House M.D. Episode 2.09 Deception

House is playing the horses at an off-track betting parlor when he strikes up a flirtatious chat with a woman named Anica. She collapses and begins convulsing. House doesn't help, but instructs someone else to call an ambulance. Yet when he notices red streaks on Anica's stomach, House has the paramedics take her to Princeton-Plainsboro and ask for a Dr. House.

The team reviews the case: a woman with grand mal and inexplicable bruising. Her platelets are 89, she's anemic and she had a blood alcohol level of .13 in the middle of the afternoon. Foreman thinks she's an alcoholic and Chase considers that she might be a hooker with an STD. House notes that her bruises are not petichieal so she's not an alcoholic or DIC. And no sign of fever or infection rules out STDs. Cameron suggests Cushing's, and House wants them to start from there. Foreman, flexing his authority, orders House to draw a patient history.

House complains to Cuddy about the new set up, but she only reinforces Foreman's power. Yet she mentions that, if there's a screw up, then it is Foreman's problem. He won't be able to fall back on House. House has Anica fill out her own patient history form while he studies her racing report. They continue flirting, and Anica tells him that her sex life is barren right now. She just moved here with no job and she doesn't know anybody. While looking at her bruises again, House notes that she must have been moving away from somewhere else. He floats the possibility of Cushing's, which Anica says she suffered from a year ago. She had brain surgery to remove an adenoma from her pituitary. House is intrigued.

House and Foreman observe her go through an MRI. Foreman doesn't see any re-growth, and House thinks this is because it is too small to see as a microadenoma. Foreman asks about Anica's lumbar puncture results, but House didn't do one because he knew what the illness was. Foreman orders him to do the procedure, which House performs as Cameron watches. House cannot get the needle inserted and Anica's blood pressure and pulse begin to rise. House asks a nurse for an IV lopressor drip.

Foreman adds hypertensive crisis to the white board. House is as convinced as ever that the cause is Cushing's. House admits to intentionally mangling the LP because Cushing's plus stress equals hypertensive crisis. Foreman thinks she's merely detoxing from alcoholism. Chase wonders if the tumor could be somewhere else, so House requests a pan-man scan before Anica dies from a cortisol overdose. Foreman agrees. Yet he says that when House doesn't find anything, then he has to put Anica on a lithium taper and enter her in the rehab clinic.

Chase and Cameron oversee Anica's CT scan. Cameron complains that Foreman was put in charge and she wasn't even asked. Chase helpfully points out that maybe Cameron isn't the person to hire when you need to say no to House.

House gamely tries to make Foreman's life miserable. After ordering MRIs for the entire maternity ward, he piles up a year's worth of discharge summaries that he has neglected and require Foreman's signature. Foreman tells House that he can't be broken.

Chase and Cameron discover a mass on Anica's pancreas. It's most likely malignant and inoperable, giving Anica two months to live. Cameron breaks the news to Anica and tells her they need to biopsy the mass to know exactly what's happening. Anica calmly signs off on the procedure.

Foreman informs House that the biopsy was negative for pancreatic cancer. The team reconvenes, and Foreman again insists on alcoholism. Cameron wonders why Anica barely read the procedure consent form. Perhaps she knows that there's nothing wrong with her. She might be faking everything and injecting herself with ACTH. Her behavior suggests Munchausen's. Foreman sends House and Cameron to break into Anica's apartment to look for syringes and such.

Cameron finds two notes at Anica's apartment. One is for an ophthalmologist appointment and the other is for a gynecologist appointment. Cameron claims that multiple appointments with multiple doctors is a sure sign of Munchausen's. House explains that a tumor pressing on the optic nerve would explain the continually changing eye prescriptions. They accuse each other of looking for evidence to support their own hypotheses. Cameron reminds House that it's no longer his call.

Back at the hospital, both doctors press Foreman to side with their diagnoses. With Anica's consent, Foreman authorizes a venous sampling to check for Cushing's. This causes House to chastise Foreman for being a coward and taking the easy way out. Cameron barges into Anica's room with the consent forms, accusing her of being mentally ill and seeking attention from doctors. Now she has to grant them permission for a completely unnecessary procedure. Anica angrily signs the form.

Foreman complains to Cuddy that House is driving him crazy. He wants to know why he was saddled with this job. Cuddy raves about Foreman's organization. Clinic time is being logged, forms are being completed and filed and she is being correctly copied on procedures. House still gets to play the mad scientist while the department is running smoothly. She wants to know whether Foreman might be interested in making this job more than just pretend.

Before Anica can be sampled, Foreman receives a call. They need to delay the procedure. Cameron inquires whether Anica's urine has turned orange. The drug rifampin causes this, and Cameron just happened to leave a bottle of pills labeled "danger" in Anica's room. The bottle actually contained antibiotics. A Munchausen's patient would have taken them because she couldn't resist dangerous pills. Cameron set all this up to prove her theory. House is shocked by Cameron's turn.

House peers through Anica's medical file. Anica tearfully begs Cameron to believe that she didn't do this to herself. Cameron explains that, once the rifampin wears off, Anica will be discharged with a psych referral. Chase notes that Anica stuck to her story 100%. House tells Foreman that Anica's records show that she's been hospitalized for different reasons each time but there is always one constant - she has low HCT. Her anemia is real. House suggests Munchausen's and aplastic anemia. The team isn't convinced. House pleads to prove it with a blood test. Foreman relents, but only allows House to use existing extra blood. He can't approach Anica.

House shoves the results in Foreman's face. Anica's Epstein-Barr titers are through the roof. It is the most common cause of aplastic anemia. Foreman notices that this sample also has evidence of Sickle Cell. Either something has changed or this isn't Anica's blood. House admits that he has lied, and again asks for a biopsy. Foreman refuses. House approaches Chase, and after prodding and threatening, Chase agrees.

Yet before he can do anything, Foreman and Cuddy intercept Chase. House sees that his plan is going nowhere and Anica has been discharged. He races outside to catch her and give her the news that she has aplastic anemia. House tells her that, because she's also sick in the head, he needs to inject her with a drug that will make her seem sick in order to confirm his diagnosis. Yet there's a catch: if she has actually done anything to herself to cause anemia, then this plan will kill her. House injects her and then walks back inside. Anica collapses and begins convulsing.

The next day, Cameron hands Foreman Anica's chart which shows that her white count is down. He can't believe House's anemia prediction was right. Foreman meets with Anica and gives her the options. She can either receive a bone marrow transplant or live with a regimen of transfusions and injections.

Anica undergoes the bone marrow transplant. Cameron, Wilson, Foreman and Chase all witness the procedure. House sits in Anica's room with her racing forms and he notices a weird smell. After sniffing Anica's pillow and bra, he rushes into the observation room and orders them to stop the test. Anica doesn't have aplastic anemia. She has an infection. There was no fever because the Cushing's suppressed her immune system. Cameron says that if that were true, then the white count would be through the roof and not low. House doesn't explain the white count.

Cameron demands one explanation and House offers colchicine. Foreman realizes exactly what House did. House leads the team into the nuclear room and nicks Anica's finger. Smelly brown pus oozes out. The bruises that Cushing's gave her made a home for bacteria. House asks Foreman if maybe they should get her started on Augmentin.

That night, House admits to Wilson that he's kind of enjoying having Foreman in charge. Foreman tells Cuddy that he'd like to run the department. She lets him know that House kept Anica at the hospital after Foreman discharged her. If not for House, she'd be dead.