Medical Discourse

In House M.D.
Language IV Final Paper

Student: Brbara A. Rodrguez

 ISP Dr. Joaqun V. Gonzlez Brbara A. Rodrguez 2016

Table of Contents

Abstract ................................................................................................................................................... 2
Introduction ............................................................................................................................................. 3
Objectification and Dehumanization of Patients in Doctors speech ...................................................... 3
Agency and nominalization ................................................................................................................ 4
Metaphors ........................................................................................................................................... 5
Disempowerment of Patients in Doctors Speech................................................................................... 6
Abbreviations ...................................................................................................................................... 7
Archaic language ................................................................................................................................ 8
Close questions ................................................................................................................................... 8
Conclusion .............................................................................................................................................. 9
Appendix ............................................................................................................................................... 10
Works Cited or Consulted ..................................................................................................................... 24

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Abstract

Language is the only tool we have to create the world around us. Every object, event, or feeling

humans have is expressed through this complex set of sounds and symbols which has been developed

during the last 200,000 years. Not only does this sophisticated system encode human thoughts so that

messages can be received and hopefully understood, it also shapes humans frames of mind.

Moreover, it is through language that humans establish and, sometimes unconsciously, perpetuate

relations of power among them. Certain groups are granted with righteousness, and are widely

revered. According to Nicola Woods (2006), the medical profession is perhaps the most exalted and

venerated. Concurrent with this granted authority on the part of the non-medical group, there seems to

be objectification, dehumanization, and disempowerment towards them in the medical linguistic

voice; rendering the medical non-medical relationship asymmetrical. It is the aim of this paper to

analyse medical speech in an episode from House M.D and explore how medical staff debase patients

through language.

Key words: language power medicine doctors patients - asymmetrical

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Introduction

In his book Describing Discourse (2006), Nicola Woods explains why doctors seem to be
granted authority and venerated:

Consulting a doctor about a health issue is characteristically a fraught experience, as the

working of our bodies are a mystery for most of us: we cannot help fearing that any
problem, no matter how trivial it might appear initially, could turn out to be life-
threatening or symptomatic of some deeper and potentially devastating disorder. Doctors,
in a real sense, hold our lives (and deaths) in their hands (p.118).

Physicians may be one of the few professionals who bear the responsibility of human life and who are
capable of assuaging pain, enhancing life-style, and predicting the future. Indeed, these scientists
seem to be devoted to helping human race to endure. Just as Woods explains above, it is widely
believed that human lives depend on them. Furthermore, the vast knowledge these professionals are
supposed to have acquired to fulfil such duty renders non-medicals in awe; and perhaps that is the
reason behind hesitating before seeking a second opinion when there is disagreement with a doctors
diagnose.
The science behind medicine is worldwide acknowledged as an unfathomable and complex
study, and its discourse contains many instances of jargon and specific vocabulary. Perhaps that is
why patients regard doctors as such knowledgeable people and look up to them. The spoken exchange
between doctor and patients, nevertheless, is constructed upon communicative routines, often
realized in in ritualized language (Woods, p. 119). That is to say, the language used during
conversation is generally a blending between scientific or specific and everyday vocabulary; and it
seems that it is rather difficult for doctors to put into everyday vocabulary their knowledge of
science. Therefore, physicians resort to different strategies in order to convey meaning to their
patients. However, it is through these strategies that they also portray disempowered, dehumanized,
and objectify patients in their speech, enabling asymmetry in the doctor-patient relationship. This
paper will analyse instances in Sleeping Dogs Lie, an episode from the series House M.D. (TV
Series, 2006) in which the language used by the doctors in their exchange with patients help construe
this unequal relationship.

Objectification and Dehumanization of Patients in Doctors speech

When patients visit a doctors office, a sequence of highly routinized events is performed in
order to find a solution to the patients complaint. This interaction between patient-doctor in general
begins with the patient explaining to the physician what the problem is, what Woods calls the
complaint stage (2006, p. 141). The language used by patients usually resembles that of a

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storytelling: narration of the episodes that constitute their ailment. Doctors listen to their patients and
select from this tale what is medically relevant and, therefore, they devoid this tale of anecdotes
and keep hard data in their records. Moreover, once the examination stage begins, patients bodies
seem to cease to exist as such and are transformed into objects which contain the clues to solve the
mystery of the illness that affects them. In the following sections an analysis of how the medical
linguistic voice empties patients voices and bodies of humanity; and how this contributes to the
asymmetrical relationship between patients and doctors.

Agency and nominalization

Language is a tool which allows us to portray different images in the hearers mind.
Depending on the wording we choose, assorted scenarios can be developed. Choosing a certain
grammatical structure produces the same effect; for example, the selection between overt or covert
subjects (i.e. agents) represents different pictures in the hearers mind. While patients seem to favour
overt subjects, indicating who is performing an action, doctors seem inclined to background this
information and foreground health conditions. During a procedure, in the examination stage, the
patient is getting a colonoscopy and the patients companion informs doctors that:

Max: She [the patient] is bleeding.

Max refers to her partner as the agent of the action bleeding. Later on, when doctors are discussing
what had happened during that procedure, they explain:

Foreman: massive sinus haemorrhage was draining down her throat and out the back.

In the doctors version, the same episode is worded differently: the patient is no longer the agent of
the action to bleed, instead it is substituted by a noun phrase: massive sinus haemorrhage. The
grammatical form in which a process is expressed as a noun is called nominalization. According to
Fairclough (1989), one of the effects of nominalization is that certain aspects of the process are left
unspecified. In this example, Dr. Foreman leaves the performer of the process unmentioned.
Moreover, in the doctors version, the nominalization becomes the agent of the whole sentence: it is
the haemorrhage that was draining. By obfuscating the patient through the use of nominalization,
Hannah seems to be dehumanized. She is no longer a person who happens to suffer from an unknown
disease, but a condition.
A similar example which may seem an instance of dehumanization is to make technology the
agents of actions. Once the patient has been admitted into hospital and doctors are discussing the case,
Dr. Foreman says:

(a) Foreman: The brain is often unaware of stage one sleep. CT showed no tumours, no clots, no seizure disorders.

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Dr. Foreman resorts to a figure of speech known as synecdoche, a special case of metonymy,
in which a part of something, in this case the brain, is used to refer to the whole thing, in this case
the human body (Lakoff & Johnson, 2003). The same strategy is used again by Dr. Foreman when
he explains

(b) Foreman: [] The liver's not compromised.

Nevertheless, in both cases Dr. Foreman uses the definite article to define the body part and not a
possessive, therefore, this body part is nominalized. With this strategy, the picture conveyed in the
listeners mind is that of independent body parts performing actions and the patient as a person is
obfuscated. According to Fairclough (1989), medical staff usually shows disengagement in the way
they look at the human body, and they do so by depersonalizing the patients organs.
With this, doctors seem to draw their attention towards that which concerns them: the
condition. Furthermore, in his second utterance in (a), Dr. Foreman chooses a technological device as
the grammatical agent of the sentence: it is the CT that showed no tumours. Woods explains that
doctors tend to depersonalize patients () by submerging their identity as people () by making
technology the grammatical agent (2006, p. 16). The person of the patient seems to be opaque in
doctors speech and the focus of attention is drawn to the ailment alone. This may function as a way
to achieve detachment necessary for doctors to be able to perform their job. Patients may not be
represented in their speech so that they keep an objective view of the problem they are trying to solve.
Metonymies have a referential function, i.e. it allows us to use one entity, the brain in the example
mentioned above, to stand for another, the patient. Metaphors function in a different way. They are
ways of conceiving of things in terms of another (Lakoff & Johnson, 2003). Nevertheless, the lexical
choices made by doctors when resorting to metaphors to talk about patients seem to objectify patients
as well.

