Family Practice

Template:Episode Season 7

*This is an article about the 7th season episode where House treats Cuddy's mother Arlene. For the 3rd season episode where House treats a young potential bone marrow donor, see Family.*
Cuddy persuading her mom to remain at Princeton-Plainsboro:

> The reason you keep coming to see me in the clinic is because you trust me. You trust my medical judgment, so here it is: if you transfer to Princeton General, you'll be treated well and you'll die. If you stay here with House, you'll be treated badly, but you'll live. I don't care if I have to slash the tires of every ambulance in this bay, mom, I am not letting you leave my hospital.
>
> Family Practice

"**Family Practice**" is a 7th season episode of *House* which first aired on February 7, 2011. This episode was shown out of production order (it was the 13th episode filmed for the season), most likely due to the necessity of David Shore scrapping an "on-the-road" arc to allow for time to rework the season.

Paula Marshall appears for the first time as Lisa Cuddy's sister Julia.

Cuddy's mother Arlene is back, and Cuddy insists that House deal with her mother's recent symptoms by coming up with a diagnosis that will satisfy her. Cuddy forbids House from relying on a diagnosis of psychosomatic illness. However, House wonders if Arlene's condition is related to the fact that when they last met, she accepted that she had drunk enough alcohol to pass out. Meanwhile, Arlene reveals that she has had a lengthy affair with a married man that she has frequently discussed with Julia but kept from Lisa, leaving Lisa to wonder how close her relationship to her mother really is. However, when Mother Cuddy throws House off of her case, House must play on the fears of his entire team in order to make one desperate stab at treating her. Meanwhile, it appears Taub has found a way to earn a little extra money.

This episode features a new, much shorter, opening montage with a short opening theme.

## Recap

Cuddy, her mother and her sister Julia are out shopping when Mother Cuddy complains of palpitations. Cuddy takes her pulse and wants to rush her to the hospital.

House and his team are in the morgue hiding from Cuddy. However, she finds him anyway. House knows about Arlene and says she's just a 65-year old woman with high blood pressure. Cuddy counters that she has microcytic anemia, but House points out it's borderline and that Arlene has a history of psychosomatic illness. However, Cuddy points out atrial fibrillation isn't a psychosomatic symptom, but House says in that case, a cardiologist should be able to handle it, and besides, Cuddy shouldn't be involved in her mother's case in any event because she can't be objective.

House finally decides to take the case (and humors everyone by wearing a lab coat), but merely provides reassurance to Arlene that her problem was probably transitory and she can keep it under control with medication. However, Arlene says it has something to do with her other symptoms, and implies House should go through her 15 year medical history. House goes through a lengthy list of trivial symptoms, but when he goes to suggest psychosomatic illness, Cuddy cuts him off. She promises a thyroid test and an environmental scan. Arlene wonders why House's lab coat doesn't fit.

Masters and Taub go to do the environmental scan. They only find sex pictures of Arlene, but they suspect an STD. However, they also find a folk remedy for arthritis.

The herbal medicine contains lead and Cuddy goes to start Arlene on chelation therapy. However, House also tells Cuddy about her mother's sex life. Cuddy is actually impressed with her mother.

Cuddy asks her mother about the herbal remedy and why she didn't tell her. She also asks about her partner, a younger man. Julia already knows about it, and that its been going on for five years. Cuddy wants to know why her mother didn't tell her and Arlene replies they don't have that kind of relationship.

Foreman is helping Taub move into a new hotel room. Rachel Taub drops by to talk to Taub. She tells him he's spoken to her brother the lawyer to get him work as a part-time medical consultant. Taub reminds her that her brother broke his nose after he found out Taub had cheated. Rachel gives Taub her brother's card anyway.

House goes to see Arlene about all the texts, telephone calls and e-mails she's been sending to him. Arlene's been doing research and realizes that lead poisoning doesn't explain all of her symptoms, but House implies it explains all her real symptoms, and she realizes he's implying she's a hypochondriac. When Arlene tells him her hand started shaking after he took the arthritis medication he prescribed, he admits she's on placebos and the shaking hand was a side effect he put on the bottle to see if she would react to it. Arlene fires him.

