House M.D. Episode 8.11 Nobody's Fault

A decimated hospital room gives few clues to its history: blood streaks on the walls and cabinets, needles and surgical equipment strewn on the floor, get well balloons clinging to the ceiling.

In another part of the hospital, a large and formal meeting room, House is seated across from a man who pointedly places a digital recorder on the long, wooden table between them. "Let the record show that we are officially convening the disciplinary hearing regarding the . . . events of February 3, 2012, in patient room 209. Dr. House, this recording will be transcribed and published along with all supporting documentation and rulings. Do you have any questions before we get started?" "Yeah," House says. "Who the hell are you?" The man looks him over for a second. "I'm Walter Cofield, Chief of Neurology, Mercy Hospital. I'll be deciding your fate today."

"It's interesting that he'd pick the old mentor to judge the new one." House recognizes Cofield as a former residency director at Johns Hopkins, where he would have trained Foreman. Cofield calmly but confidently regains the upper hand. "This hearing isn't about me, Dr. House. I know you'd like to make it about me, because then it wouldn't be about you." House is through hypothesizing about Foreman's motives. "The facts are in the file," he tells Cofield, getting up. "If you have trouble reading my handwriting, give me a call. I'm going back to work." But the facts in the file alone aren't in his favor. "The facts say you should be suspended. Which from what I understand would mean a revocation of your parole," Cofield tells him. House knows that he has no choice but to tell his side of the story.

"Patient was a 32-year-old high school chemistry teacher. He collapsed while out jogging. He was paralyzed in all four extremities." House relates the case history to Cofield, adding that scans showed no sign of stroke or structural damage, with no broken bones or signs of any trauma. The part where Foreman pleads with House to take the case because he just doesn't know what to do, well, that was just a little "poetic license" for Cofield. Meanwhile, House is downing his "Vicamins" right in front of Cofield, confirming for Cofield without hesitation that, yes, he was taking Vicodin during the case . . . and during about nine years of previous cases." It's his "process," House claims, and it's been proven to work most of the time. "Good things usually happen. Bad things sometimes happen." Shouldn't we try to learn from the times when bad things happen? "Bad things sometimes happen," House insists. "It was nobody's fault." "So then what happened?" Cofield asks.

"Those who can, do. Those who can't, teach. Those who can't teach, team gym. Those who can't move their arms or legs, teach us to laugh at others." That's how House originally presented the strange case of Bill Koppelman to the team. Pretty tame by House standards, but it catches Cofield off-guard when he hears Adams tell the story. "Are you trying to make him look bad?" he asks, thinking maybe she was not-so-subtly trying to shift the blame toward House. "Given what's happened, it's understandable that your opinion would color your testimony," Cofield says. But Adams doesn't think it was House's fault.

"I thought the patient had a liver problem," Taub says, when it's his turn to go before Cofield. "Hepatic encephalopathy explained why he passed out, why he couldn't move his limbs."

"He thought Taub's idea was stupid," Park reports to Cofield later. And House didn't think her idea, normal pressure hydrocephalus, was any good, either. "No, you idiot!" House had told her. "Patient had low opening pressure on his LP. Try un-squinting your eyes and reading the labs next time."

"Are you intentionally trying to get me to dislike you?" Cofield asks House, referring to the "un-squinting" remark. House not only confirms he did say it, but he repeats it slowly into the recorder so it's on the record.

When they are first discussing the case, Chase thinks the patient might have a heart problem. House thinks that he might be on to something, noting that the patient's potassium levels are irregular. "Could be thyrotoxic paralysis. Start him on steroids, PTU, and beta-blockers," he tells the team.

Cofield seems more concerned, though, about the orange stains on the case files, which he doesn't seem inclined to believe came from Cheetos, as House insists. No, they came from Chase's dyed hair. Not dyed purposely by Chase, but as a prank by House. "My team is made up of Type A personalities. They need somebody to break the tension every once in a while," House tells Cofield.

"House prefers chaos over cohesion," Adams says later of the orange-hair prank. "He believes that disagreement and mistrust lead to better ideas. He's not wrong." In fact, Adams explains, the steroids worked. Bill woke up . . .

"Bill? Can you hear me?" Bill's wife, Emily, asks as soon as he opens his eyes. He tells Adams and Taub that he's thirsty, which Adams assures him is normal, since he'd been in a coma for several hours. Taub explains to Bill that he's being treated for an overactive thyroid, what they believed caused him to pass out, paralyzed. When two school-aged girls arrive with flowers and balloons, Bill welcomes them as his students. "Everyone back at school is so worried about you!" one of the girls says. "Is he sick because of the explosion?" the other asks. What explosion?

