- Wilson: "How long before you get the tests back?"
- House: "We’ll know before that. If I’m wrong, he’ll just keep getting worse and slowly die. If I’m right and if we caught it in time he gets better, or if we didn’t he goes into cardiac arrest at any moment."
- ―Sex Kills
Sex Kills is a Season 2 episode of House which first aired on March 7, 2006. House quickly diagnoses a life threatening illness, but it won't do the patient much good unless he can figure out what was causing an illness in an accident victim whose heart the living patient needs for a transplant. Meanwhile, House suspects Wilson of cheating on his wife.
Here, the medical mystery is solved rather quickly, but the treatment requires House to walk an ethical tightrope in service of his patient.
The man is taken to Princeton-Plainsboro where he is examined by Foreman. He suffers from acid reflux and headaches, but denies having ever had any other seizures. He otherwise seems healthy. However, after he sends his daughter out of the room, he reveals he also has a swollen testicle.
They do a differential, but House doesn't think it is testicular cancer, because Foreman has probably already ruled it out. House thinks he has a brain infection caused by an STD even though his tests are negative. The only other explanation is lymphoma, which is terminal.
Foreman confronts the patient about when he last had sex. He claims he hasn't had sex since his divorce a year ago. House still thinks it is an STD, and points out that the patient's daughter was in the room when Foreman asks. House goes to the patient, who admits that he recently had sex with his ex-wife - whom he had incidentally met at a cheese tasting - and he didn't want his daughter to know. House gives him the STD medicines. The patient admits that he has an STD to his daughter. However, at that point, the patient starts vomiting blood. House orders him sedated. He admits to the daughter that an STD wouldn't cause that symptom.
The team starts a new differential once they find out the patient's heart is damaged. House asks the patient what cheese he ate at a cheese tasting. He determines that the patient ate unpasteurized sheep cheese and got a brucellosis infection. Normal stomach acid would kill the brucellosis, but the patient was on antacids for his acid reflux. The bacteria multiplied and attacked his heart, brain and testicle. House starts him on antibiotics.
House knows that if they didn't catch the infection in time, the patient will soon go into cardiac arrest. Unfortunately, this turns out to be the case. House continues to accuse Wilson of having an affair because he is staying late at the hospital. He tells Wilson to go home and have sex with his wife.
The patient requires a heart transplant, but is otherwise healthy. House argues he is a prime candidate, but the hospital's transplant committee refuses on the grounds that he is too old. House implies one of them is a racist due to the fact that African Americans don't live as long. However, the committee turns him down. Foreman breaks the news - the patient will be dead within a week.
Despite the committee's refusal, House has to admit that he was merely acting as the patient's advocate and he actually agrees with the committee's decision. He still appeals the decision to the Board of Directors. He then goes looking for a new heart that won't be suitable for transplant to anyone else. Cameron finds a 40 year old overweight accident victim. However, the patient had a fever and stomach ache. When the woman dies, House tells the grieving husband he needs her heart.
The dead accident victim's organs are declared non-viable and House goes to see the husband again. Foreman points out the dead woman's history shows she had hepatitis C. A diseased heart would kill the patient. However, House does not agree with the diagnosis. House and Cuddy argue with the dead woman’s husband about whether to take her off life support. However, the patient's daughter meets the husband, and he agrees to let House try, but first, in order to release his anger, he knees House in the groin.
However, it's clear the dead woman had an infection. The team has to do a differential on a dead patient. They do an MRI on the dead woman. House refuses to believe it's hepatitis C because that would mean the other patient would die. He orders a massive dose of anti-parasite medication on the theory it can't hurt.
House once again accuses Wilson of having an affair, and he warns him not to tell his wife about it. Wilson intimates he has something he wants to talk about privately. House says that if he is the person Wilson wants to talk to, he's made a poor choice.
The treatment of the dead woman doesn't go well. If the team is right, the medicine they would need to treat her disease would destroy her heart. House is ready to give up, but now the husband doesn't want the team to give up.
