Cancer Terminal

[christina aguilera's beautiful playing] (singing along)♪ to all your friends ♪ ♪ you're delirious ♪ ♪ so consumed ♪ ♪ in all your doom ♪ ♪ ah ♪ ♪ tryin' hardto fill your emptiness ♪ ♪ the breeze is gone ♪ 10-minute warning.

i'm fine. what about your meds? got 'em, mom. ♪ 'cause you are beautiful ♪ ♪ no matter what they say ♪ [whoosh, music fades] [rush of loud noises] (cd player)♪ 'cause words can'tbring you down ♪ ♪ oh, no, oh, oh ♪ ♪

[massive attack's teardrop] ♪ ♪ [sneeze] house! need you. uh-uh, forget it. i'm going home. hay fever? boy, you must bea doctor and everything.

two minutes. no, the purple thingyon the file means that "whoever"is one of yours. which means cancer, which means no wayit's two minutes. fine, i'm lying.30 minutes. ahh... mystery of life. benadryl might help.

i already did.1,000 milligrams. [sneezes] steam room? why, jimmy! we'll talk about thisin the morning. i got a nine-year-oldwith cancer. alveolar rhabdomyosarcoma. terminal kidtrumps your stuffy nose. not yet.

she's hallucinating. so the rhabdo'sin her brain. make her comfortable.she's got about a week. yeah, except there isno cancer in her brain. pristine ct scan,blood tests, protein markers--all negative. the cancer's in remission? this means the hallucinationsare unconnected. fascinating, huh?

and, not that it matters, but if you fix whatever'sgoing on in her head, you give her maybeanother year. a long timefor a nine-year-old. no. it'll just fly by. five major surgeries, a bone marrow transplant, 14 rounds of chemoand blast radiation.

it was me, i'd just stay homeand watch tv or something. not lie here undera microscope. ahh. don't worry. anything happens to you,nobody's gonna lift a finger. differential diagnosis. on your marks,get set-- hallucinationscould be caused--

whoa! wait for it. and go. latent neurotoxicityfrom the chemo treatments. no. patient's last round of chemo was two months ago--we would have seen it by now. genetic component? nah, nothing on mom. dad splitwhen she was pregnant.

his medical historyis also clean. what a guy. what about graft versus host diseasefrom the bone marrow transplant? infection travelsto her brain, she has hallucinations. bloodwork and lp were clean. but where there'sinfection, there's meningeal swelling.

that ct shows no meningealinvolvement. true. get a tox screenand an mri. we can do that, if you want toignore what we just discussed. sounds good. toxic exposure doesn't makeany chronological sense. (house) guess there is a third option. she's making it all up,

'cause she doesn't wantto get in trouble for breaking a mirror. unfortunately,we can't test for that. so...tox screen, mri, and you stay awayfrom the patient. what'd i do? oh, well, you'll just getall warm and cuddly around the dying girl, insinuate yourself, probably end upin a custody battle.

chase, you handle the mom. tell her that you'd justsit home and watch tv and die, but you hadto go through the motions of trying to save her daughter's life. it's a doctor thing. what the hell is this? black walnut and ginger. it's nice. let's lay you down, and i'llattach this thingamajiggy.

sat monitor. oh, a pro. don't have to explainanything. i like it. central line for the chemo. yeah, doesn't hurtor anything, does it? no, it's awesome. instead of an iv,saves me a lot of time and a bunchof needle sticks.

i don't thinki've ever heard anyone say they like their central linebefore. right, can i interest youin a walk in the park? [brook babbling] no, thanks. okay. don't wantany butterflies either. doesn't matter whatthe walls look like. you're still lookingfor cancer.

not today.we're looking for an infection. but i get your point. you comfortable? yep. all right.let's get this over with. a pro.i like it. whoa!look at the time. i should have beenout of here 20 minutes ago. you've only been here20 minutes.

