Selfish

Selfish
Director(s)	Dan Attias
Writer(s)	Eli Attie
Airdate	September 27, 2010
Episode number	7.2
TV.com rating	9.4/10
Guest star(s)	Alyson Stoner
Final diagnosis	Sickle cell trait
Zebra Factor	1/10

Selfish is the second episode of House season seven which will air on September 27, 2010. When Della (Alyson Stoner), a seemingly healthy and active 14-year-old, suddenly collapses during a skateboarding exhibition, House and his team struggle to diagnose her condition and reassure her parents who already have to cope with their son's terminal illness. After her body rejects a donor lung, and with time running out to save her life, Della's family is left with little hope of securing a new donor and faced with a seemingly impossible decision regarding the fate of both children. Meanwhile, House tries to appease an elderly father and his son at the clinic, and House and Cuddy begin to face the challenges of taking their romantic relationship into the workplace.

Recap

A young girl is having fun in a skateboard park as she puts on a show for handicapped kids, including her brother. As she speeds her brother’s wheelchair around the park when she lets go and collapses on the floor.

Meanwhile, House and Cuddy are down in the parking garage discussing how to break the news to everyone, including human resources. House takes the opportunity for one last feel of Cuddy’s behind. When they arrive in the lobby, they act as they always do and House agrees to take the case and keep his mouth shut until they can tell HR.

House goes to the office and tells his remaining team and Wilson that he’s seeing Cuddy. Wilson figures it’s a prank and leaves. Taub is skeptical. He starts discussing Della‘s case. Foreman is glad for them. Chase doesn’t care. House wonders where Thirteen is, and they tell him she’s gone on leave and they can’t find her. They start a differential. Chase notes the brother suffers from muscular dystrophy and wonders if the patient could have the same thing, only it hasn’t presented. However, House says it wouldn’t explain its sudden onset. The team wonders why House isn’t wondering about Thirteen. They decide to use a scare test - stop the patient’s heart. Taub and Foreman discuss the test and Thirteen.

House goes to see Wilson to convince him about Cuddy when she comes in complaining that he’s told everyone. House tells her that Wilson doesn’t believe him. Cuddy doesn’t care, but House won’t go to HR until he’s convinced. Cuddy tries confirming it, then a kiss and when Wilson is still sceptical, Cuddy grab’s House’s crotch. Wilson gives in.

The human resources manager talks to Cuddy and House, but House starts joking. Cuddy finally brings the conversation back to earth. The manager gives them agreements to sign. Cuddy agrees not to give him a raise or promotion, but the manager reminds her she can’t be biased against him either. House discusses the scare test, but Cuddy turns him down flat. She tells him to do an angiogram and EP study. House agrees.

They start the EP study and warn the patient to urinate because she’s had a lot of fluid and she won’t be able to move for an hour. When she says she doesn’t have to, the team gets suspicious and ask her when she last urinated. She tells them it was the night before. Foreman tells the parents that Della’s kidneys seem to be failing.

They start a new differential. Taub is worried that House is being too cautious because of his relationship with Cuddy. He says that given the new symptom, Cuddy was right. They finally hit upon amyloidosis and House orders confirmation and a bone marrow transplant if they’re right.

When they discuss the bone marrow transplant with the patient, she’s dead set against it even though the risk to her brother is minimal. When Taub goes to House, he’s already figured out what the problem is because the patient is an overachiever and appears to be living her brother’s life as well as her own. House sees Wilson smiling at him and Wilson says he’s happy for them. However, he’s not sure he’s comfortable about Cuddy still supervising House, mostly because House has been following Cuddy’s orders now. House tells him it was just one test he changed his mind about and not to worry about it.

Taub talks to the patient about how all her activities are typical for a boy her brother’s age. She admits that she got into them through him. She tells him her brother is her inspiration. However, when she goes to take her pills, she starts coughing up blood and they realize they need to do immediate surgery.

House and Cuddy are discussing treatment alternatives, all of which are bad. Cuddy agrees to House’s plan to use foam to replace her lung so the bleeding will be stopped quickly. However, when she leaves, House orders Chase to suture the bleeding lung instead.

House goes to Wilson and tells him that he may have been right. Although Cuddy agreed with his plan, he felt that Cuddy didn’t really agree so he abandoned it. Wilson tells him that he and Cuddy have to set ground rules. However, House just plans to avoid Cuddy at work.

The suturing worked, but Taub taunts House about not standing up to Cuddy. House starts a new differential. They decides on Goodpasture’s syndrome and House orders immunosuppressants and plasmapherisis and a kidney biopsy to confirm.

House and Cuddy go to his apartment to enjoy each other’s company. She’s noticed that she didn’t see each other in the afternoon, but isn’t suspicious. House gets a call, the kidney biopsy was clean, but they checked the lung and the patient has LAM. She needs a lung transplant. House returns to Cuddy and tells her he paid her nanny extra so she didn’t have to get home until 10 p.m.

Chase and Taub go to break the news to the parents - they have found a lung donor.

Although the transplant surgery was uneventful, the new lung started failing almost right away. They double check and confirm LAM, so either the new lung is being rejected, or it was infected before the transplant. There is no way to confirm, and treatment for rejection would make the infection worse, and vice-versa. However, since treating rejection is the safest course, they try that to see if she improves, and plan to switch to antibiotics if she doesn’t improve in the next few hours. Taub doesn’t move - he wants to wait for approval from Cuddy. He tells Taub to get the approval for the treatment.

