- Apple: "I feel fine."
- Thirteen: "I don’t mean to scare you, but so did the others."
- ―Not Cancer
Not Cancer is the second episode of the 5th season of House which first aired on September 23, 2008.
House and his team have to find out why recipients of donor organs from a particular donor are dying before the same thing happens to the last two recipients. To assist in both his personal and professional life, House hires a private detective to find out more about both the dead donees and about Wilson. The detective seems incompetent, but it turns out he has remarkable insights. He finds out that Wilson is only shutting one of his former colleagues out of his new life.
A young woman collapses suddenly on the tennis court. Elsewhere, a crane operator collapses in his cab. In an MMA bout, one of the participants collapses bleeding right after handing out a beating to his opponent without taking a significant blow himself. At a rehearsal, a music teacher playing the tuba coughs up blood before collapsing.
Foreman is describing the symptoms to the team and House. The donees all received different organs, but none of those organs failed. Four of the six donees are dead, one is dying, and only one seems healthy. All four dead donees and the sick donee had diseases in different organs. The donor died in an industrial accident. The autopsies provide no clues. House thinks it is cancer, but Foreman argues it can't be – all the symptoms are different and the tests for cancer were negative. House orders the cancer tests redone on the dead bodies and the donor’s body.
House is trying to make friends with another doctor who likes monster trucks. Foreman comes in to tell House the transplanted cornea needs to be removed. However, House thinks it is psychological. House gives an eye test to the healthy patient. However, she fails it. House thinks it is a brain problem rather than an eye problem. The patient starts hallucinating that they are going to remove her head. The hallucination seems to confirm a brain problem.
The team is watching the MMA match. They know the tennis player had a heart problem, and the music teacher had a problem with his lungs. The crane operator's liver failed and the other living donee, Frank, has pancreatic failure. Suddenly, the coffee repair guy chimes in. Kutner realizes that the coffee repair guy is not a coffee repair guy because he‘s wearing argyle socks with construction boots. House tells them he's a private investigator he hired. The private eye starts telling them about the dead people because House had him check them out. He hands House a bill for $2,300. It was the private eye who obtained most of the MMA footage. It shows the boxer may have had a temporal lobe seizure. House wants to do a brain biopsy on Apple, but they decide to do it on Frank instead. However, Taub can't get consent from the wife for the test. The healthy patient tries to lie to get her to consent, but all of a sudden Frank gets worse. He goes into cardiac arrest. Taub tries a tracheotomy and defibrillation, but can't save him. House tells Taub to make sure he saves the dead patient's brain.
They autopsy the newly deceased brain, but can't find anything. House thinks it must be cancer because metabolic diseases only attack a specific organ. Foreman thinks House merely wants a reason to consult Wilson on the problem. Kutner thinks a perforated intestine could explain the problems. House agrees its possible, but not probable. However, the living patient's colonoscopy was clean. House wants to do a colonoscopy on the donor's child. They get the mother's consent.
House checks out the private eye, who is keeping an eye on O'Shea for House. However, the private eye realizes it's a test – House doesn't care about the guy he's doing surveillance on and he really wants to find out about Wilson. The private eye tells him that he found out nothing about Wilson that will make him come back, and that this information cost House $900.
The child's colonoscopy was clean, so House still thinks it is cancer. Kutner suggests that they test the dead man's colon with water pressure. House agrees. Foreman is skeptical, but the procedure actually works. They can't find any leaks until Kutner turns the pressure up and the patient's internal organs explode onto Foreman.
Apple is getting sicker – tachycardia and labored breathing. House demands a new idea, but no-one has any ideas. House decides to treat her for cancer even though they can't confirm it – it's clear she has something wrong with her. He goes to the patient to get consent for chemotherapy. He admits that he doesn't know she has cancer, but makes out like he's trying to do away with the placebo effect. The patient consents. The patient tells House that she used to be an architect, but gave it up after she regained her sight because she found out the world was ugly – having sight didn't make her happy.
