TV Review: House, M.D. Revisited – “The Socratic Method”

The first five episodes of House, M.D.’s first season paint a portrait of its central character as someone who avoids patient contact, dismisses illnesses as trivial matters and patients as annoyances. To Dr. Gregory House (Hugh Laurie), medicine is a series of puzzles and that’s it.

But you get the idea as you watch him actually interacting with his patients that there’s something more there, something unspoken. This image doesn’t quite jibe with his impassioned confrontation with the patient in the pilot episode, or his grave expression and gentleness as he autopsies the infant in “Maternity.” There is the merest suggestion of a deeper compassion—a passionate dedication that goes beyond simply solving the medical mystery du jour. Which brings us to “The Socratic Method,” the sixth episode of season one.

House’s actions in “Socratic Method” seem to be anomalies—things that don’t quite fit—what we know (or assume) about House to that point in the series. But are they anomalies or are they glimpses behind the curtain—clues to the “real” House behind the stony façade?

Lurking in a hospital waiting area, House first hears about the week’s patient, Lucy Palmeiro, as he hides (presumably from Cuddy, who’s paging him) behind a newspaper in a hospital waiting area. Overhearing an ER doctor and Lucy’s teenage son Lucas discuss the case, House’s curiosity is piqued. Noting that Lucy is schizophrenic and has a high blood alcohol content to go along with her DVT (blood clot in her vein), the ER doctor casually dismisses Lucy’s condition, intending to treat the clot and discharge her.

House intervenes, sarcastically calling out the ER doc for making assumptions about Lucy’s condition and looking no further than the circumstantial evidence of her mental condition and the alcohol. Taking her case, House confuses everyone about why a woman with a “bump in her leg” would interest House. Even Wilson is bewildered, comparing House taking this apparently simple case to Picasso painting a fence.

Choosing to deflect rather than discuss why he’s interested in Lucy’s case, House goes into one of his classic rants about the way in which schizophrenics have been mistreated since the days of Socrates (himself a notable schizophrenic, according to House). And then continues to confound everyone by actually going to visit Lucy in her room—to talk with her. How can uber-rational House connect with the irrational Lucy?

Whatever motivates this rare show of attention for a patient, House’s involvement with Lucy and her son goes beyond striving for a diagnosis or proving a less meticulous doctor wrong. House reads to her from a book of Yeats’ poetry; he spends time with Lucas, even sending him off to the cafeteria equipped with his pager and a $20 bill to buy himself lunch when he needs to see Lucy alone. It’s a small act and tiny moment in the series, but significant. How many doctors, much less those with reputations for being jerks, would give a patient’s teenage boy lunch money, never mind his pager?

House listens when Lucas tries to explain his mother’s blood alcohol, insisting he gives it to her as an alternative to the “soul numbing” antipsychotic drug Haldol. And when Lucy ultimately calls social services to have Lucas removed to foster care, House quietly expresses his admiration for her choice. “Good for you,” he says. And understanding that Lucy would make such a self-sacrificing rational decision, House realizes that she can’t really be schizophrenic—there must be an alternative explanation for Lucy’s psych symptoms. And there is. Explaining that each of her doctors has treated and diagnosed her while wearing the blinders of their own sub-specialties, they’ve missed the bigger picture. Only by looking beyond the edges of conventional wisdom is House able to diagnose the rare Wilson’s disease, which has caused all of her symptoms—including the schizophrenic symptoms.

“Socratic Method” begins to get into the heart of how House really thinks and feels about medicine, what he sees as his role in it, and his views on conventional medical practice: dismissive, judgmental, and just plain lazy. Too often doctors are willing to take the simplest explanation without digging too much further. It’s what we later learn (“Three Stories”) is something with which House has personal experience, and it’s a particularly raw nerve. And not only the ER doctor, but Chase and Foreman too, make assumptions about Lucy that cloud their ability to understand the real underlying illness and cause of her symptoms. To Foreman, she’s crazy; to Chase, she’s an alcoholic. There’s no need to look further; send her home. As Cameron remarks after Lucy begins to bleed internally, she would have died had she been kicked to the curb.

Although he never comes out and says it, House seems to view Lucy (and her son) as victims of a dismissive medical establishment. It’s clearly something that hits a nerve within him, and in the early seasons of House, other patients, including Victoria (“Histories”), Clarence (“Acceptance”), and Anica (“Deception”), also seem to interest House for the same reason. Spending time in Lucy’s room, House listens to her. She makes little sense, answering his questions with nonsensical ravings. But, surprisingly, House keeps talking—and listening. “No one believes me,” she says at one point (to no one in particular—she’s barely aware of House’s presence in her room). “I do,” House replies, answering with a seriousness that makes us believe that he does.

House interacts with both Lucy and Lucas in ways to which we’re not normally accustomed. House is only mildly irritated when Lucas “opens up” to House about his guilt over his mother’s illness; he is (seemingly) uncharacteristically tolerant and kind to him. And when in the end Lucas accuses House of having made the call to social services, House doesn’t deny it; collaborating in a lie of omission to protect Lucy from Lucas’ anger should he learn the truth. But is House’s behavior uncharacteristic—or only uncharacteristic of what we know of him early in season one?

What is it about Lucy (and later patients) that causes House to exit his misanthrope’s fortress and “care?” Does House view Lucy and Lucas as “outside the circle” like he is? Different—“freaks” as he will refer to himself in season three—outcasts? Perhaps he relates to them and maybe even their victimhood because of his own experiences. And, they are experiences of which we are completely unaware by “Socratic Method,” only becoming clearer as the seasons pass.

It is in “Socratic Method” that we also begin to see how far House is willing to bend or break the rules on behalf of his patients. When House learns that one of Lucy’s problems is a tumor on her liver, too large to be operable, he decides to artificially shrink it with alcohol—enough to fool the surgeon that it fits within surgical guidelines. Interestingly, Wilson (and the team) support House’s ploy with little dissension even from Foreman. But Cuddy catches wind of what’s about to transpire and confronts House about it (amusingly) in the men’s room, where she is quite comfortable arguing with House about doing the procedure while he uses the facilities just a few feet away. Using an argument he has often used since—that patient care should trump the risk to the doctors’ (and hospital’s) bottom line, House ultimately tells her to do what she thinks is right. The choice is hers: either rat him out to the surgeon or remain silent on the matter and allow House to break the rules (but save Lucy’s life).

Cuddy chooses to support House, which begins to establish (one of the reasons) why she may have hired him in the first place (there are probably many reasons, but that’s for another day and another article). She knows that House breaks the rules, twists protocol and ignores medical ethics half the time, but she also knows that he’s effective when other doctors are not. She is making a judgment that there is value to a physician like House and she is fortunate to have him on her staff, able to advocate in ways she, as the dean, is unable.

There is much else that makes “Socratic Method” classic House, M.D., and I would absolutely call “Socratic Method” a must-see episode for anyone new to the series. It’s rich and more complex than it seems on its surface; it has great dialogue and humor, allows us to listen to House (and Hugh Laurie, of course) play classical piano, and propels House’s story forward, revealing him in ways yet unseen to this point in the series.