Changes: Pilot

Revision as of 02:49, 20 June 2014

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Rebecca: "I just want to die with a little dignity."

House: "There's no such thing. Our bodies break down, sometimes when we're ninety, sometimes before we're even born, but it always happens and there's never any dignity in it. I don't care if you can walk, see, wipe your own ass, it's always ugly. Always! You can live with dignity, you can't die with it."

―Pilot

Pilot is a 1st season and the series premiere episode of House, which first aired on November 16, 2004. A young kindergarten teacher is brought to the hospital and diagnosed with inoperable brain cancer by Wilson. However, when she doesn't improve with treatment, Wilson seeks out House for another opinion. When House fumbles the initial diagnosis, the patient tires of being a guinea pig just as House feels he has found the right answer. Meanwhile, new hire Eric Foreman tries to get used to working with the world's most difficult diagnostician. Cuddy, frustrated with House's lack of a work ethic, decides to go to extreme measures to get House back into the habit of working in the clinic.

In March 2012, Robert Sean Leonard who played James Wilson said in an interview that this was still his favorite episode of House. He praised the simplicity of its story and its lack of sensationalist plot elements. He also noted that for most of the episode, House himself seldom appeared, preferring to stay in the background as a shadowy character who was merely talked about by the rest of the cast, who carried the story themselves.

Recap

A school teacher in front of class suddenly begins speaking gibberish and becomes confused. Her panic mounts, and she hastily scribbles the words "Call The Nurse" on the whiteboard before collapsing in a grand mal seizure.

A month later, Dr. James Wilson introduces the teacher's case to his close friend Dr. Gregory House, a diagnostician. House is worried people will think he's a patient because of his limp. When Wilson suggests he wear a lab coat, House tells him he's afraid people will think he is a doctor. House thinks that the patient has a brain tumor, but Wilson asks him to take the case because she's his cousin. Wilson doesn't think it's cancer because she isn't improving with radiation therapy. Wilson reminds him that House has three overqualified doctors working for him that would love to work on the case.

House meets with his diagnostic team and reminds them that "everybody lies". New hire Eric Foreman wonders why House isn't with the patient, but Allison Cameron tells him that House doesn't like meeting patients. At this point, House has stopped thinking it's a tumor. Robert Chase thinks it is an aneurysm or stroke. Cameron thinks it might be mad cow disease. Foreman thinks it might be an encephalopathy, despite a negative blood test. House tells them all to proceed with the appropriate tests.

Lisa Cuddy, the Dean of Medicine, comes looking for House to berate him for not working hard enough, including being six years behind in clinic duty. He says he's going home - he can't be fired because he has tenure and is always at the hospital during his assigned work hours. Cuddy agrees that that he still has a good reputation, but it will go to hell if he doesn't do his job.

Cameron and Foreman start to do a test, but it's cancelled on Cuddy's orders - she's taken away all of House's hospital privileges, the only thing she has the power to do to House without board approval. An enraged House confronts her, but she's unconcerned with his threats. She tells him to go and do his job. He tells the team to do the MRI, then goes to do clinic duty.

The team starts the MRI, but the patient starts to feel ill and then starts to have trouble breathing. They get her out of the MRI, but she isn't breathing because of pulmonary edema. Chase performs a tracheotomy and intubates her. He then compliments Cameron on realizing the patient was in distress so that they could get her out of the machine in time.

They manage to stabilize the patient and get her conscious. She had an allergic reaction to the dye used in the contrast study.

House tells the team to give the patient high doses of prednisone. He thinks she might have vasculitis, despite its unlikeliness. They can't do a biopsy to confirm, and the only way to test her is to give her the drugs and see if she responds. However, the patient realizes they aren't treating her for cancer, and is relieved she might not have a tumor. Chase is upset that they might be misleading the patient into thinking she doesn't have cancer.

Foreman goes to the classroom to do an environmental scan. He finds a parrot and thinks it might be Psittacosis. However, House dismisses it because none of the kids are sick and it is unlikely five-year-olds would take more hygiene precautions than their teacher. House tells him to break into the patient's apartment to do another environmental scan. Foreman is resistant, but House knows that Foreman broke into someone's house and was arrested when he was sixteen. House found out from one of his teachers; he says that's why he hired Foreman. Foreman reminds House he can't be fired for refusing to break into someone's home.

