House

Hey. Thanks.

No, no, no... Here.

You got this whole thing wrong, Em.

It's the rock star that's supposed to be late, not the rock-star photographer.

Sorry. Morning sickness. Touch the belly.

It's the first time I've been asked to do that.

Come on. It's good luck.

Okay.

Hit the Kinos behind the drop.

So what do you think?

I think people aren't gonna get it.

Come on. "All-American Rejects."

Juxtaposing a classic image of Americana with modern pop culture youth.

Oh, yeah.

Everyone loves a good juxtaposition.

My fans were born in the '90s.

You know what? You do this picture, you'll gain 40 years of fans.

Yeah? Yeah.

I love the Rockwell thing. I thought so.

Okay. Kill the house lights. Let's go!

Hang on. Hey, who's in charge of the backdrop?

Naomi? Yeah?

What's wrong with it?

Well, the words are completely jumbled.

What, you can read that?

Of course.

You okay? No. Oh, God.

I could be having a...

What's the mnemonic?

"F" is for face. Is my smile crooked?

What are you doing?

"A" is for arms.

Arms.

You should really sit down.

Can someone get her some water?

"S" is speech.

I'm slurring? I'm slurring?

"F-A-S-T."

"T" is for time.

Hurry. Somebody, call 911. Tell them I'm having a stroke.

Hi. I'm Dr. House.

My boss says you're important.

Personally I don't get what's so hard about

making Scarlett Johansson look pretty.

Arms out in front of you.

Palms up like you're holding a pizza.

Close your eyes.

It's so easy you should consider a career change.

Probably make a lot more money.

Dr. Mackman tell you the clot was clear?

Yes.

And he said that you and the fetus are fine?

Yeah.

He didn't mention your pronator drift?

What's that mean?

Means Mackman is an idiot.

May I? Yeah.

So,

you take thousands of photos of someone,

but only one has to look good.

Kind of the opposite of my business.

It's not about looking good.

People are always hiding things.

I just keep shooting until I can see what's really inside them.

My eyes okay?

Eyes are gorgeous.

The vessels don't look so hot.

Microaneurysms predict further strokes.

This is gonna happen again?

Unless I can figure out the underlying cause.

Puff up your cheeks.

You should be able to keep the air in. Means there's weakness around the mouth.

So where'd you learn to self-diagnose a stroke?

Oh, my baby's biological father is a neurologist.

He once told me the FAST mnemonic could save my life one day. So...

Interesting pet name.

Most people go with "husband" or "pookie."

He's gay.

Just a sperm donor. So when you...

You turned him for a night?

Just straight for one date?

Okay.

He took a magazine and a cup into my bathroom.

A man after my own heart.

Different magazine obviously.

I'm rescinding Mackman's discharge order.

My lackeys will be in to do some tests,

take some more blood and empty your catheter bag.

Not a moment you'll want to cherish.

This is definitely different.

It looks almost like...

He's caring.

Find anything else in the patient's folder? Like a diagnosis?

Urinalysis revealed excessive protein and red blood cells.

Chem panel showed a creatinine level over 2.5.

So first she strokes, now her kidneys are shutting down. Why?

Ultrasound showed no tumors or stones.

No signs of fetal distress. No urinary tract obstructions.

BP is fine. No pre-eclampsia.

Any of you guys ever been to the Galápagos?

Was our patient there?

Dengue fever, avian pox, even West Nile.

No.

I'm looking for a vacation spot.

That mean we get vacation?

How would that differ from your current status?

You're gonna do what? Relax?

Visiting family.

My uncle's a giant turtle.

What if the kidney failure came first?

Kidneys could've caused the stroke not the other way around.

Kidneys don't often get stuck in the brain.

I'm saying it threw a clot.

Early symptoms of kidney failure are nausea, vomiting, ankle swelling.

She would've mistaken it for morning sickness.

Heart's way more likely to throw a clot than a kidney.

Echo was normal. The history indicates no sign of cardiac problems.

No, but if one were to read the history closely,

one would notice that she had six cases of strep.

In her throat. That's the one about 10 inches above her heart.

Let me rephrase, six cases of untreated strep.

She was prescribed antibiotics.

No one takes them all.

They stop when they start feeling better. All strep is untreated strep.

What happens when strep goes untreated?

Leads to rheumatic fever.

Which leads to... Cameron?

Mitral valve stenosis.

Which is a thickening in the valve of the... Kidney?

No.

The kidney doesn't have a mitral valve.

We'll go look at her heart.

Be easy to find.

It's the big red pumping thing about 10 inches below her throat.

That was weird.

He was the way he always is.

Which is weird.

Very still, Emma. Sorry.

No problem.

He caught us with your hand up my shirt. He's gotta have a reaction to that.

You think that's what the vacation is?

Yes.

The pain of losing you is obviously forcing him away.

Coronal slice appears normal.

There's no way House just lets this slide.

He's gotta be planning something.

Maybe he just doesn't give a crap.

Sagittal slice is clean.

You think he just stumbled into that closet?

He knew we were there and he wanted us to know that he knew.

Or you wanted him to know.

Now he does and you're annoyed because he doesn't care.

Right there.

Trans-axial slice. Calcified mitral valve. Barely.

That's not big enough to throw a clot.

Obviously it is, because it did.

House was right.

A valve in your heart is narrowed.

It caused the clot which lead to your stroke,

and the reduced circulation caused the problem with your kidneys.

And this will fix it?

The balloon will force the valve back open and you'll be fine.

Can we do this without a sedative?

It's very mild. There really is no risk to the fetus.

We'll monitor your baby's heart rate separately.

We won't allow it to decrease anywhere near dangerous levels.

Thank you.

You're both gonna be fine.

Go ahead, Dr. Cameron.

Listen to that heartbeat. It sounds so...

Start threading the catheter.

No, I don't want a layover in Frankfurt, Taipei, Singapore or London, Ontario.

That's why I asked for a direct flight to Phnom Penh.

How hard is it to not land? Does it matter what I answer?

Well, then fine. I'd be delighted to hold.

What's new? Can you tell Cuddy to stop interfering?

It's her job. What's new?

Good news is Emma's heart is fixed.

Bad news is it's not her underlying problem. Her kidneys are still failing.

You're vacationing in Cambodia?

You gonna unwind in the Killing Fields? Nope.

Gonna catch me a fish this big.

Mekong giant catfish. Weighs over 600 pounds.

Aren't those catfish critically endangered?

That's why it's my last chance to catch one.

All of our operators are currently...

If the mitral valve had been properly fixed the kidney should be getting better,

which leads us to the conclusion that you screwed up the procedure.

Or you screwed up the diagnosis.

The mitral valve thickening was so insignificant

it probably wasn't the cause of the kidneys or the stroke.

Probably never would've been a problem.

She needs dialysis and we need a new theory.

There are only a few possibilities.

Patient's pregnant, could be pre-eclampsia.

We eliminated it before because...

Re-check for proteinuria and low platelets. What else?

Hypoperfusion.

The fetus is basically a parasite stealing nutrients, minerals, blood.

Put her on telemetry.