EFL Movie Study Guide for:
House MD,
Maternity
(season 1)
Introduction: In this episode, an epidemic breaks out in the baby
ward. Babies are dying from an unusual infection, but the treatment is
making them die from kidney failure. This show demonstrates the difficult
decisions doctors must make, including how to tell someone their loved one
is dying. It also touches on the overuse of antibiotics, and on the need for
good hygiene among all hospital workers, from doctors to volunteers. (my
version is 38 minutes)
Characters:
Dr. House: Head of Diagnostic Medicine
Dr. Cameron: one of three young doctors; the only female on
this team
Dr. Chase: the second young doctor; from Australia
Dr. Foreman: the third young doctor; an African-American
Dr. Wilson: a slightly older doctor (oncologist?), who is
also a friend of Dr. House
Cutty (you never hear her name in this show): the head
administrator of the hospital
Note 1: Remember that this TV
show uses a lot of sarcasm (See House, Pilot for
examples)
Note 2: In addition to the paid staff, most hospitals
have volunteer workers, such as an elderly lady in this show who distributes
sterilized toys to newborn babies
*A few phrases:
*to break (bad news, the sad truth…): to tell (sth
unpleasant) to sb
exhibit A…exhibit B…: examples used to prove sth, esp. in a
courtroom
*to get our hands on sth: to obtain sth that was not easy to
obtain
Hail Mary pass: a football term, describing when you pass the
ball a long way down the field with only seconds left in the game—you
probably won't score, but if you do it will win the game. ("This is a Hail
Mary pass. It might cure your daughter. It might not.")
*managed to (do sth): an informal way to say that you did
something that was not easy to do (“It is a rare medicine, but I've managed
to find some.")
*a needle in a haystack: sth that is almost impossible to
find ("Finding out which virus she has is like looking for a needle in a
haystack. But if we don't search the haystack she will die.")
[No Audible Dialogue]: a subtitle that means you can't hear
what the actors are saying
*to rattle off (facts/numbers…): to list information quickly
or without much thought (as if from memory)
A few terms (vocabulary):
*autopsy: to examine a dead body in order to find the cause
of death
*to bug sb: to irritate sb (like a swarm of bugs)
*cluster: a group of related things that are close together;
similar things that exist in a dependent relationship (grapes grow in
clusters)
*coincidence: when unrelated things happen by chance in a way
that makes them seem related
[medical] cultures: bacteria (or other biological material)
grown for scientific use or examination
*epidemic: a large number of cases of an illness, occurring
at the same time
fever: the medical condition of having a high temperature
(98.6°F and 37°C are normal)
to hunt/to go hunting: to look carefully for sth, esp. an
animal
*ICU: Intensive Care Unit, which gives special care to those
who are very sick; often, relatives are not allowed to visit or touch
someone in an ICU (NICU is Natal Intensive Care Unit)
*infant: baby (also called a newborn)
to isolate: to keep sth far away from others ("We need to
isolate this illness to protect other patients.")
to lodge: to get stuck ("He couldn't breath because of candy
lodged in this throat.")
*maternity: related to motherhood ("Isn't this a cute
maternity dress?" "Let's visit the maternity ward.")
natal: related to birth ("Pre-natal medical care is very
important." "The natal unit delivered two babies today.")
*over-the-counter drugs: medicine that you can buy without a
prescription (Use hyphens if it is used as an adjective. "Many antibiotics
are available over the counter in developing countries.")
to plummet (plummeting): to fall quickly
postmortem or post-mortem: BrE meaning "autopsy"; literally
means "after death"
*seizure: a short, sudden loss of control of one’s body
(often due to illness or a reaction to drugs)
*a shrink: (informal) a psychiatrist or mental health dr.
to spike: to rise sharply and quickly and then fall again
("When electricity spikes, it is bad for your computer." "Her fever is
spiking at over 103°.")
a superbug: resistant bacteria; bacteria that can't be killed
with common drugs
*to take precedence: to be more important, and thus needing
more urgent attention ("In the emergency room, a heart attack takes
precedence over a broken arm.")
Dialog 1:
OB/GYN1: [Are you] Enjoying our lounge, [Dr]
House?
Dr House: [I] Just came in to get milk for my
coffee, which you're out of.
OB/GYN2: So, [what happened with] the Hartigs
[baby]?
1: Their baby gets a fever.
2: What. Don't tell me—the kid had a seizure.
1: Yep. The parents, of course, start
freaking (going crazy), and I have to deal with that for an hour.
2 (sarcastically): Like it was your fault.
1: She was perfect when I delivered her. If
you wanna (want to) blame someone, blame the pediatrician.
2: So, how is the kid now?
