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00:00Due to some graphic content, viewer discretion is advised.
00:04The human heart is a giant muscle, squeezing or contracting over 60 times each minute.
00:10At this point, your blood is a deep purple because it's just finished dropping off oxygen for all the parts
00:19of your body.
00:22Come on, follow me.
00:25Come on.
00:31Ian, I have a question and I need to go to the bathroom.
00:35Which would you like to do first?
00:37Question.
00:38Okay.
00:39Where's the bathroom?
00:41Who knows where the bathroom is?
00:43I do.
00:44Go with Ian to the bathroom.
00:45I don't have to go.
00:47We're not at school. Nobody goes anywhere by themselves.
00:49Why?
00:50In case you get lost.
00:51Or in case somebody kidnaps us.
00:53If somebody kidnaps Ian, they'll kidnap me too.
00:56I want to stay out of the class.
00:57Michael, go with Ian.
00:58Ah!
00:59Do you need help?
01:00I need you to find a grown-up.
01:02Is the baby coming?
01:03Ah! Ah!
01:04Who should I take with me?
01:05You're fine.
01:06Go to the front desk or find a security guard or...
01:09Well, I have to pee.
01:12Oh, God.
01:15Is the baby coming?
01:16I don't know how to do this.
01:18You okay, Ian?
01:20Yeah, sure.
01:22I think you are.
01:28You're bleeding.
01:33Help!
01:34Help!
01:35Help!
01:36Tofu 0
01:38Tofu 0
01:38Tofu 0
02:15Do I love you or mine?
02:19Do I, honey, do I do?
02:25Do I want you or mine?
02:29Do I, honey, do I do?
02:32Twenty.
02:33Call.
02:34You'll call anything.
02:36My stack's bigger than your stack.
02:40You in or out?
02:41You know, relative to their size,
02:43gorillas have smaller testicles than humans.
02:46Well, then you'd probably have an edge over a gorilla,
02:49but not over me.
02:50Reason is, primate testi size inversely corresponds
02:54to the fidelity of our females.
02:57You think there might be a better time to annoy me about my wife?
03:01I'm talking about poker.
03:02Right.
03:02Women are evil.
03:03You're right to drive them away.
03:04Call fold or raise.
03:05Story time can wait.
03:06We're smaller and better than chimps.
03:10Bigger and worse than gorillas.
03:12For all our rationality,
03:13our supposed trust and fealty to a higher power,
03:16our ability to create a system of rules and laws,
03:20our baser drives are more powerful than any of that.
03:24We want to control our emotions, but we can't.
03:27If we're happy, things don't annoy us.
03:31If, on the other hand, we're sitting on crappy hole cards,
03:34little tiny things annoy us a whole lot more.
03:42I raise.
03:43So are you gonna tell me an annoying story every time I raise?
03:45God, that would be annoying.
03:48I call.
03:50Dr. Cuddy, got one of your patients in the ER.
03:52Ian Alston, six years old.
03:54Uh, oh, I know him.
03:55What's the problem?
03:56I'm all in.
03:57Bloody diarrhea.
03:58Hemodynamically stable,
03:59but he's been developing some coordination problems.
04:01It sounds like gastroenteritis and dehydration.
04:03Order fluids and I'll take it on my service.
04:05Best to you, House.
04:07They scan his head?
04:08No.
04:08Why would they scan?
04:09Don't play games.
04:09Are you gonna call?
04:11How's the heart rate?
04:12Stable.
04:13I'm sorry.
04:14House, it's gastroenteritis.
04:16I'm not going anywhere.
04:17Put the order in,
04:18and have someone tell Alan and Sarah that I'll be up when I'm done.
04:23You in or out?
04:28I'm out.
04:34Stone cold bluff.
04:35You might want to spend a little more time paying attention to your cards
04:39and a little less time staring at my breasts.
04:42They don't match either.
04:44I'm gonna take some air.
04:45I'm gonna take some air.
05:14How much longer will Dr. Cuddy be?
05:16Well, given the number of mojitos she's knocking back at the party,
05:19I'd say it's gonna be at least three hours before she's even conscious.
