|Name||Dr. Peter Treiber|
|First Appearance||Post Mortem|
He is probably one of the most unpleasant doctors at Princeton-Plainsboro. He does not trust in any physician except Gregory House. About two years before the start of the series, he wanted to join House’s diagnostic team, but Robert Chase was chosen instead.
Dr. Treiber was performing an autopsy on a young woman when he suddenly performed an incision on his own head instead of the autopsy subject’s head. An orderly came in and found him bleeding profusely from the incision and complaining that he was cold. A head CT scan and tox screen were both clean.
Dr. Treiber refused to be treated by anyone except Dr. House as he tracked the mortality rate of every doctor in the hospital and Dr. House’s rate was by far the best. Dr. House first hypothesized that it was Cotard delusion and went to pass on the case. However, Dr. Foreman told Dr. House that Dr. Treiber had no history of mental illness and he had already ruled out anti-virals as the cause. Cotard also did not explain the patient’s paresthesia. Dr. House agreed to take the case. Dr. Adams noticed the patient’s AST levels were high and thought it was psychosis brought on by liver failure, perhaps from hepatitis C. However, Dr. Treiber’s bilirubin and serum protein levels were normal, and it didn’t explain the paresthesia. Dr. Chase thought Dr. Treiber may have contracted a disease from a cadaver. However, Dr. Adams pointed out Dr. Treiber handled cadavers for a living and checking them all would take too much time. However, Dr. Chase wanted to focus on the last autopsy. That patient had bad knees and used dimethyl sulfoxide to treat it. The electric current from the defibrillator could have converted it to dimethyl sulfate. When Dr. Treiber cut into the body, the blood would have released toxic fumes. Dr. Taub countered that if that were the case, everyone in the basement would have suffered ill effects. However, Dr. House supported Dr. Chase because the fumes would have dissipated quickly. Dr. Park countered that the patient’s lungs were fine. She thought it was clots - one in the hand to explain the paresthesia, another in the carotid artery to cause the psychosis. Dr. House ordered Dr. Taub and Dr. Park to look for toxins in the morgue, and ordered Dr. Chase and Dr. Adams to do an ultrasound for clots.
Dr. Treiber was upset Dr. House would not see him. Dr. Adams noted the psychosis was clearly intermittent. Dr. Chase assured him that they were carrying out Dr. House’s orders. There was no sign of stenosis or clots.
Dr. Park and Dr. Taub donned isolation suits to search the morgue. However, the test for dimethyl sulfate was negative, and there were no signs of toxins in the patient’s blood. Dr. Park noted that Dr. Treiber’s surgical instruments were not issued by the hospital. They also found several dozen cans of energy drinks.
The high doses of caffeine pointed to stimulant psychosis. He just needed hydration with oral and intravenous fluid and observation. Dr. House ordered his team to start treatment and then went on a last minute vacation.
The team reconvened to start a new differential diagnosis. Dr. Adams thought it might be an intestinal obstruction, but Dr. Park repeated Dr. House’s mantra about coincidences. She had examined Dr. Treiber and found no masses or bowel sounds. Dr. House couldn’t be reached. Dr. Taub suggested diabetes mellitus had caused nerve damage, but Dr. Park countered that Dr. Treiber’s glucose levels were normal and it was unlikely Dr. Treiber would have either failed to self-diagnose or report diabetes. Dr. Chase suggested ulcerative colitis, but Dr. Adams noted they had already ruled out clots as a cause of the symptoms and there was no blood in Dr. Treiber’s stool. Dr. Adams also noted that Dr. Treiber would not let them treat him without House’s approval. Dr. Chase countered that Dr. House’s actions had the effect of removing him from the case. Dr. Chase focussed on the complete lack of bowel sounds and suggested an intussusception, which would point to cancer. Dr. Chase wanted to do an x-ray. When Dr. Adams pointed out Treiber wouldn’t agree to any procedure that wasn’t ordered by House, Dr. Chase pointed out that all they had to do was say that House ordered it.
However, the x-ray showed no intussusception. When they told Dr. Treiber, he was convinced that it must be there because Dr. House would not have ordered the x-ray if he wasn’t sure. He wanted exploratory surgery. Dr. Taub noted the risk and Dr. Chase reminded him a contrast enema would be safer. However, the patient was in intense pain and was sure Dr. House was right and insisted because he knew from experience that radiology can often miss these things and surgery can often find them. He also insisted that Dr. Chase perform the surgery because he had the best mortality record of any surgeon in the hospital.
