The patient was admitted as a Jane Doe after collapsing during an altercation with a police officer. She had no identification and could not seem to remember her name. A drug overdose was suspected, but her tox screen was negative. Dr. Wilson was called in because of some lesions on her arm, but they were not cancerous. However, he did notice a twitch and called in Dr. Foreman for a neurological consult. Dr. Foreman examined the patient who showed normal reaction to touch and low grip strength. The patient had a seizure, but Dr. Foreman believed she was faking it. However, Dr. Wilson tested her self defence reflex and she let her own hand slap her in the head when he released it. Dr. Foreman performed an emergency blood sugar level test which showed a level of 38, well below normal. Dr. Wilson ordered an intravenous push of D-50 stat. Dr. Foreman believed it was merely an insulin overdose and went to inspect the patient's belongings. However, the smell was overwhelming and Dr. Foreman abandoned the search. Dr. Foreman thought the twitch was also faked. Although Dr. Wilson believed the twitch may indicate a tumor, Dr. Foreman suggested she be discharged after her blood sugar level returned to normal and she had a good meal.
Dr. Wilson brought the case to Dr. House, saying Dr. Foreman wasn't being objective. Dr. House agreed to take on the case. Dr. Cameron thought the twitch was a seizure unrelated to the diabetes. Dr. Chase suggested a sub-dural hematoma from a head trauma. However, Dr. Foreman noted there was no sign of head trauma. Dr. Cameron thought the twitch could indicate a brain tumor, but Dr. Foreman noted that it was a very non-specific symptom common to many other illnesses. Dr. Foreman still thought the patient was scamming the hospital trying to get a place to sleep. Dr. House wondered who the patient was. He examined the patient's belongings despite the smell. He admonished his team for not caring about the patient's medical history, which was a total mystery. However, Dr. Foreman did find an insulin syringe. Dr. House tasted the patient's vomit on one of the pieces of clothing and noted it was salty, indicating a chemical imbalance. Low magnesium and high calcium could both cause a twitch. Dr. House ordered a banana bag to correct the imbalance.
While Dr. Chase was treating the patient, she became violent. Dr. Foreman ordered to sedate the patient, but while he was trying to administer it, the patient bit him. Dr. Chase assured Dr. Foreman the patient was negative for HIV and Hepatitis C, but Dr. Foreman arranged a tetanus shot for himself and an MRI of the patient. Dr. Foreman bumped another patient to make room for Jane Doe, but Dr. Cuddy interrupted. She called Dr. Foreman and Dr. House to her office to admonish them for stealing a test, and also for not noticing that the patient's CT Scan showed a surgical pin in her arm that would have been ripped out by the MRI. She admonished both of them for trying to do an MRI without doing an adequate medical history. Dr. House planned to remove the surgical pin and then perform the MRI. Dr. Cuddy resisted because the patient had no insurance, but Dr. House assured her that Dr. Foreman thought she had a brain tumor (even though he was only giving her the MRI because he was sure she didn't). Dr. Cuddy agreed to the surgery, but refused any further procedures until the patient's identity was discovered.
Dr. House ordered Dr. Foreman to find the patient's residence and do an environmental scan. He found bats in the tent she was using, as well as a portfolio of drawings Dr. Foreman hoped to use to identify the patient. The surgery to remove the pin was successful and the MRI was clear. However, Dr. House's motive in removing the surgical pin was to identify the patient - they all carry a serial number and are carefully tracked. She was identified as Victoria Madsen, and the surgical pin was to repair a bone broken in an automobile accident in October 2002. As her medical records came in Dr. Foreman found that she was allergic to iendextran, but Dr. Foreman had started her on it to treat her severe anemia. They found the patient in respiratory arrest from an allergic reaction. Dr. Chase administered epinephrine. Dr. Foreman started the patient on pure oxygen.