05:24Weren't you at the same party?
05:25I don't drink.
05:29I want you to reach out to Grandma Cain.
05:38What's wrong?
05:39Your son's brain is losing control of his muscles.
05:42Dr. Cuddy's message said it was just dehydration from diarrhea.
05:46She's wrong.
05:49Is he gonna be all right?
05:54I don't know.
05:54All right.
06:23Let's go.
06:24Were you in one of those cages?
06:27No.
06:28No.
06:29No, no, no, no, no, no.
06:30Those are for terrorists.
06:32You were in the water with the Great White.
06:34Sure.
06:35It's no big deal.
06:36You just have to keep an eye on them.
06:38If they get too close, punch them in the nose.
06:41Send them on their way.
06:45How'd you go on?
06:46You are mean.
06:48Hey, how's that anal fissure?
06:51Did it heal yet or is it still draining?
06:53Oh, I'm sorry.
06:55I didn't realize you'd come back for seconds.
06:56I figured that after that girl on the stairwell,
06:58you'd be done for the night.
06:59He's joking.
07:01You know Adam's apple?
07:01Small hands.
07:02It's no surprises this time.
07:05I'll, uh, see you later.
07:10Got a case.
07:11Well, you could have just said that.
07:13You didn't have to screw with me.
07:14Yeah, if I didn't screw with you,
07:15you'd spend the whole night thinking you might get laid,
07:17which means you'd be useless.
07:18Better to extinguish all hope.
07:20Get Foreman and Cameron to meet me upstairs, Dad.
07:28What's so urgent?
07:29Two cases, same symptoms.
07:33What do six-year-olds and 70-year-olds have in common?
07:36Their immune systems don't work as well.
07:38Could be listeria.
07:39Already checked for that.
07:40Leukemia has a higher prevalence in both young and old.
07:43So does asthma.
07:44Oh, no, no.
07:45You want the diabetes?
07:47No.
07:51The nearly dead and the newly bred
07:53have more in common with each other
07:54than with people in the middle.
07:56It's weird.
07:57It's kind of a circle of life thing.
08:00This kid doesn't have kidney failure.
08:01He will.
08:02Based on this file,
08:03the kid just ate some bad food.
08:05Was the old man?
08:06They were nowhere near each other
08:07in any of the four dimensions.
08:10This case is 12 years old.
08:12Yep.
08:12And this case is Cuddy's.
08:14She assigned it to me.
08:16She agrees with you
08:17that this is something more than gastroenteritis?
08:20She wouldn't have assigned it to me
08:21if she didn't, would she?
08:30Are we talking about two patients
08:33with two symptoms in common
08:34and five symptoms not in common?
08:37While you were all wearing
08:38your Frankie Says Relax t-shirts,
08:40I was treating a 73-year-old woman
08:42who went through this progression of symptoms,
08:44the last of which was...
08:49In case any of you missed that class in mid-school,
08:52that one's untreatable.
08:54The kid's got the first two.
08:55It took Esther an hour and 20 minutes
08:57to go from two to three
08:59and less than a day
09:00to make it all the way to the rear exit.
09:02This is all because a child
09:03has some blood in his diarrhea.
09:06He's got a tummy ache.
09:07If there was any reason to think
09:08it was anything worse,
09:09Cuddy would be all over it.
09:10Great.
09:11Do a colonoscopy.
09:12And a six-year-old kid
09:13who probably has nothing worse
09:14than some food poisoning.
09:15And if you happen to find
09:16any purple papules,
09:17do me a favor and grab a slice.
09:19I want to check for Erdheim Chester.
09:21A disease that there have been,
09:22what, maybe 200 reported cases of, ever?
09:26If Esther's family had let me do an autopsy,
09:28there'd be 201.
09:38Do you see anything?
09:45No, and I don't expect to.
09:48Helsh usually avoids cases.
09:50If he's actually stealing a case from Cuddy,
09:52there's got to be a reason.
09:53It's not the first time I've seen this fire.
09:57About a month before Cameron was hired,
09:59some trucker came in here with these symptoms.
10:01House decided he was dying.
