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Paternity (House)
Encyclopedia
"Paternity" is the second episode of the medical drama House
, which was first broadcast on November 23, 2004. A teenage boy is struck on the head in a lacrosse
game and is found to have hallucinations and night terrors that are not due to concussion.
but listens when he hears that one of the symptoms is night terrors. The patient, Dan (Scott Mechlowicz
), is a 16-year-old lacrosse
player who has been recently hit in the head in a game. House had first dismissed the symptoms as concussion and then suggests that the cause might be post-traumatic stress due to sexual abuse. But then he notices Dan's foot twitch with a myoclonic jerk which normally only occurs when falling asleep. He immediately admits Dan and starts diagnosis with his team.
House claims that Dan's father isn't his true biological father and makes a bet with Foreman about it. Soon after, Dan has another night terror. None of the tests show why the night terror occurred, but House finds a large blockage in one of Dan's brain ventricles. House and his team relieve the pressure as fast as they can, but they find that the blockage isn't what is causing the other symptoms. It is in fact a symptom itself.
During the night, Dan is found missing from his bed. Cameron, Chase
, and Foreman search frantically to find him, soon locating him on the roof, where he is hallucinating that he is on the lacrosse field. Chase tackles him just before he steps over the edge of the building. House is excited by this new development — it rules out House's previous diagnosis of multiple sclerosis
. The new diagnosis provided by Cameron is neurosyphilis
. To treat this, they inject penicillin
directly into Dan's brain
, but during an injection, Dan suffers an auditory hallucination
, which rules out this diagnosis. House is stumped by this new development, and admits his problems to Wilson. Dan's parents are angered to discover House having coffee with Wilson while their son is dying, but House rebukes them with his intimate knowledge of Dan's current condition. He tells them to go and support Dan, after which he takes their coffee cups to run DNA tests to decide his bet on Dan's paternity. The tests show that neither parent is biologically related to Dan (winning House his bet with Foreman, Wilson
and everyone else who wagered on Dan's paternity), and a new idea hits him. He remembers a baby he treated earlier whose mother did not want to vaccinate the child.
House thinks that infant Dan caught the basic measles
virus from his biological mother (who possibly had never been vaccinated) that had mutated, remained latent for 16 years, and reappeared in his brain. Avoiding a dangerous brain biopsy to confirm this unusual case, they biopsy Dan's retina to find the virus, confirming House's diagnosis of subacute sclerosing panencephalitis
. Dan recovers fully, and reveals that he already knew he was adopted, due to his cleft chin
(which neither parent has), but that he doesn't care and loves them. At the end of the episode, it becomes apparent that House must have played lacrosse sometime in his youth. He is shown at what appears to be Dan's lacrosse game but at the end is shown to be on his own when the camera reveals the field to be empty. He clutches his cane like a lacrosse stick, seemingly dreaming about days past.
The treatment for the final diagnosis was to inject interferon
into the brain. This treatment requires consent from the patient's parents. The story exaggerates the difficulty of explaining this treatment for dramatic effect but the problem of obtaining informed consent
in complex cases is a real one.
The medical advisor for this episode was Dr Lisa Sanders
.
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 was first broadcast on November 23, 2004. A teenage boy is struck on the head in a lacrosse
Lacrosse
Lacrosse is a team sport of Native American origin played using a small rubber ball and a long-handled stick called a crosse or lacrosse stick, mainly played in the United States and Canada. It is a contact sport which requires padding. The head of the lacrosse stick is strung with loose mesh...
game and is found to have hallucinations and night terrors that are not due to concussion.
Plot
When a clinic patient claims to have an appointment for his clinic session, House is skeptical of the letter which House himself apparently wrote to the family. House realizes that it was written by CameronAllison 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...
but listens when he hears that one of the symptoms is night terrors. The patient, Dan (Scott Mechlowicz
Scott Mechlowicz
Scott David Mechlowicz is an American actor. He began his professional acting career in 2003, working in commercials and television, and is best known for his lead roles in the films EuroTrip, Mean Creek, Peaceful Warrior, Gone, Undocumented, and Cat Run.- Early life :Mechlowicz was born in New...
), is a 16-year-old lacrosse
Lacrosse
Lacrosse is a team sport of Native American origin played using a small rubber ball and a long-handled stick called a crosse or lacrosse stick, mainly played in the United States and Canada. It is a contact sport which requires padding. The head of the lacrosse stick is strung with loose mesh...
player who has been recently hit in the head in a game. House had first dismissed the symptoms as concussion and then suggests that the cause might be post-traumatic stress due to sexual abuse. But then he notices Dan's foot twitch with a myoclonic jerk which normally only occurs when falling asleep. He immediately admits Dan and starts diagnosis with his team.
House claims that Dan's father isn't his true biological father and makes a bet with Foreman about it. Soon after, Dan has another night terror. None of the tests show why the night terror occurred, but House finds a large blockage in one of Dan's brain ventricles. House and his team relieve the pressure as fast as they can, but they find that the blockage isn't what is causing the other symptoms. It is in fact a symptom itself.
During the night, Dan is found missing from his bed. Cameron, 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...
