Meaning

Meaning
Director(s)	Deran Sarafian
Writer(s)	Russel Friend, Garrett Lerner, Lawrence Kaplow & David Shore
Airdate	September 5, 2006
Episode number	3.01
TV.com rating	8.8/10
Guest star(s)	Edward Edwards, Clare Kramer, Kathleen Quinlan
Final diagnosis	1. Scurvy; 2. Addison's Disease
Zebra Factor	1. 7/10; 2. 7/10

Season Three Episodes: Meaning Cane & Able Informed Consent Lines in the Sand Fools for Love Que Será Será Son of Coma Guy Whac-A-Mole Finding Judas Merry Little Christmas Words and Deeds One Day, One Room Needle in a Haystack Insensitive Half-Wit Top Secret Fetal Position Airborne Act Your Age House Training Family Resignation The Jerk Human Error Episodes • 1 • 2 • 3 • 4 • 5 • 6 • 7 • 8

Mrs. McNeil: "I’m taking care of him for the same reason you helped us."

House: "Some guy shot you and you hallucinated?"

―Meaning

Meaning is the premiere episode of the 3rd season of House which first aired on September 5, 2006. A pain free House returns to work and to rigorous exercise. Without argument, he accepts two seemingly routine cases. He quickly solves one, but his team and Cuddy worry that he’s obsessing so hard about finding a cure for the second that he might actually kill the patient.

If the overarching plot of the entire series is wondering if House will ever be redeemed, Meaning gives us a glimpse of what might have happened if House had later succeeded in repairing his damaged leg. By this time, it is clear that House's underlying personality (his distrust of other people and his brusque way of dealing with both superiors and subordinates) pre-date his infarction by decades.  However, House continues to blame his unhappiness (which also pre-dates his injury) on his leg pain.

However, at the end of Season 2, in the midst of hallucinations, House devises a treatment plan and even in his delirious state manages to communicate it. Not only has his leg pain disappeared, he has once again embraced the physical lifestyle he had to abandon. The exercise has improved his mood to the point where work is something to be embraced, not avoided.

He chooses an interesting pair of cases. The first is a true medical mystery—a woman who is paralyzed but shows no sign of trauma. However, the choice of the second is just a mystery to his close colleagues—a cancer survivor who clearly has no medical mystery attached to him that House takes on just so he can help another human being.

The mystery case is solved, and House shows empathy towards the cancer survivor, performing tendon surgery to relieve his pain to the great relief and gratitude of the man's wife. However, House realizes that despite his connection to the cancer survivor's family, he has derived no satisfaction from the case. Despite Wilson's assurances that House can't expect this to happen overnight, House creates a new medical mystery out of the cancer survivor, convincing his team, Wilson and Cuddy that his sober judgment can no longer be trusted.

House's inability to make "progress" with the cancer survivor starts to manifest itself as physical pain in his leg. As the "treatment" for the cancer survivor puts the patient's life at risk over and over again, House appears to be caught in a downward spiral until he comes up with another "Hail Mary" at the last minute. He becomes convinced he can cure the man without putting him at further risk. However, this is where Cuddy decides to draw the line—not at the dangerous tests, but at the relatively safe diagnostic trial.

House resigns himself to not getting his way, but it turns out Cuddy trusts House's judgment more than she lets on. She decides to treat the patient herself and, to everyone's surprise, proves House right. However, Wilson becomes convinced that if House finds out he was right, there will be no stopping him in future. He convinces Cuddy to keep it quiet. Meanwhile, House's leg pain increases and his desperation for Vicodin grows until he steals one of Wilson's prescription pads.

The events in the episode are key to several themes and plots in the series. This is not the first instance, nor will it be the last, where House's instincts in taking on a seemingly routine case wind up with him hitting a home run. A short list of the beneficiaries of House's magic are Lucy Palmeiro, Olive Kaplan and Father Daniel Bresson to name just a few. The episode also lays the foundation for events later in Season 3—the fight over keeping his blood stained carpet and the eventual development of the Tritter story arc. However, by the end of the episode, it's clear that the optimism is over and that House will once again be House. Overall, the episode confirms that House is "almost always eventually right".

