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DNR (House)
Encyclopedia
"DNR" is the 9th episode in the first season of House
, which premiered on the Fox
network on February 1, 2005.
When legendary jazz
musician John Henry Giles collapses mid-session, House and his team run into technical difficulties treating the man, who was diagnosed with ALS
by his doctor in California, Marty Hamilton. Foreman, who did a residency with Hamilton, is requested to lead the case. Although Foreman and House clash at every turn, Foreman listens to House's advice and treatment options. After House's suggestion causes the patient to crash suddenly, House disobeys a DNR order and must go to court.
At the trial, House makes up a diagnosis for the judge causing a ruling in House's favor. Meanwhile, Foreman has called Marty Hamilton, Giles's old doctor, to help on the case.
player named John Henry Giles plays with a band. By mid-session he loses his breath and collapses from a lack of oxygen. At the hospital, House is intrigued that John Henry has been paralyzed
for two years without sufficient explanation. Cuddy tells House that they are only treating John Henry for pneumonia
, since his paralysis is treated by his doctor in California, Marty Hamilton. Foreman, who did a residency with Hamilton, is requested to lead the case.
Hamilton had already diagnosed the paralysis as an effect of ALS
, which would explain the pneumonia. House does not agree with this suggestion and seeks other explanations for the paralysis. As Foreman does the blood work, John Henry requests a "Do Not Resuscitate" order. Foreman has John Henry administer an IVIG, which ends up limiting the blood in his lungs, causing him to crash. Chase wants to intubate
, but Foreman mentions the DNR. House intubates anyway.
House reasons that it was the IVIG that caused the reaction, not the disease. Foreman angrily points out that this was House's fault for suggesting the treatment. House is hit with a restraining order to stay away from John Henry. Criminal charges for battery
will be filed. House presses on, ordering Cameron and Chase to consider other possibilities. Yet Foreman has called Dr. Hamilton, who is now flying in from Los Angeles.
In court, the hospital lawyer argues that House has the right to face his accuser. Since John Henry is on life support
, the trial will have to wait. Back at the hospital, Chase sees on the lung biopsy
that there is only inflammation. Since House cannot order more testing, he begins blind treatment. He suggests starting John Henry on cytoxan, which treats Wegener's disease. If House is right, John Henry will start walking again. If House is wrong, Cameron and Chase could lose their medical licenses.
House is about to administer the cytoxan when Dr. Hamilton arrives. Hamilton, who only calls House by his first name, says that he had initially checked for Wegener's. House reminds Hamilton of the error rate that occurs in those blood tests and biopsies. Hamilton wants to discontinue life support. House tells Wilson that if it is indeed Wegener's, John Henry's lungs will not be able to handle the stress and he will die. When he is removed from life support, John Henry starts to breathe on his own, so Wegener's was the wrong diagnosis.
With John Henry's arm now paralyzed, everybody but House is convinced he is stricken with ALS. The battery charges have been dropped, so House can treat John Henry once again. House visits the patient, who admits that since he cannot play the trumpet any more, he does not mind dying. House asks John Henry to just let him find out what is afflicting him. If he still wants to die, House will help make it quick and painless. The patient declines. House puts John Henry into an MRI.
Hamilton offers Foreman a job in Los Angeles that pays three times what he now makes and includes many other perks. When Foreman mentions the offer to Cameron and Chase, the latter claims that he does not work at his job for the money while Cameron says she does not hate House like Foreman does. Looking over John Henry's MRI, Cameron notices signs of a stroke
, which would explain the paralyzed arm. Foreman explains the options to John Henry. They can give him heparin
to thin his blood and remove the clot, but it could hurt his lungs. Another option is brain surgery to remove the clot. The surgery will either result in his death, or a clearing of the blood clot. Not wanting to risk his lungs, John Henry opts for the surgery, because it offers him the chance at death without prolonged pain.
The surgery is a success. John Henry can move his arm following the embolectomy
and is able to feel House touching his leg. The doctors are baffled. Hamilton thinks his ALS treatments are the answer. House thinks they need to take John Henry off the dozen drugs they are giving him in order to restart the dosage one by one to see which is having the effect. If not, the toxicity of the useless drugs could kill him.
