Season 2 X 04 : TB or Not TB

Original Airdate: 11/1/2005
Written by: David Foster
Directed by: Peter O'Fallon
Transcript by: Mari

BEGINNING

[Opens on a plane soaring over Africa. It passes over and lands next to a small villagers. The residents look overjoyed to see the plane. Out of the plane pops Dr. Sebastian Charles.]

Villager: Dr. Sebastian! [They hug.]

Sebastian: Two pallets of antibiotics for tuberculosis.

Villager: We’ve got six pallets worth of patients!

Sebastian: Stoia Tucker needs a math lesson. I’m headed back tomorrow. [Sebastian is overrun by laughing children. The villager instructs people to unload the plane. We see boxes being unloaded with the label “Stoia Tucker”. Sebastian is walking with the children, and takes a box out of his bag.] I’ve got some very special medicine here; this is from Hershey, Pennsylvania. One per person, one per person. [The kids all grab for the chocolate. Sebastian leaves the children and heads to a hut. Another villager runs up.]

Villager #2: Help, help! Dr. Sebastian, come quickly! My son, he fell. He fell on this rock. We were just waiting for his friends. [They run over to the man’s son, who is half lying in a ditch. The man speaks in his native language as Sebastian checks the boy’s vitals.]

Sebastian: I got no breath sounds on the left – give me that. [He takes a syringe and inflates the boy’s left lung.] Yeah, he’s gonna be okay.

[Cut to Sebastian giving a slide presentation in a cushy boardroom.]

Sebastian: The fall didn’t cause him to drop a lung, the lung caused him to fall. TB chewed it up. He’ll be lucky to live another year. [He changes the slide.] Now, this is Sarni. I picked up the tab for the back brace myself. The funny thing is that the brace cost more than the medicine that would have prevented her from needing it. It’s your medicine. All of the antibiotics that we need are right here in your warehouses, in your factories. [One of the board members speaks up.]

Jerry: We provide over 10,000 doses a year.

Sebastian: Which is not enough.

Jerry: You know we’d love to do more, but our hands are tied.

Sebastian: New car, Jerry? I saw it on the way in, looks beautiful.

Jerry: Don’t make this personal.

Sebastian: All the way from Germany, too, I know that’s a lot of red tape.

Jerry: I’m not like you; I’m not ashamed of making a living.

Sebastian: And I know you didn’t become a chem. major for the money. Now you want the same things that I want, you just… [He puts a hand to his forehead.] You have to, you just have to push a little, you have to push a little bit harder, harder for them.

Jerry: Sebastian? [Sebastian, now leaning on the breakfast table, collapses, taking the table with him. The board members run over.] Call 911! Isn’t someone here a doctor? [Ironic close-up on Sebastian’s face, and credits!]

[Cuddy’s office. As House walks in, Cuddy stands and shows House a cover of Newsweek with Sebastian’s pictureon it.]

House: Selling subscriptions? I heard 20 and you get a new bike.

Cuddy: Dr. Sebastian Charles collapsed during a presentation at Stoia Tucker.

House: Really? Crushed under the weight of his own ego?

Cuddy: Wow. Is there nobody you admire?

House: Well, there was this gal I met in ‘Nam who could blow out a candle without using her –

Cuddy: He thinks it’s TB. [Shehands him a chart.]

House: Good thing he’s not the syphilis expert.

Cuddy: He wants a second opinion.

House: Second to his own. Okay. [closes chart] It’s not TB.

Cuddy: What is it?

House: Oh, you want specifics?

[Cut to Sebastian, who is showing his sob-story pictures to the staff in Diagnostics.]

Sebastian: Lemma. Big Knicks fan.

Foreman: You’ve never had an episode like this before?

Sebastian: No. He died last month. Stupidly tried to share his meds with his cousin, and they only had enough for one. [House enters.] Dr. House, I’m Sebastian Charles. [He offers his hand, which House walks right by.]

House: Patients aren’t usually part of the diagnostic process.

Sebastian: Well, I’m a doctor…. Listen, I know you guys don’t make a lot of money, but –

Cameron: I wrote your people a check last month.

Sebastian: Oh, well… write us another one.

Foreman: Talk to Chase, he’s rich.

Chase: My dad, not me.

Sebastian: Every minute 4 people die of TB.

House: [writing on the board] Wow, how can you sleep at night?

Sebastian: There’s people dying in Africa of a disease that we cured over –

House: Yeah, I know. I saw the concert. Seriously, let’s say you sleep six hours, that means every night you kill 1440 people. I guess you gotta get some sleep, but come on, if you’d stayed up another 10 minutes you could have saved 40 lives. Do you send notes to the families in the morning? That’s gonna take at least 10 minutes so that’s another 40 dead, another 40 notes…. Why don’t you go wrack yourself with guilt in your own room?

Sebastian: No, thanks, I’ll stay. I’d like to hear the differential.

House: Dr. Cameron, tell the doctor why it’s not a good idea for the patient to be here.

Cameron: He’s an immunologist and a TB expert.

House: That’ll be very useful if we need somebody to say the words, “I think it’s TB.” [He sniffs.] What is that?