This episode was nominated for an American Society of Cinematographers award for Outstanding Achievement in Cinematography in Episodic TV Series.

Recap

An uncommunicative man who had been treated for brain cancer and is currently confined to an electric wheelchair suddenly drives the wheelchair into his family's pool in an apparent suicide attempt.

Meanwhile, thanks to the fact he was treated with ketamine during treatment for his gunshot injury, House's leg is pain free and he is running eight miles before coming into work each morning.

Cuddy and Wilson are discussing cases that they think will interest House. They are astounded that House has run to work. Although it's only been eight weeks since he was shot, House is raring to go. Cuddy tells him that she has a 26 year old woman who is paralyzed from the neck down despite no obvious injuries. He also agrees to take the case of the guy who drove into his pool even though there does not appear to be any real diagnostic problem. Wilson wants to know why House is taking the second case. House says it’s because he may be able to treat the patient for his pain, but Wilson doesn’t believe him.

House's team welcomes him back, and Cameron reveals the shooter was never caught. They start a differential on the paralyzed woman. Suddenly, House sees his own blood on the carpet. He says he wants to keep the stain. He then starts on what to do about the wheelchair bound man, and suggests tendon surgery to deal with pain from his atrophied muscles.

They proceed with the surgery on the wheelchair patient. His family is denying he would try to commit suicide; His son thinks he was confused. House thinks it is promising the father attempted suicide because it shows his brain is still active. The wife thanks House, astounding Cameron, who has never seen a patient thank House before. When she demands he tell her why the wife thanked him, House avoids answering by quickly running away.

Chase tells House the patient flinched when they inserted a needle for the test, meaning the woman's muscle and nerve control are slowly getting better. House burns her to show she can move, and claims that she is faking. However, the patient denies that she's faking. House orders her to be discharged.

Wilson is also astounded that a patient thanked House, and that he was with the family during surgery. House admits he didn't have any emotional response to being thanked. Wilson tells him it will come back.

Cameron comes to say the woman patient is having trouble breathing. House threatens her with a needle but she continues to have trouble. He then notices something on her neck. He puts her on her back and draws blood from her pericardium, showing it's a genuine heart problem.

The team has to keep drawing blood from around her heart. House suggests exploratory surgery to look for a spinal tumor, even though they don't know exactly where on the spine to look.

House goes to see the wheelchair patient. Cameron sees House being kind to the patient and teases House about it. He astounds Cameron by asking her out for a drink. Cameron gets very uncomfortable until House tells her he did it to prove she was only interested in him while he was ill.

House goes to see Cuddy. She won't let him do the exploratory surgery because it's too dangerous. When House tries to bargain, Cuddy pulls rank.

However, when House does more tests and can’t find anything, Cuddy finally gives in and approves the surgery. Wilson starts dogging House about how he practices medicine. They go to the woman patient's surgery when House spots that one of her toenails is cracked and discolored. He orders them to stop the surgery. House realized that she has scurvy from Vitamin C deficiency. She had a diet that didn't contain any.

House turns his attention to the wheelchair patient. He wants to discharge him. His wife is grateful that House treated his pain. House asks why she hasn't institutionalized him. She says she wants to take care of him. House thinks she does it because not taking care of him would make her miserable. As she goes to get him out of bed, House hears him make a noise. He asks the patient to do it again. He tells the wife that her husband was trying to talk.

House brings the wheelchair patient's medical records to the team. He tells the team the patient spoke, but they realize he grunted. He orders them to review the patient's medical history. Wilson accuses House of being bored while House attempts skateboard tricks. Wilson tells House to tell the wife the patient just grunted, but House refuses. Wilson leaves and, after he does, House grabs his right thigh in pain.

