Autopsy (House episode)

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House episode
"Autopsy"

Episode no.	HOU-202
Airdate	September 20, 2005
Writer(s)	Lawrence Kaplow
Director(s)	Deran Sarafian
Guest star(s)	Sasha Pieterse as Andie
House Season 2 September 2005 - May 2006
Acceptance Autopsy Humpty Dumpty TB or Not TB Daddy's Boy Spin Hunting The Mistake Deception Failure to Communicate Need to Know Distractions Skin Deep Sex Kills Clueless Safe All In Sleeping Dogs Lie House vs. God Euphoria, Part 1 Euphoria, Part 2 Forever Who's Your Daddy? No Reason
All House episodes

Autopsy is the second episode of the second season of House, which premiered on the FOX network on September 20, 2005. House and team struggle to diagnose a young girl whose cancer is not causing her more immediate symptoms.

First episode where the infallible "House" is seen sick with a box of tissues.

[edit] Synopsis

Spoiler warning: Plot and/or ending details follow.

Andie, a 9-year old girl with cancer, grabs her pills for the day. Before she can inject her stomach with another medication, she sees the bathroom shake. The mirror shatters, cutting her palm.

Although he is suffering from allergies, House reports to work. Wilson immediately buttonholes him and asks for help on a case. Andie is terminal with alveolar rhabdomyosarcoma and she is hallucinating. However, the tests show that her cancer is in remission. So the hallucinations are unrelated.

House presents the case to his team, and they offer up differential diagnoses. Ignoring his staff’s suggestions, House asks for a tox screen and an MRI. Foreman finds that both are clean. Noticing that Andie’s oxygen saturation is off by one percent, House suggests that his doctors check into it. The doctors resist because the sat rate is within the margin for error and this won’t explain her brain problems. House orders a battery of respiratory and chest tests.

Chase begins to administer another test to Andie. She’s a real trouper, having been through numerous tests with her illness. She mentions to Chase that she’s never kissed a boy and probably never will. Andie asks him to kiss her, but he can’t. She begs him, and after much thought, Chase agrees. They share a sweet, non-sexual kiss.

The next morning, House returns to the office. Chase reports that all of the new tests were also clean. Foreman throws out an off-the-wall suggestion -- neurosyphillis. Even though they don’t think a 9-year old has had sex, it is possible that she was molested. House orders treatment for neurosyphillis, IV PCN. Chase insists this isn’t possible because Andie told him she’s never been kissed. Cameron asks the girl and Andie says nobody has ever touched her.

House confers with Wilson that Andie’s sat rate has dropped another point, which Wilsons says suggests a tumor in her lung. But that doesn’t explain the hallucination. House thinks there is a tumor in the heart, but Wilson insists tests showed otherwise. House demands another explanation. Wilson points out that only one condition simultaneously affects the heart and brain -- tuberous sclerosis. But the chances of one girl having two unrelated cancers at once are statistically impossible. House is thinking about exploratory surgery. Wilson notes that it could kill an immunocompromised little girl.

House calls his team into the doctors’ lounge shower and plays an audio file of Andie’s echocardiogram on an iPod. He has them listen for an abnormality in the valves of her heart that might indicate something else. Cameron picks up on an extra flap in the mitral valve. House has a surgeon look at Andie’s mitral valve and he wants Chase there.

Chase pages House during Andie’s surgery to report that there is a tumor that starts in the lung and extends to the girl’s heart. It did not get picked up in the MRI because it runs along the heart wall. Wilson tells the mother that, because of the placement, the surgeons have to temporarily remove Andie’s heart. Wilson breaks the news that there might not be enough heart left after the tumor is removed. If the tumor has metastasized, there’s nothing they can do.

During the surgery, Chase notices a bleed in Andie’s right eye which is not normal. The next day, House and Wilson review that the cardiac tumor was benign and was not the cause of the hallucinations. The team struggles for explanations. House realizes that the heart tumor broke off a clot before they removed it. He asks for a brain angio to find the clot.

The angio comes back clean. House knows there’s a clot somewhere in Andie’s head, but exploratory brain surgery is not an option. Wilson breaks the bad news to Andie and her mother. House watches from a distance and notices that Andie has no emotional reaction to the news. Back with his team, House wonders if the clot is causing hallucinations as well as messing with her emotions. Where’s the fear center of the brain? Foreman says it’s in the amygdale, near the hippocampus. However, a cut in there will kill Andie. They won’t get to see this clot until the autopsy. This gives House an idea.

House pitches Cuddy on the notion of inducing hypothermic cardiac arrest so that they can siphon off two liters of blood and perfuse the brain while Andie’s in an MRI. He is proposing to kill her for a period of time then bring her back to life. Cuddy thinks he will need FDA approval, but because the procedure isn’t invasive, House disagrees. Cuddy knows this is the only shot since Andie will die within a day. She firmly tells House to inform the mother that this is the longest of long shots.

Wilson explains the procedure. Although the mother is shocked by this, she agrees. Wilson tells House that the description of the procedure was too much for the woman to comprehend. So House visits Andie and lays out the situation. He says that a lot of people wouldn’t want a monumental procedure just to buy another year of pain and hospital visits. Yet Andie wants to go through with it for her mother.

That night, House gathers a surgical team to practice for the surgery. Once Andie has been cooled and is on bypass, they have sixty seconds to remove two to three liters of blood out of her body and get it back in for the MRI to occur. If her body is bumped just slightly, they’ll get nothing which means Andie is dead. They run a test procedure on a cadaver. Yet every time they try to intubate, the cadaver’s head moves slightly. After many failed attempts, Foreman suggests bolting her head to the table. House is up for it.

The next day it’s time for the real show. Andie’s body is cooled down to 21 degrees. They now have sixty seconds, and begin the blood draining. The clock ticks down and they pump the blood back in. Time runs out, but nobody has seen anything. House keeps the time running. Foreman sees something four millimeters lateral to the hippocampus. Nobody else saw it. Foreman is positive he saw it. They immediately begin rewarming Andie.

Andie gets through the procedure and the surgeons work to remove the clot. Foreman directs the neurosurgeon to find the clot. Later, Andie awakes and sees her mom at her bedside.

Wilson lets House know that Andie is going home. According to the surgeon’s report, the clot was nowhere near the amygdale, which means that her fear center was working perfectly. Andie actually was brave in the face of death, despite House’s overwhelming cynicism.

As Andie is wheeled out of the hospital, a large contingent of doctors and nurses is there to send her off with applause. She approaches House, hugs him and smiles.