Locked In

Locked In
Director(s)	Daniel Attias
Writer(s)	David Foster, Russel Friend, Garrett Lerner
Airdate	March 30, 2009
Episode number	5.19
TV.com rating	8.7/10
Guest star(s)	Mos Def
Final diagnosis	Leptospirosis
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

"You’re a good guy. Easy to talk to."

―Locked In

Locked In is a fifth season episode of House which first aired on March 30, 2009. In a special episode of House, shot and told predominantly from the perspective of a patient, Mos Def guest-stars as Lee, a man who awakens after a bicycle accident in a small town in New York state, unable to move or communicate in any way apart from blinking his eyes. House, himself injured in a motorcycle mishap, occupies the hospital bed next to Lee and quickly annoys the doctors treating them both by insisting that Lee has "locked-in" syndrome. After House gets Lee transferred to Princeton Plainsboro, the team is on the case to try to "unlock" him. Meanwhile, Wilson suspects House is hiding something when he refuses to divulge why he was in New York and Taub worries that his attempt to quit the team will lead to House cutting him loose.

This was the first episode that broke away from the standard camera convention of having the viewer have an omniscient perspective. Like the patient, the viewer is "locked in" to his point of view for most of the episode. Although the technique of telling a story through a fixed point of view was not new to the series, it later became a hallmark, appearing again in the episodes Wilson, 5 to 9 and Chase.

Like many other episodes, Lee represents a part of House, in this case, the malfunctioning part that needs medical help. Lee is desperate to communicate because he knows it will help his doctors figure out what is wrong with him. He is frustrated with his inability to do so, but his efforts continue to bear fruit as minor details lead the doctors down the correct path. He even regrets not telling his wife things he could have told her when he could communicate. In the end, he is well on his way to recovery. Conversely, House is desperate not to communicate. He reaches out to a psychiatrist, but sabotages his own efforts, feeling that the therapeutic process is nothing but "whining" that will merely lead to the conclusion he had a bad childhood. When his best friend realized the truth, he accuses him of invading his privacy - a clear case of the pot calling the kettle black - and tells him to back off.

However, the episode does very little character development, even though the patient gives both the characters and the viewers an opportunity to have each one of the characters have a monologue where they feel free to explore with some expectation of confidentiality. Ironically, although the series seems to bypass him entirely at this point, the character that is the most well developed in this episode is Taub who, fearing for his job, also tells the patient how he's torn because it's just as scary coming into work each morning. However, it's not House that Taub fears, but the knowledge that he will be once again making life and death decisions. We also learn a little about Foreman, who traces his difficulty with relationships to an incident where an old girlfriend hated the gift he bought. He thinks this shows he has difficulty empathizing with the feelings of the women he's in relationships with, including Thirteen. Ironically, it's House who remains the enigma, making up several different excuses for being out of town before revealing at the end that he too has been speaking endlessly to a stranger - his new psychiatrist.

Recap

A patient in a hospital in Middletown, New York is regaining consciousness, but cannot move his legs. The doctors are talking about transplanting his organs when he hears House (who is in the hospital because of a motorcycle accident and is a patient in the emergency room himself), who thinks he is still alive despite the lack of response on the EEG. He has noted that the patient's eyes are following the attending doctor. House thinks he has locked-in syndrome and asks the patient to blink, which he can.

The patient’s attending physician realizes House is right when the patient shows obvious signs of voluntary movement of his eyes and can respond to questions. The patient remembers he was in a bicycle accident. He is told that his brain has separated from the rest of his nervous system, which has caused his paralysis. House thinks that the patient may have had brain damage before the crash which caused the crash, rather than being the result of brain trauma. The patient remembers he could not apply the brakes on his bicycle. House looks at the patient’s hands, which show no sign of him using them to protect himself as he fell. The attending thinks the patient's condition is permanent, but House tells the patient that he could have a treatable condition.

The patient later wakes up and sees his wife, Molly. House is looking at the patient’s CTs. The patient communicates that he does not want his kids to see him in his condition. His wife kisses him and leaves. Suddenly, House's team (minus Taub) arrives. They start doing a differential. Thirteen thinks he might have a brain tumor, and House is hopeful that Thirteen's diagnosis is correct because they could treat it. House has stolen some forms so he can get the patient into the MRI.

The team does an MRI of the patient. They put goggles on him, and he starts having a vision of talking to House on a beach. They talk about the patient's belief in God and how he goes to church to please his wife. The patient thinks God sent House to help him. The patient sees his kids playing on the beach.