Metaphors

The use of symbolic language in medicine is frequently common. Metaphors are used to
explain to patients what is happening to their bodies but also they are used among doctors, sometimes
to refer to patients. During the examination stage, Dr House orders his colleagues to run some tests on
the patient:

House: After you restart the immuno-suppressants, then fill her up to the eyeballs with streptomycin, sulfate gentamycin,
and tetracycline.

House refers to the patient using the metaphorical framework of the body as a container: the source is
the container; the target is her body (Lakoff & Johnson, 2003). In his speech, House portrays the
patient as an object which can be filled with medication. By resorting to this metaphor, House seems

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to objectify the patient. He does something similar when he asks his colleagues to run some tests
because:

House: The more symptoms we can force out of her, the more tests we can do.

Like metonymies, metaphors are not random occurrences, they follow a system. Lakoff and Johnson
explain that as human beings, we experience the world as outside us. Each of us is a container with a
bounding surface and an in-out orientation (2003, p. 29). Such metaphors are labelled as ontological,
because they are related to the essence or nature of the being. We understand the human body in terms
of a holder; that seems to be the reason why symptoms are inside the patient, and need to be extracted
so as to be examined.
Furthermore, metaphors seem to be a common linguistic resource in order to explain to patients what
their condition is. Once they have discovered what the problem with Hannah is, Dr. House boastfully
explains it to her and the rest of his colleagues:

House: Imagine, an idyllic river of bacteria. Okay, it's not idyllic for her, but it serves my purposes. The steroids and the
immuno-suppressants acted like a big hunk of dam across the river. Physics 101, put a dam up in front of a raging river, the
river rises. By stopping the immuno-suppressants, we blew up the dam, and a hundred foot wall of bacteria flooded her
lymph nodes.

House resorts to a hydrographic metaphor to explain to the patient what is wrong with her. The
effectiveness in communication through the use of metaphors relies on the fact that, as Lakoff and
Johnson explain, there is a systematicity behind them that allows us to comprehend what is being
talked about. We depart from a concrete domain, in this case the river, which is more graspable, to
arrive at an abstract domain, in this case, her condition. Through entailment relationships between the
concrete and the abstract domains, i.e. bacterium is a river entails that a dam can be built up on it, the
message can be put across efficiently. By picturing the concrete image of a river, the patient is able to
comprehend explanations beyond her understanding.
House applies a metaphor to refer to the body of the patient. This strategy could serve the
same purpose as nominalization and changes in grammatical agency discussed above: to establish
detachment on the part of doctors towards patients so that they are able to investigate objectively.
Nevertheless, these linguistic strategies seem to underpin the asymmetrical relationship between
patient-doctor: doctors, power-holders, appear to encroach upon patients humanity, by referring to
them as objects, and patients, in turn, seem to relinquish their rights over them.

Disempowerment of Patients in Doctors Speech

During the diagnosis and treatment stages, doctors explain to either colleagues or patients
what conclusions they have reached and what steps to follow in order to cure the ailment. To do that,
physicians resort to several linguistic strategies in order to put their message through. However, the

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message they attempt to convey is not always transparent for non-medical people as they would
expect. The use of abbreviation and archaic language seem to ostracize patients from their treatment
and render them disempowered. In addition, patients seem to have no say on their treatment
whatsoever. During the examination stage, doctors seem to lead the conversation, guiding the patients
to the answers they expect to hear, leaving aside comments which they do not consider scientifically
relevant. Patients appear to be channelled into expected replies.

Abbreviations

According to Woods (2006), abbreviations are used to avoid saying unwelcomed words
explicitly, as in the case of sexually transmitted diseases. Likewise, he adds that the use of
abbreviations sometimes helps save time. Nevertheless, it seems that abbreviations contribute to
veiling information and confusing patients. In the episode, Dr. House refers to a condition as URI,
which the patient does not understand:

House: Judging by the redness around your mom's nostrils and the tissue she's got conveniently stashed in her wristband, I'd
say her problem is more likely a URI than a PMS.
Daughter: URI?
House: Upper respiratory infection. A cold.

He could have said a cold, which is more common among non-doctors, but he chooses to use the
abbreviation in order to obfuscate the message. In fact, he continues to use them and makes a joke
about it:

House: I also think she's got a problem with SAC.

Daughter: SAC?
House: [winks at her] Thanks for playing. Stupid American child. If you want the pill, all you have to do is walk into any
health clinic in Jersey alone and ask for it.

Fairclough explains that as literacy is unequally distributed; those who can access it impose linguistic
constraints on those who cannot. Doctors, educated professionals, exclude those who are medically
illiterate though the use of discourse; more specifically, through the use of jargon, formal register, or
technical language. In this case, House uses abbreviations, common in medical jargon, which the
patient is not familiar with. By lacking the ability to meet the demand created by the lexis, patients are
unable to comprehend the message, and therefore, rendered inferior in relationship terms.
Another instance of this strategy is when doctors are examining Hannah, and her partner does not
know what is happening to her, so she asks:

Max: What's wrong with her eyes?

Foreman: Looks like REM
Max: What's that?
Chase: Rapid Eye Movements. It's what your eyes do when you're sleeping.

Foreman takes from granted that the acronym is shared by non-medical people and uses it freely.
These two instances clearly show how patients are at a loss of information and are forced to ask in

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order to understand the message. This puts them at the disempowered end of the relationship, helping
to widen the asymmetrical relationship discussed above.

Archaic language

Another way of making his message opaque to patients is through the use of archaic
language. Woods claims that the use of archaic language boarders the inexplicable: what can
possibly be gained by referring to the dorsum of the hand instead of the back of the hand? (2006, p.
126). Nevertheless, it seems that this linguistic strategy, in the same way as abbreviations, contributes
to the construction of the asymmetrical relationship between doctor-patient. Using an unfathomable
explanation renders patients confused and unable to comprehend what the treatment is.
When Dr. House talks to Hannah and gives her the diagnosis, he says:

House: You're in acute liver failure. We can continue the transfusions and the lactulose [] in a few hours you will lapse
into a coma.

Later on, when Dr. Cameron is doing a procedure on Hannah, she explains:

Cameron: I'm going to check for vascular abnormalities that can prevent us from doing the transplant. At the same time, I'm
also checking for mushroom spores to see if that's the underlying---

Even though both explanations seem quite easy to follow, they include words that obfuscate the
meaning of what is going to happen to the patient. Words like acute and lactulose come from
Latin, the word coma, however common in normal speech, like the previously mentioned acute,
comes from old Greek. There seems to be no need for Dr Cameron to use the words vascular and
spores to explain to her patient what the procedure is about. These are words that may divert the
patients attention to the message and may contribute to misunderstandings. Woods explains that the
use of esoteric and arcane vocabulary may lead not only to mystification, but even to
miscommunication in the discourse of medical care (2006, p. 126). As was previously explained, the
uneven access to technical vocabulary excludes one member of the relationship and stablishes an
unequal relationship among them.

Close questions

As mentioned above, patients do not seem to be represented in doctors speech as a way to

establish a detachment from the fact that their patients possess identities. But what happens to
patients voices? In the context of a medical consultation, the routinized language is designed to seek
and give information. Nevertheless, how much information are patients allowed to give during this
interaction? Being at the superior level in this asymmetrical relationship, doctors direct the structure
of the discourse by asking questions that demand a reply from the patient (Woods, 2006, p. 144).
During the examination stage, Dr Cameron asks Hannah the following questions

Cameron: You still feeling a lot of blood in your throat?

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Hannah: No, it's actually getting a little better.

Cameron: When Max got you the dog, did you lie about having an allergic reaction?
Hannah: No. Why?