Cuddy asks House why he is giving the patient steroids. She comes to the conclusion that House is guessing and she wants to stop the treatment. They start to argue about who is in charge. She reminds House he has no evidence that the patient has vasculitis. He asks her why she's so afraid of making mistakes. Cuddy goes to see the patient and stop the steroids, but when she arrives she finds that the patient has improved greatly and has an appetite. Cuddy realizes she may have been wrong.

Wilson examines the patient, who really wants to meet Dr. House. She asks if he's a good man. Wilson says House is a good doctor. He does admit that House is his friend, and that House may even care about him. All of a sudden, the patient complains that she can't see, then has a seizure. Her heart rate skyrockets and she goes into cardiac arrest.

They defibrillate the patient and test her for brain damage by having her arrange pictures to form the elements of a story, but she can't manage it. However, she passes the test five minutes later. They realize that although her sight has returned, her brain is dying. House tells them to stop all treatment because each of the possible diagnoses has a different time line. It isn't a tumor and the steroids helped, but they don't know why. House admits he is stumped. Foreman decides to follow House's orders to break into the patient's house and asks Cameron to come along because the police are usually easier to deal with when a pretty white girl is around.

Foreman and Cameron search the patient's home. Foreman is discussing his former criminal record. Cameron says she was 17 before she had a criminal record. Foreman fixes himself a sandwich and says he's a bit upset he got the job because of his criminal record and not his perfect academic record at both Columbia University and Johns Hopkins Medical School. Cameron says she didn't do nearly as well as Foreman in school and starts wondering how she got the job.

They report to House that they couldn't find anything to explain her symptoms, but Foreman reports that she isn't Wilson's cousin - she had ham and Wilson is Jewish. Wilson bluffs, but then gets the patient's name wrong. House calls Foreman an idiot - House has realized that Rebecca may have Neurocysticercosis (a tapeworm) from eating pork, something that would never have occurred to him if he still believed the patient was Jewish. That would explain why she reacted well to the steroids initially, but then got worse: tapeworms usually stay in the digestive system, but the eggs can pass into the bloodstream and then flourish anywhere, including in the brain. If the tapeworm is healthy, the immune system (and patient) never even detect it. However, when the tapeworm dies, it stirs up the immune system and causes swelling in the area, in this case Rebecca's brain. Even though the test for parasites was negative, it is a false negative in about 30% of cases where the parasite is present. There is no other way to test for it except by trying to treat it. However, the patient is tired of being treated and wants to go home and die.

House goes to see the patient and calls her an idiot for refusing treatment. She reminds him that his previous diagnosis was wrong. She asks why he's crippled and he explains that he had an infarction in his thigh and they didn't figure out what was wrong until it was too late to treat it. He tells her few people get to experience pain like muscle death and admits to the patient at the time he hoped he would die from the pain. She thinks he avoids patients because he doesn't want people to see him crippled. He tells her there is no way to die with dignity - everyone dies and it's always ugly. You can only live with dignity.

However, the patient still refuses treatment. The team wants House to claim she's mentally incompetent, but he won't do it. He's solved the case and he feels the work is done. The patient wants proof, but House can't do that. Chase says there might be a way to prove it to her - do an X-ray in her leg where there is likely to be another worm. Although they have the same density as cerebro-spinal fluid, they don't have the same density as muscle. House enthusiastically agrees. They do the X-ray and find a worm larva. She agrees to the drug to treat it and is surprised that it only takes two pills a day for a month. There are side effects, but they are manageable.

Cameron asks House why he hired her. He asks her why she thought he did it. He says he hired Foreman because of his criminal record, Chase because his dad called, and Cameron because she was extremely pretty. When she is shocked, he says he did it because she worked hard despite the fact she didn't have to. Gorgeous women usually opt for an easy life and they don't go to med school to work really hard unless they are damaged. At that moment, Cameron's pager goes off.

They manage to bring the patient's class in to visit her despite the rule about "family only".

House asks Wilson why he lied about the patient being his cousin. He says it got House to take the case. They talk about lying while watching a medical drama.

