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Tuesday, June 6, 2006

What Happened To House's Leg?

I've noticed we've been getting a lot of hits about what happened to Dr. House's leg. Also, "What happened to House's wife?" Even though technically Stacy wasn't his wife, they were just life partners or whatever.

The following is a recap of the episode where you will learn, what happened to House' leg, but if you're truly impatient, you can just scroll down to the second to last paragraph and get the quick summary version.

Season One: Episode 21 - Three Stories

Originally broadcast 5/17/2005
Watch and Download the Full Episode of House MD

Anyhoo, House was working Cuddy to get out of having to lecture a medical student class. He finally gave in with the agreement that he would get two hours off of clinic duty. While heading to the class he runs into Stacy, who needs him to help with a case. She gives him her husband's file. House is a bit taken aback, because he didn't know that she was married. In typical House form, he suggests it's probably just a case of indigestion, a kidney stone, or something.

His symptoms are abdominal pain and fainting. He's been to 3 different doctors, but they've turned up nothing. She's desperate for House to help, so she begs for House to take the case. House quips that he isn't sure that he wants her husband to live.

Cut scene to the class of 3rd year medical students. House is lecturing the students on a hypothetical case where 3 different patients are suffering from leg pain, one of the patients winds up in a coma. The students make suggestions as to what might be the problem, and the back and forth is much like that with House and his team. He chides them that everybody lies. Trust no one.Do your own detective work, and never have strong feelings for the patient. House also points out that sometimes a wrong diagnosis can kill a patient.

During a break, House talks to Wilson about Stacy's husband. Wilson thinks that there must be something seriously wrong with her husband if she is desperate enough to seek help from House. The students interrupt House and drag him back into the lecture hall. They continue to take guesses at what is wrong with the leg pain patients.

House suggests a scenario where a farmer is bitten by a snake. The procedure is to find what type of snake bit him, and administer the correct antivenin. If that doesn't work, then you try a different type of snake that it could have been, and administer another antivenin. Then he poses the question. Who simply tries on antivenin after another, and who would try to determine the exact type of snake it was first. The class is split. House lets them know that 1/2 the class saved the patient, and the other half killed him. The point of course being that mistakes kill.

House feeds the students more information about the 3 leg pain patients. One treatment works, the other doesn't. One patient doesn't respond to treatment, and one just might be a drug addict trying to weasel a killer score.

Back to the snakebite. He tells the farmer he's going to die from a snakebite. The farmer asks what will happen to the dog. It turns out the dog bit the man, not a snake. Patients lie. Everybody lies.

The possible druggie is having brown discharge in his urine, meaning blood. His kidneys are shutting down. This is caused by muscle death, which releases myoglobin and is toxic to kidneys. The students prescribed antibiotics and bed rest, so the patient will be dead in 3 days. They screwed up and killed someone, and they’ll need to learn to deal with that.

In the final case, it turns out that the patient is a high school voleyball player who has tendonitis. A closer exam showed a nodule in the girl’s neck. An MRI then revealed an osteosarcoma, which is a cancerous tumor in the femur. It has to be removed surgically, but if it’s too large or too ingrained the leg might need to be amputated.

Quite coincidentally, the farmer has flesh-eating bacteria contracted from the dog’s mouth. The damaged tissue has to be removed, and the farmer’s leg might also require amputation.

In one of the hospital rooms, Cuddy tells a 30something man that an MRI showed a problem... and they may need to amputate his leg.

Back in the lecture hall, Cameron, Chase, and Foreman are observing House from the back row. When House explains that an MRI showed that the a clotted aneurysm caused the leg pain, and that led to a subsequent infarction, the doctors finally realize that the three fictional patients are in fact only one real patient -- House himself.

Flashback to the hospital room, where Cuddy tries to convince the man that he needs surgery. The man is House. He refuses to allow them to amputate his leg. Stacy begs him to get the amputation, but House will have none of it.

In the classroom, the empty seats begin to fill up. House explains why doctors amputate. The more you make sure that all the bad tissue is gone for good, the less chance there is that anything can go wrong, post surgery.