Arlene wanted to leave the hospital, but Cuddy convinced her to accept the head of internal medicine, Dr. Marty Kaufman as her new doctor. Cuddy and House argue about what he did, but he tells her that if he hadn't done it, Arlene would have come up with six new diagnoses. However, Dr. Kaufman calls to tell Cuddy that Arlene is in atrial fibrillation with a heart rate of 170. Cuddy tells House that he's back on the case, but Arlene can't know about it.

House goes to Kaufman, but Kaufman tells him that Arlene doesn't want House involved. House argues he has skills and resources available, but Kaufman tells him he's on record as the attending and it's likely House will go behind his back at some point, leaving Kaufman on the hook if things go wrong.

House plants an eavesdropping device in Arlene's room. Arlene is insulting House. Chase thinks it might be leukemia, but Kaufman has already come to the same conclusion. House tells Masters to get a new case. However, when she's gone, House calls in the rest of his team. He figured Masters would get upset about the bug and needed to get her out so they could discuss the case in secret. House has a better diagnosis. When House drugged Arlene at Cuddy's birthday party, Arlene figured she had passed out from drinking. That seems to point to alcoholism, making thiamine deficiency a likely diagnosis. However, they have to slip her the pills without her knowing. Foreman thinks that they have to get Cuddy's permission, but House is way ahead of him and gets up to tell her.

Cuddy is shocked with the news, but House assures her the treatment is easy, safe and won't interfere with Kaufman's procedures. He's put thiamine in an antacid bottle. Cuddy wants to ask Arlene about the alcohol, but House predicts that it will wind up with Arlene being offended. Cuddy assures House that since her father died, Arlene has been honest with her when confronted directly. House reminds her that addicts lie.

Cuddy tells her mother that she thinks that her drinking is causing her heart problems. Arlene denies being a drunk. Cuddy leaves behind the pills and tells her they're for her stomach pain.

House finds Cuddy sitting alone. Cuddy tells House that if another matter like this arises, that he should take care of it himself without involving her. Cuddy thinks she's being a coward and realizes this is why doctors shouldn't treat their own relatives.

Taub meets with Rachel's brother. The brother apologizes for breaking Taub's nose and says he had divorce issues of his own, and he's taking anger management. He offers Taub $50,000 a year for 15 hours a week of work as a non-testifying expert. Taub agrees. However, when he looks at a scan that's lying around, he notices something that looks like a sub-arachnoid bleed. The brother tells him the case is about to settle for a large amount and that the client is fine, so he should forget it.

Arlene develops a fever, meaning House was wrong about the alcoholism, but the biopsies run by Kaufman have ruled out cancer.

House goes into the coma ward with his team to tell them can't work on Arlene's case. However, he decides to do a differential on the coma patient. He prompts the team in mime until Masters realizes the patient may have overdosed on a different drug and, if he tests positive, he will soon recover on his own. He sends Masters to run the tests.

However, when he gets the rest of his team alone, they start a new differential on Arlene. Taub guesses lupus, but once again Kaufman is treating her for it. Foreman guesses endocarditis, which means she will die on the steroids she's being treated with. Taub thinks House should warn Kaufman, but one of Kaufman's specialists in infectious disease has made the same point. House proposes to switch her meds with antibiotics. Foreman points out that it's likely that if they get caught or something happens, they will all go to jail. Foreman reminds House that he's personally involved in the case. Chase suggests asking Cuddy, but House tells them Cuddy wants no part of these decisions. House tells his team he knows it's screwed up, but orders them to do it or they're fired. Foreman wants the whole team to refuse, but Chase is convinced it's endocarditis too.

Taub wonders where his life went. He used to get awards for volunteer work, and now he and Foreman are sitting around letting Chase take all the risks. Foreman also tells Taub to forget about the sub-arachnoid bleed he thought he saw. Chase comes in and says that Julia recognized him, so he can't pull it off. Julia knows Foreman too. Taub gets a page from his brother-in-law and realizes he has to go or he will lose the consulting job.

