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All In (House)
Encyclopedia
"All In" is the seventeenth episode of the second season of House
, which premiered on the Fox
network on April 11, 2006.
when Cuddy receives the news about her new patient. She dismisses it as dehydration
and gastroenteritis
, but House, recognizing the symptoms and thinking this could be more than what she suggested, decides to drop out of the game (folding a pair of Aces to Cuddy's bluff) and take the case behind her back.
With his suspicion, House tests Ian's coordination by asking him to reach out and grab his cane, which takes Ian multiple grasps until he actually touches the cane. House concludes Ian has ataxia
and begins to assume Ian has the same disease as a former patient from 12 years ago, 73-year old Esther Doyle, who died under House's care and was never correctly diagnosed. House then drags Cameron, Foreman, and Chase out of the party to perform a differential diagnosis. Drawing up a list of all of Esther's symptoms, House is able to predict what will happen to Ian next, as well as how long it will take him to get there.
House first suspects it is Erdheim-Chester disease
and orders a colonoscopy
, but tests are negative. House, knowing the next symptom that will develop is kidney damage, orders a kidney biopsy
, which turns out to be negative. The rest of the team, annoyed, tell House that all Ian has is a stomachache due to some bad food. But after discovering Ian's urine catheter
bag full of brown urine, they realize that Ian's kidneys are indeed failing and that they are already far too damaged to be saved. The team is forced to do another differential diagnosis, however many of the diseases proposed, House already tested for 12 years ago.
Next the team postulates it is lymphoma
and tries more tests. To keep Cuddy busy and off the case, House calls Wilson and has him stall her in the poker game. However, tests are negative for lymphoma. Unable to determine what disease afflicts the two people, House orders immediate treatment to protect Ian's liver, which was the next symptom Esther developed. His plan succeeds and Ian does not develop liver damage, but instead skips the next two symptoms and goes into respiratory distress
.
Thinking it could be cancer, House includes Wilson in the differential. Wilson suggests Kawasaki disease
, but before the team begins tests, they discover a mass in his heart. Postulating that Ian, being younger than Esther, has a stronger immune system and can last longer while under assault from this unknown disease, House orders a heart biopsy on Ian. Wilson, recognizing House's ongoing grapple with Esther's case, warns him not to become obsessed, using Moby Dick as an allusion.
During the biopsy, as House collects the sample from Ian's heart, the catheter induces cardiac arrest
in Ian, prompting an enraged Cuddy to pull House off the case and ban him and his team from performing any more tests on Ian. However, House refuses to give up, stating that they still have the mass obtained from the biopsy and can perform the tests on that.
The team suggests seven likely diseases, but only has enough tumor mass to perform three tests. First the team tests for Histiocytosis
, but it is negative. Next they test for Tuberous sclerosis
but that is negative also. Desperate and with only one remaining test, House wanders the hospital trying to think of his next move, when he hears from Wilson that he won the poker tournament. Wilson won only because he had kept his hole cards, two aces, hidden the entire game, prompting House to have an epiphany. He realizes that the disease also remained a secret until the end because they biopsied the colon
before the disease had reached the Gastrointestinal tract
.
House then orders his team to perform the final test on the first disease suggested: Erdheim-Chester disease
. In dismay, the team pleads, telling him they can't waste their sample on a test for a disease they know he's negative for. House explains his reasoning about the disease not reaching the GI tract and orders the test anyway. The once-skeptical team is pleased when the test turns out positive, Ian is saved, and House finally discovers what killed Esther. The episode ends with House and Wilson playing poker and joking as they did in the beginning of the episode.
Hugh Laurie (House) plays a rendition of the song Hymn to Freedom on the piano near the end of the episode.
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 April 11, 2006.
Plot
During a field trip in a museum exhibit about the human body, 6-year old Ian Alston is found to have bloody diarrhea. Meanwhile, at charity Casino Night at Princeton-Plainsboro, House, Wilson, and Cuddy are engaged in a game of Texas hold-em pokerPoker
Poker is a family of card games that share betting rules and usually hand rankings. Poker games differ in how the cards are dealt, how hands may be formed, whether the high or low hand wins the pot in a showdown , limits on bet sizes, and how many rounds of betting are allowed.In most modern poker...
when Cuddy receives the news about her new patient. She dismisses it as dehydration
Dehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
and gastroenteritis
Gastroenteritis
Gastroenteritis is marked by severe inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in acute diarrhea and vomiting. It can be transferred by contact with contaminated food and water...
, but House, recognizing the symptoms and thinking this could be more than what she suggested, decides to drop out of the game (folding a pair of Aces to Cuddy's bluff) and take the case behind her back.