Sebastian: Oh that. I’m sorry, that’s my body powder. It’s the only thing I’ve found that works in the Sahara. I, I’m kinda used to it, I don’t even notice it.

House: Who thinks it smells like an elephant dung smoothie?

Cameron: It smells okay to me. [Sebastian laughs.]

House: That is exactly why the patient shouldn’t be in the room. If you can’t tell a man that his cologne makes you want to puke, how are you going to tell him that he’s an idiot?

Cameron: He’s not an idiot.

House: Sure, you say that now, while he’s in the room.

Sebastian: Look, I don’t have time for this. It’s TB.

House: Nope. The symptoms are too varied.

Sebastian: Well, if you haven’t seen 10,000 cases I’d agree that’s what you’d think.

House: Told you he’s an idiot. You said you wanted a second opinion.

Sebastian: No, actually. My backers wanted a second opinion.

House: Yeah, doesn’t look good if you drop dead while wearing your shoes sponsor’s logo.

Sebastian: It’s TB, and I’m not dying. I’m gonna want you to plan a PPD and induce a sputum to confirm the TB. [House nods to Chase and Foreman, who stand up. Sebastian follows.] Imaging studies’ll determine the progress, and I think we should probably take a CT scan of my lungs just so that nobody second-guesses us?

House: Wouldn’t want that. [Sebastian’s cell rings. He answers it.]

Sebastian: [on phone] Hello? No, I’m feeling much better. [Sebastian leaves the office, but goes the wrong way down the hall.] Well, what you can do is you can get your board to approve the increased med shipments that – [Cameron runs down the hall to shepherd Sebastian the right way.] No, no, no, no, don’t try. No, no, don’t do your best. Just get it done, okay? [He hangs up by the elevator.] That’s Stoia Tucker, and they’re the nice pharmaceutical company.

Cameron: I’m sorry, but it’s against hospital regs. [She holds out her hand.]

Sebastian: Oh, I need the phone. [Cameron’s beeper goes off.]

Chase: Why don’t we focus on getting you better right now? [Chase’s beeper goes off.]

Sebastian: What are you gonna do, throw me out?

Foreman: No, just the phone. [Foreman grabs it as his beeper goes off.]

Chase: Sorry, we’ve got an emergency. [Chase and Foreman run off.]

Cameron: There’s a phone in your room.

Sebastian: Yeah, I figured that there would be.

Cameron: Right, I just thought, it’s not like the hospitals that you might used to in Africa. [Sebastian gets in the elevator; Cameron stops the door from closing on her.] I don’t know what the facilities were like…

Sebastian: Thank you.

Cameron: You’re welcome.

Sebastian: And thanks for that check. [Cameron’s beeper beeps again.]

Cameron: [smiling very broadly] I should go.

[Cut to Foreman and Chase enteringHouse’s office.]

House: The nameless poor have a face, and it’s a pompous white man. [Cameron enters.]

Cameron: Yeah, what a jerk, saving all those lives like that.

Foreman: What’s the emergency?

House: [looking at his yo-yo] I can’t remember how to do Walk the Dog. The guy’s sick, he may be dying. We’ve forgotten all about doing a differential diagnosis.

Cameron: You just sent us off to test him for –

House: I had to get him out of there. Now we can all sit around and call him an idiot. Who wants to go first?

Cameron: He’s right! Tuberculosis could present in hundreds of different ways!

House: Well, by that logic, everyone in the hospital should be treated.

Foreman: Not everyone in the hospital’s been exposed to it for the last 20 years.

House: TB takes years to kill you. 2 weeks ago he was perfectly healthy, now he’s got a white board full ofsymptoms.

Chase: What about something metabolic?

House: Welcome aboard the GoodShip Asskisser. [Chase glares.] Nice day for a sail. Pucker up, me hearties.

Cameron: It’s not metabolic. Kidney, liver and thyroid are all normal. No diabetes.

Chase: What about his heart?

House: Obviously big as all outdoors.

Chase: Abnormal heart rhythm. White form showed P-R variability.

House: It’s subtle, but it’s there.

Foreman: You think it’s his heart? Sick sinus syndrome?

House: Loose throttle. Sometimes beats too fast, sometimes too slow.

Chase: Causing him to pass out.

Cameron: It would account for the episode. I’ll put him on telemetry, do a stress test and an echocardiogram.

House: Treat him like every other hospital patient. I want to see that pious, body powered toosh hanging out of his gown.

[Cut to Sebastian struggling with his hospital gown.

Sebastian: Could you give me a hand with this thing? I don’t recall asking for a stress test or anechocardiogram.

Cameron: What are you gonna do, walk out? Corporate sponsors aren’t going to like that. I need your forearm. [She prepares his arm for a shot.]

Sebastian: What’s House thinking?

Cameron: Sick sinus syndrome.

Sebastian: Well, that’s a lot more serious than TB. [Cameron sticks him… slightly.] Is that a PPD?

Cameron: If it changes color inthe next 48 hours –

Sebastian: Yeah, uh, if House doesn’t think it’s TB why would he have you test for that?

Cameron: Just covering all his bases, I guess.

Sebastian: Uh huh. He doesn’t seem like a guy who, who does that. [Cameron smiles.]