The team is dissecting the wheelchair patient's medical history and finds 214 symptoms, all of which go on the whiteboard. However, even Chase is able to eliminate all possible unusual diagnoses. Cameron thinks the symptoms are essentially random and don't show any underlying disease. House decides to perform an endoscopy to look for infection. Chase does the procedure, but the patient can't even respond to simple commands. The patient's throat collapses during the procedure, just as the team warned. They perform an emergency tracheotomy.

House can't understand why the patient gagged during the endoscopy while he was under anesthetic. House denies it was a spasm, and believes that his throat locked down. House wants to look into his brain for cancer, but the amount of dye necessary would be life threatening. House tells the wife that if it is cancer, it is a new cancer. When the wife asks if the husband could get better, Cameron shouts "No!". Although the wife realizes the test is risky, she admits her husband is all but dead and consents to the test.

The team starts the procedure and injects the contrast material. Unfortunately, the patient starts bleeding from his ear, again as the team predicted. Worse yet, the scans show nothing. House gets Foreman to review his previous radiology. Finally, the team has had enough and only Chase is willing to help with new tests.

Cuddy confronts House about his judgment. He points out that House never says he wants to help someone, he comes in with a prediction of catastrophe. She orders the patient discharged. Even Wilson refuses to help him. House then admits to Wilson his leg hurt, but has since gotten better. Wilson tells him it's nothing more than aches from the running and skateboard tricks. He refuses to prescribe him Vicodin. He accuses House of trying to get high either from drugs or solving problems.

House goes running and stops by a fountain to cool off. He then gets an idea and runs to Cuddy's house. He wakes her by knocking on her window and tells her that the patient dove into the pool because he was overheating. He thinks he has hypothalmic damage that has shut down his adrenal glands causing central adrenal insufficiency. He asks her to inject the patient with cortisol. Cuddy blows him off—she says he is guessing, not acting on evidence. He reminds her there is no risk to the shot. She tells him he has to learn to hear the word no.

Wilson finds House despondent in his office, expecting him to try to inject the patient instead. House admits he had no reason to think he was right.

Cuddy meets the patient as he is leaving. She gives him a shot of cortisol. However, the patient doesn't respond right away. Cuddy is despondent, but all of a sudden the patient starts moving and releases the seat belt on his wheelchair. He then stands up, although with difficulty. His wife and son rush to him.

Wilson tells Cuddy she can't tell anyone. She admits she had no medical reason to inject the patient. Wilson reminds Cuddy that House was just lucky this time, and if he tells House, he won't back down. When Cuddy says she can't do it, Wilson reminds her everybody lies as the strains of You can't always get what you want start to play.

The episode ends with House entering Wilson's office, taking one of Wilson's prescription pads, and writing himself a prescription for Vicodin.

Zebra Factor 7/10

Both of the diagnoses in this episode are uncommon, but not terribly rare. Scurvy is almost unknown but does occur in people who exclude citrus from their diets. Secondary (central) adrenal insufficiency is also fairly rare, but it has numerous causes.

Major Events

• House returns to work after being shot.
• It's been two months since House received ketamine which helped him regain the full use of his right leg once again.
• House is shown running for the first time.
• Cameron reveals that Jack Moriarty, the guy who shot House, was never caught.
• House watches a patient's surgery and also talks to the patient's family as well.
• House begins experiencing pain in his leg again and confides in Wilson about it. When House asks for a prescription of Vicodin, Wilson refuses to give him any.
• House tells Cuddy that he hasn't taken any drugs for three months.
• Cuddy successfully cures the paralyzed patient, but Wilson forbids her from telling House.
• House breaks into Wilson's office and writes a script for himself, knowingly forging Wilson's signature in the process.

Trivia & Cultural References

• Stephen Hawking was a brilliant theoretical physicist who had been confined to a wheelchair for forty years due to ALS
• The Butterfly is a swimming stroke where both arms are brought forward simultaneously. Until the development of the Australian Crawl, it was the fastest swimming stroke.
• Most of the exterior scenes were shot on the campus of UCLA. House runs up the Janss steps from the Wilson Quad. The scene where the team is sitting outside was shot at the Dickson Terrace between Royce Hall and the Powell Library.  
• Part of the medicine hit a home run. When House notices that Caren's jugular vein is distended, he was certainly correct that she had a cardiac tamponade.
• Cuddy seemingly pulls the number "24 times a year" out of thin air. In fact, it was the exact number of episodes in season 2, and – unknown at this time – season 3 and 5.
• The fountain House douses himself in is just a prop.