"A chemistry demonstration he was doing for his class went wrong," Taub explains to Cofield. It wasn't in the file because Bill came in unconscious, and Emily didn't know it happened. "And I was the one who questioned her," Taub says, "so if there was an oversight, it was mine." House believes that patient histories are crucial, but he doesn't believe he needs to be in the same room with the patient to get the history. "House thinks avoiding the patients allows him to stay as objective as possible," Taub says. "He's not wrong."

"If you want an accurate patient history, don't ever talk to the patient." House affirms to Cofield what Taub said, while allowing for the idea that he's also just lazy. But if House was in the room with the patient, he could read body language, ask follow-up questions, or warn him of the dangers of not being honest with him. "Can you dispute the possibility that had you visited the patient sooner, maybe talked to the wife, been directed to one of the students, that this case might have ended very differently?" Cofield asks. House has no answer.

"It wasn't exactly an explosion," Bill explains. "It was a controlled reaction that went a little haywire." But one of the students disagrees. Apparently another student filmed the entire event and posted it online. "It got, like, over 75,000 hits already." Suddenly, Bill begins violently coughing up blood.

"He had a loss of consciousness, temporary paralysis. But it was when I was told the patient coughed up blood that things really started to get interesting." House's description of events surprises Cofield. "Your patient was doubled over in pain and coughing up blood, and you found that interesting?" "Why? Is that bad?" House asks. "It's interesting," Cofield says.

"I do this demonstration every year. I usually have a student aide help me set it up." Bill plays the video and explained how the explosion happened. "Apparently, this year he added extra hydrofluoric acid, which is why it exploded." The student was trying to create a viral video, not hurt anyone. "So we figured the patient inhaled the extra large dose of hydrofluoric acid and burned his lungs, which is why he coughed up blood."

Park notices in the video that Bill was knocked backward, hitting his head against the wall, which, if his brain swelled, could have led to the loss of consciousness and paralysis. "So . . . we discussed it a while longer, and decided to treat with heparin," she tells Cofield. It doesn't escape his notice that she fast-tracks through the DDx details. "You skipped over the actual DDx, and now you're averting your eyes. I'm growing more and more curious by the moment."

The part she had hoped to leave out was Chase's prank retaliation: a stink bomb. But House had found it first and set it off in the outer office in front of the team. While he was safely behind a gas mask, of course. "You can leave when I have an answer," he told the team, as they gagged and tried to cover their noses. "How do we treat chemical burns inside the lungs?" After Park's and Adams' ideas were dismissed, Taub suggested aerosolized heparin. "But that's only experimental," Park said. "It's never actually been used before."

"Not true," House tells Cofield. "It's been used in sheep." Bill was heading downhill fast, and they needed to do something quickly. Cofield remains unimpressed. "So you busted out the sulfur dioxide stink bomb. It was manipulation. You were pressuring your team into coming up with unsafe medical ideas just to get out of that room."

"And everyone else just went along with this?" Cofield asks Park. "No, I told House I thought it was a mistake." In fact, she might have even called it insane. "You thought it was insane, and yet you let it happen. If you disagree with Dr. House on patient safety, doctor, it is your duty to speak up. Otherwise, you are equally to blame." She did try to speak up, though. "And you failed," Cofield tells her. "And that's why I went to Dr. Foreman," Park says . . .

"The heparin could cause the patient to bleed into his lungs even faster," Park tells Foreman. Foreman, busy at his desk, agrees it is crazy. "But House doesn't do crazy just for crazy's sake. If he thinks this is the only way to help the patient . . ." and he walks out.

"You did not tell me you were involved in this case when you asked me to do this," Cofield tells Foreman, who insists the heparin couldn't be related to the outcome. "If signing off on everything House does is a pattern, it affects the way House behaves, it affects the way House's team reacts to the way House behaves."

House is brilliant, Foreman tells him, and he gives him the benefit of the doubt because he's usually right. Cofield thinks that there might be another reason why Foreman is quick to wave away House's behavior.

"Getting House out of prison is the biggest decision you've made as Dean of Medicine, right? And if he's suspended as a result of this hearing, he violates his parole, and he goes back. And that probably leaves you as former Dean of Medicine. You didn't choose me to oversee this because you thought I could be objective. You chose me because you thought I'd have your back, and I'd think twice about making a decision that would get you fired. Eric, I'm sorry. But if your 'get House out of jail free' experiment blows up in your face, it's not my job to get you out of it."