Cameron: We have you scheduled for a 10:30 echo.

Sebastian: Good for you. [He chuckles as she wheels him out of the room.]

[Cut to the elevator.]

House: Every minute that we refuse to love one another, another puppy cries another tear.

Wilson: You’re just mad that he’s closer to a Nobel Prize than you are.

House: And yet I’ve nailed more Swedish babes. Crazy, crazy world.

Wilson: It’s not just a trip to Stockholm, you know. It comes with a cash prize.

House: Seriously? No wonder everyone’s going after that peace thing. [The elevator dings, and they walk out into the hospital lobby.]

Wilson: He cures thousands of people every year, you cure, what? 30?

House: McDonald’s makes a better hamburger than your mother because they make more?

Wilson: Oh, I see! So you hate him because the lives he saves aren’t as good as the lives you save.

House: Yup, that’s the reason. Nobel invented dynamite. I won’t accept his blood money.

[Cut to House in the clinic.]

Mandy: The top of my head’s killing me. [She puts her hand on her head to demonstrate.]

House: Hmmm. We spent a week doing ‘top of head’ in Anatomy. I know just where it is. [He sticks his fingers right against her sinuses, and she flinches. (Ed. – And I flinch insympathy.)]

Mandy: Ow! That is not the top of my head!

House: Eh, close enough for clinic. Your sinuses are clogged. Judging by the scratches on your hands, I’m guessing a new cat.

Mandy: It was my mother’s. She’s dead.

House: You keep a dead cat?

Mandy: No. My mother’s dead.

House: Oh. Poor cat. You’re allergic. We can control it with antihistamine, one pill a day.

Mandy: Pills?

House: You don’t like to swallow. Not surprised. Forget the pills. I’ll give you a nasal spray.

Mandy: Steroids? Is there something else you can give me?

House: Well, if you lived by the river, I’ve got a bag.

[Cut to House leaving the clinic.]

Foreman: Hey, stress test was normal.

House: But his EKG was not normal.

Foreman: Echo’s normal.

House: Two for you, one for me. We need a tie-breaker.

Foreman: Echo and stress test are more reliable.

House: Tilt-table test.

Foreman: Never works.

House: Bet you a week’s clinic duty it does.

Foreman: Hah hah, you’re on.

[Cut to Sebastian, looking oh-so-amused strapped to a table. He goes down.]

House: You like this guy? [And up.]

Foreman: You always tell us our opinion of the patient is irrelevant.

House: Medically, it’s irrelevant. [Down.] That says something about you. [Up.]

Foreman: You figure that anybody that gives a crap about people in Africa must be full of it?

House: Yes. There’s an evolutionary imperative why we give a crap about our family and friends. And there’s an evolutionary imperative why we don’t give a crap about anybodyelse. If we loved all people indiscriminately, we couldn’t function.

Foreman: Hmmm. So, the great humanitarian’s as selfish as the rest of us.

House: Just not as honest about it.

Foreman: You also always tell us motives are irrelevant. [And Sebastian is still going up…] Dr. Charles, your heart’s handling the changes in orientation just fine. No pauses on your EKG. And House drives up for the lay-up and oh, rejected! [Heh, those doctors andthose sports metaphors.]

House: What does this knobby thing do?

Foreman: I’m within protocol range, you’re not going to get a different result.

House: The way I figure it is, if this could show you problems at 6, imagine what could happen if you crank it to 10. [The table starts going up and down much faster.]

Sebastian: House, is that you?

House: Does it go to 11?

Foreman: Would you stop? You lost. I’m scheduled for clinic duty Thursday and Friday.

Sebastian: [up, down, up] Alright, I’m beginning to feel nauseous.

Foreman: Would you turn the damn thing off before you break it? [He slaps House’s hand away.]

Sebastian: Okay, I’m getting dizzy, I can’t see, I’m gonna pass out.

House: I win.

Foreman: At those speeds astronauts throw up.

House: I’m not talking about the nausea. [He points to the screen with the readout.]

[Cut to Foreman discussing the results in Sebastian’s room.]

Foreman: The test revealed a problem.

Sebastian: Yeah? House is insane? What he just did –

Foreman: Abusive and unprofessional. If he hadn’t done it, we wouldn’t have seen the problem. You’ve got an abnormal P-R interval. It could be dangerous, possibly fatal, particularly if you’re in Africa away from advanced medicine.

Sebastian: I’m gonna need a pacemaker?

Foreman: You’re scheduled for surgery this afternoon.

[Cut to Cameron and Sebastian waiting for the elevator.]

Cameron: You’ll be able to maintain your pacemaker from anywhere, you just need to get yourself to a phoneline every few months.

Sebastian: Better yet, you could join me at one of my clinics.

Cameron: I’m kind of spoiled.

Sebastian: Well, we’ll get you a hut with a view. You like sand?

Cameron: I meant medically. No PET scans, no MRIs…

Sebastian: This is ridiculous. [He gets out of the wheelchair.]

Cameron: Dr. Charles, wait –

Sebastian: I know, I know, hospital regulations. Darling – [he calls to an old woman walking by with awalker] – have a seat. [to Cameron] Come on.

