Heavy

Heavy is a 1st season episode of House which first aired on March 29, 2005. A morbidly obese 10-year-old girl has a heart attack. House is intrigued, but the obvious cause of her problems seems to be her weight, and Chase won't stop mentioning it. Can the team look through her appearance to see the real cause?
==Recap==
An obese 10-year-old girl, Jessica, is at home and is saying not feeling well as she's supposed to be going off to school. Her mother feels she is just trying to avoid school because all of her classmates are bullying her. However, while skipping rope during exercise class she complains that her arm and chest hurt and she collapses from a heart attack. Her teacher calls 911 and starts to administer CPR.
House is trying to deal with a conundrum. On Vogler's orders (backed by Cuddy), to make his department profitable, he has to fire one of his three staff members. House tries to stall for a few months, but Cuddy tells him he has a week.
Cameron comes to House with Jessica's case. Foreman is incredulous – 10 year olds don't have heart attacks, but Cameron shows all the tests are positive. Chase feels the heart attack is just because of her weight. However, House thinks there must be some other underlying condition. He suggests testing her insulin levels – they might be too high. He also drops the news that one of them will be fired. Cameron realizes it is Vogler's idea, and Foreman realizes they all have to stick together.
The mother is resistant because Jessica is already on a diet and exercising regularly, which would be the treatment for the condition they suggest she has. The patient resists being weighed, but Chase insists they need an accurate measurement. Foreman tells the kid he used to be heavy too, but grew out of it. She steps on the scale. Chase and Foreman then argue about whether you can "grow out of" obesity. Cameron isn't on Chase's side, and Foreman puts down his crankiness to his impending firing.
Wilson warns House not to take on Vogler as House lacks any talent for office politics.
They start the test, but Jessica starts to turn angry and demanding. The doctors think she has become hypoglycemic and they are forced to sedate her. Foreman explains the psychosis was normal, but the mother is mad that they weren't taking the test seriously. House comes in and reports that she was negative for hypoglycemia and diet and exercise have nothing to do with her condition, and the psychosis wasn't the doctors' fault either.
Cameron and Chase argue about whether the patient's weight has a bearing on her condition, with Foreman staying out of the fray. However, House suspects she may be taking diet pills and orders his team to find them. Foreman is angry that House has turned the team against each other to compete for the job. He asks Foreman who he should fire, and when Foreman doesn't respond, he threatens to fire him. Foreman suggests he fire Chase because he really doesn't appreciate the job. House is surprised that Foreman chose anyone – he usually doesn't enter into the fray. He discusses it with Wilson, who suggests that House quit himself.
Foreman goes to the patient's teacher. She tells Foreman that Jessica's only friend is an older kid who was assigned to her.
Vogler is upset that House hasn't fired anyone yet. He goes to Cameron and offers to help if she gets fired. Cuddy wonders why Vogler is interested in House's team all of a sudden.
The older kid tells Foreman that she's not a friend, but tells Foreman that she said she was taking diet pills. She also confirms that the patient is always exercising during recess. Foreman confronts the mother, but the patient admits she did take them – she shoplifted them. Foreman realizes that this explains all of her symptoms. Once again Chase is going on about the patient's obesity.
However, the patient develops a new problem, she starts bleeding from a skin necrosis on her chest. This can't be explained by the diet pills. House thinks that they gave her the wrong treatment – two doses of warfarin instead of one of warfarin followed by heparin, and that Cameron must be at fault. Chase and Cameron argue about whose fault it was. House tells them to take care of the patient.
Vogler goes to see Foreman. Vogler realizes from the chart that they screwed up the medication. He wonders why he's working with House. Foreman says he respects House. Vogler asks Foreman if he wants to keep his job.
House goes to see Cameron, who swears she gave the patient the right medicine – heparin. However, she doesn't have an alternative explanation. Cameron asks why House isn't backing her when she backs him when he screws up. He wonders why she would back someone who screwed up. He asks Cameron who she would fire. She suggests cutting everyone's pay. He says it won't work, but she reminds him he's stalling.
However, House goes to Cuddy and Vogler with Cameron's idea. Cuddy is enthusiastic, but Vogler shoots it down. Cuddy realizes Vogler doesn't care about the money, he only wants to boss around House, and Vogler confirms that.
The treatment is not working, and Wilson points out the necrosis is killing the patient. House agrees to have it removed. However, it means removing the patient's breasts.
Cameron comes to see House to see if he wants to fire her. She claims she didn't make a mistake. House thinks she did, but Cameron thinks House has feelings for her. Cameron wonders why he didn't make this a challenge for them to work out, and why he's not doing his usual solo activities.
Chase meets with Vogler about whether he will protect him if House fires him. He tells Chase that either Cameron or Foreman would do just as well. Chase is sure Cameron wouldn't be Vogler's rat, but he's not so sure about Foreman.