House goes to see the patient. The MRI found a lesion which House thinks is a tumor most likely causing paraneoplastic syndrome. House discontinues the anti-viral medication prescribed by the attending, who thinks the patient just has an infection. The patient realizes House is a little nuts for being obsessed about his inability to communicate. Suddenly the patient has a seizure.

House is arguing with the attending about the cancer, and the wife realizes the patient wants to go with House. House manages to get the patient transferred to Princeton-Plainsboro so he can do plasmapheresis.

Cuddy meets House and asks if he has recovered from his motorcycle accident. The patient realizes that House and Cuddy like each other. Taub shows up and House tells him that he has accepted his resignation. Taub says he thought that argument was over, but House needs to see him motivated. Wilson meets House and asks why he was in Middleton - he thinks House was there to get prescription painkillers. House tells Wilson he was there to see Wilson’s first wife to tell him how much money he is making for lectures. The patient is shocked by House's drug use.

Kutner and Taub are discussing what House is up to with Taub's employment. Suddenly, they see something and go to get House. When House returns, Taub asks the patient if he drinks and Kutner suggests it could also be opiates. House wants to skip the "Twenty Thousand Questions" and biopsy the lesion in his brain.

Thirteen tells the patient he had blood in his urine and catheterizes him again. The patient's kids arrive, but the patient does not want them there. The patient thinks he might be dying and his kids are there to see him before he does. Thirteen suddenly asks the wife and kids to leave and tells the patient he has been crying.

Chase talks to the patient before doing the biopsy. He is put under anesthetic. He starts thinking about being on the beach with House and his kids. They start talking about God again. House says he does not know if he is going to be all right. The patient regains consciousness and starts answering questions on cards. However, he soon loses the ability to blink.

House tells the wife that the biopsy may have taken away his ability to blink as that part of the brain was near the biopsy site. They start talking about the result of the biopsy. House thinks the patient may be brain dead. The biopsy was useful - it revealed damage to the myelin sheath, but they still do not know why. They do a differential, but they need a better medical history, which means they need to ask him questions. Taub suggests a brain/computer interface. They hook up the patient to the machine and tell him to think "up". Taub patiently waits by his side.

Wilson has called his first ex-wife, but she was in Mexico. He asks why House is evading questions about being in New York. House says he was visiting Foreman's brother in prison.

Taub is telling the patient about his work problems. Suddenly, just as Taub gets up to leave, the computer interface seems to be responding. Taub realizes the patient is still alive. His wife comes in and sees the monitor respond. We hear the patient thinking again.

House starts taking a medical history. The wife says the patient was in St. Louis, but the patient denies it, House realizes he lied to her about being in St. Louis.

House tries to find out where the patient was, but thinks he is lying about not being with a woman. Neurosyphillis would explain the symptoms. Taub thinks the patient is telling the truth. House starts questioning him and realizes he was at a friend's house. Taub and Kutner go to do an environmental scan of the friend's house. The patient was apparently working as a janitor at a factory because his roofing business was suffering. They go to do an environmental scan of the factory and find cadmium dust - it might be heavy metal poisoning. They start chelation therapy. Taub thanks the patient for responding.

Foreman talks to the patient about buying a necklace for his first girlfriend, who did not like it. The patient thinks Foreman is boring. Foreman thinks Thirteen did not like the bracelet he bought and wishes she could just have the guts to tell him so. The patient is more impressed that he is dating Thirteen.

The wife asks him why he lied to her. His thoughts indicate that the last time he told her business was slow, she had migraines every day.

Taub goes to see House to tell him he still wants his job. House tells him to come up with a good idea - the computer was somebody else's idea (the guy who invented it). Taub tells House that the job terrifies him and that overcoming his fear is the only way for him to matter. However, House points out that finding out about the factory and cadmium was still Kutner's idea.

Thirteen is about to close the patient’s eyes to allow him to sleep, but notices something and gives the patient eye drops with dye in them to get a good look at his cornea. She sees ulcerative keratitis and she and Foreman realize it is not cadmium poisoning.

House is studying the whiteboard when Cameron comes in to treat his injuries from his accident. House goes over the patient's symptoms, kidneys failing and losing the myelin sheath from his nerves. House deliberately swallows all the narcotics Cameron gives him before she scrubs his wound. Cameron suggests giving the patient a lumbar puncture and explains why it is a good idea. House asks why he fired her, but Cameron reminds House he did not fire her, she quit.

Wilson knows House wasn't visiting Foreman's brother and asks him why he was there again. House wonders why Wilson is so obsessed. House says he was up there checking out Wilson's new girlfriend. House suspects Wilson feared that all along. Wilson is astounded, but admits he is seeing one of the nurses who is treating his brother Danny.

