House M.D. Episode 8.08 Perils of Paranoia

"Did you and the defendant spend the evening of October 8th watching the Devils game on TV, or did you just read about the game in The Chronicle while concocting this false alibi?"

The confident prosecutor, Tommy, knows that he has the defense witness on the ropes. All he needs to do now is watch the man squirm and try to answer the question that will surely win Tommy the case. But instead he approaches the bench.

"I'm going to need a continuance," he tells the judge. The judge can't believe it. "You're one answer away from destroying their whole defense," he says. "Let's finish this up." But Tommy starts hyperventilating. "I think I'm having a heart attack," he says, clutching his chest and falling to the floor.

"He thinks he had a heart attack, but didn't. His EKG, cardiac enzymes and catheterization were all normal." Foreman is in his office, describing Tommy's case to House, who's sure that Tommy merely had an anxiety attack. "Probably because he just turned forty and still goes by the name 'Tommy.'"

Even though Tommy's wife told the ER doctors that Tommy's been feeling fine, Foreman admitted him and treated with alprazolam, an anxiety medication. "No improvements," Foreman says. "For some patients, the diagnosis of anxiety disorder can actually increase anxiety. Which is also why I told him he had a minor respiratory infection that was easily curable by medication." House is astonished. "You lied?" "I ruled out heart attack and anxiety disorder," Foreman corrects him. House is clearly impressed with Foreman's wiliness.

"Shingles could cause chest pain before a rash appeared," Park says, offering the first option as the team begins Tommy's DDx in House's outer office. But if it was shingles, the pain would be restricted to one dermatome. Asthma-induced pneumothorax? Tommy doesn't have a history of asthma.

"I treated an inmate once with similar symptoms after he tried to poison his cellmate with chlorine gas," Adams says. "He didn't realize sharing a cell also meant sharing the air?" Taub asks. "Chlorine gas pools near the ground. He thought he'd be safe in the top bunk," she says. But why would someone want to poison Tommy? "He makes a living sending people to prison," Taub notes. "He's not in prison," Chase says. "And it's kind of hard to gas a guy unless you can seal him in a room first."

House seems to think poison might be the right idea, though. "Alkalinize his urine. Go search his home, talk to his wife. See if you can get her to tell us what she used." Adams is confused. "Why would you think his wife poisoned him?" "Because dangerous people don't break into your home. They live in it," House answers. "And although his kids are old enough to want daddy dead, they're still too young to do anything about it."

House orders Adams to search the house, and Chase to talk to Tommy and his wife. What about Park and Taub? House tells Adams and Chase if they need help, they can take whomever they want. "I'll take Taub," Adams and Chase say, simultaneously. "Interesting," House says. "No, it's not," Adams argues. "It was a 50/50 choice. I'm totally fine with Taub or Park." "Cool, I'll take Taub," Chase says, getting up to leave. "And I'll take Park," Adams says, clearly less than pleased.

"You need a girlfriend." Taub and Chase have cornered Foreman in the elevator about his handling of Tommy's case. "To keep me from lying to patients?" Foreman asks. "To give you the excitement you need so you don't go looking for it," Taub says. "You're not working for House anymore, which means you no longer have him to blame if you get caught." Foreman claims that he's just doing his job, but Taub warns him he's going down a dangerous road. "And that's from a guy with one alimony and two child support payments."

"This new curve-control thing, it automatically slows the car when it senses I'm taking a curve too fast." Adams is making small-talk while driving herself and Park to Tommy's house, but Park thinks it's just to avoid talking about why Adams didn't want to work with her. "There's nothing to talk about," Adams says. "House liked poking ant hills with a stick when he was a kid. Now he's trying to do the same thing with us."

"I don't see how that's possible. Tommy's the most popular guy in his office," says Tommy's wife, Olivia, telling Taub that there's no way Tommy could have been poisoned. "He's even had defendants thank him after they were sentenced," she says. "And even if someone wanted to poison him, I don't see how they would do it. He never eats or drinks anything that we haven't made at home." Tommy's obviously scared of something, then, Taub concludes.

