Let Them Eat Cake

Let Them Eat Cake
Director(s)	Deran Sarafian
Writer(s)	Russel Friend, Garrett Lerner
Airdate	December 2, 2008
Episode number	5.10
TV.com rating	8.4/10
Guest star(s)	Samantha Shelton, Becky Baeling
Final diagnosis	Hereditary coproporphyria
Zebra Factor	8/10

Season Five Episodes: Dying Changes Everything Not Cancer Adverse Events Birthmarks Lucky Thirteen Joy The Itch Emancipation Last Resort Let Them Eat Cake Joy to the World Painless Big Baby The Greater Good Unfaithful The Softer Side The Social Contract Here Kitty Locked In Simple Explanation Saviors House Divided Under My Skin Both Sides Now Episodes • 1 • 2 • 3 • 4 • 5 • 6 • 7 • 8

Wilson: "There are dozens of other doctors"

Cuddy: "Other doctors actually use their offices for crazy stuff, like seeing patients, not throwing a ball against a wall and calling it work."

Wilson: "It’s his process. That ball saves lives!"

— Let Them Eat Cake

Let Them Eat Cake is a fifth season episode of House which first aired on December 2, 2008. A fitness guru known for her "natural" lifestyle collapses while shooting an infomercial. It soon turns out that she‘s not as natural as she says she is. Meanwhile, Thirteen participates in a clinical drug trial for Huntington's disease led by Foreman, and it leads to her remembering her mother‘s struggles with the disease. Kutner operates an online medical-advice clinic under House's name, and Taub demands a piece of the action. Cuddy moves into House's office while hers is being repaired, much to House's dismay.

Recap

During a commercial shoot, a fitness trainer is working with one of her customers. All of a sudden, she collapses and falls down the stairs of the stadium.

Cuddy brings the case of fitness trainer to House. He agrees immediately, which makes Cuddy wonder. As they leave the elevator, she tells him that she's going to use House's office while hers is being repaired.

Foreman and Thirteen are working on the clinical trial. House does a differential with Taub and Kutner. Taub thinks it is anabolic steroids, but Kutner believes her pitch that she is in an all natural program. Cuddy calls out that the patient tested negative for steroids. She gets in on the differential and House leaves the office. Kutner agrees with Cuddy that it is asthma set off by exercise in the cold. House orders them to do a stress test despite the patient's broken ankle from the fall.

Thirteen is looking at the other Huntington's patients in the trial. She starts remembering her mother’s struggles with the disease.

They do a stress test with a hand treadmill. The patient is enjoying herself as she hasn't had a chance to exercise. All of a sudden her face turns red and she collapses without a pulse. Taub rules out asthma.

Foreman is testing Thirteen's reflexes. She's upset that she got into the drug trial only because of Foreman. He says its because she has Huntington's. He tells her that the test shows the nerve degeneration has already started.

House finds Cuddy playing with the B.O.U.O.. They split up the desk. Taub and Kutner bring the test results to House – the test didn't set off her heart problems because her EKG was normal until she collapsed. Kutner thinks it's a tumor. House tells them to scan for it.

As they do the scans, Kutner tells Taub he's working on an online second opinion clinic, and that he did it under House's name. Taub tells Kutner he has two days to live (he'll tell House), unless he cuts Taub in on 30% of the proceeds. They find something in the patient's stomach – something that points to her not being "all natural" – she had gastric bypass surgery.

Taub and Kutner report to House. House thinks it has something to do with her previous obesity. Cuddy asks them to leave the office. Kutner thinks it might be nerve damage from diabetes, but House thinks it would have shown up before. House asks very loudly where his balls are. House also rules out sleep apnea. House goes to see Foreman and Thirteen too. Foreman tries to throw them out, but Thirteen wants to participate. Kutner thinks it might be poor nutrient absorption from the bypass surgery, causing SIBO (small intestinal bacterial overgrowth).

Taub goes to the patient, who justifies her surgery and the way she sells her diet program. She tried everything else first, and the surgery made her healthy and happy. He tells her to give him a stool sample.

Wilson confronts Cuddy about using House's office. He accuses her of trying to get close to House.

Kutner's side line is getting him in trouble – a patient is threatening to report him to the licensing board.

House finds the test proves it isn't SIBO despite his test of seeing whether the stool will float in water. He thinks he may have been wrong to dismiss sleep apnea and tells them to test for it in the sleep lab. Kutner and Taub monitor the patient and discuss the second opinion case. However, the patient escapes the sleep lab and goes to the treadmill. She says her broken ankle doesn't hurt, but Taub notices her leg is bleeding and she's not feeling pain.