[Cut to Cameron and Sebastian starting down the stairs.]

Sebastian: You’re smart, you’ll adapt… we going up or down?

Cameron: Basement.

Sebastian: All right. You might even find that without the technological crutches you become a better diagnostician. My heart can handle this, right?

Cameron: So far just carnival rides have set you off.

Sebastian: When you meet these people it changes you. We should talk about it over dinner.

Cameron: Are you asking me to Africa or on a date?

Sebastian: Oh, I can ask you halfway across the world, I can’t ask you to a restaurant a block away?

Cameron: Well, one’s a job, and the other’s…

Sebastian: Yeah, hospital regs,you can’t date patients, right, I wouldn’t want to risk your precious objectivity. You haven’t answered either question, by the way.

Cameron: You don’t think objectivity’s important?

Sebastian: I think doctors like House cling to objectivity like a three-year-old to a blanket; don’t get too worked up, stay calm, stay cool and maintain that correct perspective. The only flaw in their argument is when you have millions of people dying the correct perspective is to be yelling at the top of your lungs. Sorry, my head is killing me.

Cameron: Here, sit on the step. [She takes his pulse.]

Sebastian: So, you gonna go out with me or not?

Cameron: Your heart rate’s normal.

Sebastian: Yeah, of course it is, it’s one flight of stairs. I’m gonna be fine. My hand’s a little – [And withthat he vomits and collapses on top of Cameron.]

Cameron: Call a code! Second floor stairwell! [But who was she yelling to?]

[Cut to Diagnostics.]

Cameron: You were wrong.

House: Hey, I have feelings. I’m trying my best. Isn’t that enough for you?

Chase: [waving the paper] Theabnormal EKG was real…

Cameron: It’s not sick sinus syndrome.

House: Well, thank God we found out before we put the pacemaker in. And thank God you dragged him into a stairwell to get his heart racing.

Cameron: We were taking the stairs, they keep them in the stairwell.

Chase: The guy’s a selfish jerk, why would you –

Cameron: Why would you say he’s selfish?

House: Because he’s been talking to Foreman. [The phone rings.]

Chase: No I haven’t, I’m just giving my opinion. This kind of altruism doesn’t just naturally –

House: Excellent briefing.

Foreman: Hey, the guy’s still sick. Can we talk about that? The headaches point to a neurological problem. Acoustic neuroma. Brian tumor causes dizziness, loss of consciousness, messes with breathing patterns, heart rhythms –

House: Get an MRI. [picks up phone] Hello? Oh, I’m sorry, I’ll be right down. No problem, I’ll do an extra hour to make up. I’m late for my clinic duty. Here, go be me for a couple hours. [He tosses Foreman his nametag, looking smug.]

[Cut to an impatient looking womanin the clinic. Foreman enters talking.]

Foreman: Explosive diarrhea, fever… it’s probably the flu.

Cecelia: Wow, you’re good. You a Harvard boy?

Foreman: You’re not Hale, Oliver?

Cecelia: No. Carter, Cecelia.

Foreman: They put you in the wrong room, Cecelia.

Cecelia: Mrs. Carter.

Foreman: Sorry. I’ll just be a few minutes, don’t take these in order and everything falls apart.

Cecelia: I have cancer. [Foremanturns to look at her.] I felt a lump.

Foreman: I’ll go get a nurse.

Cecelia: Yeah, see you in an hour or two.

Foreman: Lie flat. Lift your left arm up and under your head? [She does so, after unbuttoning her blouse.] Right there?

Cecelia: Yeah, I felt it this morning. Oh, my cousin had the same thing.

Foreman: It’s nothing. We should check it again on your next cycle, but you really don’t have anything to worry about.

Cecelia: That’s what they told Donna. She was dead in six months.

Foreman: Look, the edges aresmooth, it has mobility, it has all the earmarks of a benign --

Cecelia: Why should I believe you? Because you’re trying to rush me out of here?

Foreman: The risks of a false positive on a biopsy outweigh –

Cecelia: Either you do the biopsy or I talk to your superior. Which is it – [looks at nametag] Dr. House?

Foreman: I’ll arrange the biopsy.

Cecelia: Thanks.

[Cut to Sebastian entering the MRI. He doesn’t look good.]

Cameron: He asked me out.

Chase: I’m shocked. I’m shocked when patients don’t ask you out.

Cameron: He also asked me to come to Africa.

Chase: Boy, he moves fast.

Cameron: I think the two questions had two different objectives.

Chase: Well, do you like him?

Cameron: Good looking single guy, genius doctor, cares about the world…

Chase: I take it you said no.

Cameron: You think I’m that hung up on rules and –

Chase: He’s not House. There’s nothing there. [Indeed the MRI is spotless. However, Sebastian’s arm does have a spot…]

Cameron: Yeah, there is.

[Cut to House in his office.]

House: Did I ask you to plant a PPD?

Cameron: It was positive, he’s got TB!

House: Well, of course he’s got TB! The guy’s been in the jungle for 20 years! If he tested positive for pink-eye would you think that was his big problem?

Cameron: I did a test, it was positive, why is that a problem?

