Detox (House episode)

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Detox is the eleventh episode of the first season of House MD, and is the eleventh overall episode.

[edit] Synopsis

The episode cold opens with Keith Foster and his girlfriend, Pam taking a joyride in Keith's (later revealed to be dead) mother's Porsche. He begins coughing blood, this distracts Pam and causes her to skid the car out, which is hit by a bus.

In the hospital, House is pestering the pharmacist for his Vicodin. Cameron enters positing Keith's case to House, during which House begins tearing into Cuddy about needing his meds. Therein occurs a four-way conversation. Cuddy is arguing with House over his Vicodin addiction, Cameron is arguing for Keith's treatment, and House and Cuddy are talking to the pharmacist. Confusion over a 16-year old having hemolytic anemia causes House to decide to admit him, without getting his Vicodin first.

The Differential Diagnosis narrows it to "infection, drugs, lupus, or cancer." House leaves to collect his pain meds. Cuddy comes up and begins arguing over the addiction again; after a lengthy row, Cuddy bets House a week, then two, then a month of freedom from clinic duty if he goes a week without the pills.

Cameron talks to the father, asking about Keith and drug use, he doesn't feel Keith uses, but reveals that Keith's girlfriend had been in rehab in the 9th grade. Keith is tested with via radioimmunoassay for drugs, gallium scan for infection, and ANA for lupus.

Keith's mother was revealed to have had pancreatic cancer during Cameron's discussion with Mr. Foster. A lymph node biopsy came back clear, similarly all the other tests came back negative. Keith begins complaining of inability to see. A retinal clot is causing blindness in his left eye. Because of the internal bleeding he already has, Coumadin (or any other blood thinners) cannot be used.

During the second round of the differential, Wilson reveals that Cuddy has placed him as a kind of watchdog to ensure House doesn't cheat on their wager. House is distracted by a highly attractive woman getting comfortable in his office. This is Ingrid, a masseuse hired by Wilson to help him with his leg pain.

While Chase is giving Keith an echocardiogram, Keith asks if the blindness will be permanent. Chase confirms. After, he goes to House's office to see Ingrid leaving, and gives a knowing look to House. He of course, denies anything illicit. After House tells Chase to double the dosage of the antibiotics for Keith, Chase tells House of an idea he has to relieve the clot in Keith's eye. The procedure works.

After the procedure, Keith and Pam are talking, during which he projectile vomits on her and crashes. While Keith is being wheeled to the ER, House openly mocks the father's understandable questions. The team is aghast at how much detox has affected their boss' already questionable bedside manner. Foreman and Chase are arguing over whether or not House still has objective judgment. Cameron, who is tapped by House, to convince the father to approve Hepatitis E treatment, which House feels must be ruled out before proceeding further with a lupus diagnosis (still heavily supported by Foreman).

After being stabilized, the team tells House how Keith's angiogram revealed "major upper and lower G.I. bleeding, severe hemodynamic compromise, (and) liver failure", and that he is now hallucinating attacks from 'someone' named Jules. Cameron claims that the hallucinations are a sign of psychosis, the fourth criterion of lupus. House agrees to add Keith to the liver transplant list.

Foreman enters House's office as he is vomiting into a trashcan, he tells House to take the Vicodin before he kills Keith. House sits with the pill in his hand, and changes frame to Chase and Cameron telling Keith's father about his situation. Cuddy is unable to do much of anything about his position on the list. Keith's father reveals that the Jules earlier mentioned was Keith's cat.

House sends Foreman and Chase to dig up Jules and bring her body to the hospital. House performs an autopsy (he has visible shakes) as the liver arrives for Keith. As House examines the cat's liver, the frame shifts to Keith's OR. House tells the surgeon, Dr. Hourani that Keith has acute napthelene poisoning, not lupoid hepatitis. The source, he says is the termites he believes to be infesting the walls of his bedroom. House begins hacking and spitting, thus contaminating the OR.

While leaving the OR, House tells the team that when Keith entered the hospital, and began eating lower calorie foods, the napthelene (a fat-soluble gas) stored in his fat cells was released, acclerating the poisoning. Cuddy and Mr. Foster confronts House and punches him in the face.

House explains the newest explanation to Mr. Foster, and how all the original and following symptoms fit. In light of all this, Mr. Foster agrees to House's latest round of treatment. Foreman and Chase, hammer open a hole in Keith's bedroom wall, and find a huge termite nest.

Back at the hospital, Cameron tells Pam and the Fosters that Keith will be just fine. Near the clinic, House and Wilson are discussing House's 'victory', achieving a week free of Vicodin. House admits he is an addict, but that this does not equate to having a problem. Wilson refutes House's argument that he 'functions' by stating that just getting by is all House has and that he alienates everyone. House claims he doesn't want anything else. Wilson is enraged by House's laissez-faire attitude and begins chewing him out. Wilson rages on about how House has changed in these last years, to which House agrees, claiming he simply has gotten older. Wilson claims House has become "miserable" and is "afraid to face (himself)". House snaps back, "Of course I've changed!" Wilson sardonically jabs at House about everything being the leg, not the pills. House states that the pills let him do his job, and relieve his pain. Defeated, Wilson leaves the office, leaving House alone. Wilson tells Cuddy House's appraisal of his addiction not being a problem. The bet is revealed to have been Wilson's idea all along. The episode ends with House reclining in his office in the midst of a Vicodin high, morosely serene, then fades to black.