Monday, November 2, 2009

The House Algorithm

We all yearn to be the antisocial and sardonic diagnostician, who as biting and sarcastic as he is, has captured our imagination with his quirky remarks and come backs. Yes, it's House as portrayed by Hugh Laurie (brilliantly I may add) who keeps us glued to the TV or our computer screens week after week as he tackles the strangest of medical cases. A challenge has been presented. House accepts and conquers it by the end of a 45 minute episode. The patient survives, House is satiated and his peers are frustrated and further alienated. Brilliant. Yet behind every House mystery, there is an algorithm or flow chart step that is consistently followed in every episode. Sort of like a Scooby Doo episode, where the gang look for clues, Velma goes "Jinkies", Fred suggests splitting up and they finally catch the "ghost" after a series of goof ups that would make the Hooded Claw wince in pain. So what's the House Algorithm? Let's find out.

Pick an interesting case.
Fever,stomachaches and sniffles? Yawn. Give the poor fellow some paracetamol and send him on his way. No fever but severe internal bleeding with an Alien Hand Syndrome? Give me  that patient file....

Talk to the team.
Gather your peons around you and demand differentials. Reply caustically as possible while shooting down all possible causes. Order an MRI, a CT scan and a blood works. Make the African American or the Indian do the hard work. That being done,pop a Vicodin and look amused. Limp away to Wilson's for some well deserved character development.

Search the house (no pun intended)
Send the lackeys, preferably the smoking bombshell with a genetic predisposition and self consciousness issue to the patient's house to look for clues. While there, the peons whine about how rough a taskmaster you are and about idiosyncrasies regarding their lives that nobody cares about. They find a bag of Ecstasy, but (surprisingly enough), the tox-screen comes clean.

Patient seems fine....NOT!
The ever-faithful plastic surgeon is doing a standard lumbar puncture, when the patient starts going into V-fib. Call in the crash cart, send out the fretting wife or girl friend and prepare to jump-start the heart. Charging....CLEAR! (ZAP!). Fade to black.

Extreme Measures
The team starts making more and more idiotic differentials and it's up to you to put them in their place. Could be lupus? It's NEVER lupus*. Suggest starting the patient on methotrexate. Ignore outcries that the patient's immune system will be fried. Relax. Your ego allows you to play God with another man's life. Ironic that you are an atheist. And besides, there's another good ten minutes before the good stuff happens. Pop vicodin and argue with your boss. Hassle her until she caves in to your demand for a dangerous and probably unwanted brain biopsy though the patient has just come out of chemotherapy. Make an abrupt comment about her pistons before limping out in triumph. Pop more vicodin for good measure.

Talking to Wilson and the impending epiphany
At a loss, you amble into Wilson's study and plop onto the sofa. After a series of back and forths, Wilson says something that somehow translates into a medical homology. Wait for your camera close up, echo Wilson's last words and amble away to the nearest phone. Or better yet, step into the operation theater just in time to stop the Australian chap from performing dangerous irreversible brain surgery on your patient.

"You have Guillian Barre Syndrome. It explains the arrythmia, the BP and the muscle weakness. Also the fever that wasn't an infection. The bad news is it's not curable, the good news is you'll live". That being said,return home and play a sad tune on your piano, while cut scenes show that your peons are having a great time. Pop Vicodin. Roll credits.

*Although Lupus is a ongoing gag in House MD, it is still a very debilitating systemic immune disorder. Read about and spread the awareness about systemic lupus here.


vigneshjvn said...

Reminds me of the mad tv parody of House MD. It follows nearly the same algorithm too. Nice analysis! :)

prateekmathur said...

well i have not seen the series so far..but now i guess i will start.. :)

Nikhil Rajagopalan said...

stop watching HIMYM and watch House NOW! :-D

blah said...

and almost every old episode will have cameron saying "it must be auto-immune"