Dying Changes Everything

"Dying Changes Everything" is the first episode of the fifth season of House and the eighty-seventh episode overall. It originally aired on September 16, 2008.

Lou (Christine Woods) is a thirty-seven-year-old woman who works as the assistant to a high-profile feminist activist and travels around the world at her boss’s side. In the middle of a meeting, Lou suddenly began to hallucinate ants crawling all over her body.

She is admitted to House’s service for what at first appear to be psychiatric symptoms. While House is in the midst of disregarding the patient, Foreman states that she was also found to have abdominal pain, anemia, and bradycardia. House moves on with running a cross-diagnosis with his team while they, in turn, are wondering if House has yet to speak with Wilson. House moves on stating that it could be an illness that was contracted while flying around the world. Suggesting that Thirteen has tested positive for Huntington's, he quickly moves on to the treatment and diagnosis of Lou, telling the team to test for vitamin B12 deficiency.

While Thirteen administers the shot, Lou complains of fecal incontinence, but Thirteen discovers that she has instead passed a large amount of blood. Upper and lower endoscopies came back normal and no source of bleeding could be found. Her pregnancy test came back positive, but when Kutner performed a uterine ultrasound he was unable to find a fetus. The team is now considering the diagnoses of choriocarcinoma and selective immunoglobulin A deficiency. House disagrees with all three possibilities and reveals that the patient has an ectopic pregnancy. In his rage with his recent encounter with Wilson, he quickly does the ultra-sound without warning and shows Thirteen that the fetus has implanted in the intestine, and this is causing Lou's bleeding and other symptoms. The fetus cannot survive where it is and is a threat to Lou’s life, so Chase has to surgically terminate the pregnancy.

Lou continues to have a slow heart rate after the surgery, while also developing new neurological signs such as constant blinking. Her heart rate continues to drop, going so low that she slips into cardiac arrest; but the team is able to implant pacer wires and revive her. Anxiety, stroke, and Tourette's syndrome are suggested for her neurological symptoms, but Taub points out that they wouldn’t explain her low heart rate. Thirteen suspects multiple sclerosis, and the patient is started on Interferon. There is no improvement on the treatment — in fact, she develops a fever. Thirteen now suspects Lou somehow became infected during the surgery. On reviewing the surgical tapes, the team notices a small nodule in the intestine that they think might possibly be a ganglioma which could have caused her symptoms. They want Chase to perform another surgery to biopsy it, but he refuses, pointing out that the patient barely survived the first surgery. Instead, they decide on a do-it-yourself biopsy procedure involving an endoscope, a light, and a scalpel — and no anesthesia. Ultimately and painfully, the biopsy is obtained. Under the microscope, it shows no ganglioma, and is suggestive of amyloidosis. To treat the amyloidosis, Taub states that they need to discover what caused it, and the team considers rheumatoid arthritis, familial Mediterranean fever, and lymphoma as possible causes of the disorder. Wilson looks at the biopsy and decides that while it doesn’t necessarily look like lymphoma, it doesn’t not look like it either, and that’s good enough for Foreman to start Lou on chemotherapy. She does show improvement on the chemo, so lymphoma seems to have been the cause of her problems. But then House appears, and pointing to the previously unmentioned bruises on her legs, says that she has diffuse lepromatous leprosy and this is what has been the cause of all her problems. Some antibiotics and Prednisone, and she’ll be cured.