Goofs

• Although it is perfectly plausible that House could give up his cane after the pain in his leg disappears, it is unlikely that he could walk without a limp given the continuing absence of his thigh muscle.
• House was probably a bit too quick in poking Caren with that needle.  An embolism was probably more likely, and sticking a needle into the chest risks piercing the heart
• When the team write up Richard's numerous symptoms on the whiteboard, they misspell diarrhea as "diarea" in one place even though it is spelled correctly in at least three other places on the whiteboard.
• Actually, an adrenal insufficiency caused by a pituitary or hypothamalic dysfunction is not diagnosed as Addison's disease but as an secondary or tertiary adrenal insufficiency, respectively. Addison's is caused by the functional loss of the adrenal cortex itself. Also, adrenal insufficiency would have shown up on other lab tests such as sodium, potassium, and cortisol levels. He also would have experienced hypotension, as he would have been in an adrenal crisis.
• Richard's recovery was probably a bit too quick.  A man who hasn't used his legs for eight years and who has just had tendon surgery would most likely not have been able to stand.
• House screws up the prescription he is forging.  He writes a prescription for Vicodin extra strength, which contains 7.5mg of hydrocodone and 750mg of acetaminophen, but the dose is written at 5-500 (5mg of hydrocodone and 500mg of acetaminophen), the strength of regular Vicodin.

Music

• House jogs to "Feel Good Inc." by Gorillaz
• You can't always get what you want plays over the final scene
• "Desire" by Ryan Adams
• "So What" by Miles Davis

Reviews

Reviews of the episode were generally positive.  Blogcritcs was particularly impressed by the use of imagery in the episode to communicate House's mood and his fear of the return of the pain.

• IMDB users rate the episode 8.9, with 44.9% rating it a 10.
• TV.com users rate the episode an 8.8

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
• Kathleen Quinlan as Arlene McNeil
• Carter Jenkins as Mark McNeil
• Clare Kramer as Caren Krause
• Edward Edwards as Richard McNeil
• Eamon Hunt as Surgeon
• Remy Thorne as Kid
• Bobbin Bergstrom as Nurse
• Terry Rhoads as Artie

Quotes

Dr. Gregory House: Relax, I'm not gonna burn you again, I'm going to *stab you*!

Dr. Gregory House: Oh, I stuck that primo! How rad am I?

Dr. Allison Cameron: You're lucky he didn't die.
Dr. Gregory House: I'm lucky? He's the one who didn't die.

Dr. Gregory House: For the first time in years I've got no opiates in my body. *Now* you question my judgment?

Dr. Gregory House: You want something, I want something. We compromise. It's the grown-up way to resolve our differen...
Dr. Lisa Cuddy: There already *is* a mechanism for that, it's called the employer/employee relationship. I get what I want—and you don't.

Dr. Gregory House: Inject him with Cortisol. The guy'll have sex with his wife again! He'll hug his kid again! Hopefully that's the combination he was using... be a shame if I cured a pedophile.

Dr. Gregory House: [to Cuddy] You're smiling, that's a bad sign.

Dr. Gregory House: I've changed.
Dr. James Wilson: No, you haven't.
Dr. Gregory House: No, I haven't.

Mark McNeil: He wouldn't kill himself.
Dr. Gregory House: Fine. I'm wrong. You obviously have a better understanding of this man who drools in front of your TV set 24 hours a day.
Mark McNeil: He—he must've been confused, all right? It must have been an accident.
Dr. Gregory House: I hope it was a suicide attempt. If he was trying to kill himself, then he knows how miserable his life is. It means there's something in there to kill. It means your dad's still there.

