I was riding a Citi bike the other day and someone screamed dr. Mike we want more house m.d. here we go house m.d. number three [Music] [Applause] [Music] thank you are are they both gonna be patients in this episode reading Wow that's a lot of blood a little poker dr. Cuddy got one of your patients in the ER be in Austin six years old oh I know and what's the problem I'm all-in bloody diarrhea hemodynamically stable but he's been developing some coordination problems sounds like gastroenteritis and dehydration order fluids and I'll take it on mr. Betts to you house they scan his head no why would they scale play games you got a call how's the heart rate stable I'm sorry house it's gastroenteritis I'm not going anywhere put the order in and if someone talented Sara that I'll be up when I'm done I hope that's a non-alcoholic beverage in her hand if you're on call and you're gonna be admitting patients to your service you probably shouldn't be drinking alcohol just saying don't cold Bluff you might want to spend a little more time paying attention to your cards and a little next time stand up my breasts they don't match either I used to play poker semi professionally during my college days I would play online before it was banned and I would make some money not a lot of money it was more about a learning experience but the friends that I played with we constantly used poker as an analogy for everything we did in life whether it was medicine talking to girls and relationships with our friends we would always somehow relate it back to poker and I feel like that's what's gonna happen in this episode everything that's gonna happen with this patient is somehow gonna turn into a poker hand what's interesting about poker is that it's a lot like life making a difficult decision you're not always gonna have all your information available at your disposal right because life is crazy and things change all the time there's variables so there's a lot of luck involved in life that's the same thing that happens in poker skill can only take you so far there's a huge luck component if your opponent has only one card that will beat you despite the fact that every other card is gonna work in your favor they may win and if they win it doesn't mean that they outplayed you means that they got lucky the same that can happen in life you can make a great decision with all the information available at your disposal and yet you could still lose or have a bad outcome follow my finger with your eyes nystagmus how much longer will dr. Cuddy be given the number of mojitos she's knocking back at the party counts it's gonna be at least three hours before she's even conscious weren't you at the same party I don't drink I just pop pills I just reach out grab my cane what's wrong abnormals brain is in descent control of his muscles dr. Cuddy's message said it was just dehydration from the diarrhea she's wrong I love house but the way he jumps to knowing that there's something more sinister happening with this child from hearing the basic story little extra some children when they have diarrhea especially bloody diarrhea with stable vital signs stable labs can act a little bit strange and as time goes on they improve by him taking a special interest in the story just from hearing that story it's a little unrealistic two cases same symptoms what does six-year-olds and seven year olds have in common this kid doesn't have kidney failure you will I was treating a 73 year old woman who went through this progression of symptoms the last of which was in case you missed that class in med school that one's not treatable do a colonoscopy and a six-year-old cutie pie is nothing worse than some food poisoning if you happen to find any purple papules do me a favor and grab a slice I want to check for a dime Chester how does he know what that is I've never even heard of it I don't know how you justify doing a colonoscopy on a child with a single episode of bloody diarrhea and a stomachache with normal vital signs normal labs just off of the fear that there could be a rare potentially life-threatening condition that hasn't yet presented itself in any other way outside of a taxi and bloody diarrhea doing a colonoscopy while it's a common procedure it's not a benign procedure things can go wrong you can the colon you can have an infection I mean if something negative happens as a result of the colonoscopy and you find nothing that's horrible you did that to the child you know how people see the Virgin Mary in danishes and stuff someone died 12 years ago and house doesn't know why Kyle sees that case now paint peeling in two hours I agree with him and yes like I said before residents don't do all the procedures you would get a gastroenterologist to do the colonoscopy internal medicine residents don't just do colonoscopies on their own this is crazy why am I getting so upset about this it's just a show chase is negative for erdheim chester let me see Silla know what that is [Music] it's not every time Chester it's exactly what we said before garden-variety viral gastroenteritis coming out back to the party don't kidney biopsy what's subjecting a child to this many procedures that are not benign on a whim is crazy there's no proof that this is what's happening you have to monitor the child watch the symptoms act clinically ego check it colonoscopy was claimed and the biopsy was negative for erdheim chester so he's gonna be alright it was just some sort of virus what's that urine no but it's brown means kidneys are shutting down still think it's not the same case now you can start thinking that it's something else doctor has had a patient a while back who exhibits as symptoms as your son then you know what's wrong no so what do you know we know the likely course the disease will take which is she had multiple system failure what happened to her she died 24 hours after her admission look telling patients information once you know what is really important because you want to honor the idea of autonomy where a patient has the ability to act upon their own body with the best information possible in this case it would be the patient's parents cuz the child can't make decisions for himself however if you have incomplete information and that information is very worrisome and it's not gonna bring any value to the patients and only gonna bring anxiety maybe best leave that information out until you have a more concrete plan or answer otherwise we're just creating a lot of anxiety a lot of worry and essentially telling these parents your child might die today because we don't know what we're doing the base of his brain has been infiltrated by a small mess we think to Atari looks that way explains a low blood pressure you might confirm the lymphoma started Esther on prednisone did anyone see the lymphoma no we saw a mess the location was consistently CNE in the blood either white blood cell shown is spindling or abnormal nuclei nothing on immuno chemistries either it's not lymphoma is having an anaphylactic reactions or something and this throat's closing up look at the right eye trim that's not Kurosaki's no it's small but it's there Esther didn't have a mass in our Hartmann he is younger take more of a pounding Esther died before the disease reached her heart the disease made it mass and made it fast could be bacteria the muscle connective tissue the kid can't take any more theories only thing we know is that whatever that mass is that's what he's got we need a piece of it I'm doing a biopsy you gonna do a biopsy the kids hard come on house out again eat this toddy Acuras code blue on paddles chest compressions chest compressions chest compressions before you shock so when you shock you right away go back to chest compression chest and Russian strength compression all this time without chest compressions is the blood not circulating can someone do a chest compressions or something he catch that he goes all in he's sure he's one I call I flip him Oh parka dayss I nailed his ass what did he get from that story my god you got almost we're hiding oh oh the Aces were high da tested for earn I'm Chester disease alright I'm paused again I'm looking up what ern I'm Chester is because this is ridiculous third I'm Chester disease it's a rare type of slow growing blood cancer in earn hime Chester the excess production of histiocytes AKA histiocytosis leads to inflammation that could damage organs and tissues throughout the body causing him to be thick and dense scarred fibrotic and this tissue damage may lead to organ failure I thought they tested for this and if they did a kidney biopsy they would have found this I don't know where he's going with this this is a disease that probably happens one in a million kind of appropriate for a house episode he tested negative so did Esther he's lied yeah the tumors got it in for you Jesus don't lie fine middle eye slope latest weed biopsy the colon again reached the GI tract yet it's there now this is liver his lungs you want it to be there because then you didn't screw up 12 years ago you can't waste our one tests on the one disease we know it's not run the tip why didn't they do the kidney biopsy take your time and say it loud they turn ready cd68 positive so dramatic I feel like start the treatment or this is how that genetics United this is how the US National Library of Medicine describes it it's a rare type of slow-growing blood cancer how is this child dying in 48 hours I don't know something about this seems Shady how they just followed regular protocol consulted the proper physicians instead of ink instead of having house run amok with this case this would have been solved so much quicker so much simpler without the child suffering these side-effects so Esther can rest peacefully oh yeah house m.d. is awesome but check out these hilarious 2 videos I know you're gonna love them and stay happy and healthy [Music]