House M.D. - Season 1, Episode 2

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Dan
Dan.
Dan? Dan, no!
- Dan?
- Dan, no!
Dr. Foreman
Dr. Foreman.
I assume you found the kid
I assume you found the kid.
He almost walked off the roof. Suicidal?
He almost walked off
the roof.
Suicidal?
No, he thought he was on his lacrosse field. Look, I was gonna run home, shower, change--
No, he thought he was on his
lacrosse field. Look, I was gonna
run home, shower, change--
Conscious? Yeah
Conscious?
Yeah.
How'd you talk him down? Actually, Chase tackled him
How'd you talk him down?
Actually, Chase tackled him.
How come you didn't do it?
How come you didn't do it?
Right. Well, I am black, but he was closer
Right. Well, I am black,
but he was closer.
Come on. You can ride up with me
Come on.
You can ride up with me.
Anybody tell the family that their boy almost stepped off a roof? They must be thrilled
Anybody tell the family that
their boy almost stepped off a roof?
They must be thrilled.
They're not suing, but I think only because Chase asked--
They're not suing,
but I think only because
Chase asked--
Why does everybody always think I'm being sarcastic?
Why does everybody
always think I'm being sarcastic?
This is great news. He doesn't have M.S
This is great news.
He doesn't have M.S.
Parents should be thrilled. The mom anyway. Ofcourse, the dad probably doesn't know--
Parents should be thrilled.
The mom anyway. Ofcourse,
the dad probably doesn't know--
Why doesn't he have M.S.? He was on the roof, thinking he was on a lacrosse field
- Why doesn't he have M.S.?
- He was on the roof, thinking
he was on a lacrosse field.
Conscious, and therefore not a night terror. You want some of this? Yeah, sure
- Conscious, and therefore not
a night terror. You want some of this?
- Yeah, sure.
He was in an acute confusional state,
He was in an acute
confusional state,
which doesn't fit with a demyelinating disease like M.S
which doesn't fit with
a demyelinating disease like M.S.
Oligoclonal bands-- Were real
Oligoclonal bands--
Were real.
They just mean something other than M.S. So, what are they telling us?
They just mean something
other than M.S.
So, what are they telling us?
That the immune system is working? Right
That the immune system
is working?
Right.
He has an infection in his brain
He has an infection in his brain.
What about sex?
What about sex?
Well, it might get complicated. I mean, we work together
Well, it might get complicated.
I mean, we work together.
I'm older, certainly, but maybe you like that. I meant maybe he has neurosyphilis
- I'm older, certainly, but maybe you like that.
- I meant maybe he has neurosyphilis.
Huh. Nice cover. Sorry. R.P.R. was negative
- Huh. Nice cover.
- Sorry. R.P.R. was negative.
We don't need a definitive test to confirm. Sure. Didn't need one to confirm M.S
We don't need
a definitive test to confirm.
Sure. Didn't need one to confirm M.S.
Okay. Let's wait for you to run titers on 1,400 viruses while this kid's brain turns to mush
Okay. Let's wait for you to
run titers on 1,400 viruses while
this kid's brain turns to mush.
So the fact that he doesn't have M.S., it's-- it's really not good news after all
So the fact that
he doesn't have M.S.,
it's-- it's really not good news after all.
Well, it is if it's neurosyphilis
Well, it is if it's neurosyphilis.
The likelihood of a false negative on an R.P.R. test: 30%
The likelihood of a false negative
on an R.P.R. test: 30%.
Likelihood of a 16-year-old having sex: roughly 120%
Likelihood of a 16-year-old having sex:
roughly 120%.
I'll start him on I.V. penicillin. We're not gonna wait for that
I'll start him on I.V. penicillin.
We're not gonna wait for that.
The most effective way to deliver the drug is right into his brain via the spine
The most effective way
to deliver the drug is
right into his brain via the spine.
We can't. In a cramped space like the brain,
We can't.
In a cramped space like the brain,
increased intracranial pressure from a high-volume drug like penicillin could herniate his brain stem
increased intracranial pressure
from a high-volume drug like penicillin
could herniate his brain stem.
It'd kill him. No neurologist in his right mind would recommend that
It'd kill him.
No neurologist in his right mind
would recommend that.
Show of hands. Who thinks I'm not in my right mind?
Show of hands.
Who thinks I'm not
in my right mind?
And who thinks I forget this fairly basic neurological fact?
And who thinks I forget this
fairly basic neurological fact?
Who thinks there's a third option?
Who thinks there's a third option?
Very good. What's the third choice? No idea. You just asked if I thought there was one
- Very good. What's the third choice?
- No idea. You just asked
if I thought there was one.
The patient has a shunt in his brain. There'll be no increased pressure
The patient has a shunt in his brain.
There'll be no increased pressure.
We can put as much penicillin into his body as we want
We can put as much penicillin
into his body as we want.
Excellent. Inject him through a lumbar puncture
Excellent. Inject him through
a lumbar puncture.
One of us is gonna do this to you twice a day for the next two weeks
One of us is gonna do this to you
twice a day for the next two weeks.
I'm ready. Go. He could get syphilis
- I'm ready. Go.
- He could get syphilis...
even if he's not sexually active?
even if he's not sexually active?
Well, it's-- it's unusual, but it's possible
Well, it's-- it's unusual,
but it's possible.
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