- "If you guys screwed something up, just come clean. It’s not going to be that bad"
- ―Instant Karma
Instant Karma is a 6th season episode of House which first aired on October 12, 2009. A billionaire insists his son be treated by House after several doctors failed to diagnose his dying son. Cuddy appoints House to make all the final diagnostic decisions, although Foreman is still in charge of the department. The father believes that his son's condition is the result of karma, saying that "everything he touches turns to gold" except for when it comes to his family. His son's health continues to decline and House diagnoses his son with Degos disease, an incurable disease. House says that his son has one more day to live, at most. The father then signs a deal that is guaranteed to make him bankrupt in hopes of making his son's health improve by evening out the success in his life, since he is a strong believer of karma. House soon after diagnoses his son with Primary Antiphospholipid Syndrome, a manageable disease. The bankrupt father is later shown with his healthy son happily sharing pizza.
Cuddy also has Foreman conduct a morbidity and mortality conference regarding the Dibala case in The Tyrant. Foreman privately discusses the matter with Chase, telling him to tie up any loose ends that the participants of the M&M might question. Chase almost admits to Cuddy that he tampered with Dibala's test results but is interrupted. He later finds the documents he needs left on the table in a blank envelope; after asking Foreman, he realises that House has figured out that he killed Dibala and tells him he'll always been in power no matter what.
Thirteen makes plans to travel for an indeterminate amount of time. After her flight plans to Bangkok are cancelled by someone, she tries to find out who. She confronts House, who says that he wanted her gone. House later confronts Foreman who says that he is over the breakup with Thirteen and didn't cancel her plans. Thirteen eventually visits Wilson who admits to the hacking. Wilson says that House needs her on the team, even if he doesn't admit it, and that she is the only one whom House hasn't influenced negatively in some way. Later, he confronts House about it, leading him to admit that he cancelled it from Wilson's office. The episode ends with Thirteen boarding a plane headed for Bangkok.
After a board meeting, a wealthy man meets with his personal doctor, who is treating his son. He is told that the only diagnosis that makes sense is incorrect, and is advised to take the son to the hospital. The son is resistant, but the father talks him into it.
Mr. Randall goes to Cuddy and asks to have House work on his case, but Cuddy tries to refer it to Foreman. However, Randall insists. Cuddy goes to House and Foreman, but he resists letting House being in charge while he is the attending. Cuddy reminds Foreman he has to prepare a morbidity and mortality report on President Dibala. Foreman and Chase resist, but Cuddy insists. They go over the son's symptoms and House orders a new medical history and a full physical. Cameron does the physical and history and finds something unusual.
Foreman and Chase discuss how they will approach the morbidity conference. Foreman doesn't want to lie, and Chase tells him not to go into details. House comes in while they discuss covering any questions. Cameron takes an x-ray which shows his large intestine is almost completely impacted. They need to do a barium enema and biopsy to attempt to confirm Hirschsprung’s disease.
House goes to visit Thirteen. He wants to know if she's getting back together with Foreman. She says she's not coming back, but she enjoyed working with House. She says she is going to Thailand.
The patient improves quickly and his appetite returns. Cameron examines his abdomen, which feels normal but looks bigger. Suddenly, the patient has a seizure. Foreman realizes he has intercranial hypertension. Foreman tells the father they need to drill burr holes to relieve the pressure. Foreman presses the father to consent. The patient is rushed into the operating room and finally the father consents. They manage to stop the seizure and relieve the pressure. Foreman realizes he has no idea what happened to the patient.
That patient's seizures don't return and there is nothing in the brain fluid to indicate a problem. The enlarged abdomen was the result of a build up of fluid as well. Foreman realizes the fluid build up is asymmetrical and House realizes the patient may have brain cancer.
Thirteen is in a cab trying to arrange an upgrade on her flight to Bangkok. However, her reservation has been cancelled.
The father is incredulous it is brain cancer. Cameron says they must have caught it early. Chase gets a page to go help with the morbidity report. He turns down Cameron's help and tells her to go home and get some rest.
Thirteen confronts House about cancelling her reservation. He says he doesn't want her back because Foreman is concentrating on his work. He denies changing the reservation.
Foreman has found out that the lab did a full blood panel of the fake sample and the cholesterol levels are too far off.
Cameron wakes up and finds that Chase hasn't been home. Chase tells Foreman that the mismatched cholesterol is no big deal, but Foreman doesn't want to continue the cover up. Cameron comes in and finds out the patient doesn't have cancer.
They start a new differential, and House thinks that it might be stomach cancer. Foreman orders an endoscopy and a new biopsy. House accuses Foreman of cancelling Thirteen's reservation, but he denies it and says he's moved on. House tells him he believes him and that Foreman is going to be a good boss.
Cameron thinks Chase has done something wrong and starts pressing him on it. He admits there is a problem with Dibala’s blood panels, but doesn't tell her the reason why. She thinks it's weird, but Chase blames Foreman's insecurities.
They tell the father the new diagnosis while Chase performs the endoscopy. The father tells them he thinks his son's illness is due to the fact he has been such a successful businessman. His business is great, but his wife has died and his son is sick - he blames karma. Suddenly, the patient starts seizing again, but it's not intracranial pressure this time.
