Paternity (House)

"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.

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

Plot

When a clinic patient claims to have an appointment with the diagnostic department, House is skeptical of the letter which he himself supposedly 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. None of the tests show why the night terrors occurred, but House finds a large blockage in one of Dan's brain ventricles. House and his team relieve the pressure, but they find that the blockage is not causing the other symptoms.

During the night, Dan is found missing from his bed. Cameron, Chase, and Foreman soon locate him on the roof, where he is hallucinating that he is on the lacrosse field. House is excited by this new development — it rules out his previous diagnosis of multiple sclerosis. The new diagnosis provided by Cameron is neurosyphilis. To treat this, they inject penicillin through a lumbar puncture, but during the 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. After House quickly elaborates in great detail exactly what Dan's condition is it at the time, he tells them to go and support Dan, after which he takes their coffee cups to run DNA tests. The tests show that neither parent is biologically related to Dan.

House remembers a baby he treated earlier whose mother did not want to vaccinate the child and hypothesizes that infant Dan may have caught the measles virus, which remained latent for 16 years. Avoiding a dangerous procedure 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 and reveals that he already knew he was adopted, but that he does not care.

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. 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 Lisa Sanders.

Error: The biopsy of the retina is taken with a needle through the central cornea, which would not be an optimum site due to scarring. Additionally, the needle moves "through the pupil", ignoring the crystalline lens located directly behind the pupil. Finally, the biopsy would seemingly be taken in the central retina known as the fovea - the area of the most sensitive vision, again leading to unnecessary permanent damage to the patient's central vision.

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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