Paternity (House)

"Paternity"
House episode
Episode no. Season 1
Episode 2
Directed by Peter O'Fallon
Written by Lawrence Kaplow
Featured music "On Saturday Afternoons in 1963 (Years May Go By)" by Rickie Lee Jones
Original air date November 23, 2004 (2004-11-23)
Guest appearance(s)
Season 1 episodes

"Paternity" is the second episode of the medical drama House, which was first broadcast on November 23, 2004. A teenage boy is struck on the head in a lacrosse game and is found to have hallucinations and night terrors that are not due to concussion.

Plot

When a clinic patient claims to have an appointment for his clinic session, House is skeptical of the letter which House himself apparently wrote to the family. House realizes that it was written by Cameron but listens when he hears that one of the symptoms is night terrors. The patient, Dan (Scott Mechlowicz), is a 16-year-old lacrosse player who has been recently hit in the head in a game. House suggests that the night terrors were a result in post-traumatic stress disorder from sexual abuse and his double vision was caused by a concussion and/or eye strain. Then he notices Dan's foot twitch with a myoclonic jerk which normally only occurs when falling asleep. He immediately admits Dan and starts diagnosis with his team.

House claims that Dan's father is not his true biological father and makes a bet with Foreman about it. Soon after, Dan has another night terror. None of the tests show why the night terror occurred, but House finds a large blockage in one of Dan's brain ventricles. House and his team relieve the pressure as fast as they can, but they find that the blockage is not what is causing the other symptoms. It is in fact a symptom itself.

During the night, Dan is found missing from his bed. Cameron, Chase, and Foreman search frantically to find him, soon locating him on the roof, where he is hallucinating that he is on the lacrosse field. Chase tackles him just before he steps over the edge of the building. House is excited by this new development — it rules out House's previous diagnosis of multiple sclerosis. The new diagnosis provided by Cameron is neurosyphilis. To treat this, they inject penicillin directly into Dan's brain, but during an injection, Dan suffers an auditory hallucination, which rules out this diagnosis. House is stumped by this new development, and admits his problems to Wilson. Dan's parents are angered to discover House having coffee with Wilson while their son is dying, but House rebukes them with his intimate knowledge of Dan's current condition. He tells them to go and support Dan, after which he takes the parents coffee cups to run DNA tests to decide his bet on Dan's paternity. The tests show that neither parent is biologically related to Dan (winning House his bet with Foreman, Wilson and everyone else who wagered on Dan's paternity), and a new idea hits him. He remembers a baby he treated earlier whose mother did not want to vaccinate the child.

House thinks that infant Dan caught the basic measles virus from his biological mother (who possibly had never been vaccinated) that had mutated, and remained latent for 16 years. Avoiding a dangerous brain biopsy to confirm this unusual case, they biopsy Dan's retina to find the virus, confirming House's diagnosis of subacute sclerosing panencephalitis. Dan recovers fully after brain surgery. Dan reveals that he already knew he was adopted, due to his cleft chin (which neither parent has), but that he does not care and loves them. At the end of the episode, it becomes apparent that House must have played lacrosse sometime in his youth. He is shown at what appears to be Dan's lacrosse game but at the end is shown to be on his own when the camera reveals the field to be empty. He clutches his cane like a lacrosse stick, seemingly dreaming about days past.

Medical aspects

The sequence of tentative diagnoses in this case was:[1]

  1. Sexual abuse
  2. Concussion
  3. Degenerative disease
  4. Hydrocephalus
  5. Multiple sclerosis
  6. Neurosyphilis
  7. Subacute sclerosing panencephalitis

The treatment for the final diagnosis was to inject interferon into the brain. This treatment requires consent from the patient's parents. The story exaggerates the difficulty of explaining this treatment for dramatic effect but the problem of obtaining informed consent in complex cases is a real one.[2]

The medical advisor for this episode was Dr Lisa Sanders.

Recurring themes

The theme that "everybody lies" appears here in the question of the patient's paternity. The parents had lied to him in not telling him that he was adopted and do not admit this to House either.[3][4]

Reception

Robert Bianco, writing in USA Today, recommended the episode as "first-rate".[5]

References

  1. ↑ Daniel T. Willingham (2010), Why Don't Students Like School, John Wiley and Sons, pp. 129–130, ISBN 978-0-470-59196-3
  2. ↑ Andrew Holtz (25 October 2006), "What the TV Show 'House' Has to Teach about the Importance of Medicine as a Team Effort", Oncology Times, 28 (20): 50, doi:10.1097/01.COT.0000295294.20513.98
  3. ↑ Leah Wilson (2007), House Unauthorized, BenBella Books, p. 48, ISBN 978-1-933771-23-6
  4. ↑ Paul Challen, "1.2 Paternity", The House That Hugh Laurie Built
  5. ↑ Robert Bianco (29 Nov 2004), "Critic's Corner", USA Today
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