1: Bowel obstruction. She's under
observation. She'll be fine.
2: The pediatrician will take all the credit.
Dialog 2:
House (in baby ICU): Exhibit A: Baby
Girl Hartig. [Full] Term baby, 42 hours old. Went into seizures six hours
ago, brought into the intensive care… diagnosed with obstruction of the
small bowel.
Dr Wilson: I'm still amazed you're actually
in the same room with a patient.
House: People don't bug me until they get
teeth. Exhibit B: Baby Boy Hausen. Another term baby, 48 hours old. Brought
into the NICU three hours before the Hartig baby. Fever of unknown origin,
101 degrees [98.6F is normal], trending upwards.
Wilson (sarcastically): Wow, that is amazing.
You found out about two sick babies.
House: Don't touch that! We have an infection
spreading in the hospital.
Wilson (scoffs): These kids have totally
unrelated illnesses.
House: They fell sick within four hours of
each other. They had the same delivery rooms, maternity rooms are
neighboring, so transmission is possible. They have the same symptoms.
Something has infected both of these infants.
Dialog 3:
House (to the hospital administrator): I want
these two kids isolated. I want the maternity ward shut down.
Cutty (sarcastically): Because you are better
at reading an X-ray than a radiologist?
House: Radiologists always overread babies'
X-rays, especially if they're asked to rule out a pathology. He read into it
what he wanted.
Cutty: Which is exactly what you're doing.
You're finding a cluster because you think it's interesting to find a
cluster.
House (sarcastically): See, this is why I
don't waste money on shrinks, 'because you give me all
these really great insights for free.
Cutty (scoffs): Shrink. If you would consider
going to a shrink, I would pay for it myself.
House: We have an epidemic!
Cutty: Two sick babies is very sad, but it
doesn't prove an epidemic.
House: How many do? (How many sick babies
do we need to prove an epidemic?)
Dialog 4:
(a brainstorming session)
House: Three sick babies, and a fourth
showing early symptoms.
Chase: They have spiking fevers.
Foreman: BP's (blood pressure)
plummeting. They're barely able to keep systolic (rate of heart
contractions) up. At this rate, they could be dead in a day.
Cutty: Where did this come from?
Cameron: Two delivery rooms, four different
maternity rooms. No common personnel and no common equipment.
Cutty: There's got to be something in common.
House (sarcastically): Yeah. That would be
the difference between an epidemic and a coincidence.
Cutty: We're gonna start swabbing (using
cotton swabs to get samples, which can be tested in a lab).
Cameron: This is like a needle in a
haystack.
House: So let's figure out what's in the
haystack. Differential diagnosis, people.
Cameron: Parasite? Virus? But these don't fit
the facts.
House: Which leads us to bacterial infection.
It's not responding to broad-spectrum antibiotics, so we've got something
resistant. [What are] The usual suspects?
Foreman: It's always MRSA in hospitals.
Cameron: Maybe [a] contaminated food or water
source. Pseudomonas.
Chase: V.R.E.? "H" flu?
House: Okay. Those are
the big ones. Cultures will take 48 hours. [They] Might as well be
postmortem. We'll start them on… I'll be in the clinic. Grab me
if you find something important… or unimportant.
Dialog 5:
Foreman: [It was a] Pretty standard
question—"How sick is my child?" You couldn't answer. You rattled off
numbers, like blood pressure and temperature; it's not what they need to
know.
Cameron: What they need to know is the
future. [Have] You
got a Magic 8 Ball (a
toy that was supposed to tell the future)?
Foreman: No, just eight years of medical
training. Look, I realize it's tough to break bad news to families.
Cameron: Not as tough as hearing it.
Foreman: And I guess being the poor guy dying
is the toughest of all?
Cameron: No. It's easier
to die than to watch someone die.
Dialog 6:
House (sarcastically): You look cheery.
What's going on?
Cameron: The Hartig and Chen-Lupino
babies—their kidneys are shutting down and the urine tests show no casts.
House: Which means the antibiotics are
causing the kidney failure. But which one did it?
Chase: Both vancomycin and aztreonam can
cause this. There's no way to know which one it is. No test.
Foreman: We can't take 'em off the
antibiotics though. They'll die of the infection.
Cameron: If we leave them on both the
antibiotics, they'll die of kidney failure.
House (after long pause): There's no point in
guessing which treatment to stop. Take one kid off vancomycin, the other off
aztreonam.
Chase: They have the same disease. You want
to give them different treatments?
Foreman: Therapeutic trial? That's wrong. We
have a duty to help both babies.
House: We have four sick kids at least, and
there may be more. If these two have different reactions, we'll know how to
save the rest.
