Locked In (House)
Encyclopedia
"Locked In" is the nineteenth episode of the fifth season of House
. It aired on March 30, 2009.
is injured in a motorcycle accident in Middletown, NY and finds himself in bed next to a patient (Mos Def
) suffering from locked-in syndrome
after a bicycling accident. His attending doctor diagnoses brain death, and suggests transplanting his heart into another patient. House notices the patient following the doctors with his eyes, and is immediately interested in taking up his case. Thirteen
suggests a well-placed tumor, so the team does an MRI. House sees a lesion on the scan. However, the patient's attending thinks the patient has an infection and has him on antibiotics. House tells the patient if he has cancer, the antibiotics could kill him. However, they could almost kill him, in which case it would confirm that the patient doesn't have an infection. Just then, the patient seizes. Communicating through blinking, the patient requests transfer to Princeton Plainsboro.
The team plans to do a brain biopsy
on the new patient, but he loses his eyelid movement in the operation, and with that, his only way to communicate with the doctors. Dr. Taub suggests they should use a brain–computer interface for communication with the patient. It takes the patient a while, but he finally manages to shift the arrow up, showing he's still mentally present. Communicating via yes or no (up for yes and down for no) on the computer, the team takes the patient's history. He claims he did not visit St. Louis, contradicting his wife. Unable to explain himself, his wife concludes he has had an affair. Further investigation reveals that the patient has stayed at a friend's home, in order to maintain the facade of a successful business. Unbeknownst to his wife, he was moonlighting as a janitor, where he was exposed to cadmium, leading the team to believe that he has heavy metal poisoning.
Thirteen
notices that he has a tear in his epithelial cells in the eye, and a Fluorescein Stain reveals ulcerative keratitis. Cameron suggests the team does a lumbar puncture, noting that polys
(polymorphonuclear leukocytes) would mean it's varicella, and lymphs, Behçet's
. During the lumber puncture however, the patient crashes. They bring him back, but his foot starts to itch, which he manages to communicate to the team after several questions. This indicates liver failure. Thirteen suggests that the dying liver released toxins which lead to locked in syndrome. Foreman suggests that the liver, kidney and eye points towards sclerosing cholangitis
. House orders a biopsy to confirm.
As the team gets ready to perform the biopsy, Kutner notices a rash on Thirteen's wrist, where some of the patient's urine had spilled. He deduces that it is a rash due to Leptospirosis
, which was transferred from rats, living in the basement where the patient had stayed. Sure enough, the patient has a paper cut on his index finger. The treatment is started, and Kutner manages to get the patient to lift a finger. The patient gradually regains control of his body, and thanks House, who has gone to the patient's room to retrieve a recorder which he's been using to listen in on his team from under the patient's pillow.
Meanwhile, Wilson gets curious as to why House was in Middletown. At the end of the episode, Wilson finds out that House was in Middleton to see a psychiatrist
, and confronts him on the issue. House reluctantly acknowledges Wilson's accusation, but says he is not going to continue any further sessions. The episode ends with Wilson predicting House will end up alone, and showing that House's vision blurs in a similar fashion to the "locked in" patient as he looks towards Wilson.
Foreman also tells the patient that he bought his first girlfriend a silver necklace and she never wore it, so he never bought his girlfriends jewelry again, until he met Thirteen. He bought her a bracelet, but again, she doesn't appear to be wearing it. Later during the liver biopsy, Kutner asks Thirteen why she's not wearing her bracelet. Foreman says he didn't realize she was wearing it at all, and Thirteen questions why Kutner noticed but not Foreman. Kutner then notices Thirteen's rash, which he attributes to the patient's urine which could have entered through a scratch from the bracelet.
gave the episode 7.8/10. Hemal Jhaveri of TVSquad described the episode as "excellent".
House (TV series)
House is an American television medical drama that debuted on the Fox network on November 16, 2004. The show's central character is Dr. Gregory House , an unconventional and misanthropic medical genius who heads a team of diagnosticians at the fictional Princeton-Plainsboro Teaching Hospital in...
. It aired on March 30, 2009.
Plot
Gregory HouseGregory House
Gregory House, M.D., or simply referred to as House, is a fictional antihero and title character of the American television series House, played by Hugh Laurie. He is the Chief of Diagnostic Medicine at the fictional Princeton-Plainsboro Teaching Hospital, where he leads a team of diagnosticians...
is injured in a motorcycle accident in Middletown, NY and finds himself in bed next to a patient (Mos Def
Mos Def
Dante Terrell Smith is an American actor and Emcee known by the stage names Mos Def and Yasiin Bey. He started his hip hop career in a group called Urban Thermo Dynamics, after which he appeared on albums by Da Bush Babees and De La Soul. With Talib Kweli, he formed the duo Black Star, which...
