeton-Plainsboro Teaching Hospital wrestle with strained personal relationships. House will say that he loves Cuddy. This will be the first episode where Cameron is gone from the show, and after House compares Chase to Cameron he loses it and punches House.

Recap

A bookstore owner recognizes famous physicist James Sidas when he makes a delivery to his store. He asks him to sign one of Sidas's books. Sidas tries to comply, but has trouble using his hands and becomes disoriented.

House is trying to get the cafeteria cashier Daria to charge Wilson for his bagel. Cuddy comes by and pays for House. Cuddy gives him Sidas’s case. He describes Sidas's case to his team. Thirteen thinks it is an infection, but that appears to be ruled out. Taub thinks it is sickle-cell anemia, even though Sidas is Caucasian. Foreman thinks it is Thrombotic thrombocytopenic purpura and when Thirteen and Chase agree, House orders tests for it. He pages Wilson, but gets no response.

Taub and Thirteen meet the patient, who is with his wife. They ask why he isn't working in a better job given his reputation. Sidas says he doesn't like thinking so much and having so much anticipation for him. He says he is happy in his new job as a courier and he likes being happy better than being smart.

Foreman talks to Chase about Cameron, but Chase says it's over. He turns aside Foreman's offer of help.

Taub talks to Thirteen as to why the patient, with such a high IQ, seems so normal. They talk about why they returned to work for House. They confirm TTP and Taub wonders why House took the case if it was so easy. However, Taub thinks it is a test. He suggests to House they do a splenectomy because plasmapheresis has been ruled out. House agrees and assures Taub he is not just testing them. He says he took the case, even though it's easy, because he wants to find out about Sidas. House is looking for Wilson in the men’s washroom, but still can’t find him.

Wilson arrives late after a dental appointment and House asks why he hasn't been answering his pages. Wilson knew the pages were about Cuddy. House is planning to break up Lucas and Cuddy by crashing Cuddy's Thanksgiving dinner with her sister. However, House doesn't know where the sister lives and Wilson says he doesn't know either.

Sidas shows signs of improvement, but all of a sudden, it appears he is delirious. Chase realizes he is having a stroke.

They manage to treat the stroke and the patient suffers no brain damage. They realize it isn't TTP because the removal of the spleen would have improved it. Taub thinks it is a form of vasculitis, but nothing showed on the CT Scan. House is trying to find Cuddy's sister by phoning people in the phone book with Cuddy’s sister’s name in the phone book. They finally decide to test for rare toxins and do an environmental scan. Taub and Chase go to the patient's apartment and Taub asks Chase for Thanksgiving dinner. Chase figures it's just because Taub thinks he is lonely and politely declines. Taub finds a lot of Sidas's notebooks. They realize he was working on physics in high school even though he wasn't part of his homework. Chase finds hidden alcohol.

Cuddy finds House doing voluntary clinic duty. She figures he is up to something, either screwing with her or trying to show he's changed. She invites him to Thanksgiving dinner. House goes to Wilson. Wilson suggests it might be a trick, but House has checked out the address even though it is a three hour drive away.

The team reports to House that they found alcohol but no toxins. Chase thinks it is liver failure and tells House to wear a less flashy tie to dinner. Everyone seems to think it is alcoholism and Foreman wants to go for Thanksgiving and do the biopsy when they get back. House lets Foreman and Chase leave, but orders Taub and Thirteen to do the biopsy as soon as possible just in case they're wrong.

The patient denies being an alcoholic, but his wife wonders when he started drinking at all. They argue about how much he must be drinking. Taub does the biopsy.

House arrives for dinner at the address Cuddy gave him, but finds that she has misdirected him to the house of her sister, who is vacationing in Hawaii. The house sitter offers him a turkey sandwich on Cuddy's direction. Cuddy and Lucas are enjoying Thanksgiving with her family.

The biopsy shows no scarring or other signs of cirrhosis, but the blood tests show an elevated albumen level. Taub thinks it might be kidney failure. It would explain everything except the stroke, but that could be explained by a related condition. They realize they have to biopsy his kidney to find out.

Lucas arrives home to find that House, having broken in, is waiting for him and having some wine. They discuss Cuddy. House figures Cuddy is trying to figure out if he's willing to change, and he realizes she always has given him a chance, but he used up too many of them. Lucas offers a coffee, but House stands up, says he's pathetic and doesn't deserve Cuddy, and collapses on the floor. He tells Lucas he loves Cuddy.

