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. Alfredo falls off the roof onto the concrete. He cannot breathe, and Cuddy notices two of the fingers on his right hand have turned purple. House suggests disseminated intravascular coagulopathy.

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

Wilson notes to House that he would've 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. 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 Michigan. According to Cuddy, House was already legend even in med-school, Cuddy was an undergrad at the time.

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 peed 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 not 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 he begs for legal clearance. 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 stats are down to 88 and his lungs are giving out. House wonders about endocarditis, which is an infected heart with little bacterial biofilms clinging to its valves. 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 mentions 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.

External links

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• "Humpty Dumpty" at Fox.com
• "Humpty Dumpty" at the Internet Movie Database
• "Humpty Dumpty" at TV.com