Histories

Histories is a first season episode of House which first aired on February 8, 2005. Wilson is convinced a homeless Jane Doe in the emergency room has a real illness, but Foreman is convinced she's faking symptoms to stay in the hospital. House takes the case just to spite Foreman, but even when they find who she is and what's wrong with her, the treatment makes her worse.
As its title suggests, the episode focuses on the importance of the medical history, one of House's favorite diagnostic tools. The episode explores the technique in several distinct ways from how interns are trained to what is expected of a sub-specialist dealing with a difficult case. Although the episode emphasizes the need for formal medical records, it also stresses the importance of going beyond what's "in the file" and looking at all relevant information regarding the patient's personal history as well.
The episode also examines the need for compassion in medical treatment. It partly does this by simultaneously doing character development and developing a backstory for both Eric Foreman and James Wilson. In addition to teaching diagnostic technique in this episode, House appears to be using the case to deliberately get under Foreman's skin. In the beginning, it seems House's motives are solely to learn more about Foreman, but towards the end it also appears clear that House is reminding Foreman about what he tried to teach him from day one - when working on a case put aside all your assumptions. Instead, use observation and deduction to find clues that will lead you to the right answer. By the end, Foreman has grown as a doctor, but also as a character within the show.
==Recap==
The woman begs to be taken into a rave party, but doesn't have the money. She pleads to find a man named James, and the doorman agrees. She is confused by the flashing lights, repeatedly calling James. A woman helps her find him, but kisses her. Another woman pushes her aside and police raid the party. She knocks over the policeman arresting the woman who pushed the gay woman aside, and falls to the floor, having a seizure. She is taken to Princeton-Plainsboro where she is admitted as a Jane Doe.
Wilson tells Foreman that although they suspected her condition was a drug overdose, her tox screen was clean. Foreman believes she might have a mental illness. They examine the patient and Foreman feels that she is faking symptoms. The patient has a seizure which turns out to be the result of low blood sugar. She is also displaying a twitch and can't remember who she is. Foreman still feels that she's faking it and wants to discharge her.
Wilson goes to House to tell him that he thinks the patient has a real problem. House wonders why Wilson is so interested in the patient and takes the case. The team does a differential, and Foreman still thinks she's faking it. House believes it's important to find out who she is. He starts going through her meagre possessions. He also points out that without memories, she can't give them a medical history. By looking at her possessions, House feels she might have an electrolyte imbalance. House tells Foreman he's taking the case because Foreman doesn't want him to.
The patient is making drawings of the doctors. Chase speaks to the patient and tells her Foreman doesn't like him either. She goes into a rage while Chase treats her and bites Foreman. Chase notes she's negative for HIV and Hepatitis C. Foreman tries to bump another patient to give the patient an MRI so he can discharge her, but Cuddy finds out about the attempt. Cuddy points out that the CT scan showed the patient has a metal pin in her arm and can't undergo an MRI. She agrees to let them remove the pin because House tells her Foreman believes it's a brain tumor.
Foreman goes out to look for where the patient was living. He trades his jacket to a homeless man to find out, and finds the patient's tent filled with bats. He also finds some papers.
The MRI is negative, but House admits he only took out the pin so that he could identify the patient (the pins have serial numbers that are tied to the patient's name). Most of the papers found are drawings made by the patient. The patient's name is Victoria Madsen. Her medical records start coming in, the first of which shows she's allergic to the anemia medication they are giving her.
The patient suffers a severe allergic reaction. They inject her with epinephrine. However, they still can't determine what might be wrong with her despite finding her old hospital records. Wilson thinks that they might have been looking for ovarian cancer. House notes that paraneoplastic syndrome might account for the twitch and orders them to scan her ovaries.
House dodges clinic duty by faking a cold.
House discusses with Foreman why he doesn't like homeless people. He also asks Wilson why he cares so much about the patient.
Cuddy gets back at House for dodging clinic duty by assigning him two students to teach them about medical histories. House sends them to interview the patient they've been assigned to.
House still wonders why Foreman doesn't like homeless people. Wilson wonders why House cares.
They find a mass on her ovary. If it's cancer, the patient will not live. House tells them to treat for tuberculosis on the off-chance that it's a tuberculoma - they can't do anything for ovarian cancer.