House goes to visit the patient. The seizures have stopped and there are no masses in his stomach. House has noted that every time they do a procedure, he has a seizure. They start thinking about infection again - Chase thinks it might be antibiotic resistant, but House points out the tests for infections have been negative. Cameron thinks it might be abdominal epilepsy. House agrees and Foreman starts treatment and monitoring.
Chase is going to deal with the cholesterol levels by claiming he gave the patient anti-cholesterol drugs without charting. Foreman doesn't want to lie, so he tries to get out of the morbidity conference. However, Cuddy insists and wonders why Foreman wants to get out of it.
Cuddy confronts House about Thirteen's reservation being cancelled, but she thinks it's Foreman. House tells her that he's fine with Foreman being in charge and that Foreman didn't change the reservations.
House finally meets the father, and abdominal epilepsy has been ruled out. The patient now has spotty patches on his skin.
They start a new differential. Foreman thinks it might be an allergic reaction. Cameron thinks it's lupus. Chase thinks its polyarteritis nodosa. House suggests a testicular biopsy and steroids. House asks if the rash is on his penis and realizes it's not polyarteritis - it's Degos disease which causes microvessels to shut down and clot. House goes to tell the father, and also tells him it's terminal. Randall thinks he's wrong, but House has double checked the biopsies. The prognosis is death within a day.
Chase goes to Cuddy and tells him that Foreman can't present the case, and Cuddy tells her that if they screwed up to come clean. Suddenly Cuddy is called away, The father’s lawyers are in the patient's room arguing with him. The father is planning on blowing his entire fortune. Cuddy tells him not to make a hasty decision. Foreman reminds him that his son is dying from a terminal illness anyway. House tells Randall bad things just happen. Randall signs the paper to ruin his company and directs his lawyers to deliver it. The patient goes into cardiac arrest and Foreman calls a code blue.
Thirteen goes to see Wilson. She realized that he cancelled her reservation because she had Cuddy track the change to his computer. Wilson tries to deny it, but Thirteen gets him to admit it. He says the House needs Thirteen because she doesn't need him. Her ability to stay detached helps keep his ego in check. She tells him goodbye, but he tells her that she's passing up a great job that she loves just because of a bad breakup.
Wilson tells House he lied about the reservation and he's realized House really did do it. House also admits he's short-sold Randall's stock and he only wanted her because she's a hot single bisexual. Suddenly House realizes something after saying, "I guess my heart is just three sizes to small".
He goes to the patient's room and tells Foreman to start heparin and intravenous immunoglobulin. Because of the heart attack, he thinks its Primary Antiphospholipid Syndrome, as Dagos wouldn't affect the large blood vessels of the heart. He also tells Foreman that Thirteen isn't over him, but he doesn't seem to care.
Chase finds an envelope in House's office that would explain why the cholesterol levels were off - Dibala's previous physician had been trying to boost his positive cholesterol levels. This would cover the inconsistency. Foreman says he didn't find the information, which probably means House found out and covered for them.
House comes in the next day and finds the patient conscious and recovering. Randall gives credit.
Chase asks House how he figured it out, and he says that it's common for fat Africans to be treated for cholesterol. He says he's not going to do anything to Chase because he's not in charge. House also mentions that a misdiagnosis is worse than murder and that they will never treat a genocidal dictator again. Chase tells House he will always be in charge whether he wants to be or not.
Cameron wakes up and finds Chase hasn't been home again. Foreman presents Dibala's case at the morbidity study. Thirteen gets on a plane. The father and the patient are having a good laugh. House sits thinking in his office.
- Foreman gives a conference on how President Dibala died at Cuddy's request.
- Thirteen sets off for Thailand.
Zebra Factor 7/10
Any antiphospholipid syndrome is rare, but the disease usually presents in conjunction with another disease (commonly, lupus). It affects about 1 in every 2,000 people. However, a case that has no underlying cause is rarer.
Trivia & Cultural References
- The title of this episode refers to the Eastern religious concept of Karma. It is most likely because of the patient's father's belief that his wife's death and his son's condition are both because of his bad karma.
- The title of the episode is also reference of a song of John Lennon: Instant Karma! (We All Shine On).
- Montreal is a large city in Canada. The NHL All-Star Game was hosted in the Bell Canada Centre in January 2009.
- Misty May is Misty May-Treanor, who “dug for gold” when she won the gold medal in beach volleyball at the 2004 and 2008 Olympics.
- More about Thailand.
- Kobe is Kobe Bryant, the starting shooting guard for the Los Angeles Lakers. Phil Jackson is his coach.
- House’s comment about the Virgin Mary on the X-ray is a reference to seeing religious imagery in everyday objects.
- Kavi Raz, who plays the Cab Driver, also played Dr. Vijay Kochar, an anaesthesiology resident in the series St. Elsewhere.
- Short selling is a stock trading technique where an investor sells shares in a company that he borrows from a third party, planning on buying those shares at a lower price at a later date. It is essentially a bet that the stock price will fall.
- The references to House’s heart being three sizes too small is a reference to the heart “two sizes too small” in How the Grinch Stole Christmas!
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