) suffering from locked-in syndrome
Locked-In syndrome
Locked-in syndrome is a condition in which a patient is aware and awake but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for the eyes. Total locked-in syndrome is a version of locked-in syndrome where the eyes are paralyzed as...
after a bicycling accident. His attending doctor diagnoses brain death, and suggests transplanting his heart into another patient. House notices the patient following the doctors with his eyes, and is immediately interested in taking up his case. Thirteen
Thirteen (House)
Remy "Thirteen" Hadley, M.D., is a fictional character on the Fox medical drama House, portrayed by Olivia Wilde. She is part of the new diagnostic team assembled by Dr. Gregory House after the disbanding of his previous team in the third season finale...
suggests a well-placed tumor, so the team does an MRI. House sees a lesion on the scan. However, the patient's attending thinks the patient has an infection and has him on antibiotics. House tells the patient if he has cancer, the antibiotics could kill him. However, they could almost kill him, in which case it would confirm that the patient doesn't have an infection. Just then, the patient seizes. Communicating through blinking, the patient requests transfer to Princeton Plainsboro.
The team plans to do a brain biopsy
Brain biopsy
Brain biopsy is the removal of a small piece of brain tissue for the diagnosis of abnormalities of the brain. It is used to diagnose Alzheimer's disease, tumors, infection, inflammation, and other brain disorders....
on the new patient, but he loses his eyelid movement in the operation, and with that, his only way to communicate with the doctors. Dr. Taub suggests they should use a brain–computer interface for communication with the patient. It takes the patient a while, but he finally manages to shift the arrow up, showing he's still mentally present. Communicating via yes or no (up for yes and down for no) on the computer, the team takes the patient's history. He claims he did not visit St. Louis, contradicting his wife. Unable to explain himself, his wife concludes he has had an affair. Further investigation reveals that the patient has stayed at a friend's home, in order to maintain the facade of a successful business. Unbeknownst to his wife, he was moonlighting as a janitor, where he was exposed to cadmium, leading the team to believe that he has heavy metal poisoning.
Thirteen
Thirteen (House)
Remy "Thirteen" Hadley, M.D., is a fictional character on the Fox medical drama House, portrayed by Olivia Wilde. She is part of the new diagnostic team assembled by Dr. Gregory House after the disbanding of his previous team in the third season finale...
notices that he has a tear in his epithelial cells in the eye, and a Fluorescein Stain reveals ulcerative keratitis. Cameron suggests the team does a lumbar puncture, noting that polys
Granulocyte
Granulocytes are a category of white blood cells characterized by the presence of granules in their cytoplasm. They are also called polymorphonuclear leukocytes because of the varying shapes of the nucleus, which is usually lobed into three segments...
(polymorphonuclear leukocytes) would mean it's varicella, and lymphs, Behçet's
Behçet's disease
Behçet's disease is a rare immune-mediated systemic vasculitis that often presents with mucous membrane ulceration and ocular involvements...
. During the lumber puncture however, the patient crashes. They bring him back, but his foot starts to itch, which he manages to communicate to the team after several questions. This indicates liver failure. Thirteen suggests that the dying liver released toxins which lead to locked in syndrome. Foreman suggests that the liver, kidney and eye points towards sclerosing cholangitis
Primary sclerosing cholangitis
Primary sclerosing cholangitis is a chronic liver disease caused by progressive inflammation and scarring of the bile ducts of the liver. The inflammation impedes the flow of bile to the gut, which can ultimately lead to liver cirrhosis, liver failure and liver cancer...
. House orders a biopsy to confirm.
As the team gets ready to perform the biopsy, Kutner notices a rash on Thirteen's wrist, where some of the patient's urine had spilled. He deduces that it is a rash due to Leptospirosis
Leptospirosis
Leptospirosis is caused by infection with bacteria of the genus Leptospira, and affects humans as well as other mammals, birds, amphibians, and reptiles.The...
, which was transferred from rats, living in the basement where the patient had stayed. Sure enough, the patient has a paper cut on his index finger. The treatment is started, and Kutner manages to get the patient to lift a finger. The patient gradually regains control of his body, and thanks House, who has gone to the patient's room to retrieve a recorder which he's been using to listen in on his team from under the patient's pillow.
Meanwhile, Wilson gets curious as to why House was in Middletown. At the end of the episode, Wilson finds out that House was in Middleton to see a psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
, and confronts him on the issue. House reluctantly acknowledges Wilson's accusation, but says he is not going to continue any further sessions. The episode ends with Wilson predicting House will end up alone, and showing that House's vision blurs in a similar fashion to the "locked in" patient as he looks towards Wilson.
Foreman also tells the patient that he bought his first girlfriend a silver necklace and she never wore it, so he never bought his girlfriends jewelry again, until he met Thirteen. He bought her a bracelet, but again, she doesn't appear to be wearing it. Later during the liver biopsy, Kutner asks Thirteen why she's not wearing her bracelet. Foreman says he didn't realize she was wearing it at all, and Thirteen questions why Kutner noticed but not Foreman. Kutner then notices Thirteen's rash, which he attributes to the patient's urine which could have entered through a scratch from the bracelet.
Production details
The majority of the episode is filmed in the first person perspective from the point of view of the patient, or in the form of his imaginings.Reception
James Chamberlin of IGNIGN
IGN is an entertainment website that focuses on video games, films, music and other media. IGN's main website comprises several specialty sites or "channels", each occupying a subdomain and covering a specific area of entertainment...
gave the episode 7.8/10. Hemal Jhaveri of TVSquad described the episode as "excellent".