The kidney biopsy confirms kidney failure. House has called in sick and the rest of the team tries to work it out themselves. Chase denies he had a bad time on Thanksgiving. He starts to focus on the patient's recent cough. Foreman suggests immunosuppresants and dialysis to treat the kidney failure. The rest of the team think he's trying to be in charge again, but he agrees to the treatment.

Sidas asks how long he has to be hooked up for dialysis. The wife is concerned about the changing diagnosis.

Thirteen speaks to Chase about Cameron and suggests counselling, but Chase just wants to be left alone.

Cuddy goes to confront House about what he said to Lucas last night as Lucas has broken up with her. Lucas told her he didn't realize how much there was between her and House. House can't remember much of last night or even how he got home, but admits he was drunk. Cuddy admits that she started feeling bad about giving him the wrong address, but has now realized House didn't deserve her sympathy. She tells him that there was never anything between them.

House is jubilant and brags to Wilson that he got Cuddy and Lucas to split up by lying to Lucas. Wilson says Cuddy probably hates him. When Wilson notes sarcastically that it's Lucas's fault for being so stupid, House thinks of something.

House goes to Sidas and tells him that he's stupid. He's realized that the cough syrup was his real addiction - dextromethorphan. Taken constantly, it lowers IQ. Although he's still smarter than average, he's a lot dumber than he used to be. However, dextromethorphan would also cause permanent brain damage, unless the patient used alcohol in moderation. He figures that Sidas was intentionally lowering his intelligence while maintaining his brain. Sidas admits that this was his plan - not being as smart made him less miserable. Dextromethorphan abuse explains all of his symptoms, even the coughing - a rebound effect. House orders a bowel lavage and activated charcoal to clean the drug from his system. When Sidas says he can't live without it, House tells him it's surprising what you can live without.

Sidas improves quickly and starts making physics drawings again. He tries to explain them to his wife, but he realizes it’s too advanced for her. He asks for juice to get his wife out of the room and confides in Foreman that his wife is now so much less intelligent than he is, it's like having sex with a monkey and he wishes his wife could at least spell "applied physics". Foreman asks if he would be happier without her. Sidas admits that he wouldn't, and that he owes her everything, but being as smart as he is makes him a jerk who doesn't really feel like he wants to be with her.

Sidas's wife realizes he is treating her differently. Foreman tells her not to worry, but all of a sudden Sidas cries out - he has no feeling in his legs.

Taub is discussing his decision to work for House with his wife. He says he can always make money, but he won't always have the opportunity to work with someone of House's calibre. Rachel denies it's about the money or his decision to work for House again without asking her. Her real problem is that he went from being the boss to doing grunt work for House. That's what he did when they first got married (he was an intern), and she only put up with it because she knew it would lead to something better. Now, House makes Taub miss Thanksgiving dinner. Taub gets paged.

Thirteen thinks Sidas has Vitamin B-12 deficiency, but that wouldn't cause a stroke. Foreman suggests a problem with the bone marrow, but that wouldn't explain the schistocytes they mistook as a symptom of TTP. Taub suggest lupus, but the ANA was negative. When Chase has no suggestions, House threatens to call Cameron. Foreman tries to stop House, but he's gone too far - Chase slowly walks over to House and punches him in the face. House hits the floor, still conscious, and Chase leaves the room.

Cuddy finds House in her office and asks if he's going to press charges, but he claims he tripped over an ottoman. House asks Cuddy to dinner, but she says there are witnesses to the assault. House writes it off as mass hysteria. When Cuddy says doctors can't punch each other out, House asks who got punched. When Cuddy asks if Chase needs help, House says Chase couldn't have punched anyone as he was with Chase when he tripped over the ottoman. He asks Cuddy to a movie, but she says she's not going to play his game because it isn't fun. She tells him to just do his job.

House goes to Sidas, who asks about his face. He says that he wants to ask Sidas for a differential diagnosis. Sidas doubts it will work given his lack of medical knowledge, but House says he has no-one else to ask anyway. Sidas talks about how smart they are and how lonely it is. He admits that he started abusing drugs when he unsuccessfully tried to commit suicide by jumping and he was put on narcotics for his injuries. He started to feel more normal and less isolated. He met his wife at the hospital and fell in love with her when he was high on drugs. House gives him more dextromethorphan. However, House then thinks of something - he asks which ribs he broke in the fall - it was the bottom 3 on the left side, but that was 12 years ago.

