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Humpty Dumpty (House episode)
Encyclopedia
"Humpty Dumpty" is the third episode of the second season of House
, which premiered on the Fox
network on September 27, 2005. Dr. Lisa Cuddy's longtime handyman Alfredo falls off her roof, causing breathing problems.
is acting up. She asks him to finish the job. Alfredo falls off the roof onto the concrete. An ambulance races Cuddy and Alfredo to the hospital. He can't breathe, and Cuddy notices two of the fingers on his right hand have turned purple. At the hospital, the doctors try to figure out the cause of this. House suggests disseminated intravascular coagulopathy
. House asks his team for a cervical MRI and treatment for DIC.
Stacy tells Cuddy that, for legal reasons, she should stay away from Alfredo. Stacy is sure that Cuddy will feel guilty, apologize and offer to pay his bills which isn't what the hospital needs. Cuddy is concerned that Alfredo could lose his hand and then his livelihood. Alfredo demands to be released so he can go back to work. Chase notices that a third finger is turning purple. Cameron finds that Alfredo isn't clotting properly, which would mean minor DIC. House points out that if the hand is dying, it could move up the arm and further. Cuddy orders a stronger medicine—human activated protein C. The staff is shocked. House points out that this treatment is only for severe sepsis. It is incredibly dangerous and could cause internal bleeding, strokes and more. Cuddy tells them to do it anyway.
Wilson notes to House that he would've ordered protein C as well. Suddenly, Alfredo screams for help because he can't move his arm. Chase tells Cuddy that the protein C caused bleeding in Alfredo's brain. The treatment is stopped and Alfredo is rushed into neurosurgery. Cuddy observes the surgery. The surgery fixes the bleed. As Cameron examines him, Alfredo suffers from a coughing fit. A chest x-ray shows lung infiltration. His fingers become darker and he has a fever. Cuddy tries to connect this to Alfredo's falling off her roof. Foreman suggests pneumonia, and Cuddy admits that it is a possibility because Alfredo asked to leave the job. House asks Cuddy to check Alfredo's house to look for possible causes. House, Foreman, and Chase secretly investigate Cuddy's house as well since Alfredo has been there for the past three weeks.
Cuddy and Cameron find a rat killed by a trap under Alfredo's dresser. The scars on Alfredo's hand must be rat bites. He has streptobacillus, which fits the symptoms perfectly. In Cuddy's bathroom, House notices a fuzzy, black aspergillus fungus on the pipes underneath the sink. Looking at an x-ray, Cuddy agrees that fungal pneumonia
is more likely. Cameron points out that the treatment for aspergillosis
is amphotericin
, which is incredibly dangerous.
Stacy asks House to take it easy on Cuddy because she actually feels for patients. They're not just a puzzle to her. Meanwhile, Alfredo's little brother tells Cameron that Alfredo hasn't peed since yesterday afternoon. Cameron is concerned, and she immediately tells House that the amphotericin might have destroyed Alfredo's kidneys and that he may be dying. Alfredo's mother overhears this and begins crying.
The team reviews what they know. The cause is not aspergillus nor rat bite fever. Alfredo tested negative for moraxella, nocardia and cryptococcus. Chase mentions that Alfredo has a low titer for Chlamydia antibodies, but this is dismissed by Foreman because the chest X-ray
s don't match a Chlamydial pneumonia. Chase persists but Cameron says the titer is probably caused by a STD
Alfredo had last year. DIC wouldn't cause a fever this high. House takes Alfredo's temperature and sees that the patient's right hand is starting to rot. House wants to amputate
the hand but Cuddy refuses to let that happen. She blames it on the medicine they gave him. If Alfredo loses that hand, he loses his job. House comments that this isn't medical thinking. House tells Stacy that Cuddy now agrees to the amputation
and he begs for legal clearance. Cuddy tells Alfredo that it is necessary, and he tearfully agrees to the procedure.
During surgery, the fingers on the other hand start to turn purple. The team gathers afterward with the news that Alfredo's O2 stats are down to 88 and his lungs are giving out. House wonders about endocarditis
, which is an infected heart with little bacterial biofilm
s clinging to its valves. One may have broken off and traveled through the bloodstream to the right hand. Cuddy points out that they tested Alfredo for endocarditis and he was negative. House asks what infection causes pneumonia and culture-negative endocarditis.