Foreman apologizes to the patient for not believing she was ill. She apologizes too - she took too much insulin to get into hospital. The patient starts complaining that the lights are too bright. She also has a fever of 105°F. She spits out the water she is given, complaining it tastes like poison.
Foreman wants to rule out tuberculosis as the treatment isn't working, but the biopsy shows that the mass is a tuberculoma, confirming tuberculosis. House wonders why the diagnosis is right and the treatment for it is making her worse. Chase, Wilson and Foreman start arguing. House orders a chest X-ray and they put the patient in an ice bath to reduce her fever. However, the patient is still terrified of the water.
Meanwhile, the students report back to House. One says the patient hurt her wrist when she fell off her horse. The other says that she did it when she fell off her porch. House asks what the patient's weight is and what color her nose is. The patient is either under 90 pounds or has a red nose. The students realize that House knows whats wrong and ask him what it is. He hands them a huge neurology textbook and tells them it starts with "C".
The team has discovered she has an infection, most likely meningitis. House orders treatment for it. However, they find the patient, who was sedated, isn't in her room.
Wilson thinks Foreman screwed up and didn't properly sedate the patient. Cuddy tells them to phone the police.
The students report back to House. They are guessing. House talks to the patient, a slight young teenager. She tells him he hurt her wrist when she swung at a bird but hit a ferris wheel. House tells the students its Korsakoff's syndrome. The patient is using clues to try to fill in gaps in her memory, but can't actually remember what happened. The students point out that Korsakoff starts with a "K". House tells them to treat everyone like they have it, as everybody lies. He tells them to put her on thiamine and give her some food.
The police recover the patient, who has collapsed and has heart arrhythmia. House thinks it is still meningitis. The police tell House that she was lying on the grass. House figures out that the police used their taser on her, which caused the arrhythmia.
Despite the treatment, the patient is getting worse. House also notes that the patient didn't respond to the first taser shot to her thigh. She turns out not to have any sensation there. Foreman thinks its diabetes mellitus. However, House jabs a needle where the patient bit Foreman, and Foreman doesn't show any reaction until he sees the needle.
The numbness, paranoia, ineffectiveness of sedatives, hydrophobia, disorientation, and sensitivity to light point to only one thing - rabies, most likely from bats. The disease has progressed too far and there is nothing they can do. However, Foreman needs to have immediate treatment.
Foreman and Wilson go out to look for the man the patient was referring to - James. They go back to the house where the rave took place, now abandoned. They find personal mementos and realize it is where Victoria previously lived. They discover that "Mr. Fury" in her comic books was her husband Paul Furia. James was her son, who died along with her husband during the car crash where she received her surgical pin. It becomes obvious that after the car crash she couldn't cope and became homeless. Foreman returns to Victoria and tells her that her husband and James forgive her. She dies peacefully.
House once again confronts Wilson about why he fought so hard for the patient. He finds out for the first time that Wilson has a brother who is homeless and he hasn't seen in nine years.
==Title==
A good play on "word" as the episode explores both the necessity for taking an appropriate medical history and the examination of a person's past life, their personal history. In this case, Victoria's medical history starts out as being non-existent and Jodi's has to be presumed by her inability to remember it.
==Goofs==
*"Hydrophobia" is a frequently misunderstood term, and this episode doesn't help. Before it was called "rabies", the most common name for the disorder was "hydrophobia" as in the disease's late stages, the patient has difficulty swallowing and even taking a sip of water causes very painful spasms. To avoid the pain, the patient avoids drinking water and even becomes agitated when water is offered to them (the same way a person with an ulcer avoids eating because it usually brings on the symptoms, even when they should be starving). As the disease progresses further, even the thought of drinking causes a spasm in the throat that is very painful. However, the rabies virus is also transmitted through saliva and, as a result, salivary production is increased. The spasms in the throat prevent the patient from swallowing their saliva, so in both humans and other infected animals, you get the typical "foaming at the mouth".
*When they suspect Victoria has bacterial meningitis, they should have acted more urgently as this can be immediately fatal. She should have received a lumbar puncture to test her cerebrospinal fluid.
