Transplant (episode)

This article is about the second episode of Season 8. For the medical procedure, see Transplant.
Transplant is a Season 8 episode of House that first aired on October 10, 2011. It's written by David Foster and Liz Friedman and directed by Dan Attias. It takes place about two months after the events in Twenty Vicodin. Thanks to his bad behavior, House is serving the remainder of his original remaining four months with another eight tacked on. However, a surprising visitor makes House an offer he can't refuse by giving him the opportunity for conditional release and return to the Princeton Plainsboro team to treat a unique patient in order to save the life of an organ recipient being treated by Wilson. Out of prison and back at PPTH, House is working in medicine again, but is put on a very short leash with a tiny office, a limited supply of Vicodin, and the constant threat of return to prison. Although House finds himself back on familiar ground, he quickly realizes that much has changed since he left - Chase, Taub and Thirteen have all left for greener pastures. For his "team", House is forced to work on the case with smart yet timid resident Dr. Chi Park (Charlyne Yi). After several inconclusive treatments and with time running out, House and Dr. Park are left with one last option to examine the patient's medical history that could compromise House's conditional agreement with the hospital. Will a man who, without a second thought, took an extra eight months in prison in order to prove himself right really abide by the restrictions, or has he learned his lesson at last? Meanwhile, House makes an effort to reconnect with Wilson despite a cold reception.
This episode marks the first appearance of Charlyne Yi as Dr. Chi Park and the first appearance of Foreman as the new Dean of Medicine.
After putting House into even deeper trouble in the Season 8 premiere, this episode tries to hit the restart button by putting House back into the role that makes the series so intriguing. However, it's made more difficult by the real world departure of key cast members. As such, House goes into crisis mode where he seems to be the only one who can save the day. However, in the end, House still remains House as if his experience has not taught him any lessons whatsoever. 
The dynamic between House and Foreman illustrates this clearly. Foreman is now House's boss but early on House is flouting Foreman's authority which, to be fair, Foreman should have seen coming. House has never put his position first, or even the patient first. The puzzle comes first and, in that situation, both his superiors and his patient get moved down the priority list. One thing that does help him is that technically, Park isn't his responsibility. Unlike his fellows, who House actually had to teach, Park really is House's assistant here and, since she hasn't been board certified yet, technically she's not qualified. As a result, Park is clearly expendible.
But in many ways we see the development of Park very quickly as someone who is difficult to push around. Her weakness is that she tries to "keep up appearances" but, as House points out, in reality Park is exceptionally passionate. She's also not a bully - she, like House, will challenge anyone or anything who gets in the way of her doing her job. It's something that House really needs.
==Recap==
C.O. Alvarez wakes up a sleeping Gregory House late at night. He tells House he has a VIP visitor - the Dean of Medicine at Princeton-Plainsboro Teaching Hospital. House says he can refuse to see any visitor and he doesn't want to see her. Alvarez says "he said you'd say that". House gets intrigued and agrees to go. He finds Eric Foreman in the visitor's room. Foreman says he can get House out of prison. There's a medical crisis to deal with. The order requires that Foreman is his employer. House declines, both for his sake and Foreman's. Foreman tells him the crisis patient is two lungs in a box- the perfect patient for House. They have to make them better in 12 hours. House finally agrees to come. 
thumb|300px|left|Surprising visitor
While prison officials start releasing House, Forman briefs him. The donor was an 18-year old victim of a motorcycle crash. Most of his other organs died due to lack of circulation, but they managed to harvest the lungs and put them in suspended animation to preserve them for 24 hours. However, the lungs have increased airway resistance and they have no idea why.
Back at the hospital, House admires the new artwork. Foreman warns him that if he breaks the law, scams Vicodin or flouts Foreman's authority, he's going back to jail. When House says "yes massah!", Foreman tells him that's a good example of what will get him sent back. He tells House Lisa Cuddy handed in her notice the day after the crash. House notices his old conference room and office been converted to an orthopedic treatment area. He looks at his old office and wonders where his stuff is, and Foreman tells him he has no idea. Foreman tells him Chris Taub, Robert Chase and Thirteen have moved on. He then leads House to a tiny, windowless office and introduces him to his new "team" - a young Asian doctor cowering in a chair.
thumb|300px|left|Introducing Dr. Park
House figures the young doctor, Dr. Park, is someone's reject - she's fully made up and pressed even though it's three in the morning. That means Foreman didn't wake her up, which meant she was already there, but had no work to do. He tells her to go back to neurology, but she says she can't because she punched her attending.