10:03Two days and a spinal tap,
10:05bone marrow extraction,
10:06and three colonoscopies later,
10:07we send the guy home
10:08with a bunch of painkillers
10:09and a diagnosis of a bad cheese sandwich.
10:13One of the guys who worked here before me
10:14said House tried to cure Esther
10:16at least three other times.
10:19You know how people see the Virgin Mary
10:21in danishes and stuff?
10:23Someone died 12 years ago,
10:25and House doesn't know why.
10:27House sees that case now,
10:28and paint peeling,
10:30and clouds,
10:32and now this poor kid.
10:34Erdheim Chester is an abnormal growth
10:36of some of the cells that fight infection.
10:37Is that cancer?
10:38Because he seems okay now.
10:40Yeah, they got the doctor kind of scared us about that.
10:42He shouldn't have.
10:43We're just testing.
10:44It'll probably be negative.
10:45I don't understand.
10:46You don't think that's what it is,
10:47but you want to do this thing to him anyway?
10:49We need to be sure.
10:50Isn't there any other way?
10:51It shouldn't take long.
10:54All right.
10:55Those ridges look a lot like purple papules.
10:59They're not purple.
10:59They're red.
11:00Probably just blood blisters.
11:04Give me the biopsy needle.
11:16How long is this going to take?
11:18Forget it, Chase.
11:19You're punching out the shark story.
11:20It's good, but she's not waiting for you.
11:23So?
11:24We couldn't confirm the source of the bleeding,
11:26but we did biopsy some blood blisters.
11:28I mean, papules.
11:30Come on, Cameron.
11:31Who's right?
11:34Chase is negative for Erdheim Chester.
11:37Let me see.
11:38Okay.
11:39Okay.
11:41Okay.
11:42Okay.
11:42Okay.
11:42Okay.
11:46It's not Erdheim Chester.
11:47It's exactly what we said before.
11:49Garden Variety Viral Gastroenteritis.
11:51Can we go back to the party?
11:52Do a kidney biopsy.
11:56Esther's shut down and exactly...
11:57This kid is not Esther.
11:59You screwed up.
11:59She died.
12:00I'm sorry,
12:00but that does not mean this kid is dying as well.
12:03Jeez.
12:04You're testy when you don't get any fuzz.
12:06Come on.
12:07Come on.
12:21What did the test say?
12:23Colonoscopy was clean,
12:24and the biopsy was negative for Erdheim Chester.
12:27So Ian's gonna be all right.
12:28It was just some sort of virus.
12:30What's that?
12:33Urine.
12:34But it's brown.
12:37Ian's kidneys are shutting down.
12:39Still think it's not the same case.
12:56So, what can cause bloody diarrhea,
12:59ataxia,
13:00and kidney failure?
13:02I'm gonna do a biopsy.
13:03Forget it.
13:04That battle's over.
13:05His rising creatinine is his kidney's way of saying,
13:08go on without me.
13:10What explains everything?
13:14E. coli HO-157 causes bloody diarrhea
13:17and leads to hemolytic uremic syndrome.
13:20Toxins from the bacteria cause these kidneys to shut down.
13:23We should start him on plasmapheresis.
13:24Clear, concise, and completely plausible.
13:28And exactly what I did last time.
13:30Didn't work.
13:31What else?
13:32Good pasture syndrome.
13:33Circulating antibodies cause kidney failure and bleeding.
13:36But not the purple papules.
13:38If you throw in Esther's next symptom,
13:39brain,
13:40it makes me think heavy metal toxicity.
13:42His hematocrit would have to be low.
13:43It's at 44,
13:44and Esther's never dropped below...
13:4542.
13:46You have the file memorized?
13:48It's my lucky number.
13:49What about lymphoma?
13:51Causes kidney failure,
13:52GI bleed,
13:53and can infiltrate the base of the brain.
13:56Do you check Esther for that?
13:58She never showed any signs.
14:02If he has lymphoma this far advanced,
14:04we should be able to see it in his blood and brain.
14:06Chase,
14:07run a blood smear in immunochemistry.
14:09So, for him to get an MRI.
14:11I'll page Cuddy.
14:12No, you won't.