, and Foreman search frantically to find him, soon locating him on the roof, where he is hallucinating that he is on the lacrosse field. Chase tackles him just before he steps over the edge of the building. House is excited by this new development — it rules out House's previous diagnosis of 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...
. The new diagnosis provided by Cameron is neurosyphilis
Neurosyphilis
Neurosyphilis is an infection of the brain or spinal cord caused by the bacterium Treponema pallidum. It usually occurs in people who have had untreated syphilis for many years, usually about 10 - 20 years after first infection.-Symptoms and signs:...
. To treat this, they inject penicillin
Penicillin
Penicillin is a group of antibiotics derived from Penicillium fungi. They include penicillin G, procaine penicillin, benzathine penicillin, and penicillin V....
directly into Dan's brain
Lumbar puncture
A lumbar puncture is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid for biochemical, microbiological, and cytological analysis, or very rarely as a treatment to relieve increased intracranial pressure.-Indications:The...
, but during an injection, Dan suffers an auditory hallucination
Auditory hallucination
An auditory hallucination, or paracusia, is a form of hallucination that involves perceiving sounds without auditory stimulus. A common form involves hearing one or more talking voices...
, which rules out this diagnosis. House is stumped by this new development, and admits his problems to Wilson. Dan's parents are angered to discover House having coffee with Wilson while their son is dying, but House rebukes them with his intimate knowledge of Dan's current condition. He tells them to go and support Dan, after which he takes their coffee cups to run DNA tests to decide his bet on Dan's paternity. The tests show that neither parent is biologically related to Dan (winning House his bet with Foreman, 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,...
and everyone else who wagered on Dan's paternity), and a new idea hits him. He remembers a baby he treated earlier whose mother did not want to vaccinate the child.
House thinks that infant Dan caught the basic measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
virus from his biological mother (who possibly had never been vaccinated) that had mutated, remained latent for 16 years, and reappeared in his brain. Avoiding a dangerous brain biopsy to confirm this unusual case, they biopsy Dan's retina to find the virus, confirming House's diagnosis of subacute sclerosing panencephalitis
Subacute sclerosing panencephalitis
Subacute sclerosing panencephalitis is a rare chronic, progressive encephalitis that affects primarily children and young adults, caused by a persistent infection of immune resistant measles virus . No cure for SSPE exists, but the condition can be managed by medication if treatment is started at...
. Dan recovers fully, and reveals that he already knew he was adopted, due to his cleft chin
Cleft chin
The terms cleft chin, chin cleft, butt chin, superhero chin, dimple chin, or a chin dimple refer to a dimple on the chin. It is a Y-shaped fissure on the chin with an underlying bony peculiarity...
(which neither parent has), but that he doesn't care and loves them. At the end of the episode, it becomes apparent that House must have played lacrosse sometime in his youth. He is shown at what appears to be Dan's lacrosse game but at the end is shown to be on his own when the camera reveals the field to be empty. He clutches his cane like a lacrosse stick, seemingly dreaming about days past.
Medical aspects
The sequence of tentative diagnoses in this case was:- Sexual abuseSexual abuseSexual abuse, also referred to as molestation, is the forcing of undesired sexual behavior by one person upon another. When that force is immediate, of short duration, or infrequent, it is called sexual assault. The offender is referred to as a sexual abuser or molester...
- Concussion
- Degenerative diseaseDegenerative diseaseA degenerative disease, also called neurodegenerative disease, is a disease in which the function or structure of the affected tissues or organs will progressively deteriorate over time, whether due to normal bodily wear or lifestyle choices such as exercise or eating habits...
- HydrocephalusHydrocephalusHydrocephalus , also known as "water in the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head,...
- Multiple sclerosisMultiple sclerosisMultiple 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...
- NeurosyphilisNeurosyphilisNeurosyphilis is an infection of the brain or spinal cord caused by the bacterium Treponema pallidum. It usually occurs in people who have had untreated syphilis for many years, usually about 10 - 20 years after first infection.-Symptoms and signs:...
- Subacute sclerosing panencephalitisSubacute sclerosing panencephalitisSubacute sclerosing panencephalitis is a rare chronic, progressive encephalitis that affects primarily children and young adults, caused by a persistent infection of immune resistant measles virus . No cure for SSPE exists, but the condition can be managed by medication if treatment is started at...
The treatment for the final diagnosis was to inject interferon
Interferon
Interferons are proteins made and released by host cells in response to the presence of pathogens—such as viruses, bacteria, or parasites—or tumor cells. They allow communication between cells to trigger the protective defenses of the immune system that eradicate pathogens or tumors.IFNs belong to...
into the brain. This treatment requires consent from the patient's parents. The story exaggerates the difficulty of explaining this treatment for dramatic effect but the problem of obtaining informed consent
Informed consent
Informed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...
in complex cases is a real one.
The medical advisor for this episode was Dr Lisa Sanders
Lisa Sanders
Lisa Sanders is an American physician, medical author and journalist.She is a graduate of the College of William & Mary and is part of the Department of Internal Medicine, Yale University School of Medicine....
.
Recurring themes
The theme that "everybody lies" appears here in the question of the patient's paternity. The parents had lied to him in not telling him that he was adopted and do not admit this to House either.External links
- "Paternity" at Fox.com