House: Because now he’s got thebig red target on his arm, the stubborn jerk thinks he’s right! He won’t letus do any more tests.

Cameron: Well, maybe he’s not the only stubborn jerk. [House does an exaggerated “what, me?” kind of gesture.] I did an LP2: low glucose and he has an increased sed rate. Everything screams tuberculosis!

House: Not everything!

Cameron: If any of the symptoms are caused by the TB it would throw off our diagnosis.

House: You’re right. Gotta treat the TB.

Cameron: Who knows, maybe he’ll just get better.

House: You’d like that, wouldn’t you? [Cameron leaves.]

[Cut to the cafeteria lunch line.]

Wilson: So it’s TB, but not TB?

House: I’m complicated.

Wilson: The guy does know tuberculosis. If he says it can manifest itself –

House: He’s not even a real doctor, he’s a human telethon.

Wilson: Is that your problem with him? You see hypocrites every day, why is this guy so special?

House: You think I have a hypocritical attitude to hypocrisy? The problem is there are 26 letters in the alphabet and he only uses two of them. He treats thousands of patients with one diagnosis. He knows the answer going in. It’s cheating.

Wilson: So it’s all because he’s one of them useless specialists?

House: Oh, did I hurt the big time oncologist’s itty bitty feelings? [House, at this point, start covering his steak with salad greens.] You’re a big help to patients who actually have cancer. Other times you’re just annoying. [Cuddy walks up.]

Cuddy: You’ve outdone yourself.

House: I’ll say. My salad’s covering a free t-bone steak.

Cuddy: Cecelia Carter, remember her?

House: Last week they said it was “Mystery Stew”, they owe me.

Cuddy: She was just in my office crying because of the way you treated her.

Wilson: That doesn’t sound like you!

House: Then it probably wasn’t.

Cuddy: I get that you like to shock people. Stun them out of complacency, out of stupidity. But this woman thought she had cancer, she had a lump in her breast! What were you trying to accomplish?

House: Let me ask you something; if this were another doctor, if this patient were complaining about, let’s say, I don’t know, Foreman, you’d just dismiss this as the paranoid bitching of another paranoid bitch and file it under ‘P’ for –

Wilson: Paranoid?

House: Am not.

Cuddy: You’re right.

House: Good.

Cuddy: Apologize to her before the end of business today. [She leaves.]

Wilson: What did you do to Ceci?

Houes: I have no idea. [to theregister] Just a salad today, big breakfast.

[Cut to Cameron entering Sebastian’s room.]

Sebastian: Hey. [Cameron giveshim a little cup of pills, which he looks at.] Levofloxacin?

Cameron: You have a resistant strain of TB.

Sebastian: Wow, you just walk right in with these.

Cameron: That’s what we doctors do. We write down the name of some medicine and someone gives it to us.

Sebastian: You know, there’s parts of the world where you get knifed walking around with this. I mean, regular stuff’s bad enough, but treatment for the resistant strain? [holds up a pill] I could get $6 a tablet for that one. And I’d take it for two years. Streptomycin, now that’s two grand… ten grand, cure one person. I had a patient in Jani once. It was a mother, had three little boys. She had resistant TB, she couldn’t afford these. She couldn’t afford bread. We gave her the regular stuff, but no surprise she died.

Cameron: I’m sorry.

Sebastian: I’m not taking these pills.

Cameron: Because she couldn’t getthem you’re not going to take them? That’s insane!

Sebastian: Why, because I’m betterthan her?

Cameron: Because letting her die was wrong but letting you die is just as wrong.

Sebastian: Well, maybe I won’t die. Maybe somebody’ll pay a little more attention to my story.

[Cut to House’s office.]

Cameron: He figures the pharmaceuticals need something big to force them into action. This’ll get alot more media play than a thousand African villagers dying. [The phone rings. Chase checks the caller ID – it’s Newsweek!]

House: So he won’t take the pills.

Chase: News Week’s calling you!

House: And he won’t agree to anymore tests.

Cameron: He has his diagnosis.

House: See what happens when you don’t listen to me?

Cameron: Maybe millions of lives get saved –

House: Yeah, that’s my point. Increased heart rate, night sweats, loss of consciousness… besides rough sex, what do they all have in common?

Cameron: T –

House: It’s not TB!

Chase: His autonomic nervous system?

Cameron: We know that it’s not a brain tumor.

Chase: So what else could beeating his nerves?

Foreman: Fabry’s, autonomicdisregulation syndrome, shy-drager syndrome, it doesn’t matter. He won’t letus test him. [The phone begins to ring again. House picks up.]

House: [on phone] In my opinion, Dr. Sebastian Charles is an idiot. Yeah, you can quote me. C-u-d-d-y. [Chaseand Foreman laugh to themselves.]

[Cut to Cuddy’s office.]

House: Sebastian is refusing life-saving treatment.

Cuddy: He’s refusing TB treatment. You don’t think he has TB, ergo you should care less.

House: He won’t let me test him.

Cuddy: And what do you want me to do about it?

House: Hold him down.

Cuddy: Have you apologized to Cecelia Carter yet?

