Jessica.
Jessica. Come on. We gotta go.
- Move it or lose it, sister. - I don't feel good.
Mmm. You don't feel warm. My stomach hurts.
- Well, honey, if you don't have a fever-- - I don't wanna go to school. I can do my work at home.
Jessica, what's wrong?
Everybody hates me.
Oh, they don't hate you.
They don't even know you because they're too ignorant to try.
I hate myself. Jessica, don't say that.
Oh, honey. Look at me. Look at me.
You are a wonderful, beautiful little girl.
Don't let a few bad apples-- A few? Try my whole class.
Remember the story where the guy keeps saying that he hates green eggs and ham?
And then at the end he realized he really loved them?
One day, they're gonna realize what a great kid you really are.
You just gotta be like Sam-I-Am. And don't give up.
Okay.
That's it. Keep goin'.
Good. Nice. You're doin' great, Jessica. You're doin' great.
Hey. Hey, Seth.
- You wanna spend the rest of class sittin' on the bench? - No.
Keep goin', Jess. You got 40 more seconds.
My arm hurts. Come on. Tough it up. You can do it. You can do it.
- My chest hurts. - How do you think the ground feels?
Hey, Seth. Two laps. Bye.
Hey, Jess. It's just a stitch. Okay? Just... keep breathin'. You got it.
I can't.
Only 10 more seconds. You got it.
Jessica? Jessica?
Jessica!
Oh, my God. Hey, go to the office. Get Miss Parsons. Now!
- I'm on the playground at Finley Elementary. One of my students is havin' a heart attack.
Yeah, she's 10. Don't you think I know that? Just send the damn ambulance.
Come on. Wake up. Come on, sweetie.
Dr. Bender, call extension 2870.
You ever seen an infected pierced scrotum?
Um, no, but I know a few people on whom I'd like to see it happen. We need to talk.
Well, if pain's what you're after, the penis is really the way to go.
- I'd recommend the apadravya. - We're not talking.
Oh. It sounded like we were.
No, you're attempting to avoid talking because you know what I wanna talk about.
Nipples? You need to get rid of one of your people.
Absolutely. As soon as I do performance reviews.
And then review the reviews, ofcourse.
A decision like this can't be made without proper, you know, review.
Shouldn't take longer than a month, maybe two.
Four at the most, unless it gets complicated.
There's no way outta this.
You might as well get it over with as fast as you can, like ripping off a Band-Aid.
Only instead of a two-cent piece of tape and gauze, it's a human being.
- Like you care. - Like you don't.
You have a week. Get it done.
We have a referral from Dr. Lenkiewicz.
- Don't know him. - He knows you.
- What's the problem? - Heart attack.
- Definitely don't know him. - The patient's 10.
Ten-year-olds do not have heart attacks. It's gotta be a mistake.
Right. Simplest explanation is she's a 40-year-old lying about her age.
Maybe an actress trying to hang on. I meant maybe the tests were wrong.
That's what the E.R. thought. Three C.K.-M.B.'s were positive.
The E.K.G. shows classic signs of S. T. elevation. It's a heart attack.
She's morbidly obese. The "morbid" part of that raises alarms.
Come on. It takes decades to eat your way into a heart attack.
Doesn't take decades to kill yourself. If I was that fat, I'd be pretty tempted to knock back a bottle of pills.
It's not a drug overdose. The fatigue, muscle pain and difficulty concentrating have been bothering her for over a year.
That's because of her weight, her depression.
That's what five pediatricians, two nutritionists and a psychologist said.
The heart attack would seem to indicate that they missed something.
- It's gotta be something genetic. - What about metabolic syndrome "X"?
Insulin resistance?
Syndrome "X" could cause a stroke. I don't know about a heart attack.
- It could, if her blood pressure was high enough. - Which is likely, considering her weight.
Fits the symptoms. Me likee. Do a hyperinsulinemic euglycemic clamp.
Oh, and one more thing.
I've been told that I gotta get rid of one of you guys by the end of the week.
New sheriff. Belt tightening. You know how it goes.
Okay. Carry on.