The team continues with the differential. They guess it might be a toxin. House orders a more thorough tox screen. He does an environmental scan of the house himself with the husband‘s help. He only finds that the woman dyed her hair and took diet pills.
The patient's heart becomes so weak it can't pump blood to the brain. Cameron comes back from the woman's workplace. House starts to suspect infidelity and gonorrhea. They test the patient and start treating her. She tests positive. However, she's not getting well enough fast enough for the patient, who will die before the gonorrhea is gone. They decide to proceed with the transplant and treat the disease in the patient.
House lies to the patient's husband about what was wrong with her. However, he realizes he has to tell him soon so he can be treated for gonorrhea before he gives it to someone else.
The patient survives the transplant. The husband admits that he had cheated on his late wife and probably gave her the gonorrhea. He didn't want to believe he gave it to her because it probably caused the accident. He also realizes he should have told House about it.
The patient awakes and finds his daughter and ex-wife by his side.
Wilson shows up at House's apartment. He has not been cheating; his wife has just admitted she was. They have separated and Wilson asks to stay with House for a few days.
- House wears his lab coat once again in order to secure a new heart for his current patient who's dying of heart failure.
- Wilson tells House that his wife has cheated on him and moves into 221B Baker St. temporarily.
Luckily, due to pasteurization and proper handling of milk products, brucellosis has become very rare, with only about 100-200 cases appearing in the United States each year. Matters have improved in the last forty years, when there were usually over 6,000 cases a year. Gonorrhoea on the other hand is far more common, and after Chlamydia is the second-most commonly-diagnosed sexually transmitted infection in the United States, and believed to affect around 120 people per 100,000 of the population.
The title, as usual, refers to multiple things:
- the patient's STD she received from her husband after the latter had an affair.
- the clinic patient's need for medication to stop the urge he has to have sex with cows. However, this is a fake claim. The patient makes this claim because he feels an attraction to his step-mom.
- Wilson's relationship with his wife slowly fading and eventually, Wilson's wife's sexual affair 'kills' their relationship.
Trivia & Cultural References
- House's 'wrong shoes' analogy is a very good example as bowling shoes and any other shoes differ. Bowling shoes are soft, heeless and treadless soles so they don't scratch or mark the floors.
- Amy, the patient's daughter, tells her dad that someone 'beat the Lakers.' The Lakers are an NBA basketball team who, despite recent struggles, are historically one of the league's best teams.
- Byron was a 19th-century poet.
- "Elsie" is Elsie_the_Cow, the mascot of the Borden Dairy Company
- This is the second episode in which House can be seen wearing a lab coat.
The patient asks for depo-provera. House points out that this will chemically castrate him - which it turns out the patient knows. The patient claims it is to deal with his sexual attraction to cows. House figures that the patient is there on a fraternity prank and writes him a prescription for something similar but harmless.
The patient returns claiming he has been kicked by a cow. He still can't convince House he is really in love with a cow, partly because the injury seems to have a splinter in it. To dissuade the patient, House tells him he would need painful and humiliating tests to confirm his condition. Surprisingly the patient agrees.
However, the test results show the patient eats beef. House is clearly not convinced he loves cows. The patient finally admits his hot new stepmother is coming onto him. House finally agrees to prescribe the depo-provera.
- "Here With Me" by Jamie Dunlap, Joe Lervold , Scott Nickoley, and Stephen Lang
- "Honky Tonk Woman" by Taj Mahal (at the end when Wilson arrives at House's apartment)
- House is not properly inserting the laryngoscope. A doctor should always hold onto it with their left hand because the light on the instrument will otherwise be obstructed and the physician would not be able to find the landmarks he needs to insert it into the endotracheal tube past the vocal cords.
- House puts the petri dish he's using to hold cheese into his pocket, then does it again without ever taking it out of his pocket.
- Needle biopsies are not performed on testicular cancer. Cancers of this type can travel up the path of the needle and metastasize. Ultrasound is the usual way to confirm or, if necessary, a surgical biopsy.
- An MRI is not a good way to look for gallstones. Ultrasound or a CT Scan are both better.
- IMDB users rated the episode an 8.5. It did best with individuals under the age of 18 (10.0) and worst with males over the age of 45 (8.3).