oh, can't slip anythingby you, can i? it's a patient in one. i'm taking a sick day. take some claritin. everyone's a doctor,suddenly. patient in one requested a male doctor. balls are in your court,doctor. union rules. i can't check out this guy'sseeping gonorrhea

this close to lunch. exam room one. it's sexist, and a verydangerous precedent. people could to choosethe sex of their doctors, you gals would beout of business. sore throat? that's not lupus. well, not everyone can operate a zipper.

you know, the up, the down.what comes next? my new girlfriend... never been with a guywho wasn't... c-circumcised. so she freaked and-- aha. and you wanted rivkahto feel all gemutlicht. i get it.it's a shandah. aah! i got some box cuttersand, um...

just like abraham did it. i sterilized them. which, uh,i was told you're sup-- stop talking. i'm gonna geta plastic surgeon. get the twinkie backin the wrapper. house. hey, house. andie's mri and tox screenwere clean.

no infection,no neurotoxins. oxygen saturation is 94%. check her heart. her oxygen saturationis normal. it's off by onepercentage point. it's within range.it's normal. if her dna was offby one percentage point, she'd be a dolphin. we've got a patient who,for no obvious reason,

is hallucinating. since it's not obvious,i thought we'd go with subtle. it doesn't matter. if her sat percentage is off, that means her blood isn't getting enough oxygen. that's a problem withher lungs, not her heart. and a lung problemisn't causing hallucinations. but the lungs could leadto somewhere that is. welcome to the endof the thought process.

primarypulmonary hypertension? maybe peor pulmonary fibrosis. maybe some bizarre caseof kyphoscoliosis. [chuckles] while i'm resting, you guysget some arterial blood gases. once you confirmthat she is hypoxic, i want a plethysmorgraphy,chest x-ray, ct, and vq. and if all that comesback negative, then sneak a catheterinto her lungs.

and don't worry--i don't sleep in. i'll get bagels. you ever hadthis test before? what's it for? this... goes all the way up the vein by your hip into your lung. if i find somethingup there blocking anything, i pull it out--simple.

it's gonna be easy. the doctor at sloan told mei had a great aorta. oh, you have hadthis test before. sorry.i just like hearing you talk. i've never kissed a boy. there's time yet for that. there was a boylast summer. i was at one of thosecancer camps. mm-hmm.

i just never hadthe guts to ask him. you know,there's a good chance... i'm not gonna walkout of this hospital. even if i do,i'm nine. not a lot of kissinggoing on in the third grade. you will walk out of here,all right? and you will kiss a boy. there you go. smile.

will you kiss me? no one will ever know. i'm--i'm--i'm sorry. i can't. i won't tell anyone. listen, you'renine years old. i'm 30. i just want to knowwhat it feels like. once.

this isn'tyour last chance for that. what if it is? please kiss me. bagels. (foreman) you didn't sleep in. didn't sleep.didn't breathe. i'm dying. (chase) pulmonary angiogram of andie's lungs was clean. arterial blood gases

and ct scan were also normal. her heart and lungs are fine. which gives usno explanation for the diminishedsat percentage. yeah, oddly enough,sometimes normal is normal. sometimes we can't seewhy normal isn't normal. get her symptomson the board. whoa, you're letting metouch the markers? it's written down in myadvanced health care directive.

should i be incapacitatedin any way, you run the board,then foreman. chase, you're just not ready yet. what else? guys, i know wesort of ruled out infection, but if we forget the labs for a minute, there is one infectionwe didn't test for because of her age:neurosyphylis.

there's no way. if the infection dippedinto her cerebral cortex, all peripheral functionscould be compromised. no, she hasn't had sex.she's nine. (foreman)maybe it wasn't her idea. i mean, she's been arounda lot of adults. all the hospital visits, the counselorsat the cancer camps. you think she'sbeen molested?

hiding it pretty wellif there's any of that going on. yeah, all girlswho have been molested want to talk about it. break out the rape kit. she hasn't had sex. why are you so sure? she told me she'd neverkissed a boy. you read her diary too? she asked me to...kiss her.