Some kind of game. House's own version of Punk'd.
It's not House. It's Vogler.
We can't let it get to us. We've gotta stick together. Why?
Are you suggesting we start slashing each other's throats?
I'm suggesting it's a zero-sum game. Your loss is my win. That's not conducive to team play.
Which is what House seems to want. Look, I'm with Cameron.
It may be a bad strategy, but I don't wanna give House that satisfaction.
Come on. Sick kid, remember?
She's diabetic?
No, but it's similar.
M.S.X. patients don't respond normally to insulin, which causes their body to create too much,
and that leads to metabolic abnormalities.
We're going to do a test to be sure, but there are certain dangers.
Is this... thing treatable?
It's controllable through proper diet and exercise.
Wait. Jessica already eats right, and she exercises every day.
I know you've already seen several nutritionists--
- And we've done everything they've recommended. - I understand, but--
Why can't any of you doctors see past her weight?
If diet and exercise are the treatment, then the diagnosis is wrong.
It might be. But the only way we'll know is if you let us do this test.
It's really bad, especially at night. It's like my heart is on fire. Like it's, um--
Oh, I don't know. Like, uh--
Burning? Exactly.
Hmm, sounds almost like... heartburn.
So, can you give me somethin'? Like a thesaurus?
What? I take it you never mentioned this during any of your prenatal visits.
Prenatal?
I'm not pregnant.
Sorry, you don't get to make that call unless you have a stethoscope. Union rules.
I know when I'm pregnant, all right? I have six kids.
That's why my husband had a vasectomy, and we use condoms.
Vasectomies can reverse themselves. Condoms break.
Okay. This... is what a woman is supposed to look like.
Okay? We're not just skin and bones.
We have... flesh. We have... curves.
You have little people inside you.
Okay, okay.
I'm sorry. I guess I must have just been brainwashed by the media...
and all those years of medical training.
- Damn right. - I'll see if I can find some antacids while the nurse gets some blood.
Blood? Why?
The heartburn. Gotta make sure it's not... spreading.
I don't want to.
The test involves some pretty precise measurements.
If we don't know exactly how much you weigh, we won't get the right answers.
Let me tell you a secret. When I was your age, I was heavy too.
Were you over a hundred?
Way over. Kids in my neighborhood used to call me "Rerun".
Rerun? He was a heavy guy from TV. I-- I used to pretend I liked it, but I didn't.
How come you're not heavy anymore?
Ninth grade, grew five inches. Everything kind of evened out.
You think that'll happen to me? Well, yeah.
Your mom's tall, and you are a little short for your age. Probably spring right up.
Obesity isn't something you just grow out of.
I take it you've never seen a baby? She's not a baby. She's 10.
And you figure making her feel like crap would do her a world of good?
- Yeah, if it gets her off the couch. - I'm sure she's already under enough pressure.
Not from Mummy. Everything in society tells us we have to be thin to be successful.
No. Society tells you you have to be thin to be attractive. And guess what?
That's what attractive means, that society likes looking at you.
I think we should be telling our kids it's fine as long as they're healthy. Right.
You weigh 90 pounds because it makes you healthier?
Forget it. He's just cranky because he knows he's the one who's gonna get the ax.
So, any thoughts?
On what? Sharon's plan for Gaza?
Who you gonna let go?
I'm thinking I can convince Vogler it would be more cost-efficient to keep all of them. Yeah, you should be able to pull that off.
Most billionaires aren't very good with numbers.
It will be more cost-efficient once I grab Cameron's ass, call Foreman a spade, and Chase--
Well, I'll grab his ass too.
You are uniquely talented in many areas, but office politics is not one of them.
Don't take Vogler on.
- Separate or together? - Together.
Increasing glucose to 6.9 milligrams per minute.
Are you okay? - I'm thirsty.
-Just a little bit longer, and you'll be done. - Like Dr. Chase.
Wanna put some money on it?
I said I'm thirsty. Just five more minutes.
Okay, sweetheart? I'm not your sweetheart. Don't call me that.
-Jessica, that's not nice. - They're the ones who aren't nice.