In both cases, Dr. Cameron narrows down the answers of the patient to just two possibilities: yes or
no. The patient is not allowed to give further information about how she is feeling. According to
Woods (2006), there is a tendency to ask either close-ended wh-questions or yes-no questions by
doctors, those that merely require confirmations. Hannah has not been given the opportunity to word
her viewpoint on the treatment or the diagnosis. Camerons questions channel Hannahs speech into
only one possible reply. This silencing on the part of the patients perspective may be interpreted as
an instance of disempowerment. Patients are not allowed to express themselves even though it is their
health what is being at risk and their bodies that bear the pain and treatments.
Moreover, there are prosodic features which support this. According to Brazil (1997), a speaker can
claim dominance when he or she has a choice of two courses of action: if he/she wishes to proclaim,
he/she will resort to either p or p+ tone, and of either r or r+ tone when he/she wishes to refer;
whereas the non-dominant speaker must use either p tone or r tone1 to answer accordingly. In the
example above, Dr. Cameron used two rises to ask her questions, whereas Hannah resorted to a fall,
which is the expected response to a question which carries a rising tone. Furthermore, Brazil (1997)
explains that doctors usually exert overt control, discouraging irrelevances, deciding when one stage
in the consultation will end and the next begin (p. 84) and that is also seen in the choices in the
prosodic features.

Conclusion

The medical staff has been regarded as the most devoted and learned professionals since their
task came into being. Highly praised in most cultures, doctors are admired apparently due to their vast
knowledge on the human body, which seems unfathomable for non-doctors. Patients seem to deem
these scientists prodigies, in whose hands lie the existence of all human kind, and become therefore
linguistic power bearers. Medical speech is fraught with examples of how doctors adjust themselves
as power-holders by controlling conversations and demeaning patients voices and bodies. In their
speech, physicians tend to objectify and dehumanize patients with the seeming aim of obtaining an
objective view of their bodies, their objects of study. Doctors obfuscate patients as doer of actions,
and hence, as animate beings capable of performing activities with volition. The patients linguistic
voice is devoid of agency and their narrative is turned into nominalized sentences, which leaves
certain aspects of patients speech unspecified. Furthermore, patients bodies are compared to non-
human entities, or become containers which can be filled with medication, through the use of
metaphoric language. In addition, doctors seem to turn their explanations opaque utilizing
abbreviations and archaic language so that patients are unable to comprehend the malfunctioning of
1
In Brazils theory r and r+ tones stand for fall-rises and rises respectively and p and p+ for fall and rise-falls.

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their bodies. Patients are rendered powerless and incapable of utter their opinions on the matter. In a
similar vein, patients do not seem to be allowed to enlarge on the retelling of their consultation for
doctors channel their answers into two possible replies. Doctors questions conduct patients answers,
both contextually and prosodically, to what they expect to hear, encroaching on their right to express
themselves. To conclude, the discourse of medicine embodies a particular type of power relation.
Medical staff and patients are positioned in an asymmetrical relationship where doctors exercise
power over patients through the use of language.

Appendix

Episode opens with sound of dripping tap. Camera pans in on the exceedingly vexed face of the
Patient of the Week, Hannah. Camera pans up to reveal culprit dripping tap into sink. Camera
whooshes out of kitchen, pans up the stairs of the house, moving all the way back into the bedroom.
Sound of dripping tap magnifies.]
[Dramatic flash as the camera zooms back in on the vexed face of the teenager, and then there is a
rapid transition of time on the clock beside the bed to signify the passing of many hours. Hannah is
awake this entire time, and the camera focuses on her at short intervals, continuing to show her
frustration at being awake.]
[Hannah sits up in bed, and all the noises in the house and the nearby area outside seem to magnify,
intensifying her frustration. The dripping tap noise becomes faster, as does the hissing noise of the
radiator, the ticking clock downstairs, and the noise of a passing car is heard outside, magnified
greatly.]
Max: Hannah, you OK?
Hannah: [quietly panting]
Max: Still can't sleep?
Hannah: [very slightly shakes her head] I'm fine.
Max: [sighs] Can I do anything to help you?
Hannah: Just go back to sleep, I'm going to go get a glass of wine.
Max: I can keep you company.
Hannah: You have work in the morning.
Max: Are you sure? You don't want me to?
Hannah: I'll be right back. Just sleep.
[Hannah stands, exits the bedroom. The camera flicks in a mild psychotic fashion.]
[Camera focuses on the alarm clock, now showing that it is 8:00AM. Max wakens from sleep,
discovers that Hannah is not beside her in bed. Max sits up and then walks down the stairs to
investigate.]
Max: Hannah? [Pauses, reaches the bottom of the stairs, sees Hannah on the floor in the room
adjacent to the one she moves into] Hannah?
[Max moves over to Hannah. Camera pans in on Hannah to reveal that she is slowly and repeatedly
thumping her head against the wall. Max rushes over to her, crouches down in front of her. Max raises
Hannah's chin up to inspect her. Notices empty pill bottle on the floor nearby, which camera quickly
pans in to reveal the empty pill's label, "Sleeping Capsules". Max quickly picks up the bottle.]
Max: [desperate tone] What did you do?
Hannah: I just wanted to sleep.
Max: I'm calling an ambulance...
Hannah: [slowly tilts her face towards the camera, revealing blood on the wall, and a trickle of blood
which is running down her left cheek.]
[Black out.]
[Cue to House MD Opening Sequence with Theme Song "Teardrop" by Massive Attack]

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[Camera pans up in an aerial shot on House, to reveal that he is lying on an examination table in exam
room one, a medical journal covering his face. He is fast asleep and snoring. Sound of the door
opening. Then a 'click' as the light switch is turned on.]

Cuddy: [stands in the doorway for a brief moment, then loudly shuts the door.]
House: [jumps, startled from sleep, takes the Medical Journal off his face.]
Cuddy: You've seen one patient in the last two hours.
House: Complicated case. I'm a night owl - Wilson's an early bird. We're different species.
Cuddy: Move him into his own cage.
House: Who'll clean the droppings from mine? [Rolls over, turning his back to her]
Cuddy: [walks to the other side of the examination bed, hands him the file] Twenty-five year old
female with sleep issues.
House: I'm guessing she's... what's the medical term? Upset. These 25-year-old females are usually
completely rational. They're rocks. Really. [glances at the file momentarily] Eh... my theory seems to
be supported by the fact that she swallowed a bottle of sleeping pills. Get her a shrink. And I need
some shut-eye.
Cuddy: She's a little bit more than upset. She hasn't slept in ten days.
House: She's lying. Without REM sleep, your neurons stop regenerating - the brains shut down lobe
by lobe. She'd be insane after five days - dead by ten.
Cuddy: Give me a little credit, I know what gets you off. She took the pills to sleep, not to kill herself.
House: Clever alibi.
Cuddy: They didn't work. She stayed awake, even though she downed the whole bottle.
House: [seems intrigued, takes the file from Cuddy]
Cuddy: And the longest anyone has ever survived without sleep is eleven days. Which gives you
about 22 hours. [exits]
House: [sits up properly and reads the file]
[Cue to House's office area.]
Cameron: [slaps a medical journal down on the table] You stole my article.
Foreman: I wouldn't do that.
Chase: [gives Foreman a wary glance]
Cameron: I wrote up the case where we induced hypothermic cardiac arrest in the terminal cancer girl.
Foreman: I wrote my own, I didn't steal yours.
Cameron: You knew I was writing one, you gave me notes!
House: Got a case. It can wait, you two finish. [To Chase] Five bucks says someone loses an eye.
Cameron: [snatches the file from House and begins reading through it]
House: Fine. You're only putting off the inevitable. Twenty five year old female, hasn't slept for ten
days.
Cameron: I assume the ER tried giving her some sedatives, we should up the dosage.
Foreman: Sedation isn't the same as sleep.
Cameron: Thanks for your insight. For someone who hasn't slept in ten days, sedation is a great start.
Foreman: Sleep is an active process. Reboots the system, restores the brain, sedatives don't---
Cameron: [interrupts him] The brain is being stressed, we need to relieve that. [To House] You've had
my article on your desk for the last four months!
House: I'm a very slow reader. No fever, no white count, means no infection.
Chase: Schizophrenia?
House: No delusions.
Cameron: You read his!
House: I signed it, I didn't read it. [pauses] Aside from the sleeping pills, tox-screen was clean. No
cocaine, meth, amphetamines, or diet pills.
Chase: Only medications she'd had recently are steroids for poison ivy, and ibuprofen for a knee she
hurt skiing.
Cameron: Nothing that would cause sleep disturbances. When did you get his article?
House: Ahh.. about three weeks ago. Let's go back to the beginning.
Chase: How far back?
House: Genesis. God said, let there be light.