Clinic Patients

House is finally forced to go to the clinic for the first time in nearly six years. Cuddy gives him an interesting case - a patient with bright orange skin. He tells the patient his wife is having an affair because she hasn't noticed the color change and that it was caused by the fact he's been eating too many carrots and taking too much niacin. This patient asks to have House fired for making him think his wife was having an affair, but Cuddy won't do it because he's the best doctor they have. We see that the patient is no longer wearing his wedding ring.

The next patient is a 10-year-old boy with asthma. The mother is not giving him his steroids because she's worried about the side effects. House reminds the mother her last doctor weighed no drugs against no oxygen. He suddenly realizes something and goes back to his patient, but tells the mother if she doesn't trust steroids, she shouldn't trust doctors.

The next patient thinks he has chronic fatigue syndrome or fibromyalgia. House thinks he is just getting older. House goes to buy some mints and puts them in a Vicodin bottle, which he then gives to the patient. House keeps the Vicodin for himself. However, the patient later comes back for a refill.

Zebra Factor 7/10

Neurocysticercosis is the most common parasitic neurological disease in the world. It is very common in the developing world, but is somewhat rarer in New Jersey. In a patient with no history of foreign travel, it is very rare.

Major Events

Gregory House, the head of Diagnostic Medicine, his team of Robert Chase, an intensive care specialist, Eric Foreman, a neurologist, and Allison Cameron, an immunologist, House's best friend James Wilson who is also the Head of Oncology and Lisa Cuddy, Dean of Medicine are all introduced for the first time.
House reveals that Foreman was a car-thief during his teenage years.
After having his authority pulled by Cuddy, House grudgingly starts working at the clinic after a six-year absence. He will make up his time by 2054.
House is revealed to have developed an addiction to the pain medication, Vicodin, and reveals that his limp was the result of an infarction.
Cameron learns that House hired her because she's extremely pretty. She also discovers that he hired Foreman due to his juvenile record and Chase because his father made a phone call.

Title

The title of the episode comes from the fact that this is the pilot episode of the show, shot in order to attempt to sell the series to a network. It also goes by the unofficial title "Everybody Lies". In foreign markets, the title of this episode often refers to this unofficial title.

Trivia and Cultural References

The Wikipedia article on this episode was the featured article for November 24, 2010.
The pilot was filmed with an orange hue lens.
Unlike the rest of the series, this episode was filmed in Vancouver, British Columbia. The rest of the series was shot in Los Angeles.
The patient's name is a reference to Irene Adler, the female foil of Sherlock Holmes.
Tuskegee is a reference to a clinical study starting in the 1930s where African-American men with syphilis were deliberately not treated for the disease in order to study the disease's progression to see if it differed from the progression of the disease in Europeans. The study continued well after the discovery in 1947 that penicillin was effective against the disease at any stage. Doctors deliberately kept their patients in the dark about the fact they had syphilis and even went so far as to ensure they were denied entry into the Army during World War II, where they would have been treated. The study was only discontinued in 1972 when it became public in the press. The study only showed that syphilis affected African-Americans the same way it affected Europeans. See also the episode Informed Consent where the same issue is raised.
Mengele is a reference to Josef Mengele, a Nazi physician at the infamous Auchwitz death camp. Not only did Mengele make daily decisions about who was fit enough to work at the camp and who would be immediately gassed, he performed pointless experiments, often on sets of identical twins. Mengele survived the war and escaped to Argentina, where he died in 1979 never having faced justice.
Jewish dietary laws prohibit the consumption of any animal with cloven hooves if it does not chew its cud. As such, all products derived from the pig are non-Kosher and may not be consumed by observant Jews. Later in the series, we learn that Wilson isn't particularly observant and keeps bacon in his refrigerator.
House says, "As the great philosopher Jagger said, 'You can't always get what you want.'" Jagger refers to Rolling Stones lead singer Mick Jagger. "You Can't Always Get What You Want " is a song by Rolling Stones. The beginning of the song is heard at the end of the episode.
General Hospital is a soap opera on ABC. It is the longest running soap opera still in production (as of 2014) and the third longest running dramatic series of all time. It has won 11 Daytime Emmys for Most Outstanding Drama Series, a record. House is watching it in two scenes.
The 2007 Scrubs episode "My House" is an homage to the series in general and this episode in particular, with a reference to the Orange Man and a character appearing with a cane
This episode gave David Shore his first nomination for a Humanitas Prize, which instead was awarded to the writer of an episod of The West Wing. However, Shore won the Humanitas the following year for another first season episode, Three Stories
A version of the episode exists with a couple of extra minutes of footage. It was distributed only on DVDs sent to certain subscribers to Entertainment Weekly.
Christopher Hoag scored the episode and was nominated for an Emmy for "Outstanding Music Composition for a Series (Dramatic Underscore)" for this work.