Jessica. You're not, either. I don't wanna do this anymore.
Jessica. Jessica, you have to calm down. No! No!
Let me go.
Check her blood sugar. She's gotta be getting hypoglycemic.
I've never seen her like this before. Something's wrong.
Let go of me! Get it out of me!
Let go of me, you son of a bitch! You bastard!
Oh, no.
She's sedated. Mrs. Simms, don't worry.
Hypoglycemia can cause temporary psychosis and is a common complication during an H.E.C. procedure.
I never wanted it done in the first place.
We understand you're upset-- You were supposed to be monitoring her condition,
but instead you were bickering and placing bets.
I apologize if it looked like we weren't devoting our full attention to your daughter, but I assure you--
Oh, please. Save your pathetic insincerity for your boyfriend.
You're wrong. She is, in fact, pathetically sincere. And they didn't screw it up.
- Who are you? - I'm from the lab.
The blood tests show your daughter was not hypoglycemic, which means her psychosis wasn't caused by anything these doctors did.
- So then what was it caused by? - I've no idea.
Huh. But you'll be happy to hear it cannot be cured by diet or exercise.
What else could cause uncontrollable rage in a 10-year-old?
Nothing that could also cause a heart attack.
I assume I don't have to point out that now would be an extremely good time...
for one of you to distinguish yourself with a brilliant idea.
A hypercoagulable state can cause a blood clot.
- Blood clots can cause a heart attack. - More likely to cause a stroke, not the psychosis.
No, you're wrong. If a clot made it to the amygdala area of the brain, it might cause uncontrollable rage.
Right, because anything's possible, but nothing's gonna cause multiple clots in a kid this age.
- She's fat. - Obesity doesn't cause blood clots.
Extremely obese patients can get a fat embolus.
Right, after they've had liposuction, which she's clearly never had.
- How do you know? - Because we have her medical records,
and because no plastic surgeon in his right mind is gonna give a 10-year-old liposuction.
Have you ever met a plastic surgeon who was in their right mind?
- She hasn't had liposuction. - Thank you.
But what about some other ridiculous obesity treatment?
Like what? Diet pills can cause heart attacks and blood clots.
- Her tox screen was negative. - Wouldn't show over-the-counter weight loss drugs.
Her mother wouldn't give her diet pills. She thinks her daughter's perfect just the way she is.
She's lying.
Okay. You two, heparin and warfarin to prevent further clotting.
And you find those pills.
Not diet pills.
You might wanna broaden the search just a little.
And don't just ask the mom.
If she hasn't mentioned it yet, she's not-- If you're gonna fire someone, go ahead and do it.
But don't treat us like lab rats, testing how long it takes to get us at one another's throats.
- So what should I do? - I don't give a damn what you do.
Yes, I had noticed your complete indifference.
You don't even offer a medical opinion anymore.
- Who would you fire? - Not my call.
I want your opinion.
Fine, it's you.
Either way, you're making a choice.
Chase.
- Because he screwed up an angio a month ago? - Anyone can make a mistake.
Right. So it's the money. You resent it, but you're gonna tell me that he doesn't need the job.
He doesn't appreciate the job.
He was ready to go three rounds with Cameron for it.
He wants the job. He just doesn't appreciate it.
There's nothing wrong with just wanting to hang out, but this is not the place to do it.
- I'm surprised. - You thought I'd pick Cameron?
I didn't think you'd pick at all.
Guess he's not the "rise above the fray" guy he'd like us to think he is.
You practically forced it out of him.
He's scared of losing his job, just like everybody else.
I've been thinking. You've made it quite clear that you're miserable here.
I am not miserable. You're not happy.
And you are? With my job, yes.
I am exactly where I wanna be, doing exactly what I wanna do.
Think I sense a hint of sarcasm there.
Why don't you pick yourself? Quit? Hmm, I was wrong.
About Vogler or Foreman? Mrs. Hernandez's pregnancy test.
Who's Mrs. Hernandez? Either a woman carrying an alien baby or your newest patient.
So you never saw her with any pills. She never mentioned anything?
No, ofcourse not.
