Motor Neuropathy Differential Diagnosis

Drum solo This is a really nice room. Yeah, it sounds thick. Too bad he’s not coming. Look, I talked to him myself. He’ll be here. Right. You’re the one who said that the song could use a horn part. So I got the best John Henry. You think I’m stupid Of course, I do. That’s not the point. He’ll be here, okay playing piano ltigt Take a left up ahead.ltigt South Street I canceled this gig. You said you didn’t want to do any sessions for a while. For a while. I called her.

I uncanceled it. Are you up to it Let’s find out. You lied to me John Henry’s never gonna show up Will you stop It’s been, like, two hours. And we will keep waiting. I mean, you’ve heard this guy play, and you know what he does. So can you just shut up, Tommy door opens Oh, my God! Am I late RB tracks music shuts off You need to hear it again Nope, I get it. Let’s try one, see what we get. Let’s do it.

Music resumes jazz improvising choking You okay I can’t breathe. I can’t breathe. Call an ambulance! ltigt Now!ltigt New Age music I want in. John Henry Giles You a fan of his music He’s a musician That paralysis thing. Guy can’t walk for two years, nobody knows why. It seems mildly interesting. Forget his paralysis. Tell that to the rest of his bowling team. As far as this hospital is concerned, this is a simple case of lobar pneumoniaboring. But that not walking thing that could turn into something serious.

House DNR

Marty Hamilton is his primary physician out in California. He’s dealing with the paralysis. Know all about it multiple treatments, multiple surgeries. Making real progress. Fixed everything but the legs. Dr. Hamilton already called and asked for your team. And by team. I don’t mean you. Like I always say, there’s no I in team. There’s a me, though, if you jumble it up. Foreman did his residency with Hamilton. I know, I accidentally glanced at his resume before I hired him. He wants someone he can trust. He must have spoken to Foreman’s parole officer.

Someone who will stick to the pneumonia. John Henry’s on an experimental protocol for the paralysis. I respect that. I’m not gonna get in his way. It’s Foreman’s case. It’s pneumonia. He can handle it. Guy’s already paralyzed. How badly can he screw it up So.what are his sats ltigt Staying in the 90s on the nasal canula.ltigt Coughing up much sputum ltigt Almost none. He seems to be stabilized.ltigt Dr. House, is there anything back from micro Not yet. You gonna fire me You can make up for it by washing my car.

Oh, this is fun. ltigt Let’s keep him on the broad spectrum antibiotics.ltigt And since he’s displaying septic physiology, draw blood for adrenal and thyroid function. How about the paralysis We’re sticking to the pneumonia. You certainly are,ltigt bossltigt ltigtlike a wet tongueltigt sticks to dry ice. ltigt The paralysis has already been diagnosedltigt ltigt by Dr. Hamilton.ltigt It’s ALS. Lou Gehrig’s disease. It’s a lovely diagnosis. They make movies about it. No tests, no treatment. It’s a disease of exclusion. Because Hamilton has excluded everything else. I haven’t. What else could it be.

GuillainBarre, which would be reversible. Excellent. ltigt No.ltigt The progression of the paralysis would be symmetric. This wasn’t. Transverse Myelitis. Hamilton tested for it, negative. And he was negative for masses and AVM Antibodies could be attacking the nerves. ltigtMultifocal Motor Neuropathy.ltigt Uncommon, but it fits. It’s also treatable. ltigtDid Hamilton try putting the guy on IVIGltigt No, because the MRI showed Let’s do an MRI of our own.’s my case. ltigt ALS fits.ltigt It even predicts the pneumonia. Paralysis is progressive. It’s a death sentence. That doesn’t make it wrong.

Soft jazz playing music stops So you think the breathing stuff is connected to my ALS It makes sense. So it’s just gonna get worse, huh Well, Dr. Hamilton Great guy. Really smart doctor. And his treatment obviously isn’t working. Do you think I’m gonna die here, or you think I get to go back home first An MRI would give us a better idea. MRI, come on. For pneumonia Dr. House thinks we should test for House Yeah, I heard about him. Obsessive son of a bitch That’s him.