The sleep lab results rules out apnea. Cuddy has spilled hydrogen sulfide in House’s office, and then leaves for the evening.

Thirteen returns, but Foreman comes to tell her to be more prompt for her appointments. House wants to do an NCV test to test the patient’s nerve impulses. The patient admits to being a hypocrite, but justifies it by making her clients healthier. Taub asks for her arm, but she has trouble lifting it. Taub realizes it's her muscles that are the problem and cancels the test.

Kutner runs into his second opinion patient in the elevator, but he and Taub try to waylay her on her way to House. The figure the second opinion patient just has a staphylococcus infection and needs antibiotics.

Taub tells House that the fitness trainer might have myasthenia gravis. House wonders why it took them so long to do the test and rules out myasthenia gravis because her breathing is improving and all the weakness is in her extremities.

They head off to Cuddy's office, which is still being repaired. House thinks it might be heavy metal poisoning. He then breaks Cuddy's private toilet. He orders chelation therapy for the patient.

Thirteen finds Foreman in her apartment. He wants to know why she keeps missing appointments. However, he finds she has been doing everything she's been told. She just doesn't want to hang out in the waiting room with the other Huntington's patients because it reminds her about what will happen to her. Foreman says he understands, but tells her she needs to get over it and show up on time or not at all. We see a flashback – Thirteen avoided going to the hospital with her mother when she had to be institutionalized. Her father tells her she will regret it.

The chelation doesn't work. The team is sitting on the stairs because Cuddy has removed all the furniture from House‘s office. Kutner's pager goes off, as does Taub‘s, and House wonders who could be paging them. Taub thinks it might be Guillain-Barre syndrome set off by the gastric bypass. House orders plasmapheresis.

Kutner's second opinion patient is having a seizure. Kutner thinks she is faking, but Cameron notices she is bleeding from her ear. Cameron tells them to get House.

When the patient wants to use the wheelchair to get around. Taub tells the patient she's not dying and she’s strong enough to walk.

Kutner starts a differential on the second opinion patient with Cameron and Chase. They tell him to ask House. However, Kutner comes up with a good idea – a tumor causing paraneoplastic syndrome. Chase agrees to do the scan in return for 25% of the income from the second opinion clinic.

Wilson points out that House's plan to convince the contractor he has control over Cuddy's renovations will keep her in his office longer. He tells him to ask her out.

The patient's clients seem to show up to visit her. They appear to confront her about the gastric bypass and start attacking her. She's having hallucinations.

The team is in House’s office despite the lack of furniture. Thirteen leaves the differential to go to her appointment, but thinks it might be CNS lymphoma. Cuddy tells House to test for it and other possible diagnoses before trying a brain biopsy. House tells his team to do the tests. He tells Cuddy he thinks she's doing it because she's hot for him. She tells him that he's always in her office because he's hot for her. However, she leaves after House touches her breasts.

Thirteen and another patient with Huntington’s are in the clinic waiting for Foreman. She asks Foreman to have her appointment changed. Foreman tells her he can't and she should get to know the other patient. We flash back to when Thirteen's mother was leaving to be institutionalized. Thirteen stayed in her room. Finally, Thirteen goes to talk to the other patient and help her with her coat.

The initial tests are negative. The patient asks for chocolate cake. She's sure it must be a brain tumor and confronts Taub about not telling her the truth. Taub tells her it might be a prion disease, which might be terminal. She asks for cake again, and Taub relents.

Taub reports the negative test results to House, whose furniture has been returned. House asks Taub about his affairs. Taub says he enjoyed it, but it felt hollow. House thinks he's lying. Taub tries to stop House from doing the brain biopsy himself without Cuddy‘s approval, but House threatens to fire him. When they arrive in the patient's room, they find her doing flexibility exercises.

House is wondering why the patient got better. Taub tells her about the chocolate cake and House admonishes him for not telling him right away. House leaves the room to see the patient. He brings another more cake. The patient is not feeling well again. He diagnoses a form of hereditary coproporphyria that can be treated by reversing the gastric bypass and switching to a high carbohydrate high sugar diet. When she was chubby, she was treating the problem herself. However, instead of going back to her old diet and reversing the bypass surgery, she asks for drug treatment instead even though it will only mask the symptoms and not treat the underlying problem. House figures she would rather be pretty than healthy.

Kutner and Taub talk about how superficial the patient must be as they go to see the second opinion patient. She has had a respiratory arrest and died.