Foreman: So you're going to flip a coin (to
decide by seeing which way it falls/stops) and condemn one of these kids
to die based on random chance?
House: I guess I am.
Lawyer: Do you want to lose your medical
license? I strongly advise you to come up with a medical rationale why baby
"A" should get medicine "X" and vice versa. You can't experiment on babies.
House: Fine. I'll get the parents' consent.
Lawyer: Their informed consent. They have to
know the other kid is getting a different treatment. That's their legal
right.
House: It would be
unethical for one patient to know about another patient's treatment. Two
more babies have just become symptomatic. I defer to your legal wisdom.
Which takes precedence—six dying babies or a missing consent form?
Dialog 7:
House: Neither antibiotic kills it. What the
hell is this?
Foreman: It's a superbug.
House: This is our fault. Doctors
overprescribing antibiotics. Patients getting them over-the-counter.
(sarcastically) Got a cold? Take some penicillin. Sniffles? No
problem; have some azithromycin. Is that not working anymore? Well, try
levaquin. [There are] Antibacterial soaps in every bathroom. They'll be
adding vancomycin to the water supply soon. We bred these superbugs. They're
our babies, and they're all grown up, and they've got body piercings and a
lot of anger (i.e., we created these superbugs and now they act like
rebellious teenagers).
Wilson: On the other hand, maybe antibiotics
had nothing to do with it. Did you see how low the baby's BP was at the end?
Maybe it was heart damage. Maybe a virus, not bacteria.
Foreman: If it's a virus we're screwed. We
can't chase down a virus. There's a thousand possibilities. The babies don't
have enough blood to run that many gels.
Wilson: We could only do five or six before
we risk exsanguinating (bleeding them to death) the kids.
House: We're all tired. Go home. There's
nothing more you can do tonight. I'll do the autopsy myself.
Dialog 8:
Foreman (to a patient's mother): Tests show
that this is Echo virus 11. It lodges in the intestinal tract.
Cameron: This kind of virus causes diarrhea
(拉肚子) and flu-like symptoms in adults, maybe a rash (皮疹), but for newborns it
can be deadly. It's damaging her heart.
Mother: Is there anything you can do?
Foreman: Viruses are more difficult to treat
than bacterial infections. We still haven't found a cure for the common
cold.
Mother: So, you mean there's no vaccine?
Foreman: There's a company in Pennsylvania
developing an antiviral. It has had positive results in a lab setting. We
managed to get our hands on it. But there are no guarantees.
Mother: Okay.
Cameron: I know it is hard, not being able to
touch your own baby. So, can I get your guys' help with something? We need
someone to hold your daughter Maxine up off the bed while the nurse changes
her sheet.
Mother: Sure
Discussion:
1. Look at dialog 2. Why didn't the
administrator (Cutty) want to believe or follow Dr. House's diagnosis that
there was an epidemic in the hospital? Give at least three reasons. Why did
Cutty offer to pay for Dr. House to see a shrink? Do you think he should see
a shrink? Why or why not?
2. Look at dialog 5. Tell your partner if you
think it is easier to die, to be told that a loved one is dying, or to tell
a patient that someone is dying? Explain your answer. What would you have
said to these parents?
3. Look at dialog 6. Talk about Dr. House's
decision. What would you have done? Would you risk losing your medical
license to save a patient? Explain your answer.
4. Look at dialog 7. Do you think the easy
availability of antibiotics is a problem? Should antibiotics be available
over-the-counter? Should we use "antibacterial soaps"? Why or why not?
5. Look at dialog 8. Tell your partner what
you think of Cameron's idea to let the parents hold Maxine up while the
nurse changed her sheet. Explain why she did this, and whether or not it was
a good idea.
6. At the end of the show, you saw the cause
of this virus. Explain the problem to your partner. What lesson(s) can
hospital personnel learn from this show?
Role play:
(choose one)
1. Look at dialog 8. Foreman suggested that
this mother try a new drug that had not been fully tested. Pretend that you
are Foreman and your partner is the mother—and she is afraid of untested
medicine. How would you convince her to try the experimental drug?
2. Pretend that the lawyer "won" the argument
in dialog 6. You took all six babies off the same drug, and they all died.
You are Cutty and your partner is the lawyer. Talk about what happened and
about how that will affect the hospital's reputation. Should the lawyer
apologize or was he right to insist that everyone honor the patients' right
to "informed consent"?
3. Instead of a creating
a role play, write at least five sentences with some of the phrases and
medical terms in this lesson. When you finish, bring them to me so I can
help you correct them.
Notes: These dialogs have been changed
for educational purposes. This isn’t a transcript of the show!
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
*I want students to learn these terms
