Instant Karma (House)

"Instant Karma" is the fifth episode of the sixth season of House. It aired on October 12, 2009. The title is a reference to the 1970 John Lennon song Instant Karma!

Plot

Wealthy and successful Roy Randall ends his business meeting partway through and heads upstairs to his ill son Jack's room. Jack's doctor says the diagnosis is not what he thought, and recommends his father get him to the hospital. Roy wants House to work on the case, and despite explaining that House is currently unavailable, Cuddy eventually agrees to get House on the case. The patient will officially belong to Foreman but House will lead the team. House decides to start off by completely re-analyzing Jack's history and symptoms. Cameron does a physical on Jack; she notices that Jack feels no pain when she presses his belly. Cameron shows the team Jack's x-rays. She says he's constipated. Foreman diagnoses Hirschsprung's disease. They do a barium enema and a biopsy to confirm.

Cameron reviews the x-rays they've done on Jack over the course of over a week which show his colon is clear. Cameron checks Jack's belly and says while it feels better, it appears larger. Just then, Jack's right eye fixes (lateral rectus palsy) and he seizes. They give him diazepam for the seizure. Foreman sees Jack's optic disc is swollen, indicating intracranial hypertension. They give him furosemide and phenytoin to relieve the pressure but it does nothing so they rush him to the O.R to relieve the pressure before Jack's brain herniates and he has irreversible brain damage. They paralyze him for the procedure with pancuronium. They manage to relieve the pressure and Jack does not have any more seizures, but he continues to build up fluid in his abdominal and dural cavities. Foreman notices the shape of the fluid collection is odd, House recommends they do a dural biopsy to confirm brain cancer.

Meanwhile, Cuddy also says that he and Chase must present the Dibala case, which unsettles Chase. Foreman and Chase go over the Dibala presentation, making sure they're covering all the evidence. Foreman is extremely apprehensive about the situation. It will get a lot of attention since it was House's case. House overhears Foreman saying, 'I just need to know you've got everything covered,' and asks them what they're talking about. Later, Foreman tells Chase that when Cameron ran Dibala's blood, the printout he got was only what tests Cameron ordered, but the lab did a full work up and Chase did not check the man's cholesterol. Foreman informs a speechless Chase he was off by 20%. Cameron asks Chase what's wrong. Chase denies anything is wrong, but finally tells her there is a problem with the figures on Dibala's blood panels.

A sub-plot also revolves around Thirteen. House finds Thirteen at a cafe. She tells him she is making travel plans and does not intend to return to the hospital. They discuss her relationship with Foreman. They say good-bye to each other and Thirteen watches House leave with a smile. Thirteen is shown going to her flight, but it turns out her reservation got cancelled. She goes to Wilson and House's apartment and tells House to stay out of her life. She accuses him of spying on her and then cancelling her reservations to get her back on the team. House claims Foreman is working much better without her, so he doesn't want her back. House accuses Foreman of canceling Thirteen's reservations. Foreman denies this, saying he intends to move on. House tells him he will be a good boss.

Chase and Cameron tell Roy Jack might have brain cancer, adding that there is no visible signs of a mass so if it is cancer they've caught it early. Cameron wants to help with the biopsy but Chase tells her to stay home and rest, and that he will wake her up when he gets back. Cameron wakes up, but Chase is not there. Chase and Foreman are at the hospital going over the Dibala case, not knowing what to make about the new cholesterol problem. Cameron arrives and tells them Jack's biopsy results came back negative. House suggests adenocarcinoma of the stomach, which would cause all Jack's symptoms and not show up on the CT. Chase and Cameron scope Jack and get another set of biopsies.

Roy tells Cameron he inherited a business when he was 24 and made major deals until he was very rich. He says everything he touches turns to gold except his family. First he lost his wife, now his son. He thinks it is karma. Just then, Jack starts to seize again, but the readouts show it is not intracranial pressure. There are no signs of masses in Jack's stomach or esophageal lining and he's still accumulating subdural and peritoneal fluid. House notes that Jack seizes every time they try to look at something. It can't be cancer. Chase suggests a drug-resistant strain of an infection, but all the tests have been negative. Cameron suggests abdominal epilepsy. The seizures would look like pain and protein malnutrition would cause fevers. It is their best theory so they start him on gabapentin. However, Jack's EEG shows no interictal spikes so Jack can't have abdominal epilepsy, but he has a rash on his chest.

Chase talks with Foreman about Dibala's case. He says he could have 'prescribed' statins and simply forgot to chart it. Foreman figures Chase is going to accuse the pharmacy of bad bookkeeping but Chase suggests they say he just went up and took it out. Foreman walks away and says he'll handle it. He tells Cuddy that he can't do the Dibala presentation as he is very busy with Jack's case and that House is pawning his responsibilities onto Foreman. Cuddy reminds him they're Foreman's responsibilities, not House's. Cuddy is firm that Foreman present the case.