They go to see the "patient". James Wilson is there with Dr. Ron Simpson. Simpson says they first thought the problem was ARDS and starts briefing House. House calls out "Prison!" to break the tension. House thinks it's a tick borne illness, but they have already tried antibiotics. House then turns to cocaine, but when they say the tox screen was clean, House notes that if he died right after using it, none of the metabolites they test for would be in his urine. Simpson agrees with the suggestion and wants to start treatment, but House stops him - treatment would destroy the lungs if he's wrong. He agrees to take Dr. Park and look for the drugs.
House follows Wilson out of the room. He has guessed that they need the lungs for one of Wilson's cancer patients. He goes to thank Wilson for getting him out, but Wilson insists that it was all Foreman's idea. Wilson was opposed to it until Simpson's first three diagnoses were wrong. House asks about Wilson's wrist, and he says it's fine. House also admits that he was wrong, and although he hasn't changed, he has paid for it. Wilson says he can believe anything he likes, but he and House aren't friends any more.
thumb|300px|left|Reconnecting
Wilson goes to see his patient Vanessa. Wilson warns her that they probably won't find another set of lungs. He tells the patient and her sister Theresa that a consultant has been brought in. When Theresa asks if he's good, Wilson gives him a cool endorsement.
House and Park go to the patient's home. He wants to know why Park assaulted her boss and tells her they have something in common that way. She says her attending grabbed her behind. He figures she's staying on-call to avoid her boyfriend, who would most likely attack the attending himself. However, she says it's her parents - if they found out what she did, they would be mortified. She tells House they know her on-call schedule because she still lives with them.
Mr. Weathers lets them search the room, but tells them his son doesn't do cocaine. Park warns House that he's about to throw them out, but House says the father may be mad, but he realizes the son's death would be useless unless the transplant succeeds. The father tells them that his son was at a poker game before the accident. House finds a pair of glasses, but notices the patient isn't wearing them in any of his pictures. The father tells him they're only a couple of weeks old. House asks about headaches, and the father confirms he was suffering from them. House tells the father it wasn't cocaine, but was probably a brain tumor. House then goes to answer the doorbell, because his ankle bracelet probably tipped off the police he wasn't in the hospital. The police officer escorts House to his vehicle.
The police officer returns House to Foreman, who is angry House has already broken the conditions of his release. He wants to know why House didn't just tell him where he was going. House tries to blow him off, but Foreman tells him the Board of Directors was tough to convince and if House can't solve the case and make it look like Foreman can control him, it's all over for both of them.
They find the dead patient's body at the morgue. Park says she isn't worried about the disciplinary hearing. Park plans to take the body to the MRI, but instead, House performs a physical examination and finds a mass in the arm. He goes to take a biopsy. House figures that since Park is overly concerned about how others see her that she plans to leave the hospital for another job before a disciplinary hearing. She admits she had a recent interview. House tells her she's running away to protect her parents. Park admits it, but says that maybe she should drive her car into her parent's living room instead.
Wilson goes to see his patient again. They talk about her old boyfriend Bobby. However, Wilson realizes his patient has stopped urinating. He realizes it's the nitroglycerine she's been given for her angina. They have to cut it back, which means her chest pain will return.
Wilson finds House in his office playing "My Heart Will Go On". Wilson is angry that House isn't working on the case, but House assures him they have a diagnosis and Park is confirming it. After they argue about their old friendship, Park comes in to announce the "tumor" was just coagulated plasma they gave the patient in the emergency room. She did an MRI and found no sign of cancer. House thinks it might have been the plasma, but Park realizes every unit of plasma has 25 donors who will have to be tracked down.
House asks permission to go track down the donors, but Foreman refuses even though House points out Park can't do the job in six hours by herself. Foreman tells him he can't trust him, and they don't have money for more staff - Neurology is paying for Park and House is only being paid minimum wage. Foreman throws House out.
