S8E22: Everybody Dies

This is a preserved copy of "Everybody Dies", originally published at politedissent.com. Wayback capture: 2012-12-18. Original URL: http://politedissent.com/archives/8992.

The final episode of House. I liked it and found it fitting, even if the medicine was spotty, but YMMV

⚠️ Spoiler warning — plot details for this episode follow.

House awakens on the second floor of a burning abandoned warehouse next to the body of a dead junkie. Through a serious of flashbacks told as question and answer sessions with House’s subconscious — played by various former characters, both alive and dead — we learn what brought House to his current predicament.

The junkie was a drug-seeking patient who showed up in the clinic, trying to connive House into writing him a prescription for narcotics. House wasn’t fooled, but decided to admit the patient after he noticed Cullen’s sign — bruising around belly button — a sign of pancreatitis (or, if the patient had been female, an ectopic pregnancy). House obtains an ultrasound of the patient’s abdomen which shows no pancreatitis, but does show blood and air within the peritoneum — neither of which should be there. The storytelling gets a little muddled at this point and House ultimately explains that the patient has a perforated ulcer (which would get both air and blood into the abdomen).

Later the patient suffers respiratory arrest and codes. While his team dithers about blaming it on a pulmonary embolus (“a clot in the lungs”), House calmly enters the room, searches through the code blue trolley, and injects the patient with naloxone. This immediately brings the patient, screaming, out of his arrest. It turns out the patient had overdosed on some heroin he had acquired. (Naloxone blocks the effects of narcotics on the opioid receptors. This will dramatically cure narcotic-related respiratory depression, but it also abruptly ends all the pain-killing benefits and euphoric effects of the medication, which explains why the patient woke up screaming.)

After the code, House sits and talks to the patient, who admits he will never give up heroin, because he likes the way it makes all his problems go away. This description of heroin intrigues House, even as he now diagnoses the patient with ALS (amyotrophic lateral sclerosis, i.e. Lou Gherig’s disease), based on nothing more than the twitching of the base of the thumb (the thenar eminence) and thinning of the muscle there (suggesting muscle atrophy). A short conversation later, he notices a bulge in the patient’s right supraclavicular notch and a handy ultrasound reveals a foreign body. It seems the patient had once inhaled some plant matter which caused an autoimmune reaction, which explains all his symptoms (the ALS ones, anyway. Kind of, if you pretend. Maybe the ulcer too, I’m not so sure. Not the drug addiction, though — can’t blame that one on an autoimmune disease.)

After that, House goes missing for two days and ends up in an abandoned warehouse, which just happens to be on fire, with his former patient dead next to him. It’s left to conjecture, but I think it’s fair to assume that House was intrigued by the patient’s description of heroin and decided to score some with the patient. House passed out, the patient OD’d, and…well, I don’t know how the warehouse caught on fire. It just did, OK?

Foreman and Wilson manage to track down House and arrive at the burning warehouse just in time to see him try to escape before being brought down by a collapsing rafter. Then to add insult to injury, the warehouse explodes.

A body is removed and identified as House through dental records. Everybody who is anybody is at the funeral – except Cuddy, but to be fair, he did try to kill her. In the middle of his shockingly appropriate (and classic Kubler-Ross) eulogy, Wilson receives a text on House’s cellphone –conveniently in his pocket — telling him to “shut up you idiot.” A short time later Wilson meets up with a clearly alive House who explains that he escaped out the back door of the warehouse and switched dental records. With him now officially “dead” he is free to spend the next five months with Wilson.

As the episode fades, we see the Chase is now head of the Princeton Plainsboro Diagnostics Department, with Adams and Park still working on the team. Taub is spending time with both of his daughters, and both of their mothers. Cameron heads out the door of her ER in Chicago to meet with her husband and child. Foreman discovers House’s conspicuously hidden hospital ID in his office. And Wilson and House head off into the sunset on their motorcycles.

The medicine was very random and entirely illogical this week. That being said, this episode was never going to be anything other than Greg House himself, and I’m going to respect that by not highlighting any errors or giving any letter grades this time. If you really want, you can probably divine my opinion on the medicine by my comments in the plot summary. Or there’s always the comments.

I thought this was a fitting end for the series. House himself was such a complex character and had such a rich history over eight years that there was no way they were going to be able to keep everybody happy, or even satisfied, with any ending. This ending hit most, if not all, of the key points: friends, family, pain, loneliness, and mystery.

It wasn’t a perfect episode, or probably even a great one – too many coincidences for my taste – but it was at least a very good episode.

Medically, as much as I complained, let me make it clear once last time that the medicine on House was still miles ahead of every other medical show. Even the bad medicine on House was better than what passed for good medicine on other shows.

Thanks for stopping by and reading — and commenting, or at least lurking — for the past eight years. Next year, I’ll continue to review Fringe, and any new medical show that catches my eye. In the meantime, I’ll continue to focus on the depiction of medicine in pop culture, particularly comics. (For those of you playing, the House Challenge scores should be updated and completed by the end of holiday weekend.)

One last thought: a bit of advice for all current and aspiring writers who want to write good medical scenes. It’s simple — Primary Care. Specialists are great, they are the big names and bring in the big bucks, but they only look at one small part of the problem (which is fine, we need them to do that in the real world). But if you want someone who knows how everything fits together, who sees the forest for the trees, then talk to your primary care doctor. Have them take a quick look over the script (or story or novel or comic) to make sure it hold together medically as a whole. Most of my complaints about medical writing could be solved with this one little step.