TV Review: House, M.D. – “Locked In”

What would it be like to see House through a patient’s eyes? That is the perspective with which we are provided in “Locked In,” House, M.D.’s 19th episode of season five. Executive producer/writers Garrett Lerner and Russel Friend (this time writing with David Foster) have given us yet another introspective and complex episode (Lerner and Friend wrote last year’s two-part finale “House’s Head”/”Wilson’s Heart” and Foster co-wrote "Birthmarks" with Doris Egan) as rapper-actor-activist Mos Def guest stars as Lee, a patient who can neither move nor talk.

Involved in a bicycle accident, Lee appears to be all but dead. His ER doctor has diagnosed a fatal brain stem injury and is already assessing his organs for donation. In an ironic coincidence, House has also been involved in a bike accident — on his motorbike, and miles from home, in Middletown, New York. Chance has placed House in the same ER suite at Middletown General Hospital, where he observes the patient — and the doctor's prognosis. Realizing that the ER doctor is wrong, House inserts himself into the case in his usual unassumingly humble manner. Understandably, the ER doc dismisses House, doubting he’s even a real doctor. (Not much of leap, since the very banged up and bruised House has crashed his motorcycle and more resembles a street person than a genius physician.)

The ER doctor points out to House that the patient’s eye movements are random; the spikes on the monitor are involuntary responses in the patient's dying body. They are the easy answers, but it is just as easy for House to prove that Lee isn’t “brain dead.” House knows that Lee’s eye movements and the other indicators are not mere random spikes and involuntary motion, and wastes no time in showing the ER doc, who has no choice but to agree. House is right; Lee has “locked-in” syndrome. The ER doctor’s dismissive attitude towards the patient seems almost negligent. (But this is a primary conceit of the series: conventional thinking misses subtle symptom and clues — things that House would never miss.)

Even after Lee is declared not to be dying, the ER doctor, following a conventional diagnostic path (the accident caused the brain damage) accuses House of wishful thinking, giving the patient false hope for considering it was brain damage or illness that caused the crash. If House can diagnose which medical condition caused the crash, there might be hope for Lee’s recovery beyond simply learning to "live with it."

What distinguishes House from other doctors? House is outcome-driven. "Living with it" is not part of his vocabulary. It's probably something he has heard over and over since his infarction, and has never accepted for himself — or for his patients. Why simply fix a patient when you can heal him? And it is this attitude that has saved the lives and the quality of life for countless patients admitted onto House's service. From John Henry Giles in "DNR" (season one) to Patrick in "Half Wit" (season three); the dwarf teenager in "Merry Little Christmas" to Richard in "Meaning" (also season three), and into the current season, House looks at a patient file and asks "why not?"

If it is possible to send the patient home better off than before the current illness, why not? What stunned Cameron in season three's "Cane and Able" was that House didn't consider the possible with his young patient. Depressed and second guessing himself, House played it safe and contented himself with simply fixing the problem. She knew there was something terribly wrong.

I love the inherent irony of a television series that places the most cynical of doctors as the advocate of the dying and hopeless: the one doctor who relentlessly pursues a cure — and a better quality of life — long after every other doctor has given up.

Lee’s doctor is an avatar for all the physicians and administrators House rails against: doctors who either don’t care; don’t want to take the time or the risk; doctors more interested in their own lifestyles than the lives of their patients. Taking the easy way out has never been House’s MO, and like death itself, this sort of “do the best you can and what will be, will be” medical attitude is House’s archenemy.

Lee insists that God has sent House to him, continuing a recurrent House theme. (I’ll never forget the appropriateness of the song “Waiting for an Angel,” which played over the final scenes of season four’s “Lines in the Sand,” which really was the first overt suggestion of that series element).

House is with Lee in every fearful moment, as each plays out in his mind. In Lee’s “quiet place,” whether it is with the cool MRI glasses or in Lee’s dreams, House is there as guide and guardian. He is there to see Lee through his ordeal—relaxing on a sandy beach as he watches his children build sandcastles or discussing philosophy cynic to skeptic. This is how Lee understands House. Someone who has saved rescued him from certain death; listening to him when (literally) no one could — or would. I wonder how many others of House’s patients, near death, finally able to find the one doctor to listen, see House in the same way. (Of course, their families wouldn’t see House this way; they’d see the overly harsh, blunt, and caustic side to him, which the patient is too sick to see.)

But enough about the patient. What was House doing in New York? And how did House, an experienced and able biker, manage to crash his beloved Honda? As he had with the brain implant in “Half-Wit,” the methadone treatment in “The Softer Side,” House goes to great lengths to conceal from Wilson what is actually going on. An intensely private man (whose bombast is an effective cover for his extreme introversion), House never wants people to know his business.