However, House enlists Wilson to help. Wilson calls him to suggest a peanut allergy and insists he's only helping out for his patient's sake.
House goes to retrieve his whiteboard, but Betty intercepts him and threatens to tell Foreman. However, House steals a marker and starts using the window of his old conference room as a whiteboard. Park calls to suggest dengue fever. House furiously starts writing down possibilities. Later, Park calls from an underpass where a homeless donor has been drinking heavily. She also notices there's a crew there to scrape off old paint. They both think of lead poisoning.
Wilson's patient is having severe chest pain. House calls him out and tells him Park has started chelation. He offers Wilson a Reuben sandwich. Wilson thanks him and hopes the diagnosis is right. House says that even if Wilson's patient dies, someone will get the lungs. Wilson says he's given up red meat and throws the sandwich in the trash.
Foreman drops by the lungs to get a status report. Park tells him the lungs appear to be responding to chelation. She wants to know who he's checking up on. He asks about House. She says she has no idea if he's okay. She then sees her father outside. He says he got a text asking him to bring dinner. He dropped by Neurology, who said she was on leave. She quickly says she's been asked for a consult on the case. The lungs start to crash and she says she has to go. It's obvious the chelation isn't working and after a few quick tests, they realize it's a vasospasm. Foreman runs to get a calcium channel blocker. Luckily, it works. The lung starts getting pink again, but Park notices one lobe is still oxygen deprived. It appears to be dead.
House plans a biopsy of the dead lung tissue. Park realizes House stole her phone and texted her father. He tells her she has to tell her parents about hitting her attending. She says it was wrong to have done it. However, he remembers her screaming at the painting crew at the overpass and realize she gets angry very easily. When Dr. Mike Pinto leaves his office to do the biopsy, House goes to steal his old chair back, but Park won't help. They discuss why chelation made the lungs worse. Park has already tested the plasma, and it was negative for any of the toxins they thought of. House then thinks of sarcoidosis, but the patient's ACE levels were normal. When Park starts suggesting the underpass may have had other heavy metals, House realizes that if the patient had iron toxicity, the chelation would have made it worse. He orders a test. He then accuses Park of trying to steal the chair when Pinto returns.
Wilson's patient is getting worse with severe shortness of breath. They have to use an oxygen rich slurry to fill her lungs. He tells her it's going to hurt. She refuses.
Wilson confronts House in one of the bathrooms. He tells House his patient has signed a do not resuscitate order. House tells him he's not trying hard enough with his patient. Wilson leaves in a huff.
Park does the tests as Foreman comes by. He asks if her father coming by was House's idea. She says that House must pull stunts like that a lot. Foreman assures her that's as close as House gets to giving people compliments. He also tells her he gave her a good reference for her new job. He confirms he didn't mention the fight, and how that works out well for everyone. Park wonders why it works out well for Foreman and points out that she's very well qualified and he should be firing her attending instead. He says he can't talk about it until the hearing. He offers to call her new employers back, but she calms down and tells him he doesn't have to. She then calls him back to look at the slides - no iron, but lots of white blood cells, which indicate an infection. She wonders how they could have possibly missed it (MISTAKE: on the biopsy slide not only she saw white blood cells, she should recognize the WBC as Eosinophils which then should direct her to Eosinophilic pneumonia. But is doesn't as they wanted to drag the episode a bit longer) .
House is munching on someone's fruit basket. Park reminds him that they already treated for infection with antibiotics. House realizes the infection is hiding inside the cells of the lung where it would be safe from the antibiotics. They would have worked if the patient had a fully functioning immune system. He wants to try antibiotics with immunoglobulin. Park asks if House is using metaphors with her because he thinks she's stupid. He says he used metaphors with his old team because they were stupid too.
thumb|300px|left|Metaphors
Wilson brings Bobby to see Vanessa. Bobby says Vanessa invited him, but Wilson admits she didn't and it was his idea. He goes to leave until Vanessa calls him over.
Wilson finds House in radiology and won't leave him alone to rest. He tells House Vanessa has agreed to the lung slurry and that he was right to push him. House wonders if they are friends again, and Wilson says he's just thanking him for good advice. As Wilson goes to leave, House tells Wilson that he likes him and has fun with him. He tells Wilson that if he still likes him and has fun with him, to do whatever it takes to get over it. Wilson admits he doesn't like House and leaves.