Would it be all right if I, uh, talk to a couple of her friends?
Her friends? I'm not gonna interrogate them.
I just wanna ask if Jessica ever mentioned anything.
It's-- It's pretty important. She's very sick.
I understand. It's just, well--
Jessica really doesn't have any friends.
Not one? I've tried to help,
make the kids include her more, but... kids can be--
- Kids? - I was gonna say jerks.
All the fifth-graders are assigned an eighth-grade buddy.
Maybe you could talk to hers.
What's the status on House?
He asked for time to complete performance reviews for everyone in his department.
And you told him no and gave him how long?
A week. He'll do it.
Guy's never done what he's told. I don't see why he's gonna start now.
Hi. Edward Vogler.
Is Dr. House claiming that I'm forcing him to get rid of one of you?
I assume his goal is to stir up antagonism toward me.
- And your goal is? - I am forcing him.
I'll do whatever I can to ease the transition for whoever he chooses.
- If you're feeling guilty about your decision, there is an easy solution. - I don't feel guilty.
Then... why approach me and tell me all this?
I don't feel guilty. That doesn't mean I don't feel bad.
I'm rich, but I'm still human.
I just wanted you to know...
that if there's anything I can do for you, my door's open.
Thank you.
You're lookin' for info? Thought you already had House all figured out.
I do. Don't know his team though.
The ultrasound and biopsy confirmed our worry.
The tumor is extremely large, at least 30 pounds.
Oh, God. It's actually a personal record for this clinic.
But it's completely benign. There's no sign of cancer at all.
I've already spoken with Dr. Bergin, and he's available first thing in the morning.
For what?
For the surgery.
But if it's not cancer, it can't kill me, right?
Mmm, no. I'll have a huge scar.
I won't be able to wear a bikini.
- You wear a bikini now? - Yeah. You got a problem with that?
Nope. But I've never gone swimming with you.
I knew it. That's what this is all about.
You are trying to force me to have cosmetic surgery.
Yeah, that's exactly why I planted a 30-pound tumor on your ovary.
It's not gonna kill me. The only thing surgery is gonna do is change the way I look.
That is the definition of cosmetic surgery.
Uh, it would also relieve your heartburn and discomfort.
Yeah, right. Why give an antacid if you can cut someone up...
and make them a little easier on your eyes?
My husband... loves my body. He can't get enough of it.
You think he's gonna wanna touch me if I look like I've been gutted like a fish?
That was unexpected.
Yeah, it was.
All she does during recess is run laps around the playground.
She says she's exercising, but everyone knows it's just because no one wants to play with her.
I mean, I'm only her buddy because Ms. Ayers assigned her to me.
That does not mean I am her friend.
I'll make sure her doctors are all clear on that.
Thanks.
So, has she ever said anything to you about diet pills?
- Ha. She told you that too? - What do you mean?
I totally busted her for taking drugs one day.
She totally lied, said that they were diet pills her mom had given her.
Come on. Get real. No way a girl like that is taking diet pills.
I didn't give her diet pills. I would never do that.
Right. So it was her imaginary mom.
She didn't take any pills. The girl's lying.
Why would she lie? Because she's another mean little jerk.
- Mom. - I'm sorry, honey.
Clemmie didn't lie.
I did. I took the pills.
I told her you gave them to me because I didn't wanna get in trouble.
Where did you get them? I took them from the store.
Why? Why would you do that?
Because I didn't wanna be ugly anymore.
- Oh, baby. You're not ugly. - Yes, I am.
I know you don't think so, but I am. I'm disgusting.
Jessica, please don't say that.
I just-- I just wanted to fit in.
You know, have friends?
Or at least have one person my age be nice to me.
Oh.
Listen, the, uh--
The pills cause blood clots, heart attacks and insomnia.
It explains everything. We'll keep her overnight to make sure,
but, uh, she'll be fine.
Thank you.
I can't believe she was that desperate.
Yeah, I'm sure that if everyone I knew hated me,
couldn't bear to look at me, I wouldn't go so far as to shoplift.