I think House’s efforts to “change” his story are something especially personal for him. Outwardly, House refuses to let his leg define him. But he makes his leg “not matter” so much that it defines him anyway. (He even admits this during his “No Reason” hallucination in season two — as Wilson.) So when he tries to do something about it, he can’t admit it. "I'm fine," is House’s automatic response. Even when he knows he’s not.

Confronted with a bleak and lonely future and so many losses (and near losses) this year, House finds himself wanting to make changes. If he can change, maybe there’s a slim chance he can finally accept his greatest loss (his leg) and finally move past it. If he can’t, then he has no future with Cuddy; no way to believe in even the slightest chance of happiness with her (or anyone else). Locked in. Isolated. Forever. Although he’s adamantly opposed to the concept of therapy, he is now desperate enough to try even that most hated option.

In one of their one-sided conversations, House reminds Lee that it is he and Lee’s wife Molly who are helping him get through his ordeal. “Although the MRI is more useful than four hours of hand holding… I think,” reflects House, wondering (uncharacteristically) if that’s actually true. It’s the tiniest of moments — almost a throwaway line — but in the greater context of House’s trip to New York, knowing in retrospect that he’s seeing a psychiatrist, the comment takes on greater meaning. It’s a moment of introspection that, for House, is incredibly significant.

Of course, Wilson’s curiosity about House’s New York trip immediately leads him to think drugs. Sometimes, House leaves Wilson little cookie crumbs so he can figure out the great mystery, but not this time. Therapy for House is a desperate measure, and if it fails, or he can’t go through with it, House would be unable to return to his public state of denial. It would be “out there.” House is trying to change; House is trying to “get better.” It would be an admission that the drugs aren’t the panacea House insists they are for him. And so when Wilson finally discovers House’s secret, his reaction is to shut down, pretend it doesn’t matter. Like many of their confrontations over House’s pain and emotional issues, Wilson has pushed one button too many.

“Locked In” also plays well as an exploration of House’s process, how his team works, and why everyone on it is a necessary player. And it also explores why House needs his staff completely committed to the answer. In this case, the answer is less in diagnostic testing than in knowing which yes/no questions to ask a man who can only communicate by blinking. Admonishing the staff, House teaches them that it’s not how many questions to ask in taking the patient’s history, but figuring out the right questions. Every answer motivates a new set of questions, and in the final history, House does the questioning, cutting to the core of the one missing puzzle piece. I loved the surreal feel to that scene, reminding me (as did all the dream-like scenes) of “Three Stories” from season one and last season's finale episodes.

When House is in his “zone,” nothing else matters. Not even his own health or comfort. He hasn’t time for anything or anyone but the problem — and its solution. And in that great scene, with its shifting backdrops and dreamlike intensity, we see House at his best.

House has no use for doctors like Lee’s attending back in Middleton; he needs doctors who can color outside the lines, push the envelope, and think outside the box. Every new bit of information is tested. What more information can be gleaned? Lee’s foot itches; why? He has ulcerative keratitis. His liver is failing. Why? What does that tell House? What new questions can be asked to bring them closer to the answer? It’s a sort of relentlessness that isn’t easy to maintain, but it's what House demands of himself — and his staff.

House tells Taub that he doesn’t want (or need) on his team someone who would rather be somewhere else. For House to do what he does so well, he needs total commitment. And House’s dismissive attitude forces Taub to think about whether being on House’s team is simply “another job” or something important enough to prove his undying commitment. I keep thinking of what House told Foreman in season one’s “DNR.” “He (Foreman’s old mentor) thinks you do your best and what will be will be. I think what you and I do matters. He sleeps better at night; he shouldn’t.” This is what sets House and his team apart from other doctors. And at this point, with Taub not even sure he wants to be on the staff, House can’t be certain about his commitment to the work. But in the end, Taub’s decision to go “all in” to keep his job is rewarded by the satisfaction that they have, against all the odds, saved the life of a man left for dead.

I can’t finish this commentary without mentioning how much I loved Dan Attias’ direction. Not only do we get the physical sense of Lee’s frightened and wary point of view, we are brought inside his emotions, feeling with him hope, frustration, despair as House and the team go through their usual trial and error, testing, guessing, re-evaluating process to uncover the underlying cause of Lee’s illness.

And what about that final moment: Wilson’s warning that House will end up alone? As the elevator doors are about to close, locking House into the box, his field of vision blurs. Was that the camera suggesting that House is “locked in” and isolated? Or is there something really wrong with House that has him so unnerved that he’s seeking to change the way he lives his life? The preview for next week, coming on suddenly, almost as an add-on to the episode, suggests that something is terribly wrong with House. New episode next week, which already has me excited.