Known Unknowns

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House: "Interesting reflex of guilt just now. Your patient’s been dying for six weeks. Couldn’t have predicted he’d go this weekend. Or could you? Euthanasia. Let’s tell the truth, we all do it. It’s a great opening line. Are you insane!?"

Wilson: "I didn’t want your notes before, and I don’t want them now."

— Known Unknowns

Known Unknowns is a 6th season episode of House which first aired on November 9, 2009. After a wild night out, a teenage girl (guest star Annabelle Attanasio) is brought to Princeton-Plainsboro Teaching Hospital with severely swollen appendages. The team must work to diagnose the young girl, who is less than honest about what happened the night she fell ill. As her condition worsens, she becomes unable to distinguish fact from fiction and she starts to lose blood faster than the team can transfuse. Meanwhile, Wilson, Cuddy, and House spend a weekend away from the hospital to attend a medical conference, but things don't go as planned when House's private investigator, Lucas Douglas, returns. House confesses his feelings for Cuddy to Wilson who says that she is better off without House. Chase’s strange behavior after the death of Dibala leads Cameron to believe that Chase is having an affair.

Recap

While a young woman recalls her night with a rock band, her friends notice that her left ankle has swollen up. She suddenly notices her hands have swollen up too, and she collapses on the carpet.

House is complaining that Foreman has e-mailed him an x-ray that he can't read on his cell phone screen. Wilson reminds House that they are going to a medical conference that afternoon, but House doesn't want to go. Wilson reminds him that as a term of his release from Mayfield Psychiatric Hospital, they have to stay together. House tells him that he will tell Foreman he can't deal with the new patient, but he's not going anyway.

House arrives at the hospital where the team explains the patient has severe edema, seemingly because she has the joints of a much older woman. House figures she just has Rhabdo from trauma, she said she jumped off a fence into a pool. The rest of the team have other theories, but House insists. Chase agrees to perform the tests for all the suggested diagnoses.

Chase confides in Foreman that Cameron thinks he's cheating on her.

House goes to get Cuddy to agree to release the patient, and realizes she's going to the medical conference too. He says he's going as well but she's checked and his name isn't on the attendee's list.

House goes to Wilson to tell him he's going to the conference. Wilson realizes House knows Cuddy is going, and tells him to be ready in two hours.

Chase comes in and tells him he can't leave and that the patient can't have Rhabdo because there is no sign of muscle crush. However, House goes to give the patient a pair of drumsticks and asks her to play along. She does for a while, but soon becomes unable to move her arms. He realizes her potassium was too low the previous night to climb stairs to jump into the pool or to play the drums with the band and tells Chase to get a better medical history and that the patient is a liar who still has Rhabdo.

They question the patient and she admits that instead of staying with the rock band, they followed a comic book artist around for several hours, including following him to a restaurant. Cameron goes to get food from the restaurant, but they note no-one else got sick. Foreman realizes that she ate the whole meal despite being thin. He figures the patient might be bulimic. They go to do a barium swallow.

Wilson and House go to pick up Cuddy. House finds out Wilson is presenting at the conference, but wonders why he didn’t ask for feedback like he usually does. Wilson tells House to ask Cuddy out, but House has a plan. Cuddy shows up with Rachel.

Cameron asks Foreman about Chase. He tells her to talk to Chase and that Chase is not having an affair. The barium swallow is negative and bulimia is ruled out. However, when the patient's parents show up, she starts to crash. They realize she is bleeding into her heart.

They call House, who figures it might be a toxin. Cameron goes to do an environmental scan and House says get a better medical history.

House is masquerading as a "Dr. Phil Perlmutter" to get into the conference.

Foreman questions the patient and her friend, and they soon realize that the patient is making things up.

Cameron catches up with the comic book artist. He remembers the patient and her friend, and makes a pass at Cameron.

Foreman realizes that she is also bleeding into her brain, which has affected her thalamus and her memory. He also finds out that there was a gap when the patient went to "get ice" that the friend can't account for.