"My first job out of law school was at the Health Department. If you'd have seen some of the kitchens at the processing plants I have, you'd cook all your own food, too." Tommy is explaining his extreme eating habits to Chase. "The poison wouldn't have to be in food. Have you gotten any strange letters or packages recently?" Chase asks. No, Tommy says. Chase asks about his home. "We've got two young kids. There's definitely no poisons I could have accidentally been exposed to," Tommy tells him. But what if it wasn't accidental? "How are things between you and your wife?" Chase asks. Tommy just laughs. "Absolutely not. This is coming from a man whose eyes are wide open. I've prosecuted hundreds of despicable acts by husbands, wives, parents. I can assure you . . ."

". . . I love my husband," Olivia is protesting her innocence outside Tommy's room to Taub. "And I would not ever, even for a second, consider doing anything to hurt him."

"No pesticides, fertilizer, or fuel in the garage," Adams says, reconvening with Park, who's checked the main house. "There's not even a bottle of Wite-Out in this place," Park says. They're just about to leave, when Park notices something strange. "The dining room's on the other side of that wall," she says, pointing to a large bookcase in a study. But it ends like three feet further over." She takes a magnet from the refrigerator that Tommy and his wife use to open child-proof cabinets and starts placing it over various parts of the bookcase, until she finds the lock. The two pull back the bookcase to find another locked door, inside of which is a massive stash of weapons.

"That's impossible. You must have broken into the wrong house." Olivia can't believe what Park and Adams are telling her about the hidden bunker. But it was definitely her house. She turns to Tommy. "I had it put in during the remodel last year," he tells her. It wasn't in the plans they looked at together. "I didn't want the city to know about it," Tommy says. "I'm sorry. I should have told you. I just didn't want you and the kids to worry." But why does he think he needs so many guns?

"You're not going to believe this." Adams and Park find House at a nurse's station in the clinic. "Imperio absenti chaos regit," House says, while cherry-picking only the best-looking female patients to see. "He's worried that 'too big to fail' applies to our banks but not our government." But how did he know? "Because that's what every idiot with a bunker full of assault rifles is scared of."

Chase wonders if Tommy's paranoia is actually a symptom, maybe of cocaine abuse. "This isn't necessarily paranoia," Park says. "Societies do fall apart. Look what happened with London and the riots." "There's a difference between an isolated riot and the fall of civilization," Chase says.

"Imagine what would happen if there was a terrorist attack on the food supply or a pandemic where we had to ration the antibiotics," Park says. "That's ridiculous," Adams tells her, which gives House to perfect opportunity to needle the two of them.

"Oh shut up," she says to House. "We know what you're trying to do and it's not going to work." But Park says it was a little harsh. "I think you're a good person and a fine doctor, but it's ridiculous to think anyone needs an arsenal of assault weapons," Adams says. "He's obviously paranoid. What about Farr's Disease?"

Park says that Tommy isn't hallucinating. "As far as we know," Adams says. "We should do a mental status examination and get a CT of his basal ganglia." Park disagrees. "If it's not poison, it's most likely atrial fibrillation brought on by hyperthyroidism or sleep apnea."

"There's only one way to settle this," House says. "Actually, there's two, but we don't have enough JELL-O for the first. Mini-mental, CT, and get a hair sample to check for past cocaine use. Check his TSH levels, and get a sleep study." He says to make it a fair fight, Taub will be "stuck" with Park. "He's not stuck with me!" Park protests. "And it's not a fight," Adams tells House.

"So what do you think? Is the patient paranoid, or am I?" Park and Taub are in the lab. "I don't think stockpiling weapons is the most reasoned response, but given what I've seen at Bloomingdale's on Black Friday, I wouldn't say it rises to the level of mental illness," he tells her.