House: Trust me, she doesn’t want to hear it from me. Look, the guy is killing himself, am I the only one who realizes this is a bad thing? [Cuddy begins to put on lipstick.] If he was a Christian Scientist refusing meds we’d have 18 attorneys…. You’re putting on make-up. That’s not a good sign for my side, is it?

Cuddy: Sebastian has called a press conference for 3. He’s asked me to be there to confirm the diagnosis on the prognosis.

House: You are as big a media whore as he is.

Cuddy: Of course I am. It couldn’t possibly be that I think he’s right and I’d like to be a small part ofwhat he’s doing.

House: Oh, whores can like the sex. Doesn’t mean they’re not whores. And with that eyeshadow… I am totally screwed, aren’t I?

Cuddy: Totally. [She leaves.]

[Cut to Sebastian’s room.]

Cameron: How’re you feeling?

Sebastian: A little weak.

Cameron: You’re having a good day. The symptoms will quickly focus more and more on your lungs, you’ll find it difficult to talk and eventually breathe at all.

Sebastian: I think I know what I have to look forward to.

Cameron: I know. I just came to ask if you’d be willing to accept any treatment.

Sebastian: Naw, if you’re trying to scare me into any –

Cameron: No. Palliative treatment. Narcotics, Fentanyl patch, morphine drip, whatever it takes. We can make your last days fairly comfortable. And if you have another good day, maybe dinner.

Sebastian: [takes Cameron’s hand] Thank you. [House notices the cozy scene and decides to intervene.]

House: You want third-world treatment? [turns up the thermostat] You got it. Boy, is it hot here in Jani!

Cameron: What are you doing?

House: What am I doing? [He knocks all of Sebastian’s things off of the tray of the bed.] Putting everything on the floor of the hut. Uh oh, wicked magic box with the moving pictures!

Cameron: You think he’s a hypocrite?

House: [unplugging the TV] Hypocrite? No, everyone in Africa’s got cell phones or running water. [Speaking of cell phones, it just got dropped in the toilet. It’s a tight fit,though, so House prods it down the hole with his cane.] Hah, this thing just will not flush.

Sebastian: Do you really think that if you come in here and make it a little hot, make it smell a little, that I’m just going to fold and abandon everything that matters to me?

House: [wiping his cane on Sebastian’s blanket] Lousy sanitation over there, too. You are not the same as them, your life is not the same. And you are cheapening everything they’re going through by pretending you are.

Sebastian: I am the same, I’m not special.

House: You can’t demand to be treated like any third-world sick person and call a press conference!

Sebastian: They treat me special! That doesn’t mean I am! Now what kind of selfish jerk wouldn’t take advantage of that fact?

[Cut to the press conference.]

Sebastian: It’s all preventable. Stoia Tucker makes medications right here, in New Jersey. They have warehouses full of the stuff; there’s more than enough to go around. So if I can get them, why can’t Lemma? Why can’t Quesmo? And why can’t Sarni? [He snaps.] Another person just died. Where is your outrage?

[Cut to House snapping as he watches the TV with Wilson in the coma patient’s room.]

Sebastian: [on TV] No, I have no intention of martyring myself, I’m just putting myself…

House: [keeps snapping] Sure, they’re dying, but it’s got a great beat.

Wilson: Must be hot as hell under those lights.

House: Yup. [Foreman enters.]

Foreman: Hey, why the page? He okay?

House: He’s in a coma. I need youto apologize to Ceci, Cecily…

Foreman: Mrs. Carter? For what?

House: For whatever I did.

Foreman: You didn’t do anything.

House: That has been my position all along.

Cuddy: [on TV] X-rays are negative, so he’s not contagious at this point, his condition’s currentlystable –

House: D’you notice how all the self-sacrificing women in history – Joan of Arc, Mother Theresa, can’t think of any others – they all die alone. The men on the other hand get so much fuzz it’s crazy.

Wilson: It’s an unfair world.

Foreman: House, she was scared and unreasonable.

House: Insulting a woman with breast cancer – that’s a move best left to the pros. Frankly, you don’t have the chops.

Foreman: I didn’t insult her! I did the unnecessary biopsy, like she wanted. [House moves to change the tinton the TV.] It was negative, like I knew it would be.

House: What did you do, call ‘em perky? You are years away from mad skills [Ed. – m4d sk1llz?] like that. I need you to apologize.

Foreman: You know, Cuddy’s only doing this because she thinks it’s you.

House: Welcome to the world. Everyone’s different, everyone gets treated different. You try fighting that, you end up dying of TB. [House hits the TV.]

Wilson: What are you doing?

House: Testing the patient’ sautonomic nervous system.

Wilson: Of course.

House: His internal heating and ventilation should be off, shouldn’t be able to sweat. That’s why he’s got that awful body powder. Take it away, crank up the heat, stick him under the lights, can’t cool himself. He should be turning bright red.

Wilson: The picture’s fine. [House looks puzzled, and then leaves, leaving a puzzled Foreman and Wilson.]

[Back to the press conference.]

Sebastian: I’m asking Stoia Tucker to save these lives, millions of lives. Including my own. [House barges in.] Dr. House, I would appreciate it if you left us alone. [House grabs a TV light and shines it in Sebastian’s face.] Get that out of my face.