14:14She thinks the kid has a stomach ache.
14:15She'll come right up here and do one of two things.
14:17If she agrees with me, I don't need her.
14:19If she disagrees, I don't want her.
14:20You can't handle people disagreeing with you?
14:22She might have a different take on this.
14:24Subordinates could disagree with me all they want.
14:26It's healthy.
14:27People who can shut me down, on the other hand,
14:30forget Cuddy.
14:31I'll have Wilson keep her busy.
14:40Keep your answers short and discreet.
14:42Is Cuddy still playing?
14:45The chicken...
14:46Is still in Piccadilly Square.
14:47Brilliant.
14:48She'll never suspect that Normandy is her target.
14:51Is that house?
14:52Tell him that the blinds just went to 2040,
14:55and he's running out of chips.
14:56How's she doing?
14:57What's going on?
14:58The way you took off,
14:59something's obviously...
15:00Love to chat, but got a game to play.
15:02How's she doing?
15:03The patient is on life support.
15:05We're about to pull the plug.
15:06Are you talking about me?
15:07What have you got?
15:08Mmm.
15:09Those sound like high-dose cardio meds.
15:11Two hearts.
15:13You got the flush?
15:14Still waiting on the final labs.
15:16Is she drinking her seltzer?
15:18No.
15:19Hydration is not a problem.
15:21I mean, she's bluffing.
15:22We'll push her all in.
15:26Golf.
15:28Tooth care.
15:29Show me your hearts.
15:36Seven of clubs.
15:37Oh, dear.
15:38Sounds like I messed up.
15:40You're gonna be stuck with her for a while.
15:42Talk to you soon.
15:45Oh, yes!
16:02Why are you taking a picture of his head?
16:04We're looking for lymphoma, but...
16:06Wait, so it's not Erdheim something,
16:08and it's not his kidneys,
16:09but his kidneys are failing?
16:11What...
16:11Where's Dr. Cuddy?
16:12Um, Dr. House mentioned another case.
16:14Is there another patient with the same thing that Ian has?
16:16Not exactly.
16:18What does that mean?
16:19Dr. House had a patient a while back
16:21who exhibited the same symptoms as your son.
16:23Then you know what's wrong.
16:26No.
16:27So what do you know?
16:28We know the likely course the disease will take.
16:31Which is?
16:32She had multiple system failures.
16:34What happened to her?
16:40She died 24 hours after her admission.
16:50Mr. or Mrs. Alston,
16:51would you mind giving me a hand?
16:55He's...
16:56He's having trouble sitting still,
16:57and it's impossible to look at the detail we need.
16:59So I figure it might feel more comfortable
17:01hearing your voices.
17:08Ian, honey?
17:11Just sit still.
17:13You'll be done in a moment.
17:14We'll...
17:14We're here with you.
17:16I'm scared.
17:19It's okay, honey.
17:20It's...
17:21It's only a big camera.
17:23It's gonna take a picture of your head.
17:26You love it when I take your picture at home,
17:28don't you?
17:28Yeah.
17:30And you have to hold still for that, too, right?
17:34But this isn't like that.
17:38I know it's scary, Ian.
17:40But you can do it.
17:43You're getting to be so grown up.
17:48So just...
17:50hold perfectly still.
17:51Just for a little bit.
17:53Mommy, are you crying?
17:55No.
17:58No.
17:59No, honey.
17:59I'm just tired.
18:02Okay.
18:03I'll try.
18:06I'll try.
18:09I'll try.
18:09Let's go.
18:11I'll try.
18:12I'll try.
18:12Yeah.
18:12No.
18:15No.
18:16What?
18:17No.
18:19No.
18:20No.
18:33The base of his brain's been infiltrated by a small man,
18:36We think...
18:37Pituitary?
18:37Looks that way.
18:38Explains a low blood pressure.
18:42Pretty much confirms the lymphoma.
18:50If we'd started ester on prednisone...
18:52Uh, did anyone see the lymphoma?
18:55No, we saw a mass. The location was consistent with...
18:58Didn't see any in the blood, either.
18:59White blood cells show no spindling or abnormal nuclei.