(house)i rest my case. a regular nine-year-old girldoes not have sex on the brain. not when a doctor's threadinga catheter through her veins. well, she's nota regular nine-year-old. she's got terminal cancer. cancer doesn'tmake you special. molestation,on the other hand-- she wanted one kissbefore she dies. if she's never kissed a boy,it's a fair bet

she's never had sex. tell thatto all the hookers who won'tkiss me on the mouth. hey, here's a theory. she has been molested,seeks refuge in romantic fantasieswith older men with great hair, and i think youleft out the punch line. victims of molestationlearn to work the angles. manipulate people.

you did it, didn't you? you kissed her. it wasn't sick. it was one kiss for a dying girl. one small-- one small kissbefore she dies. thank you. this is exactly whyyou can't touch my markers. go seeif she's had sex.

no one's ever touched me. we just needto be sure. i like your hair. i used to havereally curly hair. i always wanted itto be like yours is. all right. that's it. you're fine. with a patient.

she dying? then she can wait. will you excuse mejust two minutes? if only she'dbeen molested. then we'd havesomething to go on. no forced entry. one hallucination. maybe it was just...bad pork. maybe there's nothing--

she's not fine. her sat percentagedropped another point. which could suggest a tumor in her lung. lung wouldn't explainthe hallucination. ct scan showedboth lungs were clean. which means there'sa tumor in her heart. not a chance.give me that. i loosened it.

i opened it. we've got an mriand an echo of her heart. there's nothing there. give me one otherexplanation... for low oxygen saturation. [sniffs] there's only one conditionthat simultaneously affects the heartand the brain, but she-- perfect.let's go with that.

tuberous sclerosisin a kid that also has alveolarrhabdomyosarcoma? two different, unrelatedcancers at the same time is a statistical no-no. what's the rate of cancerin the general population? one in 10,000? don't--don't startwith the numbers. the way i figure it, one in 10,000 of them

should haveanother cancer. little girlwon the lottery twice. it happens. so you're gonnacut her open? exploratory surgery. gotta find this thing. you're justgonna grope around inside an immuno-compromisednine-year-old? she could dieon the table.

i know it'ssomewhere near the heart. house... you've gottado better than that. [italian opera playing] why are we here? [music shuts off] better acoustics. now listen to this. [heartbeats]

that's a mitralheart valve. no, get the waxout of your ears. this is the patient's aortic valve. i downloaded the audio of her echocardiogram. what are wetrying to hear? tumor. (chase) they tend to keep quiet on account of themnot having any mouths.

but we could hear an abnormality in the sound of the valve. which would indicatethe presence of something. the tumor, for example. if we can tell a surgeon where to look, this is no longeran exploratory surgery. it's a precision strike. her aortic valvesounds normal. too bad.

now listento the dulcet tones of andie'stricuspid valve. [beat changes] normal. (house) and this... is her mitral valve. i don't hearanything weird. oh, you guys make me sad. listen again.

she's hadone hallucination. why are weoperating on her? [recording shuts off] why are werisking her life? because wilson thinksit'd be nice to give the girl a yearto say good-bye to her mommy. guess maybe she stuttersor something. now shut up and listen.tricuspid. [slow heartbeat]

mitral. [beat quickens] again. (cameron)wait. there. there's an extra flap. i'm gonna ask a surgeon to looka the mitral valve first. chase, i want you there. i don't like reading surgeons' reports.

they're boring. i'm not really sure i should bespending more time-- she'll be unconscious. you'll be safe. [opera resumes] i'll be therewhen you wake up. i'm gonna be fine, mom. brave kid. she even gave her moma pep talk.

mature, brave.she's a wonder. what's your problem? these cancer kids. you can't put them allon a pedestal. it's basic statistics. some of them have got to bewhiny little fraidy-cats. you're unbelievable. if there's not one yellow bellyin the whole group, then being bravedoesn't have any meaning.

andie handles an impossiblesituation with grace. that's not to be admired? you see grace becauseyou want to see grace. you don't see grace becauseyou won't go anywhere near her. idolizing is pathologicalwith you people. you see things to admirewhere there's nothing. yeah, well,we're evil. you findthings to admire where you shouldn'tbe sniffing at all.

like debbie in accounting. she's...nice. you shouldn't know that.you're married. so the little kiddying of cancer, i shouldn't like her? if you're dying,suddenly everybody loves you. you have a cane.nobody even likes you. i'm not terminal.i'm merely pathetic. you wouldn't believe the crappeople let me get away with.

