House MD, pilot – EFLsuccess.com

House MD, Pilot, 2024 www.EFLsuccess.com

Introduction: When I taught English to medical students, I showed a few episodes of “House MD,” an American TV show about doctors. A “pilot” is the “first drama” (i.e., premiere) in a series. The pilot usually introduces the characters and makes viewers want to see more episodes. I like this episode because “pain” is in everyone’s life, and it is a good topic for discussion. In this episode, a young teacher loses the ability to talk and then faints. Diagnosis is difficult. The doctors try different treatments, and each treatment raises questions that we can talk about after the show. (2004; Season 1, episode 1; 42 minutes; I skip some parts in class, and watch it in two sessions)

Setting: Mostly in a big hospital, likely connected to a university, in the USA. Since this is a medical show, you WILL see blood, cutting, and even go on journeys into the patients’ bodies.

Note 1 At one point you hear them say that a worker earns $8 per hour; in America, this is not much money! When this show was filmed, for example, just to talk to a doctor could cost $100; many college students spent $800-$1200 per year on textbooks.

People and proper nouns:

Dr. Gregory House: Head of Diagnostic Medicine
Dr. Cameron: one of three young doctors (female, if that helps you keep track)
Dr. Chase: the second young doctor (from Australia)
Dr. Foreman: the third young doctor (African-American)
Dr. Wilson: a slightly older doctor (oncologist), who is also a friend of Dr. House
Dr. Lisa Cuddy: Dean of Medicine at this “teaching hospital” and thus House’s boss
Rebecca: the main patient in this episode (a kindergarten teacher)

Note 2: This TV show uses a lot of *sarcasm; that is, they say things that are the opposite of what they mean, in order to make an unkind joke or to show that they are annoyed. Examples:

Dr. House says to Dr Wilson: “You’re the renowned [famous] oncologist; I’m just a lowly infectious-disease guy.” (Dr. House really meant that his own specialty was more important in this case than the other doctor’s specialty.)
Dr. Cameron: “Was she lying? Yes, the patient probably knew she was allergic, and figured it was an easy way to get someone to cut a hole in her throat.” (Dr. Cameron meant that the patient wasn’t lying about her medical condition, she just didn’t know she was allergic—and this almost killed her.)
Dr. Wilson: “Look into this case. Don’t leave all the fun for the coroner.” (Dr. Wilson isn’t saying that it is “fun” for a coroner to determine why a patient has died, he is asking Dr. House to get involved and hopefully to prevent death.)

Vocabulary (including medical terms):

Underlined words are vocabulary terms; *key terms; bold indicates a pair of synonyms; black terms are in part 1; blue in part 2. sth = something; sb = somebody. For a list of common abbreviations see https://eflsuccess.com/common/