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Foreman: Sleep is initially controlled by external light cues.

Chase: And if her brain can't interpret those cues..
Cameron: Optic-nerve disease.
House: I'm sensing another article.
Cameron: I'll go run the tests.
[Cue to examination area. Patient is seated on one side of the eye examination equipment, Cameron
on the other.]
Cameron: I'm injecting a dye which will allow us to look at your retina and your optic nerve.
Hannah: Everything's kinda blurry.
Cameron: Normal because of the dye. It's going to be that way the next few hours.
[Foreman opens the door, enters]
Foreman: Need a hand?
Cameron: No.
Foreman: [amused sigh] We're never going to work together again?
Cameron: I just don't see the need to make you feel better by forgiving you.
Foreman: [sighs] I wasn't asking for forgiveness, I was asking if you needed help.
Cameron: It's unprofessional to be talking about this in front of a patient. Maybe that doesn't matter to
you, but...
Foreman: It doesn't matter. She's not listening.
Cameron: [glances at Hannah] She's asleep.
Foreman: Normal stage one brain waves.
Cameron: You mean she's... better? [
Hannah: [opens her eyes again] It's still blurry.
Foreman: You.. fell asleep.
Hannah: No I didn't.
[Both Cameron and Foreman look rather stunned]
[Cue to hospital cafeteria area.]
House: [takes some vicodin out the pill bottle he had in his pocket and places it inside of a folded
napkin]
Foreman: Negative for optic nerve disease.
House: But she sleeps.
Foreman: For like 10 seconds. Maximum, one minute. We also checked the ocular pressure. It's
normal.
House: [begins loudly crushing the vicodin folded inside of the napkin with the back handle of his
cane] And she doesn't know she sleeps.
Foreman: The brain is often unaware of stage one sleep. CT showed no tumors, no clots, no seizure
disorders.
House: [unfolds the napkin and sprinkles the crushed vicodin over his food] So.. she sleeps, she just
can't stay asleep.
Foreman: You... going somewhere with this?
House: You know what keeps me awake at night? Monsters in the closet.
Foreman: [laughs] There's no monster in the closet, we looked.
House: Well, it's certainly not showing up on the scans. [pauses] Where's Cameron?
Foreman: She felt I could deliver the news on my own.
House: Oh, this is going to work out great.
Foreman: [silently smirks]
House: [wipes his hands off on the napkin] Come on.
[House and Foreman exit the cafeteria area]
[Cut to Princeton Plainsboro Hospital hallways]
House: If you two guys can't play nice together, I'm taking away your toys. I don't care whose fault
this is.
Cameron: If YOU hadn't---
House: [interrupts her] I especially don't care if it's my fault. [pauses] Whatever this woman has, it's
not showing up on our tests, which means she's sick... just not sick enough for us to see it.
Chase: [amused] You want us to make her sicker?

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House: Yes. I want to stress her body. Specifically her brain. Keep her awake.
Cameron: But probably even with the few minutes of sleep she does have, its torture.
House: So is cutting people with knives. But you can totally get away with that if you have a doctor
coat on.
Foreman: House, those few seconds of sleep are maybe the only reason she's still alive.
House: The more symptoms we can force out of her, the more tests we can do, the more tests we do,
the more information we get, the quicker we make a diagnosis. [pauses] See how much more fun it is
when you guys get along? [points to Cameron and Foreman] You two, take the first four hours.
[House exits into his office. Cameron, Chase, and Foreman walk in the opposite direction down the
hall]
[Cut to Hannah's patient room]
Hannah: [is lying in her bed, her head leaning forward]
Foreman: Hannah?
[silence]
Foreman: [louder] Hannah.
Hannah: [jolts awake]
Foreman: You fell asleep.
Hannah: No I didn't.
Cameron: Your brain doesn't remember, it was just a few seconds.
Max: Is this really necessary?
Foreman: The sooner we find out what's wrong, the sooner she can get a real night's rest.
Cameron: Hannah? [pauses, lightly shakes her] Hannah? Hannah.
Foreman: [rolls his eyes, sighs, moves over, pokes Hannah's thumb with a needle]
Hannah: [jolts awake once more, wincing in pain] Ow... what did you do that for?
Foreman: You fell asleep again.
Hannah: No I didn't.
Cameron: We're sorry.
Foreman: We have to do this.
Cameron: [moves him away from the patient, then speaks in a lower voice] You don't have to be
cruel.
Foreman: [amused sigh] You know what happens when you're nice. Nothing.
Cameron: That's how you define nice? Not stealing?
Max: [desperately] Doctors?
Hannah: [has her head relaxed and forward once again]
Foreman: She fall asleep again?
Max: [points to the area of the bed]
[Foreman and Cameron become intrigued. Camera is cued to the lower bed, where there is a large
patch of blood on the sheets. The sheet is raised to reveal more bloodstain on the bed, coming from
the underside area of Hannah's lower half]
[Scene change to House's office. Area is completely dark, the lights are all off. House is seated at his
desk, leaning back in his chair, his feet up on his table. He is asleep and snoring.]
[Sound of footsteps moving up the hallway. Cameron pushes the glass door open, turns on the lights.
House wakes up, wincing at the light.]
Cameron: We've got rectal bleeding.
House: What, all of you? [moves his feet off the table and sits in his chair properly] So the monster is
peeking out from under the bed. Which either means she has a clotting disorder, or she has a tumor in
her colon.
Chase: We'll do a colonoscopy.
House: Who's keeping her awake now?
Foreman: I figured once we found another symptom, it really didn't matter.
Cameron: [sarcastically] Yeah, he's got all the ideas.
House: [stern] Who is with her?
Chase: Her partner is donating blood, so she's with the nurse.
House: Probably singing her lullabies. [pops open his vicodin bottle] I want her awake.
Chase: You have to sedate a patient to do a colonoscopy.

