Big Baby (House)
Encyclopedia
"Big Baby" is the thirteenth episode of the fifth season of House
and the ninety-ninth episode overall. It aired on January 26, 2009.
. After this, ITP (idiopathic thrombocytopenic purpura
) and lymphoma are considered. House
orders the team to start Sarah on methotrexate
for the ITP and also wants to give her total body irradiation (which is not a standard treatment for ITP).
Cameron
has been hired by Cuddy
as a temporary replacement so that Cuddy can spend more time with her new baby Rachel. One of Cameron's newfound duties is keeping House in line. This is why House supposedly wants to irradiate his patient - he has no intention of actually doing so; rather, he simply wants to test Cameron's limits. Cameron allows House to perform the procedure, even though it is not necessary. Also, the methotrexate is not working. House therefore has his team double the dose and add prednisone
, as well as fake the radiation treatment, putting Sarah in the room but not actually irradiating her. While she is being "irradiated", she needs to urinate. When she gets up, she collapses. Thirteen
and Taub
discover that she has no pulse and defibrillate her.
Meanwhile, Wilson
visits Cuddy. Cuddy reveals that she is having trouble bonding with Rachel. Wilson tells her to just give it time. Also, Foreman
is troubled by his discovery that Thirteen is on a placebo
, and consults with Chase
about surreptitiously switching her to the real thing. Chase tells him that this is unwise. Foreman also goes to Cameron, who suggests likewise.
The team meets to discuss Sarah's new symptoms. Tests revealed no structural heart defects, and after some deliberations the possibility of cold agglutinin disease is raised. House wants to give the patient an ice bath to confirm, and goes to Cameron again. Cuddy stops by at the hospital. She has found out about Cameron's permissiveness with House and admonishes her. House barges in while the two are talking. He brings up Cuddy's bonding problem (of which Wilson told him), and suggests giving Rachel up. Cuddy leaves, and Cameron tells House to perform a test on a sample of the blood before trying the cold bath. The blood clots when exposed to cold, but when the patient is put in the cold bath, her vital signs remain normal.
While she is in the cold bath, Sarah recounts a story about how she became a special needs teacher. Six years ago, she transposed a room number and went to the wrong class. House decides that this is a sign of a left hippocampal lesion due to multiple sclerosis
and wants a brain biopsy, but the team is skeptical. Kutner
suspects a pancreatic tumor and wants to perform an ERCP (endoscopic retrograde cholangiopancreatography
). Both go to Cameron, who sides with House but orders him to scan the patient's brain first. The MRI is normal, but when Kutner performs the ERCP, Sarah begins to have trouble breathing - she has pleural effusions
. House now suspects equine encephalitis
and tries to get approval for a nerve conduction test (which requires cutting off the top of Sarah's skull). He goes to Cameron again, who stands up to House and denies the procedure. Thirteen and Foreman go to the school to look for any sign of equine encephalitis but find nothing. Thirteen expresses her interest in being a mother, despite her Huntington's.
Wilson again visits Cuddy's house, with a picture frame of what Rachel will roughly look like in 18 years (which he later reveals to be just a generic picture that "came with the frame"). He tries to convince her that, right now, Rachel is only a baby who is not able to interact with Cuddy in the way she expected, but in time she will. However, Cuddy seems unconvinced.
After this, House goes to Cameron again, and pressures her into letting him run the nerve conduction study (and she even assists in the procedure). A skeptical Kutner (who believes it is lymphoma
in the spleen
and wants a splenectomy) calls Cuddy and puts her on speakerphone in the middle of the procedure. Cuddy talks to House and the team while simultaneously dealing with her crying baby. Sarah reveals that she is becoming annoyed by the crying, but her blood pressure falls significantly, instead of rising as expected, and the test is ended. The annoyance intrigues House, however, as it seems that Sarah is normally very tolerant of annoyance. While the procedure is ongoing, a desperate Cuddy pleads with Rachel to stop crying, promising to give her anything she wants to make her happy. Rachel stops crying, and Cuddy finally feels a bond. Also, Foreman, having asked everyone else he knows, goes to House about switching Thirteen's drugs. House tells him that rationally it is not worth it, but also reminds Foreman that love makes people do stupid things.
House is stumped by Sarah's annoyance and spends some time pondering it. Cuddy stops in his office with Rachel. She lets House hold Rachel, who throws up on House's shirt, which causes him to rant about the development and evolution of man. Suddenly, House realizes what is wrong with Sarah: a patent ductus arteriosus
(PDA). The ductus arteriosus allows blood to bypass the lungs while developing (since there is no air and the lungs are filled with fluid). When the infant is born, it normally closes, but Sarah's opens during periods of stress, draining oxygenated blood back into her veins. This means that her brain does not get normal oxygenated blood levels, resulting in the observed neurological symptoms and the blood pressure drop during the nerve test. It also disrupts normal pulmonary blood flow resulting in the pleural effusions and causes excessive turbulence in the bloodstream causing the damaged platelets.