I'm not talking about the shoplifting. I'm sure she didn't even know they were dangerous.
She probably saw them advertised on TV or over the Internet.
Right. So I guess it's the media and pharmaceutical companies' fault now,
not the fact that she can't stop shoveling food down her throat.
No one forced her to get fat.
- No one forced a cancer patient to get cancer. - Give me a break. It's not a disease.
Have you seen the latest research? Yes, I have.
What I haven't seen lately is a kid eating an apple or riding a bike.
You Americans can't even compete with the rest of the world in basketball anymore,
unless, ofcourse, it's the type you play with a remote control on a big-screen TV.
- Right. - Wait, wait, wait.
Are you gonna let him say that? He insulted our basketball teams.
Oh, my God.
It hurts so bad. Please. What happened?
- She's bleeding. - From where?
Oh, my gosh.
Just please stop it. Please!
Diet pills brought her to us. We gave her the sores.
You think she got a staph infection from something here?
I'm not saying the hospital gave her the sores. I'm saying we did, by treating her.
Warfarin-induced skin necrosis.
- Highly unlikely. We started her on heparin before the warfarin. - Who gave her the heparin?
- I did warfarin. She did heparin. - Sure you didn't both give her warfarin?
Yes. I did not screw up.
Did you actually see her prepare and administer the heparin?
'Nuff said.
You were standing right there. I was preparing my own dose.
- Yeah, right. There's gotta be some other cause. - None that I can think of.
Let's fix the mistake.
Give her unfractionated I. V. heparin and low molecular weight heparin by subcutaneous injection, stat.
Making me look bad is not gonna save your job.
You think you're incapable of making a mistake?
You think that I'm just gonna roll over and take this?
House isn't gonna protect you just because you kiss his ass.
Vogler wants to know what he can do for me.
Hey! Stop worrying about your asses and start worrying about the patient's.
She sleeping?
As a result of the sedatives, yeah. Can't let her wake up. Too much pain.
"Warfarin-induced skin necrosis".
I... have no idea what that means.
But it says here we gave her the warfarin.
And I do know what "induced" means. We did this?
At this point, it's not exactly clear.
You should probably talk to Dr. House.
Oh. You two need time to get your stories straight.
He doesn't tell me what to do.
So you don't just blindly follow his commands. You're your own man.
And yet here you are, working for a guy you can't stand.
I respect him. What exactly is it you respect?
His attitude toward humanity? He thinks we're all idiots and liars.
How about his attitude toward you? Plays with you like a cat with a ball of string.
What do you want? I wanna know if you wanna keep your job.
If he chooses to let me go, I can live with that.
- That's not an answer. - Are you offering to protect me?
- Still not an answer. - I want my job.
Dr. Chase. Boss.
What was that about? He wanted to know what warfarin is. I don't know.
Brr. Icy.
I'll definitely think twice before correcting one of your mistakes again.
Correct all you want. Course, it's a bit more productive if there's an actual mistake.
Right. I always forget that part.
I gave her the heparin, which means the necrosis is not a reaction to the warfarin,
which is probably why she's not responding to your treatment. Yet.
If you didn't screw up, then what is it?
You don't have an answer. Yet.
When you come up with something, let me know.
I'll be in the clinic, warming up.
I'm the only one who's always stood behind you when you've screwed up.
Why? Why would you support someone who screws up?
Because I'm not insanely insecure, and because I can actually trust in another human being,
and I am not an angry, misanthropic son of a bitch.
I'm sorry. You said you weren't angry.
Who would you fire?
No one.
Not an option.
If everyone took a pay cut and put in a few more hours, we could all stay for the same amount of money.
Figures you'd try and come up with a solution where no one gets hurt.
The problem is, the world doesn't work that way just 'cause you want it to.
Figures you'd stall and refuse to deal with the issue.
Problem is, the world doesn't go away just because you want it to.
Excuse me. Dr. House?
My wife saw you yesterday. Lucille Hernandez?
Uh, he's not in today.
My wife said he walked with a cane.
He's also got a bit of a drug problem. Sometimes doesn't show up for weeks.