The team reviews the symptoms: fever, stomach pain, seizures, peritoneal and subdural fluid collection and a rash. Cameron notes that if it is not cancer or infection it has to be autoimmune. Chase says polyarteritis nodosa. House tells them to start Jack on prednisone and get a testicular biopsy - if Jack has any real inflammation, it will be down there. Foreman says he will do it with Cameron. Cameron asks what's going on. Foreman claims the father will not be happy with a fourth set of biopsies and Cameron has a better rapport. He says he also wants Chase to over-prep for Dibala's M and M. House asks if the rash is on Jack's penis. It is, meaning it is most likely affecting the small blood vessels which explains why they did not see any inflammation on the biopsies. He says it is Degos disease. House tells Roy Jack has Degos disease, which is incurable. Roy insists House is wrong, but House rechecked all the biopsies. Jack has a day at most.

House sees Chase agitated in the differential room. Chase goes to Cuddy's office and tells her Foreman can't present the Dibala case, but not because of time. He starts to tell Cuddy the truth when they get interrupted. Cuddy is called to pediatric ICU by a bunch of lawyers. Before she goes she tells Chase to come clean if they screwed up as it won't be that bad. In Jack's room, Roy's lawyers are calling him insane, but House says he is merely irrational. Roy believes it is karma and that if he gets rid of everything he has, it'll help his son. The lawyers tell him that thousands of lives will be affected if he goes bankrupt. Roy signs the paperwork to divest himself of his business. As Roy's lawyers exit the room Jack flatlines.

Cuddy tells House Thirteen called to say someone hacked her email and cancelled her reservations. She suspects Foreman. House is surprised she's not accusing him. Cuddy wants to know if he still believes Foreman should be in charge. He tells her that Foreman loves power, he loves puzzles. Cuddy says House loves both. House says, "But when I had both..... It wasn't Foreman because he said he'd moved on." Thirteen later shows up at Wilson's office. She thanks him for thinking it was worth breaking the law to keep her around. Thirteen had the techs chase IP addresses to find out who accessed her email; only her and Wilson's IP addresses showed up. He tries to say it was House but eventually admits he did it. He says House needs someone that does not need him. She's the only one who does not feed into his crazy vortex, she keeps his ego in check. Wilson tells her it is a great job, maybe even better now that House is at least trying to have real relationships with people. He tells Thirteen to not throw it all away due to a bad breakup. Thirteen bids Wilson farewells and leaves.

Wilson goes to House and says he confessed to cancelling Thirteen's reservation. House says he knows it was not Wilson and asks why he confessed to it. Wilson asks House why he did it, and he responds that Thirteen is making a mistake as she is a good doctor. House starts to tell Wilson he was born with a heart three sizes too small, then has an epiphany. He goes to Jack's room. He tells Foreman that the cardiac arrest was a coronary event, meaning Jack's coronary vessels were obstructed, which can't be from Degos. He says it is primary antiphospholipid syndrome and tells him to start Jack on heparin and IV immunoglobulin. House also says that when Thirteen got 'screwed over' she went to him, Cuddy and Wilson - everyone but Foreman. He says she's not over him. Foreman replies, 'Or she is.'

Chase finds some test results sitting on Dibala's file. He goes to Foreman and brings the document. It shows that one of Dibala's doctors prescribed niacin-bound chromium supplements to increase the HDLs. Neither Foreman nor Chase requested the information, which means someone else knows. The next day, House sees in the papers that Roy declared bankruptcy. He stops by Jack's room. He finds Jack sitting up in bed. Roy tells House, "It worked." House says the medicine worked. When Roy insists it was karma, House shakes his head and leaves. House enters the office and Chase is sitting at his desk, playing with his ball. Chase wants to know how House knew. House explains that Dibala was a "fat, old, black guy" so he had to be taking something for his cholesterol. Chase tells House that he'll always be in charge whether he wants to be or not.

Cameron wakes up alone in her bedroom, and is upset that Chase is gone again without telling her. Foreman presents the Dibala case with Chase in the audience. Meanwhile, Thirteen arrives at the airport and boards the plane to Thailand. Roy and Jack share a pizza. House sits in his office lounge chair.

Music

• "Fire Escape" by Fanfarlo - Plays in the cafe where House meets Thirteen
• "Sarah" by Ray LaMontagne - Plays at the end of the episode.

See also

• Dural tail sign of meningioma

External links

• "Instant Karma" at the Internet Movie Database