Park feels like it's not just House, but the whole team who doesn't respect her, especially Chase, who doesn't even hide it. Taub tells her that's only because Chase hasn't known her as long as he's known him. "And I'm not just saying that because you own a gun," he says. She doesn't though. She says that she's thought about it, but worried she'd probably end up shooting an annoying family member. "What about you?" she asks him. "If anarchy breaks out, I plan to do what my ancestors have done throughout the ages: run," he says.

Just then Foreman walks in for a word outside with Taub. "Stop telling the nurses I'm looking for a girlfriend!" Apparently, he's already had two lunch offers and a box of cupcakes since the morning. "So, a few people are nice to you, and your first thought is, 'Hmm, this seems strange,'" Taub says. He denies it, but admits to Park that he did it for Foreman's own good.

"He's not paranoid, he's just stupid." House is talking to Wilson in the cafeteria. But wait, doesn't House own a gun? "Why would I need a gun? The only thing I own worth protecting a thief would need a crane to get out of my apartment." "You don't own anything you need. You own things you want. And you're definitely the type who'd want a gun," Wilson says. "You like anything dangerous. Monster trucks, motorcycles, fireworks." House insists that he's not lying about not owning a gun. "I stand corrected," Wilson says. House looks him over. "If you believe me, then this issue would be resolved with no further action necessary," House says. "Absolutely," Wilson agrees. "It's not resolved, is it?" House asks. "Not even close," Wilson says.

"It's not cocaine. Hair samples were clean." Chase finds Adams looking at Tommy's CT scans. "It's not looking good for Farr's either," she says. "I'm not seeing any calcifications." She wants to know why he didn't want to take Park with him this morning. "She's weird," he says. "She's not weird," Adams says. "She's a good doctor." "Lots of good doctors are weird," he says. "Look at House."

Chase asks if she owns a gun, and guesses correctly that she does, but for fun, not protection. "Work in a prison, you learn criminals rarely target strangers. And you've got more money than you know what to do with. So, anything that seems different and fun is worth trying." He tells her he's got a few guns himself, back in Australia, for "hunting roos." She can't believe he hunts kangaroos. "They're so cute," she says. "They're also delicious," he tells her. "You're screwing with me," she realizes. "Totally," he says.

"You don't have to stay. We won't have the results until the morning." Park has set up Tommy in the sleep lab, and Olivia wants to stay with him, but Tommy thinks she should go home and be with the kids. She doesn't understand why he wanted kids if he thinks it's the end of the world. "Look, you have a spare tire in your car, right?" Tommy says. "That's what those guns are. I mean, I hope to God I never have to use one." As he's explaining how his guns are like a "jack in the trunk," Park notices blood on his sheets. "What's that from?" she asks. She pulls back the sheet to reveal a small, bloody wound on his leg. He can't feel it.

"He also spiked a fever overnight." The team assembles the next morning to talk over the new developments in Tommy's case. "Systemic sclerosis can cause lower extremity ulcers," Taub says. Park says it would have to be pretty far along, considering his first symptom was just a few days ago. "His paranoia started at least a year ago," Adams says. "If he's paranoid," Park counters. "We should biopsy the skin lesion, and start him on enoxaparin." "Shouldn't we wait for the biopsy results before we start treatment?" Park asks.

House turns to Adams: "Now's your chance. She's leading with her chin." But Adams says that she agrees with Park, prompting House to call them both idiots. After the rest of the team leaves, Park asks House if he's messing with her to amuse himself or to try to manipulate her to make her useful. "Why do you care?" he asks. "I deserve respect. I'm a good doctor," Park says. "People respect you," he says. They just don't like you."

"How's your wife?" Chase asks Tommy, as he and Taub are performing a biopsy of his leg. Tommy says that she just needed some time. "It's not the guns. I shouldn't have lied about it," he says. "I'm not a nutcase. I just want to do everything I can to protect my family."