The M.R.I.'s are rented, but, um--
Did you make a decision? He's not gonna fire anybody.
Yes. I'm gonna cut the pay of all four of us.
Seventeen percent across the board will allow you to keep us all for the same amount of money.
I believe it's what you suits call a "win-win".
All right, uh, i-if you can-- No.
If he can work it so we keep the current staff for the same amount of money,
what difference does it make?
It's not about the money.
This is not a negotiation. It never was.
I need to know that whatever I ask you to do,
however distasteful you find it, you'll do it.
And just as importantly, you need to know that.
What's going on with my wife?
Even if I was Dr. House,
physician-patient confidentiality protects me from annoying conversations.
She told me about the tumor. Yeah? She also tell you why she's refusing to have it removed?
I don't care about a scar. And she can always gain the weight back.
- You want her to regain the weight? - Yeah. I mean, only if she wants to.
Why? I've always thought she looked sexiest when she was pregnant.
Something about knowing she's a mother just makes me want to-- Tell her that and leave me alone.
I did. You gotta talk to her. I couldn't bear it if something happened to her.
The tumor is benign. Nothing's gonna happen, except maybe some more heartburn.
What if it gets even bigger, or it changes?
You know where to find us. Building's not going anywhere.
Tell her it's cancer. You obviously don't have a problem with lying. Oh. Way to win me over.
We got six kids. She can't afford to take a chance.
You have kids. How novel. That changes everything.
So if Mommy gets heartburn, one of them might catch on fire.
Please. I don't know what we'd do.
They are cute.
Have her come back in. What?
Your plight has moved me. Tell your wife to come back.
The necrosis is getting worse.
Maybe because we're treating her for the wrong thing.
- Have you found the right thing? - No.
Then we continue the treatment, hope it's just taking longer than it should.
At this point, it doesn't matter what caused the necrosis.
- Or who. - If we don't stop it from spreading, it'll kill her before the end of the day.
What else can we do? Get rid of it. Remove the dying flesh before it penetrates the abdominal wall.
Do it.
There's still a chance the heparin treatment could start to take effect.
We're gonna wait as long as we can, but if there's no change in the next few hours,
we're gonna have to treat the symptoms directly.
So you can get rid of the sores? Through surgery.
Technically, it's an amputation.
Amputation? But the sores are--
Warfarin-induced necrosis attacks fatty tissue, mainly in the breasts.
Wait. Are you talking about cutting off my daughter's... breasts?
- She's 10 years old. -A radical mastectomy may be her only chance for survival.
I'm sorry, but I'm gonna have to ask you to sign this.
Could we talk?
What, no roses, no chocolates?
If you're here to apologize-- I'm not here to apologize.
Uh-oh.
That means you're here for something more complicated.
Do you want to fire me?
Yes. Just waiting for an excuse. Thank God Vogler came along. Whew.
It's the only reason I can think of why you're insisting that I made a mistake.
Really? Because there is another explanation.
Perhaps not as much fun as your Freudian analysis,
but maybe you actually made a mistake.
You're doing this because you can't deal with your feelings for me.
I believe that you are the only one to express feelings.
And if we're gonna look at this from a first-year psych point of view, maybe you want me to fire you.
Maybe that's why you're acting weird-- You're the one being different.
You're always pushing things, pushing the rules, pushing us. But not this time.
You jumped on this idea like a life raft. Not one question about what else it could be.
No riding us for other answers. I have the answer.
Then why aren't you watching TV or playing your damn Game Boy...
or whatever else you have so much fun doing by yourself?
Maybe I should just quit.
Make it easy for everyone.
Maybe you should.
Men are pigs.
You called me in to tell me--
I should've realized the vasectomy and condoms was overkill, but this was too obvious to miss.
Cute kids.
Love her green eyes and his baby blues.
- Ofcourse, since both you and your husband have brown eyes-- - Where'd you get that?
From the father of three, maximum four, of your six children.
So I'm thinking maybe the reason you don't want surgery...
is that while your husband will find you attractive no matter what,
all the other men you're sleeping with might not be so open-minded.
Which brings me back to my original thesis: Men are pigs.
