- I was riding a city
bike the other day and someone screamed, "Dr. Mike,
we want more House M.D." Here we go, House M.D. Number Three. Bee-whoop! (soft beat music) - [Lady] Oh, God. - [Boy] Is the baby coming?
I don't know how to do this. - [Dr. Mike] Aww. - You okay, Ian? - Yeah, sure. - Uh-oh. - [Lady] I don't think you are. - Are they both going to be
patients in this episode? - You're bleeding. - Wow, that's a lot of blood. Hmm, a little poker. - Dr. Cuddy, I've got one
of your patients in the E.R. Ian Austin, six years old. - Oh, I know him. What's the problem? I'm all in. - Bloody diarrhea, hemodynamically stable, but he's been developing
some coordination problems. - Sounds like gastroenteritis
and dehydration. Order fluids and I'll
take it on my service. Bets to you House. - Did they scan his head? - No, why would they scan his - - Don't play games. You gonna call? - How's the heart rate? - Stable. - [Cuddy] I'm sorry. House, it's gastroenteritis. I'm not going anywhere. Put the order in and
someone tell Allen and Sarah that I'll be up when I'm done. - I hope that's an nonalcoholic
beverage in her hand. If you're on-call and you're going to be admitting patients to your service, you probably shouldn't be
drinking alcohol, just saying. - [Cuddy] Stone cold bluff! You might wanna spend a
little more time paying attention to your cards
and a little less time starring at my breasts. - They don't match either. - I used to play poker semi-professionally during my college days. I would play it online
before it was banned and I would make some
money, not a lot of money. It was more about a learning experience, but the friends that I played with, we constantly used poker as an analogy for everything we did in life, whether it was medicine, talking to girls, relationships with our friends, we would always somehow
relate it back to poker. And I feel like that's what's
gonna happen in this episode. Everything that's gonna
happen with this patient is somehow gonna turn into a poker hand. What's interesting about poker is that it's a lot like life. Making a difficult
decision, you're not always gonna have all your information available at your disposal, right? Because life is crazy and
things change all the time, there's variables. So there's a lot of luck involved in life. That's the same thing
that happens in poker. Skill can only take you so far. There's a huge luck component. If your opponent only has
one card that will beat you, despite the fact that every other card is gonna work in your favor, they may win. And if they win, it doesn't
mean that they out played you. It means that they got lucky. The same thing that can happen in life. You can make a great decision with all the information
available at your disposal, and yet you can still lose
or have a bad outcome. - Follow my finger with your eyes. - Nystagmus. - How much longer will Dr. Cuddy be? - Well given the number
of mojitos she's knocking back at a party, I'd say
it's gonna be a least three hours before she's even conscious. - [Mother] Weren't you at the same party? - I don't drink. - I just pop pills! - I want you to reach
out and grab my cane. (suspenseful music) - What's wrong? - Abnormal proprioception. - Your son's brain is losing
control of his muscles. - Dr. Cuddy's message said it was just dehydration from diarrhea. - She's wrong. - I love House, but the way that he jumps to knowing that there's
something more sinister happening with this child
from hearing the basic story, it's a little extra. Some children, when they have diarrhea, especially bloody diarrhea,
with stable vital signs, stable labs, can act a little bit strange and then as time goes on, they improve. By him taking a special
interest in this story, just from hearing that story,
it's a little unrealistic. - Two cases, same symptoms. What do six year olds and
70 year olds have in common? - [Foreman] This kid
doesn't have kidney failure. - [House] He will. I was treating a 73 year old woman who went through this
progression of symptoms, the last of which was - And in case any of you missed
that class in med school, that one's untreatable. Do a colonoscopy. - On a six year old kid who probably has nothing worse than some food poisoning? - If you happen to find
any purple papules, do me a favor and grab a slice. I wanna check for Erdheim-Chester. - How does he know what that is? I've never even heard of it. I don't know how you
justify doing a colonoscopy on a child with a single
episode of bloody diarrhea and a stomach ache, with normal
vital signs, normal labs, just off of the fear that
there could be a rare, potentially life-threatening condition that hasn't yet presented
itself in any other way outside of ataxia and bloody diarrhea. Doing a colonoscopy, while
it's a common procedure, it's a benign procedure,
things can go wrong. You can rupture the colon,
you can have an infection. I mean if something
negative happens as a result of the colonoscopy and you find nothing, that's horrible! You did that to the child. - You know how people see the Virgin Mary in danishes and stuff? Someone died 12 years ago
and House doesn't know why. House sees that case now in
paint peeling and clouds. - I agree with him. And yes, like I said before, residents don't do all the procedures. You would get a gastroenterologist
to do the colonoscopy. Internal medicine residents don't just do colonoscopies on their own. This is crazy. Why am I getting so upset about this? It's just a show. - Negative for Erdheim-Chester. - Let me see. - Still don't know what that is. (suspenseful music) - It's not Erdheim-Chester. - It's exactly what we said before, a gun variety gastroenteritis. Can we go back to the party? - Do a kidney biopsy. - What? Subjecting a child to this many procedures that are not benign on a whim is crazy. There's no proof that