"At first I thought it might be frostbite, but I haven't really been out in the cold." A long-haired young man is showing House the blue-dotted fingers of his hands. "Looks absolutely nothing like frostbite," House says. He says the man needs to take a long vacation, at least a month. "Wait, is this like a bucket list thing? It's cancer," the man concludes, crestfallen. "It's silver," House says. "I'm guessing silver nitrate mixed with petroleum jelly that your boss put on the petty cash, so he'd know who to have arrested for stealing it." Suddenly the man gets it. "Damn!" "It's diffused into your skin, and the only way to get rid of it is to get new skin. That normally happens every thirty days," House says, smiling as he checks out a page he just received.

"Got your page." House walks into his apartment and sees Wilson - caught in a net, suspended about five feet off the floor. "You're an ass," he tells House. House won't let him down until he admits he's been bested. "All right I admit it! Despite the fact that I know there's a gun in here, I'd never find it because you are more devious . . ." "Clever," House inserts. "Devious," Wilson insists. House starts to walk away. "All right fine. Clever. More clever and you'll always be one step ahead of me."

Foreman is hitting a punching bag angrily at the gym when he gets a page. As he's getting ready to leave, a beautiful woman approaches. "You're either preparing to fight Pacquiao or you're having a bad day," she says. She introduces herself as Anita. "Nice to meet you," Foreman says. "You can tell Taub that he's going to get the same treatment as this heavy bag if he doesn't cut this crap out." Anita looks confused. "Who's Taub?" Foreman says he's sure she's a nice person who doesn't realize what she's been sucked into. "But really, I'm not interested," he tells her. "OK. And I'm sure you're a nice person. But I just moved from Atlanta. It's my first time at this gym. So, definitely don't know who this Taub guy is. But I already agree: he's a jerk," Anita says, laughing. "Are you sure you don't want to start over?" Foreman doesn't say anything. "Take your time," she tells him. "I'll be around." When she leaves, Foreman calls Taub. "Can't talk now, I'm a little busy," he says. Tommy is having a freak-out in his room, throwing a stool through the window and screaming, as Taub and Chase try to control him.

"He was hallucinating he was being attacked by bears." Later, Tommy is in restraints in his bed, and the team watches him from the hallway. Adams and Park agree that it's paranoia but disagree on when it started. Park thinks that it's new, which points to tularemia, while Adams thinks it's chronic, which points to GAD autoimmunity. Chase has another theory: "This could all be psychiatric. An untreated schizoid disorder he's finally lost the ability to suppress." But schizophrenia doesn't cause skin ulcers or fevers. "No, but digging delusions out of your skin with dirty fingernails could cause both," Chase says.

Park is convinced that Tommy isn't a psych case, but has an infection that spread to his brain. She wants to treat with broad-spectrum antibiotics. "Which will kill him if it's a GAD autoimmunity," Adams says. It's up to House. "Treat for GAD. Corticosteroids and IV immunoglobulin." Park follows House down the hall after he leaves. "I'm not paranoid and they don't dislike me. They don't even really know me."

House walks into his apartment and notices a trip wire between the living room and the kitchen. He stands back and yanks on it with his cane. He's safely out of the way when a net shoots past him. Wilson jumps out of the closet. "Gotcha!" House just looks at him. "You poor, dumb bastard." He sends Wilson on his way, confident that he's the more clever of the two of them. He walks into his bathroom, and the knob comes off in his hand. He's trapped. He looks through the hole in the door where the knob used to be and sees Wilson on the other side of the door. "Touché," House says.

Foreman and Anita are continuing a date in Anita's apartment. As they're kissing, they hear someone call for Anita from the other room. "Oh my God, you have to go," she tells Foreman. "Do you have a boyfriend?" he asks. It's not her boyfriend. It's her husband.