So who do you think is right, Hamilton or House Hey, they’re both excellent physicians. Come on, one of ’em says ALS, the other one says not ALS. You gotta pick one, son. Everything points to ALS. Then no MRI. And I want one of them papers that say I don’t want nothing done if something go bad. A DNR Mr. Giles, you don’t wanna rush into It’s been two years. I ain’t rushing. I wanna sign one. Now. While my arm still works. soft jazz playing He signed a DNR.

He rhymes with dinner He signed a DNR. Oh. That makes more sense. You tell him it might not be ALS No. No wonder he signed. Who wouldn’t I started him on IV steroids and Synthroid. Great. If it was my case, I’d be adding a little IVIG to the mix. For his pneumonia That’s my story, and I’m sticking to it. He doesn’t want anything done. No treatment. DNR means do not resuscitate, not do not treat. You do nothing, doesn’t matter which one of us is right. Hang on to that DNR.

That signature could be worth a lot of money real soon. This is Dr. Foreman. What’s Mr. Giles’ status Okay, increase the steroids to 100 milligrams every 12 hours. And, uh, start him on IVIG. Yeah, yeah, I’m sure. One gram per kilo. My nature isn’t what it used to be. The little man has lost some bounce in his step. He needs to crank it up, have himself some fun this weekend. He wants the blue pills. You’re talking about your penis in the third person. Me and him, two people.

Separate vacations That would be a drag for one of you. ltigt I don’t think you need the pills.ltigt I think you have a conflict of medications. You need to up your insulin to chocolate chip ice cream levels. Insulin Yeah, you remember. That’s the stuff you take for the diabetes ltigt that you forgot to tell the nurse about.ltigt Your hands. No hair. which means nerve damage. And your shoes look about two sizes too small, ltigt which means you’ve lost sensation in your feet.ltigt And then there’s your pants.

My pants tell you I have diabetes No, they tell me you’re an idiot. ltigt Powdered sugar on the right pant leg.ltigt Based on the two napkins in your pocket, I’d be willing to bet it’s not your first donut of the day. pager beeping You’re giving me the pills Sure, why not If you’ve got heart disease from ignoring the diabetes, they’ll kill you. Otherwise, you two have a fun weekend. machine beeping O2 sats are dropping. Lung sounds Junky. Mucus plug No, it’s our mistake. Sludging from the IVIG.

Blood can’t get through to his lungs. Start heparin, 500 ccs IV push He won’t last long enough for it to work. We’ve got to intubate him, stat. We can’t. He’s DNR. What Someone likes music. Oh, yeah. beeping His sats are in the 70s. How long has he been like this 10 minutes. Why aren’t you doing any The IVIG put him in respiratory failure. You put him on the IVIG We did this. So undo it. Chase! It’s too late. We killed him. Nobody killed him! He’s not dead!.

Chase, intubate him! He’s DNR. What are you doing You can’t do this! Bag. You can’t do this. Bag! He had a bad reaction to some medicine we gave him. What did you just do He saved his life. ltigtHe’s stable on the ventilator.ltigt ltigtOxygenating well.ltigt The IVIG made him worse, which means Multifocal Motor Neuropathy was a bad diagnosis. Okay, what’s really wrong with him What’s wrong with you Everyone knows what’s wrong with me. What’s wrong with him is much more interesting. You tubed him, and he didn’t wanna be tubed.

He has a legal paper saying just that. To intubate or not to intubate That is the big ethical question. Actually, I was hoping we could avoid it. Maybe just practice some medicine. There’s no question. It’s the patient’s decision. If the patient is competent to make it. If his thyroid numbers aren’t making him sad. God, you don’t believe that. Thyroid levels were a little It’s nothing. Do not defend him. Why did he sign that DNR I didn’t talk him into He signed the DNR ’cause he didn’t want a slow, painful death from ALS.

