| abstract
| - Jeremy accompanied his wife to the hospital when she had trouble breathing and suffered stomach pain after she was involved in a robbery and rape attempt. However, when the doctors thought her problem was salmonella from smoking marijuana, he became combative and thought the doctors wouldn’t trust them when he told them they didn’t smoke much. When it turned out the initial diagnosis was incorrect, they thought it might be a stress induced allergy. They took Tracy to do a treadmill stress test. Jeremy was very upset as it was obvious that Tracy was in pain and Dr. Foreman kept speeding up the treadmill. However, as he made his objections, Jeremy suddenly doubled over in abdomen and chest pain. Dr. Foreman called for a wheelchair for him. Jeremy was soon as sick as Tracy. The doctors soon ruled out the possibility of a myocardial infarction or an aortic dissection. Dr, House suggested it might be psychosomatic or a panic attack, but Dr. Cameron pointed out the pain persisted after the patient was given lorazepam and morphine. Dr. Foreman suggested that the conditions might be unrelated as Jeremy had chest pain and Tracy had throat problems, but Dr. House insisted they could not ignore the shared stomach pain. Dr. Cameron pointed out if a married couple had the same illness there were only two possibilities - they got it from each other or from the same source so it was either an infection or environmental. Dr. House instructed his team to test for infections and do an environmental scan. Dr. Foreman and Dr. Chase searched the couple’s apartment. Dr. Chase found condoms which he thought odd because Tracy was on the pill. Dr. Chase thought that perhaps it was an STD, but Dr. Foreman pointed out neither had complained of any reproductive tract symptoms. Dr. Chase thought they might be embarrassed talking about it. Once Dr. House learned about the condoms, he was sure that Jeremy had passed on an STD to Tracy, but Dr. Foreman was not convinced given the couple’s commitment to each other. Dr. Chase pointed out that gonorrhea explained all their symptoms - Fitzhugh-Curtis syndrome explained the stomach pain and costocondritis and bladder infection explained the chest and abdominal pain. However, Tracy explained that the condoms were her idea as they had a recent pregnancy scare. Jeremy insisted that Tracy was the only woman he had ever had sex with. Jeremy thought that Dr. Foreman was judging him harshly because he was a white man with a black wife. However, the patients had no scarring or purulent discharge typical of an STD and the tests came back negative. Dr. Foreman pointed out that the patients needed more morphine to deal with their increasing abdominal pain. Dr. House instructed Dr. Foreman to take Tracy off steroids to see if she developed a fever - if she didn’t, the cause would have to be environmental. However, Tracy soon was in a coma although Jeremy was still lucid. They had to up his morphine again. He told the doctors that his wife’s hallucination was about his father - a drunk pill-popping racist who broke his arm for seeing her. They ran away when they were sixteen. His father has since committed suicide. Tracy’s radiology showed her brain was affected. The doctors had ruled out an environmental cause because no-one else they knew was sick. Dr. House thought it might be sarcoidosis - it had both brain and chest involvement, and it had known environmental causes, although neither patient had been exposed to the known environmental causes. However, Dr. Cameron pointed out sarcoidosis wouldn’t explain Tracy’s throat problems and that most cases of sarcoidosis cause scarring of the lungs, which neither patient had. However, Dr. House ordered methyltrexate and wanted to do a biopsy of Tracy’s brainstem despite the risk of almost certain brain damage. Dr. Cameron pointed out that since Jeremy would benefit from the biopsy, he could not give informed consent. However, Dr. House was opposed to appointing a guardian ad litem. However, Dr. Cameron went to Dr. Cuddy who insisted on a guardian ad litem. Dr. House opposed this because it would take days to arrange it, but Dr. Cuddy was unmoved. Dr. House offered to have Dr. Wilson ask for the consent and Dr. Cuddy agreed. Dr. Wilson explained the procedure to Jeremy, but he refused consent because his wife was brilliant and he wouldn’t risk brain damage. He offered to have the procedure done on him, but Dr. Wilson pointed out that this would be pointless as he had no brain involvement. Jeremy noted he would and asked the doctors to stop treating him so he would get worse. Dr. House was angry with Dr. Wilson and Jeremy about refusing the biopsy and refusing treatment. To put pressure on him, he ordered the morphine withdrawn, but his team refused. Instead, Dr. House injected Jeremy with naloxone. Jeremy still refused treatment or consent to the biopsy. Dr. Foreman sedated the patient until the naloxone wore off. Dr. House went to Dr. Cuddy to try to get a court order to do the biopsy, but she refused. Jeremy did get worse - but not with brain involvement. Instead, the doctors found out his lactic acid levels were risking because his intestines were necrotic. This ruled out sarcoidosis. Tracy continued to get worse and Jeremy’s lactic acid levels continued to rise and he started vomiting blood. Small cell vasculitis explained his symptoms, but it wasn’t infectious or environmental. Dr. Foreman argued they had different diseases - vasulitis for him and porphyria for her. Dr. House ordered hematin for Tracy and a resection of the small intestine for Jeremy. However, after Jeremy’s surgery, the biopsy showed the intestine was not dead - there was just swelling and edema, most likely from stress. Dr. House started a new differential. Dr. Cameron pointed out that these symptoms ruled out an allergy. Dr. Chase suggested syphilis, but Dr. Foreman still thought that unlikely because of the couple’s long term relationship. However, Dr. House was intrigued about why the couple ran away from home. Dr. Foreman blamed Jeremy’s racist father, but Dr. House wondered why Dr. Foreman thought the father was racist just because he disliked Tracy. He thought, perhaps, there was a personal reason he didn’t want them to be together. Dr. House then told his team to focus on genetic diseases - they were missing the same gene that prevented fluid buildup - hereditary angioedema. Dr. Chase noted how rare it was and it was nearly impossible that two unrelated people would have it. Dr. House, however, noted both patients had green eyes and might be half-siblings. It would explain why the father was enraged that they were dating and why the father was taking pills - he probably had it as well. However, Dr. House realized they didn’t have time to test and ordered treatment. Tracy eventually responded to treatment and came out of her coma. Jeremy was thrilled. The doctors realized the couple must be half-siblings. Dr. Foreman hoped they could hide this from them, but Dr. House pointed out that once they knew what was wrong with them, it would eventually come out. As Dr. Foreman told them about their treatment regime, he broke the news that they had to be related through the same father and needed a DNA test. Tracy immediately realized that this explained why her skin tone was lighter than both her parents and that people had already seen similarities between them and this explained it. Dr. Foreman tried to explain it was different because they didn’t grow up together, but Tracy asked for a separate room. Dr. Foreman spent some time with Jeremy to help him through the breakup.
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