kidsnurse | House: 4.08 You Don't Want To Know--a few observations

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House: 4.08 You Don't Want To Know--a few observations

Interesting episode, which I'll sum up for myself by pointing out that if the PPTH staff would simply stop drinking coffee they'd all be a lot healthier....

Six years ago, my mother went to breakfast with a friend, who requested decaf coffee. Forty-five minutes later, she was on her way, via ambulance, to the hospital--where she spent two days in the ICU. Because she'd been given the wrong coffee. She was allergic to caffeine. Good thing 13 wasn't, right? Can you say involuntary manslaughter, House?

And 13, spiking the coffee of an opioid-dependent patient with more narcotics--without knowing how much he'd already ingested? Let's try repeating after me again--only it's your turn this time, 13. Involuntary. Manslaughter. And much easier to prove, too, as I do believe that 13 might just have a vague idea that House takes frequent doses of opioids. But maybe not, as she seems pretty clueless in the first-do-no-harm department anyway.

And... I won't even go into the sheer unlikelihood of anyone getting the wrong blood with all the current checks and re-checks in place. And I'll also leave alone the illogic behind House's experiment, except to say, one bag 'tainted'? okay. an entire lot tainted? Uh... no. Just... no. [And I'll just throw in here, for fun, that AB is the rarest blood type, and that the blood bank of a Level 3 trauma center is highly unlikely to just toss a bag of the precious stuff at anyone who doesn't demonstrate a medical need for the transfusion. Just sayin'.]

We all know that we'll never know how and why House knows Wilson's bloodtype. Because that would require someone besides the viewers to actually remember that the line was spoken. And if the writers can't remember Cuddy's several-episode-arc-of-desperation, mere months ago, to get pregnant, well then--it would be truly unreasonable of us to expect them to remember one 60-second scene, wouldn't it? [Even Lisa Edelstein questioned this apparent oversight about Cuddy's character in this November 20 TV Guide interview.]

What I don't know--and yes, it's been frustrating me for over a week--is how the writers of last week's Ugly got away with insisting that we had to find that 'target rash' for a definitive dx of Lyme Disease. Considering that the rash can disappear after just a few hours and that 50% or more of patients never get any rash at all, I'm wondering if the med consultants had gotten into the continuity monkeys' absinthe that week. [ more info on Lyme here]

And by the way? I'd figured out Huntington's chorea for 13 a mere eighteen minutes into the episode. And sometimes I wish I had no medical backround at all, and could buy all these informational errors they are so freely disseminating. [more info on Huntington's here]

[And by the way, again. I'm so proud of myself that I didn't even touch on the fact that following House's liver [and kidney and lung] biopsy, the inadvertent patient was not made to lie quietly on his right side for two hours. There are damned good reasons for this precaution. But i'm guessing that the immortal House is immune to all those scary little complications to which the rest of us are susceptible . I mean, a transfusion reaction, a large overdose of narcotics, three painful and potentially dangerous invasive procedures, and a short time later even Wilson's aware that Super!House is --and I quote--"about to run out of here...." Yup--real proud of myself that I haven't mentioned this wee disregard of medical reality! ;) ]

And... we need more Wilson.

*** edited to include even more ranting, and also a link to a great Lisa Edelstein interview, 11.21.07 at 5:00pm.

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And sometimes I wish I had no medical backround at all, and could buy all these informational errors they are so freely disseminating.
nope, doesn't work. These errors are so blatantly obvious anyone with a standard general knowledge can pick up on them. At least I do most of the time.

I really thought, leading up this ep, that they wouldn't go for Huntington's chorea because it's so well-known and is automatically tragic. Something less high profile like essential tremor could also end her career but wouldn't kill her. But no.

The throw-away diagnosis of lupus irked me to no end. It's not so easily treated as "let's give him steroids and boot him out the door." Not unless your medical consultants have lupus confused with a case of poison ivy. Jeeze . . .

*edited because I spell better when I've had at least 20 ounces of coffee*

Is it that well known?

I'd never heard of Huntington's, myself, until last night.

Anyway, after last night I really dislike 13. I can't judge her for the not-wanting-to-know thing, but I can and do hold it against her that she drugged House and then stabbed him.

The drugging in order to test him and make sure he wasn't going to die, I can sort-of forgive. The no-local-anesthesia liver biopsy, I cannot.

Interestingly, House apparently can forgive it. Another example of pretty girls making him stupid? Or is he just so screwed up that he figures he deserves the abuse?