Dr. Allison Cameron: You did something for which she's grateful and you're... embarrassed?
Dr. Gregory House: For you. She saw you coming and thought you were a 14-year-old boy. I set her straight.
Dr. Allison Cameron: I am not telling you what went wrong... or right. Until you tell me why she said "Thank you."
Dr. Gregory House: Oh, you got me. You know I need to know. I am so gonna fold. Except you're forgetting there's one thing I can do now. [Looks over Cameron's shoulder. She glances in that direction then House runs in the opposite direction]

Dr. Lisa Cuddy: I have to tell him, he was right.
Dr. James Wilson: Why did you do it? Why did you think he might be right?
Dr. Lisa Cuddy: Because he's... House.
Dr. James Wilson: Medically. What made you think he was right.
Dr. Lisa Cuddy: Nothing.
Dr. James Wilson: He got lucky. That's all that happened. Telling him "No" was a good thing. Because next time he won't be lucky, he'll kill someone. Just because he was right doesn't mean he wasn't wrong.
Dr. Lisa Cuddy: [Exhales. Long pause] I see him everyday. I can't just...
Dr. James Wilson: Everybody lies.

Dr. Lisa Cuddy: You *ran* here?
Dr. Gregory House: [Out of breath] It's just... eight miles.
Dr. Lisa Cuddy: Why did you...
Dr. Gregory House: Why does a dog lick it's... what's a workplace-acceptable euphemism for testicles?
Dr. James Wilson: Because he can.

Wilson: You're fabricating a mystery because you're bored.
House: I am not bored.
Wilson: You didn't tell the wife it was only a grunt?
House: Of course not. Because then she would never have consented to a bunch of dangerous tests. I don't remember you being this bitchy.
Wilson: The Vicodin dulled it. In the sober light of day, I'm a buzz-kill. You're giving false hope to a family that's been wrecked. Don't torture them. Let it go. Tell the wife it was only a grunt. Tell her to go home.
House: I can't let her down like that. Pumped her up with too much false hope.

Foreman (explaining why he is going through the case files thoroughly): I'm happy we're doing this....
Cameron: You like wasting your time?
Foreman: I'm learning.
Cameron: To do what? Reconsider solved cases because you don't want to deal with the real world? He's pushing, there's nothing.
Foreman: Cameron, you are an excellent doctor. You'll get lots of tearful thank-yous from grateful patients.
Cameron: Yeah, am I such a bitch for wanting that?
Foreman: 'Well, it's not a bad thing. But it's not why I'm here. I took this fellowship to learn from House.
Cameron: He's teaching you to become a masochist.

Cameron, to House about the diagnosis: Stop it. You're enjoying this.
House: I find it interesting.
Cameron: It's interesting only if you're right. If you're wrong, we're torturing this guy to amuse you.

House, to the team after he almost killed the patient twice: Redo every blood test he's ever had. Re-scan his head.
Cameron, with certainty: No. He's been sick and suffering for eight years. I'm not going to help you make it worse. I'm not going to help you make it interesting.
House: That's okay. Foreman's better at that stuff than you are. We need five millimeter cuts...
Foreman, after thinking for a moment: No.
House looks at Chase, so does Cameron
Chase, after thinking about it for a bit: How many millimeters?

House: My leg hurt.
Wilson: How bad?
House: Enough that I'm telling you.
Wilson: Did it go away?
House: Ached for a while. First time I've felt anything there since the surgery.
Wilson: But it went away.
House: It's muscular. There was some cramping. What are you smiling about?
Wilson: You're 40-something years old. You've been running God knows how many miles a day. Fallen a hundred times off that skateboard. And you're shocked to have some soreness?
House: Just give me a prescription.
Wilson: For Vicodin? House, people get aching joints, cramps—they put on an ice pack, they take some ibuprofin.
House: I know what the pangs of middle age feel like.
Wilson, interrupting: No, you don't because you've been stuffing Vicodin every five minutes since you turned middle aged.
House: The surgery didn't work.
Wilson: Don't play me.
House: You think this is a scam?
Wilson: I think you want me to feel sorry for you and either do the end-around on Cuddy or give you the drugs. [Wilson puts away his prescription pad] Either way you get the high you think you need. [House starts to walk out] House, your surgery worked. You're fine. It's just going to take time for it to feel good.