"After you'd administered the heparin, I see there's a discharge order on the chart, and yet the patient never left." True, Adams tells Cofield. House wanted a therapeutic bath for Bill before he left, to make sure there weren't any residual chemicals from the blast. "But we wound up finding something." A large rash over Bill's chest. And Bill soon became agitated, saying, "I gotta get out of here. Just let me get out of here!"

Park and Adams disagreed on what the issue really was. Park thought that it was psychosis brought on by the steroids they'd given him, while Adams downplayed his "freak-out," and thought it was the rash that might kill him: invasive strep.

"I thought Park and Adams were both right, but that their conclusions were both wrong," Taub tells Cofield. He thought the neurological symptoms and the rash both pointed to an underlying disease. "Together with the lung, it added up to Wegener's. So how does House handle it when three smart doctors come up with three different, but equally valid ideas?"I run a diagnostic trial," House tells Cofield. He ordered high-dose steroids for Bill. "Multiple birds, single stone. If Taub is right, then he can walk out of here cured. If Adams is right, he'll spike a fever, get hypertensive, we can treat it, he can walk out of here cured. If Park is right, he goes all Cuckoo's Nest on us, we can cross brain off the list, diagnose him, he can walk out of here cured."

Cofield is beginning to wonder if House is actually trying to make this easy for him. "By your own admission, if you give the patient steroids, two of the three outcomes make him worse," he says. House maintains this was the fastest way to get a diagnosis, the perfect diagnostic moment. "In light of what happened, do you still think it was the perfect diagnostic moment?" Cofield asks. "Yes," House says. "My theory accounted for all the medical outcomes. It did not account for the disobedience of my own team."

"At the time, it seemed like a good idea." Adams is recalling to Cofield how Chase agreed that Bill's rash might be strep, and he wanted to do a biopsy. "I know this is hard, but please tell me exactly what happened next," Cofield says.

"2 cc's of lidocaine . . ." Adams draws the medicine from the bottle while Chase puts on his surgical gloves and get the scalpel ready. Suddenly, Bill shoots out of bed, enraged. He grabs the scalpel and lunges at Adams, cutting her and knocking away the needle and the bottle. Chase tries to subdue him: "You're in a hospital! Calm down." They fight across the room, knocking over furniture and anything else in their path.

"So your position is that your team's disobedience caused this?" Cofield asks House. "So who do you blame? Dr. Adams or Dr. Chase? Or both?" House doesn't blame either one. "So who do you blame, Dr. House?"

During the scuffle, Taub and some orderlies race in to help. It takes two men to hold Bill, while Taub administers a sedative. Bill crumples to the ground and for a moment it's silent. Then Adams looks over to Chase: "Oh my God." He looks down and sees three-quarters of the scalpel sticking out of his chest. Stunned, Chase pulls out the scalpel and collapses. Taub and Adams immediately starting working on him. The scalpel had hit Chase's heart.

"Fortunately, only the knife tip reached the cardiac muscle," Adams tells Cofield. It made a finger tip-sized laceration in the left ventricle. Adams is struggling to maintain her composure. "At that moment, he could only stay alive as long as my finger plugged the hole. It could have been me on the floor. It should have been me. It was my theory. I held the needle in front of the patient that set off his paranoia. If you're looking for someone to blame, blame me."

The team races Chase through the hospital corridors to surgery, all the while Adams is on top of him with her finger in his chest.

"My diagnostic test worked. It proved the patient had a steroid-induced psychosis," House says to Cofield. "And that's what you took away from this situation?" Cofield asks. "Your colleague was stabbed. Are you telling me you didn't care?"

"How bad is it?" House gets to the operating room as they are working on Chase. "Bad," Taub says. But they are able to patch the laceration and Chase's blood pressure stabilizes. "What was his heart rate?" House asks. Park looks at him, confused. "He doesn't have one; he's on bypass." But House isn't talking about Chase; he's talking about the patient. Adams can't believe it. "You're DDxing?" "Park, come with me. Taub's got this," House said.

"My friend is here because you didn't listen to me," she tells him. "I did listen to you!" House says. "Chase didn't listen to me. At this point, being here makes you feel better. You're not helping Chase or our patient." But it's clear that no one is going with House.