Huntington's is rare, but--once you know someone with it, even if your acquaintance is through, say, a fictional character in a book, what you learn is so memorable, so distressing, so horrifying, that it sticks with you. forever.

and i didn't even touch on the fact that following the liver biopsy, the inadvertent patient was not made to lie quietly on his right side for two hours. there are damned good reasons for this precaution. but i'm guessing the immortal house is immune to all those scary little complications.....

here i go again. shutting up now.

Woody Guthrie, father of Arlo, had it. I remember seeing a documentary about him, years ago, and they showed some of the ravages of Huntington's.

As

kidsnurse says, it was horrifying.

Or is he just so screwed up that he figures he deserves the abuse?

I'm thinking it was just more sloppy writing. Last night's House was a pod-person.

Folksinger Woody Guthrie died of it, and his family was instrumental in spurring the research that led to the genetic testing. Before that, I don't think most people had heard of it.

I had major problems with them doping House and testing him against his will. And I don't think it's so much that Thirteen is making House stupid as maybe he thinks he deserves this, that he's "taking his own medicine" for what he's done. Still, it's bothering me a lot on many levels.

don't think it's so much that Thirteen is making House stupid as maybe he thinks he deserves this, that he's "taking his own medicine" for what he's done

i have the same thought. it appears that's his overriding attitude this season. i'm currently 'studying' that attitude, in a new fic. it makes me unutterably sad.

edited because 'overriding' is a word, and superfluous hyphens are just... superfluous!

Amen to the more Wilson, we all need more Wilson.

Hello Kidsnurse,

I'm not really bothered by medical approximations or even errors because I'm ready to buy anything the writers will throw at me : I know nothing at all about medical stuffs and besides, my english isn't that good that it would allow me to understand doctors talks ;-)

As for the rest : I want 13 to be fired. Seriously ! She drugged him and "biopsied" his liver without lidocaine ? What ?! As a revenge ? Besides, she bears an uncanny ressemblance to Cameron and as you know, I'm not a great fan of that kind of character.

I'm happy Big Love is gone, was not really funny, was he.

I didn't miss Cameron neither Chase although I like the latter in this season.

More Wilson, more Wilson, more Wilson, I AGREE !

Anyway, I liked this epi very much.

I wonder if we'll see, in this season, a new Nemesis for House. Or, will he be his own Nemesis ? Or will it be a "cheer-up" season, without any kind of personal drama for our fav doc...

Take care,
Pffff5

And sometimes I wish I had no medical background at all, and could buy all these informational errors they are so freely disseminating.

You poor thing! I wish you could enjoy the show as blithely as I do. But it is fascinating for non-medical types to read your analyses of the medical procedures afterwards. <3

i'm glad you enjoy my rants. sadly, what i point out isn't even the half of it, and the inaccuracy seems to be getting more consistent. i mean, i'm willing, and even eager, to overlook an occasional error, but it's been bothering me so much lately that i even felt compelled to go back and add more to this post, because i was still bugged.

i need a life.....

Rant away!!! It's entertaining *and* educational; what more could one ask from the internet?

Uhh you made me curious about the new epi. Yesterday in Germany the showed "One day, One room" but the translation of the epi-title scares me. Really I mean it scares me. The german translation-monkeys named the epi "Zwangsarbeit". This translation of the title sucks. Arrgh,
whatever I want to see the new epi and I always need more Wilson (okay, I need more time for the fandom-stuff too, but who cares?)

"Zwangsarbeit" ?!

Now, I've got limited German knowledge, but doesn't that mean slave labour?

Yes something like that. The translation in Germany really sucks. In that case they mean that House was comply by Cuddy to do clinic-duty I guess but that was just a not so important part of those epi. The important part was the abusing and the sense and the implications of the sentence "One Day, One Room" but it seems the translation-monkeys in Germany don´t saw the epi. Or maybe my lonly little stupid braincell wasn´t working as I saw the epi.

I have no medical background (yet), and even I was really appalled by the blatant inaccuracy of this ep. This show makes it seem that anything can happen, which while true, never actually happens.

And am I the only one who picked up on the fact that, other than the symptoms the patient presented with, he seemed to have no prior complications? More autoimmune diseases cause extra antibodies, right? Lupus cannot be the only answer (as it never was enough before.)

More autoimmune diseases cause extra antibodies, right?

well, yeah, but, ya know, we were at the end of the episode, and coming up with an accurate dx would've taken time, and maybe even a bit of effort, and, well, we wouldn't have wanted to ruin our thus-far-perfect record of medical inaccuracy, would we?

i'm shutting up now.......