[heart monitor beeping] they found a tumor. it's in her lung,extending into her heart. it wasn't visibleon the mri because it's growingalong the heart wall. now, becauseof the placement, the surgeon has to temporarilyremove andie's heart. it's called an explant. they cut out the tumor,

replace any damaged heart muscle with bovine patches. that's a patch made from a cow's pericardium. it's a sacthat encloses the heart. what are her chances? the problem is there might notbe enough heart left once they removeall of the tumor. and if the tumor'smetastasized, there's nothingwe can do.

dr. murphy. just let metie this off. doctor. what? she's got a bleedin her eye. they got the tumor,repaired her heart, but she bledout of her eye. she didn't bleed outof her eye from a heart tumor. true.the cardiac tumor was benign.

it's impossible. statistically-- oh, shut up. if the tumor's benign, that means it didn'tcause her hallucinations. that's whyi'm mentioning it. so the tumoris a coincidence. this is bad. you're startingto state the obvious.

no, you said it would be there.it was there. it can't bea coincidence. (house)a nine-year-oldwith terminal cancer gets an unrelated benign tumorgrowing in her heart--why? it's benign?that's impossible. talk to wilson. and the retinal bleed--another coincidence? a clot could createpressure behind the eye, cause the bleeding.

a clot could explain the eye, but doesn't explainthe hallucinations. a clot couldcause mini-seizures. great, another thing that'snot causing hallucinations. (foreman) post-seizure psychosis. the brain sort of correctsitself after the seizure by hallucinating. the clot could explain the eyeand the hallucinations. but what about the tumor?

tumors the sizeof an octopus wrapped arounda little girl's heart are not just a coincidence. she's not healthy.she's never been healthy. what's the theory here? this girl's body's a lemon? faulty manufacturing?everything's falling apart? the tumoris afghanistan. the clot is buffalo.

does that needmore explanation? okay, the tumoris al qaeda. the big bad guy, the brains. we went in, wiped it out. but it had already sent out a splinter cell. a small teamof low-level terrorists quietly living in some suburb of buffalo, waiting to kill us all. are you trying to say

that the tumor threw a clotbefore we removed it? it was an excellent metaphor. angio her brainbefore this clot straps on an explosive vest. (house) angio was clean. there's no clot? there's a clot.we just can't find it. we can't do exploratorysurgery on her brain. are you sure you're nota neurologist?

[sighs] she's gonna die. well, the clot's not gonnago away quietly. it could blow at any time. are you gonnalet them know? i guess so. can i come with? to tell andieshe's gonna die? that's very un-you.

well, she'ssuch a brave girl. i want to seehow brave she is when you tell hershe's gonna die. go to hell. [mother crying] what would you do if you weretold you were gonna die? i don't know.i'd be devastated. you'd cry like a baby. everybody would.

she's not doing anything. she's a rock. she's brave. yeah, yeah, yeah.why? she's gone through more than most people doin a lifetime. so what? does that meanshe's ready to die? what if her bravery...is a symptom?

the clot is causing the hallucinations and messingwith her emotions. you think her braveryis chemically based? it'd tell us whereto look for the clot. where's the fear center? in the amygdala,near the hippocampus. it's a big area,and a busy one. you blindly cut in there, you could kill her. only time you're gonnasee this clot is at autopsy.

then let's do that. is it still illegal to performan autopsy on a living person? are you high? if it's tuesday,i'm wasted. it's wednesday. i want to inducea hypothermic cardiac arrest. once the patient'son bypass, we siphon offtwo liters of blood, then perfuse the brainwhile she's in an mri.