What was happening to him had nothing to do with his ALS. Right, exactly! It’s the IVIG! You screwed up! You’re not gonna let him die because you screwed up! Technically, your case. You screwed up. Is that what this is about Looking bad in front of your old boss You assaulted that man. Fine, I’ll never do it again. Yes, you will. All the more reason this debate is pointless. His lungs are worse. Any theories Oh, I’m sure he just went to the little boys’ room. Come on, people.

Uh, vasculitis Wouldn’t likely hit both lungs. It could be Wagner’s Granulomatosis. Dr. House Cuddy sent me a stripper again Love that woman. So thoughtful. Sorry. There are case reports of Wegener’s hitting both the lungs and the spine. Well, it’s not great, but it’s better than ALS. ltigt At least it’s treatable.ltigt It’s a restraining order. ltigtYou’re not to come within 50 feet of John Henry Giles.ltigt And they’ve asked the D.A. to file criminal charges for battery. Cameron, test the blood for CANCA. These are criminal charges. They’re not gonna let you take blood.

To make more tests. He has blood left in the lab. Just add on a CANCA. Foreman still got you doing ltigt bronchoscopic suctioning for the pneumonialtigt Every four hours. While you’re down in his lungs, grab a biopsy. We’ll need to confirm Wegener’s. And move the patient to the second floor ICU. Why It’s right above the clinic. I’m sure it’s 50 feet in any direction. It’s nice having a court order saying you don’t have to work clinic duty. shouting Dr. Cuddy! Excuse me. You paged me. Why the yelling.

His bed is behind that wall. The plaintiff’s. I can’t, you know, come any closer. It’s right over the clinic. Very cute. Can we get the lecture over with ‘Cause I’ve gotta Actually, I’ve got nothing to do. Take your time. Need a lawyer You don’t have a problem with what I did When I hired you, I knew you were insane. I will continue to try and stop you from doing insane things. But once they’re done. trying to convince an insane person not to do insane things is, in itself, insane.

So when I hired you, I also set aside $50,000 a year for legal expenses. So far, you’ve come in under budget. Great. Any chance you could help me run some tests Dr. Foreman called Dr. Hamilton. He’s flying in from L.A. You can talk to him. Dr. Hamilton is flying in as a friend of John Henry’s. to pull the plug. Yeah.I need a lawyer. ltigt Your honor, on behalf of Gregory House,ltigt we have convened an emergency session of this court ltigt to bring a motion requesting that John Henry Gilesltigt.

Remain on life support. Mr. House faces criminal charges for battery ltigt against.ltigt John Henry Giles. You beat up a guy in a wheelchair Dr. House is alleged to have forced a tube ltigt down Mr. Giles’ throatltigt against his will. A medical tube, saving his life. Dr. House, please let your attorney speak for you. I’m sorry, your honor. I was way out of line. So, uh, your client ltigt forced the patient into this position,ltigt ltigt and now he wants a court orderltigt ltigt to force the patient to stay that way.ltigt.

Without the tube, there’s a high likelihood that Mr. Giles will die. I assume the patient knows that. He had a DNR. That’s why your client ltigt is facing criminal charges, rightltigt Exactly. And Mr. Giles’ death will violate ltigt my client’s sixth amendment right.ltigt His right to face his accuser. He’s clever, huh Your honor, inltigt Commonwealth of Pennsylvania v. Hoselton,ltigt ltigtthe Third District ruled that a defendantltigt ltigtmay not use that status to rule againstltigt clears throat Why are you doing this It’s not gonna keep you out of jail.

No. Even if you win, the restraining order and battery charge stay in place. What have you gained Time. To diagnose him You can’t get near him. I don’t wanna be near him. Some doctors have the messiah complex. They need to save the world. You’ve got the Rubik’s complex. You need to solve the puzzle. Are you done Or do you have more references to 1980s fads I’m trying to listen to this. ltigt That DNR may not be valid.ltigt ltigt The patient was suffering from depressionltigt brought on by a thyroid imbalance.