House puts forward psittacosis
, but Chase mentions Alfredo doesn't have any pet parrots. House orders a round of doxycycline, which Cuddy notes will make the clotting problems even worse. Cameron points out that, if House is wrong, Alfredo will lose his hands and feet. House and Cuddy barge into Alfredo's room. House asks the mother, in perfect Spanish, where Alfredo usually works on Saturday night. She says that he doesn't work. House knows that she's lying. House realizes that Alfredo works the cockfight
s on Saturday night. Cuddy and Foreman head down to the warehouse district and find a cockfight
. They see Alfredo's brother carrying cages of dead birds. Cuddy calls House with the news. House says he put Alfredo on the psittacosis
meds as soon as she left. Cuddy later gives Alfredo the diagnosis and explains that his asthma had made him vulnerable to the disease, which is why he got it and not anyone else. It is then revealed that he and his family are suing the hospital for the loss of his hand.
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 September 27, 2005. Dr. Lisa Cuddy's longtime handyman Alfredo falls off her roof, causing breathing problems.
Plot
Alfredo, a construction worker at Dr. Cuddy's house, complains that his asthmaAsthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
is acting up. She asks him to finish the job. Alfredo falls off the roof onto the concrete. An ambulance races Cuddy and Alfredo to the hospital. He can't breathe, and Cuddy notices two of the fingers on his right hand have turned purple. At the hospital, the doctors try to figure out the cause of this. House suggests disseminated intravascular coagulopathy
Disseminated intravascular coagulation
Disseminated intravascular coagulation , also known as disseminated intravascular coagulopathy or consumptive coagulopathy, is a pathological activation of coagulation mechanisms that happens in response to a variety of diseases. DIC leads to the formation of small blood clots inside the blood...
. House asks his team for a cervical MRI and treatment for DIC.
Stacy tells Cuddy that, for legal reasons, she should stay away from Alfredo. Stacy is sure that Cuddy will feel guilty, apologize and offer to pay his bills which isn't what the hospital needs. Cuddy is concerned that Alfredo could lose his hand and then his livelihood. Alfredo demands to be released so he can go back to work. Chase notices that a third finger is turning purple. Cameron finds that Alfredo isn't clotting properly, which would mean minor DIC. House points out that if the hand is dying, it could move up the arm and further. Cuddy orders a stronger medicine—human activated protein C. The staff is shocked. House points out that this treatment is only for severe sepsis. It is incredibly dangerous and could cause internal bleeding, strokes and more. Cuddy tells them to do it anyway.
Wilson notes to House that he would've ordered protein C as well. Suddenly, Alfredo screams for help because he can't move his arm. Chase tells Cuddy that the protein C caused bleeding in Alfredo's brain. The treatment is stopped and Alfredo is rushed into neurosurgery. Cuddy observes the surgery. The surgery fixes the bleed. As Cameron examines him, Alfredo suffers from a coughing fit. A chest x-ray shows lung infiltration. His fingers become darker and he has a fever. Cuddy tries to connect this to Alfredo's falling off her roof. Foreman suggests pneumonia, and Cuddy admits that it is a possibility because Alfredo asked to leave the job. House asks Cuddy to check Alfredo's house to look for possible causes. House, Foreman, and Chase secretly investigate Cuddy's house as well since Alfredo has been there for the past three weeks.
Cuddy and Cameron find a rat killed by a trap under Alfredo's dresser. The scars on Alfredo's hand must be rat bites. He has streptobacillus, which fits the symptoms perfectly. In Cuddy's bathroom, House notices a fuzzy, black aspergillus fungus on the pipes underneath the sink. Looking at an x-ray, Cuddy agrees that fungal 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...
is more likely. Cameron points out that the treatment for aspergillosis
Aspergillosis
Aspergillosis is the name given to a wide variety of diseases caused by fungi of the genus Aspergillus. The most common forms are allergic bronchopulmonary aspergillosis, pulmonary aspergilloma and invasive aspergillosis. Most humans inhale Aspergillus spores every day...
is amphotericin
Amphotericin B
Amphotericin B is a polyene antifungal drug, often used intravenously for systemic fungal infections...