The patient isn't improving and they start to prepare Jessica for surgery. House wonders if it could be that Cameron didn't give her the wrong medicine. Finally, Chase suggests the obesity isn't a cause of the problems, but a symptom. Finally, House realizes that the patient's mother is not just heavy, but tall, as is the patient's father. House deduces that her obesity is a symptom – along with her height (shorter than normal for her age), he concludes it's Cushing's syndrome, which causes hyper-cortisol that could account for all of her symptoms, although it only rarely causes necrosis. Foreman points out her cortical levels were normal, but House points out Cushing's can cause cortisol to be released in phases. However, if they treat her for it if she doesn't have it, she will die. But Foreman points out that if they're right, the surgery on her breasts won't help her. He suggests using a MRI to locate whatever might be able to cause the high cortisone levels. They do the MRI and find a tumor on the pituitary gland that confirms Cushing's. She needs surgery, which is dangerous, but she will improve quickly once it is removed, including losing weight.
The surgery goes well. Jessica comes in for a follow up visit and has lost a great deal of weight. Even Chase is impressed.
House goes to Cuddy with his decision – he's firing Chase. However, Vogler refuses to let him fire Chase (because he can't find another snitch) and tells him to pick someone else. House refuses. Vogler tells him to pick someone else or it'll be the whole department that is fired.
We're left with Cameron writing up her resume and everyone pondering their position.
==Clinic Patient==
A woman comes in complaining of a burning sensation in her chest. However, House thinks it's just heartburn. He also thinks the woman, who is on the heavier side, is pregnant. However, she says that this is her normal body shape and that her husband has had a vasectomy and they also use condoms. House goes to get some antacids, and makes up an excuse to draw a blood sample to test it for the hormones that appear during pregnancy.
However, the blood tests and ultrasound turn up something surprising - a 30 pound benign tumor on her ovary. However, she doesn't want to have surgery because of the scar, and figures the doctors want to change the way she looks. Wilson tries to reassure her that the surgery will deal with her other symptoms as well, but she walks out in a huff.
The patient's husband shows up to see House. He doesn't mind her being overweight. The husband is still concerned and asks House to lie to the wife so she will have the surgery. He agrees to see her again after seeing photos of the kids.
House says he should have realized it before because of the double precautions against further pregnancy, but he has realized from the eye color of some of her children that they aren't her husband's. He realizes that although the husband is okay with the surgery, her lovers won't be. He tells her that other men won't care about the scars either, and she agrees.
==Zebra Factor 6/10==
Cushing's disease is quite rare, and the symptoms shown by Jessica are realistic enough. However, it is the difficulty of obtaining a diagnosis that is rather unrealistic. Cushing's disease is often considered as a possible diagnosis if the patient reports weight gain despite proper diet and lifestyle. In addition, the phasicity of cortisol blood levels, and thus the lack of information provided by a single negative result (a fact learned as early as medical school) is why they are not useful in ruling out the diagnosis of Cushing's syndrome: the tests used are blood levels of ACTH (the pituitary hormone that causes the adrenal glands to produce cortisol) and urinary cortisol levels, which are not disturbed by the phasicity of cortisol secretion. Furthermore, obesity alone cannot explain why a 10-year-old girl had a heart attack. A case like Jessica's would have been resolved rather quickly, in real life.
==Major Events==
*Chase intensely dislikes fat people.
*Chase is working for Vogler and reporting back to him on what House does.
*It's inadvertently revealed that nobody would be fired when all three of House's fellows are seen doing the follow up visit with Jessica.
==Trivia & Cultural References==
*The title has a double meaning:
**A reference to the patient's weight (she is heavy).
**A reference to Vogler acting as the bad guy (in movie slang, the bad guy is often referred to as "the heavy").
*It's possible for two brown-eyed people to have a blue-eyed child, as long as both parents have the recessive gene for blue eyes.
==Quotes==
:House: What if it's not the warfarin?
:Chase: It has to be, the sores presented right after we...
:House: Right, right, right, but let's just say it's not. Come on, come on, what do you got?
:Foreman: Can I have a second to think?
:House: No, there's no time to think. Just say the first thing that comes into your head.
:Chase: She's fat.
:Foreman: Enough, already, okay? We got it. You hate fat people
:Chase: That's not what I meant!
==Cast==
*Hugh Laurie as Gregory House
*Lisa Edelstein as Lisa Cuddy
*Omar Epps as Eric Foreman
*Robert Sean Leonard as James Wilson
*Jennifer Morrison as Allison Cameron
*Jesse Spencer as Robert Chase
*Cynthia Ettinger as Mrs. Simms
*Jennifer Stone as Jessica Simms
*Susan Slome as Lucille Hernandez
*Ramon Franco as Mr. Hernandez
*Karen Goberman as Mrs. Ayers
*Chi McBride as Edward Vogler
*Rose Colasanti as Cashier
*D.J. Evans as Classmate Two
*Bryan Fabian as Classmate Three
*Alec George as Classmate One
*Teddy Lane Jr. as Mr. Conroy
*Austin Leisle as Seth
*Alyson Morgan as Clementine
Category:Episodes
Category:Season 1