Taub goes to pass along House’s insults, and she storms into his office. Instead, House caves again and goes with Cuddy’s orders. He tells her he will deal with Taub, who he claims went behind his back.

They go with the antibiotics, but the patient doesn’t improve. Taub is angry that House is on Cuddy’s short leash. They’re pagers go off and they find the patient in distress. They realize the antibiotics aren’t working and they have to switch to methylprednisilone.

Wilson finds House eating salad, which he hates, and realizes House is tied up in knots over Cuddy. He tells Wilson he caved again. Wilson tells him his next plan should involve Cuddy. Chase and Taub arrive to tell him that the steroids didn’t work either. House wonders if the diagnosis of LAM was correct, and Chase assures him they’re right about that. However, there is no explanation why the lung is failing. House figures the LAM test must have been wrong. He turns down a plate of French Fries to go and think.

While he’s hanging out outside the patient’s room, her brother comes to confront him. He tells the brother that he’s just distracting him. However, the brother mentions something that piques House’s interest - the patient never gets sick. House goes in to ask when the patient last had a cold or anything minor. The patient admits that she had minor aches and pains for about a year, but didn’t think they were serious, and they were clearly not as bad as what her brother had to go through.

Taub chases House, who has figured it out. The LAM test was a false positive - she has sickle-cell trait, which explains all the symptoms, including the low level cold symptoms and why it got worse at altitude. Taub realizes the transplant committee will never give her a second lung given her condition. However, House realizes that if they get a transplant from a willing donor, they won’t need their approval.

Cuddy finds out about House’s plan - to take half a lung and marrow from the brother. She tells him he can’t present that option. However, House tells her there is no other treatment. She points out that the brother would be lucky to live to 25 with two good lungs. House finally gives in. Cuddy is astounded, and is worried that he gave in just because of their relationship. He agrees that’s probably the reason. He admits that the relationship is screwing up his judgment, and wants to know why her’s is unaffected. She admits she’s affected too - she didn’t really want to agree to his plan to foam the lung. House said he knew he was right about her not wanting to do it. She tells him that she will find someone else to supervise him.

House finds the patient’s father in his office. He admits that the transplant committee won’t agree to another transplant. The father begs for other options. House finally tells him about the option of taking the lung and marrow from the brother, although it would significantly shorten his life. However, they can’t wait past the following morning - after that, it will be too late.

The father and mother spend the night discussing the option. The patient wants to know where her parents are because they seemed to be arguing. She realizes that they might be discussing giving her a lung and marrow from her brother. Taub reassures her that they are doing everything they can. The parents realize they have to make a choice, but either one will be bad. They see doctors rushing and they find the daughter has left the room and collapsed in the stairwell. She’s in respiratory arrest.

They get her stabilized and back in bed. However, the hypoxia sped up her decline, leaving them with less time to make a decision.

Cuddy breaks the news to House - they can’t find him a new supervisor. She tells him that he can present the treatment option, and he admits he already has. He apologizes, but she says she should probably be angrier. The parents come to him and tell him that they aren’t going to take a lung from the brother. When Cuddy tries to comfort them, House instead insults them and asks if they are on drugs. When Cuddy protests, House starts pressing for the transplant and Cuddy starts arguing with him and then they see the brother. He goes to his sister and asks her to take half his lung. He reminds her it will never be him out there doing all those marvelous things she does. She says she can carry a piece of him with her, and this is the great thing he can do with his life. He doesn't want to live without her.

House and Cuddy walk away. House thinks they got lucky that the brother took away the tough choice from the parents. Cuddy reminds him that this was the first honest interaction they had with each other since they started dating, and that if they keep being honest, they will probably keep getting lucky. House tells Cuddy she has a big behind and puts his hand on it again. She takes his hand off her behind, but keeps holding it as they walk to the elevator.

Clinic Patient

The patient, who is 102, comes in with his 80 year old son, and complains of fatigue and weakness. The son assures House that his father is usually very strong, but now has tingling in his feet and legs. The son wants a full battery of tests. House thinks its just old age, but the son insists on tests.

The son later finds House and tells him the real problem is that his father won’t agree to be put in a long-term care facility. He bribes House to tell his father that he needs to go to such a facility. House asks for more money. The son gives him the plan - pretend to run tests and then tell the father he can’t live with the son anymore.

However, the father comes in to tell House that the problem is his son won’t let go. He gives House money to tell the son he needs to be put in a nursing home.

House comes in with the “test results” and tells them that the father needs round-the-clock care. They pretend to protest, but when House hears a new symptom - that the father can’t tell the difference between hot and cold lately, he gets interested again. He asks to see the father’s teeth and finds worn dentures. He asks to see the father’s denture cream and realizes he has zinc poisoning. He just needs better fitting dentures, not a nursing home. He gives them back their money.

Zebra Factor 1/10

Sickle cell trait is not very rare, even in persons of Caucasian descent. In certain populations, it can affect up to 25% of individuals.

-A blood test that should have been/was conducted at the beginning of the episode should have revealed the final diagnosis immediately, thus saving the girls life.

Trivia & Cultural References

- Actress and comedian Stephanie Courtney, who plays Della's mom in the episode, is well known in the United States from her work in a series of commercials for Progressive Insurance as their bubbly sales representative Flo.

Links

In depth review at Blogcritics

Previous episode: Now What?

Selfish

Next episode: Unwritten

Videos

thumb|300px|left|Making it officialthumb|300px|left|Breaking the newsthumb|300px|left|Convincing Wilson