"His fever's going through the roof, which means we were wrong about GAD, and the steroids kicked the infection into high gear." Park is explaining Tommy's condition over the phone to House, who's still locked in the bathroom. "Or it is GAD and we started treatment too late," Adams says. House orders them to increase the steroid dose. But if it's an infection, that would kill him.

"With neurological symptoms progressing this fast, he's dead either way," House says. "If we increase the steroids, then either death comes slower, which means we were too late for the GAD, or death comes faster, which means we were too stupid with the infection."

"We were already stupid with infection, but it's not too late," Park says. "He's young, and was perfectly healthy two days ago. He can fight this off if we give him a chance." House thinks for a minute. "Fine," he says. "Then this shotgun is not going to work. We need a sniper rifle. Start running DNA assays for sporotrichosis, meningococcemia, and any other Boggle-winning words you can think of."

Wilson opens the bathroom door. "Well, you don't have a gun. But you do have my sunglasses, my tennis racket - I can't imagine why . . ." "Had to kill a mouse," House says. "It was really hard with those stupid little sunglasses." ". . . and my money clip," Wilson finishes. "Was there any money in it?" House asks. "Not anymore," Wilson says. He tells Wilson to lock up on his way out.

"This is ridiculous. Every moment we waste looking for a phantom infection is time we could be treating him." The team is in the lab, and Adams and Park are still arguing over Tommy's diagnosis. Foreman comes in and asks to speak with Taub. "You're an ass," he tells Taub. He blames Taub for putting the idea in his head to date, which lead to his close call with Anita's husband. "So, you don't date anyone unless I put the idea in your head? You really do need psychiatric help," Taub says. "Unlike you, I don't need drama," Foreman says. "I like my job, and I'm happy with my life." "You're so happy with your life you've got nothing better to do at midnight than to come back into work to yell at me?" Taub asks. "Stay out of my business," Foreman says, and walks away. Chase walks over. "Good for him," Taub says. "A married one's not a keeper, but it's a start." "You're an idiot," Chase says, as suddenly both of their pagers go off.

Tommy is gasping for breath when Chase and Taub get in. "Get me a trach kit," Chase says. He carves into Tommy's neck, but it's not working. "There's no breath sounds," he says. Taub thinks he's blocked before the incision point. "We need racemic epinephrine." The nurse says they tried that already. "We're going to try it again if it's our only choice," Taub says.

"We got him breathing, but barely." The team meets House the next morning outside of Tommy's room. "At least we know tracheal edema isn't from anything we did, because we're not doing anything," Adams says, pointedly. "Which is a good thing, because neither GAD nor systemic infection would cause anaphylaxis or tracheal edema," Taub says. "And an allergic reaction wouldn't get worse three days after he was admitted," Park concludes. So they've got nothing. "Unless he was still being poisoned," House says. But his wife wasn't even around when Tommy was hallucinating. "What about squamous cell carcinoma?" Park asks. "If it's only in his epithelium, it wouldn't show up in his chest x-ray." And it might cause hallucinations if he also had paraneoplastic syndrome. "Get a biopsy," House says.

"Admit it." House comes back to his office and finds Wilson, who holds up a hand gun. "Two hours ago, I found this in your closet, in a box with your name on it. I knew you'd move it somewhere outside your apartment until you were certain I'd given up looking, so I had to convince you that I'd given up looking." Wilson is awfully pleased with himself.

"That's not a gun," House says. Wilson just laughs. "Yes, it's a paperweight, with a handy storage compartment for .45 caliber bullets," he says, holding up a bullet. "And that's not a bullet," House says. "Admit it," Wilson says, "I'm more clever and more devious. You can even have it back. It's not my problem if you go back to prison. My problem is you thinking you're always one step ahead of me."