[Back to the TV room.]

Cuddy: What are you trying to prove, House? [Foreman takes House’s chair and grabs some of Wilson’s chips.]

[Press conference.]

Sebastian: Dr. House, I would appreciate it if you left the room.

House: He’s sweating like a pig.

Cameron: It’s a hundred degrees in here, House, because you turned up the thermostat.

Sebastian: Did they hear me? The media, did they listen?

House: He’s disoriented.

Sebastian: They, they have to hear me.

House: His arteries are clamping down. [A monitor starts beeping.]

Cuddy: I want everybody out of here, now!

House: Get the crash cart, he’s having a cardiac arrest! [More beeping.]

Cuddy: Get them out! Everyone, I want everyone out of here now! [Nurses rush in, having to maneuver past the TV cameras. Cameron gets the paddles.]

Cameron: Clear. [She shocks him. Cuddy shakes her head.] Come on, Sebastian. Clear! [Another shock.]

Cuddy: I’ve got sinus rhythm.

House: [in the camera’s face] That is not TB! [TV room.] Wilson: Compelling television.

[Cut to Sebastian’s room, now camera free.]

Sebastian: Do whatever tests you want.

House: I want to treat you for TB. Dr. Cameron found low sugar in your cerebrospinal fluid. It’s a classic finding of TB.

Sebastian: And now you think TB’s the problem?

House: Nah. TB caused cardiac arrest on a hot day, your work in Africa would be even more futile than it already is.

Sebastian: Can you get to your point, please?

House: That white board in my office, we’re up to about a dozen symptoms now. Cardiac arrest, clearly not TB. CSF sugar clearly is TB. The rest of them could go either way. Unless we know which ones are which I can’t diagnose you. [He holds out the pills, which Sebastian takes and places on the tray next to him.]

Sebastian: I’ll take any other tests or treatments you might want to prescribe.

House: So you’re not special, but TB is.

Sebastian: People die of TB because we let them, it’s our choice.

House: People die of malaria because we let them, they die of dysentery –

Sebastian: Nah, TB’s my disease.

House: You own a disease? Well, I’m sorry I missed the IPO on dengue fever.

Sebastian: Look, I know I have away about me. I know I piss a lot of people off, and a whole lot more I just annoy. But you’re the first person that I’ve ever met who I think is actually annoyed by what I do. Do you think I’m not saving any lives, or is that a bad thing?

House: Right now, I’m just trying to save your life.

Sebastian: Or do you just have a problem with hope? [House rolls his eyes.] You know, the difference between our jobs is not numbers or styles. It’s that I know I’m gonna fail. Even if I save a million people there’s gonna be another million. You couldn’t handle that. I think you resent anyone who can.

House: Can’t we just agree that you’re incredibly annoying? Take the pills or I let you die, do an autopsy, call my own press conference, and make sure the world knows that you didn’t die of TB. Corporate sponsors will be disappointed, but they’ll find another disease.

Sebastian: Why would you do that?

House: Because I’m just a mean son of a bitch. [House leaves, and Sebastian takes the pills.]

[Cut to various scenes of Sebastian taking his medication like a good boy, various medical tests performed by the Ducklings, and symptoms being crossed off or circled on the white board.]

[Cut to Diagnostics.]

House: So we still have to explain P-R variability, syncope, headaches, and… low sugar?

Foreman: That was classic TB.

Chase: Apparently not.

Cameron: You’ve rerun the test?

Chase: Yeah.

House: This is good!

Foreman: Good? This is bizarre.

House: Bizarre is good! Common has hundreds of explanations. Bizarre has hardly any.

Cameron: What else could cause low CSF sugar?

House: Uh-uh. I get to ask thequestions. I’ve found you look a lot smarter asking the questions than dumbly not answering.

Chase: High insulin levels in hisblood.

Cameron: They’d have to be very high.

Chase: Okay, very high insulin levels in his blood.

Cameron: How could he get highinsulin levels? We’ve checked daily blood sugars, all normal!

House: See how smart she looks? Cause she asked the question.

Cameron: And it’s not glucagonoma because he has no rash. It’s not self-induced because he’s not an idiot, and it’s not a tumor because the CT and the MRI were both negative.

House: Which just leaves tumor. [He leaves, they all follow.]

Cameron: Why do you do this? Why do you ignore what I say like I’m not even –

House: Small tumor. Really, really tiny. So small we can’t see it. Nesidioblastoma.

Chase: An abnormal growth of theinsulin-secreting glands of his pancreas?

Foreman: It only intermittently secretes insulin.

House: It responds to stress. Like if, oh, I don’t know, if someone accidentally puts the mechanical bull on 11. [They pile into the elevator.] Easily removed by surgery.

Cameron: Except, if it’s so small we can’t see it, how’re we even going to prove it’s there?

House: “She asked, looking clever.”

Cameron: We just start hackingaway at his pancreas until he gets better?

House: How do you prove something exists when you can’t see it? Does God exist? Does the wind blow?

Foreman: We know because the leaves move.

House: Look for effects. [They get out of the elevator, where Cuddy and Cecelia are moving toward them.]

Foreman: Uh, we should look the other way. It’s Cuddy with your patient.