"So he just walked out?" Cofield asks Taub, who says that there really wasn't anything for House to do. "Speaks to a certain callousness on Dr. House's part, don't you think?" Cofield asks. Taub doesn't understand. Is callousness punishable now? "You agree that empathy is a useful quality for doctors?" But Taub doesn't think House is the problem.

"Your friend got stabbed," Cofield says. "He may die from those wounds. If you had been in that room, maybe it would have been you." Taub is quick to say he would not have been in the room. "Implicitly, you just said that Chase was at fault," Cofield realizes.

House goes to Bill's bloodied, destroyed hospital room, looking for anything that might help him with the diagnosis. He finds a tape from Bill's heart rate monitor and immediately goes in search of the team, who are huddled around Chase's bed following his surgery. "Lungs, rash, now excessive RR variability. Go." He really expected them to help diagnose Bill, who he now thought might have autonomic dysregulation, while Chase is clinging to life. The loud arguing that ensues wakes Chase. "You made it bud," Taub tells him. "You're in the PACU. You've been in surgery. The anesthesia's just wearing off," Adams says, as Chase tries to get his bearings. "Did I have an epidural?" Chase asked, and Taub told him no. "I can't feel my legs."

"Dr. Chase? I'm Walter Cofield. I'm a neurologist . . ." Chase, in a recovery room, slowly removes his oxygen mask and cuts off Cofield. "I know who you are," he says. Does he feel up to answering some questions? "Well, it's not like I can get up and run away," Chase says. It's been some 12 hours now since he started interviewing House and the team. Cofield says that he'd been imagining Chase with orange hair this whole time. "I dyed it back," Chase says.

Cofield pulls out the recorder: "Were you angry with Dr. House?" It was just a prank, not uncommon. "May I ask why that matters? Are you trying to prove that I was distracted? That my judgment was compromised?" Chase asks. So who does he think was at fault for what happened to him? "I don't think it was anyone's fault," Chase tells him. "I was angry, but I wasn't distracted. And I think that if there's any chance that I'm going to walk again, it's because Dr. House is a genius."

"What about warmth? Can you feel the sheets on your skin?" House asks Chase, but no, he can't feel anything. House rejects Chase's suggestion that it might be post-traumatic syringomyelia. "No, forget the nerves. Think arteries. Blood flow to his spinal column is cut off. There's a clot in the radicular artery. Prep a room for an embolectomy. Let's get that thing out of there before it does any more damage."

"There it is." Chase is awake and participating during the embolectomy, watching the team's progress on a monitor. "Don't get too excited," Taub warns him. "We've still got to get it out. It still could have done permanent damage." As they are working, House walked in. "Patient does not have autonomic dysregulation. There's blood in his urine bag. Kidneys are failing." He wants them to DDx Bill while they are operating on Chase. "Got to be now," House says. "Foreman is transferring our guy to Princeton General as soon as there's a bed available, since the doctors here can no longer be objective since the stabbing."

"In the middle of a procedure that could basically save your life, House is actually trying to drag people away? How do you work with a guy like that?" Cofield asks Chase. "He wasn't trying to pull anybody away. Everyone had already refused to work on that case. He knew the answer," Chase says. "He wanted to check on me. But he needed an excuse. Otherwise, he could be accused of caring." "So, your testimony is that Dr. House's complete lack of concern is evidence of his deep concern?" Cofield asks.

Chase nods, but then something catches Cofield's eye. "Did you just do that?" he asks Chase, pointing to his feet. "What?" Chase asks. "Wiggle your toes," Cofield says. After a second there's a slight twitch. Chase can't believe it. Cofield takes a pen and runs it up the bottom of Chase's foot. He can feel it.

"Congratulations. It was the clot." Chase should gain back at least some of the function. "One more thing, sorry: you knew that your patient was at risk for a psychotic break when you brought a scalpel within his reach. Why did you ignore that risk?" Chase is near tears from emotion. "I thought I was right about the rash. I would do it again." "I thought so," Cofield says, putting his recorder away. What does that mean? "You brazenly defied your boss. Now, that happened either because Dr. House has established that that's OK in his world, or his prank war distracted you, or House makes medicine a game and you just wanted to beat him. Whatever the reason, it boils down to the fact that you may never walk again because House created an atmosphere that promotes recklessness."

"This will be our last round of questions." House and Cofield again sit across from one another, while outside it's pouring rain. "I've spoken with Dr. Chase. You know he regained movement."