In the end, the PDA is fixed and all appears well with Sarah. One of her special needs students comes to see her, spilling juice on her, but she doesn't seem bothered by it. Meanwhile, at Cuddy's house, Cameron decides to quit, saying that she will always say "yes" to House due to their relationship, and that any other person would always say "no" - Cuddy is the only one that can do the job. Finally, Foreman decides to risk his medical career for Thirteen's sake and switches her from the placebo to the real drug, while Cuddy is shown rushing to work again, leaving Rachel at home with a caregiver (but not before giving her baby a kiss). As Cuddy walks toward the door, the baby suddenly starts crying again. Cuddy pauses a moment with the strain of separation showing in her face, but then continues without looking back.
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...
and the ninety-ninth episode overall. It aired on January 26, 2009.
Plot
Sarah, a 29-year-old special needs teacher, is working in her class when she coughs up blood and collapses. The team initially suspects a problem with her blood and orders a bleeding time test, which shows a clotting problem later shown to be abnormal plateletsPlatelet
Platelets, or thrombocytes , are small,irregularly shaped clear cell fragments , 2–3 µm in diameter, which are derived from fragmentation of precursor megakaryocytes. The average lifespan of a platelet is normally just 5 to 9 days...
. After this, ITP (idiopathic thrombocytopenic purpura
Idiopathic thrombocytopenic purpura
Idiopathic thrombocytopenic purpura is the condition of having an abnormally low platelet count of no known cause . As most incidents of ITP appear to be related to the production of antibodies against platelets, immune thrombocytopenic purpura or immune thrombocytopenia are terms also used to...
) and lymphoma are considered. House
Gregory House
Gregory House, M.D., or simply referred to as House, is a fictional antihero and title character of the American television series House, played by Hugh Laurie. He is the Chief of Diagnostic Medicine at the fictional Princeton-Plainsboro Teaching Hospital, where he leads a team of diagnosticians...
orders the team to start Sarah on methotrexate
Methotrexate
Methotrexate , abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, ectopic pregnancy, and for the induction of medical abortions. It acts by inhibiting the metabolism of folic acid. Methotrexate...
for the ITP and also wants to give her total body irradiation (which is not a standard treatment for ITP).
Cameron
Allison Cameron (House)
Allison Cameron, M.D., is a fictional character on the Fox medical drama House, portrayed by American actress Jennifer Morrison. An immunologist, Cameron was a member of Dr...
has been hired by Cuddy
Lisa Cuddy
Dr. Lisa Cuddy, M.D., is a fictional character on the Fox medical drama House. She is portrayed by Lisa Edelstein. Cuddy was the Dean of Medicine and hospital administrator of the fictional Princeton-Plainsboro Teaching Hospital in New Jersey. She also becomes House's love interest through the...
as a temporary replacement so that Cuddy can spend more time with her new baby Rachel. One of Cameron's newfound duties is keeping House in line. This is why House supposedly wants to irradiate his patient - he has no intention of actually doing so; rather, he simply wants to test Cameron's limits. Cameron allows House to perform the procedure, even though it is not necessary. Also, the methotrexate is not working. House therefore has his team double the dose and add prednisone
Prednisone
Prednisone is a synthetic corticosteroid drug that is particularly effective as an immunosuppressant drug. It is used to treat certain inflammatory diseases and some types of cancer, but has significant adverse effects...
, as well as fake the radiation treatment, putting Sarah in the room but not actually irradiating her. While she is being "irradiated", she needs to urinate. When she gets up, she collapses. Thirteen
Thirteen (House)
Remy "Thirteen" Hadley, M.D., is a fictional character on the Fox medical drama House, portrayed by Olivia Wilde. She is part of the new diagnostic team assembled by Dr. Gregory House after the disbanding of his previous team in the third season finale...
and Taub
Chris Taub
Christopher Michael "Chris" Taub, M.D., is a fictional character on the Fox medical drama House. He is portrayed by Peter Jacobson. He becomes a member of House's new diagnostic team in the Season 4 episode titled "Games".-Professional life:...
discover that she has no pulse and defibrillate her.
Meanwhile, Wilson
James Wilson (House)
James Evan Wilson, M.D., is a fictional character on the Fox medical drama House. He is played by Robert Sean Leonard. The character first appears in the show's pilot episode when he introduces a medical case to Dr. Gregory House, the protagonist of the show. Wilson is Dr. House's only true friend,...
visits Cuddy. Cuddy reveals that she is having trouble bonding with Rachel. Wilson tells her to just give it time. Also, Foreman
Eric Foreman
Eric Foreman, M.D., is a fictional character on the Fox medical drama House. He is portrayed by Omar Epps.-Background:A neurologist, Foreman was a member of Dr. Gregory House's handpicked team of specialists at Princeton-Plainsboro Teaching Hospital's Diagnostic Medicine Department...
is troubled by his discovery that Thirteen is on a placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...
, and consults with Chase
Robert Chase
Dr. Robert Chase is a fictional character on the Fox medical drama House. He is portrayed by Jesse Spencer. His character was a part of the team of diagnosticians who worked under Gregory House until the end of the third season when House fires him. However, he was then re-hired in season 6...
about surreptitiously switching her to the real thing. Chase tells him that this is unwise. Foreman also goes to Cameron, who suggests likewise.