House arranges an MRI with ferrous oxide contrast. Taub says this better be important because his wife is now ready to leave him. When Chase arrives, House uses Taub as a human shield. House explains that, in a normal patient, ferrous oxide is absorbed by the spleen, unless the patient doesn't have one, in which case it is absorbed by the liver and is toxic. Chase has already removed the spleen and wonders if House thinks he missed it. The scan shows that the patient has several spleens throughout his torso. When the patient broke his ribs, the spleen ruptured, but then broke off and travelled to different parts of his body. It was TTP all along, but Chase didn't remove all of the spleens so the splenectomy was ineffective. They schedule more surgery.

Chase chases down House in the hall, and apologizes for doing so much damage. Chase says it wasn't about what House said, it was about everyone asking if he was okay about Cameron. He figured by hitting House, it would keep everyone else from talking to him about it.

Sidas recovers from surgery and plans to return to a life with his wife in it - back to dextromethorphan and being a courier. Taub wonders why House is okay with the patient's decision, and House tells him ignorance is bliss. Taub takes a picture of House's broken nose, saying he's going to put them on T-shirts and mugs. Instead, he shows the picture to his wife and says he did it himself. Rachel wonders if he is going to be fired or arrested, but he tells her not to worry. They make up.

House catches Cuddy leaving the hospital and asks if they can still be civil to each other. He offers her tickets to a carnival so she can take Rachel Cuddy. He says he bought them off a nurse, but she turns them down anyway.

House realizes that Cuddy hasn't really split up with Lucas. House tells Wilson that he's realized she just said they did so he would back off. House says he hasn't got anything else planned and that he's okay with that.

Cuddy tells Lucas that she knows that House figured out they didn't break up. When Lucas asks how she knows, she says she just knows. Lucas says maybe House isn't so bad after all. Cuddy admits that would be nice.

Clinic Patient

House starts asking about the patient's symptoms, which are vague, and all the patient's reactions are normal. The patient asks if he's always this rude and what he thinks she has. He asks, as an insurance company spy, if she shouldn't have a better job. She denies it, but he notes that the handwriting in her medical records is way too neat to be from real doctors, she's asking more questions than she's answering, and he's already searched her purse (he was looking for gum) and found the list of questions she was supposed to have memorized. He buys her silence and a show that she’s pleased with $20 so he can impress Cuddy. However, Cuddy has left for the day and the patient runs out when House looks like he wants his money back.

Major Events

House tries to break up Cuddy and Lucas's relationship. They pretend House succeeded, but then Cuddy realizes House hasn't been fooled.
We see Nurse Jeffrey Sparkman for the first time
In order to keep people from asking him about Cameron, Chase punches House. The tactic works.
Taub uses House's black eye by pretending he hit House so his wife won't be worried about him seemingly taking a step back in his career.

Title

The title of this episode comes from the last lines of the poem Ode on a Distant Prospect of Eton College by Thomas Gray: "where ignorance is bliss,/'Tis folly to be wise." It may refer to the following:

The patient prefers to dumb himself down because he is happier when he is not intelligent.
Cuddy prefers not to know if House has changed or whether he is trying to do something mean.

Zebra Factor 7/10

TTP is a very rare disease, with an incidence of about 1 in a million. It is more common in pregnant females (see Kids) but almost unknown in white Caucasian males.

Trivia & Cultural References

James Sidas is based on Wiliam James Sidis, a genius considered to have had an IQ of 250 to 300 and who would only work in menial jobs later in his life.
"MIT" is the Massachusetts Institute of Technology, one of the leading science and engineering universities in the United States.
NOVA is a long-running science program produced by Boston PBS station WGBH.
The purported photograph of a young Sidas on the back of the book is actually actor Jonathan Brandis, who committed suicide in 2003 at the age of 27.
Thanksgiving is an annual holiday in the United States, celebrated on the fourth Thursday of November. Like many holidays around the world held at harvest time, it is often when extended families get back together.
Mike Tomlin is the head coach for the Pittsburgh Steelers. House was most likely referencing the common perception that Tomlin is Omar Epps's celebrity look-alike.
House wears a Hugo Boss tie.
Toroidal helicon plasma devices are used in fusion power experiments.
Nurse Jeffrey appears for the first time.

House: "Sorry, I can’t remember if I mocked you yet for being a male nurse"

Jeffrey: "I think this counts"

―Opening salvo

An ottoman is a type of upholstered stool used as furniture, that usually matches the couch. It is named after the Ottoman Empire, where the concept originated.
At the end of the episode, when talking to House about Cuddy and Lucas, Wilson references the World War II Native American "code-talkers", using the name of the movie made about them, Windtalkers .
Polite Dissent pointed out a trope unique to the series - an air vent that the team finds contraband in because the cover hasn't been properly replaced.