you're actually talkingabout killing her. just for a little while.i'll bring her right back. oh, well, in that case,go ahead. why are we even talking? if we do nothing,she's dead in a day. maybe a week. the kind that lasts. we need fda approvalfor any surgical technique that's used for diagnosticpurposes.

absolutely, if we weredoing anything invasive. but there's nothinginvasive... gah. you know, i'm notcutting into her head. i'm just looking for a clot. not invasive? you're killing her. don't split hairs.if it works, she lives. make surethe mom understands that thisis a million-to-one shot.

i'll see that wilsonpasses that along. the plan...is basically to reboot your daughter. like a computer. we shut her down,then restart her. how do you restarta nine-year-old girl? we cool her corebody temperature to 21 degrees celsius. use blankets, ice.

sort of like...hibernation? not quite. in hibernation,a bear's heartbeat is just very slow. in cardiac arrest,there is no heartbeat. so she's dead. temporarily, yes. by cooling her,we limit the risk of damage when we...remove her blood.

not all of it. two to three liters. half her blood? then we put it back. it's calledperfusing the circuit. in this case, her brain. and using an mri, we'd havea very brief window to hopefully seethe outline of the clot.

if it's thereand it's operable, we go get it. and andiewalks out of here. whew. signed consent forms. great.thanks. you sound better. i stacked a comboof mentholatum, a few vicodin, and...

something elsewhich i can't remember. should be able to ridethe high for a couple hours. what did andie say? about what? about this. i didn't talk to her. she doesn't need to know the specifics of this procedure. what if you're rightabout her?

what if she justis that brave? that doesn't meanshe's mature enough to handlethis kind of decision. either she understandsor she's not brave. you can't have itboth ways. if she does understand... then she deservesto know what's going on. i'm dr. house. [weakly]i've seen you around.

your mom tell you what we're gonna try? sorta. tomorrow's testscould take 10 hours. given yourpresent condition, you might not evenmake it through. my mom's done a lotof research. how do you feelabout it? if we figured maturity came fromhow much time you've got left instead of how longyou've been here,

this would be your call. i don't have a choice.right? i could give you one. i wanna get better. you've got cancer. even if i fix this-- i have a year. a year of this. a lot of peoplewouldn't want that.

a lot of people would... just want it to be over. are you askingif i want to die? nobody wants to die. but you're going to. the only question is how. how muchyou're gonna suffer, and... and how long. i'm asking if youwant this to be over.

what wouldyou tell my mom? i would give her10 excellent medical reasons why we can'tdo this procedure. i can't just leave her'cause i'm tired. but you can't stayfor her either. but she needs me here. this is your life. you can't do thisjust for her. i love her.

thank you for joining mefor tonight's dress rehearsal. playing the part of andieis morty randolph. for his donation to science,we give our thanks. once andie is cooledand goes off bypass, we have 60 seconds to gettwo liters of blood out of her bodyand back into her for the pictures to findthe clot in her head. if our staris bumped tomorrow, while my mri is on...

[screeching] these red lightswill go off. which will mean we haveno usable test results. no test results, it's good-bye, broadway. you guys will be wearingbad cat suits in des moines. now, neurosurgeons here, with a view of the monitors. cardiac surgeon there,in case we need to open her up. anesthesiologists: one by the cardiac bypass machine,

one by the cooling apparatus. girls in the chorus,if you're over 5'10", stick with me. okay, give me 60 secondson the clock. [beep] (house) show time. a-five, six, seven, eight! siphon off the blood through the arterial line. whoosh!sound of blood draining.

more whoosh. [imitating liquid chugging] and we... [alarm screeching] kill her. again. sorry, my hand-- how hard can this be? it's a little busy down here.

if we didn't have to lavageher gastrointestinal-- again! we could bolt herto the table. gruesome and low-tech. kiss me, i love it. (nurse)here you go, doctor. this'll make you sleep. a lot of people. big musical number, kiddo.

a lot of people hereto make you look good. you're kind offreaking me out. he gets that sometimes. deep breath, honey. okay, go. [drill whirs] [drilling] (woman) body temperature 37 degrees celsius. (man) start the cooling.

you, go. she's shivering. 200 milligramsof vecuronium. (woman) 24 degrees celsius. [steady beep] (foreman)we have afib. [beep continues] she's dead. that's the whole idea.

go. (woman) one liter out. (woman) two liters. okay, put the blood back in. reperfuse the circuit. anything, people, anything at all. (man) internal carotid artery in cavernous sinus is fine. vestibulocochlear nerveintact. middle meningeal artery clear.