House is paged as the lungs start to get discolored right after the immunoglobulin is started. This would appear to rule out infection. Simpson tells House he screwed up and that the lungs will soon not be viable for transplant. House goes over all the diagnoses and says he needs ideas. Park and Simpson start throwing out diagnoses, but they are all eliminated. House leaves to think.
House breaks into his old conference room by breaking a window. The technician comes by and throws him out. House starts bouncing a ball until he sees someone having a birthday party. He sees the smoke from the candles and thinks of something.
House realizes that because the dead patient was at a poker party, he most likely inhaled large amounts of cigar smoke. If he had eosinophilic pneumonia, the smoke would have been enough to kill him. He probably collapsed while riding his motorcycles. Park notes that they gave him steroids, which would have treated it. House feels they have to do something more drastic, like radiation therapy. Park wants to just use a stronger cocktail of steroids and immunosuppressants, but House points out that if they go that route, Wilson's patient will die.
They irradiate the lung despite the risk of damaging healthy tissue. It starts working. Foreman comes in. Park announces she's not leaving even if it means a hearing. She calls her father.
The transplant goes ahead and Wilson's patient starts to recover. Theresa thanks Wilson for calling Bobby.
House goes to light a cigar when he hears Foreman calling him. He takes him to his old office, where all his stuff has recovered from storage. Foreman says Orthopedics still gets the conference room. House wonders where Taub, Chase and Thirteen are going to sit. Foreman says "You're welcome". Wilson comes by and punches House in the nose. He then offers to buy dinner. House suggests a new vegetarian place, but Wilson says he wants a steak. He says he will be at House's apartment at 8.
House then settles back into his chair, content.
==Major Events==
*House is released from prison early to help on a case involving a set of lungs taken from a man who died in a motorcycle accident.
*It's revealed that Foreman is the new Dean of Medicine, Cuddy having given her resignation the day after House crashed into her living room.
*PPTH is revealed to have changed the course of a year as with Cuddy's departure, Foreman was promoted to succeed her as Dean of Medicine and presumably with House in prison, the diagnostics department was shut down, its team members departing from the hospital with House's former office and conference room now belonging to orthopedics.
*Dr. Chi Park is introduced for the first time.
*Wilson informs House that he has changed in their time apart, saying that he's given up eating red meat.
*House implies he may or may not have been raped during his time in prison.
*House tries to mend his relationship with Wilson by allowing him to punch or kick House, only for Wilson replies to tell House he doesn't like him, and doesn't want to repair the relationship.
*House and Wilson reconcile after Wilson punches House in the nose, resulting in their friendship being reformed once again.
*House is given back his old office while the outer conference room is still being used by orthopedics.
==Zebra Factor 6/10==
Eosinophilic pneumonitis is fairly rare.
==Title==
The title is drawn from the procedure planned in the episode. 
==Trivia & Cultural References==
*"Hofstra" is Hofstra University, a private university in Hempstead, Long Island, New York. 
*House's nicknames for his team are Kato and Black Beauty, references to Green Hornet. Kato was the Green Hornet's Asian assistant.
*The "bad deal for Manhattan" refers to the legend that the Dutch bought the island for $24.
*The references to the necklace being thrown into the ocean and one thousand people going down in a gigantic boat is from the film Titanic.
*The reference to Reverend Moon is Sun Myung Moon, the Korean founder of the Unification Church.
*Gomguk is a Korean soup made with various cuts of beef that are simmered slowly in broth. 
*Sri Lanka obtained independence from Britain on February 4, 1948.
*Blitzkrieg was a tactic used in World War II consisting of highly mobile troops largely composed of tank divisions.
*Ralph Garman, who portrays Bobby, is wearing his own trademark leather jacket. 
*"Park" is the third most common family name in Korea and is used by 8% of the population of the Korean Peninsula. 
==Music==
*"My Heart Will Go On" by Celine Dion plays on Wilson's laptop when Wilson enters in his office while House is waiting for him. It was also featured in the soundtrack of the movie Titanic, which explains the multiple references to the movie House makes during that scene.
*"Yesterday Was Hard On All of Us" by Fink plays during the closing scene.
