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The Unofficial Guide to House, M.D.
By Barbara Barnett
ECW PRESS Copyright © 2010 Barbara Shyette Barnett
All rights reserved.
A Character Study Wrapped in a Mystery Wrapped in a Medical Procedural
Rebecca Adler engages with her kindergarten students about how they spent their weekend. Suddenly she starts to babble incoherently, much to the amusement of the five-year-olds in her class. But as she tries to scrawl the words "Get help" on the blackboard, they quickly realize something's not right with Miss Rebecca. A normal life disrupted abruptly: something House fans will soon recognize as the episode "teaser." It sets the stage for the medical mystery to be solved in the hour to come. Rebecca's symptoms point to something wrong with her brain. But what?
By the end of the episode, we'll know: it's a dying tapeworm in the brain. The medical gymnastics to get from "incoherent babble" to the final diagnosis frame the pilot episode of House.
After the "teaser" segment, the camera focuses on two men walking in what appears to be a hospital foyer. At first, only their legs are visible; one man wears a white doctor coat and the other leans heavily on a wood cane, walking with pronounced limp.
We are about to meet Dr. Gregory House, legendary, "world-famous" doctor. He's a specialist in infectious diseases and nephrology (kidney diseases) — and head of the Diagnostics Department at the fictional Princeton-Plainsboro Teaching Hospital. And big hint: the famous doctor is not the one wearing the white lab coat. The one in the coat is House's best friend, head of oncology, Dr. James Wilson, who wants him to take the case of our young kindergarten teacher from the teaser. He tells House that his cousin "Rachel" (note, not "Rebecca") has seen several doctors, but is still sick.
Department of Diagnostic Medicine?
Outside House's universe, in the real world, there is no such medical sub-specialty as "diagnostic medicine," although this may be changing. In 2009, the National Institutes of Health established the Center for Rare and Undiagnosed Diseases to evaluate patients for diseases "resistant to diagnosis," which is essentially what House does on a smaller scale.
Most doctors are diagnosticians in one way or another, and they perform "differential diagnoses" all the time. You don't feel well; something hurts. And it prompts you to see your family physician. After you describe your symptoms, the doctor takes a medical history, does a few tests, and, based on all that, delivers a diagnosis — hopefully.
But what if the symptoms, the history, and the tests don't add up? Or what if the doctor thinks he has the answer, you do what he tells you to do, but you're still sick — and getting worse by the hour? And what if you have consulted doctor after doctor and still come no closer to finding out what's wrong?
The Princeton-Plainsboro Diagnostics Department is one of a kind, created especially for Dr. Gregory House, who happens to have a genius for diagnosis. He is a sort of medical court of last resort. People seek him out when no one else can help.
Standard medical practice warns that when you "hear hoofbeats, think horses, not zebras." Don't get exotic; consider the easiest explanation first. And usually, that works. But House and his elite group of medical fellows — board-certified physicians acquiring advanced training from a brilliant practitioner — are equipped to hunt down the medical zebras, the cases other doctors miss. In "Pilot," House explains that if Rebecca's illness "is a horse," her family doctor would have figured it out, and the case "never gets near this office."
As they consider the case, House's fellows process new information through their own specialties: Eric Foreman is a neurologist; Allison Cameron is an immunologist; Robert Chase is an intensivist (critical care specialist). House's dual specialties of infectious diseases and nephrology (diseases of the kidneys) round out the constellation of expertise. His holistic way of looking at symptoms, coupled with vast medical knowledge, helps him finesse the team's educated guesses into probable new diagnoses.
As the medical story unfolds in "Pilot," we begin to learn more about House and the rest of his team. This debut episode begins to sketch out the key roles and relationships of the series. House is the sardonic, embittered antihero, misanthropic and disillusioned. His philosophy of life is "Everybody lies." Wilson, his best friend, is the classic straight man or sidekick. House's team is young, pretty, smart. (Hey, this is a Fox show, right?) We meet Dr. Lisa Cuddy, the chief hospital administrator, and dean of medicine at Princeton-Plainsboro. She is also House's boss and main adversary. But we quickly observe that their banter sparkles with the hint of something more than mere antagonism between boss and difficult employee.
For the first time, we see what will become familiar components of House's unique modus operandi. He holds court either in front of the whiteboard in his office or rapidly walking the hospital's corridors, guiding the team in a way that would make Socrates proud. On the surface, House's dismissive process with his fellows in these differential diagnosis sessions seems brutal. As House himself describes the process: "I thought I'd get your theories, mock them, then embrace my own" ("Merry Little Christmas," 3.09). But that's not really what House does. Instead, he acts like a giant filter for his team's theories, educated guesses, even wrong diagnoses, which through this process become the seeds of something potentially lifesaving.