The team meets to discuss Sarah's new symptoms. Tests revealed no structural heart defects, and after some deliberations the possibility of cold agglutinin disease is raised. House wants to give the patient an ice bath to confirm, and goes to Cameron again. Cuddy stops by at the hospital. She has found out about Cameron's permissiveness with House and admonishes her. House barges in while the two are talking. He brings up Cuddy's bonding problem (of which Wilson told him), and suggests giving Rachel up. Cuddy leaves, and Cameron tells House to perform a test on a sample of the blood before trying the cold bath. The blood clots when exposed to cold, but when the patient is put in the cold bath, her vital signs remain normal.
While she is in the cold bath, Sarah recounts a story about how she became a special needs teacher. Six years ago, she transposed a room number and went to the wrong class. House decides that this is a sign of a left hippocampal lesion due to multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
and wants a brain biopsy, but the team is skeptical. Kutner
Lawrence Kutner (House)
Lawrence Kutner M.D. is a fictional character on the Fox medical drama House. He is played by Kal Penn. He becomes a member of House's new diagnostic team in "Games", the ninth episode of the fourth season...
suspects a pancreatic tumor and wants to perform an ERCP (endoscopic retrograde cholangiopancreatography
Endoscopic retrograde cholangiopancreatography
Endoscopic retrograde cholangiopancreatography is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems...
). Both go to Cameron, who sides with House but orders him to scan the patient's brain first. The MRI is normal, but when Kutner performs the ERCP, Sarah begins to have trouble breathing - she has pleural effusions
Pleural effusion
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...
. House now suspects equine encephalitis
Equine Encephalitis
Equine encephalitis may be caused by several viruses:* Eastern equine encephalitis virus* Western equine encephalitis virus*West Nile virus* Venezuelan equine encephalitis virus...
and tries to get approval for a nerve conduction test (which requires cutting off the top of Sarah's skull). He goes to Cameron again, who stands up to House and denies the procedure. Thirteen and Foreman go to the school to look for any sign of equine encephalitis but find nothing. Thirteen expresses her interest in being a mother, despite her Huntington's.
Wilson again visits Cuddy's house, with a picture frame of what Rachel will roughly look like in 18 years (which he later reveals to be just a generic picture that "came with the frame"). He tries to convince her that, right now, Rachel is only a baby who is not able to interact with Cuddy in the way she expected, but in time she will. However, Cuddy seems unconvinced.
After this, House goes to Cameron again, and pressures her into letting him run the nerve conduction study (and she even assists in the procedure). A skeptical Kutner (who believes 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...
in the spleen
Spleen
The spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...
and wants a splenectomy) calls Cuddy and puts her on speakerphone in the middle of the procedure. Cuddy talks to House and the team while simultaneously dealing with her crying baby. Sarah reveals that she is becoming annoyed by the crying, but her blood pressure falls significantly, instead of rising as expected, and the test is ended. The annoyance intrigues House, however, as it seems that Sarah is normally very tolerant of annoyance. While the procedure is ongoing, a desperate Cuddy pleads with Rachel to stop crying, promising to give her anything she wants to make her happy. Rachel stops crying, and Cuddy finally feels a bond. Also, Foreman, having asked everyone else he knows, goes to House about switching Thirteen's drugs. House tells him that rationally it is not worth it, but also reminds Foreman that love makes people do stupid things.
House is stumped by Sarah's annoyance and spends some time pondering it. Cuddy stops in his office with Rachel. She lets House hold Rachel, who throws up on House's shirt, which causes him to rant about the development and evolution of man. Suddenly, House realizes what is wrong with Sarah: a patent ductus arteriosus
Patent ductus arteriosus
Patent ductus arteriosus is a congenital disorder in the heart wherein a neonate's ductus arteriosus fails to close after birth. Early symptoms are uncommon, but in the first year of life include increased work of breathing and poor weight gain...
(PDA). The ductus arteriosus allows blood to bypass the lungs while developing (since there is no air and the lungs are filled with fluid). When the infant is born, it normally closes, but Sarah's opens during periods of stress, draining oxygenated blood back into her veins. This means that her brain does not get normal oxygenated blood levels, resulting in the observed neurological symptoms and the blood pressure drop during the nerve test. It also disrupts normal pulmonary blood flow resulting in the pleural effusions and causes excessive turbulence in the bloodstream causing the damaged platelets.
In the end, the PDA is fixed and all appears well with Sarah. One of her special needs students comes to see her, spilling juice on her, but she doesn't seem bothered by it. Meanwhile, at Cuddy's house, Cameron decides to quit, saying that she will always say "yes" to House due to their relationship, and that any other person would always say "no" - Cuddy is the only one that can do the job. Finally, Foreman decides to risk his medical career for Thirteen's sake and switches her from the placebo to the real drug, while Cuddy is shown rushing to work again, leaving Rachel at home with a caregiver (but not before giving her baby a kiss). As Cuddy walks toward the door, the baby suddenly starts crying again. Cuddy pauses a moment with the strain of separation showing in her face, but then continues without looking back.