Isn´t it sad that they give way to THE running gag in the show with such poor medical base...It occured to me while watching the show that something about the medical stuff was kind of squishy this time...and I don´t get everything because I´m german (btw...I hate the German translation-monkeys [thanks for this expression to chaoskir] too...They made the title "words and deeds" into "Dr. Cuddys biggest lie" wtf?)
Well, back to the medicine which I have not the slightest idea of...I rewatched the episode to actually get what this lupus thing is all about. And I didn´t get it, but hey, maybe it´s really just me.
Did I mention that I love the show anyway? Hugh Laurie could read from a phone book and I would watch it but ranting when we are accustomed to nearly flawlessly witty (can i use so many adverbs in a row? ;) writing is justifiable.

Wow, lots of ranting!

It's got to be difficult to watch a medical drama while having medical knowledge. This may be a weird comparison but I'm a skydiver and when I see skydiving portrayed on television I just snicker. It is so far from reality it's funny.

Now I know you probably get ticked off every time they do things like you've listed but just try to remember it's a TELEVISION SHOW and they have to take some liberties when putting together these episodes. I sure wouldn't want their jobs. Not that I'm saying they should disregard real life scenarios and ignore the factual based medicine but sometimes I feel it needs to be done for dramatic measure.

Oh, and everyone is ripping 13 for drugging House but didn't she actually ask Cole what drug he used since she assumed it was him? Or am I mistaken here. Maybe that was just a cover, I don't know. It's almost like she was covering up for someone else by taking the blame. Just my thoughts.

Yes, I agree with you that House seemed to recover awfully quick for everything that was thrown at him but then they have to cram so much into one 45 minute episode., he has to recover quickly to do his thing. One of my coworkers just had a breast biopsy done and was still pretty sore 2 days later.

Feel free to rant any time. I also have a question...I'm attempting to write a fic involving medical issues and was wondering if you'd be willing to answer a few questions if they should arise. I'm doing research on the internet but some procedures are hard to locate. If you can't, I totally understand.

Off to read your latest fic now..... Oh, and hope you had a nice Thanksgiving! I just got home from the relative's house.

About the biopsy and soreness: keep in mind that House, as far as we know, is still throwing down handfuls of vicodin.

That's a good point. It's easy to forget that he's always hopped up on an opioid based pain killer. Probably would take care of most pain.
I have noticed that they seemed to have backed off showing House popping pills every scene. Now it's limited to maybe once or twice an episode when we see him actually pop a pill.

easy to forget that he's always hopped up on

accck! no, he's not 'hopped up'--ever [unless he supplements with, say, lsd. or morphine] and yeah, here comes

kidsnurse, getting on her soapbox with yet another mini-lesson as regards chronic pain, and its treatment: the opioids [especially the milder ones, like Vicodin] are surprisingly ineffective for treatment of acute pain, especially when the patient is already opioid-dependent and has built up a tolerance over the years. so house's 'usual' doses of vicodin would have little to no effect upon the 'new', acute pain the candidates inflicted on the poor man.

even when people who are not chronic pain patients are given opioids for pain relief, say after surgery, they're normally first given stronger pain meds via the parenteral route while the post-op pain is still in the acute phase, before it settles into the chronic phase where it can more easily be controlled through the use of oral narcotics.

kidsnurse is shutting up now... we can all stop rolling our eyes! ;)

You're right. That was a poor use of words on my part. I, for one, feel House needs the Vicodin and I wasn't implying that he was high. I was trying to relay the point that he is under the influence of pain meds already and it may help alleviate some of the discomfort. Since I'm not in the medical field I'm unaware of how certain meds actually work for chronic and acute pain. All I know is what I've been given in the past from previous knee surgeries, notably Dilaudid and Vicodin(I hated the way I felt with this medication).

Please feel free to get on your soap box. Some of us are less educated in the field of pain relief.

I need to think ahead before posting sometimes. Oh, and I didn't roll my eyes either. I actually felt bad for my phrasing of House's drug usage.

oh, i figured you'd just 'phrased quickly,' as it were. but since the comment to which you responded was anonymous, and i couldn't respond to him/her directly.... and you know me... i can never resist a perceived chance to "educate," heaven help us all!!! ;)

i'll be glad to answer your questions, if i can. but i've gotta be honest--if i don't know it, and it can't be found via google, and i really, really need the info, i find myself up at U of F, in the med library--or i just alter my plot! [remind me to tell you how the plotline of an entire novel once transformed that way. hee!]

happy thanksgiving!

There were some really strange things that happened in this episode. The medicine was pretty awful and I have no knowledge of blood typing and crossing. I'm really trying to understand how one of House's employees feels comfortable dosing him, and then giving him a liver biopsy without his consent and without a local. I noticed that the newbies call him House instead of Dr. House.