House and Cuddy meet at a 1980s-themed costume party, House oddly dressed in ruffles and wig. They start dancing and recollect about how they first met. It was Cuddy's third day at school. She was at the book store and House figured her out in about thirty seconds. They talk about who approached whom, and how they tracked each other down at a party. House said he was going to call Cuddy, but that was the day he found out he had been expelled from Hopkins and saw no point in pursuing anything. Cuddy, seemingly surprised and flustered by the revelation, leaves to go back to her room.

Wilson gets a call telling him his patient has passed away. House said he told Cuddy he was always interested in her, and she just walked out. House finds out that Wilson's talk is about euthanasia.

Chase and Cameron try to track the patient's movements on security cameras. They realized she went back for a journal that the comic book artist left behind in the restaurant so she would have an excuse to meet him.

Wilson and House go down to the lake to discuss his paper, and House tells him not to say it openly - it will ruin his career. Wilson says he has to say what he thinks is right, just like House would. House reminds him that hasn't worked out for him personally.

Cameron and Chase go to see the comic book artist and confront him and ask to search the room. He shuts them out. Chase tells Cameron the artist would never risk his wife and career for a one-night stand, and follows up that he isn't having an affair either. Cameron doesn't believe the artist and realizes the patient's symptoms are explained by an overdose of roofies.

Wilson goes to see Cuddy and Rachel. They talk about House. She says she can't rely on him, especially now that she's a mother.

Foreman rejects Cameron's diagnosis because the patient is now bleeding behind her kidneys. Foreman is transfusing red blood cells, but the patient keeps bleeding out. Cameron thinks it is a toxic reaction and suggests using amobarbital as a truth serum. Chase accuses her of being angry at the comic book artist and taking it out on him. Chase want to call House, but Foreman says House wouldn't go with anything safer.

House is dipping into the minibar despite the buffet downstairs. They talk about Wilson's speech again. Wilson deflects and tells her to go see Cuddy - she needs a babysitter. Wilson realized that House has drugged the grape soda from the minibar, and just before he passes out he tells House that Cuddy is better off without him.

They prepare to give the patient amobarbital. After she is dosed, she starts talking about the comic book artist. However, her heart rate is increasing. She admits she realized he gave her a tablet and then started touching her. The father wants to kill the artist, but Foreman has been monitoring the patient’s pericardial blood flow and realizes she is still lying.

House goes to see Cuddy and wonders why it is so quiet with Rachel in the room. House offers to babysit, but Cuddy says Rachel is in day care. However, he then hears Rachel cooing. He walks in and finds her with Lucas Douglas. They talk about how awkward the situation is and House agrees to leave.

Wilson finally regains consciousness and finds the phone ringing. It's Foreman looking for House, but House isn't in the room. Foreman updates him about the bleeding problem and tells him the comic book artist has a dog so they are treating for rickettsia. Wilson realizes he is late for his talk.

However, a well dressed House is giving the talk instead, and he's giving Wilson's original talk. Wilson is still looking for his pants. House is obviously taking the heat for Wilson's talk to save his career. Wilson finally shows up and realizes what has happened. House then adds something - that he never does anything less than his best. Although there are many questions, House dodges them all. Wilson finally realizes that the crowd still thinks House is Dr. Perlmutter.

Wilson catches up with House and tells him about the ricketsia. They then talk about House's deception. House wonders why Wilson is angry with him. He thinks that Wilson is more upset about his patients dying all the time then not being able to give his speech. As he's telling Wilson how guilt is affecting him, he thinks of something and calls his team.

House has realized the blood transfusions are killing the patient. She got vibrio vulnificus from oysters. The patient denies it, but she's lying again. Chase wonders why no-one else is sick, but House has an explanation - she's more succeptible because she has haemochromatosis as well. Because they thought she had bulemia, she got iron supplements, which made it worse. When she started bleeding, they gave her more blood, which contained even more iron and made the bleeding even worse. She needs treatment for the vibrio and chelation for the haemochromatosis.