this is what's happening. You have to monitor the child, watch the symptoms, act clinically. Ego, check it. - [Dr. Chase] The colonoscopy was clean and the biopsy was negative
for Erdheim-Chester. - So he's gonna be all right, it was just some sort of virus. - What's that? - Urine. - But it's brown. - His kidneys are shutting down. - Still think it's not the same case? - Now you can start thinking
that it's something else. - Doctor had a patient a while back who exhibits the same symptoms as your son. - Then, you know what's wrong. - No. - So, what do you know? - We know the likely course
the disease will take. - [Father] Which is? - She had multiple system failures - - What happened to her? - She died 24 hours after her admission. - Look, telling patients
information once you know it, is really important
because you want to honor the idea of autonomy where
a patient has the ability to act upon their own body with the best information possible. In this case, it'd be the patients parents because the child can't
make decisions for himself. However, if you have
incomplete information and that information is very worrisome and is not gonna bring
any value to the patient and only gonna bring anxiety, maybe best leave that information out until you have a more
concrete plan or answer. Otherwise, we're just
creating a lot of anxiety, a lot of worry and essentially telling these parents your child might die today because we don't know what we're doing. - [Cameron] The base of his brain has been infiltrated by a small mass. We think - - Pituitary? - Looks that way. - Explains the low blood pressure. - Pretty much confirms the lymphoma. If we'd started Ester on prednisone - - Uh, did anyone see the lymphoma? - [Cameron] No, we saw a mass. The location was consistent with - - Didn't see any in the blood either. White blood cells show no spindling or abnormal nuclei, nothing
on immunochemistries either. It's not lymphoma. - Can't breathe. - Uh-oh. - Chase! *monitors beeping* - [Mother] What's happening? - Sounds like he's having an anaphylactic reaction to something and
his throats closing up. - [Mother] Ian, come on. Honey, just relax. Ian breathe. - [Chase] Look at the right atrium. - That's not kawasakis. - No. It's small, but it's there. - [Foreman] Ester didn't
have a mass in her heart. - Ian's younger. He can take more of a pounding. Ester died before the
disease reached her heart. The disease made a mass and made it fast. - Could be bacteria. - Muscle. - Connective tissue. - [House] The kid can't
take anymore theories. Only thing we know is that
whatever that mass is, that's what he's got. We need a piece of it. I'm doing a biopsy. - You're gonna do a
biopsy on the kid's heart! Come on, House! - And out again. *monitors beeping* - Cardiac arrest. Code blue. - Code blue. - Come on, paddles! Chest compressions, chest compressions, chest compressions, before you shock! *shock* - [House] Again. *shock* - So when you shock, you
right away go back to chest compressions, chest
compressions, chest compressions. All this time without chest compressions is the blood not circulating. Can someone do some chest compressions? - Wait, I've got something. - He's back. - [Wilson] He can't
stand it, he goes all in. He's sure he's won. I call, I flip 'em. Oo! - Pocket aces. - I nailed his ass. (suspenseful music) - What did he get from that story? God, you gotta love this. - The aces were hiding all along. - Oh, the aces were hiding, duh. - Test him for Erdheim-Chester disease. *Dr. Mike laughs* - All right, I'm pausing it. I'm looking up what Erdheim-Chester is because this is ridiculous. Erdheim-Chester Disease. It's a rare type of slow
growing blood cancer. In Erdheim-Chester the excess
production of histiocytes, AKA histiocytosis, leads
to inflammation that can damage organs and tissues
throughout the body causing them to be thick
and dense, scared fibrotic, and this tissue damage
may lead to organ failure. I thought they tested
for this and if they did a kidney biopsy, they
would have found this. I don't know where he's going with this. This is a disease that probably happens one in a million, kind of
appropriate for a House episode. - He tested negative. - So did Ester. - The disease lied. - [Cameron] Yeah, the
tumors got it in for you. Diseases don't lie. - Fine, it didn't lie. It slow played us. We biopsied the colon, it
hadn't reached the GI tract yet. It's there now. It's in his liver, his lungs. - You want it to be there, because then you didn't
screw up 12 years ago. - We can't waste our one test on the one disease we know it's not. (suspenseful music) - Run the test. - Why didn't they do the kidney biopsy? (suspenseful music) - Take your time and say it loud. - They turn red. - CD68 positive. *House hits wall* *Dr. Mike laughs* - It's so dramatic. I feel like - - Start the treatment. - This is how the US National Library of Medicine describes it. It's a rare type of slow
growing blood cancer. How is this child dying in 48 hours? I don't know. Something about this seems shady. Had they'd just followed regular protocol, consulted the proper physicians, instead of having House
run a muck with this case, this would have been
solved so much quicker, so much simpler, without
the child suffering these side effects. - So Ester can rest peaceful now, huh? - Yeah. - House M.D.'s awesome, but check out these hilarious two videos. I know you're gonna love them. And stay happy and healthy. (soft beat music)
