Humpty Dumpty (House)

House (TV series) episode
episode_name = Humpty Dumpty
episode_no = HOU-203
airdate = September 27, 2005
writer = Matt Witten
director = Dan Attias
guest_star = Sela Ward as Stacy Warner
Ignacio Serricchio as Alfredo
Christine Avila as Luisa
J.R. Villareal as Manny


season = 2
diagnosis = Endocarditis due to psittacosis

Humpty Dumpty is the third episode of the second season of "House", which premiered on the FOX network on September 27, 2005. Dr. Lisa Cuddy's longtime handyman Alfredo falls off her roof, causing breathing problems.

Plot

Alfredo, a construction worker at Dr. Cuddy’s house, complains that his asthma is acting up. She asks him to finish the job. Alfredo falls off the roof onto the concrete.

An ambulance races Cuddy and Alfredo to the hospital. He can’t breathe, and Cuddy notices two of the fingers on his right hand have turned purple. At the hospital, the doctors try to figure out the cause of this. House suggests disseminated intravascular coagulopathy. House asks his team for a cervical MRI and treatment for DIC.

Stacy tells Cuddy that, for legal reasons, she should stay away from Alfredo. Stacy is sure that Cuddy will feel guilty, apologize and offer to pay his bills which isn't what the hospital needs. Cuddy is concerned that Alfredo could lose his hand and then his livelihood.

Alfredo demands to be released so he can go back to work. Chase notices that a third finger is turning purple. Cameron finds that Alfredo isn’t clotting properly, which would mean minor DIC. House points out that if the hand is dying, it could move up the arm and further. Cuddy orders a stronger medicine -- human activated protein C. The staff is shocked. House points out that this treatment is only for severe sepsis. It is incredibly dangerous and could cause internal bleeding, strokes and more. Cuddy tells them to do it anyway.

Wilson notes to House that he would’ve ordered protein C as well. Suddenly, Alfredo screams for help because he can’t move his arm. Chase tells Cuddy that the protein C caused bleeding in Alfredo’s brain. The treatment is stopped and Alfredo is rushed into neurosurgery. Cuddy observes the surgery.

The surgery fixes the bleed. As Cameron examines him, Alfredo suffers from a coughing fit. A chest x-ray shows lung infiltration. His fingers become darker and he has a fever. Cuddy tries to connect this to Alfredo’s falling off her roof. Foreman suggests pneumonia, and Cuddy admits that it is a possibility because Alfredo asked to leave the job. House asks Cuddy to check Alfredo’s house to look for possible causes. House, Foreman, and Chase secretly investigate Cuddy’s house as well since Alfredo has been there for the past three weeks.

Cuddy and Cameron find a rat killed by a trap under Alfredo’s dresser. The scars on Alfredo’s hand must be rat bites. He has streptobacillus, which fits the symptoms perfectly. In Cuddy’s bathroom, House notices a fuzzy, black aspergillus fungus on the pipes underneath the sink. Looking an x-ray, Cuddy agrees that fungal pneumonia is more likely. Cameron points out that the treatment for aspergillosis is amphotericin, which is incredibly dangerous.

Stacy asks House to take it easy on Cuddy because she actually feels for patients. They’re not just a puzzle to her. Meanwhile, Alfredo’s little brother tells Cameron that Alfredo hasn’t peed since yesterday afternoon. Cameron is concerned, and she immediately tells House that the amphotericin might have destroyed Alfredo’s kidneys and that he may be dying. Alfredo’s mother overhears this and begins crying.

The team reviews what they know. The cause is not aspergillus nor rat bite fever. Alfredo tested negative for moraxella, nocardia and cryptococcus. Chase mentions that Alfredo has a low titer for Chlamydia antibodies, but this is dismissed by Foreman because the chest X-rays don't match a Chlamydial pneumonia. Chase persists but Cameron says the titer is probably caused by a STD Alfredo had last year. DIC wouldn’t cause a fever this high. House takes Alfredo’s temperature and sees that the patient’s right hand is starting to rot.

House wants to amputate the hand but Cuddy refuses to let that happen. She blames it on the medicine they gave him. If Alfredo loses that hand, he loses his job. House comments that this isn’t medical thinking. House tells Stacy that Cuddy now agrees to the amputation and he begs for legal clearance. Cuddy tells Alfredo that it is necessary, and he tearfully agrees to the procedure.

During surgery, the fingers on the other hand start to turn purple. The team gathers afterwards with the news that Alfredo’s O2 stats are down to 88 and his lungs are giving out. House wonders about endocarditis, which is an infected heart with little bacterial biofilms clinging to its valves. One may have broken off and traveled through the bloodstream to the right hand. Cuddy points out that they tested Alfredo for endocarditis and he was negative. House asks what infection causes pneumonia and culture-negative endocarditis.

House puts forward psittacosis, but Chase mentions Alfredo doesn’t have any pet parrots. House orders a round of doxycycline, which Cuddy notes will make the clotting problems even worse. Cameron points out that, if House is wrong, Alfredo will lose his hands and feet. House and Cuddy barge into Alfredo’s room. House asks the mother, in perfect Spanish, where Alfredo usually works on Saturday night. She says that he doesn’t work. House knows that she’s lying. House realizes that Alfredo works the cockfights on Saturday night.

Cuddy and Foreman head down to the warehouse district and find a cockfight. They see Alfredo’s brother carrying cages of dead birds. Cuddy calls House with the news. House says he put Alfredo on the psittacosis meds as soon as she left. Cuddy later gives Alfredo the diagnosis. It is then revealed that he and his family are suing the hospital for the loss of his hand.

Trivia

* The low antibody titers for Chlamydia which are mentioned by Chase might have actually been antibodies made for the psittacosis disease, which is caused by Chlamydophila psittaci. But because there wasn't any reason to assume Alfredo had been in contact with parrots this isn't easily linked to psittacosis in this case.
* House may have even hinted psittacosis earlier on in the episode when he sent Cuddy and Cameron out to check Alfredo's house: "...or pulling the wings off his pet parrot..."
* The title is taken up from the nursery rhyme Humpty Dumpty that tells the story of character that falls off a wall and is so badly injured he cannot be put together again by "All the king's horses and all the king's men".
* At one point House refers to his group as the Scooby Gang a term used on the TV show Buffy the Vampire Slayer to refer to Buffy's friends who help her.

External links

* [http://www.fox.com/house/ FOX.com-"House" official site]
* [http://televisionwithoutpity.com/show.cgi?show=151/ Television Without Pity-"House" recaps]
* [http://epguides.com/House/ House Episode Guide at epguides.com]
* [http://www.tvguide.com/tvshows/house/100213/ TVGuide's Page: Full list of House Episodes]
* [http://www.housemd-guide.com/ House M.D. Guide]
* [http://www.imdb.com/title/tt0412142/ "House M.D." IMDB Profile]
* [http://politedissent.com/archives/921 Medical Reviews of House: Humpty Dumpty]