Reviews

The show did not get off to a strong start. It finished 62nd in the ratings the week it premiered with about 7 million viewers. Although many of the reviewers thought Gregory House was a unique and fresh character, they challenged the plausibility of the main premise of the show - that a doctor who behaved with such cruelty would be tolerated because of his talent. Reviewers also thought the rest of the character were largely stereotypes and that the premise of a doctor who consistently finds a string of rare diseases to diagnose was implausible.

However, the show was reviewed better than a similar show; Medical Investigation. Critics thought MI was too plot driven and liked house House, M.D. was more character driven. Reviewers also preferred House's character to the characters on the competing show.

Re-reviewing the Pilot later in the series, Blogcritic noted that House's characterization has barely changed from his appearance in this episode. It also notes something important - House has trouble opening up to friends and colleagues, often using humor and sarcasm to deflect. However, he has no problem opening up to Rebecca and sharing his near-death experience with her. This is a consistent pattern through the series and points out that perhaps the reason House hates meeting patients is not for the reasons he states (they lie and they're boring), but because he has problem keeping his composure around them. This does back up one of House's other reasons for not meeting patients - he doesn't want to get emotionally invested in the case because he knows his objectivity will suffer. The critic also noted how well crafted the show was from the very beginning - very little that appeared in the Pilot had to be changed once the series started.

TV.com users rated the episode 8.9. They picked Gregory House as the most valuable character.
IMDB users rated the episode 8.7 with 39.7% rating it 10

Medical Ethics

Goofs

While on the bus and while running to work, Rebecca's sweater is blue. However, when she talks to Melanie and goes to class, the sweater is green.
When Rebecca arives in class, a young girl with long hair in the front row is seated. However, when the camera angle changes, the same girl is seen approaching her seat.
Steroids don't make neurocysticrcosis better, then worse. When a patient is propertly treated with albendazole, the death of the worms often causes a severe immune reaction which in and of itself can be life-threatening. As such albendazole is usually given together with steroids to lessen the chance of an immune reaction. However, if the steroids are discontinued too early, the patient can get develop the immune reaction as well.
Yes, House is using the cane in the wrong hand. However, it is revealed later in the series that he does this deliberately.
Noting that it is 12:52 p.m., House announces that General Hospital will be on in eight minutes. However, in the Eastern Time Zone, it airs at 3:00 p.m.
It is strange that there is a tracheotomy kit in the MRI room as most cutting implements are made out of steel. The kit would have to be made out of non-ferrous metal if it were in the MRI room.
After the tracheotomy tube is removed, the bandages used to cover the wound are too high. A tracheotomy is performed where the neck meets the chest so wrapping a bandage around the neck would not be sufficient.
Actress Rekha Sharma is identified as Reika Sharma in the credits.

Gallery

The gallery for Pilot can be found here.

Quotes

"I'm sorry, am I supposed to be afraid of yelling? What's it going to lead to, more yelling? You trying to hurt me, yeah that's scary. But I'm pretty sure I can outrun you. Oh, yeah, I looked into that philosopher you quoted, Jagger, and you're right, "You can't always get what you want." But as it turns out, "if you try sometimes, you get what you need.""

―Cuddy, winning the clinic duty battle

Student: "You can smell our parrot if you need to."

Foreman: "I thought you said you didn't have any pets."

Student: "A parrot is a bird."

— Pilot

On Cuddy walking away from House up the stairs:

"People used to have more respect for cripples, you know. *turns to a patient in a wheel chair* They didn't, really."

―Pilot

Foreman: "So we're just going to do nothing and watch her die?"

House: "Yeah. We're going to sit and watch her die. We're going to see how fast she does it. It's like you said, each diagnosis has its own timeline."

— Pilot

Foreman to Cameron on House's discovery of his past:

"You know, after years of slavery, civil rights movements, and, most importantly, living like a monk, getting nothing less than a 4.0 GPA, don't you find it disgusting that I was hired because I'm a delinquent."