House: Dr. House has an emergency.

Foreman: We can’t avoid her forever.

House: Eventually she’ll die. You sure she doesn’t have breast cancer?

[Cut to Sebastian lying on the OR table.]

House: We think you have a tumor,easily removed surgically. We’re going to poke it with a stick.

Sebastian: And if there’s no tumor?

House: Nothing happens. Splenic artery, it’s a hard left off the celiac. [Chase goes for the artery.]

Sebastian: If there is a tumor?

House: What usually happens when you poke something with a stick? It pokes back.

Cameron: He’s stuck in the superior mesenteric.

House: I knew we should have stopped for directions. Men.

Chase: I’m there.

House: We’re going to inject calcium into your pancreas. The beta cells will release insulin. If there are too many beta cells because of a tumor, your blood sugar will drop precipitously.

Sebastian: How do we know it won’tgo too low?

House: Fingers and toes crossed.[to Chase] Go ahead. [Chase injects the calcium. CGI shot of it entering the artery.]

Cameron: Glucose is holding steadyat 75.

House: No leaves rustling. Blow harder.

Chase: I already gave him 1 amp.

House: Well, I guess now would be the time to give him more than 1 amp. [CGI of more calcium entering.]

Cameron: 50. It’s starting todrop. 45.

Sebastian: I think my arm’s shaking.

Foreman: I’m gonna start him on aglucose drip. He’s gonna seize

House: Not yet.

Foreman: He’s continuing to drop.

House: Not fast enough. [Monitor beeps.]

Cameron: He’s seizing.

Chase: We’ve got to reverse this.

Cameron: He’s at 40, 38, 35…[Monitor gets to 30, before -- ]

House: Push an amp of D-50, you want to kill the guy? [CGI of the meds entering the system.]

Cameron: We’re back to 40.

House: Congratulations, you have a tumor.

[Cut to House and Cameron leaving the elevator into the lobby.]

House: Are you gonna go out with him?

Cameron: Is that any of your business?

House: Nope.

Cameron: I don’t think so.

House: Two days ago you were holding his hand. What’s changed?

Cameron: He practically lives in Africa, there’s no future.

House: On the other hand, maybe there’s too much of a future now. You weren’t attracted to him because he was prepared to die for a cause, you were attracted to him because he was actually doing it.

Cameron: Right. It’s that simple.

House: That was simple?

Cameron: I put a label on them and go from there.

House: Everybody does it. We are who people think we are. People think he’s a great doctor so they give him stuff.

Cameron: He is a great doctor.

House: The reality is irrelevant. [House looks into the clinic and sees Cecelia sitting there.] I’ll prove it. People who know me see me as an ass, treat me as an ass. People who don’t know me see a cripple, treat me as a cripple. What kind of selfish jerk wouldn’t take advantage of that fact? [He enters the clinic, and walks by Cecelia, deliberately leaning his cane on her boot.]

Cecelia: Ow!

House: Oh, my goodness, are you okay?

Cecelia: Yeah. [Cuddy comes toher door.]

House: [exaggerated, toward Cuddy] I am so sorry. It was completely my fault.

Cecelia: It’s nothing, I’m fine.

House: Well, I’m very relieved, I feel terrible.

Cecelia: Don’t worry about it, I’mfine.

House: You sure? Okay. [They shake hands. Cuddy and House make faces at each other. As House leaves, Cuddy walks through her office door to Cecelia.]

Cuddy: How’s everything?

Cecelia: I’m gonna go. My foot’skilling me.

Cuddy: Oh, what did you do?

Cecelia: It was nothing, it wasall my fault. [She leaves.]

[Cut to Sebastian’s room, where heis packing and talking on a (new?) cell phone.]

Sebastian: [on phone] Yeah, listen Fugawi, relax. I’m gonna be back on Tuesday. Tell Sarni I’m gonna bring her a new brace. All right. [He hangs up. Cameron comes in with a wheelchair.] You get ‘em?

Cameron: Six month supply. Shouldfix you right up. See you when you come back for a refill?

Sebastian: Yeah, I’ll be back intwo months.

Cameron: You’re gonna give them away?

Sebastian: Well, you know howthese things happen, you leave a bag in the airplane, drop some pills down thedrain…. I have an idea. You could bring me the refill in Africa.

Cameron: I don’t think so.

Sebastian: You actually likeworking for House, you find this satisfying? [He nods, gives her a little kisson the cheek, and they hug. Aww. Sebastian leaves as the closing musicstarts.]

[Cut to Sebastian leaving thehospital, and meeting the press outside.]

Sebastian: Thank you, thank you, Iappreciate that. I appreciate the support.

[Cut to House and Wilson watchingfrom the balcony.]

House: It’s not aboutthe kids dying every 8 seconds, it’s about the media stroking. Adulation andpats on the head.

Wilson: That’s yourproblem with him, isn’t it?

House: Look at him, heloves it. Eats it up.

Wilson: Yeah, the manactually enjoys what he does. [Pointed look.]

House: Listen, I savedhis life. That means I get credit for every life he saves from here on out.

Wilson: I’ll make sure Stockholm knows. [He leaves.]


END