19:03Nothing on immunochemistries, either.
19:04It's not lymphoma.
19:35No.ded
19:36FIRE FIRE
19:36FIRE
19:41house it's a train you know what kind of train i'm thirsty it's closed
19:52it's not now
20:00you got one advantage we know where the tracks are going the fact that the end of the line
20:05is death is an advantage the fact that we know it's an advantage means maybe we can get ahead
20:12of it next station is the liver we got about 90 minutes before it gets there maybe we can cut
20:18down a tree across the line just outside of town i'll do an ultrasound no treatment will tell us
20:23more faster how can we start treatment if we have no idea what we're treating for treating for
20:27everything give him acetylcysteine and interferon and silimarin and whatever else you can think
20:47out to protect the liver
20:49what's going on oh just catching up on some tv how are you doing well thanks to your last consult
20:55the patient has improved dramatically tell house the patient is about to kill the doctor she says
21:00the patient i heard what do you got well cutty just raised and uh you're paired what nines
21:08how do you know anything lower you wouldn't sound so excited jacks are higher your voice sounds like
21:15debbie from a county is sitting in your lap ask cutty if she can beat a pair of threes wait
21:20what's
21:21going on if you're gonna mess with me wouldn't it be more fun to do it in person yes it
21:24would
21:27um can you beat a pair of threes what did she do i left orders for po fluids doctor enough
21:33with
21:33the codes she obviously knows it's me she's drinking herself did she stop yes go all in
21:40um but just do it you couldn't care less about this charity event you claim not to be messing with
21:47me obviously you're either trying to keep me shut up look last time i wanted the game to go on
21:53i
21:53still do means that this time you get to win hold on
22:04my fault
22:08oh
22:14house are you sure you're okay
22:16home
22:17home
22:18home
22:20home
22:20home
22:20home
22:20home
22:21home
22:24home
22:26home
22:48that seemed to be working livers holding its own good with the platelets are dropping even better
22:55Why? It means he's getting sicker.
22:57It's new. New is good.
23:00Because old ended in death.
23:05I can't breathe.
23:08Chris!
23:10What?
23:12What's happening?
23:18Ian, come on.
23:20Honey, just relax.
23:23Ian, breathe. Come on, honey.
23:24Please. Please, honey.
24:19We had to put him on a ventilator.
24:20He's back on Esther's path.
24:23He managed to make the train skip a few stations,
24:26which means that instead of 12 hours,
24:28he's probably got less than two.
24:30Which begs the question, why?
24:32What do we do?
24:34Acetylcysteine could mess with the lungs?
24:35Mess with them, not shut them down in 20 minutes.
24:38Your furon modulates the immune system.
24:40It could affect a cancer of the blood, like one of the leukemias.
24:43It doesn't speed them up. It slows them down.
24:45Slows down all 500 of them?
24:47Anybody know where we can find an oncologist at this hour?
24:55What effects would interferon have on leukemia?
24:59Depends on what type.
25:00It could make it better, it could make it worse.
25:01A four-year fellowship to learn that.
25:03Tell House if he wants to play cards,
25:05he can get his ass back down here and play.
25:08You hear that? She wants me off the phone.
25:10Means she's vulnerable. Go all in.
25:12But, um, the party's over in less than three hours.
25:16It's over in less than two hours.
25:18Which means you either have three of a kind or just threes.
25:24I'm guessing threes.
25:27I bet 500.
25:31Go all in.
25:32You obviously want to bust me.
25:34Why would you...
25:35Either you go all in or I tell everybody in the building
25:37that you wear toenail polish.
25:40I'm all in.
25:44Oh, cool.
25:46I'm betting you have a pair of threes,
25:47but even if you have three,
25:52it's not gonna beat trip nines.
25:57Oh, oh, oh, no.
26:00Oh, no.
26:01Oh, oh, that's gotta hurt.
26:03What happened?
26:04I just killed two birds with one string.
26:06Goodbye.
26:08Fine. Keep playing.
26:09I need you to recommend a good oncologist,
26:11because if I don't get one up here in the next few minutes,
26:13I got a dead six-year-old.