―Pilot

Cameron: "So because you now respect this woman, you're just going to let her die?"

House: "I've done my job: I've solved the case."

— Pilot

House: "No, it wasn't that racial thing. I saw a doctor... with a juvenile record. I hired Chase because his dad made a call. I hired you because you're pretty."

Cameron: "You hired me because you wanted to get into my pants?"

House: "I can't believe that that would shock you. It's also not what I said. No, I hired you because you look good; it's like having a nice piece of art in the lobby."

— House on why he hired his team

"I'm your doctor. You've been good to me and good to this hospital, of course I care, but I don't see how this conversation is going to end well for me. Either he's right and your wife is having an affair, or he's wrong, and you're here to rightly say that I need to fire him. I can't do that. The son of a bitch is the best doctor we've got."

―Cuddy to Orange Guy

Nurse: "*walks into the clinic room* Dr. House? There's a patient here to see you. *parts blinds to reveal another former clinic patient* He says he needs a refill."

House: "*turns to Wilson* Got change for a dollar?"

— Pilot

"Everybody lies"

―House's credo

Rebecca Adler: Am I ever going to meet Dr. House?

Dr. James Wilson: Maybe at the theater or the grocery store.

Rebecca Adler: Is he a good man?

Dr. James Wilson: He's a good... doctor.

Rebecca Adler: Can you be one without the other? Don't you have to care about people?

Dr. James Wilson: Caring is a good motivation. He's found something else.

House: "Unfortunately, you have a deeper problem. Your wife is having an affair."

Orange Guy: "What?"

House: "You're *orange*, you moron! It's one thing for *you* not to notice, but if your wife hasn't picked up on the fact that her husband has changed colors, she's just not paying attention."

— House breaks the news to his first clinic patient in five years

House: "Not many people get to experience muscle death."

Rebecca: "Did you think you were dying?"

House: "I hoped I was dying."

— House reveals to Rebecca the source of his disability

"Because I'm a doctor. Because when we make mistakes people die."

―Cuddy explaining why she opposes House's treatment plan

House: Gorgeous women do not go to medical school... unless they're as damaged as they are beautiful. Were you abused by a family member?
Dr. Cameron: No.
House: Sexually assaulted?
Dr. Cameron: No.
House: But you are damaged, aren't you?

"Oxygen is so important during those prepubescent years, don't you think?"

―House to Asthma Mom over her reluctance to get Asthma Boy to use his inhaler

"I need thirty-six Vicodin and change for a dollar"

―House, scamming Vicodin and financing placebos for Tired Guy

Rebecca: "I wanted to thank Dr. House"

Cameron: "He cured you, you didn't cure him."

— Rebecca and Cameron expressing regret that House has once again abandoned the patient after he solves his puzzle

"How come we always tell you what we did, and you never tell us what you did?"

―One of Rebecca's students asks why she never opens up about herself

Foreman: "I thought everybody lies"

House: "Truth begins in lies. Think about it."

— House expands on the philosophy of his credo.

"Pretty much everyone I like is five years old"

―Rebecca on her friendships

House: "...she's my patient that's what you do with patients. You give them medicine."

Cuddy: "You don't prescribe medicine based on guesses. At least we don't since Tuskegee and Mengele."

House: "You're comparing me to a Nazi? Nice."

— Cuddy on medical ethics

Cameron: "You can't diagnose that without a biopsy."
House: "Yes, we can, we treat it. If she gets better we know that we're right."
Cameron: "And if we're wrong?"
House: "We learn something else."

"People choose the paths that grant them the greatest rewards for the least amount of effort"

―House on how most beautiful women differ from Cameron

Foreman: "Isn't treating patients why we became doctors?"

House: "No, treating illnesses is why we became doctors. Treating patients is what makes most doctors miserable."

— House on his approach to patients

House: "See that, they all assume I'm a patient because of the cane."

Wilson: "Then why don't you put on a white coat like the rest of us?"

House: "Then they'll think I'm a doctor."

— House on why he doesn't wear a lab coat

Foreman: "Oh, Cameron, I need you for a couple of hours"

Cameron: "What's up?"

Foreman: "When you break into someone's house, it's always better to have a white chick with you."