With his suspicion, House tests Ian's coordination by asking him to reach out and grab his cane, which takes Ian multiple grasps until he actually touches the cane. House concludes Ian has ataxia
Ataxia
Ataxia is a neurological sign and symptom that consists of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum...
and begins to assume Ian has the same disease as a former patient from 12 years ago, 73-year old Esther Doyle, who died under House's care and was never correctly diagnosed. House then drags Cameron, Foreman, and Chase out of the party to perform a differential diagnosis. Drawing up a list of all of Esther's symptoms, House is able to predict what will happen to Ian next, as well as how long it will take him to get there.
House first suspects it is Erdheim-Chester disease
Erdheim-Chester disease
Erdheim–Chester disease is a rare disease characterized by the abnormal multiplication of a specific type of white blood cells called histiocytes, or tissue macrophages . Usually, onset is in middle age...
and orders a colonoscopy
Colonoscopy
Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected...
, but tests are negative. House, knowing the next symptom that will develop is kidney damage, orders a kidney 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...
, which turns out to be negative. The rest of the team, annoyed, tell House that all Ian has is a stomachache due to some bad food. But after discovering Ian's urine catheter
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
bag full of brown urine, they realize that Ian's kidneys are indeed failing and that they are already far too damaged to be saved. The team is forced to do another differential diagnosis, however many of the diseases proposed, House already tested for 12 years ago.
Next the team postulates it is lymphoma
Lymphoma
Lymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
and tries more tests. To keep Cuddy busy and off the case, House calls Wilson and has him stall her in the poker game. However, tests are negative for lymphoma. Unable to determine what disease afflicts the two people, House orders immediate treatment to protect Ian's liver, which was the next symptom Esther developed. His plan succeeds and Ian does not develop liver damage, but instead skips the next two symptoms and goes into respiratory distress
Respiratory distress
Respiratory distress may refer to either/both:* Labored breathing, the physical presentation of respiratory distress*Shortness of breath or dyspnea - a sensation of respiratory distress-See also:*List of terms of lung size and activity...
.
Thinking it could be cancer, House includes Wilson in the differential. Wilson suggests Kawasaki disease
Kawasaki disease
Kawasaki disease , also known as Kawasaki syndrome, lymph node syndrome and mucocutaneous lymph node syndrome, is an autoimmune disease in which the medium-sized blood vessels throughout the body become inflamed. It is largely seen in children under five years of age...
, but before the team begins tests, they discover a mass in his heart. Postulating that Ian, being younger than Esther, has a stronger immune system and can last longer while under assault from this unknown disease, House orders a heart biopsy on Ian. Wilson, recognizing House's ongoing grapple with Esther's case, warns him not to become obsessed, using Moby Dick as an allusion.
During the biopsy, as House collects the sample from Ian's heart, the catheter induces cardiac arrest
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...
in Ian, prompting an enraged Cuddy to pull House off the case and ban him and his team from performing any more tests on Ian. However, House refuses to give up, stating that they still have the mass obtained from the biopsy and can perform the tests on that.
The team suggests seven likely diseases, but only has enough tumor mass to perform three tests. First the team tests for Histiocytosis
Histiocytosis
In medicine, histiocytosis refers to an excessive number of histiocytes, , and is typically used to refer to a group of rare diseases which share this as a characteristic...
, but it is negative. Next they test for Tuberous sclerosis
Tuberous sclerosis
Tuberous sclerosis or tuberous sclerosis complex is a rare multi-system genetic disease that causes non-malignant tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin. A combination of symptoms may include seizures, developmental delay, behavioral...
but that is negative also. Desperate and with only one remaining test, House wanders the hospital trying to think of his next move, when he hears from Wilson that he won the poker tournament. Wilson won only because he had kept his hole cards, two aces, hidden the entire game, prompting House to have an epiphany. He realizes that the disease also remained a secret until the end because they biopsied the colon
Colon (anatomy)
The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
before the disease had reached the Gastrointestinal tract
Gastrointestinal tract
The human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. ....
.
House then orders his team to perform the final test on the first disease suggested: Erdheim-Chester disease
Erdheim-Chester disease
Erdheim–Chester disease is a rare disease characterized by the abnormal multiplication of a specific type of white blood cells called histiocytes, or tissue macrophages . Usually, onset is in middle age...
. In dismay, the team pleads, telling him they can't waste their sample on a test for a disease they know he's negative for. House explains his reasoning about the disease not reaching the GI tract and orders the test anyway. The once-skeptical team is pleased when the test turns out positive, Ian is saved, and House finally discovers what killed Esther. The episode ends with House and Wilson playing poker and joking as they did in the beginning of the episode.
Hugh Laurie (House) plays a rendition of the song Hymn to Freedom on the piano near the end of the episode.
External links
- "All In" at Fox.com