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House: Why? Just because of the pain? [places the pill in his mouth] If you find a tumor in her colon,
you can knock her out. If you don't - she stays awake.
[Foreman, Cameron and Chase look rather bothered at this, but exit]
[Cut to examination room, colonoscopy equipment is in the room. Chase is positioned behind Hannah,
who is lying on her side with her back to him, Cameron is beside him. Hannah is flinching and
making loud pained noises]
Hannah: [groans] It hurts!
Max: Can't you hurry?
Chase: Trust me, you don't want me to hurry.
Hannah: [groans louder] God, you're killing me!
Max: [smiles at her] Hold my hand.
Cameron: Keep breathing nice and steady. [pauses] How am I supposed to work with him?
Chase: Maybe.. we shouldn't be talking about this right now?
Cameron: You think I'm overreacting?
Chase: [sighs] Um.. I need you to relax your anus.
Hannah: [continues her moaning and groaning noises]
Max: We're not here. We're skiing. It's Thanksgiving, at Vail.
Hannah: You really want me to think about killing myself on a snowboard?
Max: Come on. You never fell.
Hannah: [buries her head in the blankets and makes a loud moan in torment]
Max: You were awesome.
Cameron: Is that what you told him - I'm hysterical and I need to relax my anus?
Chase: I told him... how many cases do we work up in a year? They're all weird, he could have written
up any one of them.
[Cue camera to Hannah's face. A large amount of blood begins coming out of her nose]
Max: She's bleeding.
[Cameron immediately rushes to her side of the bed to help]
Hannah: I can't breathe, I can't breathe.
Chase: Hold on.
[Cameron pinches the bridge of Hannah's nose while Chase continues the colonoscopy.]
[Black out.]
[Cue to House's office area.]
Foreman: We packed her nose to control the bleed, and started transfusing two units of whole blood.
Cameron: Pathology from the rectal bleed showed traces of nasal epithelium.
Foreman: So the butt bleed is just a nosebleed.
Cameron: That much blood is not a 'just a' anything.
House: When two people fight this much - you know what it means.
Foreman: It's gotta be a massive sinus hemorrhage, that was draining down her throat and out the
back.
Cameron: The question isn't what, it's why.
House: Oh, get a room.
Foreman: Rat poison mixed with some sort of neurogenic toxin can cause bleeding and sleep
disturbances.
Cameron: Do you have a specific type of neurogenic toxin in mind, or should we just start running a
thousand different tox-screens?
House: Just pretend I'm not here. I'll be reading.
Foreman: It also could be some kind of coagulopathy.
Cameron: Or it could be us, do you have any idea what it feels like to have a six-foot long hose
shoved into your large intestine?
House: No. But I now have a much greater respect for whichever basketball player you dated in
college.
Cameron: [sighs] We've basically been torturing this girl for the last eight hours.
Foreman: We've been poking her foot, not punching her face.
Cameron: Extreme stress can cause high blood pressure, which can cause bleeding.

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Foreman: Wouldn't keep her awake for ten days.

House: What if the poison ivy wasn't poison ivy. She got the rash that was diagnosed as poison ivy
around the same time the insomnia started. Rash plus nosebleed, plus sleep disturbance equals
Wegener's Granulomatosis. Start corticosteroid treatment.
Foreman: The poison ivy treatment was steroids.
House: Much lower dosage. Get her back on the juice, triple the dose. Get a cianga, and an upper
airway biopsy to confirm the wegener's.
[Cameron and Foreman get up to leave the room. Foreman opens the door and motions for Cameron
to go out before him. Cameron gives him a weird glance before exiting, Foreman then turns and
shrugs back at House, who raises his eyebrows in response.]
[Cut to Exam room one. House enters.]
Mandarin Woman: [speaks in Mandarin to her daughter, whom is standing beside her.]
Daughter: She has a... menstrual problems. They're really bad, the pain keeps her in bed all day, plus,
she's super depressed.
House: [pulls up a chair with his cane] She said 'super depressed'?
Mandarin Woman: [continues to speak in Mandarin]
Daughter: She heard that birth control pills can make her feel better.
House: [sighs] She wants birth control pills for her PMS.
Daughter: I guess.
House: Judging by the redness around your mom's nostrils and the tissue she's got conveniently
stashed in her wristband, I'd say her problem is more likely a URI than a PMS.
Daughter: URI?
House: Upper respiratory infection. A cold.
Daughter: I don't think so...
House: I also think she's got a problem with SAC.
Daughter: SAC?
House: [winks at her] Thanks for playing. Stupid American child. If you want the pill, all you have to
do is walk into any health clinic in Jersey alone and ask for it.
Daughter: [sighs]
House: What exactly was your plan? [clicks his pen and begins writing a prescription] You were
going to exchange the birth control pills for some over the counter decongestants in the hopes that
your mom's cold lasts another six years?
Daughter: No.
House: [pulls off the prescription paper and hands it over]
Daughter: That for a cold?
House: No. That's for your ovaries. I assume you haven't had a stroke, have you ever had a blood clot?
Daughter: No.
House: Super. In three months when you need a refill, take a bus to a free clinic. Don't wait around
hoping for mom to get another sniffle. [stands upright once more, then leans closer to the Mandarin
mother] Not the sharpest chopstick in the drawer, is she?
Mandarin Woman: [happily thanks him in Mandarin]
[House exits the exam room, Cameron is waiting outside the door for him.]
Cameron: Is this just one of your experiments? You just wanted to see how I'd react to being screwed
over by Foreman?
House: [shuts the exam room door] Nice idea, but no. This was just good old-fashioned laziness. I
gotta hand it to Foreman though, he knew that you were a suck up and I don't give a crap. He
successfully exploited us both.
Cameron: Right. We're both victims. A simple heads up, that's all I needed. You know, between your
incredibly witty remarks about anal sex and Cuddy's breasts, you could have tipped me off.
House: Then I'd have Foreman pissed at me. And as annoying as you can be, at least I know you're
not going to pop a cap in my ass. Witty, huh?
Cameron: [sighs, starts to walk away]

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 ISP Dr. Joaqun V. Gonzlez Brbara A. Rodrguez 2016

House: You on the other hand, continue to be flabbergasted every time someone actually acts like a
human being. Foreman did what he did because it worked out best that way for him. That's what
everyone does.
Cameron: That is not the definition of being human. That's the definition of being an ass.
[Cut to patient's room.]
Chase: This will numb you up. [sprays an anesthetic spray at the back of Hannah's throat] And this
will keep your tongue out of the way. [places a ] Don't worry, you shouldn't feel anything except for a
slight pulling.
Foreman: So you think I was out of line?
Chase: That article was going to sit on House's desk for the next six years.
Foreman: I could have told her.
Chase: You could have written it for her too. She knows House as well as any of us. She should have
known she was waiting for him to do something he was never going to do.
Hannah: [her eyes begin rapidly moving left to right]
Foreman: [watches her] Chase?
Chase: [also turns his attention to the female] Hannah? Still with us?
Max: What's wrong with her eyes?
Foreman: Looks like REM.
Max: What's that?
Chase: Rapid Eye Movements. It's what your eyes do when you're sleeping.
Max: But she's awake.
Foreman: Hannah. [pause] Hannah can you hear me?
Hannah: [comes out of her daze] Yeah of course.
[Cut to House's office area)
House: Was she sitting up or lying down?
Chase: Sitting up.
House: Then it wasn't REM.
Cameron: But Chase says her eyes are moving the exact way.
House: Did you start her on the steroids?
Chase: Not yet, we were still doing the---
House: Then she wasn't sleeping.
Chase: How do you know?
House: Because we haven't done anything yet. She may be able to sleep with her eyes open, but
unless you also discover that she's got two extra teats in the hooves of her feet, there's no way she'd be
able to retain enough muscle tensity during REM sleep to sit upright. It's a movement disorder. Which
rules out Wegener's. Where's Foreman?
Chase: Keeping her awake.
House: Good.
Chase: Rabies could cause muscle spasms, malaise, anxiety, and wakefulness.
Cameron: I don't think she'd forget being bitten by a crazed animal.
Chase: She could have been exposed to an open wound.
House: Did she have a dog?
Cameron: For less than a week. She had an allergic reaction, so they had to give it away.
Chase: Allergies.
Cameron: Animal allergies seems unlikely, but its possible that---
House: When?
Cameron: When what?
House: When did she get rid of the dog?
Cameron: About a month ago. Her girlfriend gave it to her for her birthday.
House: Well then it's not allergies. She's just leaving her girlfriend.
Cameron: You... spoke to the dog?
House: If her birthday was a month ago, she would still be on steroids for the poison ivy. And those
meds would have suppressed any reaction she might have had to the dog, which means she lied about
being allergic. The dog's a commitment. You pretend to be allergic, because you don't want to tell

