- House, I'm looking at you, sir. Are you going to give
me a zebra or a horse? I don't know, let's check it out Woo! - [Paramedic] What, are you kidding me? Tub-o-goo gas gotta be over six bills. You ain't gonna lift him
with a couple of blankets. - Now this is tough. - [Paramedic] You got
a better idea Einstein? Yeah, just roll him off. (laughter) What? He's already dead, ain't like he's going to feel it. - It's actually a situation that some of my paramedic
friends discussed with me, about legitimately having trouble getting humans outside of their homes, into the ambulance and into the ER. There's even been times that I've heard them talk
about injuring themselves, bringing patients out of their homes. Because they were perhaps
overweight or obese, or perhaps their environment wasn't safe. - Alright, one, two, lift. (fart noise) (laughter) - Come on man. - Me? You're the kielbasa king. - It wasn't me. - Well, it wasn't me either. - Don't look at me. - Is the patient alive? Did
no one check for a pulse? - Trust me, skin's cold,
pupils are fixed and dilated. He's not breathing. - He's got a pulse. - He's not dead if he has a pulse. - 46 year old guy in a coma. Doesn't appear to be
anything wrong with him, except the fact that he
weighs over 600 pounds. - Who says that? Who, who talks about a
patient's weight like that and says there's probably nothing wrong? Do you know that? Do you know his history? He can't even give you his full history. There is no way you could
have results this quickly. Like, at least get an echocardiogram. - Blood sugar's normal,
cholesterol is lower than mine, tox screens clean, no sign of trauma. - [Foreman] Sure there
wasn't a mix-up in the lab? - Three times? - I'm glad that they rechecked because if a clinical picture, meaning what a patient
looks like, behaves like, or symptoms are like,
don't match the labs, you should be rechecking those labs. Too many times I've had that happen. Recheck the labs and find out
that they're completely normal or the other way completely abnormal. So I always like to keep laboratory error in the back of my mind. Or in the front of my
mind, forefront of my mind. My mind. - Nothing abnormal in the
EEG or the neurological exam. - Who gets an EEG when
a patient just rolls in? It's too soon. You should get a CAT scan,
see what the lungs are like. Get an echo, see with the
anatomy of the heart is like. You should see what the digestive system is like with a CAT scan. When a patient comes in and
you don't know what's going on, you have to throw all
the tests at the patient in order to understand what's going on. You need to check for substance abuse. You need to check for toxic metabolites, Complete metabolic panel,
the complete blood count. Look at all these values and
not just jump to conclusions. I mean like doing EEG
seems like the 50th step and they've skipped over one through 49. - Improperly prepared
puffer fish can have toxins that could cause a coma and might not show up on the tox screen. - And if it was a puffer fish, he'd be dead in six to eight hours tops. He's been in a coma at least 24. - How do people know these
facts about puffer fish? Come on Foreman, you didn't know that. You Googled it. He Googled it. - It's ridiculous, a
person shouldn't be able to eat themselves into oblivion and then just expect everyone to pull out the stops to fix everything. - What we were supposed to do? Refuse treatment to anyone who's obese? - [Chase] Come on, give me a
break, the guy's not obese. He's not even morbidly obese. He's suicidal. - People who attempt suicide get treated. - Plenty of non-compliant diabetics don't. - Wait, non-compliant
diabetics do get treated. I don't know why he said that. And patients who are addicted to food, or perhaps have an emotional issue, that is causing them to
overeat and become 600 pounds, or perhaps have a medical condition that's causing them to
gain this much weight, shouldn't be judged. Like you can't be a
doctor and be this judgy and be successful as a clinician. - We should do an LP and
look for neurosyphilis. - Is not syphilis. - How do you know? - Whatever he has is connected to his gut, not what's below it. MRI his brain, look for clots. (chiming sound)
- She said that the blood was drawn three times.
(whooshing sound) In that time they couldn't
check for syphilis? (booming sound) - 1, 2, 3. (grunting)
(thudding noise) - Not going to lie this
is a true challenge for hospital and hospital systems, when patients can fit in the equipment. That's why we are trying to create newer equipment that is more capable in handling patients of all
different sizes and shapes. - No bleeds, clots, infarcts. - I don't see any edema either. - So what do we do now? - An LP, even if it's not an STD, the fever points towards
some sort of infection. - [Chase] I'm not sure you
can do an LP on guy his size. - Did they get a chest X-ray? Like, if you at least had a chest x-ray you could do that portable, you could do it right in the bed. You could see if that
there is a lung infection. You could rule that out. Check the urine, see if there's a urinary tract infection
with a pyelonephritis going up to the kidneys. Like why aren't they talking
about the most common things? This show is all about zebras, not horses. Remember that saying?