*When Foreman is treated for rabies, the shot is given in his abdomen, an incredibly painful procedure. Although this was once the way rabies vaccine were given, nowadays rabies vaccine consists of one shot in the posterior and five in the muscle of the upper arm. Done carefully, the procedure is painless.
*Had Foreman actually been far enough along in the disease's progression to not be feeling sensation at the site of the bite injury, the disease would most likely have been untreatable. In any event, the disease would have been progressing too quickly. Rabies is still asymptomatic after two days - it often has an incubation period of at least ten days before any symptoms manifest.
*All patients who are even suspected of having tuberculosis are immediately isolated and put on airborne precautions. If they are suspected of having bacterial meningitis, they are put on contact precautions. These diseases were not only suspected but confirmed, yet nobody in the patient's room wore any kind of PPE.
*The Taser sequence doesn't make a lot of sense. Firstly, Tasers are illegal in New Jersey and although a police officer can get permission to use one, it's not routine for police to carry them. In addition, a police grade Taser uses two electrodes (meaning two burn marks, not one) and the voltage causes the muscles to involuntarily contract, usually resulting in the target collapsing due to lack of muscle control. Pain isn't a factor - even if Victoria's leg had been numb, the muscle still would have been effective.
*On the $100 bill House tries to use to bribe the cop, the portrait of Benjamin Franklin is facing the wrong way. Franklin's portrait on a genuine bill faces the holder's right.
*When they need to give Victoria epinephrine, they give her an intramuscular injection even though she's on an IV bag. In a situation like that, the drug can be added directly to the IV line - it's faster and safer. Minutes later, they give her haldol in the IV line.
*Polite Dissent specifically pointed out a common issue throughout the series - the doctors often perform all the procedures themselves. In a typical hospital setting, diagnostic procedures are usually performed by specialists. For example, Foreman does a biopsy of the ovaries, but as a neurologist, it's unlikely he would have had any training on locating the ovaries, let alone doing a biopsy.
==Zebra Factor 7/10==
In 2005, there was only 1 human case of rabies in the United States. During 1980-2004, a total of 56 cases of human rabies were reported in the United States. Among the 55 cases for which rabies viral variants were obtained, 35 (64%) were associated with insectivorous bats.
By coincidence, there was a rabies epidemic in New Jersey at about the same time the episode aired, although this was due to an outbreak in the raccoon population. A doctor in the area would've been on the lookout for possible symptoms of the disease, so in reality even this rare disease could've been recognized in the emergency room.
Worldwide, the World Health Organization estimates that approximately 55,000 people die from rabies each year, mostly in Africa and Asia, and mostly from dog rabies.
The only effective preventative is a series of vaccinations which must begin as soon as possible after exposure, most preferably within 24 hours. The longer the delay, the more likely it is that the virus will spread to the brain and cause death. There is an experimental form of treatment of rabies- the Milwaukee Protocol, which was first used in 2004 on Jeana Giese, who is known to be the first survivor of rabies without preventive treatment. It is a very compilcated protocol with a very low success rate, but it remains the only treatment that gives patients any chance of surviving.
==Trivia & Cultural References==
*Mental illness is one of the major contributing factors to homelessness.
*When Foreman replies that the treatment for advanced ovarian cancer is a "pine box", he is referring to an inexpensive type of casket, often used to bury the destitute.
*The massive textbook House hands the medical students is Adams and Victor's Principles of Neurology by Allan Ropper and Robert Brown. It is a genuine medical text.
*One of the businesses in Victoria's sketches is named "Kaplow's Pawn Shop".
*A Taser is a weapon that delivers an electric shock that causes loss of voluntary muscle control.
*House mentions he likes The O.C.. (Which also was broadcast on Fox.)
*Victoria was the first adult patient on the series to die. The first patient to die was Baby Boy Chen-Lupino in Maternity.
*The Alien movies are a series of eight sci-fi/horror movies - four main films, two spin-offs and two prequels. A common theme in the movies is a monster bursting from a person's chest.
*Baby It's Cold Outside is a well known duet by Frank Loesser. It was first performed in the 1949 film "Neptune's Daughter".
