Officer Joe Luria was the euphoric cop in Euphoria.
Case History[edit | edit source]
Joe was chasing a criminal named "Babyshoes" when he became unable to control his laughter. Babyshoes took the opportunity to try to shoot him but the bullet shattered on Joes bullet-proof vest, although fragments of the bullet hit his head, driving Joe to the ground. However, after this, Joe continued to laugh.
Joe was brought to the ER at Princeton-Plainsboro Teaching Hospital. The case was assigned to Dr. House. Dr. Foreman thought it was drugs. Dr. Chase didn't agree because Joe was a cop. Joe’s tox screen was clean. Dr. Chase thought it might have been caused by the trauma of being shot, but Joe was euphoric prior to being shot and the bullet fragment was in the wrong part of the brain to cause that symptom, and Joe also had a cough and his lung x-ray was cloudy. Dr. Chase though those symptoms plus an elevated heart rate pointed to carbon monoxide poisoning. Dr. Cameron dismissed this suggestion because Joe’s symptoms came on while he was outside. However, Dr. House thought he may have got it in an enclosed area before he went outside. He told his team to test Joe’s arterial blood gases and if his carboxyhemoglobin levels were higher than 15%, stick him in a hyperbaric chamber. Dr. House told Dr. Foreman to check his automobiles and homes, and Dr. House agreed to check out the police precinct.
The blood test confirmed that Joe had low level carbon monoxcide poisoning so they put him in a hyperbaric chamber. Joe was still giddy. Dr. Chase asked how clean his house was, Joe said that he kept pretty clean. However, Dr. Foreman arrived at Joe’s apartment and found otherwise. Joe had an extremely messy house with old food everywhere, Dr. Foreman took samples. He also found that Joe had a marijuana grow-op.
Dr. House questioned Joe’s partner as there was no carbon monoxide leak at the police station because most of the officers would be sick. However, Dr. House noted someone coughing near where Joe sat - close to an air conditioner.
Dr. House thought it was Legionnaires disease from stagnant water in the air conditioner. However, Dr. Foreman blamed the marijuana, although Dr. House disagreed because Joe got worse at the hospital and ordered treatment for Legionnaire‘s.
After treatment with antibiotics, Joe felt better. His euphoria had gone, his COHb levels had dropped, his heart rate was back to normal and he was breathing better. Joe thought Foreman had a problem with cops. Chase told him that his lung infiltrates were clearing up. He had Legionnaires, but it was clearing up. However, Foreman noticed that Joe couldn't see but he still thought that he could.
They did a test of Joe‘s retina. He could physically see but his brain couldn't process the information. This meant both occipital lobes were damaged. Dr. House thought that it was a stroke. It most likely wasn’t the bullet, which would have only affected one lobe. Dr. House ordered heparin to thin his blood and to look for a blood clot and remove it. Dr. Foreman felt the clot would have to be a the top of the bilateral vertebral arteries. However, if they used exploratory surgery, it would most likely cause brain damage. Dr. House wanted to do a contrast MRI but Dr. Chase pointed out if the bullet was ferromagnetic, the MRI would rip the fragments out of his skull. Dr. Foreman informed him that his as the Kevlar bullet-proof vest Joe was wearing wouldn't shatter the bullet but would instead catch it, the fact that it did shatter meant that Babyshoes was using hollow point bullets that were ferromagnetic. Dr. Cameron thought they could do an angiogram, but Dr. House pointed out that the skull would create too many artifacts to get a decent view. However, he allowed the procedure.
As Dr. Foreman and Dr. Cameron did the angiogram, Dr. Foreman told him that he knew about the pot. Dr. Cameron thought Dr. Foreman should quit the case. Dr. Cameron told Dr. House about Dr. Foreman’s behavior, but he insisted he was just joking with the patient. The angiogram showed some clotting possibly around the circle of Willis, and it was growing. However, Dr. House pointed out that this information told them very little about the type of clot it was. Dr. House still wanted to do an MRI. However, removing the bullet fragments surgically was impossible - they were too deep and Joe was on blood thinners. Instead, Dr. House decided to try an experiment. He found a corpse in the morgue that had been donated for medical research and shot it with the kind of bullet that Babyshoes had used. He wanted to see if they could do an MRI without causing damage to the patient.