Foreman prepares for the lumbar puncture. Suddenly, the patient has a heart attack. He is back on the beach again, but denying the existence of God. The House in the vision admits that he does not know what is wrong.

Kutner manages to revive the patient. They are arguing when House tells them to shut up because the patient appears to be trying to communicate. The patient finally communicates he has an itch in his right foot. House realizes his liver has failed completely. Foreman comes up with sclerosing cholangitis and House orders a biopsy.

They prepare for the biopsy and Thirteen says she likes the bracelet Foreman got her, she just doesn't want to wear it at work where it can get patient fluids on it. Suddenly, Kutner notices a rash on her wrist. Thirteen admits that she got some of the patient's urine on her wrist. Kutner thinks the patient may have an infection that he passed on to Thirteen, leptospirosis, that is found in rats like the ones in the friend's house. That would cause the liver failure and result in the release of toxins that would cause the locked-in syndrome. They find a paper cut near one of his fingernails, where the infection could have entered. They test the rats at the friend‘s home and they turn out positive for leptospirosis. They start treatment and ask the patient to try to move. Kutner tells him to try harder. The patient finally moves his right index finger.

House comes to the team to congratulate them. Taub claims credit for coming up with the diagnosis, but House realizes that it was really Kutner's idea. However, House does not mind because it shows Taub cares about the job.

Wilson realizes that House wasn't up in Middletown scoping out his girlfriend, and has stolen House's phone, which he hasn't been answering while Wilson has been with him. Wilson called the number and got in touch with House's psychiatrist. House silently walks away. When they reach the patient's room, House angrily tells Wilson he had no right to invade his privacy.House then removes a recorder from underneath Lee's pillow. Lee tells House God sent him, and House tells the patient he’s no longer interesting. House says he's not going back because the psychiatry isn't working. Wilson tells him he will end up alone.

Characters

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

Guest Stars

• Mos Def as Lee
• Faune A. Chambers as Molly
• John Kapelos as Dr. Kurtz
• Skye Barrett as Jolie
• Scotty Noyd Jr. as Drake
• Bobbin Bergstrom as Nurse

Major Events

• House reveals that he was in New York to go see Foreman's brother but Wilson soon discovers that he has in fact been seeing a psychiatrist.

Zebra Factor 8/10

Leptospirosis is very rare in temperate climates like New Jersey, with only about one in 5 million people getting infected in a given year (about 60 cases a year in the United States). Locked-in syndrome is even rarer, with only a few dozen recorded cases.

Trivia & Cultural References

• House talks about the patient's doctor teaching him to blink out "kill me" in Morse Code - this is an allusion to the 1971 film Johnny Got His Gun (the film whose footage appeared in Metallica's music video "One") where a patient in a similar situation communicates through Morse Code by moving his head, and asks the Nurse to kill him.
• Middletown, New York is a town of about 25,000 that is just north of the New Jersey/New York border.
• The Gibson Goldtop is a variety of the Gibson Les Paul, named after one of the primary developers of the electric guitar.
• Duane Allman was a guitarist and co-founder of the Allman Brothers Band who died in a motorcycle accident in 1971.
• Fishkill is a medium security prison in Fishkill, New York, on the Hudson River north of New York City.
• More about Computers that can read your mind.
• Oedipal refers to a theory in psychology that men are driven by a subconscious desire to possess their mother and kill their father. It is named after the story of Oedipus Rex, whose parents abandoned him when it was predicted he would marry his mother and kill his father. Oedipus was adopted and when he heard the same prediction, he abandoned the people he thought were his parents to avoid the prophecy, and instead encountered his biological father, who he killed in a dispute, and went to marry the man’s widow. When he found out the truth, he removed both of his eyes to punish himself.
• "Save the cheerleader, save your world." After returning to PPTH, House tells Taub he may or may not have accepted his resignation. He says this quote to Taub as advice on how to keep his job. This quote is a reference to the theme of the first season of the NBC TV show, Heroes (Save the cheerleader, save the world).
• Much of the style of the episode is drawn from the 2007 French film The Diving Bell and the Butterfly(based on the real life case of Jean-Dominque Bauby) which also features a patient with locked-in syndrome (due to a stroke) and similarly has sequences where the patient's family visits him at the beach.
• House comes up with six different explanations of why he was in Middleton:
  • He tells Thirteen he was buying Duane Allman's Gibson Goldtop
  • He tells Cuddy he was buying her a Victorian corset
  • He tells Wilson he went to see his "ex-ex-ex-wife" to tell her about his earnings from the lecture circuit so she can ask for more alimony (which shuts Wilson up because he doesn't want his ex-wives to know)
  • When Wilson confronts him again, House says he went to visit Foreman's brother
  • When Wilson confronts him again, House bluffs and accuses Wilson of having an affair with someone in the area. He turns out to be right.
  • House finally admits he went to see a psychiatrist.