Instead, Taub goes to see Timothy, the patient whose scan he saw in his brother-in-law's office, and tells his mother to get him a cerebral angiogram or he might bleed to death.

House realizes that his team hasn't switched out the medication. He comes up with another plan to do it when Arlene has a nap.

Masters goes to Cuddy to tell her that it's likely House is still working on Arlene's case. She found out that Chase ordered both prednisone and antibiotics from the pharmacy for the coma patient and that she thinks House is trying to switch out her mother's meds.

Cuddy confronts House, but he reminds her it was her idea not to make any difficult decisions. However, House admits he's not sure it's endocarditis, but it's the best fit. He asks for her help to switch out the meds.

Cuddy asks Arlene why she treated her and her sister Julia so differently. Arlene says that although she loves them the same, Julia has more in common with her and is nicer to her. She says she likes Julia more.

The scan comes back on Timothy, showing what Taub saw was a harmless anatomical anomaly in a bone in the skull pressing against a blood vessel.

However, Arlene suffers an allergic reaction. Kaufman can't understand - prednisone can't cause allergic reactions, but Cuddy realizes it was the antibiotics.

House and his team gather in Cuddy's office. Arlene is back on prednisone. She's breathing normally, but the atrial fibrillation is back and her fever is up. However, since Kaufman didn't know about the antibiotics, he took her off the prednisone and started thinking it was endocarditis. House starts a new differential and figures it's a fungus. Foreman argues that the treatment is dangerous and will just confuse Kaufman. Cuddy doesn't think she can go through with it, and House snaps and says she never should have let Arlene fire him. When House tells Cuddy to switch the meds again, the rest of the team tells Cuddy it's a bad idea. Cuddy tells the rest of the team they can leave. Cuddy knows House is right. However, Masters comes in. Surprisingly Masters agrees with the fungal endocarditis diagnosis, but wants to tell Arlene. House tells Cuddy to get out of the office. House then threatens to have Masters' career destroyed if she tells anyone. Masters has anticipated this and doesn't think that anyone will believe House. However, House has her - the coma patient had a do not treat order and if she tells anyone about Arlene, he will have Masters prosecuted for criminal assault for the blood draw on the coma patient. He reminds her that he didn't actually tell her to do the blood draw - it was her idea. Masters realizes she's been set up. House tells her that he did it because Arlene is the patient with the highest priority.

Masters runs to the bathroom to vomit.

Taub is in the men's room when his brother-in-law comes in and assaults him. He tells him the mother fired him, rejected the settlement and reported him to the bar. He threatens to sue Taub and tells him not to bother Rachel again.

Masters goes to Arlene's room and asks to speak to Dr. Kaufman and Arlene alone. Kaufman is furious. Arlene fires Kaufman and insists on being transferred to Princeton General. Cuddy agrees to call the ambulance. House asks Masters if she's happy about what she's done.

House tells Cuddy she just killed Arlene. They start arguing who's at fault. House tells Cuddy she never confronts her mother. House is afraid Cuddy is going to blame him for her mother's death and tells Cuddy to get her back.

Cuddy intercepts her mother and tells her that she realizes Arlene was tough on her because she was smart and ambitious, unlike Julia. She reminds her mother that she trusts her medical judgment. She tells her that she will die at Princeton General. At Princeton-Plainsboro, she will be treated rudely, but will live.

Arlene agrees to stay. They start her on anti-fungals. Arlene wonders why House is so great when he doesn't have a department to run anymore. Cuddy wonders how Arlene got that idea. Arlene says House told her that, but House says he was just being sarcastic. House begins to realizes that Arlene doesn't understand when other people are being sarcastic. That speaks to central nervous system involvement before heart involvement. All of a sudden, Arlene loses consciousness. All the symptoms point to heavy metal poisoning, but she was treated for it. House realizes she's still being exposed to the toxin. He performs emergency surgery and finds that her hip replacement broke down and is poisoning her and breaking down her muscles, metallosis due to cobalt poisoning. She needs more chelation and an immediate replacement of the hip joint.