, which is incredibly dangerous.
Stacy asks House to take it easy on Cuddy because she actually feels for patients. They're not just a puzzle to her. Meanwhile, Alfredo's little brother tells Cameron that Alfredo hasn't peed since yesterday afternoon. Cameron is concerned, and she immediately tells House that the amphotericin might have destroyed Alfredo's kidneys and that he may be dying. Alfredo's mother overhears this and begins crying.
The team reviews what they know. The cause is not aspergillus nor rat bite fever. Alfredo tested negative for moraxella, nocardia and cryptococcus. Chase mentions that Alfredo has a low titer for Chlamydia antibodies, but this is dismissed by Foreman because the chest X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s don't match a Chlamydial pneumonia. Chase persists but Cameron says the titer is probably caused by a STD
Sexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
Alfredo had last year. DIC wouldn't cause a fever this high. House takes Alfredo's temperature and sees that the patient's right hand is starting to rot. House wants to amputate
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
the hand but Cuddy refuses to let that happen. She blames it on the medicine they gave him. If Alfredo loses that hand, he loses his job. House comments that this isn't medical thinking. House tells Stacy that Cuddy now agrees to the amputation
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
and he begs for legal clearance. Cuddy tells Alfredo that it is necessary, and he tearfully agrees to the procedure.
During surgery, the fingers on the other hand start to turn purple. The team gathers afterward with the news that Alfredo's O2 stats are down to 88 and his lungs are giving out. House wonders about endocarditis
Endocarditis
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices...
, which is an infected heart with little bacterial biofilm
Biofilm
A biofilm is an aggregate of microorganisms in which cells adhere to each other on a surface. These adherent cells are frequently embedded within a self-produced matrix of extracellular polymeric substance...
s clinging to its valves. One may have broken off and traveled through the bloodstream to the right hand. Cuddy points out that they tested Alfredo for endocarditis and he was negative. House asks what infection causes pneumonia and culture-negative endocarditis.
House puts forward psittacosis
Psittacosis
In medicine , psittacosis — also known as parrot disease, parrot fever, and ornithosis — is a zoonotic infectious disease caused by a bacterium called Chlamydophila psittaci and contracted from parrots, such as macaws, cockatiels and budgerigars, and pigeons, sparrows, ducks, hens, gulls and many...
, but Chase mentions Alfredo doesn't have any pet parrots. House orders a round of doxycycline, which Cuddy notes will make the clotting problems even worse. Cameron points out that, if House is wrong, Alfredo will lose his hands and feet. House and Cuddy barge into Alfredo's room. House asks the mother, in perfect Spanish, where Alfredo usually works on Saturday night. She says that he doesn't work. House knows that she's lying. House realizes that Alfredo works the cockfight
Cockfight
A cockfight is a blood sport between two roosters , held in a ring called a cockpit. Cockfighting is now illegal throughout all states in the United States, Brazil, Australia and in most of Europe. It is still legal in several U.S. territories....
s on Saturday night. Cuddy and Foreman head down to the warehouse district and find a cockfight
Cockfight
A cockfight is a blood sport between two roosters , held in a ring called a cockpit. Cockfighting is now illegal throughout all states in the United States, Brazil, Australia and in most of Europe. It is still legal in several U.S. territories....
. They see Alfredo's brother carrying cages of dead birds. Cuddy calls House with the news. House says he put Alfredo on the psittacosis
Psittacosis
In medicine , psittacosis — also known as parrot disease, parrot fever, and ornithosis — is a zoonotic infectious disease caused by a bacterium called Chlamydophila psittaci and contracted from parrots, such as macaws, cockatiels and budgerigars, and pigeons, sparrows, ducks, hens, gulls and many...
meds as soon as she left. Cuddy later gives Alfredo the diagnosis and explains that his asthma had made him vulnerable to the disease, which is why he got it and not anyone else. It is then revealed that he and his family are suing the hospital for the loss of his hand.
External links
- "Humpty Dumpty" at Fox.com