26:17If you need help, ask.
26:19These games are insane.
26:22Games have a higher success rate.
26:24Well, I don't see anything that looks like leukemia.
26:26You do a bone marrow biopsy?
26:28No time.
26:29Even if there is an occult blood cancer,
26:31you wouldn't expect interferon to make it worse.
26:33Certainly not this fast.
26:34What would move this fast?
26:36Autoimmune diseases.
26:38If his bodies on defenses are attacking him,
26:39then beefing him up is just gonna put fuel on the fire.
26:42Sarcoidosis could be in his brain and lungs.
26:44No.
26:44No enlarged hyalur lymph nodes on his chest x-ray.
26:46The systemic nice just suggests juvenile rheumatoid arthritis.
26:49Mark Kawasaki's disease.
26:51Can't be Kawasaki's.
26:52It doesn't affect the elderly.
26:54Uh, the...
26:55This is a kid's x-ray.
26:57How has had another patient?
27:01Who may or may not have had Kawasaki's.
27:02This kid, on the other hand,
27:04he makes antibodies that are eating the inside of his arteries.
27:08Choking off blood through his major organs one by one.
27:11First the GI tract, then the kidneys,
27:13then the brain, now the lungs.
27:16Can anyone think of a reason why Kawasaki's can't affect the elderly?
27:21Other than that it doesn't?
27:26Nice.
27:26We can confirm with blood work.
27:28We need an ANA sed rate.
27:30Labs will take two hours.
27:32What was the old lady sed rate?
27:34Elevated.
27:3498.
27:35You can't use another patient's labs to diagnose Kawasaki's disease.
27:39What, is that like a dare or something?
27:40You don't have time to be wrong.
27:42Fine.
27:43We'll look for Kawasaki where he lives.
27:45Ian's coronary arteries.
27:53This other patient.
27:57The old lady.
27:59Esther?
28:03Have you read Moby Dick?
28:05It was a book?
28:07It was ten years ago.
28:09Twelve.
28:10Obsession is dangerous.
28:11Only if you're on a wooden ship and your obsession's a whale.
28:14I think I'm in the clear.
28:15You do realize it's a metaphor.
28:17You do realize that the point of metaphors is to scare people from doing things by telling them that something
28:21much scarier is going to happen than what will really happen.
28:25God, I wish I had a metaphor to explain that better.
28:28Go back to the game.
28:30Don't worry.
28:30I'm not gonna get eaten by witches.
28:37Coronary arteries clear.
28:39No aneurysms.
28:40Flip the mode.
28:41Let's see the flow.
28:46How did that other woman die?
28:49She went into respiratory distress.
28:52Her heart and liver were already...
28:54No.
28:56Did she suffer?
28:59Was she in pain?
29:01No.
29:01No.
29:02I don't know.
29:06Lemon of flow.
29:08No blood clots.
29:09No wringled edges.
29:10Dan, shut it down.
29:12We're just wasting time.
29:19Look at the right atrium.
29:21That's not Kawasaki's.
29:23No.
29:24It's small, but it's there.
29:26Esther didn't have a mass in her heart.
29:28Ian's younger.
29:29It could take more of a pounding.
29:31Esther died before the disease reached her heart.
29:33The disease made a mass and made it fast.
29:35Could be bacteria.
29:36Muscle.
29:37Connective tissue.
29:38The kid can't take any more theories.
29:40Only thing we know is that whatever that mass is,
29:42that's what he's got.
29:43We need a piece of it.
29:45I'm doing a biopsy.
30:01I'll shut the blinds.
30:03I'll let him watch.
30:04I'll do my best work on the big stage.
30:09Passing through the superior vena cava.
30:11You're in the atrium.
30:13Pull back.
30:15You've hit the wall of the heart.
30:18These procedures would be so much simpler if you could do them on healthy people.
30:23And out again.
30:27Eat that.
30:28Cardiac brace.
30:31Come on.
30:32Paddles.
30:35Come on.
30:36Cards.
30:37Clear.
30:39Code blue.
30:40I feel real.
30:41Code blue.
30:43I feel real.
30:45Again.