The DNR order was witnessed by Dr. House’s own staff, aa Dr. Foreman. My staff are idiots. I’m sure you know what it’s like, your honor. Sit down. ltigt The validity of the DNR is a question of fact.ltigt Dr. House should have the opportunity to make his argument at a full trial. And this poor guy has got to stay on life support until we can schedule a trial. Your honor Dr. House, ltigt I will hold you in contemptltigt if you don’t sit down. I have a medical issue.

If it pertains to this case, your attorney It doesn’t. Do you have any history of heart disease in your family Your honor ltigtYour fingers,ltigt they show signs of clubbing, ltigtwhich indicates a heart problem.ltigt Remember Bart Giamatti ltigt Same thing.ltigt He just dropped dead one day. Please see your doctor. ltigt He’s admitted this isn’t relevant.ltigt Can we get back to the motion Of course. I’m sorry. ltigtYour honor.ltigt ltigt a person’s right to control the treatmentltigt ltigt of their own body is fundamentalltigt ltigt to understanding this case.ltigt ltigt A long line of cases, both federal and state,ltigt.

Ltigt stand to.ltigt Congratulations. Impressive legal argument. I watchedltigt Matlockltigt last night. Say no more. I didn’t notice any clubbing on the judge’s fingers. Neither did I. So the family history thing. Every family has some history of heart disease. And mental illness. Biopsy only shows inflammation. Start him on Cytoxan. You’re diagnosing Wegener’s based on a little inflammation Unfortunately, I think we’ve exhausted all the tests we can do in our capacity as the doctors that he doesn’t want doing tests on him. But you don’t We’ll know I’m right if he starts walking.

Can’t do any more tests, but you want me to treat him Medicine’s in the pharmacy. Patient’s immobilized in the ICU. Sounds like a simple geography problem. Are you asking us to jeopardize our medical licenses for this treatment Can I help you Uh, I’m Dr. House. Greg, right I’m Marty Hamilton, John Henry’s doctor. We should talk. Appreciate any list of medications, anything like that. I’ve started him on Cytoxan. For Wegener’s, right Look, Greg, I checked you out. You know, I know you’re a good doctor. You have to appreciate that I’m a good doctor too.

Why Wegener’s is one of the first things I looked for. The biopsy and the blood tests were negative, just like yours. There’s an error rate,ltigt Marty.ltigt And there’s a time to let go. Look, I’m gonna take him off the ventilator and John Henry’s going to die. He’s accepted that. Hey! How you doing How you doing Listen, Dr. Hamilton, I’m sorry. I should have never put your patient on ltigt It’s not your fault.ltigt No, it’s mine. Eric. That’s not what I said. Everybody asks about you out in L.A.

Ltigt How’s the old place doingltigt Oh, this is wonderful. Before you guys break out the oil, ltigt I should point out that you can’t pull the plug.ltigt I have a court order. You used to, but I have the right to face my accuser. Judge said so. Not if no one’s accusing you. All the charges have been dropped. He doesn’t have to die. It’s not Wegener’s. If it’s Wegener’s, his lungs won’t be able to handle it. As soon as they pull that plug, he’ll die. That’s why they call it. pulling the plug.

Whispering I’m gonna miss you. breathing He’s still breathing. His O2 sats are holding. He’s holding his own. He’s still breathing. It’s not Wegener’s. Wrong again. ltigt Wilson He’s stable, but one of his arms is now paralyzed.ltigt The real question is, why is he still alive Do you think he’s just being stubborn He’s alive because you were wrong. It’s not Wegener’s. Yeah, I seem to be doing that a lot lately. People keep living because of my mistakes. Progression of the paralysis pretty much confirmed Hamilton was right it’s ALS.