— Foreman on American race relations

Rebecca: (about House) He's your friend, huh?
Dr. Wilson: Yeah.
Rebecca: Does he care about you?
Dr. Wilson: I think so.
Rebecca: You don't know?
Dr. Wilson: As Dr. House likes to say, "Everybody lies."
Rebecca: It's not what people say. It's what they do.
Dr. Wilson: (pause) Yeah. He cares about me.

"People choose the paths that gain them the greatest rewards for the least amount of effort."

―House, on why he's intrigued about why Cameron went to medical school

"So how'd you get the job? You stab a guy in a bar fight?"

―Foreman asks Cameron why House hired her

Cameron: "House doesn't believe in pretense. Figures life's too short and too painful. So he just says that he thinks."

Foreman: " "I say what I think" is just another way of saying "I'm an assho"..."

— Cameron gets Foreman up to speed on their boss's personality

" I assume it's a corollary if "people lie" that "people screw up.""

―Foreman suggests they re-do the tests

House: "I'm angry! You're risking a patient's life!"

Cuddy: "I assume those are two seperate points."

— Cuddy deflects House's tantrum over having his privileges revoked.

The Audition Scene

This is the scene that the actors trying out for the House character had to play out, including Hugh Laurie. It's repeated in this episode.

Cuddy: I was expecting you in my office 20 minutes ago.
House: Really? Well, that’s odd, because I had no intention of being in your office 20 minutes ago.
Cuddy: You think we have nothing to talk about?
House: No, just that I can’t think of anything that I’d be interested in.
Cuddy: I sign your paychecks.
House: I have tenure. Are you going to grab my cane now, stop me from leaving?
Cuddy: That would be juvenile. I can still fire you if you’re not doing your job.
House: I’m here from 9 to 5.
Cuddy: Your billings are practically nonexistent.
House: Rough year.
Cuddy: You ignore requests for consults.
House: I call back. Sometimes I misdial.
Cuddy: You’re 6 years behind on your obligation to this clinic.
House: See, I was right, this doesn’t interest me.
Cuddy: 6 years, times 3 weeks; you owe me better then 4 months.
House: It’s 5:00. I’m going home.
Cuddy: To what?
House: Nice.
Cuddy: Look, Dr. House, the only reason that I don’t fire you is because your reputation still worth something to this hospital.
House: Excellent, we have a point of agreement. You aren’t going to fire me.
Cuddy: Your reputation won’t last up if you don’t do your job. The clinic is part of your job. I want you to do your job.
House: Well, like the philosopher Jagger once said, “You can’t always get what you want.”

Cast

Hugh Laurie as Dr. Gregory House
Lisa Edelstein as Dr. Lisa Cuddy
Omar Epps as Dr. Eric Foreman
Robert Sean Leonard as Dr. James Wilson
Jennifer Morrison as Dr. Allison Cameron
Jesse Spencer as Dr. Robert Chase
Robin Tunney as Rebecca Adler
Andrew Airlie as Orange Guy
Rekha Sharma as Melanie Landon
Maya Massar as Asthma Mom
Dylan Basu as Asthma Boy
Ava Hughes as Sydney
Kyarra Willis as Kid Two
Ethan Kyle Gross as Molnar
Candus Churchill as Substitute Teacher
Michale Ascher as Egg Salad Lady
Alana Husband as Tech
Janet Glassford as Reception Nurse
Mycole Metcalf as Doctor
Rachel Lana Li as Child in classroom
Maria Nicotero in various roles
Ian Thompson as Bus Driver

Release Dates

United States - November 16, 2004
United Kingdom - June 9, 2005
Israel - June 11, 2005
Australia - June 26, 2005
Italy - July 1, 2005
Iceland - September 1, 2005
Spain - September 27, 2005
Estonia - December 16, 2005
France - March 1, 2006
Hungary - March 22, 2006
Germany - May 9, 2006
Netherlands - August 2006
Sweden - September 19, 2006
Finland - September 21, 2006
Mexico - January 10, 2007

In other languages

Latin America

Piloto

Links

This article is also available in Spanish at es.dr-house.wikia

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Paternity

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 {{Quote| I assume it's a corollary if "people lie" that "people screw up."|Foreman suggests they re-do the tests}}
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 ===The Audition Scene===
 This is the scene that the actors trying out for the House character had to play out, including Hugh Laurie. It's repeated in this episode.