(man) five seconds. (man) we're over the limit. we've got to start rewarming her, or there'll be permanent damage. keep looking! there! i didn't see anything. it was there. you sure?

four millimeters lateralto the hippocampus. i saw it. (man)house, she's out of time.she's gonna be a vegetable. i saw it. that's good enough for me. they were ableto restart her heart. she's doing as wellas can be hoped. (pam) so they found the clot. we think so.

the neurosurgeons are attemptingto remove it right now. and when will we know if there was any damage? a few hours. [sobbing] [bird york's in the deep] ♪ thought you had ♪ ♪ all the answers ♪ ♪ to rest your heart upon ♪ ♪ but somethin' happens ♪

♪ don't see it coming, now ♪ ♪ you can't stop yourself ♪ ♪ now you're out there ♪ that's where i am. there's nothing there. you're not there yet.keep going. i'm there. are you sure you saw-- there it is.

i think i can get it. ♪ life keeps tumbling ♪ ♪ your heart in circles ♪ ♪ till you let go ♪ ♪ till you shed your pride ♪ ♪ and you climb to heaven ♪ hi, mom. ♪ and you throw yourself off ♪ ohh, hi, baby.

[crying] ♪ now you'reout there spinning ♪ ♪ in the deep ♪ you're treatingyour stuffy nose with... cocaine? ♪ in the deep... ♪ diphenhydramine. antihistamine. it's a...new delivery system.

it's a blood-brainbarrier thing. it's all about speed,isn't it? one thing to another,never standing still. you're...pretty good at that. i know my wayaround a razor blade. it's time. just a couple more rocks. andie's going home. right.

the parade of the small,bald circus freaks. sorry, i...got a thing. i read the surgeon's report. oh? clot was nowhere nearher amygdala. means her fear emotions were working perfectly. yeah. yeah.

so her...braverywas not a symptom. i was wrong. she genuinely is a self-sacrificing saint, whose life will bring hernothing but pain. which she willstoically withstand... just so that her mom doesn'thave to cry quite so soon. i am beside myselfwith joy. [inhales]

she enjoys lifemore than you do. she stole that kissfrom chase. what have you done lately? i'm pacing myself. unlike her, i havethe luxury of time. she could outlive you. [bell dings] ♪ in the silence ♪ ♪ all your secrets ♪

♪ raise theirworried heads... ♪ in case you want to seereal butterflies. ♪ back together... ♪ [kiss] ♪ flipping ♪ i'm not gonna kiss you,no matter what you say. ♪ in the deep ♪ ♪ it's sunny outside. you should go for a walk.

not much for the long walksin the park. now git. [elvis costello's beautiful] ♪ every day ♪ ♪ is so wonderful ♪ ♪ and suddenly ♪ ♪ it's hard to breathe ♪ ♪ now and theni get insecure ♪ ♪ from all the pain ♪

♪ i'm so ashamed ♪ ♪ i am beautiful,no matter what they say ♪ ♪ words can't bring me down ♪ liquid cooled... ♪ i am beautifulin every single way ♪ right leg? ♪ yes, wordscan't bring me down... ♪ huh? your right leg?

you can still ride. we got excellentfinancing right now. it lists for 10,800. i'll let you steal itout the door for 10,300. could i test-driveone of these things? ♪ no matter what you do ♪ ♪ no matter what we say ♪ ♪ we're the songinside the tune ♪ ♪ full of beautiful mistakes ♪

♪ and everywhere we go ♪ ♪ the sun will always shine ♪ ♪ tomorrow we might wake upon the other side ♪ ♪ or the other time ♪ ♪ we are beautiful... ♪