Cuddy, Wilson, House, Lucas and Rachel have dinner together and House asks how Lucas and Cuddy got together. Cuddy hired Lucas to see who was skimming money from accounting. House wanted to know why they kept it secret. She says she likes to keep her private life private. Lucas starts rattling off about all their problems and can't shut up. He offers to buy House a ginger ale and House accepts.

The patient starts to improve. However, her parents are leaving her to her own devices again. The patient finally admits that he never knocked on the artist's door and merely left the journal next to it.

House watches Cuddy and Lucas play with Rachel. He seems resigned to the fact and wants to raid the minibar again. Wilson tells him that House often needs to hear that he's right from someone else and forgives him for giving the speech. It turns out Perlmutter was in Toronto, giving him an alibi, and House won't be recognized because he hasn't been at a conference in fifteen years.

Cameron and Chase start talking. He once again denies having an affair. Cameron offers to help because she knows, whatever it is, its eating away at him. Chase admits to his deceptions that caused the death of President Dibala.

Major Events

Cuddy and House finally talk about how they met at the University of Michigan.
Chase confesses to Cameron that he switched Dibala's test results.
It's revealed that Cuddy and Lucas have started seeing each other.

Zebra Factor 9/10

Vibrio vulnificus is very rare, with an incidence of about 1 in 1 million every year, or about 300 cases per year in the United States. It is very difficult to get infection and most people with a normal immune system can easily fight off the bacteria without help. It mostly affects people who are immunocompromised or already have liver disease.

Trivia

The title of this episode comes from a statement by Former United States Secretary of Defense Donald Rumsfield. The "known unknowns", according to Rumsfield, are things that people know they do not know.
The name of the band Jordan and Phoebe follow in to the hotel is "Pharmacide".
Victory or death is one of the most common battle cries and fighting mottos in the world.
The episode contains one of the hallmarks of one of it's writers, Doris Egan - House travels out of Princeton.
The conference is entitled "Pharmacology and Public Policy".
Ramadan is the month of fasting in the Islamic calendar, where Muslims refrain from food during daylight hours.
The Adirondacks are a range of geological features in north-eastern New York State. Unlike other mountains, they were not formed by tectonic forces but were instead revealed when the surrounding land eroded away to expose harder igneous formations from about one billion years ago.
The convention scenes were filmed at the Lake Arrowhead Resort & Spa in Lake Arrowhead, CA, about 80 km (50 mi) east of Los Angeles, on the other side of the mountains from San Bernardino.
Eddie Money was one of the most successful rock performers of the 1970s and 1980s, with ten top 40 hits during that period of time, Two Tickets to Paradise reached #22 in 1978.
Rutgers is Rutgers University, the largest university in New Jersey with over 50,000 students at several campuses throughout the state.
Shanghai is the largest city in China and is the most heavily influenced by Western culture.
Patty & Selma are the sisters of Marge Simpson on "The Simpsons". "House" was one of several Fox shows to mention "The Simpsons" that week, as that show was celebrating its 20th anniversary. The reference was a clue in a scavenger hunt contest run by Fox during the week. The "always smokin'" comment refers to their habit of chain smoking.
Lars Ulrich is the drummer for Metallica.
Hippocrates was an ancient Greek physician and is widely regarded to be the father of Western medicine and the author of the Hippocratic Oath
Lots of drumming references. The "high-hat" is a pair of cymbals on a stand that is activated by a pedal. "Headbanging" is shaking one's head violently in time with the music.
Stilleto was portrayed by Megan Taylor, who also worked as a production assistant on the series.
Bushido is the term that describes the life of a samurai in Japanese culture. The term is also used in Wilson
Bruce Springsteen is a popular entertainer who was born and raised in New Jersey.
House attends the 80s party dressed similarly to Prince George, the character played by Hugh Laurie in the 1987 comedy sitcom Blackadder the Third which aired in Laurie's native United Kingdom.
Cuddy's outfit at the 80s party is based on Jennifer Beal's character from Flashdance. Lisa Edelstein sang the sountrack from Flashdance in the television series Almost Perfect
Some of the other guests at the 80s party also reference films from the 1980s. One man is dressed up in a Ghostbusters costume, and another like John Cusack's character from Say Anything... with a boombox over his head. Say Anything is also referenced in The Tyrant and Ghostbusters is referred to in Two Stories. There was also a marshmallow man in Ghostbusters.
Jane Fonda is an Academy Award winning actress who released a best-selling line of workout videos.
"Time After Time" is also the song that Napoleon and Deb slow dance to in Napoleon Dynamite.
The Times is a reference to The New York Times.
Angela Merkel is the Chancellor of Germany.
A Fjord is a narrow inlet formed by glacial erosion. Although found in many places, they are most commonly associated with Norway. In the Monty Python "Dead Parrot Sketch", the salesman blamed the parrot's lack of movement on "pining for the fjords".
Toronto is the largest city in Canada. The band Metric, which plays the song in the opening scene, was founded there as well.
Skinny Dipping is the act or practice of swimming in the nude in a pool, body of water or hot tubs.
House refers to the patient as a "Gossip Girl", a reference to Gossip Girl, featuring Leighton Meester