- TV.com users rated the episode an 8.8. They chose Lisa Edelstein as their Most Valuable Performer.
- Polite Dissent gave most aspects of the episode grades in the B range.
This is not the first time House has played fast and loose with the organ transplant system (see Control). It's important though to examine the key concepts of organ allocation - Utility, Justice and Dignity.
Henry has already been turned down by the Transplant Committee due to his age. As the committee notes, hearts are a scarce commodity as they can only be obtained from deceased patients. In addition, medical ethics makes it clear that organs can only be harvested from a donor who has already been declared dead - a patient's demise cannot be sped up for the convenience of organ donation (that would offend the "dignity" concept).
This puts House in an ethical quandary as he now looks for organs that, for one reason or another, are not suitable for transplantation. This puts his patient at severe risk and may offend the "utility" principle. As we later see in Family, there is no point in going forward with a transplant if it will wind up killing the patient. House is hoping against hope that he can "cure" the defect in the organ. In reality, this usually points to ultimate failure, reducing its utility and ignoring the effect on the patient's dignity. House has always had difficulty dealing with the issue of the patient's wishes (see Pilot) but in this case he also has to deal with the deceased donor's husband.
Unfortunately, because he's in a hurry, he jumps the gun and once again offends the dignity principle - both the donor and the donor's family are entitled to respect (see this problem arise again in Wilson (episode)). In the end, it's the decision of the donor's family to make the donation in accordance with the wishes of the deceased donor. There is often a tendency to pressure family members who, unless the donor made their intentions clear, are often in a poor position to make such a difficult decision.
In addition, once, as in this case, the donor is rejected from the usual transplant list, it is unfortunate that the person who would have been first in line loses an opportunity. A lot of patients die on the waiting list, and this is particularly true of heart transplant patients.
- Hugh Laurie as Gregory House
- Lisa Edelstein as Lisa Cuddy
- Omar Epps as Eric Foreman
- Robert Sean Leonard as James Wilson
- Jennifer Morrison as Allison Cameron
- Jesse Spencer as Robert Chase
- Greg Grunberg as Ronald Neuberger
- Keri Lynn Pratt as Amy Errington
- Adam Busch as Tony (Clinic Patient)
- Ron Perkins as Dr. Ron Simpson
- Yvette Nicole Brown as Ellen Stambler
- Howard Hesseman as Henry Errington
- Noel Conlon as 1st Table East
- Susan Grace as 1st Table North
- Craig Patton as 2nd Table East
- Marcie Lynn Ross as 2nd Table West
- Jean St. James as Cecile Errington
- Stephen DeCordova as 2nd Chief Surgeon
- Bobbin Bergstrom as ER Doctor
- Michael A. Casey as Heart surgeon
- Rosemary Garris as 2nd ER Doctor
- Alexander Hall as Doctor
- Brianna Konefall as Tony's Stepmom
- Kitty Kreidler as Laura Neuberger
Dr. Gregory House: We're going to cure her.
Dr. Allison Cameron: We're going to cure death?
Dr. Gregory House: Bwah-ha-ha-ha-ha! Doubt it.
Dr. Gregory House: When guys have brain/crotch problems, it's usually the result of using one too much and the other too little.
Dr. Gregory House: Cheese is the devil's plaything.
Dr. Lisa Cuddy: He's 66 years old.
Dr. Gregory House: He told me he was 65. Liar. I'm outta here.
Dr. Eric Foreman: His right testicle was almost twice as big as his left.
Dr. Gregory House: Cool!
Dr. Gregory House: If you really cared about me, you'd find me a better corpse.
Dr. Allison Cameron: I thought we were wearing the wrong shoes for cancer!
Dr. Gregory House: We're wearing the wrong shoes for testicular cancer. They're perfect for lymphoma - except Chase's, they're just goofy.
House: Who's the lucky woman?
Wilson: My wife.
House: No, I don't want to know who gets the chocolates; I want to know who you're having the affair with.
Wilson: [to the man selling the chocolates] Fell on his head as a child, tragic.
