Доктор Хаус. Обзор серии S1E05. "Осуждай, если хочешь".

The main character moment involved Dr. Chase, who was revealed to have been studying for the priesthood at one time. Other than that, the character moments were few and far-between. Sure, there were nuns, but that was pretty much a shortcut the writers used to suggest a deeper meaning to the episode instead of actually writing a deeper meaning. On the plus side, there was at least one Sound of Music joke.

This episode of House, “Damned If You Do,” is a repeat of one of the early episodes from last season. My review at the time was fairly brief. I stand by it, but I thought I’d take a second look at the episode, particularly the medicine. As usual, there are some significant spoilers in the review…

House’s final clinic patient of the day is Sister Augustine, a nun complaining of a rash on her hands. He diagnoses her with contact dermatitis and recommends an over-the-counter antihistamine and a topical steroid cream. Shortly after taking the antihistamine, Sister Augustine develops severe wheezing. House gives her a shot of epinephrine; it restores her breathing, but unfortunately it knocks her into cardiac arrest. Epinephrine is the medical name for the hormone adrenalin. Sister Augustine is successfully resuscitated and admitted to the hospital.

The team considers the diagnoses of cellulitis and vasculitis, particularly Churg-Straus Syndrome. Cellulitis is a type of skin infection and vasculitis is an inflammation of the blood vessels. Labs are drawn and Sister Augustine is started on high dose steroid therapy. The tests come back normal but Sister Augustine develops olfactory hallucinations, religious visions, and seizures — signs of brain injury. She is subsequently diagnosed with herpetic encephalitis, an infection of the brain caused by the herpes virus (though the diagnosis is forgotten halfway through the show).

The team next suspects that Sister Augustine has Mixed Connective Tissue Disorder. The usual treatment for this condition is steroids, but since they will also worsen her encephalitis, the steroids cannot be used. Steroids work by dampening the immune system. This is good for connective tissue diseases when the body is under attack by its own immune system; however, slowing down the immune system is bad idea during infections. House suggests placing Sister Augustine in a hyperbaric oxygen chamber. Foreman believes the idea is dangerous and complains to Cuddy, who takes House off the case.

Cuddy takes over and, frankly, does a horrible job. She focuses only on symptoms and doesn’t even bother to look at causes. She’s dangerous too, putting the patient on a NSAID (a Non-Steroidal Anti-Inflammatory Drug — the same class of drugs as Motrin, Advil and Aleve) despite the fact that the patient is in kidney failure and liver failure — which this class of drug can cause or worsen.

After talking to the Mother Superior, House learns that Sister Augustine lived a fairly wild life before becoming a nun. He also realizes that she’s been drinking figwort tea. According to him, combining figwort tea and epinephrine will lead to a cardiac arrest (though I can find no evidence or documentation of this anywhere).

House resumes care of Sister Augustine. He is convinced that she is suffering from some kind of severe allergic reaction. She is moved to a special non-allergenic room, but she still goes into anaphylactic shock. Belatedly, House realizes that she must be allergic to something within her, and a CT scan reveals an old copper IUD. It turns out that she was allergic to copper and the recent exposure to some new copper pans kicked the allergy into overdrive.

The medicine in this episode was pretty good excepting the problems I mentioned above. I will also point out that connective tissue diseases and vasculitis cannot always be ruled in or out by lab tests alone. This is one of the few episodes — and quite possibly the only one — where it take three separate diagnoses to explain the patient’s symptoms.

This was an early episode and the soap opera elements were just coming together. The beginnings of Cameron’s infatuation with House can be seen, as well as the start of the House versus Foreman ego battles.

This episode earns a B+ for the mystery, and an A for the solution; the medicine deserves a B overall (marked down for Cuddy’s ham handedness). The soap opera also earns a B. There’s not much, but what is there is good.