Music

In the opening scene, Stadium Love by Metric
In the video game soundtrack, Fuel by Metallica
The first song at the party is The Safety Dance by Men Without Hats.
The second song at the party is Time After Time by Cyndi Lauper.

Continuity Errors

After Jordan falls to the ground during the scene she talks to her girlfriends, the camera shows her "swollen hands", which are now completely normal in size.
House asserted at the end of the episode that he hadn't attended a U.S. conference in 15 years - this was why there was no chance he would be recognized. This doesn't quite match up with events from five seasons ago. House may have forgotten - or wanted to forget - that he attended the National Cardiology Conference in Season 1's "Role Model", and gave a speech at Ed Vogler's request. While the location of that conference isn't revealed in that episode, the name of the conference makes it likely it was held at a stateside location.
When House and Wilson argue after House delivers Wilson's paper, House's collar keeps switching back and forth from inside his jacket to outside his jacket.

Reviews

IMDB users rated the episode 8.6 with 33.9% giving it a "10"
TV.com users rated the episode 8.3. They chose Jesse Spencer as the episode's most valuable performer

Medical Ethics

Goofs

"Sydney" is misspelled on the poster for the 10 Nation Tour.

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
Jesse Spencer as Robert Chase
Peter Jacobson as Chris Taub
Michael Weston as Lucas Douglas
Annabelle Attanasio as Jordan
Marcus Giamatti as Jeffrey Keener
Bianca Collins as Phoebe
Eric Lutes as Derek Retzinger
Holly Gagnier as Michelle Berkley
Annie Young as Madison
Lindsay Johnston as Kaitlin
Ana Lucasey as Avery
Rachael Marie as Brianna
James R. Bowers as Drummer God
Andre M. Johnson as Dave
Tom Astor as Pharma Guy
Michael D. Nye as Joseph Schultz
William Christopher Stevens as Man
Sharon Swainson as Registration Woman
Corey Miguel Curties as Security Guard
Bobbin Bergstrom as Nurse
Sean Field as Pharmacide Bassist
Elsa Morales Myers as Pharmacy rep at the 80s party
Alan Mueting as Doctor
William Myers as Pharmacy Rep
Philip Ongert as Pharmacide publicist
Lei'lah Star as Kid Patient
Megan Taylor as Stiletto

Release Dates

United States - November 9, 2009 on Fox
Canada - November 9, 2009 on Global
Australia - March 7, 2010
Hungary - April 21, 2010
Germany - September 14, 2010 on RTL
Japan - August 23, 2011
Israel - July 14, 2010 on HOT3
Czech Republic - September 8, 2010 on TV Nova
Poland - October 14, 2010 on TVP2
Slovakia - October 26, 2010 on STV1
Sweden - December 14, 2010 on TV4

In Other Languages

Links

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Brave Heart

Known Unknowns

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Teamwork