But House had no idea. Cofield turns off the recorder and leans back. "Are you really this indifferent to the fact that Dr. Chase is hurt?" Why can't he even go tell Chase he's sorry? "I didn't do anything wrong," House maintains. "It's not an admission of guilt. He's your friend, and he's not well," Cofield says. Chase is a coworker, House corrects him. "A coworker whom you've known for almost ten years, who nearly died and who's still scared he may not walk." House is unmoved.

"Are you going to have me fired for bad manners?" he asks, putting his feet up on the table and pulling out a Vicodin bottle. "I'm just trying to understand why a man in your position, with your abilities, is incapable of shaking the impulse to act like an ass," Cofield says. House wants to go back on the record so they can get this all over with. Cofield turns the recorder back on and then tells him to put the Vicodin away. "My leg hurts," House says. But as he pops the can open, there's an explosion of confetti. "Is that supposed to be funny?" Cofield asks, wiping away the debris from his desk. House smiles, but then he has a thought. "Two explosions," he says, getting up to leave. "We're not done here," Cofield tells him.

"Hey, hold on!" House catches up to Bill as he's being loaded into the ambulance to be transferred. But the paramedics were warned by Foreman not to listen to House. "Said to tell you he's no longer your patient." The ambulance drives away, but House finds Bill's wife. "Your husband has a tumor in his lymph nodes." She points out that he's been wrong every time so far. But he's convinced he's figured it out. "The explosion in the classroom caused the cancer cells to break open. It's called tumor lysis syndrome. His body's flooded with an excess of phosphates, potassium acids, all kinds of cancerous junk. It explains the paralysis, the bleeding, the heart and kidney issues, everything." And the psychotic break? "Turns out, we caused that," House tells her. She starts to walk away. "This is treatable! You have to tell the new doctors that he needs total body irradiation and plasmapheresis." But she doesn't want to hear anything from House.

"Where's Cofield?" House is walking back to the room Cofield was using just as Foreman is leaving. "I wasn't done testifying." "Apparently, you were," Foreman says. "He said he'd have his decision tomorrow."

The next day, House, Foreman, and the team, minus Chase, gather in the meeting room to wait for Cofield. He walks in, and places the familiar recorder down on the table. "This case is a fiasco. Didn't sleep last night. Dr. House is obviously brilliant. But Dr. House is also a fiasco. If I were to exonerate him, condone his completely reckless, immature, almost misanthropic behavior, I would essentially be sending the message to the other doctors in this hospital that it's OK to act that way." Just then, Bill's wife, Emily, rushes in. "I'm sorry. I came to speak with Dr. House. And when they told me he was in here, I thought I should say something. I mean, he wasn't the nicest doctor I've ever met. But he was right. They found the tumor. They are removing it and they are starting plasmapheresis. They expect a full recovery. He saved my husband's life. Well, I guess that's it. Thanks again."

After she leaves, Cofield resumes his statement. "As I was saying, Dr. House's process is dangerous, inappropriate. But he is effective. I've decided that I would be doing this hospital a disservice if I did anything to change that process. Congratulations, Dr. House. This unfortunate stabbing incident is officially nobody's fault." And he turns off the recorder. No one can quite believe it.

"Coward," House says to Cofield, noticing his file folder. "You've got like 20 pages of notes there. You were expecting to bore us for at least half an hour." House grabs the folder. "You've got my parole form in here. You were going to send me back to prison. Good things usually happen, bad things sometimes happen. That fact that that would-be widow came in just in time to sob all over your soft, mushy heart, the fact that her husband's going to live, does not change whether or not I did the right thing!" House walks out.

"How'd you get the firing wire into the Vicodin bottle without me noticing?" House finds Chase in a physical therapy room, painfully learning to walk again. "What was the point of the orange hair?" Chase asks. House tells him his hair smelled like Adams. "And since there's no way that you're doing her without me knowing, it means you're just doing her shampoo. Which means you were out late drinking with some new girl, or, because there is no new girl, trying to make up time by showering at the hospital, because you're too lazy to buy your own shampoo. So I found a way to let you know to not be late." "You couldn't just ask me to stop being late?" Chase asks. "What fun would that be?" House says. "None of this is fun, House," Chase says, as he's breathing heavy and trying to steady himself on parallel bars.

"They've decided that your being stabbed was nobody's fault. They're wrong," House tells him, looking down. "I'm sorry." "Anything else?" Chase asks. "I'm kind of busy." "Nope, that was it," House says, and walks out.