(horse neigh) "When you hear hoof beats,
think horses, not zebras." Doesn't mean you forget the zebras, (shouting) - Calm down man, calm down. (shouting) - Get him out already. - I'm trying. - Come on. (crashing) (panting) - We still have no idea why he was in the coma to begin with. - Or why he woke up. I
wonder if it is hormonal. Acute adrenal insufficiency
could cause a temporary coma. - It can, and also a thyroid
storm can cause a coma. Although a thyroid storm
would probably come with a rapid heart rate,
also not weight gain. If you have a hyperactive thyroid, although if you have
an underactive thyroid followed by thyroid
storm, which can happen, cause the thyroid, even in like, certain conditions like
Hashimoto's and Graves' disease. Sometimes it flips on and off between hyper and hypothyroid. It's not always so clearly defined, especially in the beginning
of the onset of disease to later stages of disease. - Let's do a full STD panel and check his genitals for chancres. - Well, first of all, you
should have checked him for chancres beforehand
and you should have done a full STD panel before hand. It's like the cheapest test you can do. If you're talking about all these MRIs that you're breaking,
costing millions of dollars, the $300 STD panel would
have been worth it, Don't you think? - You having any problems
with your vision? - No, I have nystagmus. I've
had it since birth, I'm fine. - [Cameron] You're not fine,
you want a coma for two days. There's something wrong with you. - Was something wrong
with me, now I'm better. Now I'd like to go home. - The patient can always leave. Like, if he can think
about the consequences, if the patient can
verbalize those consequences and it's safe for them
to leave in that sense, they can choose to leave. They will leave against medical
advice, which is an AMA, but it's within their rights,
it's patient autonomy. - Wait, let us take you
all the way outside. - I'm fine. - It doesn't matter, it's hospital rules. - Oh, screw the rules, I've
been on my back for four days. I need the exercise, right? - George, come on, let us
just take you to the taxi. - Don't worry, I may not be able to climb Everest, but I can walk. (suspense music) (dinging sound)
- First of all, if a patient has not gotten up since he's been admitted to the hospital, would get a PT evaluation to see if he's capable of walking on his own. And if he is not, he can
not safely go home alone. He would at least need to
go to a subacute rehab stay where he could learn
how to walk on his own and take care of himself. 'Cause if a patient can't get up and walk, you're essentially setting
them up for failure by sending them home. - George? (glass smashes) - I think we should focus
on the coma and the fever. - We have a rather large piece of tempered glass that begs to differ. - I just mean it's not connected. - How could you possibly know? - Because I did it. I didn't think he should be discharged, so I gave him three grams of phenytoin. (spitting noise) - What hospital is this? She drugged the patient
so he wouldn't leave. Oh my God. (clanking noise) (comical music playing) Don't poison your patients. Even if you think it's right for them because you are not God. (screen whooshes) - [Sam] What would happen to her...? - Medical license loss? We'll do it in order. They find out, medical review committee, medical board suspension, followed by medical board reevaluation, followed by loss of medical license, either temporarily or forever, depending on how angry the patient is, prior situations, et cetera, et cetera. Lawyer up. - It can't be Chagas, he's
never been outside the country. - But his stomach has. The food we eat no longer
comes from America's heartland. It comes from South America's
deforested jungle land where lettuce now grows and
lettuce pickers now poop. Get a sample of his CSF. - How are you going to get a sample of his cerebral spinal fluid? That's going to be tough. - [George] You want to
drill a hole in my head? It's gotta be something
other than a parasite. I buy my produce at the
best market in town, and I always wash it. - [Cameron] Leafy vegetables
can suck contaminated water through the roots right into the plant. - I've never heard this,
this sounds farfetched, but I hope they researched this. (drilling noise) Please tell me this is a
neurosurgeon doing this, Not like, Foreman. It's Foreman, oh my God. These are they're all neurosurgeons, infectious disease specialists,
family medicine doctors, cardiologists, they run MRI machines... Oh cramp! - What'd you do? - Nothing, why? What's wrong? - I can't, I can't see. - Vision's blurry or you've lost it? - I didn't lose it, you took it from me. - [Cameron] George, calm down. - I can't see! - This is actually why patients are kept awake during some neuro procedures, because in case you do touch something, you want to know right away so that you don't continue
doing damage to that area. - Blindness plus comma says diabetes. - No, blood sugar, urine dipstick, and hemoglobin A1-C are normal. - Were normal, when you tested. He's been in and out of a coma, Whatever's going on is waxing and waning. - That's not true because
the hemoglobin A1-C gives you an average of the blood sugars over the last three months. So it doesn't mean it was normal today, and it could be different tomorrow. It still will give you the
average of the last three months. So I don't agree with House here. - I'm not diabetic. - As soon as you drink
this, the sooner I get to go waste my time with something else. - Get off of me. - No dessert till you
finished your dinner. (struggling sounds) - It's a classic House situation, where he's just losing his
mind, fighting a patient. (shouting) - Go. - Oh wait, his liver is failing now? He's jaundiced? What's happening? - Get x-rays of his hands. Tell him the lung cancer is in
no way connected to obesity. - You don't think he'll
realize we're lying? - You're not, lung cancer
is got nothing to do with... - I meant about him having lung cancer. - You didn't notice his fingers? - I noticed they were fat. - You should've pissed him off. He would have grabbed you and
you would have felt the bones. They're not just fat, they're clubbed. - This is the first x-ray
they're getting? Are you joking? He was in a coma in the ICU and they're just getting an x-ray now? Oh, they're getting an x-ray of his hand. I thought there's the first
chest x-ray they're getting. - Your tests were positive. You have a small cell lung carcinoma. It caused a paraneoplastic
neurologic syndrome. - Paraneoplastic basically means that as a result of having this
tumor, it's secreted hormones that have altered the way
that his body behaves. - It's inoperable, but there there are radiation treatments available. - (soft gasping) - They might give you a few more months. - I never smoked. - Not all lung cancer cases
are caused by smoking. Some are caused by asbestos. (footsteps walking away) (solemn music playing) I would ask if he had any
questions at that point. I mean, you're just delivering
a life-changing diagnosis, you spend 10 seconds and you leave. I think that's kind of cold. - Check out the harsh reality
of being 800 plus pounds here. Click it, check it out, as
always stay happy and healthy. (upbeat outro music)
Great review.
Tho I'd like to note that Foreman actually is a neurologist/neurosurgeon, so he was the right person for that procedure.
Watching it now!
I'm curious, you said "it secreted hormones that have altered the way that his body behaves." Could this be affecting his weight and be the reason that he's gained so much is that not tied?
House is all about the zebras. His team only gets involved in a case as a final resort, or on occasion if a case (not a patient because House hates them) catches his attention for some reason. That is the whole purpose of his department.