Dr. Chase performed the surgery with Dr. Taub’s assistance. They found no intussusception, but did find an obstruction in the small intestine.
After re-convening the team, Dr. Chase noted that Dr. Treiber was suffering from a series of neurological symptoms that started in his head and spread to his hand and abdomen. It fit an attack of acute intermittent porphyria. Dr. Chase wanted to treat with heme, but Dr. Adams pointed out that the deception of the patient may have gone on too long - heme could actually hurt the patient if he didn’t have porphyria. However, Dr. Chase was not persuaded and went to speak to the patient. He managed to convince Dr. Treiber that House ordered the treatment, and Dr. Treiber agreed.
However, Dr. Treiber soon developed a pleural effusion, ruling out porphyria. He demanded to speak to Dr. House. Dr. Chase admitted they didn’t know where he was.
When Dr. Foreman discovered the deception, he told the team they were lucky Dr. Treiber didn’t want to start criminal proceedings. Dr. Foreman managed to convince Dr. Treiber to let him take over as attending, but told Dr. Chase he was to have no further contact with the patient. Dr. Chase went to leave, but Dr. Foreman told him he still had to work on the case. Dr. Foreman had already done an MRI of the heart and found enlargement of the left ventricle that indicated an infiltrative disease. Dr. Taub thought it was sarcoidosis. Dr. Foreman agreed and ordered steroids and a biopsy to confirm. However, Dr. Chase disagreed, believing it was more likely that it was a prion disease, most likely contracted from one of the autopsies. Dr. Foreman thought it was unlikely - Dr. Treiber was very fastidious and would most likely have taken the necessary precautions against infection. Dr. Chase noted that Dr. Treiber worked on the premise that doctors screwed up and wanted to do a brain biopsy. Dr. Foreman noted that this would most likely kill the patient in his present condition, so Dr. Chase offered to test the brains in the morgue. When Dr. Foreman noted that there were too many samples, Dr. Chase noted that he had three other doctors to work with and they could start Dr. Treiber on amphotericin while they did the heart biopsy. However, Dr. Taub pointed out the amphotericin and contrast for the heart biopsy would damage the kidneys - they could only do one. Dr. Foreman ordered the biopsy.
Dr. Chase decided to test the brains in the morgue. However, Dr. Park came to tell him that the biopsy showed fibrosis. This ruled out prion diseases and acidosis. She asked that Dr. Chase join the team for a new differential, but he said it was pointless as this new evidence would convince Dr. Foreman it was an infection. Dr. Chase was sure the answer was in the morgue and remained there to do an environmental scan.
As Dr. Chase predicted, Dr. Foreman thought the fibrosis had to indicate an infection. Dr. Adams went to test the biopsy samples for viruses and to start Dr. Treiber on anti-viral medication.
Dr. Chase thought it might be MRSA and started running tests.
However, Dr. Treiber’s condition continued to get worse. He was soon in a coma.
The rest of the team became convinced Dr. Chase might be right about the morgue being the cause of the illness. They joined Dr. Chase there, but he admitted that he was wrong - Dr. Treiber’s methods were immaculate and he had not made any mistake that might result in him getting ill. He went to wash his hands while Dr. Park suggested an autoimmune condition such as Goodpasture’s syndrome but Dr. Adams noted that Dr. Treiber’s kidneys were fine and suggested vasculitis, but there was no fever. Dr. Taub suggested lymphoma, but that would have shown up in the heart biopsy. However, all of a sudden, Dr. Chase started looking at Dr. Treiber’s soap and left the morgue.
Dr. Chase started Dr. Treiber on thyroid hormones. Dr. Treiber soon regained consciousness. Dr. Chase explained that the triclosan in his anti-bacterial soap not only killed staphylococcus, it affected thyroid function. Triclosan mimicked thyroid hormones and caused the thyroid to shut down. Combined with the caffeine in his energy drinks, it caused induced hypothyroidism. The psychosis was the first symptom. To make things worse, when the emergency room put him on sedatives, which caused a hypothyroid crisis. Dr. Treiber noted that he probably wouldn’t have thought of that, and Dr. House didn’t think of it either.