==Goofs==
*When House first looks at Foreman, Foreman's computer is slightly open. However, a few seconds later, it's completely closed.
*Park suggests heavy metal poisoning by beryllium or asbestos. However, beryllium is the second lightest metal, and asbestos is not a metal.
*When Wilson punches House in the face, the sound of the punch occurs before Wilson's fist reaches House's face. 
*It's probably impossible to keep a pair of vital lungs in a box. 
*It's never explained how House re-gained his medical license. A felony conviction is usually an automatic disqualification.
*The radiation treatment works too quickly. Usually treatment like this has to be repeated several times over a long period of time.
*Vanessa suffers from active angina, which is usually a disqualifying condition for a transplant.
*Nitroglycerine won't cause kidney problems.
*It's unlikely a patient susceptible to eosinophilic pneumonia has never had symptoms of the disease before. After all, the patient has probably been around cigarette or cigar smoke.
==Reviews==
Scepticemia gave the episode a brutal review, calling the medicine questionable and the acting poor. 
* IMDB users gave the episode an 8.3 rating with 25% of users giving it a "10". It did best with females over the age of 45 (8.8) and worst with males over the age of 45 (7.9).
* Polite Dissent liked the story and the medical mystery, but felt the medicine was weak and the solution was unsatisfying. 
* TV.com viewers rated the episode an 8.0. They chose Charlyne Yi as their most valuable performer.
==Medical Ethics==
===Dealing with family===
Part of a physician's training is dealing with the family members of the patient. Issues can arise both when family disagrees with the patient's choice of treatment, or when the physician must inform the family of bad news. It's particularly difficult when there is no hope for the patient, but the family insists on continued treatment.
As such, ethical guidelines warn physicians to maintain as good a relationship with family members as possible. Good physicians are trained on strategies to build rapport with families, including providing information on the possible outcomes of a case to both allow the family to continue trusting the physician and to prepare them for what difficult decisions might come. This issue was most adequately addressed in Maternity when Allison Cameron downplays the risk to the newborn infant, which blindsides the family when the worst happens.
Unfortunately, this plays entirely to House's weaknesses. Guidelines suggest building bonds with the family in tense situations, something House has no interest in. Park is correct to call House out on treating Stevie's father poorly. It's not just that they might be thrown out. The father will remain an important resource until the case is resolved and casting aspersions on his late son at this stage is not going to get House anywhere. As it turns out, Stevie's death was not due to his behavior, but to an underlying illness. If House had made an attempt to take a medical history, much as he had done with Gabriel Wozniak in Son of Coma Guy, he may have been able to reach the conclusion more quickly.
==Cast==
*Hugh Laurie as Gregory House
*Robert Sean Leonard as James Wilson
*Omar Epps as Eric Foreman
*Jesse Spencer as Robert Chase (credit only)
*Peter Jacobson as Chris Taub (credit only)
*Odette Annable as Jessica Adams (credit only)
*Charlyne Yi as Chi Park
*Liza Snyder as Vanessa
*Heather McComb as Theresa
*Bruce McKenzie as Mr. Weathers
*Ron Perkins as Ron Simpson
*Michele Marsh as Betty
*Ralph Garman as Bobby
*Wayne Lopez as C.O. Alvarez
*Charles Rahi Chun as Kwansik Park
*Kamall Shaikh as Technician
*Jimmy Stathis as Mike Pinto
==Quotes==
Dr. Gregory House: Hey, we both assaulted our bosses. It's like we're twins.
Dr. Chi Park: I'd really rather not…
Dr. Gregory House: Okay, I'll go first. My boss dumped me. And yours what? Called you his China doll? Joked about what a crappy deal you got for Manhattan? Assumed you have a huge penis? I have no idea what flavor you are, so I thought I'd just cover the spread.
Dr. Chi Park: My mom's Filipino, Dad's Korean and my boss grabbed my behind.
House: Behind what? Oh, yeah, your--grabbed your tushy.
Dr. Gregory House: I'm not interested in another department's sloppy seconds.
Dr. Chi Park: I'm not sloppy seconds.
Dr. Gregory House: 3:00 a.m. If Foreman had called you in from home, you wouldn't have pressed clothes, coiffed hair and makeup which means you were already here in the hospital.