*When hearing that Foreman's parents have been married for forty years, Wilson exclaims "mazel tov", "good luck/congratulations" (literally, "good constellation"). Many non-Jews would be at a loss to respond, but not House, who replies in Yiddish "kein ayin hara" or "no evil eye".
*The real Swedish word for "friend" is "vän".
*Battlefield State Park is a real part of the Princeton Battlefield, the site of the Battle of Princeton in 1777.
*A common trope in television and movies is to speak of a bribe by referring to the name of the person on the corresponding bill. House's request that the officer might want to speak to "my friend, Benjamin Franklin", is a euphemism for exchanging information for $100 (Franklin appears on the bill).
==Reviews==
*IMDB users rated the episode an 8.6 with 29.5% of users rating it a 10. It rated best with females age 18-29 (9.1) and worst with IMDB staff (7.5).
*TV.com users rated the episode an 8.7. They voted Hugh Laurie as their Most Valuable Performer.
*Polite Dissent thought the medicine was average (C through B+) and didn't comment on the dramatic plot.
==Medical Ethics==
===Treating the homeless===
In the United States, medical care for the very poor is provided under a 1960s program called "Medicaid" where states and the federal government share the cost of treating people who fall below a certain income level. At the time this episode was shot (before the implementation of the Affordable Health Care Act a.k.a. "Obamacare") only the very poor qualified for this program.
However, there is a catch - Medicaid recipients are required to undergo a screening process to check whether they are eligible for the program. That usually requires that a person has a verifiable home address and a permanent residence. As such, although most homeless people are well below the income cut-off, they're unable to keep up with the bureaucratic requirements, particularly if they have mental health issues as well.
Although hospitals with emergency departments are required under federal law to take all comers regardless of insurance status, they are usually only required to ensure they are stable and may thereafter discharge them. A person may go to an emergency room with a medical problem, but in most cases will only be prescribed medication.
This leaves individuals with mental illness in a particularly vulnerable and precarious position. Although many good outpatient centers exist that do great work, without community support patients are soon off their medication (or can't afford to get further medication) and wind up back in the emergency department. In rare but well publicized cases, patients with a mental illness have been driven to different neighborhoods or even different states so that they can no longer return to the hospital that discharged them.
Not surprisingly (as House noted with drug addicts), the homeless tend to get ill more often than the rest of the population. They are often exposed to communicable diseases. They don't eat well. They are rarely in the position to get the benefits of pharmacological therapy that can manage chronic conditions. Many of these problems disappear once the individual gets permanent housing and regular medical care. However, although such community care is cheaper than the cost of frequent ER visits, there is political opposition to such programs in much of the United States and other industrialized countries, particularly in cities where housing costs are expensive and affordable housing is scarce.
Cases such as Victoria's are not atypical. Indeed, many homeless people learn how to "work the system". However, in many cases, alternative programs just aren't there and the only way the homeless person can "get by" is by staying in densely populated areas where they can live off whatever they can find or beg.
===Taking proper medical histories===
The necessity of taking a medical history is a constant theme throughout the series, but this episode probably does the best job of any of them in balancing both the importance of a medical history and House's key maxim everybody lies. In this episode, we have two patients where getting a proper medical history is impossible, both due to the patients' underlying mental state. In Victoria's case, her medical history turns out to be critical to her care - she has a history of allergies and a surgical pin that means she can't have an MRI.
As Cuddy points out, House is an expert in taking medical histories and works it into his diagnostic method. Although he often seems to be disinterested in the patient's records, that's simply a front. In many cases, he's able to quickly skim a history for the most relevant information based on a theory that he's already formed. As with any differential diagnosis, he eliminates certain possibilities right away and the patient's medical file is often the best way to do that - it shows what conditions have already been ruled out and what symptoms can be ruled out based on previous test results. House usually admonishes his fellows for their failure to think through the details or to not fully explore what is already in the file. Nevertheless, he also accepts ideas that contradict the file as long as the diagnosis can otherwise be justified and there is cause to believe that the file is wrong. Foreman learned this, literally, on the first day with his first corollary to House's maxim - If people lie, assume people also screw up.