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your girlfriend that you're not planning on being around that long. So I think we can move onto
options other than allergies.
Chase: We should still do a scratch test. If she's allergic to one thing--
House: She is not allergic.
Cameron: Okay. Well, we could either base the diagnosis on your admittedly keen understanding of
lesbian relationships, or, we could do a scratch test.
House: Do a scratch test.
[Cue to patient's room]
Cameron: You still feeling a lot of blood in your throat?
Hannah: No, it's actually getting a little better.
Cameron: Good. Maybe things are just starting to improve on their own. Just a few more. You want
some water to wash out your mouth?
Hannah: No, Im OK.
Max: Come on, that can't taste good. I'm going to get you a soda. It's OK, isn't it? [Cameron nods.
Max leaves.]
Cameron: You and Max have got a very nice relationship.
Hannah: Yeah.
Cameron: She's very supportive.
Hannah: Uh-huh.
Cameron: When Max got you the dog, did you lie about having an allergic reaction?
Hannah: No. Why?
Cameron: If you have pre-existing conditions, it's important we know. But, if you don't, it's just as
important. If I'm wasting my time doing---
Hannah: [speaks over the top of her] You're not going to tell her, are you?
Cameron: It's none of my business.
Hannah: She's a good person. We've just been together so long, I... [pauses] I'm tired of her. Sounds
terrible, doesn't it?
Cameron: I guess it happens sometimes.
Hannah: My back hurts.
Cameron: Hannah, can you turn over?
Max: [enters] What's wrong?
Cameron: I'm not sure.
[Cameron pulls up Hannah's shirt to reveal a dark red patch of skin)
Hannah: Oh my god.
[Cue to House's office.)
Cameron: She has massive internal bleeding.
Chase: Did she have access to aspirin?
Cameron: She'd have to take a hell of a lot.
Chase: Why not? Considering her current mental state.
House: What about her mental state?
Cameron: [sighs] You... were right about her wanting to break up.
House: It just means I was right, doesn't mean she's suicidal.
Chase: A bottle of pills is what landed her here in the first place.
House: Sleeping pills. God knows why she'd want them. What else can cause sleep disorder, and
internal bleeding?
Cameron: Drugs or alcohol can mess with the sleeping, and compromise the liver.
House: What are you doing here? Who's keeping her awake?
Foreman: Doesn't matter. Liver function tests are through the sky. The liver's not compromised, it's
dead. She doesn't need a diagnosis, she needs a new liver.
House: She's not getting a new liver unless we can figure out what's wrong with her.
Foreman: Test for cirrhosis, twelve hours. Test for hepatitis, eight, she's not going to last another six.
House: So your advice is we just give up?
Foreman: My advice is that we narrow our focus to conditions that we can diagnose, treat and cure in
less than six hours. And there's nothing on that list.

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House: The girlfriend donated blood, right?

Chase: Yeah. So?
House: That means they're the same type.
Cameron: You can't ask the person she's about to dump to donate half her liver!
House: Does seem tacky, doesn't it.
[Cue to patient's room]
House: I'm Doctor House. I'm in charge of your case.
Max: What's going on? How come no one is keeping her awake any more?
House: You're in acute liver failure. We can continue the transfusions and the lactulose. But it's only a
stopgap. There's really nothing we can do to stop the toxins from building up in your bloodstream.
Which means that in a few hours you will lapse into a coma. And you won't wake up. I'm sorry.
Max: That's it? You're giving up? You're... not going to try to figure out what's doing this to her?
House: Well even with the right diagnosis, any treatment is going to take longer than the time she has
left.
Max: If it's her liver, can't she get a transplant?
House: Wouldn't work without a diagnosis. Whatever killed the first liver will do the same to the
second.
Max: But it... but it would give you more time to make the diagnosis, to get her better.
House: Well, it may give us an extra day or two, but, no procurement agency is going to let a liver go
to a patient with an undiagnosed pre-existing---
Max: Hannah and I have the same blood type. Couldn't I be the donor?
House: It is medically possible for us to take a part of your---
Max: Please, I don't care about the risks!
House: [To Hannah] You're very lucky to have such a devoted partner.
[Cue to House's office area)
House: I just bought us 36 hours. Differential diagnosis - which monster eats your liver, screws up
your sleep, and causes bleeding?
Cameron: Does Max know Hannah plans to leave her?
House: Didn't come up, so I guess, no.
Cameron: If she knew, there's no way she'd go through with this.
House: And if you didn't have a pathological need to create a close personal relationship with every
dying person you meet, we would be blissfully ignorant of any ethical dilemmas and might actually be
able to concentrate on the differential.
Chase: Scratch test was negative.
Foreman: It's rare, but any of the hepatitis viruses can cause sleep disturbances, and liver failure.
Chase: Nope, PCRs were normal.
Cameron: We have an ethical dilemma.
House: No we don't. Continue.
Chase: What about splenic cancer, or non-Hodgkins lymphoma? She's the right age.
House: It could explain the bleeding. Maybe the liver failure.
Cameron: We're withholding information relevant to her decision to risk her life. How is that not an
ethical dilemma?
House: It's not medical information.
Cameron: Who cares?
House: The AMA.
Foreman: Wilson's disease could explain the liver, and neurological symptoms. It also causes bleeding
disorders.
Chase: No Kayser-Fleischer rings in her eyes.
House: The rings don't have to be there if there's neurological symptoms.
Cameron: This is immoral.
House: Look, let's say you're right. We tell, she changes her mind, our patient dies. How is that
moral? [pauses] What else?
Foreman: Poison mushrooms can cause liver failure, sleep disturbances, and internal bleeding.
Chase: She's not shrooming, she's a sports nut.

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 ISP Dr. Joaqun V. Gonzlez Brbara A. Rodrguez 2016

House: Right. Skiers never party.

Cameron: She's doing this out of love, and Max doesn't know---
House: It's only moral to save a person if they love you? That's kind of a selfish way of looking at life.
I like Wilson's disease, like cancer, love mushrooms.
Foreman: Yeah, but we don't have the time to test for any of these. Before she can get the transplant,
we need to do about 80 procedures.
House: So do those tests, and my tests at the same time. Use the PET to look for cancer, and Wilson's
while you endoscope her bile ducts and scrape her stomach for mushroom spores. One of you CT her
liver, While the other two check protein CA125, and CA19.5. Oh yeah, if anyone says anything to
Max, they're fired.
Cameron: We have to.
House: We have to not. Because she's not our patient.
Cameron: She's getting surgery, she's someone's patient.
[Cue to hospital hallways.]
House: Need a little help.
Cuddy: Inexplicable rash on a patient's scrotum you need me to look at?
House: 27 year old female wants to donate half her liver to her dying girlfriend.
Cuddy: That's very generous. This the sleepless girl? What's she got?
House: Liver failure.
Cuddy: I suppose I should have figured that out when you said she needed a new liver.
Cuddy: You don't have a diagnosis.
House: The transplant buys me time.
Cuddy: Let's just skip the part where I say this is insane.
House: It was her idea.
Cuddy: If she wants to be an idiot, it's her call. You don't need me. Have one of your team walk her
through the process.
House: The donor and the donee sort of have opposing interests, right? Can't really advise them both.
Cuddy: You're concerned about the ethics of this? What's going on? What do you know?
House: Nothing medically relevant.
Cuddy: But you know something. And it is relevant.
House: If I can't tell her, I can't really tell you, can I? And if you're advising her.
Cuddy: I assume this information is in the medical file.
House: My patient's confidential file.
Cuddy: This hospital's file.
House: You can either satisfy your curiousity, or remain ignorant, do nothing ethically wrong and my
patient doesn't die in three hours.
[Cue to examination area with Cuddy and Max]
Cuddy: These tests and the counseling normally happen over weeks, sometimes months.
Max: It's okay.
Cuddy: The most important part we're skipping is time. Time for you to change your mind.
Max: I don't want to change my mind.
Cuddy: Not now, but with time and perspective, maybe we learn things---
Max: If we had the time then wed take the time, but we don't. So can you get this over with?
Cuddy: Either I sign off on this, or it doesn't happen. So I need you to listen to me. Because there's a
chance that you will die on that table.
Max: I just want me and Hannah to be able to lie in bed together. As old ladies. Compare scars.
Cuddy: I need you to lie on your side. And hold your knees.
[Cue to examination area with Cameron and Hannah)
Cameron: I'm going to check for vascular abnormalities that can prevent us from doing the transplant.
At the same time, I'm also checking for mushroom spores to see if that's the underlying---
Hannah: I don't do mushrooms.
Cameron: If you lie about your love life, maybe you lie about drugs. Open.
[Cameron inserts the endoscopy equipment into Hannah's throat)

