Acceptance (House)

Plot

A death row inmate, Clarance, started having mysterious hallucinations, he was seeing all the people he killed in the past, and he malfunctioned. His heart started pumping air instead of blood and he had trouble breathing. House discovered that he had fluid in his lungs. House liked the mystery and wanted to admit him to the hospital immediately before it was too late. Because Clarance was a dangerous criminal, they had to clear a whole floor to examine and treat him. House got Stacy to get a court order. Cuddy wasn't in favor of this plan and wanted him out as soon as he got better. They had to send him back to death row as soon as he got better to receive his death penalty. House killed him by curing him.

The team realizes that the inmate has a lot of acid in his blood and speculated that he is taking drugs. Doctors don’t usually test for this type of drug that is why there was a delay. It was unexpected. House sends Chase back to prison to inspect the cell Clarance was sleeping in, in order to find the cause of all the acid. House gives Clarance some alcohol to get the acid out of his system.

Meanwhile, Cameron feels that the hospital is spending money unnecessarily on Clarance because he was going to die no matter what the outcome was. She wanted House to focus on those who really needed help. House refused leaving Cameron to deal with it herself. Cameron treats a woman with terminal cancer on her own. She sees a friend in her and shows sympathy toward her, because she is alone. Clarance sees Foreman's tattoo and wonders how he went from a gang to wearing a white coat.

Rivalry is shown between House and Stacy when they start working together, but toward the end of the episode they start to accept each other as co-workers. In the end Clarance is diagnosed with phaeochromocytoma (PCC), it is surgically removed and he is then sent back to death row to receive his death penalty.

Medical

A phaeochromocytoma (PCC) or pheochromocytoma, is a neuroendocrine tumor of the medulla of the adrenal glands, or extra-adrenal chromaffin tissue that failed to involute after birth and secretes excessive amounts of catecholamines, usually adrenaline and noradrenaline. Extra-adrenal paragangliomas (are closely related, though less common, tumors that originate in the ganglia of the sympathetic nervous system and are named based upon the primary anatomical site of origin. It appears in the episode.

Symptoms that the inmate experienced includes: flank pain, elevated heart rate, elevated blood pressure, palpitations, anxiety and diaphoresis. PCC can also cause malignant hypertension.

The diagnosis can be established by measuring catecholamines and metanephrines in plasma or through a 24-hour urine collection. Surgical resection of the tumor is the treatment of first choice, either by open laparotomy or else laparoscopy. Given the complexity of perioperative management, and the potential for catastrophic intra and postoperative complications, such surgery should be performed only at centers experienced in the management of this disorder.

Themes

This episode looks at the different stages of death. Denial, Anger, Bargaining, Depression and Acceptance. House compares these steps to the woman that Cameron is treating. He urges Cameron to tell her patient that she is dying. This can also be compared to the relationship House has with Stacy. At first they refused to work with each other. There was a lot of conflict going on between them and House tried everything to get her off his case. Eventually they accepted each other as co-workers.

In the end we find House contemplating. He walks over to his board and erases the 5 steps of death, He stops at depression and thinks again. He wonders if he is busy dying (He is depressed: Viewers know that because of his obsession over alcohol and pain killers and that he isn’t able to find happiness in everyday events) and when he will start accepting it.