Assuming thisltigt isltigt a progression of his paralysis. He can’t move his arm. Yes, his arm is paralyzed. Yes, his legs are paralyzed. Why is everyone so gungho to connect those two conditions You can think I’m wrong. But that’s no reason to stop thinking. How about this one He’s not our patient. Nope, not good enough. He could have suffered a stroke ltigt when he was intubated.ltigt Blood clots are common in paralyzed patients. The inactivity causes ltigtNot interested in why.ltigt Let’s get an MR angiogram, check for an embolic stroke.

He doesn’t want you treating him. He dropped the court order. Yeah, and that girl dropped the charges against Kobe. That doesn’t mean he should call her and see ltigt if she’s free to get a sundae.ltigt ltigt Good point.ltigt But I can go within 50 feet of him now. You need me, you have them page me, anytime. Okay. coughs Get out of here. Sure, that makes sense. You hate me for saving your life. In fairness to your side, you were also dying because of me, so You knew I didn’t want to be saved.

That’s what’s interesting. Your thyroid was low, but not enough to cause depression. So you came here to tell me that even if I can’t walk, I can still hear the birds sing Enjoy a rainbow, the feeling of sunshine on my face Those things are fun. Okay, life sucks. Your life sucks more than most. It’s not as bad as some, ltigt which is depressing all by itself.ltigt Do me a favor. Just let me find out what’s wrong with you. ltigt Then if you stillltigt want to kill yourself.

I’ll give you a hand. That sound fair Yeah. Sure. I’ll stick around to indulge your obsession. It’s over. I lost my air. The session the other night with those kids, that was a test to see if I could still play. I can’t. You mean, that’s all you are A musician I got one thing. Same as you. Really Apparently you know me better than I know you. I know that limp. I know the empty ring finger. That obsessive nature of yours, that’s a big secret. You don’t risk jail and your career.

To save somebody that doesn’t want to be saved unless you got something, anything, one thing. The reason normal people got wives and kids and hobbies, whatever, is because they ain’t got that one thing that hits them that hard and that true. I got music. You got this. The thing you think about all the time. The thing that keeps you south of normal. Yeah, makes us great. Makes us the best. All we miss out on is everything else. ltigtNo woman waiting at home after workltigt with a drink and a kiss.

That ain’t gonna happen for us. That’s why God made microwaves. Yeah. But when it’s over. it’s over. Yeah. What are you doing It’s not over for me. Either you’re gonna call the cops again or we’re doing this. If you wanna die, you can do it just as easily inside an MRI machine. patron chatter ltigt So I’ll going back to L.A.ltigt I’m doing the Dana lectures again this year. Wow. That’s quite an honor. It’s all political. Don’t be modest. You’ve earned it. I got lucky on a couple of studies I was doing.

Ltigt It all sells tickets.ltigt You remember last year’s lectures, don’t you I remember the cigar bar afterwards. Only reason to attend the thing cigars and pool. You enjoy working with Dr. House Not the word I’d use. We work too hard not to enjoy ourselves, right Hmm, you seeing anybody Kinda sorta. Serious I don’t know. Could be. You think she’d, uh, enjoy L.A. Hamilton offered me a job. You gonna take it I haven’t decided. Already have the most prestigious fellowship. It’s a partnership. Three times the money. Car allowance.

Moving expense. Pension plan. A chance to work for a guy who gives a crap what other people think. So why didn’t you just tell him yes I made a commitment here. Right. House would let you out of it in a heartbeat. Or he wouldn’t, just to jerk me around. Would you guys have taken the job I don’t need the money. I’m not like you. I don’t hate House. You guys really don’t have a problem with him, with what he did He knows we disagree with his choice.

Choice Chase, it’s not apples and oranges. It’s right and wrong. And he does it like he doesn’t care. He assaults the guy and moves on to the next differential diagnosis ltigt What do you want from himltigt More handwringing, more torment You want him to cry himself to sleep at night Yeah! Yeah, I want some clue ltigtthat he knows it’s a big deal.ltigt That it scares him, that it matters. Whoa. What is that It was a stroke. Well done, Cameron. House called it. The arm and legs are unrelated.

