Kendall Pearson is the young woman who plans to set a record for the youngest person to sail around the world. She is the daughter of Bobby Pearson and Paige Pearson. She is portrayed by actor Michelle DeFraites.
Case History[]
Kendall collapsed during a practice run. She recovered quickly, but the sponsors of her voyage insisted on medical clearance before she was allowed to depart. She was admitted to Princeton-Plainsboro Teaching Hospital and was assigned to Dr. House and his team. There was time pressure as if she did not leave within three days, she would not be able to set the record for being the youngest person to accomplish the feat of sailing around the world. Ms. Masters suggested dehydration as Kendall complained of dizziness when the Coast Guard rescued her. However, Kendall's pulse and blood pressure were normal when the Coast Guard reached her. Ms. Masters then suggested a seizure caused the collapse, but a seizure in this situation would almost always have resulted from head trauma and there was no sign of it. Dr. Taub reviewed the videotape of the incident and noted she had struck the small of her back on a railing before she collapsed. He theorized that she had damaged her adrenal glands as a result and then adrenaline insufficiency caused the collapse. Dr. House thought it fit and ordered a blood draw every 15 minutes for four hours to track her cortisol levels. He ordered Dr. Hadley and Ms. Masters to do the blood draws.
Dr. Hadley did the first draw. Kendall asked if there was any way to speed up the process as she had preparation work to do for her sail. Ms. Masters suggested using a treadmill and seeing if her adrenal glands would respond. The procedure would only take about thirty minutes.
However, during the treadmill test, the patient's fingers started to turn blue from lack of blood flow. Dr. Hadley started her on vasodilators and it appeared that Kendall would not suffer the loss of her fingers as a result of the incident. However, this also ruled out adrenal insufficiency. Dr. Chase pointed out low cardiac output could explain both symptoms. That could be caused by a cardiomyopathy, which could have been caused by mercury poisoning due to her high-fish diet. However, Dr. Taub noted Kendall's red blood cells had normal morphology, ruling out mercury. Dr. Hadley suggested Raynaud's phenomenon - it could have caused a vasospasm in the ulnar artery which would explain the fingers turning blue. However, Dr. Foreman pointed out that a cerebral vasospasm would explain both the fingers and the initial collapse. Dr. House agreed with Dr. Foreman and ordered a calcium channel blocker infusion in the basilar artery.
Dr. Hadley and Dr. Foreman started the procedure. However, when he removed the catheter after the procedure, he got a good view of Kendall's cerebral midline. Her pineal gland had calcified. It explained her symptoms and all she would need was hormone replacement therapy.
However, after Kendall was discharged, she collapsed in the parking lot. The collapse was traced to a hypertensive crisis caused by neural overstimulation in her kidneys. She was scheduled for a sympathectomy. Kendall would recover and be ready to sail in about 36 hours. However, during surgery, she developed low blood pressure due to reduced cardiac output. Her right atrium pressure was 8 due to equalization of pressures, indicating restrictive pericarditis. That meant what looked like a calcified pineal gland was really a granuloma. That appeared to indicate granulomatosis with polyangiitis. Dr. Hadley wanted to start Kendall on steroids, but Dr. Masters (now on her first day as a medical intern) pointed out her creatine kinase was high, which couldn't be explained by granulomatosis with polyangiitis. Dr. Taub put it down to dehydration, but Dr. Masters pointed out the calcification of the pineal gland could also be due to sarcoidosis. Dr. House agreed with Dr. Hadley and ordered three-fold immunosuppressants.
Dr. Masters stayed to run more tests to explain the elevated creatine kinase levels. However, while considering the test results, she realizes that certain infections carried by poultry could cause the symptoms the patient was showing. She went to the patient to ask her if she had ever been sick after eating poultry. The patient admitted she got sick after eating canned pheasant a few months before. Dr. Masters told her that salmonella enteritis. It often infects bones. Dr. Masters started examining the patient's bones and joints to see if any of them were tender or painful. She found a very tender part in her upper left arm.
They did an MRI to pinpoint the infection. However, instead of an infection, they found a cancerous growth in the humerus.
After a biopsy, the growth turned out to be a lymphosarcoma. However, the only way to treat it properly was to amputate her left arm before starting chemotherapy and radiation therapy. However, the patient resisted the amputation. She said she felt fine and if she left on her sailing trip soon, she could still beat the record. However, if she delayed the amputation, it was very likely the cancer would spread. However, the patient was still insisting on her sail. She said it was only going to take one month and she could take extra precautions and fly back if anything went wrong on the trip. Although Ms. Masters tried to insist, Mrs. Pearson insisted on discussing the matter with her family.
However, although they could proceed with only the consent of either of Kendall's parents, both refused to provide their consent at their daughter's insistence. Her father told Dr. Masters that it was likely that Kendall could get status as an emancipated minor if they pressed the amputation. In such a case, she could still refuse surgery.
Dr. Masters asked Dr. House to step in to speak to Kendall and her parents. However, Dr. House said that as the diagnosis was completed, he had no further interest in the case and would respect the patient's wishes. He told Dr. Masters if she wanted to save the patient's life, she would have to do something about it herself.
Dr. Masters went to Dr. Wilson for advice. He said there was no problem with her attempting to keep trying to convince the patient to have the surgery. He said it was all a doctor can do. However, he did tell her that Dr. House also chose to forgo an amputation in an attempt to keep his leg. However, his medical proxy consented to surgery when he was under sedation, and that probably saved his life.
Dr. Masters went to the patient to tell her she needed to have the amputation immediately, but the patient was still insisting on putting it off. She was going to leave the hospital that day.
However, before Kendall was discharged, she started suffering from bradycardia and a third-degree heart block, most likely from a paraneoplastic syndrome. Dr. Foreman realized they had to get her to an operating room to install a pacemaker and start plasmapheresis. Dr. Masters went to the patient's parents and told them of the patient's condition and reminded them if the same thing had happened at sea she most likely would have died. Ms. Masters told them they had no choice but to amputate immediately and start treatment for the cancer. They signed the consent form for the amputation.
The patient was taken to the operating room. Dr. Chase had already established clavian access and Dr. Taub was ready with the temporary pacemaker. However, Dr. Masters caught up to them and told them to administer calcium chloride to break up the heart block. She admitted she caused the bradycardia. She presented them with the consent form to proceed with the amputation.
The patient was angry that her arm had been amputated, but appeared to be in a position to make a full recovery. Dr. Masters told her they found cancer in a lymph node in her neck, showing the cancer was already spreading, making the amputation an immediate emergency. She would have died if she had gone on the sail. Mrs. Pearson thanked Dr. Masters for her work.