As the episode goes from start to finish, Foreman is transformed by the case into someone who assumes a patient's history because of her circumstances (she's homeless, so she's obviously lying) to someone who finally understands that the deeper a doctor understands a patient, the easier it is to deal with their illness. By finally breaking the puzzle of "James" and "Mr. Fury", Foreman finally finds a way to treat the untreatable by simply providing the patient with some comfort about her underlying anxiety. Ironically, it turns out the patient was lying, but as House frequently points out later in the season, people lie for a reason and the reason they lie for might also point to what they might die for.
==Quotes==
:House: [to Foreman] Go check out the 'hood, dawg.
:Foreman: A tuberculoma doesn't give you a temperature of 105.
:Chase: Then it's a tuberculoma and something else.
:Wilson: The "something else" is going to melt her brain.
:House: Poach. Better metaphor.
:Wilson: You know, in some cultures, it's considered almost rude for one friend to spy on another. Of course, in Swedish, the word friend can also be translated as "limping twerp".
:House: Okay, you two, grab some scalpels and settle this like doctors.
:Cuddy: [approaching with two female interns] Dr. House!
:House: Time for Girl Scout cookies already?
:Wilson: Get me some Thin Mints.
:Wilson: You really don't need to know everything about everybody.
:House: I don't need to watch The O.C., but it makes me happy.
:House: You gonna tell me why this case?
:Wilson: She's my new girlfriend, I'm having a tattoo designed, I was hoping you could find out her name.
:House: So, she's just another sick person that kindly Dr. Wilson has made sure doesn't get lost in the big ugly system.
:House: [mocking Foreman] Hey! He knows more homeless people than any of us!
:Foreman: And the cancer wouldn't account for the alleged twitch, or any of her other alleged symptoms.
:House: Actually, it would. Neoplastic syndrome associated with a cancer could cause her to twitch like a bunny on crystal meth.
:House: Patients lie but usually only one lie at a time.
:House: The only thing we know for sure about Jane Doe is that her name isn't Jane Doe, which means no medical history.
:Wilson: The only question is whether she dies in two months or three.
:Foreman: Oh, God!
:Wilson: You were right. There's nothing we can do for her here. Might as well put her back on the street.
:House: Unless it's not cancer.
:Chase: Oh, you're joking?
:House: Well, hard not to. There's nothing funnier than cancer.
:Wilson: Fake low blood sugar - now THAT'S acting!
:Wilson: Yes, I forgot. I need a reason to give a crap.
:House: You're giving two craps.
:Wilson: The metric system always confuses me.
:Wilson: You don't walk out of a room with ten milligrams of Haldol in your system, you don't walk at all.
:Foreman: It was ten milligrams, I gave it to her...
:Cuddy: It doesn't matter! Bacterial meningitis, highly contagious, if she is out of the hospital, we are so liable.
:Wilson: Not to worry. She'll be dead before she can kill anybody.
:House: Wrong coat. The cape's in the closet, I had it cleaned.
:Foreman: Funny.
:Chase: Why are we on this case?
:Cameron: Because Wilson asked House to do him a favor.
:Chase: I think House just wants to prove she's sick so Foreman will be wrong.
:Cameron: [with a sigh] Oh, you boys.
:House: You gonna save her?
:Foreman: In her comics, Mr. Fury lives in Sloan Harbor. The night she came in, she was at a rave at 1408 Sloan Street.
:House: You've been reading. My, how you've changed.
:Cuddy: You are a doctor; do what doctors do. Pick up the phone, dial 911 and a cop on the other end does what cops do and finds the missing person! I assume the rest of you have doctor things to do. [to House] I know you do.
:House: And you still think nothing's wrong with her.
:Foreman: Well, nothing's changed.
:House: We almost killed her–-that's different.
:Cameron: A twitch could indicate a brain tumor.
:Foreman: Or about a dozen other things. Come on, there's two things homeless people are good at-–getting sick, and running scams. If you're so worried about it being a brain tumor, get her an MRI. When she's clear on that, then you can bounce her out of here.
:Wilson: Well, you've got her all figured out.
:Foreman: I've known a lot more homeless people than you have.
:Wilson: Yes, you've got that going for you.
:Foreman: Okay. Even if she's not faking, what's so fascinating about this case?