Hamilton asks House which medications are used to treat John Henry. House resists, but then realizes that Hamilton needs to know because the patient is worsening. He cannot feel his leg anymore. House prescribes steroids and a second MRI. Meanwhile, House and Foreman discuss their working relationship. House tells Foreman to take the new job if he thinks Hamilton is a better doctor.
The MRI results show that John Henry suffers from arteriovenous malformation
. It was compressing his spine, which caused the paralysis. Foreman wonders how Hamilton could have missed something so simple. House points out that they all missed it too, so something must have been hiding it. It was the inflammation that they first saw on the lung biopsy. The steroids treated the inflammation and allowed the AVM to show on the MRI. After surgery to remove the AVM, John Henry walks out of the hospital with a simple cane, not a wheelchair (with House commenting that eventually John Henry won't even need the cane). John Henry then gives House his own trumpet, on the condition that House never plays it. As the two leave the Hospital, House tells Foreman that he will see him tomorrow, calling him by his first name "Eric", in mockery of Dr Hamilton's familiar style.
House (TV series)
House is an American television medical drama that debuted on the Fox network on November 16, 2004. The show's central character is Dr. Gregory House , an unconventional and misanthropic medical genius who heads a team of diagnosticians at the fictional Princeton-Plainsboro Teaching Hospital in...
, which premiered on the Fox
Fox Broadcasting Company
Fox Broadcasting Company, commonly referred to as Fox Network or simply Fox , is an American commercial broadcasting television network owned by Fox Entertainment Group, part of Rupert Murdoch's News Corporation. Launched on October 9, 1986, Fox was the highest-rated broadcast network in the...
network on February 1, 2005.
When legendary jazz
Jazz
Jazz is a musical style that originated at the beginning of the 20th century in African American communities in the Southern United States. It was born out of a mix of African and European music traditions. From its early development until the present, jazz has incorporated music from 19th and 20th...
musician John Henry Giles collapses mid-session, House and his team run into technical difficulties treating the man, who was diagnosed with ALS
Amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis , also referred to as Lou Gehrig's disease, is a form of motor neuron disease caused by the degeneration of upper and lower neurons, located in the ventral horn of the spinal cord and the cortical neurons that provide their efferent input...
by his doctor in California, Marty Hamilton. Foreman, who did a residency with Hamilton, is requested to lead the case. Although Foreman and House clash at every turn, Foreman listens to House's advice and treatment options. After House's suggestion causes the patient to crash suddenly, House disobeys a DNR order and must go to court.
At the trial, House makes up a diagnosis for the judge causing a ruling in House's favor. Meanwhile, Foreman has called Marty Hamilton, Giles's old doctor, to help on the case.
Plot
A famous wheelchair-using trumpetTrumpet
The trumpet is the musical instrument with the highest register in the brass family. Trumpets are among the oldest musical instruments, dating back to at least 1500 BCE. They are played by blowing air through closed lips, producing a "buzzing" sound which starts a standing wave vibration in the air...
player named John Henry Giles plays with a band. By mid-session he loses his breath and collapses from a lack of oxygen. At the hospital, House is intrigued that John Henry has been paralyzed
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
for two years without sufficient explanation. Cuddy tells House that they are only treating John Henry for pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
, since his paralysis is treated by his doctor in California, Marty Hamilton. Foreman, who did a residency with Hamilton, is requested to lead the case.
Hamilton had already diagnosed the paralysis as an effect of ALS
Amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis , also referred to as Lou Gehrig's disease, is a form of motor neuron disease caused by the degeneration of upper and lower neurons, located in the ventral horn of the spinal cord and the cortical neurons that provide their efferent input...
, which would explain the pneumonia. House does not agree with this suggestion and seeks other explanations for the paralysis. As Foreman does the blood work, John Henry requests a "Do Not Resuscitate" order. Foreman has John Henry administer an IVIG, which ends up limiting the blood in his lungs, causing him to crash. Chase wants to intubate
Intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...
, but Foreman mentions the DNR. House intubates anyway.
House reasons that it was the IVIG that caused the reaction, not the disease. Foreman angrily points out that this was House's fault for suggesting the treatment. House is hit with a restraining order to stay away from John Henry. Criminal charges for battery
Battery (crime)
Battery is a criminal offense involving unlawful physical contact, distinct from assault which is the fear of such contact.In the United States, criminal battery, or simply battery, is the use of force against another, resulting in harmful or offensive contact...
will be filed. House presses on, ordering Cameron and Chase to consider other possibilities. Yet Foreman has called Dr. Hamilton, who is now flying in from Los Angeles.
