House Watch: What Causes Delusions?

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The season 7 premiere of House M.D. — “Now What?” — was re-aired last night on Fox. Since your House Watcher didn’t cover it the first time around, here’s a quick review. Spoiler alert: If somehow you missed this episode twice, trash your Vicodin and watch before reading on. Once again, all the possible diagnoses are in bold below.

The episode mostly centers on the burgeoning relationship between House and Cuddy, who call in sick to spend the day together. House has recently lost a patient, and Cuddy has broken off her engagement and finally started a relationship with her top employee, so both badly need a day off. (More on 5 Ways to Beat the Winter Doldrums)

The trouble is, there’s a new case at the hospital: its neurosurgeon, Dr. Richardson (George Wyner, a longtime TV utility player), is out sick — for real. The other neurosurgeons at the hospital are also out — one is at his daughter’s wedding — so Princeton-Plainsboro risks losing its status as level-one trauma center. The ER will have to close, and the ICU patients will have to be moved.

House sends Chase and Thirteen to Richardson’s home, where he’s literally hugging the toilet. He believes he has food poisoning from bad sushi. But he says he has already taken promethazine (a sedative and anti-emetic) and trimethobenzamide, which is used to treat nausea. Neither has worked. (More on ‘Love Hormone’ Oxytocin Enhances Men’s Memories of Mom — Good or Bad)

Highly focused on helping the hospital on the day before her departure from it, Thirteen wants to try ondansetron, a drug that controls nausea by manipulating levels of serotonin in the brain, and prostaglandins, which would help repair Richardson’s stomach lining. (Chase objects that neither would treat Richardson’s underlying condition, whatever it is.)

Because it inhibits serotonin, ondansetron shouldn’t normally cause euphoria, but when Richardson emerges as a new man from his bathroom — a new man who is clearly high as a kite — Chase says, “I take it this is one of the side effects of the drugs.” Thirteen answers, “Who cares? Let’s go.” (More on Forget IQ: The Emerging Science of Collective Intelligence)

Richardson accompanies them back to the hospital, but he’s now very high and keeps stripping off his clothes. “You know flourescent lights flicker at the same frequency as the human brain?” he asks.

“You know the human brain doesn’t flicker?” Taub responds.

But the hospital still needs a neurosurgeon, so Taub lies to an administrator: Richardson merely has high blood sugar, which can be treated easily by rehydration. Thirteen says the top two contenders for his real illness are hepatitis and peptic ulcer disease (sores in the stomach lining).

But his labs show him to be negative for everything, which prompts Foreman to suggest that his behavior “is not a side effect of ondansetron. What if it’s a symptom?” (More on Post-Thanksgiving Travel? Blame Jet Lag for Your Memory Loss)

Richardson then says he recently went to a seafood festival at the convention center. Thirteen asks if he ate toad eggs, which can cause nausea and also make you high. She rushes to get the antidote, which works unbelievably fast.

All in all, “Now What?” is not a great episode from a diagnostic standpoint, but it was a reestablishing episode to set up season 7. George Wyner’s performance as Richardson was, it should be noted, highly entertaining. I have little comment on the relationship between House and Cuddy except to say I think they both may have a severe case of delusions.

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