:House: At the moment, how much you don't want me to take it. That's pretty fascinating.
:Foreman: Okay. Why are we on this case--just because Wilson asked?
:House: Do I need a better reason?
:Foreman: Most people wouldn't, you do.
:House: And what is the treatment for advanced ovarian cancer?
:Foreman: Pine box.
:House: Vomit... it's still moist. What do you think, maybe a couple of days old?
:Wilson: Didn't we have a conversation about friendship?
:House: Yeah – I had some follow-up questions.
:Julia: I thought you were supposed to be listening to our patient histories?
:House: No, I'm supposed to be teaching you. If I can do that without listening, more power to me.
:Chris: You're reading a comic book.
:House: And you're calling attention to your bosom by wearing a low-cut top. Oh, I'm sorry--I thought we were having a "state the obvious" contest. I'm competitive by nature.
:Wilson: Did your pager really go off, or are you ditching the conversation?
:House: Why can't both be true?
:House: I hate to cite a cliché, but... Dad on the streets?
:Foreman: Dad's with Mom.
:House: They're both living on the streets?
:Foreman: That's why you insisted on the MRI? So you could remove the surgical pin from her arm?
:House: You didn't think I was going to do it to save your sorry ass, did you?
:Cuddy: I can't believe you authorized this.
:House: Really? It sounds exactly like something I'd do.
:Wilson: He's wrong.
:House: Foreman is wrong? The neurologist is wrong? About a neurological problem?
==Major Events==
*We find out about Foreman's family for the first time - that his mother and father are still married and have been for forty years.
*Wilson tells House that he has two brothers, one of whom is homeless and who he hasn't seen in nearly nine years.
==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
*Leslie Hope as Victoria Madsen
*Larry Clarke as Officer Gilmar
*Smith Cho as Julia
*Ogy Durham as Chris Dewey
*Brandon Brocato as Phil
*Suzanne Ford as Mrs. Whitney
*Farrah Skyler Greye as Nurse
*Leslie Karpman as Jodi
*Graciella Evelina Martinez as Tall Girl
*Kevin Moon as EMT
*Patty Onagan as Girlfriend
*Bonnie Perlman as Shelly Diamond
*Troy Robinson as Cop One
*Paul Sklar as Cop Two
*Charles C. Stevenson Jr. as Walter
==Music==
*Trip Like I Do by The Crystal Method
*On Fire Like This by Mutayor at the rave
==Release Dates==
*United States - February 5, 2005 on Fox
*Canada - February 5, 2005 on Global
*Estonia - February 17, 2006
*Hungary - May 24, 2006
*Germany - July 11, 2006
*Finland - November 23, 2006
==In Other Languages==
A surprising problem with translation here. Getting the precise sense of "histories" as it's meant in this episode (the plural of history, as in medical history) is difficult to express in Spanish or French. For one thing, "history" is the wrong word to use in these languages. It is translated as "Antécédents médicaux" in French ("medical background") and "Historal medico" in Spanish ("medical record"). As such, the translators generally went with "false friends"; words that look like literal translations of "history", but aren't. Because Romance languages generally lack the "null article" of English (i.e. there's no need to use "The" before "Histories" in English), a correct translation would require the use of a plural article (such as "Les" in French). However, that doesn't create a title that makes a lot of sense in the target language. In Spanish, "historia" means either "history" or "story", depending on context and making it plural in any context takes away the possibility of "history" which generally isn't pluralized and points to "story" which often is. Similarly the French "histoire" has several possible translations, but in this context "story" or "tale" would be the most common translation as "the History of a Life" just doesn't make sense.
*Spanish - Historias (Eng. Stories)
*French - L'Histoire d'une vie (Eng. - The Story of a Life)
==Links==
*Episode page at IMDB
*Episode article at The TV IV
*Episode page at House MD Guide
*A lesson plan dealing with the episode at Spiritual Journeys
*Episode guide at Ace Showbiz
*Mirror of this article at the Vietnamese language House Wiki
*Episode page at TV.com
*A review of the medicine by Polite Dissent at archive.org
*Episode transcript at Clinic Duty
Category:Episodes
Category:Season 1
Category:Episodes ending in the patient's death