S8E14: Love is Blind

This is a preserved copy of "Love is Blind", originally published at politedissent.com. Wayback capture: 2012-06-18. Original URL: http://politedissent.com/archives/8788.

A soap opera and pathos heavy episode of House

⚠️ Spoiler warning — plot details for this episode follow.

Will is young man with diabetes who has been blind since birth. While trying to cross the street one day, he is overcome by the suddenly extremely loud sounds of the city and is admitted to Princeton Plainsboro hospital for evaluation. House initially suggests that Will must be hyperglycemic and hyperosmotic (too much sugar in the blood, and the blood is too concentrated, a severe complication of diabetes), but the lab studies don’t bear that out. The team suggests drug abuse, schizophrenia, or seizures. House favors the latter and orders an EEG. The study is normal and no seizures are seen, except that Will starts choking in the middle of the test — somehow three of his teeth came loose and he aspirated them. The differential diagnosis now includes heavy metal poisoning, radiation exposure, poisoning, or an infection caused by periodontitis. He is started on antibiotics for the likely infection.

Though he has been stared on the medication, Will doesn’t improve and he suffers a seizure. The new differential diagnosis still contains epilepsy and periodontitis as possibilities, but now drug use has been added — primarily because Park accidentally ingested some LSD when she scored a few snacks while searching the patient’s apartment. Will admits that he did try some LSD a few times because he thought it might let him “see.” An MRI of the brain is ordered and a suspicious lesion is seen. Brain damage from the drugs is a possibility, but so are a congenital malformation, a brain tumor, or a clot. House suspects that clot, and diagnoses Will a clot of the cerebral venous sinus thrombosis. Adams thinks that lupus may have caused the clot, but House goes with Behçets disease, and starts Will on heparin (a blood thinner for the blood clot) and interferon and steroids for the Behçets.

Once again, despite medication, Will seems to be worsening. He is coughing up blood again. Park thinks the clot in the brain is breaking up and part of it traveled to the lung. A scan of the lungs is checked and it does show a blockage consistent with Park’s theory. Suddenly, Will starts screaming that his eyes are in pain. When the team takes off the bandage over them, they see the eyes are seriously swollen and infected. Chase suspects a Strep infection while Adams favors a viral cause. House disagrees and points to a fungal cause of the infection: mucormycosis. The treatment of choice is amphotericin B, a potent and nasty antifungal that — on top of the strong antibiotic he was already on – will most likely cause him to become deaf. Will resists the treatment — he doesn’t want to become deaf as well as blind. Adams brings back his ex-girlfriend who convinces him to try the treatment, and the end of the episode suggests he may not be permanently deaf.

For the second time in the last handful of episodes, I find that I have few major criticisms to make. Admittedly, much of the medicine was rather superficial this episode — to allow time for the patient’s girlfriend(s), Park’s trip, and House’s mother storylines — so there wasn’t all that much medicine to evaluate. (Don’t get me wrong: I think most of the differential, and the final diagnosis were extremely unlikely and not a good fit, but I can’t characterize them as blatantly wrong or impossible.)

Here’s a couple quick thoughts:

The ototoxicity of amphotericin was overrated. It can cause hearing loss, but it’s not “guaranteed” even with gentamicin (and was gent the right drug to be treating a dental based infection with?)

They can’t tell the difference between a lung infection going to the brain, and a brain infection going to the lung. Speaking of that, where were all the pulmonary symptoms? He coughed up blood, twice – and once was from aspirating teeth. Where were the other symptoms– the ones that should have predated the neurological symptoms he was admitted with?

For an episode about a diabetic, and with the team frequently blaming the patient’s diabetes for his various ailments, there was little talk of blood sugars, diabetic treatment, and whether or not his diabetes was well controlled.

I found the medical mystery was only average this week with an ill-defined presenting complaint. The blindness was a nice twist, as was the fact that the team overlooked it when looking for symptoms. I give the mystery a C+. The final solution fit, more or less, and it was nice to see some consequences of the diagnosis (albeit unrealistic ones) I give it a B. The medicine was haphazard and superficial, but rarely wrong. It also earns a B. The soap opera was good and was clearly the driving force of this episode. Billy Connolly is always welcome. I give it an A.