In court, the hospital lawyer argues that House has the right to face his accuser. Since John Henry is on life support
Life support
Life support, in medicine is a broad term that applies to any therapy used to sustain a patient's life while they are critically ill or injured. There are many therapies and techniques that may be used by clinicians to achieve the goal of sustaining life...
, the trial will have to wait. Back at the hospital, Chase sees on the lung biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
that there is only inflammation. Since House cannot order more testing, he begins blind treatment. He suggests starting John Henry on cytoxan, which treats Wegener's disease. If House is right, John Henry will start walking again. If House is wrong, Cameron and Chase could lose their medical licenses.
House is about to administer the cytoxan when Dr. Hamilton arrives. Hamilton, who only calls House by his first name, says that he had initially checked for Wegener's. House reminds Hamilton of the error rate that occurs in those blood tests and biopsies. Hamilton wants to discontinue life support. House tells Wilson that if it is indeed Wegener's, John Henry's lungs will not be able to handle the stress and he will die. When he is removed from life support, John Henry starts to breathe on his own, so Wegener's was the wrong diagnosis.
With John Henry's arm now paralyzed, everybody but House is convinced he is stricken with ALS. The battery charges have been dropped, so House can treat John Henry once again. House visits the patient, who admits that since he cannot play the trumpet any more, he does not mind dying. House asks John Henry to just let him find out what is afflicting him. If he still wants to die, House will help make it quick and painless. The patient declines. House puts John Henry into an MRI.
Hamilton offers Foreman a job in Los Angeles that pays three times what he now makes and includes many other perks. When Foreman mentions the offer to Cameron and Chase, the latter claims that he does not work at his job for the money while Cameron says she does not hate House like Foreman does. Looking over John Henry's MRI, Cameron notices signs of a stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, which would explain the paralyzed arm. Foreman explains the options to John Henry. They can give him heparin
Heparin
Heparin , also known as unfractionated heparin, a highly sulfated glycosaminoglycan, is widely used as an injectable anticoagulant, and has the highest negative charge density of any known biological molecule...
to thin his blood and remove the clot, but it could hurt his lungs. Another option is brain surgery to remove the clot. The surgery will either result in his death, or a clearing of the blood clot. Not wanting to risk his lungs, John Henry opts for the surgery, because it offers him the chance at death without prolonged pain.
The surgery is a success. John Henry can move his arm following the embolectomy
Embolectomy
Embolectomy is the emergency surgical removal of emboli which are blocking blood circulation. It usually involves removal of thrombi , and is then referred to as thrombectomy. Embolectomy is an emergency procedure often as the last resort because permanent occlusion of a significant blood flow to...
and is able to feel House touching his leg. The doctors are baffled. Hamilton thinks his ALS treatments are the answer. House thinks they need to take John Henry off the dozen drugs they are giving him in order to restart the dosage one by one to see which is having the effect. If not, the toxicity of the useless drugs could kill him.
Hamilton asks House which medications are used to treat John Henry. House resists, but then realizes that Hamilton needs to know because the patient is worsening. He cannot feel his leg anymore. House prescribes steroids and a second MRI. Meanwhile, House and Foreman discuss their working relationship. House tells Foreman to take the new job if he thinks Hamilton is a better doctor.
The MRI results show that John Henry suffers from arteriovenous malformation
Arteriovenous malformation
Arteriovenous malformation or AVM is an abnormal connection between veins and arteries, usually congenital. This pathology is widely known because of its occurrence in the central nervous system, but can appear in any location. An arteriovenous malformation is a vascular anomaly. It is a...
. It was compressing his spine, which caused the paralysis. Foreman wonders how Hamilton could have missed something so simple. House points out that they all missed it too, so something must have been hiding it. It was the inflammation that they first saw on the lung biopsy. The steroids treated the inflammation and allowed the AVM to show on the MRI. After surgery to remove the AVM, John Henry walks out of the hospital with a simple cane, not a wheelchair (with House commenting that eventually John Henry won't even need the cane). John Henry then gives House his own trumpet, on the condition that House never plays it. As the two leave the Hospital, House tells Foreman that he will see him tomorrow, calling him by his first name "Eric", in mockery of Dr Hamilton's familiar style.
External links
- "DNR" at Fox.com