Dr. Chi Park: Yes, I was on call for neurology.
Dr. Gregory House: Well, if that were true, you'd be working right now and unavailable to help which means that you're hanging out in the hospital pretending to work which means you're not just a reject, you're a cowardly reject who was trying to hide her rejectedness from someone.
Dr. Chi Park: I am not a reject.
Dr. Gregory House: Then go back to neurology.
Dr. Chi Park: I can't. I punched my attending.
Dr. Chi Park: Why aren't you more alarmed? We're running out of time.
Dr. Gregory House: AAHH, SHE'S DYING! Were you able to figure out what was wrong while I was screaming?
Dr. Chi Park: Did you use metaphors for your old team? Or do you just think I'm particularly stupid?
Dr. Gregory House: No, they were stupid too.
Dr. James Wilson: [Punches House hard in the face] Dinner later? I'll pick something up.
Dr. Gregory House: [from the floor] I… I probably know a new vegetarian place.
Dr. James Wilson: Screw that. I want a steak. I'll meet at your place at eight.
Dr. Eric Foreman: Get this straight. You break the law, you go back to jail. Scam extra Vicodin, back to jail. Flout my authority, make the hospital look bad, back to jail. I own you.
Dr. Gregory House: Yes, massa.
Dr. Eric Foreman: See, that would be an example.
Dr. Chi Park: Violence isn't an appropriate way to handle conflict. It was a moment of weakness.
Dr. Gregory House: You barked at me, picked a fight with a painting crew. Maybe it's time to recognize it's not a character flaw. Maybe it's your character.
Alvarez: Get up, House.
House: Must be some mistake. I specifically requested my wakeup startle three hours from now.
House: Nice painting. Blues and greens. Calming, but with a hint of nurturing. Totally offsets the stench of suffering and death. Where's my patient? We need to not talk.
House: Prison! Sorry. I thought I heard everyone else think that. I was in prison, you see. It was a long time ago, but still you're curious. Never was raped, not raped-raped. Well, raped-raped, but not raped-raped-raped. Well, now that we've got that completely behind us.
Dr. Simpson: Sorry, Dr. House. Welcome back.
House: Is there cake?
Mr. Weathers: I told you, my son didn't do cocaine.
House: Druggies are not known for their honesty. Trust me on this one.
House: Running away from home is a time-honored tradition. But you're not doing it to flee your parents, you're doing it to protect them. That's an insult to everything teen prostitutes have worked for.
House: Nice.
Dr. Wilson: What?
House: Nothing.
Dr. Wilson: Don't start that.
House: Start what? I'm enjoying our conversation. The repartee.
Dr. Wilson: There was no repartee.
House: That was repartee.
Dr. Park: I told you I'm Korean and Filipino.
House: And I told you I wasn't listening. By my actions.
Dr. Wilson: House, the nurses saw you come in.
House: Enter.
Dr. Wilson: It's a bathroom.
House: Ah, explains the hole in this chair.
==Release Dates==
* United States - October 10, 2011 on Fox
* Canada - October 10, 2011 on Global
* Brazil - October 10, 2011
* United Kingdom - October 13, 2011 on Sky1
* Australia - October 21, 2011 on Channel Ten
* Israel - January 11, 2012 on HOT3
* Belgium - January 15, 2012
* Finland - January 17, 2012
* Hungary - March 7, 2012
* Germany - March 13, 2012 on RTL
* Sweden - September 4, 2012 on TV4
* Netherlands - November 21, 2012 on SBS6
* Czechia - December 3, 2012 on TV Nova
* Slovakia - January 15, 2013 on STV1
* Finland - August 5, 2013 on MTV3
* Japan - September 10, 2013
==In Other Languages==
France and Quebec - Second souffle (Eng. "Second Breath")
==Links==
*Episode page at House MD Guide
*Episode page at IMDB
*Episode review at Scepticemia - Includes a tremendous flowchart diagram
*Episode guide at Ace Showbiz
*A list of the music tracks at Tunefind
*A review of the medicine at Time Magazine
*A review of the medicine at Polite Dissent (at archive.org)
*Episode article at Wikipedia
*Episode transcript at Clinic Duty
*Episode at TV.com
Category:Episodes
Category:Season 8
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