*allergy/allergic reaction: a condition that makes you ill (or gives you skin problems, etc) because of contact with something your body can’t handle (e.g., an insect bite, oil from some plants, chemicals in the air); when you get sick because of an allergy it is called an “allergic reaction.”
aneurysm: when a blood vessel (or artery) is filled with too much blood (esp. due to disease)
*biopsy: the removal of cells from a body so that they can be examined for disease (“We need to do a biopsy immediately to find out what is causing this problem.”)
*cholesterol: a substance in the blood, esp. coming from fried food (“Too much cholesterol can be harmful to one’s health.”)
to con: to persuade sb to do sth by deceiving them (“My roommate conned me into giving her $50 for car repairs but she really wanted it to pay a gambling debt!”)
*CT/CT scan ( or CAT scan): a device that gives a sectional (3-D) picture of the inside of someone’s body (I believe the letters come from “Computed Tomography”); the term can also refer to the process or result of using this machine
coroner: an official whose job is to determine why sb died, using medical tests
*courageous=brave
delinquent (see “phrases/sayings”)
*diagnosis/diagnostic/diagnostician: the process and tests used to find out what an illness is (diagnostic is an adj; a diagnostician is a doctor with this specialty). (“Doctor House has the reputation of being a top diagnostician.”)
dignity: the feeling of self-respect, honor, poise in a time of difficulty (the opposite is a feeling of dishonor or humiliation)
*fatigue=tiredness
*genetic: characteristics you got from your biological parents (or “the gift of God”) instead of what you work for (good looks and IQ, vs makeup and education); related to the part of a cell that controls its characteristics or development (遗传性)
HMO: Health Maintenance Organization–an medical organization that provides health care to members under a group insurance plan (often without giving patients many choices, in order to save the HMO some money)
*hygiene: common practices (such as washing one’s hands and throwing out trash) that make you and your environment clean, esp. to prevent illness (“Good hygiene at home would keep many patients out of the hospital!”)
*the immune system: [c] the parts of your body that work together to protect you from disease
*to inject (into a vein): to put (medicine) into the blood through a needle
ischemic syndrome or condition: related to a lack of blood (e.g., to the brain or heart) because something is partially blocking the arteries
lesion: damage to skin, brain, etc., caused by injury or sickness
MRI: Magnetic Resonance Imaging–a process that creates a picture of the inside of your body, using strong magnetic fields (磁铁?)
*nerve: the “wires” inside your body that carry information to and from the brain
neurocysticercosis: infection of the central nervous system due to tapeworms
neurologist: a doctor whose specialty is the body’s nervous system (network of nerves)
oncology/oncologist: the study of tumors/a specialist in this field
*oxygen: an important element in our air, and in our bodies (氧气)
*parasite: a plant or animal (e.g., a worm) that can’t live except by being part of another plant or animal
*sanitary: (adj) describing sth that is especially clean or free from infection, bacteria or other unhealthy things; also called “hygienic”
seizure: a short, sudden loss of control of one’s body (often due to illness or a negative reaction to drugs)
*side effect(s): an unexpected (and often unwanted) effect/consequence caused by medicine, events, change, etc. (“Side effects of this medicine include headaches and a sore throat.”)
steroid: a chemical (or drug) that can fight illness or build muscles
stroke: a serious medical condition when an artery in the brain bursts or becomes blocked
*tumor: a useless mass of cells in your body that have multiplied too quickly (some are dangerous and some are not) (“If this is a dangerous tumor, then she has only a few weeks left to live.”)
vascular: related to the tubing system that carries body fluids (esp. blood)
vasculitis: inflammation of a blood vessel (in this story, it is in the brain)
*to ventilate: to pump oxygen into a patient’s lungs (sometimes this requires doctors to cut a hole in the patient’s neck)

Phrases/sayings:

to babble like a baby: to “talk” without making sense (“After taking the medicine, she babbled like a baby for a minute before falling asleep.”)
*change–“Do you have change for a dollar?” This means “please give me coins instead of this dollar, so I can buy something from a machine that doesn’t take paper money.” (“Before we had transportation cards, riders had to get on the bus with exact change.”)
“He’s a delinquent.” This means that, as a youth, he broke the law or did socially unacceptable things.
*“Good call.” This means “You made the right decision.”
*intermittent problem: something that is sometimes wrong or bad, but sometimes fine (“This muscle has an intermittent problem; three times last week it hurt but most of the time it is OK.”)
*to screw up: to make a mistake (see dialog 2)
to trigger a response: the trigger is the “button” you push to make a gun fire, so this is talking about the situation or cause of a response or reaction
to trust sb implicitly: to believe sb completely without doubt (“If I were her student I would trust her implicitly.”)

Useful pattern for asking questions:

What happens when you give steroids to a person who has a tapeworm?
What happens when you tell bad news to a person who is already feeling bad?
What happens when you sell fake medicine to a person who is in terrible pain?
What happens when you ______________ to a person who ______________?

Sentences/dialogs from the movie: (part 1)

(*These dialogs have been changed for educational purposes. This isn’t a transcript of the show! Blue indicates a key dialog or sentence. http://www.imdb.com/ is a great place to find movie facts and more)

Say these dialogs out loud with your friends; it will help you prepare to watch the movie. The underlined words are defined in the vocabulary section above.