The only scenes that I truly loved were the House/Wilson ones. But I really, really need a lot moar Wilson. I love the best friend of Wilson S4 House but the other S4 Houses I really don't enjoy. That's probably why I TiVo through everything but the H/W scenes on subsequent multiple rewatches. I really don't enjoy House running around PPTH as if he were a mental patient on the loose.

Cuddy stopped House from firing Taub but she uses House's challenge to try and get rid of Kutner and CTB. Why not just fire them and 13 for that matter. Or suspend House's hospital priveleges since Cuddy holds him responsible for 13's patient kill. Yes the medicine is bad but the central premise of a medical mystery show taking place at a large urban hospital also stretches credulity. Maybe, they're setting House up for a tightening of the reins like never before. I hope so because as it stands, reality seems to have taken a holiday.

I'm still holding out for that ketamine coma...

I think

kidsnurse already knows that about me. *nods* I think she, too, might hope. Because then it means that the insanity (from mid-last season to now) never happened! And as a future medical student, this crap bothers the hell out of me, too.

gahdzuks reminded me a couple of weeks ago that it's fiction. I KNOW. Still...it...bothers.

*edited twice because I can be coherent when I put in the effort...make that three times and me getting the sleep I richly need*

reminded me a couple of weeks ago that it's fiction

and--while i was watching You Don't Want To Know, and then while writing my own antidote to it, T5 (http://kidsnurse.livejournal.com/43010.html), i, too, kept reminding myself of that. and i discovered that--while i absolutely know, intellectually, that house is a fictional character, as are wilson and cuddy--emotionally, all three are terribly real to me. and that's... just the way it is.

while i absolutely know, intellectually, that house is a fictional character, as are wilson and cuddy--emotionally, all three are terribly real to me. and that's... just the way it is.

Glad to know I am not the only one who feels like this. It is very rare that this happens, I could probably only name two or three other shows that have aired (JAG, Tour of Duty, and Kingdom)where the characters are so well played that I become attached and pretty much think of them as real people, separate from the actors / actresses who play them.

I know exactly what you mean about wishing you didn't know these things sometimes. I mean you barely scratched the surface on the inaccuracies and errors of this episode, as I'm sure you know. They take such liberties.
I actually just watched the most recent ep. last night with my brother (a fourth year dental student), my mom (a pediatrician) and my dad (a dentist) and we all sat there laughing at all the inaccuracies and missteps. I think I might have guffawed when House ordered an MRI because they were thinking neoplasm. As soon as he jumped straight to MRI without a chest x-ray or CT, which are far better for visualizing that sort of thing, I knew the guy had to have the key still in him. But then, I do study in the school where the MRI was invented.
My younger brother, who's still in high school just wondered why we couldn't sit back and enjoy the show. Their complete disregard for medical accuracy is something I've chosen to mostly overlook because the show amuses me, but it definitely irritates me when I know just how many people watch it and think it demonstrates the reality of medicine.
I actually really wanted to write some crack!fic where House and Wilson watched an episode and pointed out and poked fun at all of the medical inaccuracies, but haven't had time yet. This week's episode would make great fodder, but then so would many many others.
Ah well, it is what it is, and at least it's entertaining. :)

I actually really wanted to write some crack!fic where House and Wilson watched an episode and pointed out and poked fun at all of the medical inaccuracies

oh--this sounds wonderful, and the perfect antidote to my own peevishness about the increasing medical inaccuracies in the show! please do!! please.... *is begging*

during the first couple of seasons, i was glad to overlook the occasional error [even the 1000mg benadryl dose house ingested] because it was so clear that the writers were trying to get it right. but it's becoming increasingly clear that they've ceased trying, at all. and that's having a negative effect on my patience, and on my tolerance for error. not that the writers care, but still.... :(

The one I have relinquished is sterile fields. I just know that they think being able to emote on screen is more important that accuracy; and thus, House will never have a mask on. I pretend that it is because he knows it has never been proven that surgical masks decrease infection rates, and he usually does wear gloves . . . only gloves (shakes head). But, I thought the sterile technique in this episode really was at an all time low.

it's a damned good thing, too, that we've made a conscious decision to relinquish the concept of the sterile field; else, by now, we'd be babbling incoherently in some decidedly nonsterile padded room somewhere! ;)

they messed up how you tell blood type as well.

if i'd listed all the medical errors in that episode--well, i'll put it this way; it'd take far less time and space to list what they did correctly.

sigh.....

Minor nitpick but AB is not the rarest blood type.

AB negative is the rarest blood type. AB positive is the second rarest.

huh? so... i'm looking for the nitpick here. yes; ab neg is rarest, and ab pos comes next. so how does that make the observation that ab [as a blood group] is the rarest blood type incorrect?

i'm confused.

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House: 4.08 You Don't Want To Know--a few observations

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