Four fragments of the bullet got lodged in the skull of the corpse. Dr. House was also worried that Dr. Foreman was grinning when he shot the corpse. However, Dr. Foreman insisted he was fine. As they were about to start the MRI, Dr. Cuddy entered and admonished House for shooting a corpse. She didn't want him to turn the MRI on but he did,. There was a short flash as the MRI machine stopped working just as it pulled the bullet fragments out of the skull of the corpse. As a result, the machine was going to be out of commission for at least two weeks.
Dr. Foreman thought the clot might just go away on his own. Dr. House told them to perform an echocardiogram to see if the clots were originating in his heart. However, Joe’s heart was clean, They were about to ultrasound his legs to look for a deep-vein thrombosis when Joe developed tachycardia. His heart rate was 150 and rising. Dr. Chase ordered saline. All of a sudden, blood started pouring from Joe’s eyes. His blood pressure was crashing and he went into shock. Dr. Chase realized Joe had intracranial bleeding. However, Dr. Foreman was laughing and joking about how the patient was both bleeding and clotting.
Dr. Foreman and Joe were quarantined, although Dr. Foreman insisted he was fine They drilled a hole in Joe's skull to relieve the intracranial pressure. Dr. Chase and Dr. Cameron brought a portable MRI machine to scan Dr. Foreman‘s head. Dr. House told Dr. Foreman to eat all his meals, take his body temperature every half-hour, and to take any medication he was prescribed.
Dr. House tested his own blood and told Dr. Chase and Dr. Cameron to test theirs as well. If their sed rate was elevated, they would be put in isolation. Dr. Cameron wanted Dr. Foreman to be brought in on the differential, but Dr. House said he couldn’t be objective. Dr. Foreman’s MRI showed an area of increased T2 attenuation in the singular cortex. That part of the brain affects emotion and there was something fuzzy on the scan that was probably the source of the problem. Dr. Chase thought it might be West Nile virus or eastern equine encephalitis. Dr. House ordered blood tests on Dr. Foreman, but given that he was the only one who was sick, he thought that Dr. Foreman got exposed to a toxin at Joe's home. Dr. Cameron was ready to go to Joe’s apartment, but instead Dr. House ordered her to re-test all the samples that Dr. Foreman brought back.
Dr. Chase went into isolation to get a blood sample from Dr. Foreman, who was getting giddier, even laughing when Dr. Chase took a clumsy blood sample. Dr. Foreman asked for the differential, and Dr. Chase told him about the MRI and how they thought it was either a toxin or a virus. Dr. Foreman thought it was a staphylococcus infection. Dr. Chase pointed out to Dr. Foreman that it would cause a fever, but Dr. Foreman noted Joe had a fever and he might be getting one. He told Dr. Chase to give him and Joe Ommaya reservoirs to deliver linezolid directly to their brains and them they'd be cured.
The samples from Joe’s apartment tested negative for toluene, arsenic, and lead. The blood tests were negative for West Nile and encephalitis. Dr. Cameron wanted to go back to Joe’s apartment, but Dr. House refused permission. Dr. House wanted to biopsy Joe's brain, but there was too much edema from the bleeding because of the heparin. Dr. House decided to biopsy Foreman's brain instead. Instead, Dr. Chase told him about the staph infection, but Dr. House rejected the symptoms and realized Dr. Foreman had suggested it. Dr. House went to talk to Dr. Foreman instead. Joe was suffering from distal and proximal arm contractures. Dr. House told Dr. Foreman that it wasn't staph because it hadn‘t presented on the skin. It also would have affected organs other than the brain first, and if it was limited to a brain abscess, it would have shown up clearly on the MRI. He finally showed Dr. Foreman the MRI. Dr. Foreman showed Dr. House he now had a fever of 101.6F. He insisted on treatment for staph.
They drilled a hole in Dr. Foreman’s skull to insert the reservoir. They did cognitive tests during the procedure to make sure they weren’t doing any permanent harm to the brain. However, Dr. House used the opportunity to do the brain biopsy instead.
