For the man who appeared as a hallucination in Guardian Angels, see Old Man
- Cameron: Do you understand what this means
- Older man: Is it okay if I sleep here tonight? It's cold outside.
- — Admission at emergency room
Older Man was the homeless patient who Allison Cameron treated in the Season 3 episode One Day, One Room. He was portrayed by actor Geoffrey Lewis.
House had taken on a fake case to get out of clinic duty, which meant Cameron had nothing to do, so she went to the clinic to help out. She was assigned an older homeless patient who had discharge documents from another hospital. As she read them, she found that the man had terminal cancer and had only days to live. After confirming with him that he understood the prognosis, he asked if he could spend the night in the hospital and Cameron had him admitted.
However, the patient refused all pain medication. As Cameron struggled to get him to accept it, he told her he wanted to be remembered. Cameron swore to remember him, but the patient once again asked why she should bother. When she tried to comfort him, he told her that he had wasted his life and didn't deserve to be remembered.
Reaching the diagnosis[]
Cameron starts with a definitive diagnosis of lung cancer, which is written on the discharge sheet: "Patient has a six centimeter mass in the right lung. Cancerous. Inoperable." The patient most likely appeared in an emergency room. Typical symptoms of late stage lung cancer are constant coughing, shortness of breath, obstruction of the large airways (which would show on examination or with a stethoscope), bleeding from the large airways (e.g. coughing up blood, or obvious on examination), pain, severe fatigue and wasting of the body. With any severe lung symptoms, radiological investigation would be an obvious next step. If the mass were in the right place, a biopsy would most likely not be necessary.
Explaining the medicine[]
Lung cancers can be inoperable for a number of reasons:
- It might surround the major blood vessels in the chest, such as the pulmonary vein and pulmonary artery.
- The patient may be too ill to survive the surgery
- The side effects of the surgery may be too severe, such as resulting in full or partial paralysis
Chemotherapy and radiation therapy may be options for lung cancer, but face many of the same limitations for very ill patients.
Although patients differ, one of the worst aspects of end stage lung cancer that almost always occurs is a buildup of fluid around the lungs, which leads to coughing, shortness of breath and fatigue. Pain is a common symptom, but varies greatly between patients. Death usually stems from respiratory distress.
Purpose of the character[]
This character serves as a contrast to the patient in the main plot, where House is forced to assist a woman who is trying to recover from a rape. Like House, Cameron is taken out of her element here and is faced with a particularly difficult patient given her general skill set. If you switched the roles of House and Cameron here, Cameron would be much more comfortable and useful dealing with the rape patient:
- "You need to get her to talk about what happened.... She's gotta make this real... there's no way she can pretend this didn't happen, so she has no choice but to process it."
- ―Cameron's advice to House on how to deal with rape victims
We can guess what would happen in the reverse situation. The patient here manipulates Cameron's emotional response. House lacks any such response and would be fine with just letting the patient suffer, or at least pretending to until the patient agreed to treatment. We see this approach work for House very well three seasons later in Lockdown where we see House having to deal with a terminal cancer patient.
Trivia[]
- Older Man is one of several character with no known first or last name.
Terminal medical care in the United States[]
In most countries, this patient would have been referred to hospice care after such a diagnosis, but such facilities are rare in the United States. This is ironic because here the patient had to be treated in the emergency room as he was too sick to be discharged at that point. It is an unfortunate truth that hospitals treating emergency patients without the ability to pay have an incentive to discharge them if it is at all possible.
But, of course, something here is weird. At the time the episode was made, the actor, Geoffrey Lewis, was 72 years old. A person that old in the United States should have been covered by Medicare.
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