Clinic Case: Patient Heal Thyself

[House enters a clinic waiting room. Seated at a regular chair (not the exam table) is a woman with graying hair, sunglasses, and a dog by her side wearing a guide dog harness.]

House: [He doesn’t say anything, just stands by the door and looks at her. It would seem that he’s going kill some time. She turned her head slightly toward him as he walked in. The dog gets up and comes over to House for a pet.]

Patient: Hello?

House: Hello there. Just taking a moment to read through your file. [House pets the dog, scratches under its chin.] Nice dog. [He stands up from the dog, and points for the dog to go back to his master, which it does. House continues to stand near the door looking in her direction, holding the patient clipboard under his arm. Not reading it.]

Patient: Thank you, he’s such a faithful fellow. [She leans down to pet the dog.] I was just in to see if I could get something for this arthritis that been acting up lately.

House: Oh yeah, right. Well, I suppose you should get up to the exam table then.

Patient: I’d be happy to, but, um -- could you help me please? [She stretches out her arm for an assist.]

House: Oh, all right, if you insist. [He takes her arm and guides her to the exam table.]

Patient: [At the previous statement, she tilts her head toward House a little funny, puzzling over his “if you insist” comment.] Thank you so much. Sometimes the simplest things can be so challenging in an unfamiliar setting.

House: Now let’s see, arthritis you said? [Starts examining her hands, a basic exam.]

Patient: Yes, that’s what it says in my file. [She sounds a little miffed]

House: Um hm. Yes, I read that. [He’s got the stethoscope out now, listens to her chest for a moment.] Tell me, how long have you been sight impaired?

Patient: It’s in the questionnaire that you’ve got there.

House: Sorry, must’ve glanced past that part. How long? [He stands upright, goes over to the light switch and flips it off, then as she talks, he goes over to the exam room shades to draw them so the room is now fairly dark.]

Patient: About five years. [She tilts her head as if to listen better to the shades being drawn.] You know, that’s the quietest doctor’s clipboard I ever heard.

House: [Smirks.] Yes, isn’t it just fascinating what they can do with wood and paper technology these days.

Patient: Yes, I hear some doctors have even started using laptops to – OUCH! [She’s responding to something that House just did.]

House: Sorry about that. Where and when do you feel the most pain?

Patient: [Really aggravated now.] It’s in my file.

House: Yeah, yeah, I know, we’ve been through that. Now it’s your turn to tell me. You take a nice deep breath open your mouth, then expel air through your vocal chords, and noise comes out. You move your lips a little to formulate words.

Patient: You didn’t read my file, did you?

House: [Rolls his eyes, determined not to answer her.] Is your arthritis worse in the morning, afternoon, evening, or about the same at all times?

Patient: Why didn’t you read my file?

House: Is your arthritis worse in the morning, afternoon, evening, or about the same at all times?

Patient: Worse in the morning.

House: And how did you lose your sight?

Patient: I know doctors are famous for not being able to write, but can you also not read?

House: Oh, I can read all right, I just choose not to.

Patient: And why would that be?

House: Because paper can make it so easy to – let’s say “make mistakes.” You start out with a blank form, fill in a few lines, check a few boxes, and poof you have what seems to be a complete patient history that may or may not tell the whole picture. I assume you had help filling out the form?

Patient: Yes, one of the nurses helped me.

House: So she read the questions to you, and she filled out the paper based on your answers.

Patient: Yes, that’s how it worked.

House: See, not only does that make it easy to make a mistake, but it also makes it easier to lie. Check a box here or there that shouldn’t be, omit another one or two . . . personally, I prefer being lied to directly by the patient herself. [House steps away toward the supply cabinet, and pulls something out.]

Patient: [She’s indignant] Lied to? Wh - Whatever are you talking about?

House: [He doesn’t respond to her question. But as he approaches her, he suddenly lifts a flashlight to her face and shines it into the sunglasses.]

Patient: She flinches badly and even puts her arms up to keep him from flashing the light into her face.

House: So tell me, why would a kind and sweet little old lady such as yourself fake being blind? Is it the breaks from the IRS? Is it the handicap parking spaces? Perhaps the fun of insisting someone owes you change for a twenty when you know you just gave them a ten?

Patient: Damn, you’re good. And you didn’t even read my file! My regular doctor has been seeing me for three years and hasn’t questioned me even once!

House: Why?

Patient: [Sighs] About five years ago, there was a blind man in my apartment complex who passed away. He didn’t have family, and apparently his guide dog was old enough that the guide dog training people said it shouldn’t go to anyone else. So old Shep came to live with me.

House: This isn’t Shep, is it?

Patient: No, this is Peyton. As they predicted, Shep passed away within the year. But when he passed I got another dog. Not long after that I was invited to a costume for a party, and, well, I—

House: Thought it would be fun to impersonate a cripple? [House makes a point of adjusting his stance to lean on his cane.]

Patient: Oh no, no, it wasn’t like that, I promise! I just needed a costume in a hurry, and it just seemed so simple, so easy to put on the sun glasses, and go as . . . [she shrugs and her voice trails off].

House: OK, so that’s one party. Why keep it up?

Patient: Well, I didn’t have many friends, and when I went to that party, it was like a whole new world opened up to me. The taxi driver actually UNDER charged me! Imagine that, a New York City cabbie undercharging someone he could rip off so easily. I could read plain well what his meter said, but he knocked it in about half.

House: Wow, they say that miracles do happen. Must not have been in America long enough yet.

Patient: When I got to the party, I got so many people who thought the whole thing was real, I was just doted over all night long. Felt kind of nice. [She gets a smile across her face of fond memories.]

House: So it’s a full-time job now?

Patient: Pretty much. At first, I just rented every movie I could find with blind characters in it, sort of fascinated with how they coped in the world, how they behaved. And before I knew it, I was sneaking out of my apartment and going places where people wouldn’t know me. Eventually I even moved to New Jersey so I could live it all the time. Are you going to call a psych consult on me?

House: Only if you keep seeing the other doctor who’s a complete moron.

Patient: How did you figure it out anyway?

House: Well, for one thing, that harness and that dog are not matched to your height. Your harness handle should be about six inches shorter for it to be appropriate for you. No respectable guide dog organization would have set you up that way. Then there’s the fact that guide dogs aren’t supposed to come running up to strangers for attention. And then, of course there was the very first clue, which was seeing you out in the waiting room with the nurse. If you’re supposed to be blind, it doesn’t stand to reason that you should be looking over the form to check her answers.

Patient: Well, if you’re not going to call for a psych consult, will you at least give me something for this arthritis?

House: On one condition.

Patient: What’s that?

House: [Leans forward to tell her, but we don’t hear it, the scene fades.]

[Next we see House standing at the reception area, next to a nurse. Wilson is just walking up to the desk as well.]

Wilson: You paged me?

[The little old lady comes out of the exam room. She’s not holding the dog by the harness handle, but rather the short leash attached to it, walking him like he’s a normal dog. In her other hand, she’s got her sun glasses and a bottle of pills. She makes a point of looking around her, and stepping around someone as she approaches the desk.]

Patient: [To the nurse.] I just want to thank you so much dear for helping me fill out all that nasty paperwork. But it was worth every minute of your time, as it helped Dr. House immensely. He’s just such an amazing doctor. Thank you, thank you both. [She turns and walks out the door.]

[Wilson and the nurse are looking at each other with a sort of disbelief mixed with “he’s done it again.”]