The patient was sedated and stabilized. More medical records came in. The patient had most recently been treated for frostbite and clinical depression. She had been on Prozac. She had also been scheduled for two ultrasounds, but had only had one. Dr. Wilson thought it might indicate abdominal pain. He realized that they were looking for ovarian cancer and that the first ultrasound was negative and the patient didn't want to undergo a second procedure. However, her CA125 was normal, showing she probably didn't have cancer. However, Dr. House noted that twitching is one of the symptoms of paraneoplastic syndrome. He ordered an ultrasound of her ovaries. The ultrasound showed a solid non-cystic mass, 5x3 cm., with central necrosis. The prognosis was death in 2-3 months and there was no way to treat it. However, Dr. House suggested it might not be cancer, it could be a tuberculoma from tuberculosis. Dr. Wilson noted that ovarian cancer was a far more likely diagnosis, but Dr. House started her on INH, revamptin and streptomycin in any case as there was no treatment for advanced ovarian cancer.
Dr. Foreman administered the antibiotics, but the patient was aware she probably didn't have a tuberculoma. He apologized for not believing the patient was sick, but she apologized for taking too much insulin because she did want to stay at the hospital. However, the patient soon started complaining about how bright the lights were and Dr. Foreman realized she was photophobic. She was also running a fever of 105F. Dr. Foreman shut the shutters and went to give the patient water, but she spit it out, indicating hydrophobia. A nurse came in and turned on the light, but Dr. Foreman shouted at her to turn it off. He then sedated the patient.
Dr. Foreman reported the patient's fever to Dr. House, ruling out a tuberculoma even before the biopsy came back. However, Dr. Chase's biopsy showed it was clearly a benign tuberculoma. Although they had her on the right treatment, it was killing her. The biopsy was checked for a second and third time and still came back as a tuberculoma. Dr. Chase felt that a fever of 105F had to indicate some sort of bacterial infection, but the patient was on three antibiotics for the tuberculoma. Dr. Wilson thought that the small intestine had been nicked during the biopsy, but Dr. Foreman had performed the biopsy and denied that he had nicked the patient's intestine. The patient had no fever on admission. They had put the patient back on Prozac, which Dr. Cameron felt could have caused seratonin syndrome and the fever. When Dr. Wilson pointed out that she had been on the drug before and it caused no side effects, Dr. Foreman suggested she never took it. Dr. House ordered blood cultures, urine cultures and a chest x-ray. He then ordered the Prozac discontinued and treatment with Bromocryptine in the event that it was seratonin syndrome. They also put the patient in an ice bath to try to lower her fever.
The urine cultures and chest x-ray were negative. The lumbar puncture indicated elevated proteins and white blood cell count. The gram stain was negative, and it appeared to be meningitis. Dr. House ordered ceftriaxone for the meningitis. However, when they went to the patient's room, they found that she was missing despite having been sedated.
Dr. Foreman insisted she had received 10mg of haldol, which should have knocked her out. Dr. Cuddy was worried about the hospital's liability as meningitis was highly contagious. Dr. Chase reviewed the security cameras and saw the patient leave the hospital.
The patient was readmitted unconscious with superventricular tachycardia and a heart rate of 150 bpm. The police officers that brought her in said she was just passed out on the grass in a park. Dr. Foreman ordered an intrevenous push of adenosine. Her heart rate returned to normal and her Arrhythmia stabilized. Dr. Chase thought dehydration or fever might have elevated her heart rate. Dr. House still thought it was meningitis and ordered treatment despite what appeared to be a new symptom. He confronted the police officer and noticed he had a taser. That would have caused the tachycardia. However, the patient continued to get worse, even with treatment. Dr. House examined the patient and noticed a taser wound on her thigh, which made it appear that she was not stopped by it. He poked the site with a needle and found the patient unresponsive to pain stimulus at her thigh, although her toes did respond to stimulus. Dr. Foreman thought this localized numbness could be from her diabetes. Dr. House took a mouth swab, and Dr. House stuck Dr. Foreman with a needle where the patient bit him. He did not respond until he saw the needle sticking out. The localized numbness, photophobia, disorientation, paranoia, ineffectiveness of sedatives, and hydrophobia all pointed to one diagnosis - rabies, most likely from a bat bite. The swab test was positive. As the patient's symptoms had presented, the disease was untreatable. Dr. Foreman was given the rabies vaccine to keep him from developing the disease.
Dr. Foreman found her last residence and realized that the "James" she was talking about was her son who, along with her husband, the "Mr. Furia" she had ranted about, had died in the automobile accident where she was injured. Dr. Foreman went to the patient, who mistook him for her son. When she called out "James", Foreman corrected her, telling her that he was her husband, and that he forgave her for the car crash.
Prognosis: Death within two days.