Humpty Dumpty (''House'')

"Humpty Dumpty" is the third episode of the second season of House, which premiered on Fox on September 27, 2005. Dr. Lisa Cuddy's longtime handyman Alfredo falls off her roof, causing breathing problems.

Plot

Alfredo, a construction worker at Cuddy's house, complains that his asthma is acting up. Cuddy tells him to continue working, and Alfredo falls off the roof onto the concrete. He cannot breathe, and Cuddy notices that two of the fingers on his right hand have turned purple. House suggests disseminated intravascular coagulopathy (DIC).

Stacy tells Cuddy that, for legal reasons, she should stay away from Alfredo. Cuddy is concerned that Alfredo could lose his hand and thus his livelihood. Alfredo demands to be released so he can go back to work. Cameron finds that Alfredo's blood is not clotting properly, which indicates minor DIC. House points out that the tissue death could move up the arm and even further. Cuddy orders a stronger medicine—human activated protein C. The staff is shocked.

Wilson notes to House that he would have ordered protein C as well. Suddenly, Alfredo screams for help because he cannot move his arm. Chase tells Cuddy that the protein C caused bleeding in Alfredo's brain. The treatment is stopped, and Alfredo is rushed into neurosurgery. The surgery fixes the bleed, but as Cameron examines him, Alfredo suffers from a coughing fit. A chest X-ray shows lung infiltration. Foreman suggests pneumonia, and Cuddy admits that it is a possibility because Alfredo asked to leave the job. House asks Cuddy to check Alfredo's house to look for possible causes, while House, Foreman and Chase go to Cuddy's to see if it was something from there. While searching Alfredo's home, it is mentioned that Cuddy knew House while they both attended the University of Michigan—House as a medical student and Cuddy as an undergraduate. Cuddy reveals that House was already a legend even in med school.

Cuddy and Cameron find a rat killed by a trap under Alfredo's dresser. The scars on Alfredo's hand must be rat bites. He has streptobacillus, which fits the symptoms perfectly. In Cuddy's bathroom, House notices a fuzzy, black aspergillus fungus on the pipes underneath the sink. Looking at an x-ray, Cuddy agrees that fungal pneumonia is more likely. Cameron points out that the treatment for aspergillosis is amphotericin, which is incredibly dangerous.

Stacy asks House to take it easy on Cuddy because she actually feels for patients. They're not just a puzzle to her. Meanwhile, Alfredo's little brother tells Cameron that Alfredo has not urinated since yesterday afternoon. Cameron is concerned, and she immediately tells House that the amphotericin might have destroyed Alfredo's kidneys and that he may be dying. Alfredo's mother overhears this and begins crying.

The team reviews what they know. The cause is neither aspergillus nor rat-bite fever. Alfredo tested negative for moraxella, nocardia and cryptococcus. Chase mentions that Alfredo has a low titer for chlamydia antibodies, but this is dismissed by Foreman because the chest X-rays do not match a chlamydial pneumonia. Chase persists but Cameron says the titer is probably caused by a STD Alfredo had last year. DIC would not cause a fever this high. House takes Alfredo's temperature and sees that the patient's right hand is starting to rot. House wants to amputate the hand but Cuddy refuses to let that happen. She blames it on the medicine they gave him. If Alfredo loses that hand, he loses his job. House comments that this is not medical thinking. House tells Stacy that Cuddy now agrees to the amputation and begs for legal clearance. When Cuddy tells Alfredo this, he asks if this procedure will cure him. Cuddy says it won't but it will give them more time to figure out what's wrong. Alfredo says that he had to quit school when he was 12 to work to help his family. He's never had a good job, money to put away or even his own home. He works so his younger brother, Manny can stay in school and that Manny is the best in his class. If Alfredo loses his hand, he won't be able to work his jobs and Manny will have to quit school to work just like he did. Cuddy tells Alfredo that it is necessary, and he tearfully agrees to the procedure.

During surgery, the fingers on the other hand start to turn purple. The team gathers afterward with the news that Alfredo's O2 sats are down to 88 and his lungs are giving out. House wonders about endocarditis. One may have broken off and traveled through the bloodstream to the right hand. Cuddy points out that they tested Alfredo for endocarditis and he was negative. House asks what infection causes pneumonia and culture-negative endocarditis.

House puts forward psittacosis, but Chase objects that Alfredo does not have any pet parrots. House orders a round of doxycycline, which Cuddy notes will make the clotting problems even worse. Cameron points out that, if House is wrong, Alfredo will lose his hands and feet. House and Cuddy barge into Alfredo's room. House asks the mother, in perfect Spanish, where Alfredo usually works on Saturday night. She says that he does not work. House knows that she's lying. House realizes that Alfredo works the cockfights on Saturday night. Cuddy and Foreman head down to the warehouse district and find a cockfight. They see Alfredo's brother carrying cages of dead birds. Cuddy calls House with the news. House says he put Alfredo on the psittacosis meds as soon as she left. Cuddy later gives Alfredo the diagnosis and explains that his asthma had made him vulnerable to the disease, which is why he got it and not anyone else. It is then revealed that he and his family are suing the hospital for the loss of his hand. Cuddy says they'll settle as the case seems pretty solid. The settlement will be enough to keep Alfredo's family going and to keep his brother in school. Later, during a thunderstorm, Alfredo is learning to deal with the loss of his hand and Cuddy is at home with her roof leaking.

External links

Wikiquote has quotations related to: Humpty Dumpty

• "Humpty Dumpty" at Fox.com
• "Humpty Dumpty" on IMDb
• "Humpty Dumpty" at TV.com