House: Norwegian chocolate. Frankly, you buy that stuff the terrorists win.
Wilson: Some people bottle up their feelings, have them come out as physical pain. Healthy human beings express feelings such as affection by giving gifts.
House: Gifts express guilt. The more expensive the expression, the deeper the guilt. That's a 12 dollar box so that means you haven't slept with her yet, or she wasn't that good.
Wilson: It's not all about sex, House.
House: Really? When did that change?
House: Wilson! How long can you go without sex?
Wilson: How long can you go without annoying people?
House: No seriously. A week? A month?
Wilson: I'm not having an affair.
House: I didn't say you were. Not in this conversation. I'm talking about a patient!
Foreman: People have impulse control, we don't need sex.
House: Well not like air, but as a biological imperative, sure we do. There's two things we get stupid for: money and sex, and since money rarely enters the bloodstream....
House: This girl's father will die by next weekend unless he gets your wife's heart.
Cuddy: House, don't you think that's a little manipulative?
House: No, it's hugely manipulative.
Donald Neuberger: You're an ass.
House: Hey listen, you take your wife off life support, and I'll have forgotten about this in two weeks. Gale here on the other hand—
House: Whatever. You're mad at me. Fine I get that. Take it out on me, not on her.
Donald: [knees House in the groin] Fine. Your dad can have her heart.
Foreman: You really don't need to be here.
Donald: I assume House is a great doctor.
Chase: Why would you assume that?
Donald: Because when you're that big a jerk, you're either great or unemployed.
Tony: Leather shoes, hamburgers. How could anybody do that to a cow?
House: Make love, not belts?
Tony: I want to get Depo Provera.
House: Actually, at your age, as long as you're careful, the risk of you getting pregnant is pretty limited.
Amy: If you do Mom again you have to wear a condom.
House: A way to a man's heart is through his stomach.
Henry: I had sex with her mother.'
House: I think she knows you've done it by now.
House: A disease that attacks his brain, heart, and testicles. I think Byron wrote about that.
House: She's a fridge with a power out. You start poking around inside, the vegetable goes bad. No offense.
Henry: I assume you've been in love?
House: Is that the one that makes your pants feel funny?
House: Key to a long life – exotic women, boring cheese.
House: So I have to wonder what could be more humiliating then someone calling your girlfriend a cow and not being metaphorical?
Dr. Cameron: She's positive for gonorrhea.
House: I think that's the first time those words have been uttered in joy.
Patient: I think I broke my ankle. I was kicked.. by a hoof. I'm so in love, she was so beautiful.
House: Which one?
Patient: One of the black or white ones I'm not sure which type...
House: Not which type, which one? I want a name.
Patient: Why would it have a name?
House: Not it - she.. or he, I wanna know of her dreams, her hopes.
Patient: It's a cow.
House: Hey, I'm not the one who said he was in love.
Wilson: Does it occur you that maybe there's some deeper guidance, than keep your mouth shut? That maybe a friend might value concern over glibness? That maybe... maybe I'm going through something that I need to have an actual conversation about?
House: Does it occur you that if you need that kind of a friend, you may have made some deeper errors.
- United States - March 2, 2006 on Fox
- Canada - March 2, 2006 on Global
- Germany - February 20, 2007
- The Netherlands - April 12, 2007 on SBS 6
- Estonia - May 4, 2007
- France - May 31, 2007
- Bulgaria - May 31, 2007 on NTV
- Hungary - June 20, 2007
- Czech Republic - June 25, 2007 on TV Nova
- Belgium - September 13, 2007 on KanaalTwee
- Japan - September 25, 2007
- Finland - December 13, 2007
In Other Languages
- Spanish - El sexo mata (Eng. literally "Sex Kills")
- French - Maladies d'amour (Eng. "Love Diseases")
- Episode article at Wikipedia
- Episode page at IMDB
- Episode page at House MD Guide
- Episode summary at TV.com
- Episode page at The House Of Fan
- Episode article at TVIV
- A review of the medicine at Polite Dissent via archive.org
- Episode transcript at Clinic Duty
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