Lines in the Sand (House)

Lines in the Sand is the fourth episode of the third season of House, and the fiftieth episode overall.

Plot Overview

Adam, who is severely autistic, is learning shapes and words in his backyard. His father, Don, is trying very hard to show Adam words, but Adam seems more interested in drawing lines on his chalkboard. While eating his lunch, Adam begins to choke and scream loudly. Adam's doctor is Dr House (Hugh Laurie).
In light of House's actions in response to the recarpeting of his office, insisting the old carpet be returned, he soon finds himself under a house observation by much of the main staff, doctors, and even his own team of young diagnosticians; all are a derivation from "the line of reasoning" to House's monotonic inference.

General Overview

While House is doing the differential diagnosis for Adam, he notices that his blood-stained carpet has been taken out. He goes to complain to Cuddy, who has no intentions of indulging House's request. As a result, House refuses to work in his office. He begins to work in other people's offices during the course of the episode. While House is complaining to Cuddy, the rest of House's team tries to strap Adam down and get him into an MRI machine. After the MRI, Chase and Cameron go to Adam's house to run tests. Foreman tells House that all the tests are negative. Then, House holds a meeting in the clinic, and orders his team to get a stool sample. During the sample, Adam has another fit and coughs up fluid from his lungs. House moves into Wilson's office after he is evicted by Cuddy, and Wilson is not happy. The team finds a heart problem. House brushes this off and continues with his diagnosis. House's team takes a biopsy of the lymph node under Adam's arm per the suggestion of Foreman, and find that there are liver cells under his arm. Another differential in Wilson's office shows that Adam's liver may be damaged and is flowing into the lymphatic system, and was deposited in the underarm lymph node. House then moves to Cuddy's office for the differential and discusses the calcium carbonate in Adam's stool when House is evicted by Cuddy again, because she tells House that Adam is in a cardiac intensive care unit. Adam is stabilized and House discusses the possibility of Pica, and suspects that Adam put something unnatural in his mouth. He orders his staff to get samples from the house. While searching the house, Cameron finds jimson weed, and suspects that might be the source of the problem. However, House is skeptical.
House finally makes a connection and stops the surgery to remove Adam's eye and shows that he has worms floating in his eye, and in other parts of his body. This is due to Adam eating sand with raccoon feces inside.

Diagnoses

Adam was diagnosed with raccoon ringworms, which caused his heart, lung, and liver problems, and his right eye to roll back into his head. He got the ringworms after eating contaminated sand from the sandbox in his backyard.

Clinic patients

Ali: A daughter of a clinic patient in the last episode, who has an obvious crush on House. She tracks down House by visiting the clinic, flirting heavily with him and even flashing him at one point (the short exchange between them is cut short by Foreman). Cuddy tells House that Ali is stalking him and that she will call security. As House is leaving for the night, he finds Ali sitting on his motorcycle. She continues flirting, mentioning that the age of consent is fourteen in Iceland and that it's just an arbitrary number. However, Cuddy interrupts their exchange again and sends Ali on her way. Cuddy lies to House, trying to get him away from Ali, but then cracks under House's pressure and reveals that Ali is locked in her office and House should talk her out of what she is doing. House discovers that she suffers from Coccidioidomycosis, caused by the fungal spores of Coccidioides immitis in her brain ,which she then inhaled during an earthquake in Fresno . House says as most of her symptoms developed in her head, it may be that the spores are mostly concentrated in her sinuses and the Frontal lobe of her Cerebral cortex, most likely due to sniffing a flower coated in a loose dust-like film of the spores, headaches, cough and her flawed judgment. It should be noted that impaired judgement is not a symptom of Coccidioidomycosis, and was likely invented by House (given his apparent and subsequent over acting of disappointment) as a means to get rid of her.

The Constipation Woman: a woman who has constipation finally can use the bathroom, but she cannot recognize what it is in the toilet. She wraps it in tissue paper and wants House to take a look.

The Back Pain Man: a man cannot fix his back pain problem after many failed treatments. Suddenly he does not feel pain anymore and he figures he needs to go to the hospital.

Notes

Medical Terms

• Coccidioidomycosis (caused by fungal spores)
• Baylisascaris procyonis
• Pica
• Coccidioides immitis
• Myalgia
• Fungal Meningitis
• Autism
• Asperger's Syndrome

Music

"Waiting on an Angel" by Ben Harper: Closing Scenes, Adam gives House his PSP and House gets his old carpet back.

Arc Advancement

Referbacks

• Informed Consent: Ali, who express her interest on House in this episode, develops her crush in that episode.
• Control: House asks Cameron why she does not "accept [him] for [him]" like "other age inappropriate girl who has a thing for me". Cameron expresses her interest on House on that episode.

Trivia

Allusions and References

• The Wizard of Oz: House greets his team with the cry of "Hello, my pretties…". This echos the cackling greeting of the Wicked Witch of the West played by Margaret Hamilton from the 1939 film The Wizard of Oz.
• Casablanca: House recites the famous last scene from the film Casablanca in an effort to get Ali to leave. This dialogue is also a fitting explanation for why they can't continue their relationship.
• Dog Day Afternoon: While trying to convince Cuddy to give him back his carpet, House shouts "Attica, Attica!", which is a reference to the 1975 movie Dog Day Afternoon. The character played by Al Pacino named Sonny Wortzik used the cry as a battle chant.
• Henry Gray's Anatomy of the Human Body: House says "So, think maybe Gray's Anatomy got it all wrong?". It is a reference of Henry Gray's Anatomy of the Human Body, an anatomy textbook widely regarded as a classic work on human anatomy. This is also a possible reference to the competing medical drama, ABC's Grey's Anatomy.
• "Lucy in the Sky with Diamonds": Foreman says "Our kid's been tripping on 'Lucy in the Sky with Cubic Zirconium'." It is a reference to The Beatles' "Lucy in the Sky with Diamonds", a song that many speculate was written in reference to LSD, a drug which John Lennon− in particular had been using heavily at the time. It also refers to the fact that jimson weed is a cheap alternative to LSD, similar to cubic zirconium being a cheap diamond substitute.
• Alice Doesn't Live Here Anymore: House asks Adam to recognize what he eats with cards. He shows a card of backyard, says "This is your backyard--you may know it as Mel’s Diner". This is a reference of Alice Doesn't Live Here Anymore, a movie which character Mel Sharples (Vic Tayback) owned a diner.

Goofs

As Dr. Wilson leaves his office for the second time in the episode, if you watch the door carefully you'll see that after he closes it, it bounces back open slightly (note the shadow it casts) and then is promptly 'closed' again.