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 ISP Dr. Joaqun V. Gonzlez Brbara A. Rodrguez 2016

Cameron: Aren't you at all concerned about what Max is going through right now? Shoving a tube up
her rectum. Then they're going to swab her stomach just like I'm doing. It's going to hurt just like this
hurts, which is nothing at all like the risk she's taking on the table.
[Cameron removes the endoscopy equipment from Hannah's throat once again)
Cameron: And you don't love her, do you.
Hannah: I'm not leaving her because I don't----
Cameron: I'm not talking about the leaving, I'm talking about this. If you care for her at all, you won't
let her do this blind.
Hannah: You'd really tell?
Cameron: Yeah.
Hannah: You'd die?
[Cue to House's office area. The lights in the room are off. Wilson enters, and drops a medical journal
onto the floor, next to House, whom is sleeping on the floor)
Wilson: I take it you've seen that?
House: Seen it, digested it, watched it blow up my entire department.
Wilson: You read Cameron's version?
House: I didn't read either.
Wilson: It was good.
House: Better than Foreman's?
Wilson: Maybe. He was more analytical about the diagnostic procedures. She concentrated more on
the ethical dilemmas of informed consent. How any patient can really be informed without a medical
degree.
House: The same old party lines.
Wilson: Foreman should have told her.
House: Ah, shoulda, woulda, coulda.
Wilson: If you allow this sort of thing in your department, you're basically saying it's OK.
House: No, I'm saying that I don't care what they do as long as my life isn't interrupted by pointless
conversations like this one.
Wilson: They won't trust each other, and they won't trust you.
House: They shouldn't.
Wilson: Deception like this is just one step removed from actively sabotaging one another. Then what
would you do?
House: I could be the kindest gentlest boss in the world, and Foreman still would have done what he
did because that's who he is. We can only hope that Cameron has learned something.
Wilson: Right. Because you're all about the teaching.
House: Our children are the future.
[Cue to Hospital hallway]
Foreman: Hey! Cuddy cleared Max for surgery. She's OK to go.
House: How's our patient?
Foreman: She's also cleared.
House: I don't care about the prep, what about the diagnostic tests?
Foreman: It looks negative for Wilson's disease, we'll know for sure in an hour.
Chase: Blood proteins are normal, it's not---
House: Where's Cameron?
Chase: Taking a sample of the bile duct.
House: Surgery is supposed to start in about 15 minutes.
Chase: She had a chance to get one last---
House: Hannah and Max will be in the same room.
Foreman: You wanted us to do as much as we can before---
House: Both awake. With Cameron.
[Cue to Operating Theater area]
Cameron: Maybe we should give these two a minute together before the surgery.
Max: You ready, honey?
Hannah: Max.
Max: It's okay. I'm right here.

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 ISP Dr. Joaqun V. Gonzlez Brbara A. Rodrguez 2016

Hannah: I need you to know something.

Max: I know. I love you too.
[House shoves the door open with a dramatic bang)
Hannah: I dont know how to say this...
House: Good lord.
Max: You can tell me anything.
House: She hasn't slept in eleven days. Are you trying to torture her?
[House feeds anesthetic into Hannah's IV line which promptly makes her drift off to sleep)
House: Ding ding, let's go.
House: I told you---
Cameron: I didn't say a word to Max.
House: This is exactly why you got screwed with Foreman. You're looking for people to do the right
thing.
Cameron: She hasn't slept, her judgments compromised due to inactivity in her pre-frontal cortex.
House: Oh, she could have the best pre-frontal cortex in the history of mankind, but given the choice
of life versus death, those bad bad people are going to choose life.
Cameron: Then why did you sedate her? If she wasn't going to tell, if she was never going to do the
right thing, why bother knocking her out? [pause] This isn't about them, if she talks, if she does the
decent thing, then you don't get to solve your puzzle, your game's over, you lose.
House: Yeah. I want to save her. I'm morally bankrupt.
[Camera pans over both tables in the operating theater. The surgery is in progress. Camera pans up to
observation room above the operating theater, where Cameron and Cuddy are watching.]
Cuddy: How's it going?
Cameron: They're about to remove Hannah's liver.
[Camera pans back down to the op-theater)
Surgeon#1: All right. I'm good to go. We can start removing Max's liver.
Cuddy: You want to let me in on what the big secret is between these two?
Cameron: Did you read Foreman's article?
Cuddy: It was good.
Cameron: He basically stole it from me.
Cuddy: So?
Cameron: You're on his side?
Cuddy: Sides? No, this isn't dodgeball.
Cameron: What am I supposed to do? Just sit back and take it?
Cuddy: No, write another article. Kick ass until you're sitting behind some big expensive desk and
someone from Johns Hopkins calls and says 'We're thinking about hiring Eric Foreman as our head of
Neurology'. And you can say whatever you want.
Cameron: [scoffs] Lovely. Revenge as motive for success.
Cuddy: Ah, it doesn't have to be a motive. But it sure tastes good.
Surgeon#1: She's in VF, I've got no pulse.
Surgeon#2: She's arresting.
Surgeon#2: Paddles.
House: Oh! I am so relieved you two are here. Without you looking at me, they're playing foosball
down there.
Cameron: Max's heart stopped.
House: Your patient is on the other side. Now get yourself upstairs and figure out what Hannah has or
Max has risked her life for nothing.
Surgeon: Charging... clear. We're okay.
[Cue to House's office area.]
Chase: Max's cardiac arrest was caused by hypoxia from hypoventilation. They restarted her heart and
the right lobe of her liver was successfully transplanted into Hannah.
House: Now, where were we before we were so rudely interrupted by the liver transplant?