Well, you make enough calls, one of them is bound to be right. Yeah, he’s just a lucky, lucky guy. ltigtListen, listen.ltigt I just think it wouldn’t hurt him to learn a little humility. So what’s the verdict Embolus. ltigt The arm problem was caused by a clot.ltigt ltigt There’s a good chanceltigt we can still bust the clot with TPA. Do it. See what happens to his arm. We found a blood clot in your brain. We’d like to start you on heparin. ltigt It’s a blood thinner.ltigt What are the side effects.

Your lungs are kind of chewed up from the pneumonia. Good chance there’ll be an infusion. Bleeding Into his lungs. It’s our best chance to give you back the use of your arm. I don’t need my arm without my air. The damage would likely be minimal. No. It’s his call. Or we could do an embolectomy. Basically, we’d go in and pull the clot out. He’s saying no to drugs, and you’re recommending ltigtbrain surgeryltigt Bypasses the risk to the lungs. It’ll either help your arm Or it’ll kill me.

From your point of view, it’s a winwin. Okay. We’ll set up the procedure for today. We’re in your carotid artery. This is going to take us all the way up into your brain. You all right Yes. All done. You still okay I think so. ltigt I don’t know, I guess.ltigt it’s just with Dr. Hamilton here, I noticed a difference in styles. His style involves humility scoffs Another difference in our styles. I don’t care much for apologies. You can go. I didn’t know you were standing there when I said that, okay.

It was completely rude. Do you mean genuine humility You know, with all the selfdoubt and the self questioning, or Hamilton’s polite, patronizing, aw shucks humility You’re both excellent doctors. Thank you. And humility is an important quality. Especially if you’re wrong a lot. You’ve been wrong every step of the way. Of course, when you’re right, selfdoubt doesn’t help anybody, does it pager beeping We gotta go. Congratulations, Greg. Congratulations. Why, Marty ltigtJohn woke up. He can use his arm.ltigt Thank you. Now, look, I know we’ve had our differences,.

But I think when a person does something well, it ought to be recognized. Phone works. Next time you wanna make me feel all warm and fuzzy, leave a message. Don’t get me wrong. I’m overcome with joy. Doc. Yeah What You just touched my leg. What, are you gonna charge me with assault again No. I felt it. ltigt House He now has feeling all the way up to the calf.ltigt This is the way medicine evolved. Patients sometimes get better. You have no idea why, but unless you give a reason,.

They won’t pay you. Anybody notice if there’s a full moon You’re saying he just spontaneously got better No, I’m saying let’s rule out the lunar god and go from there. Something he’s on is working. The enzyme replacement protocol is working, reversing the ALS. The timing doesn’t seem suspicious to you Do you think Dr. House will see it that way Figure it’s his medication doing the job. I’m sure he will. It’s one of ours. How do we figure out which drug is doing the trick Easystop all of them.

One of those drugs is helping him. And the rest steroids, antibiotics, antiinflammatories they’re toxic. We leave him on all of them He’ll walk again. Yeah, to his own funeral. But if we stop everything, he’ll get worse. ltigt True.ltigt Then we’ll add our medications back, one at a time. He gets better, then we’ll have our answer. And if he doesn’t get better Then we’re in trouble. Not as much as he is. But I suppose that was your point. I assume you want me to convince Hamilton to stop his treatment too.

Don’t care. You know, at least five of the medications are part of his protocol. If his stuff was helping, the guy would be playing tennis months ago. It’s our round of treatment that’s helping. Right, so that’s what you’ll stop. So your philosophy is if they don’t want treatment, they get it shoved down their throat. But if it might cure their paralysis, whoa, better slow down. Yeah. ltigt My old philosophy used to be live and let live.ltigt But I’m taking this needlepoint class, and they gave us these really big pillows.