Dr. Chase: I've had to relieve the pressure three times in the last two hours. So either we figure out what's causing blood to build up around her heart, or I follow her around with a needle for the rest of her life.

House: (to Cuddy) For the first time in years I've got no opiates in my body, now you question my judgment.

Dr. Cuddy: You want to trade? (in an Amish accent) We're not swappin' a couple a' goats for your help puttin' up a barn.

Dr. Wilson: The fifth level of happiness involves creation. Changing lives.
House: Sixth level is heroin. Seventh level is you going away.

Dr. Cuddy: You've been back at work 24 hours and you're already playing hide-and-seek in a woman's spine!
House: Who won the pool?

Dr. Cameron: We should give her a local (anesthetic).
House: That would defeat the point of me being nasty.

Dr. Foreman: 2002; patient had dry eyes...
Dr. Chase: Dry eyes plus a grunt. It all makes sense.
Dr. Foreman: Could be a neurological issue.
Dr. Cameron: I get hay fever I put drops in my eyes. I don't go to a neurologist.
Dr. Foreman: Dry eyes could indicate an autonomic dysfunction. It goes on the board.
Dr. Chase: What about coughing? Or boogers? Should we include boogers?

Dr. Cuddy: Twenty-four times a year you come storming into my office spouting that you can help someone. Except you never say those words. You say something like, "His pancreas is going to explode because his brain is on fire!

House: Would you like to get a drink?
Dr. Cameron: Are you… are you serious or are you just trying to change the subject?
House: No I'm serious. I drink, you drink, we can do it at the same time, at the same table. Do you eat? We could do that too. Hey, if the answer's "No" that's cool, but...
Dr. Cameron: No it's just... you're just coming off surgery and you're not yourself yet and I work for you and even though last year's... agh. You're smiling. I'm saying no and you're smiling.
House: Well don't take it personally, it's just cause you're full of crap. You have no interest in going out with me. Maybe you did when I couldn't walk, when I was a sick puppy that you could nurture back to health. Now that I'm healthy there's nothing in it for you.

Dr. Cameron: You are not healthy. Cuddy wants to see you.

Dr. Cameron: The leg looks fine. Totally pain-free?
House: When did this turn into "What did you do over your summer vacation?"
Dr. Foreman: It's a little weird to discuss the case while you're staring at your blood on the floor.
Dr. Cameron: I asked Cuddy to replace the carpet.
House: I like the carpet. What'd you do over the summer.
Dr. Cameron: I…
House: Redo the tests.'

International Air Dates

• United States - September 5, 2006 on Fox
• Canada - September 5, 2006 on Global
• United Kingdom - March 22, 2007
• Netherlands - June 21, 2007 on SBS 6
• Germany - September 4, 2007
• Czech Republic - November 12, 2007 on TV Nova
• Hungary - November 21, 2007
• Belgium - December 6, 2007 on KanaalTwee
• Estonia - January 4, 2008 on TV3
• Sweden - February 5, 2008 on TV4
• Japan (limited release) - May 18, 2008
• Japan (full release) - May 27, 2008
• Norway - July 17, 2008 on NRK1
• Finland - August 7, 2008 on MTV3

In other languages

• France & Quebec - Retour en force (Eng. Comeback, literally "Return in force")
• Spain & Latin America - Significado (Eng. Meaning - literal translation)

Links

• Episode page on IMDB
• Episode article at Wikipedia
• Episode page at House MD Guide
• Review at Blogcritics
• Quotes at House MD Quotes
• Promo at The House of Fan
• Episode transcript at Clinic Duty
• Episode page at TV.com
• A review of the medicine at Polite Dissent

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Meaning

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