Goofs

• When Kutner defibrillates Lee, he holds the paddles in the wrong position.
• It's unlikely liver failure would affect one small part of the brain (the cause of locked-in syndrome). A liver issue would be more likely to cause systemic problems with the brain.
• House's suggestion that they use plasmapheresis doesn't make much sense. It is used to treat blood cancer and certain other blood problems, but none of Lee's symptoms point to a blood problem.
• While it is true that liver enzyme tests can return to normal after the liver completely fails, there would be many other symptoms of liver failure in the meantime.
• If liver failure caused itching (which it can) it would be widespread and not limited to a single area. In addition, the patient's bilirubin levels would be sky-high if the liver failure were the cause of the itching.
• Even if a patient with locked-in syndrome improves (most die within 4 months), it takes months of recovery, not days.
• Leptospirosis would have caused uveitis, not ulcerative keratitis, and uveitis wouldn't show up with fluorescent stain.
• If Lee's liver was that bad, he would probably require a transplant, not just antibiotics.

Reviews

The episode received generally positive reviews. Although some reviewers noted having the story told from the point of view of an immobile character had been used frequently in the past (Rear Window, M*A*S*H, ER [where Cynthia Nixon played the immobile patient], Alfred Hitchcock Presents, Tales from the Crypt, The Twilight Zone and The Diving Bell and the Butterfly) they also conceded the technique was an effective one and the episode executed it well. Most of the critics also enjoyed Mos Def's performance.

• TV.com users rated the episode an 8.7
• IMDB users rated the episode a 9.1, with over 63% of users giving it a 10.
• Polite Dissent enjoyed the medical mystery (giving it an A-), but thought the medicine was very average (a C-) and the final solution a big stretch (a D grade). He thought the non-medical plot was weak as well (giving it a C).

In other languages

	Title
Spain & Latin America	Encerrado (Eng. Locked)
France	Je Suis Vivant! (Eng. I'm Alive !)
Germany	Eingeschlossen (Eng. Lockend In)
Quebec	Enfermé de l'intérieur (Eng. Enclosed inside of...)
Czech	Vězeň ve vlastním těle (Eng. Prisoner in one's own body)
Polish	Zespół zamknięcia(Eng. Closed syndrome)

International Air Dates

• Canada: March 30, 2009 (Global)
• Australia: April 8, 2009 (Channel 10)
• Latin America: May 7, 2009 (International Channel)
• Denmark: August 8, 2009 (Kanal 4)
• Netherlands: October 29, 2009 (SBS6)
• Poland: November 4, 2009 (TVP2)
• Germany: November 10, 2009 (RTL)
• Hungary: November 11, 2009
• Slovakia: December 1, 2009 (STV1)
• Czech Republic: March 24, 2010 (TV Nova)
• Sweden: April 6, 2010 (TV4)

Quotes

• Kutner: (talking to Lee) The infection destroyed your liver which released toxins that caused the locked-in syndrome. You were dying of a paper cut.

• House: Hey, genius. I could violate certain ethical laws to rip the organs out of a guy who's still alive. Possibly certain law laws, too. But you won't.
• House: Blink if you can hear me.

Lee: (thinking) I hear you! (blinks)

House: Oh, this is going to be fun...

• Molly: I don't know how God is going to get us through this. But He will.

House: Stop it, I'm blushing.

• House: She's the smart one. I just keep Dark and Darker to fill out the quota.

• Lee: (thinking) I never thought I'd be praying for a brain tumor, but please, dear God...

House: If you're praying in there, stop it right now.

• Dr. Cuddy: What were you doing up there, anyway?

House: Antiquing. I found you a late Victorian corset. Come by later, I'll tie you up.

• Dr. Wilson: Your crash was ten miles from the Orange County Progressive Pain Clinic.

House: You live ten miles from Mary's Dress Shop. Yet that's not even on my list of reasons that I think you're secretly a transvestite.

• Lee: How come I'm not better? God's not supposed to work in trial and error.

House: God's mistakes are well-documented. If he'd done everything right the first time, there'd have been one plague and zero great floods.

• Dr. Gregory House: If you can't bring Mohammed to Princeton, bring Princeton to Mohammed. My diagnostics posse, Hot, Dark and Darker.

• Lee: *You're* my relaxing scenario?

Dr. Gregory House: I guess you like me.