Cuddy shows Wilson her new office. Wilson remarks how her desk has character. Cuddy realizes it isn't what she ordered – it's the desk she had from medical school. She realizes House called her mother and had it shipped to the hospital.

Thirteen comes to see Foreman. She admits that she wasn't freaked out by a look at her future – she was upset about being reminded her about her mother. She admits that she wanted her mother to die. Her mother was always yelling at her because of the Huntington's and embarrassing her in front of her friends. She hated her mother even though she knew it was just because of the disease, but she didn’t care. She never said goodbye to her mother. Foreman comforts her.

Taub and Kutner go to the morgue to see the second opinion patient. All the tests were negative and she was stable when Chase left her. House finds them there. He calls them idiots and frauds as well as killers. He tells them the patient had an easily treatable disease. Suddenly, House starts CPR and the patient arises. It soon turns out that it was all a scam on Kutner and Taub to teach them a lesson. The patient was acting all the time, House was feeding them old test results, and Chase and Cameron were in on it. House is going to let them keep up the website and share 50% of the profits with him and 25% with Chase. The actress tells him he still has three hours of the two days he paid for.

Cuddy comes to see House when she sees him with the actress and figures he's with a prostitute. She turns around and goes to leave.

Major Events

• With her office unusable after being destroyed from the last episode, Cuddy start using House's office which greatly annoys him.
• Thirteen starts her clinical trials.
• Kutner reveals that he's set up an online clinic in House's name. Taub blackmails him for thirty percent of the profits or he'll tell House.
• Chase is able to convince Kutner to give him twenty-five percent of the income.
• Both Kutner and Taub then treat a hooker who shows up at the hospital who eventually dies. In the end, the whole thing is revealed to have been a prank that House set up himself. He tells Kutner and Taub that he knows about the online clinic and demands fifty percent of the earnings.

Zebra Factor 8/10

Porphyria in all its forms is very rare. It is also difficult to diagnose as there is no definitive test unless the patient is having an attack.

Goofs

• Cuddy's office was perfrctly fine in the previous episode. Granted, it would need some disinfecting due to sick hostages that were in it, not remodeling the entire thing.

Trivia and Culture References

• "Let them eat cake" is the traditional translation of the French phrase "Qu'ils mangent de la brioche" (more properly translated as “Then they can eat brioche“) supposedly said by French queen Marie Antoinette upon learning that the peasants had no bread. However, the phrase first appears in The Confessions of Jean-Jacques Rousseau, which was published when Marie Antoinette was only 13. Brioche is a luxury bread enriched with eggs and butter, and was written to reflect the obliviousness of the aristocracy to the nature of a famine.
• House’s remark that his lack of requests for consults is because of the “Democrat’s health care plan” is a reference to health care reform that was put into effect in 2009.
• House's comment about Kutner calling Foreman "clean and articulate" is a reference to Joe Biden's infamous remark about Barack Obama during the 2008 Democratic Presidential primary race.
• The answer “A Duck” to the question “What else floats in water” is a reference to Monty Python and the Holy Grail, in particular, the scene where King Arthur comes across a mob trying to burn a witch.
• House’s line (imitating Sean Connery) that “He sends one of yours to the hospital, you send one of his to the morgue” is from The Untouchables.
• The Hindenburg is a German airship that crashed in New Jersey in 1937, killing 36 people.
• House quotes Edmund Burke when saying "all that is needed for evil to succeed is for good men to do nothing" (though the source is unknown and the exact wording may vary).
• Julia Putnam appears as the nine-year-old version of Remy Hadley.
• Lori Petty appears for the first time as Janice Burke.

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
• Kal Penn as Lawrence Kutner
• Olivia Wilde as Remy Hadley
• Samantha Shelton as Emmy
• Becky Baeling as Deedee
• Brad Grunberg as Irv
• Lori Petty as Janice Burke
• David Lengel as Video Director
• Nicole Cannon as Nurse Helen
• Christopher Stapleton as John Hadley
• Julia Putnam as 9 Year Old Thirteen
• Danielle Petty as Anne Hadley
• Bobbin Bergstrom as Nurse
• Lydia Grote as Amy Hadley
• Alan Mueting as Visitor
• Mark Clem as Emmy's Client

Links

• Episode page at House MD Guide
• Episode article at Wikipedia
• Episode review at Blogcritics
• Quotes at House MD Quotes
• Preview at Aceshowbiz
• Promo at The House of Fan
• Episode page at TV.com
• Episode article at TVIV
• Episode page at IMDB
• A review of the medicine at Polite Dissent

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Let Them Eat Cake

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