House assigns his staff to run tests (often rerunning tests already done by other doctors, who, of course, cannot be trusted because "they're idiots"). They often take a patient history, even breaking into a home or workplace to identify possible toxins or environmental factors (as well as family secrets) that might affect the diagnosis. In "Pilot," Foreman breaks into Rebecca Adler's home, and there he finds a key piece of medical evidence, which indirectly leads to the final diagnosis. Throughout, the team constantly evaluates new information and re-evaluates what they've already done, often revisiting discarded theories as some new bit of relevant information comes to light. If they're right, another piece of the medical puzzle is in place; if they're not, they've still learned something they hadn't known before about the culprit.
House leaves no stone unturned or oblique angle unexplored. Not even House's own ideas are sacrosanct. He is willing to be wrong — and wrong again — until the answer is found and the patient is diagnosed, treated, and fixed. It doesn't matter to House whether it's his idea or someone else's — as long as it's right.
As the team hones in on the most likely diagnosis, House often uses imaginative metaphors to explain what's going on in the patient's body. Antibodies may become blitzing linebackers; a blood clot is represented as a terrorist sleeper cell (with a tumor being represented by Osama bin Laden). The metaphors not only enlighten the fellows, but help make the complex medical issues and physiology more understandable to the viewers.
And then it comes: eureka! Something triggers a faraway look in House's eye. If House were an animated series, a lightbulb would appear over House's head. He has his answer, and most of the time, it is in time to save the patient, who by now is likely hovering at death's door.
Sometimes the answer strikes him when he's alone. At a dead end, House becomes withdrawn and introspective. He knows he and his team are missing something, but doesn't know what. He stares at the whiteboard; maybe he plays with one of the toys on his desk, always deep in thought, and deep inside himself. This is as much a part of his process as tinkering with test tubes and MRIs.
But House usually needs a muse to spark that final flash of brilliance. Often Wilson or Cuddy serve that purpose; perhaps a clinic patient says something that makes the final puzzle piece click into place. On rare occasions, the doctor who refuses to see patients pays a rare visit to sit at his or her bedside. But this is the moment of his medical magic; it's where objective science and logic give way to intuition and inspiration.
In "Pilot," House pays Rebecca one of these rare visits towards the end of the episode, and it's the first time she has met the elusive Dr. House, although she has been inquiring about him since being admitted. They already have come up with the correct diagnosis, but having undergone so many tests, Rebecca is ready to die, refusing to be guinea pig to even one more of House's experiments. To her, it's over, and unless they can prove the diagnosis to her, the next procedure is just one too many.
As he will do in several episodes over the years, House shares an important (and personal) piece of himself — as if it is only that keeping the patient from giving up entirely. In "Pilot," Rebecca insists on knowing why she should keep fighting to survive — not give up when she sees that he so obviously has. "What makes you think I'm so much better than you are?" she persists.
Ultimately, House comes away from this encounter willing to let Rebecca die, honoring her request to simply be left alone because they have no proof. "No more tests," he explains to his staff. But when Chase suggests a simple procedure to confirm House's diagnosis, something clicks and House realizes they can, indeed, obtain the proof Rebecca demands — and cure her.
This pilot episode only begins to render the remarkably textured (but even after six seasons, essentially unknowable) central character. A recluse, particularly during the first five seasons, House avoids patients at all costs. He doesn't return phone calls, answer his mail, or honor requests for speaking engagements. He is brusque and blunt with no readily apparent bedside manner. He tells it like it is, usually not the way you would want to hear it. But when you're dying, House might inquire, would you want a nice doctor who held your hand while you died, or a not-so-nice doctor who got you well?
Gregory House is a man uncomfortable in his own skin. He hides from patients; he hides from everyone. Is it laziness? Is House a slacker? Or is there something else? We soon realize House's attitudes have as much to do with his self-image as a general contempt for society. "See that?" House observes to Wilson as they walk the hospital foyer in "Pilot," "They all assume I'm a patient because of this cane."
Wilson's solution is simple. All House needs to do is "put on a white coat like the rest of us." House counters, "People don't want a sick doctor." And therein lies House's dilemma. That one sentence defines, within the first 10 minutes of the series, an essential key to his character, helping us understand and sympathize with him, even as his other actions might repel us.
House's wounded spirit doesn't prevent him from making outrageous remarks and snarky snipes, "House-isms." Snappy, often insightful one-liners populate his speech: "Everybody lies" and "Treating illness is why we became doctors. Treating patients is actually what makes most doctors miserable."
In juxtaposition to the intensity of each week's diagnosis, House "does time" in the hospital's free clinic, treating patients who could be as easily treated as by a "monkey with a bottle of Motrin." These "clinic beats" provide a break in the tension, sometimes a bit of comic relief during the main action of the episode.