1. Wilson [giving general information about Rebecca]: Twenty-nine year old female. First seizure was one month ago. She lost the ability to speak; babbled like a baby. Progressive deterioration of mental status.
Dr. House [ignoring what Wilson said]: Did you see that? They all assume I’m a patient because of this cane.
Dr. Wilson: So put on a white coat like the rest of us doctors.
Dr. House: I don’t want them to think I’m a doctor. People dont want a sick doctor.
Dr. Wilson: That’s fair enough. I don’t like healthy patients. Let’s get back to the 29-year-old female. She’s my cousin.
Dr. House: And she doesn’t like the diagnosis. She likely has a brain tumor. She’s going to die. Boring.
[Dr. Wilson gives evidence that suggests that the tumor diagnosis is wrong, but House is not interested.]
Dr. Wilson: Come on. Why leave all the fun for the coroner? What’s the point of putting together an overqualified team of doctors if you’re not gonna use them?
2. Dr. House: I don’t trust patients because everyone lies.
Dr. Foreman: Can we trust the blood test results from another hospital or HMO? I assume it’s a corollary if “people lie” that “people screw up”.
Dr. House: Right. Do the test over.
Dr. Foreman: If we expect her to lie, should we even talk to the patient?
Dr. House: Yes. Everybody lies, but truth begins in lies.
Dr. Foreman (after House leaves): That doesn’t mean anything, does it?
3. House: I don’t think it’s a tumor.
Foreman: In first year medical school we were taught: if you hear hoofbeats, you think horses, not zebras.
House: Are you in first year medical school? Give me a differential diagnosis. What are the other suspects? Run more tests. Let’s find out what kind of zebra we’re treating here.
4. [After running some tests, House tells the team to give Rebecca steroids. The doctors object, saying that they need more tests.]
House: Yeah, I know. I have no reason to think that it’s vasculitis, which is treated with steroids. But it could be. So, we treat her. If she gets better, we know we’re right.
Cameron: And if we’re wrong?
House: Then we learn something else.
5. Dr. Chase: You shouldn’t have told her this might cure her. It’s a long shot guess.
Dr. Cameron: Perhaps, but I’ve given a dying woman a couple days’ hope.
Dr. Chase: False hope.
Dr. Cameron: If there was any other type of hope available I would have given her that.
6. [Dr. Cuddy is Dr. House’s boss, and we see that they do not get along well. House claims that he is there on time; Dr. Cuddy says this isn’t good enough.]
Cuddy: Your billings are practically nonexistent. You ignore requests for consultations. You are six years behind on your obligations to serve as a “regular” doctor in our clinic. Look, the only reason I don’t fire you is because your reputation is still worth something to this hospital.
House: Excellent. We finally have a point of agreement–you’re not gonna fire me.
Cuddy: Your reputation won’t last if you don’t do your job. I want you to do your job.
House: But, as the philosopher Jagger once said, “You can’t always get what you want.”
Cuddy: Yet he also said, “But if you try sometimes, you get what you need.” I’m pulling your authorization for all testing procedures, until you start working in the clinic.
7. [Foreman visited the kindergarten, looking for clues. He found a parrot (bird), and wondered if Rebecca’s problems could have been caused by Psittacosis, a nerve illness spread by birds. House says this isn’t the problem.]
House: Have you investigated the patient’s home?
Foreman: No. Tomorrow I can ask for her key.
House: Would the police call for permission before dropping by to check out a crime scene?
Foreman: She is not a criminal, she is a kindergarten teacher!
House: And if I were a kindergarten student, I would trust her implicitly. But for all we know, she could be running a meth lab and making drugs at her home. Look, I’ll give you a ‘for instance…’ [House talks about how the restaurant worker who made Foreman’s sandwich probably has a cold, and should have stayed home, but she needs her small paycheck and came to work anyway.] So, should I trust her? I want you to check the patient’s home for contaminants, garbage, medication.
Foreman: I can’t just break into someone’s house.
House: Isn’t that how you got into the Felkers’ home? [Foreman gives House an angry look.] Yeah, the court records were sealed, you were 16, it was a stupid mistake. But your gym teacher talks too much. You should thank him.
Foreman: I should thank him for having a big mouth?
House: Well, I hired you because I needed somebody around here with street smarts: someone who knows when they’re being conned, knows how to con.
8. (time: 27:03 to 28:11)
Patient: Doctor, I am tired a lot, and think I may have Chronic Fatigue Syndrome.
Dr. House: Being tired is a normal part of getting older. What are your other symptoms?
Patient: Headaches, mild fever, sometimes I can’t sleep, I have trouble concentrating.
House [to himself]: Apparently not while researching this stuff on the Internet.
Patient: I was thinking that it might also be Fibromyalgia. Is there a medicine for that?
House [sarcastically]: Excellent diagnosis. You know, there just might be.
[House asks the pharmacist for “change for a dollar” and then puts candy in a medicine bottle (which was once filled with “Vicodin”–the very strong pain medicine that House takes). A nurse gave this to the patient. In other words, House decided that the illness was due to anxiety, and all he needed was “fake pills”. Indeed, they helped, and later the man returned and said: “I think I need a refill.”]