"This proves nothing, because it's not a gun," House insists. "It's a prop, from Dorothy Dietrich's magic act. Look it up! The only woman to do the 'catch a bullet' trick. I won this off her prop master in a poker game. It's fake! It's plugged," House says, sticking a pencil down the barrel. "Look for yourself," he says, pointing it at Wilson. "Don't point that thing at me!" "Fine," House says, and he puts the bullet Wilson was holding in the chamber. "What the hell are you doing?" Wilson asks. House tells him to pull the trigger. "Don't be insane!" Wilson says. "They're blanks. You pull the trigger, I drool a little fake blood, and I spit out the bullet that the audience thinks I caught in my teeth. Go ahead." He hands Wilson the gun. "I'm not shooting you!" Wilson tells him. "All right, I'll shoot you," House says. "House, don't!" Wilson yells. "It's not real," House says. "Which means you didn't prove that I have a gun, which means you've proved nothing. Admit it." Wilson walks toward the door, dejected. "You win." "And it feels good," House says, as Wilson walks away. As he's looking at the gun barrel, he gets an idea.

"You were wrong. Don't feel too bad, we all were." House finds Chase and Park in Tommy's room. "His trachea wasn't swollen. It was blocked, by a pseudomembrane growing across it. Means he's not paranoid, he is an idiot and was poisoned." House removes Tommy's breathing tube to scope his trachea. "The good news is, the poison didn't come from your wife. It came from a little bastard of a bacterium whose crap can cause chest pain, respiratory distress, skin ulcers, growth of pseudomembranes across the airway and, in very rare cases, hallucinations. Call the CDC. Tell them we need antitoxins as soon as possible." "Diphtheria?" Park asks. "We didn't guess it because nobody gets it. Instead of building bunkers, you should be getting boosters. As in routine vaccines against stuff that is actually scary."

"Diptheria?" Foreman asks Taub about Tommy as he's walking into work. "House pulled it out of nowhere," Taub says. "Cool," Foreman says. Taub asks if Foreman's just getting in. "I had a meeting about a new parking validation system," he tells Taub. "Cool," Taub says.

"How are you feeling?" Park is checking on Tommy. "Not great, but better," he says, as Olivia walks in. Park tells her the antitoxin is working and Tommy should be able to go home in a few days. "That's good news, but we've moved out," Olivia says. "Oh, come on, honey," Tommy says. "I'm sorry I lied, but . . ." "I don't want to be lied to and I can't live like that," she says. "I can't live in that home." Tommy begs her to stay. "I love you," he says. "I love you, too," Olivia tells him. "Which is why you're not going to live there, either. I don't care if we might need them. I just know that I can't live my life feeling like we do. It's not worth living in fear." "OK," Tommy says. "I'm sorry."

"You know, there's a bunch of us going to Happy Hour after work." It's later in the day, and a nurse brings in some files to Foreman. "I'm craving nachos," she says. "You interested?" "Thanks, but I've got a lot of work I need to get done," he says. "If you change your mind, we'll be at Rudy's," she says.

"Hey." Park steps into the elevator at the end of the day, with Adams and Chase. "Would you like to get a drink sometime after work?" Park says, looking at Chase. He seems confused. "You mean, all of us, or just us?" Chase asks. "I was thinking just the two of us," she says. "Did Taub put you up to this?" he asks. "No, it was just something I'd been thinking about and I figured what the heck, might as well ask," she says. Chase looks like he doesn't quite know what to say. "Well, it's probably not a good idea, you know. With us working together." "Didn't you marry someone you used to work with?" Park asks. "Yeah, but it . . . all right, sure," he finally says. "When?" "Tonight?" she asks. "Sure," he says.

Foreman is sitting in his office working. He sits back and heaves a sigh, grabbing his cell phone. He dials the phone and says, "Hey, changed my mind."

House is in his apartment, reaching up onto a closet shelf to put the prop gun back into a small box with a label on it that reads "House." Next to it is a thin, sheathed sword with a white hilt. He pulls the sword out enough to read the inscription: "John House," House's father.

Foreman is sitting at a bar nursing a drink. "Glad you changed your mind," a woman says. Foreman smiles. It's Anita.