House meets the private eye again. He starts telling House about Wilson. Wilson has a new job, but hasn‘t started there yet. Cameron has been seeing him, but only to counsel him. Cuddy has been contacting him too. Wilson hasn't mentioned House at all.
The patient has started vomitting from the chemo, but her symptoms are improving. Foreman congratulates House for diagnosing cancer, but House realizes it isn't cancer.
House thinks it is a disease that acts just like cancer, just isn't. The tuba player was taking a drug that was for arthritis, but also attacks cancer cells. He died anyway. House realizes he's missing something. He goes to visit Wilson for a consult because he needs Wilson's ideas. Wilson tries to send him away, but House won't go. House admits he hired a private eye to spy on him. Wilson says he wants to move on and shuts the door.
House runs into the private eye, who listened to his breakup with Wilson. House admits Wilson was his only friend. The private eye tells him that things are what they are. House realizes the patient's seeing everything as ugly is a symptom. House tells her his theory – the donor had cancerous stem cells. They masqueraded as proper cells in every patient, but because they were cancerous, they didn't perform their assigned function and failed under stress. He thinks that the chemotherapy is merely hiding the problem by shrinking the cells but not destroying them. He tells Cuddy that the patient has cancerous stem cells in her brain – that's why she can‘t see even though her eyes are fine, and why she sees everything as ugly. He wants to remove a part of the patient's skull and needs Cuddy's approval. She refuses to discontinue the chemotherapy and wonders why she is paying $2,300 for a coffee machine repair.
To keep House from trying to make the patient crash, she hires security guards for the patient. All of a sudden, the patient's heart starts to race – we see someone in argyle socks walking away from the patient's bed dressed as an orderly. House ordered the private eye to change the chemo for saline, as proven during the dialogue later on when the private eye said "But I swapped her meds".
The neurosurgeon and Chase start drilling into the patient's skull before they realize the trick. Chase wants to stop, but House tells him that the dangerous part is already over. They use a neural net to see if any part of the brain is not transmitting signals properly. The private eye shows up and they watch the surgeons remove an anomaly in her brain. The private eye tells House he owes him $5,000.
The patient has her eyes bandaged, but realizes House is in the room with her. He tells her that her perception of ugliness was a symptom of her disease. The patient is astounded how different things look. She notices how sad House looks.
House goes back to his office and calls the private eye to see if he can put him on retainer.
- House begins hanging out with Dr. O'Shea in an attempt to find a replacement for Wilson.
- Lucas Douglas, Private Investigator is introduced for the first time.
- House puts Lucas on retainer.
Zebra Factor 10/10
The idea that certain cancerous cells have characteristics in common with stem cells is, at present, merely theoretical. Current theories believe that regular cancer therapy destroys most of the cancer cells, but not the cancer stem cells, which grow new tumors. As far as can be found out, there are no cases where cancerous stem cells from one patient thrived in another, although there are documented cases where a specific type of cancer was transferred from one person to another through transplant of the affected tissue. That was part of the plot of The Mistake.
Trivia & Cultural References
- More about Tennis
- The MMA bout in the show used genuine MMA fighters David Anthony Buglione as the loser Rico, and Dennis Keiffer as Danny, the deceased winner.
- Argyle is a textile pattern of diamonds in a checkerboard pattern that derives from the tartan of Clan Campbell in Argyll, Scotland.
- Near the end of the episode, House is shown in his office throwing and catching a cricket ball, probably a reference to Hugh Laurie’s English roots.
- After Cuddy denies House's request to open Apple's skull, the song that plays during the chemotherapy montage is Dave Matthews Band's "You Might Die Trying".
In Real Life
Although transplant donors are screened for routine diseases, transplant cross-infection is a rare complication of transplants. Recipients are at particular risk because of the immunosuppressant drugs they receive. In one case in Texas described on "Killer Outbreaks", a dead man with rabies was misdiagnosed at death with cocaine intoxication and the three transplanted organs killed all three recipients. A similar plot occurred in the TV show Scrubs, episode 'My Lunch'.
Dying Changes Everything