Lee: Either that or you got sent here.

• Lee: [after watching House and Cuddy] Is he hitting on her?... If she turns around then she's into him too. [Cuddy turns and looks at House] And there you have it.

• Dr. Gregory House: You know how you hate it when I meddle in your lies... uh, I mean your life.

Dr. James Wilson: Why are you being so evasive? Unless you have something to evade?

• Dr. Chris Taub: This is gonna mean months of sleepless night wondering if I could've done something differently... Maybe it's not that I'm sick of House, it's that I'm sick of being scared out of my mind to go to work every day.

• Dr. Allison Cameron: [Handing House some pills before scrubbing his wound] Here, this is going to hurt even more. Take two now, two later.

Dr. Gregory House: [Swallowing all the pills] Oops.

• Dr. Gregory House: Why did I fire you again?

Dr. Allison Cameron: You didn't. I quit.

• House: See the irony here is... You're kind of fascinating. So many questions... But if you could answer any of them, you wouldn't be fascinating

• Taub: Sorry I didn't show up in Middletown. I didn't get the message.

House: Probably because there was no message. I've decided to accept your resignation.

Taub: Uh. I thought we were past this. I decided to stay.

House: No, you didn't. You had it decided for you. So now you're stuck here with a boss who knows that you want to be somewhere else, which means you're no longer motivated to impress me. Which means you're no longer motivated to come up with good ideas. Unless I'm wrong. "Save the Cheerleader, Save your world."

• Taub: I want to keep my job.

House: Great. All you've got to do is come up with a good idea.

Taub: How about we hooked the guy's brain to a computer so he can communicate.

House: That's a great idea. For the guy who invented the computer that can read minds. Your idea was to use his idea.

• Taub: I realized that what we do here terrifies me -- and overcoming that is the only way I can matter.

House: Kutner found the battery factory. Kutner came up with the cadmium. Maybe you don't matter.

• House: Rat pee. Very nice idea. Who came up with it?

Taub: I did.

Kutner nods his approval at Taub with his back to House.

House Good.

Taub leaves

House: (to Kutner) You okay with him claiming the credit?

Kutner It was his idea. He saw the rash—

House: If he did, he'd have hung a "Mission Accomplished" banner in my outer office.

Kutner: Don't toy with him. If you're going to fire him—

House: The fact that he stole your idea means that he cares enough to lie. That's all I needed to know. Rat pee. That's a very nice idea.

• Wilson: House. [Giving House his cell phone] You left this in my office.

House: No, I didn't. So either I have a hole in my pocket—

Wilson: Oh, that's right. I remember now: I stole it. Because if you had gone up there to check out my girlfriend, you wouldn't have come back here and lied to me about it, you would have thrown her right in my face.

House: You underestimate the entertainment value of your obsessions.

Wilson: And then there were all those calls you weren't taking in front of me. So, I dialed the number of the calls you weren't taking. You're seeing a psychiatrist.

House: [Entering the patient's room and reaching under the pillow] You had no right to invade my privacy.

Wilson: [Seeing House revealing a recording device] Is that—

House: Yeah, it's irony.

Lee: Hey... God sent you.

House: Suddenly you're not so fascinating.

Wilson: You're spying on your team.

House: Prioritize, Wilson. Is that really what you want to torture me about right now?

Wilson: I don't want to torture you at all. I think this is a great thing. Not something you have to drive an hour out of town to shroud in mystery.

House: Yeah, whining on someone's couch. That's an excellent use of my time. Maybe I'll discover that my childhood wasn't perfect.

Wilson: So, your attitude about therapy clearly hasn't changed. And yet you went. Which leads me to believe that maybe something else has changed. Maybe you think you can change. I credit Cuddy with that.

House: Not much credit to take, because I'm not going back.

Wilson: Oh, House, please. I assume you went because you're tired of screwing up every chance you get at happiness.

House: Delete contact.

Wilson: Do not let the fact that I found out about it—

House: Don't beat yourself up. I'm not going back because it doesn't work.

Wilson: You'll end up alone.

• House: His doctor's busy teaching him how to blink out "kill me" in Morse code.

Links

• Episode article at Wikipedia
• Episode page at TV.com
• Episode page at IMDB
• Episode recap at Cinema Blend
• Episode page at House MD Guide
• Episode review at Blogcritics
• Review of the medicine at Polite Dissent
• Episode guide at TV Fanatic
• Episode guide at MSN
• Episode recap at Buzzsugar
• Episode transcript at Clinic Duty
• Episode article at TVIV
• Episode review at AOL TV
• Episode quotes at House MD Quotes

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Locked In

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