30:50Nothing.
30:51Again.
31:07You got a clock on this?
31:09How much longer are you going to keep doing this?
31:11Clear.
31:16Wait.
31:17I've got something.
31:21He's back.
31:30What have you done?
31:32What we came here to do.
31:33It almost killed him.
31:34I know.
31:35It was right here.
31:36Give me a bacutana.
31:37His brain's been oxygen deprived for over eight minutes.
31:40There might be nothing left.
31:41He might tell the parents.
31:43Who the hell is that bacutana?
31:52You.
31:53You.
31:53You.
31:54You.
31:55You.
31:56So, what's he got?
31:57Brain damage.
31:59Good chance.
31:59I was talking about before that.
32:01You're not worried about...
32:02Things I can't do anything about, I try not to.
32:05Yeah.
32:05Things just roll off you like water off a duck.
32:08Histiocytosis.
32:09Very unlikely in a 73-year-old.
32:11Whatever this is, it's very unlikely.
32:14Come on.
32:14More ideas.
32:15Let's go, people.
32:16Genetic disorders could cause masses everywhere.
32:18Tuberous sclerosis.
32:20If it's genetic, he's had it all his life.
32:21Why now?
32:22I don't know.
32:23It sure fits nice enough.
32:24We haven't ruled out leukemia yet.
32:26Or sarcoma.
32:27He could have multiple soft tissue tumors.
32:29Or sarcoidosis.
32:31Multiple neurofibromatosis.
32:32Chondrocytomas.
32:36How's it going?
32:37When?
32:37I got called away by the angry parents of a patient.
32:41There are three of you here.
32:42None of you have the sense to stop him.
32:44To pick up a phone and call me.
32:45I told them you'd signed off.
32:46The parents are mad because their kid is dying.
32:49It's understandable.
32:50If he doesn't die, they won't be mad anymore.
32:52Well, if he's brain damaged, they might still be a little ticked.
32:55Had to do it to save him.
32:56You had to do it to diagnose Esther.
32:58You may have killed a six-year-old
33:00because you're obsessed with a woman who's been dead for 12 years.
33:04Sometimes you lose house.
33:05You're not God.
33:06He's not dead yet.
33:07No, but you're done with him.
33:08It's my case now.
33:09Go home.
33:10Go ride your motorcycle.
33:11Go brood in a dark room.
33:13Just don't go near Ian again.
33:22So, anything else?
33:23Or is it just these seven?
33:25Drop it, Hal.
33:26She's right.
33:26No, she's not.
33:29You know she's not.
33:30We should have called him.
33:31I'm surprised you didn't.
33:33You're gonna have to find a way to let this go.
33:35We can't go near Ian.
33:36We don't need to go near him.
33:38We have his tumor.
33:41Look, Cuddy may be right that we screwed up the protocol.
33:43She may be right about my screwed up obsession.
33:46But I'm right about the medicine.
33:48How many tests could we do with that?
33:51Look, we cure the kid, we solve everybody's problems.
33:54How many?
33:58Maybe two good pieces.
33:59How many okay pieces?
34:02Three would be pushing it.
34:05Three tests, seven choices.
34:09Okay, what's first?
34:12Sarcoidosis seems most likely.
34:14Yeah, so likely that Cuddy's gonna think of that all on her own.
34:17She's got the kid's whole body to play with.
34:19Let her do that test.
34:21What's next?
34:22It's moving too fast to be sprinting.
34:24It has to be grown from something that's already done.
34:26Genetic disorder, tuberous sclerosis.
34:28Or it's his immune system, histiocytosis.
34:32There are more documented cases of histiocytosis amongst older people and tuberous sclerosis.
34:36Let's start with that.
34:43Wing or drumstick?
34:48Gonna need a little more than that.
34:49A little more is more than a third.
34:51If we have to repeat this test because you didn't cut us enough.
35:00I'm adding one microliter of the immunoperoxinase.
35:03Make it two.
35:04I don't want the house biting off our heads because we weren't sure if it turned red or not.
35:14That's definitely not red.
35:22The problem could still be an abnormal cell growth but a different cell line.
35:26Sarcoma?