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Foreman: Dopa decarboxylase was processed normally and the ceruloplasmin and copper levels were
normal. So no Wilson's disease.
Cameron: Gastric content was negative for spores, so no mushroom toxicity.
House: And the initial tests were negative for cancer.
Wilson: Which cancer were you looking for?
House: Any of them.
Cameron: We ran blood tests for ovarian, lung, and lymphomas.
Wilson: Not going to tell you much. Her blood was thick after she was given immuno-suppressants.
They fight rejection, they also mess up our ability to get any clear readings.
House: Great battles kick up a lot of dirt. Obscure the battlefields so the generals can't see what's
going on.
Wilson: So what are your orders, General House?
House: Sound the retreat.
[Cue to Post-op patient room area.]
Foreman: How are you feeling?
Hannah: [sighs] Is Max OK?
Foreman: She's still unconscious, but her vitals look good. [sighs] We need to stop all the immuno-
suppressant drugs which are protecting your new liver.
Hannah: [shakes her head] But if you stop the drugs, I'll die.
Foreman: You're dead anyway if we don't figure out what caused all of this. By removing any outside
influences, it will help us see what's really going on with your body.
Hannah: So you did this to buy me a couple of days, and now you're taking them back? [pause] Will it
hurt?
Foreman: As your body begins to go into acute organ rejection, your liver will begin to swell. And
thatll put pressure on-- [pauses] Yeah, it'll hurt. But we can knock you out.
Hannah: Mmm. No. If Max wakes up, I want to talk to her.
Foreman: [silently nods his head.]
[Cue to Exam room one. The Mandarin mother and the daughter have returned.]
House: [Opens the door and moves inside.]
Mandarin woman: [Speaks in Mandarin, using a flustered tone as House enters]
Daughter: She's been taking the decongestants, but she's not getting better, She.. also says...
House: What?
Mandarin woman: [grabs House's hand and places it on her chest.]
Daughter: Her boobs are bigger.
House: [Promptly yanks his hand away. Looks intrigued, then places it back where it was.] Wh... how
could you get them mixed up? They come in a little wheel, they don't look anything like
decongestants.
Daughter: Oh god, the cashier put them both in the same bag, I thought I gave her the right ones.
Mandarin woman: [Asks a question in Mandarin]
Daughter: [Slowly responds to her.]
House: No, you gave her the wrong pills.
Daughter: You speak Mandarin?
House: I can count to ten and ask to go to the bathroom and [Gongxi, ni kuai
dang zumu le. "Congratulations, you're going to be a grandmother."]
Mandarin woman: [Looks appalled)
Daughter: I'm not pregnant! We haven't even done it yet!
Mandarin woman: [begins speaking to her daughter in a flustered tone] (What did he mean by that?)
Daughter: [quickly argues back to her mother in Mandarin] (I don't know!)
Mandarin woman: (Look at you, you're lying, your face is already reddening!)
House: Okay, I'm going to leave you two alone now. I'm sure you've got a lot to talk about.
[House picks up his book and leaves Exam Room one, leaving the mother and the daughter to argue
and bicker with each other.]
[Cue to House's office area.]

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Cameron: Fever is 106, she's in full rejection mode.

House: Is that supposed to surprise me?
Cameron: Her white count is normal.
House: Normal is not normal. She's been on steroids, transplant team gave her a cocktail of immuno-
suppressants, she hasn't slept in over a week. Her white count should be in the tank.
Foreman: Looks like the problem is some sort of infection. Probably causing hypotension, shock the
liver.
Chase: We should start broad spectrum antibiotics
House: Yeah, you might want to add some chicken soup. It's just as useless, but it's got chicken. We
need to know exactly what kind of infection we're dealing with, what infection causes sleep
disturbance, bleeding, movement disorder, organ failure, and abnormally normal white count.
Chase: What about tularemia?
Cameron: Chest was clear. Tularemia doesn't cause movement disorders.
Foreman: It would if she developed meningitis.
Cameron: There is no ulcerations on the skin. [sighs] The bleeding, it looks more like leptospirosis.
House: Without conjunctivitis and elevated creatinine?
Forman: What about typhoid, or some kind of relapsing fever?
Cameron: Makes sense if we were in the Sudan.
House: You sure she hasn't been out of the country?
Cameron: She hasn't even been out of the state in at least a year and neither has Max.
Foreman: Maybe she lied. You talked to her friends? Neighbors?
Cameron: You don't know? Come on, if you don't stay up to date on my notes, where's your next
article going to come from?
House: You talked to the dog?
Cameron: We're not as up on foreign languages as you are.
House: [scoffs] Has the dog been traveling?
Cameron: It came from a breeder.
House: Where?
Cameron: I don't know. A place called Blue Barrel Kennels. They only had the thing for like, two
days.
House: Blue barrel is a kind of cactus. Do you see many cacti in Jersey?
[Cue to post-op patient's room. House slides the door open and walks inside.]
House: Wanna see a magic trick? [moves his hand in and pinches Hannah's nose, pretending to steal
her nose. He then shakes out his hand, feigning surprise as her 'nose' disappears] Oh no, where'd it go,
where'd it go? [Raises Hannah's left arm up] Is it here? [searches it momentarily, then places it down
again] How about here? [raises her right arm and pulls up her sleeve, revealing a large pustule wound]
There it is. Oh, it doesn't look anything like a nose.
Cameron: That wasn't there this morning.
[House pulls up Hannah's sleeve completely and nods to Cameron, who turns away to take a syringe
out of a drawer. House then inserts the needle into the pustule and withdraws completely solid-black
fluid from it)
House: Give that to the lab, and call the CDC.
Chase: And tell them what?
House: That we have a patient with the plague.
Chase: The... black plague?
House: [nods] Looks that way.
Cameron: The plague is carried by rodents, not dogs.
House: Where there's dogs, there's fleas. If they hail from the southwest, then those fleas can't tell the
difference between prairie dogs and puppy dogs. A small percentage of plague cases present with
sleep disturbance. Imagine, an idyllic river of bacteria. Okay, it's not idyllic for her, but it serves my
purposes. The steroids and the immuno-suppressants acted like a big hunk of dam across the river.
Physics 101, put a dam up in front of a raging river, the river rises. By stopping the immuno-
suppressants, we blew up the dam, and a hundred foot wall of bacteria flooded her lymph nodes.
Foreman: We better find out where that dog is now.

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 ISP Dr. Joaqun V. Gonzlez Brbara A. Rodrguez 2016

House: After you restart the immuno-suppressants, then fill her up to the eyeballs with streptomycin,
sulfate gentamycin, and tetracycline.] Use a garden hose if you've got one. Get yourselves some
prophylactic treatments as well.
Hannah: I've got the plague?
House: Don't worry, it's treatable. Being a bitch though, nothing we can do about that.
[Hannah glares at him. House simply exits.]
[Cue to hospital hallway, outside of Hannah's post-op room area.]
Cameron: You weren't in your room.
Max: The surgeon said I'd heal faster if I walk. Got this far, needed a rest.
Cameron: What you did was crazy, but it was pretty amazing too.
Max: Yeah. I'm a hero. [watches Hannah through the glass from her place across the hallway] She's
been planning to leave me.
Cameron: Really?
Max: [nods] She told a friend. The friend let it slip.
Cameron: You knew, and - you gave up half your liver anyway?
Max: She can't leave me now.
Cameron: You really want her to stay out of guilt - that's not going to make either of you happy.
Max: You don't know that. I love her. I just want her to stay.
[Cue to House's office area. The lights are dimmed, Foreman is sitting in a chair and reading.
Cameron slowly approaches him]
Cameron: I don't own House's cases. You had just as much right as I did to write it up. You should
have told me, but, I should have handled it better too.
Foreman: [settles back in his chair]
Cameron: If we want this not to get in the way of our friendship, I think we both have to apologize
and put it behind us.
Foreman: I like you. Really. We have a good time working together. But ten years from now, we're
not going to be hanging out and having dinners. Maybe we'll exchange Christmas cards, say hi, give a
hug if we're at the same convention. [sighs] We're not friends. We're colleagues. And I don't have
anything to apologize for.
[Cameron looks rather shocked as the camera pans out of the office area. The camera shifts into the
next room and focuses on House, whom is fast asleep in his chair.]
END

Works Cited or Consulted

Brazil, D. (1997). The Communicative Value of Intonation in English. Cambridge: CUP.

Fairclough, N. (1989). Language and Power. NY: Longman.

Hess, S. (2012, May 14). Live Journal . Retrieved February 29, 2016, from House Transcripts:
http://clinic-duty.livejournal.com/10464.html

Lakoff, G., & Johnson, M. (2003). Metaphors We Live By. Chicago: University of Chicago Press.

Quinion, M. (2000). World Wide Words. Retrieved February 25, 2016, from World Wide Words:
http://www.worldwidewords.org/qa/qa-syn1.htm

Woods, N. (2006). Describing Discourse. A Practical Guide to Discourse Analysis . London: Hodder
Education.

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