Later on, Joe asked Foreman if he was awake. Joe recognized Dr. Foreman’s voice. Joe was now aware that he couldn't see. Dr. Foreman thought that his awareness could be a sign of improvement. Joe told him that the morphine barely took the edge off the pain. He was afraid he was going to die. Joe asked him if he believed in prayer. Dr. Foreman said he didn‘t, and Joe admitted he didn‘t pray, but his father always did. Foreman told him that his father did. Joe asked if Dr. Foreman wanted to try praying, and he agreed.
Dr. Foreman's biopsy showed nothing more than inflammation. He was also negative for staph. Dr. House told Dr. Chase to retest all the samples for anything that might affect the brain. He told Dr. Cameron to continuously monitor Dr. Foreman so they could establish a time line of the progression of the illness. Dr. Wilson noted that Dr. House was being cautious. Dr. House snapped back that oncologists never catch diseases from their patients.
Joe was in a great deal of pain. They couldn't up his morphine anymore. Dr. Foreman wondered why no-one had gone back to Joe’s apartment. Dr. Cameron realized Dr. Foreman’s left side peripheral vision was reduced. All of a sudden, he stabbed Cameron with contaminated needle so that she would go back to Joe's apartment to save herself.
Dr. Chase ruled out SSPE. He also compared Joe’s vaccination record with Dr. Foreman’s and found nothing that was missed for both of them. Joe's pain had gotten worse, he was over his limit on morphine.
Dr. Cameron got into an isolation suit and went back to Joe’s apartment.
Dr. Foreman put morphine directly into Joe’s carotid artery to deliver it directly into the brain (as Joe's constant scream reminded him the fact what he will experience himself). Dr. Chase warned him that this could cause cardiac arrest, but Dr. House pointed out that pain induced cardiac sympathy was the consequence of not reducing the pain. Joe’s pain got better for a moment, then got bad again. Dr. House realized that Joe had developed hyperalgesia - an insensitivity to narcotics and painkillers. The infection had spread to the pain center of Joe’s brain. The morphine couldn‘t do anything. Dr. House told Chase to put Joe in an induced coma before the pain killed him.
Dr. Cameron continued to collect samples from Joe’s apartment.
Dr. Foreman suggested aureobasidium, but it required cedar. Dr. House figured out that Foreman had sent Dr. Cameron back to Joe’s apartment because he wasn’t angry that Cameron wasn’t around. When Dr. Cameron came out of Joe‘s apartment, she found Dr. House waiting for her, She told Dr. House that Dr. Foreman had stabbed her with a needle. However, Dr. House noted that it was unlikely the disease was blood borne and if she thought she had it she would not have bothered getting into an isolation suit. He looked at the samples and noticed that Joe had three loafs of rye bread in his house and sent Dr. Cameron back into the apartment. He realized that Joe hadn‘t bought the bread for himself. Dr. Cameron found pigeons on the roof, but no pigeon feces. Joe had been using bird feces as fertilizer for the marijuana. Dr. Cameron found a pail of feces in the growing area. Dr. House thought it was Cryptococcus neoformans.
Dr. Foreman felt bad about missing the pigeon feces, but realized he only needed Amphotericin B and flucytosine. Dr. Foreman noted from Joe’s EEG that Joe was still in pain even though he was unconscious. Dr. Cameron was showing no symptoms. She tested the sample and it was negative for Cryptococcus. Suddenly, Joe had wide complex tachycardia and it looked like V-tach, which progressed to V-fib. Dr. Foreman tried to restart his heart with a defibrillator and injected epinephrine and started CPR, but could not restore a normal heart rhythm. Dr. House pronounced Joe dead at 12:26 p.m.
|#02||"Autopsy"||#10||"Failure to Communicate"||#18||"Sleeping Dogs Lie"|
|#03||"Humpty Dumpty"||#11||"Need to Know"||#19||"House vs. God"|
|#04||"TB or Not TB"||#12||"Distractions"||#20||"Euphoria (Part 1)"|
|#05||"Daddy's Boy"||#13||"Skin Deep"||#21||"Euphoria (Part 2)"|
|#07||"Hunting"||#15||"Clueless"||#23||"Who's Your Daddy?"|
|#08||"The Mistake"||#16||"Safe"||#24||"No Reason"|