End part 1 at 21:28, when Dr Foreman says “…for breaking into some lady’s house.” Then show clip 8 if needed.

Discussion: (part 1)

A1. Tell your partner one thing you learned from this show, either about medicine, English, or something else. Be ready to tell the class what your partner says.
A2. In a small group, each student should make up a sentence with one of the phrases and/or medical terms in this lesson.
A3. Do you agree with Dr. House that “everybody lies”? (See dialog 2) Explain.
A4. House told Dr. Foreman to break into the patient’s house to look for medical clues. Do you think he should have asked the patient for her key instead? Why or why not? Do you think Dr. Foreman will do what his boss asked him to do? Why or why not?
A5. House said he had hired Foreman because he needed someone with “street smarts.” What criteria should hospitals use when they hire doctors or other staff? Explain your answers.
A6. Look at dialog 8. Is “fatigue” a kind of pain? What about the patient’s other symptoms—are they “pain”? Explain.
A7. List the people who experienced “pain” in this show.
A8. Should people always try to get rid of pain, or can pain be a good or “normal” thing?
A9. What do you do when you are in pain? (Here’s a sentence pattern you can use: “When I experience pain in my (mouth/arm/emotions/self-image…), it helps to…”)

Vocabulary matching exercise:

(match each number with a letter) (see “Some Answers” below)

1. b	courageous	a. sth that makes you ill because your body can’t handle it
2.	hygiene	b. brave
3.	CT	c. a device that gives a sectional picture on your body’s inside
4.	diagnosis	d. to use a needle to put sth into the blood
5.	allergy	e. the process of finding out what an illness is
6.	inject	f. common practices that make you clean, esp. to prevent illness
7.	oxygen	g. a useless mass of cells that have multiplied too quickly
8.	parasite	h. an animal/worm that lives only by being a part of another animal
9.	sanitary	i. the “wires” inside your body
10.	tumor	j. to pump oxygen into a patient’s lungs
11.	ventilate	k. an important element in our air
12.	nerves	l. sth that is especially clean or free from infection or unhealthy things

Sentences/dialogs from the movie: (part 2)