You got nothing to worry about. They'll pretty much have sex with anyone:
fat, skinny, married, single, complete strangers, relatives--
You... are sick. So are you.
And I'm sure there are Web sites full of men...
looking for married women with surgical scars.
So have the surgery. Please?
Okay.
Thanks.
Why have you been talking to Cameron?
- If House picks you, I'll be needing a new source in that room. - If he picks me?
Sure. Foreman's smarter. House has got a thing for Cameron.
I've been feeding you information so you'll protect me.
And I will protect you as long as I need you.
And you will feed me information as long as you need me.
I spoke with Cameron because if I have alternatives,
I don't need you.
She's not gonna rat on House.
Foreman never said anything about talkin' to me?
Interesting, huh?
It's been almost three hours. Still no change in her condition.
I think we should get her into surgery.
So what do you wanna do?
Assume that Cameron didn't screw up.
What if it's not the warfarin? It has to be. The sores presented right after we administered it.
Right, right, right. But let's just say it's not. Come on. Come on. What do you got?
Can I have a second to think? No. There's no time to think. Just say the first thing that comes into your head.
She's fat. Enough already, okay? We got it. You hate fat people.
That's not what I meant. We already considered obesity as a cause.
So did all her other doctors. No, I mean what if it's not a cause? What if it's a symptom?
Okay. So, what could cause obesity and skin necrosis?
I don't care if it makes sense. Just give me something.
- Ulcers secondary to vasculitis. - No, that's just sores, not obesity.
- Pyoderma gangrenosum. - More sores.
Let's look at it from the other side. What has obesity as a symptom?
Hypothyroidism? Genetics are more likely. Her mom's heavy too.
She's not just heavy, she's tall.
We have any history on the dad? Yeah.
6'1 ".
Kid's short.
We got stunted growth, high blood pressure, blood clots, obesity--
- It's Cushing's. - No. Necrosis doesn't present--
In rare cases, Cushing's can cause hypercalcemia,
which can lead to the same skin necrosis as warfarin.
It's perfect. It explains everything.
Except it's not Cushing's. She's had multiple blood tests, and none show abnormal cortisol levels.
The hypercortisolism could be cyclical. We didn't catch it in the right phase.
- We'll have to do another U.F.C.-- - There's no time. We've got less than an hour to make a call.
If we treat for Cushing's and we're wrong, she's dead.
If we assume it's not Cushing's, she'll lose her breast and may still be sick.
- Do an M.R.I. - You want us to look for hypercortisolism with an M.R.I.?
No, I want you to look for what could cause hypercortisolism with an M.R.I.
Nothing on the adrenals.
Heard Cameron went home. Is she sick?
Go back to the pituitary views.
- She seemed okay. - Think she's got another reason for leaving?
I hope so. Wait, stop.
There. What's that?
Huh. A tumor.
It's Cushing's.
The tumor causes Cushing's. Cushing's messes with hormone production.
Hormones control everything: growth, weight--
Can you fix it? She'll need surgery to remove the tumor.
Once it's gone, everything will get normal very fast.
- No mastectomy? - No.
Thank God. The surgery is dangerous.
The pituitary's located between the cavernous sinuses,
basically right between the eyes.
The area contains the nerves that control eye movement and the major arteries that feed the brain.
Oh, my God.
The surgeon will approach the gland transsphenoidally.
An incision will be made under the lip,
through which he'll insert a fiber-optic microscope.
Once the tumor's found, he'll cut it into small pieces and remove it through the same hole under the lip.
The whole procedure should take about three hours, and your daughter should be able to go home in a few days.
The sores will go away, as well as her fatigue and the muscle pain.
She'll even start losing weight.
Jessica. Hi.
- Is that really you? - Yep, it's me.
You look fantastic.
- She always looked fantastic. - Yeah.
- It's been a week. - Actually, it's over a week.
How have you guys been?
Who is it?
Chase.
No, Chase stays. Pick someone else.
The deal was-- The deal's changed.
- Pick someone else. - No.
Mmm.
Pick someone else, or it'll be the whole department.
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