House hates working in the clinic, finding it boring and beneath his skills. By treating Rebecca, he has come out of hiding to take on a patient as a favor to Wilson, exposing himself to the prospect of making up six years of neglected clinic duty. Too bad for House, but those "clinic beats" are much beloved by series fans and sorely missed when they went largely AWOL by season four.
Is Formula a Bad Thing?
The series signature formula makes it in some ways predictable, and indeed, television critics and some fans have nailed the show as a bit too predictable. In fact, at one point in season two, House self-referentially remarks to Wilson, "People will think I'm formulaic" ("Hunting," 2.07), certainly a nod to the show's critics at the time.
Yes, House is often formulaic. It has a formula, and nearly every episode revolves around that formula — even the occasional "special" episodes (with some notable exceptions, including the two-hour season six premiere, "Broken").
Perhaps in the beginning, when David Shore first struck pen to paper (or keystroke to pixel), the series was intended as a straight-on medical mystery — a "procedural" drama similar to the wildly popular CSI — except that instead of criminal perpetrators, House battles rare diseases and death. If you were tuning in only for the show's main plot, just stopping by for the differential and to see House work his medical magic, your criticism would be valid. But you also would not be doing justice to the series, which is not really a medical procedural — except at its topmost layer. The heart of the series is everything that happens beneath the skeleton of the case's predictability. It's between the lines and under the surface, deep within the relationship exchanges, ethical dilemmas, social commentary, and most crucially, the detailed character study of the show's complex central character.
On House, the formula isn't a negative; it is the pivot point for House's story and the story of his universe. It is the constant in nearly every episode, the framework upon which everything else is layered to create a complex, elegant, and nuanced story.
Case in Point: A Closer Look at "Sports Medicine"
So how does it all fall together, this mix of medical mystery procedural and detailed character study? An episode in the middle of first season, "Sports Medicine" (1.12), is a good place to search for the answer. Like all House episodes, "Sports Medicine" revolves around a patient with a mysterious set of symptoms. The main medical plot drives the action, and feeds several subplots and character reveals, creating a rich and intricate story.
Directed by film director Keith Gordon, "Sports Medicine" introduces us to Hank Wiggen, a star baseball pitcher. (According to the plot, he struck out the great Sammy Sosa!) Wiggen is getting back to his career after being suspended from professional baseball for drug use. In the teaser, he is filming an antidrug public service announcement directed, in a self-referential cameo, by series executive producer and director Bryan Singer. While softly lobbing a baseball, Wiggen inexplicably breaks his arm.
Wiggen's history and easily broken bones suggest steroid abuse to House. Testing, talking, and brainstorming, he and the team refine the diagnosis to Addison's disease plus steroid abuse. But then Wiggen's liver fails, putting his life in immediate danger. It's not until the hyper-observant House — in a classic series epiphany moment — discerns a subtle symptom in Wiggen's wife, Lola, that House uncovers an important lie, and puts it all together.
Wiggen has cadmium poisoning from smoking contaminated marijuana. Despite his episode-long protestations to the contrary, he is not at all "drug-free."
Test, guess, treat, guess some more, more treatment, "aha!" moment, and, voila! Another life saved by Dr. Gregory House. It's the classic House formula: part science, part intuition and observational skill, part unearthing secrets and lies. House's genius puts together seemingly disparate bits of information to figure it all out. But the mystery of Hank Wiggen's broken arm is but one thread of this multifaceted episode.
Monster Trucks and Cotton Candy — Also Known as the B Plot
At the end of "Sports Medicine," House attends a monster truck rally, something we've learned is a particular passion of his. The planning of this outing, winding through the episode, at first appears to be there simply as comic relief. Admittedly, it's pretty amusing to watch House obsess over monster trucks, score $1,000 tickets, and act like a 10-year-old who's gotten a Wii for his birthday. But this subplot provides the vehicle (so to speak) to delve into several crucial character threads explored later in the first season — and on into the next.
House loves monster trucks. He loves to watch these gigantic vehicles crush smaller vehicles into flattened metal pancakes. It's such a "regular guy" thing, that it's hard to imagine the dour and miserable House getting excited about it. However, the gleam in his eye when he asks Wilson to share this treasured event — complete with "owners' passes" at a $1,000 apiece — is a classic moment in the series.
Wilson begs off, explaining that he has a speaking engagement. The disclosure drives an important secondary plot woven into the episode's main fabric. As House tries to find an alternate companion for the event, it seems everyone on the staff will be attending Wilson's lecture. But House learns by chance that the lecture has, in fact, been canceled — and that his best friend Wilson has lied. The news hurts House, and he wonders why Wilson would be avoiding monster trucks for a speaking engagement that doesn't exist. The answer, uncovered by the episode's end, springboards into one of the series' most important story lines.
Excerpted from Chasing Zebras by Barbara Barnett. Copyright © 2010 Barbara Shyette Barnett. Excerpted by permission of ECW PRESS.
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