9. Rebecca: Am I ever going to meet Dr. House?
Dr. Wilson: You might run into him someday at the movies or on a bus…
Rebecca: Is he a good man?
Dr. Wilson: He’s a good doctor.
Rebecca: Can you be one without the other? Don’t you have to care about people?
Dr. Wilson: Caring is a good motivator. Dr. House has found something else.
Rebecca: He’s clearly your friend. Does he care about you?
Dr. Wilson: I think so.
Rebecca: You don’t know? Caring is not about what people say, it’s what they do.
Dr. Wilson: Then yes. He cares about me.
[Rebecca suddenly has another attack.]
Rebecca: I can’t see. I can’t see!
10. [The doctors had to shock her to get her heart started. Afterward, when she woke up, they asked her to arrange some pictures to tell a story. She could not put them in order at first, but did soon after that.]
House: We still don’t know what is causing this, but how much time do we have?
Foreman: If it’s a tumor, we’re talking a month or two. If it’s infectious, a few weeks. If it’s vascular, that’ll probably be fastest of all. Maybe a week.
House: We’re going to stop all treatment.
Foreman: We’re just going to watch her die?
House: Yes. Specifically, we’re going to watch how fast she is dying. You just told us–each diagnosis has its own time frame. When we see how fast it’s killing her, we’ll know what it is.
Foreman: There’s got to be something better we can do; something better than watching her die.
House: Well, I’ve got nothing. How about you?
11. [While breaking in to the patient’s house, Foreman and Cameron discuss what we learned in dialog 7. It makes Cameron wonder why she was hired. We also learn that Rebecca’s dog has fleas, and Foreman ate some ham he found in the refrigerator.]
Foreman: You know what? After centuries of slavery, decades of civil rights marches, and more significantly, living like a monk, never getting less than a 4.0 GPA… you don’t think it’s kind of disgusting I get one of the top jobs in the country because I’m a delinquent?
Cameron: You went to Hopkins, right?
Foreman: Yep.
Cameron: So you went to a better school than I did. You got better grades than I did.
Foreman [joking]: So how did you get the job? Did you stab a guy in a bar fight?
Cameron: I don’t know. Is it possible that he hired me because of my looks?
Foremen: Would that upset you, to think that you were hired because of some genetic gift of beauty instead of some genetic gift of intelligence?
Cameron: I worked very hard to get where I am.
Foreman: House says that people choose the paths that gain them the greatest rewards for the least amount of effort. Beautiful women don’t have to do much–they marry the rich, or people just give them stuff. You chose a different path. Maybe that’s what he saw in you.
12. House: What did you find that doesn’t explain these symptoms?
Foreman: Dr. Wilson convinced you to treat this patient under false pretenses. Adler’s not his cousin. She’s not Jewish.
Wilson: Rachel Adler’s not Jewish?
Foreman: I had ham at her apartment.
Wilson: Dr. Foreman, a lot of Jews have non-Jewish relatives, and most of us don’t keep kosher.
Foreman: You don’t even know her name! You called her Rachel. Her name is Rebecca.
House: You idiot!
Wilson: Listen, He’s…
House: Not you. Him. [Looking at Foreman.] You said you didn’t find anything. You found ham. Where’s there’s ham, there’s pork. Where there’s pork, there’s neurocysticercosis.
Chase: Tapeworm? You think she’s got a worm in her brain?
13. House: Tapeworms reproduce. This parasite can produce 20,000 to 30,000 eggs in a day. Most go out into the toilet. But some get into the bloodstream, which takes them everywhere.
Wilson: As long as it’s healthy, the immune system doesn’t even know it’s there.
Foreman: So, this one isn’t healthy. What do we do? Nurse the little guy back to health?
House: It’s too late for that. It’s dying. The immune system wakes up, attacks the worm, and everything starts to swell. And that is very bad for the brain.
14. Rebecca: Doctor, how did the tests come out?
Dr. House: The protein markers for the three most prevalent brain cancers came up negative, so you don’t have cancer. You are not responding to radiation treatment, so it isn’t a tumor. The problem is a parasite.
Rebecca: Doc, I have decided that I don’t want any more treatments. I don’t want any more experiments. I want to go home and die.
House: You’re being an idiot. You have a tapeworm parasite in your brain. It’s not pleasant, but if we don’t do anything you’ll be dead by the weekend.
Rebecca: Have you actually seen the worm?
House: When you’re all better, I’ll show you my diplomas. Patients always want proof. We are not making cars here. We don’t give guarantees. But I’m pretty sure about this.
Rebecca: You were sure I had vasculitis, too, and prescribed steroids—that experiment failed. Now I can’t walk and I’m wearing a diaper. What’s this treatment gonna do for me?
House: I’m not talking about a treatment. I’m talking about a cure. But it is strong medicine. Possible side effects include abdominal pain, nausea, headaches, dizziness, fever and hair loss..
Rebecca: What if you are wrong?
House: Because I might be wrong, you want to die?
15. Rebecca (to Dr. House): What made you a cripple? (What hurt you so badly that you must walk with a cane?)
House: I had an infarction.
Rebecca: A heart attack?
House: An infarction is what happens when blood flow is obstructed. If it’s in the heart it’s a heart attack. If it’s in the lungs, it’s a pulmonary embolism. If it’s in the brain it’s a stroke. I had it in my thigh muscles.
Rebecca: Wasn’t there something they could do?
House: There was plenty they could do, if they had made the right diagnosis. But the only symptom was pain. Not many people get to experience muscle death.
Rebecca: Did you think you were dying?
House: I hoped I was dying.
Rebecca: So you hide in your office and refuse to see patients…because you don’t like the way people look at you.
House: People don’t want a sick doctor.
Rebecca: You feel cheated by life, so now you’re going to get even with the world. But you want me to fight this. Why? What makes you think I’m so much better than you?
House: What…you’re scared you’ll turn into me?
Rebecca: I just want to die with a little dignity.
House: There’s no such thing. Death is always ugly. We can live with dignity. We can’t die with it.