Music

Games People Play by James Taylor - during Cuddy's Thanksgiving dinner
Enditol by James Taylor - over the closing scenes

Reviews

TV.com members rated the episode an 8.0. They picked Jesse Spencer as the episode's most valuable performer.
IMDB members rated the episode an 8.6, with 29.6% of users giving it a "10". The episode performed best with females under the age of 18 (average 9.5 rating) and worst with males under 18 (7.3).
For once, Polite Dissent was actually rather happy about the medicine in this episode. He gave all the medical aspects a B and admitted the final solution was based in fact - failure to remove spleen remnants has happened with other real life patients. However, he thought the scenes between House, Cuddy and Lucas were strained and gave them a C.

Medical ethics

Goofs

When House and Wilson get on the elevator together, they enter the elevator to the audience's left. However, when they leave the elevator, it's the one on the right.
As House and Lucas talk to each other, the pillow next to Lucas goes from crumpled to upright back to crumpled again.
When Taub takes a picture of House, it is clear that the lens is closed.
Although it is a common belief that alcohol will offset the detrimental effects of dextromethorphan, this has never been proven. In fact, dextromethorphan abuse causes permanent brain damage, and Sidas would not have returned to normal intelligence levels just from discontinuing it.
Before operating on a patient to remove their spleen, it is usually a good procedure to run a CT Scan. If they had, they certainly would have found the accessory spleens and removed them at the same time as the main spleen.
If a physcian suspects liver damage, a biopsy is not a good first step, particularly if a lack of platelets is going to cause severe bleeding. It is a much better idea to run lab tests and abdominal scans, which would be much more informative in any case.
A patient suffering an injury to the spleen is more likley to develop splenosis rather than accessory spleens.
The mnemonic "Otis Campbell" is for explaining the causes of a seizure, not a stroke. It's named after the town drunk on The Andy Griffith Show. It appears that House prefers the mnemonic MOIST PLLACEB
The effects of dextromethorphan aren't accurately described. One of the clear side effects is euphoria, which is why a lot of people abuse it.
Although Sidas has thrombotic thrombocytopenic purpura, he doesn't exhibit either thrombocytopenia or purpura
Schistocytes aren't unique to TTP. They can also occur with DIC.
A really good test for TTP is ADAMTS13, which is accurate and pretty much unique to the disease. Although the test is mentioned, they don't appear to have run it or it would have ended the episode really early.
Sidas's CT Scan was clear even though he had extra spleens. Maybe they didn't CT his abdomen.

Quotes

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 (credited only)
Jesse Spencer as Robert Chase
Peter Jacobson as Chris Taub
Olivia Wilde as Remy Hadley
Michael Weston as Lucas Douglas
Esteban Powell as James Sidas
Vicki Davis as Dara Sidas
Jennifer Crystal Foley as Rachel Taub
Larry Cedar as Ed Beringer
Andrea Gabriel as Ronnie
Patrick Price as Jeffrey Sparkman
Dava Krause as Daria
Cheryl Carter as Diana
Gabrielle Thomas as House sitter
Bobbin Bergstrom as Nurse
Felicia Chong as Hospital Secretary
Eric Naroyan as Cuddy's Dinner Guest

Release dates

United States - November 23, 2009 on Fox
Canada - November 23, 2009 on Global
Australia - March 21, 2010
Hungary - May 5, 2010
Israel - July 28, 2010 on HOT3
Czech Republic - September 22, 2010 on TV NOVA
Germany - September 28, 2010 on RTL
Poland - October 28, 2010 on TVP2
Slovakia - November 9, 2010 on STV1
Sweden - February 28, 2011 on TV4
Japan - September 6, 2011

In other languages

Links

Previous episode:
Teamwork

Ignorance is Bliss

Next episode:
Wilson (episode)

@@ Line 145: / Line 145: @@
 * [[Omar Epps]] as [[Eric Foreman]]
 * [[Robert Sean Leonard]] as [[James Wilson]]
-* [[Jennifer Morrison]] as [[Allison Cameron]]
+* [[Jennifer Morrison]] as [[Allison Cameron]] (credited only)
 * [[Jesse Spencer]] as [[Robert Chase]]
 * [[Peter Jacobson]] as [[Chris Taub]]