What’s your philosophy on employee relations That’s a very tiny pillow. Great. Sounds like you know what you’re doing. knock on door ltigt Greg.ltigt Can I have a word Can’t it wait for the commercial,ltigt Martyltigt Say hi to my friend Jimmy. Pleasure. Your.diagnostic trial Seriously, commercial’s in about five minutes. It’s a dangerous game. Only if we’re watching in the bathtub. I need to know exactly what medications ltigt you were giving John Henry.ltigt Forget it, and if Foreman tells you what John Henry used to be on You’re gonna fire him.

No, I’ll make him live out every day of his twoyear contract. Foreman asked to leave Not yet. How do you know I made him an You’re a polite twit, but you’re not an idiot. I need to know what medications you’ve taken him off of Wait a second. You’re not an idiot. Youltigt needltigt to know what medications I’ve stopped because. He’s getting worse. Right now, you still work for me. Come on. No feeling, no wiggling. Bad news is John Henry’s back where he started. Good news is Hamilton looks bad.

Yeah, it’s not whether you win or lose, it’s whether the other guy loses. What was the first thing we put him on Steroids for the pneumonia. Put him back on them. Give him 24 hours. See what happens. His lungs aren’t great. It might cause another respiratory collapse. I sure hope not. I didn’t much like that lawyer. Get an MRI. He already got one, and an MRA. Well, obviously something is different now. Do it again. Chase, take care of the scan. Cameron, put him on the steroids. We should probably talk, huh.

LtigtChase Thin cuts.ltigt What levels T9 through the cauda equina. ltigtSame as the last time.ltigt ltigtYou really think Houseltigt would let Foreman out of his contract ltigt He has to.ltigt If he doesn’t, he’s telling Foreman he needs him. House can’t handle that. Oh, my God. I checked him out. He’s a great doctor. Do you think he’s better than I am Is this about your ego Answer the question. It’s not gonna change how I think about myself. ltigtMight affect my opinion of you.ltigt But that shouldn’t affect your opinion of yourself.

Now I’m getting confused. If you think he’s a better doctor than I am, you should take the job. Otherwise, you should get him to buy you two or three more nostalgic lunches and then politely decline. It’s that simple I should just ignore the mockery and abuse Oh, how do I abuse you How do you not If I make a mistake I hold you accountable. So what Dr. Hamilton forgives. He’s capable of moving on. That is not what he does. I screwed up his case. He told me.

LtigtHe never said you were forgiven.ltigt I was there. He said it wasn’t your fault. So So it was. ltigtYou took a chance. You did something great.ltigt You were wrong. But it was still great. You should feel great that it was great. ltigtYou should feel like crap that it was wrong.ltigt That’s the difference between him and me. He thinks you do your job, and what will be will be. I think that what I do and what you do matters. He sleeps better at night. He shouldn’t. Arteriorvenous malformation.

Intradural, compressing his spine. Causing his paralysis. How could Hamilton have missed an AVM Well, we missed it too. ‘Cause it wasn’t there before. You’re saying it just grew overnight No. It was on the spine. It wasn’t on the MRI. Same anatomic location. It’s not there. Whatltigt isltigt there Nothing. Or something. that looks like nothing. ltigt Cameron Background noise, static.ltigt Scar tissue Inflammation If it’s inflammation, the steroids would have shrunk it down. Revealing the AVM. Which has always been there, hiding behind its own swelling. We remove that, he’ll walk again.

Drilling pills rattle Dr. House. Cora’s meeting me outside with the limo. I’m being discharged. 50 bucks says I can beat you to the curb. chuckles Thanks for sticking with the case. I can’t do anything else. You’re much more easily amused when you can walk. How bizarre. I’m guessing that you weren’t exactly Mr. Sunshine, even before your leg got messed up. I want you to have this. Wow. You can sell it if you want to. Just promise me you won’t play it. How many of those pills you taking.

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