End part 2 at the end of the episode.

Discussion: (part 2)

B1. Tell your partner one thing you learned from this show, either about medicine, English, or something else. Be ready to tell the class what your partner says.
B2. In this episode (and most cases in this TV show), diagnosis was very difficult. Why?
B3. At one point, the patient decided that she didn’t want any more treatment (she just wanted to die). Are patients in your country allowed to make this kind of decision? What do you think about her attitude? What would you say to her, if you were her doctor or counselor.
B4. Dialog 12 helps us see why Dr. House is always in pain. Can you understand why he is often sarcastic, irritable and unhappy? Do you think this behavior is acceptable? Explain.
B5. Let’s think of pain as both physical and emotional. What effect does pain have on the people in this show? Talk about each person: Dr. Foreman—the pain of being hired for strange (and maybe prejudiced) reasons; Dr. House—a constant physical pain in his thigh muscle; the main patient—physical and emotional pain; Dr. Cuddy— the “pain” of managing an unusual doctor like House; the male patient—fatigue, headaches, etc.
B6. What is a doctor’s responsibility in relation to the pain his/her patient feels? Should the doctor deal with pain, or only deal with illnesses and other problems?
B7. If doctors earn a high salary, then medical care must be expensive (patients must be rich, or insurance companies or the government must pay a lot for health care). But some people can’t afford insurance or expensive medical care. If doctors earn a lower salary, then more people can afford medical care, and this lets the government (or medical/insurance companies) spend more money on research. Talk about the good and bad aspects of a high/low salary. Also talk about who should pay for medical care: the patient, the patient’s workplace, insurance companies (can poor people afford adequate insurance?), local government, federal government, or someone else?
B8. Did you understand the sarcasm (see note 2) in this show? Dr. House uses sarcasm a lot. Why? Do people use a similar form of speech when they speak in your native language?

(see “Some Answers” below)

House’s smart team of doctors discusses options.

Some Answers to this post’s exercises/questions:

vocabulary matching answers: 1b, 2f, 3c, 4e, 5a, 6d, 7k, 8h, 9l, 10g, 11j, 12i

To understand some of the medical terms I looked at http://www.nlm.nih.gov/medlineplus/mplusdictionary.html or http://www2.merriam-webster.com/cgi-bin/mwmednlm

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