Taub hears a knocking at his door, and Rachel walks in. Foreman called her. She said she wasn't told that Taub thought the brother's client had a bleed in his head and she will cut her brother out of her life if the brother retaliates. Taub wonders why she cares. She says he was a crappy husband, but he is a good person. She gives him a hug.

House un-fires Masters again. He realizes that Masters stood up to him even if it meant getting thrown out of medical school, and he's impressed. She wonders what she has to do to keep her job. House tells her to keep him from doing things Cuddy will regret.

Julia wants to know why Arlene wants to keep her old hip joint. Arlene realizes that the hip joint has been causing all of the problems she's been complaining about for the last fifteen years. Cuddy admits Arlene may have been really sick all that time.

## Major Events

* Cuddy's mother gets sick, and she insists House work on the case.
* Masters reveals she was voted "homecoming geek" at high school.
* On the other hand, Taub reveals he was voted class president and was best boy at his prep school.
* Taub also reveals he's won awards for volunteer work.
* Taub has also fixed cleft palates in Guatemala as well as Bangladesh.
* House seems to come up with the right diagnosis and implies Cuddy's mother is a hypochondriac, so the mother fires House.
* Cuddy's mother continues to develop serious symptoms, so Cuddy insists House work on the case without the knowledge of her mother or the attending physician.
* Taub is offered a job by Rachel Taub's brother working as a medical-legal consultant. However, he sees an x-ray related to another legal case, and insists on telling the person they may have a sub-arachnoid bleed. Instead, it turns out to be a harmless anomaly. However, the client fires Rachel's brother, and he proceeds to beat up Taub in retaliation.
* It is revealed Cuddy has obtained substantial academic honors, graduating Summa Cum Laude from the University of Michigan and being elected to the AOA fraternity in medical school.

## Zebra Factor 6/10

Cobalt poisoning is very rare. It is usually the result of exposure to dust in a work environment involving the creation of tungsten carbide, which is commonly used in drill bits. It is used in medical devices (like artificial hip joints) because it adds strength to metals, but because of this toughness, it rarely breaks down in the body.

## Trivia & Cultural References

* Despite being credited in the opening credits, Robert Sean Leonard (James Wilson) does not appear in this episode.
* The song at the beginning of the episode is Mr. Sandman. It was a #1 hit for The Chordettes in 1954.
* House is right that medical ethics codes generally prohibit a physician from treating a family member, except for routine care.
* House may have made a reference to werewolves when asked by Chase what could cause Cuddy's mom to turn into a patient named Stewart. He responds Lupus (as in wolf) to possibly suggest werewolf.
* House says to his team "Pop quiz, hotshots!" A reference to the movie Speed.
* Azarcon is a folk remedy which consists of lead salts. Although used for the treatment of arthritis, it is highly poisonous.
* Guatemala is a country in Central America.

## Goofs

The Mexican folk remedy Azarcon is identified in the episode as lead chromate, a lead compound used as a yellow pigment in artist's oil paints. However, Azarcon is actually lead tetraoxide, a lead salt. Nevertheless, both are deadly.

## In Real Life

This episode has brought attention to cobalt poisoning from replacement hip joints[1] [2] [3][4] [5]. In Germany, Dr. Jürgen Schäfer (who, like House, specializes in difficult cases), had just seen the episode when a patient came to him with progressive deafness, blindness and heart failure. After learning of the patient's hip replacement, he correctly diagnosed him with cobalt poisoning from the worn hip joint. In another case reported in *The New England Journal of Medicine,*cobalt poisoning was diagnosed after the patient's heart transplant. The article noted that if the problem had been diagnosed earlier, the patient probably would not have needed the transplant.

## Links

* Episode page at IMDB
* Episode review at Blogcritics
* Episode recap at The Celebrity Cafe
* Episode transcript at Clinic Duty
* Episode page at House MD Guide
* Episode guide at Ace Showbiz
* Episode page at Series and TV
* Episode page at TV Rage
* Episode page at TV.com
* Episode recap at Roxy's Blog

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## Video

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