DNR (House)

"DNR" (short for do not resuscitate) is the 9th episode in the first season of House, which premiered on the Fox network on February 1, 2005.

When legendary jazz musician John Henry Giles collapses mid-session, House and his team run into technical difficulties treating the man, who was diagnosed with ALS by his doctor in California, Marty Hamilton. Foreman, who did a residency with Hamilton, is requested to lead the case. Although Foreman and House clash at every turn, Foreman listens to House's advice and treatment options. After House's suggestion causes the patient to crash suddenly, House disobeys a DNR order and must go to court.

At the trial, House makes up a diagnosis for the judge causing a ruling in House's favor. Meanwhile, Foreman has called Marty Hamilton, Giles's old doctor, to help on the case.

Plot

A famous wheelchair-using trumpet player named John Henry Giles loses his breath and collapses from a lack of oxygen while playing. At the hospital, House is intrigued that John Henry has been paralyzed for two years without sufficient explanation. Cuddy tells House that they are only treating John Henry for pneumonia, since his paralysis is treated by his doctor in California, Marty Hamilton. Foreman, who did a residency with Hamilton, is requested to lead the case.

Hamilton had already diagnosed the paralysis as an effect of ALS, which would explain the pneumonia. House does not agree with this suggestion and seeks other explanations for the paralysis. As Foreman does the blood work, John Henry requests a "Do Not Resuscitate" order. Foreman has John Henry administer an IVIG, which ends up limiting the blood in his lungs, causing him to crash. Chase wants to intubate, but Foreman mentions the DNR. House intubates anyway.

House reasons that it was the IVIG that caused the reaction, not the disease. House is hit with a restraining order to stay away from John Henry. Criminal charges for battery will be filed. House presses on, ordering Cameron and Chase to consider other possibilities. Dr. Hamilton flies in from Los Angeles.

In court, the hospital lawyer argues that House has the right to face his accuser. Since John Henry is on life support, the trial is put on hold. Back at the hospital, Chase sees on the lung biopsy that there is only inflammation. Since House cannot order more testing, he begins blind treatment. He suggests starting John Henry on cytoxan, which treats Wegener's disease, putting Cameron's and Chase's medical licenses on the line.

House is about to administer the cytoxan when Dr. Hamilton arrives. Hamilton states he has already checked for Wegener's. House reminds Hamilton of the error rate that occurs in those blood tests and biopsies. Hamilton wants to discontinue life support. House realises that if it is Wegener's, John Henry's lungs will not be able to handle the stress, killing him. However, John Henry starts to breathe on his own after being taken off life support, disproving House.

With John Henry's arm now paralyzed, everybody but House is convinced he is stricken with ALS. The battery charges have been dropped, so House can treat John Henry once again. House suggests an MRI.

Meanwhile, Hamilton offers Foreman a job in Los Angeles, which he later declines, after some consideration. Looking over John Henry's MRI, Cameron notices signs of a stroke, which would explain the paralyzed arm. Foreman explains the options to John Henry. They can give him heparin to thin his blood and remove the clot, but it could hurt his lungs. Another option is brain surgery to remove the clot. The surgery will either result in his death, or a clearing of the blood clot. Not wanting to risk his lungs, John Henry opts for the surgery.

The surgery is a success. John Henry can move his arm following the embolectomy and is able to feel House touching his leg. The doctors are baffled. Hamilton thinks his ALS treatments are the answer. House thinks they need to take John Henry off the dozen drugs they are giving him in order to restart the dosage one by one to see which is having the effect. If not, the toxicity of the useless drugs could kill him.

The MRI results show that John Henry suffers from arteriovenous malformation. It was compressing his spine, which caused the paralysis. Foreman wonders how Hamilton could have missed something so simple. House points out that they all missed it too, and that it was hidden by the inflammation that they first saw on the lung biopsy. Steroids treat the inflammation and allow the AVM to show on the MRI. After surgery to remove the AVM, John Henry walks out of the hospital with a simple cane, as opposed to his wheelchair. John Henry then gives House his trumpet as a gift, on the condition that House never plays it.

Medical terms used

• Bronchoscopy
• Embolism
• Immunoglobulin A
• Cytoxan

External links

Wikiquote has a collection of quotations related to: DNR

• "DNR" at Fox.com
• "DNR" at the Internet Movie Database
• "DNR" at TV.com