Clinic Case: The Car “Incident”
[This scene takes place in Exam Room 1. There is a 20-something man sitting on the exam table as House walks in.]
House: You were in a car accident ten days ago, didn’t seek medical treatment then, and now you’re coming to a free clinic instead of going to, oh I don’t know, what do they call that place? The emergency room?!?
Patient: Well, yeah. I mean, I can still walk and everything, it’s just that it’s real painful, and I thought maybe you could prescribe me something for the pain and give me some crutches. I think just a week or two on crutches and I should be just fine.
House: Me doctor. You patient. That means you come to me for my expert advice, you don’t tell me what to do for you, got it?
Patient: [shrugs] OK
House: You say the pain is mostly in your right leg.
Patient: Yeah. Like I said, I can walk on it, but I have this sharp shooting pain in my calf, like right behind the knee.
House: Extend your leg straight. [the patient extends his leg, but very slowly, and wincing in pain]
Patient: It kinda hurts to do that.
House: Me doctor, remember? I happen to be highly skilled in the art of pain detection. [takes out the vicodin and pops a couple] Pants off.
Patient: Oh, right, well, OK.
[The patient starts undressing. After he has his pants off, he turns to toss them onto the chair, and we get to see his backside. There is an enormous black and blue area on the back of his right leg behind and a little below the knee joint. The left leg is a little bruised, but more of a purple and yellow look of a bruise that has healed for a few days.]
House: Wow, impressive.
Patient: Huh? [Patient has turned around and now getting back up to the exam table.]
House: Unbutton your shirt too. You don’t need to take it off, just unbutton the top 3 or 4 buttons.
[The patient looks at him skeptically.]
House: [in a “gay” voice and mannerism] Oh, come on, don’t be shy. I’m a doctor, I’ve seen it all before.
[The patient unbuttons three buttons. House grasps his right collar and lifts the shirt up in order to look underneath at the patient’s shoulder, then repeats for the left side.]
House: Tell me, what kind of [he air-quotes the phrase] “car accident” was this?
Patient: Uh, well, I uh . . .
House: [House has come to the conclusion that this is a drug-seeker who injured himself deliberately.] Come on, you can tell me. Did you have someone drop a bowling ball on your leg? It’s a bit big for a sledge hammer. A lead-weighted cricket bat, perhaps?
Patient: What? No! I told you, it was a car accident!
House: [gets in the guy’s face, looking into his eyes, all around the head region] You see, if you were buckled in, your chest and one of your shoulders would have a nice fat purple strip on it from the seatbelt. No bruising means you weren’t buckled in. If you weren’t buckled in, then it would stand to reason that would have some head trauma from slamming into the windshield, the airbag, or the back of the seat in front of you. No signs of head trauma. So again I’ll ask you, what kind of [air quotes] “car accident” was this? [under his breath] God, normally I hate it when people use air quotes.
Patient: Well, it was more like an “incident” than an “accident.”
House: And now there are hints and allegations. Come on, tell me what happened. [House motions for the patient to roll over onto his stomach so that House can examine his leg.]
Patient: [now lying on his stomach] I wasn’t inside the car; I was in front of it.
House: Doh! Why didn’t I think of that! Funny thing, the English language. Most people who were in front of a car during impact would say they were “hit” by a car. Instead, you chose to say you were in a “car accident.” I suppose there’s no such thing as the “language police” to call on you, but if I didn’t know any better, I’d say you were choosing your words carefully in order to avoid telling me something.
Patient: [in a confessional tone] The car was barely moving, but I got pinned against a wall. My right leg was stuck real good, but my left wasn’t too bad. When I got free, I was able to walk right away, so I didn’t think it was a big deal. I iced it for a couple of days and have been taking Motrin. I just figured it would heal. The pain has been getting worse though, not better.
House: [House has finished palpating the bruise, and now motions for the patient to sit back upright. When he’s upright, House gives him a thermometer.] Girlfriend?
Patient: [muffled with the thermometer in his mouth] I don’t have a girlfriend.
House: Boyfriend?
Patient: No way dude, I’m straight!
House: Sister? Brother? Parent?
Patient: What?
House: Who was it?
Patient: [takes thermometer out of mouth] Who was who?
House: [looks
at the thermometer] You idiot. Who was driving the car?!? Who were you trying to protect by not telling
me what happened? Were they drunk? Because you do know that, as a physician, I’m
required by
[Author’s note: That last line is just House messing with the guy.]
Patient: No, no, there’s no one. No one was driving under the influence, there’s no one I’m protecting. In fact, no one was even driving the car!
House: First, you say it’s an accident, then you say it’s an incident, and now you claim that no one was driving. [House walks over to the phone and picks up the receiver as if to call the cops.]
Patient: [loudly] It was me, OK!?!
House: [stops lifting the phone, turns slowly to look at the guy with a puzzled look on his face]
Patient: [really confessional tone now] Winter was coming on, and I don’t like to have to wait in the car for it to warm up and get all the ice off it. So I wanted to install a remote starter.
House: [House gets a look on his face like he’s trying to figure it out before the guy tells him] And?
Patient: Well, apparently you’re not supposed to install a remote starter in a car with a manual transmission.
House: Because if the car is in gear when you remote start it—
Patient: It lurches forward.
House: [trying not to laugh] You ran yourself over.
Patient: [very embarrassed] Yeah, I hit myself with my own car.
House: OK, I kind of get the part about having installed a remote starter illegally. But explain to me how you end up starting the car while you’re standing in front of it.
Patient: Well, see, the car was parked in my garage, and I was a little late for work, so I was really rushing. So as I came out of the hallway and crossed in front of the car to get to the driver’s side, I thought I’d hurry things along a little and hit the button on my key ring.
House: I see. [pause] so um, this obviously begs the question. I’m sorry, but I just have to ask it. Did you at least have the garage door up when this happened?
Patient: [even more embarrassed] Um, no -- I usually hit the button to open the garage door once I’m inside the car.
House: So, you were pinned against the wall inside a carbon monoxide factory. Just how long did it take you to get out?
Patient: Only 10 or maybe 15 minutes. I hollered for my neighbor to come help me, but it seemed like it took a long time for him to hear me and come help.
House: Your cell phone wasn’t working?
Patient: [Gets a look on his face that says he never thought of using the cell phone.]
House: Wow. You see, you’re the reason why some people find it so easy to question the theory of evolution. That fact that you can actually manage to pull off a stunt like that and live to tell about it is amazing all by itself. Add to that the fact that you’re still young and likely to breed later is a sure sign that natural selection just isn’t working as well as it did when we were hunter-gatherers and fighting off saber-tooth tigers.
Patient: [Has sort of a glazed look on his face, totally not understanding what House was talking about.] Um, can you do something for my leg?
House: You have a severe hematoma with a fever. That means that what started out as a nasty bruise has turned into an even nastier infection. Too much blood pooled in one area, and the body wasn’t able to absorb or get rid of it all, so it started rotting. I’m admitting you for surgery to have the necrotic tissue removed and the site flushed with antibiotics. They’ll probably send you home tomorrow, but you’ll be on antibiotics for a while, and you’ll need to learn how to use a mirror to actually look at the thing from time to time. [pause] Which, if you’d learned how to do that a week ago, you might not have let it get this bad. Unfortunately for the rest of the human race though, you’ll live.