In the flashback, House utterly refuses surgery. He insists on having a bypass to try and restore the circulation to his leg, thus revitalizing the tissue. Stacy is in disbelief at his stubbornness. The surgery appears to be successful, but with the agonizing pain that he was told he would go through. House studies his own chart, and is disturbed by the rise in his potassium levels. He calls a nurse, and demands to be given a dose of calcium glutinate, but before she can do anything, House goes into cardiac arrest. Cuddy runs in and fires up the paddles.

Were back to the classroom again, and House explains that the patient was clinically dead for more than one minute. House flashes to the time when he was "dead." He sees the farmer, and the volleyball player. They are wearing prosthetic legs, and living almost as if nothing had ever happened. They have adapted, and the technology of prosthetics is very good.

Wilson interrupts and asks if house thinks the visions were real. He says it's just a chemical reaction in the brain, as it begins to shut down. Cameron and Foreman ask why he would explain it that way, and not in a more religious fashion. House replies that it is more comforting for him to believe that life isn't simply a test. (To see if you're worthy of an afterlife)

Flashback. Stacy is by House in his hospital bed. He is struggling with the pain, and she pleads with him to just go through with the amputation. He tried it his way, now it's time to do it the right way. He would never let one of his patients refuse the correct treatment the way he is doing himself. He wants to be put into a chemically induced coma to sleep through the agony of recovery. Stacy has a plan, that as his medical proxy, she can make decisions for House while he is under. Cuddy agrees to it even though she is torn on the ethics of it.

Once House is under, Stacy asks about that middle ground where it's more drastic tissue removal than a bypass, but less drastic than an amputation. Cuddy explains how they would cut out the dead muscle tissue, and Stacy agrees to have them go forth with that procedure.

House explains to the students that so much muscle was removed that the leg was nearly unusable. Since they took so long to finally remove the tissue, the patient is still in chronic pain, to this very day. As the students begin to debate whether stacy made the right decision, House asks when the class is over. Cuddy, who was another observer of the class by this point, replies that the class was actually over 20 minutes ago.

House limps out of the class and we see him back in his office. He calls Stacy and tells her he will see her husband the next morning.

Whew! To summarize, what happened to House's leg was that there was muscle death of the leg. He should have had it amputated, but he didn't. Instead, he wound up with a nearly useless, and chronically painful leg. Stacy, as a participant in this demise, well, I guess the relationship was all downhill from there. House realizes it was all his fault. If he would have just got the amputation, he wouldn't have screwed it all up.

So that's what happened to House's leg. I hope that clears things up.


JoeyB said...

Great review. Thanks much for the in depth recap.

Anonymous said...

I'm new to the House MD series, but I do have to say, thanks so much for the recap. It was a great breakdown of how and why House is in his current condition.

Dr. House MD said...

I'm glad you found it enlightening. We'll be back with new content for the new season.

Anonymous said...

Okay, but I haven't seen anyone answer this question:

If House is in so much pain now that he's doing risky/insane things like asking his boss to inject morphine directly into his spine (just saw that rerun), then why doesn't he just have his leg amputated now? If he realizes that he SHOULD have allowed it to be amputated before...what's different now?

Or, at the very least, why aren't his friends/colleagues pushing the amputation solution?

Have they addressed (dismissed) this idea in any episodes?

Anonymous said...

I am a resident in general surgery. Patients who develop serious infections with the complication of serious pain before amputation have a very high risk of having phantom pain following amputation. Phantom pain is very hard to treat since there is not a real nerve ending to anesthetize. So, even though I haven't seen this on any episode, I am thinking this would be the reason to not have an amputation at this point.

Julia said...

Thanks, Anonymous. I hadn't even thought of the phantom pain possibility.

Collin Grady said...

You're slightly mistaken on the recap - the farmer and volleyball player are real cases, it's only the third one that is House.

Anonymous said...

The brown discharge was not blood.
It was waste (dookie).

Anonymous said...

The discharge was urine, blood, and waste. Dr. House used crayons to color a piece of paper to make this point (I think he used red, yellow, and brown).

Anonymous said...

so does house get bite by a dog or is it just a metaphore for his leg?