35:26Muscle cells are throughout his body.
35:28Would explain the geography.
35:29Genetic disorder is far more likely than a six-year-old.
35:31Tuberous sclerosis.
35:33Radial activity calls a GI blade.
35:34The time course fits.
35:36So for me, you agree with both of them.
35:38Thanks for playing.
35:38If we have enough tissue for two tests, why not do both?
35:41Then we don't have to think as hard.
35:43Taking the pressure off the choice makes us less likely to think critically.
35:46Sarcoma is more likely to hit a six and 70-year-old.
35:49Tuberous sclerosis it is.
35:50You think sarcoma is less likely?
35:52It's more likely.
35:53The test for it, on the other hand, is less reliable.
36:09Destin's negative.
36:10Well, that's okay.
36:11If the tumor cells haven't matured, the KI-67 protein wouldn't have turned off.
36:17What happens if we don't solve this?
36:19Kid dies.
36:20I mean for the next 12 years.
36:23K.O. 67 is negative.
36:29And PCH antigen is negative.
36:43Mighty Casey's down to his last strike.
36:45Mighty Casey struck out.
36:48Thanks a lot.
36:49Gonna read that this weekend.
36:51Chondrocytoma.
36:51Connective tissue has been in all the places we've been looking.
36:54The kid is too sick for that.
36:55We're better off testing for sarcoma.
36:56We would have seen signs of that when we tested for tuberous sclerosis.
36:59Tumor cells look like muscle under the microscope.
37:02No, they didn't.
37:02They looked like fat.
37:05I vote for neurofibromatosis.
37:08Why?
37:09Because the other choices suck worse.
37:20Give me a minute.
37:21All right.
37:45Thanks.
37:49What?
37:51You want me out of here?
37:55You come up with anything?
38:00No.
38:27Hey.
38:28We can talk about it tomorrow.
38:38I, um...
38:41I won the poker tournament.
38:45I totally played this guy Berman from Business Affairs.
38:48I got great cards, but I don't bet.
38:50Just call. No raises.
38:53Berman pairs his king on the flop.
38:55I keep calling.
38:56The river turns.
38:58I check.
38:59He can't stand it.
39:00He goes all in.
39:02He's sure he's won.
39:05I call.
39:07I flip him.
39:08Oh!
39:09Pocket aces.
39:10I nailed his ass.
39:21The aces were hiding all along.
39:32Testing for Erdheim-Chester disease.
39:35Erdheim-Chester? That's not even on the list.
39:37Because we already did it.
39:39He tested negative.
39:40So did Esther.
39:41Disease lied.
39:42Yeah, the tumor's got it in for you.
39:44Diseases don't lie.
39:46Fine, it didn't lie.
39:47It's a slow platus.
39:48We biopsied the colon.
39:49It hadn't reached the GI tract yet.
39:51It's there now.
39:53It's in his liver, his lungs.
39:55You want it to be there?
39:56Because then you didn't screw up 12 years ago.
39:59We can't waste our one test on the one disease we know it's not.
40:05Run the test.
40:18You sure about this?
40:20Wait, let me think about that.
40:22Don't pressure me.
40:23Just run the damn test.
40:28Cells look like macrophages.
40:30That's a good start.
40:37Take your time and say it loud.
40:50CD 68 positive.
41:04Start the treatment.
41:34Let's pray with you.werve
42:05So, Esther can rest peaceful now, huh?
42:09Yeah.
42:16Forty.
42:23You got lucky.
42:25You gonna call?
42:27What I do is not just based on the flip of a card.
42:32You guessed. You got lucky.
42:35It fit.
42:36It could just as easily have been sarcoma or tuberous sclerosis.
42:39No, not just as easily.
42:42Maybe not, but it wasn't impossible.
42:48Are you gonna call?
42:51You know, relative to its size,
42:54the barnacle has the largest penis of any animal.
43:02You got lucky.
43:03You got lucky.
43:05You got lucky.
43:05You got lucky.
43:05You got lucky.
43:06You got lucky.
43:06You got lucky.
43:06You got lucky.
43:06You got lucky.
43:07You
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