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HD in House

The television medical drama House is one of the most famous examples of the use of Huntington’s disease in the media. One of the main characters, Thirteen, is affected by Huntington’s disease in many different capacities, and several episodes are devoted to exploring the emotional impact of HD. In this review, we attempt to parse out each episode and understand the societal implications of the portrayal of HD, understanding as well that much of HD’s recognition, at least within the United States, is as a result of the show’s coverage of this stigmatized disease.

Season 4, Episode 8: You Don’t Want to Know^

In this episode, Thirteen has an interaction with the main doctor, House, in which House accuses her of being sick and hiding it after Thirteen drops a file and is very flustered by it. Thirteen states that there is “fun in not knowing” what affects her, but she is clearly disturbed by her shaky hands and strange body movements throughout the episode. At this point, Thirteen knows that she is at risk for Huntington’s disease, as her mother had it, but she has not been genetically tested to confirm her gene status.

Later on, House says Thirteen knows the answer to her strange movements. He was snooping through her wallet and found an old picture of what he assumed to be Thirteen’s mother around the age of 32. House postulates that a person doesn’t update a photo in 20 years because the individual is not talking to you or that individual is dead.  House further states that Thirteen is “pretty young to have a dead mom.”

House: I googled her obituary. Said she died at New Haven Presbyterian after a long illness. Parkinson’s.

Thirteen: Huntington’s chorea.

House: I’m sorry.

Thirteen: I’m leaving when this case is over.

House: No, you’re not.

Thirteen: You don’t want a doctor on your team who’s slowing losing control of her body and mind.

House: Huntington’s isn’t the only thing that causes tremors.

Thirteen: You think it’s just a coincidence?

House: I think you’re the only one on the team who drinks decaf. I’ve been switching it out with regular ever since you dropped that file. Your trembling is because you’re hopped up on caffeine. First file wasn’t my fault. Medical explanation for that is people drop things.

Thirteen: I’ve been walking around thinking I’m dying.

House: You are.

Thirteen: You don’t know that.

House: You have Huntington’s; it’s inevitable.

Thirteen: No, you don’t know that because I don’t know that.

House: How could you not get tested? If your mom had it,  that’s a 50% chance. You’re a bomb waiting to explode.

Thirteen: Not knowing makes me do things I think I am afraid to do. Take flying classes, climb Mt. Kilimanjaro, work for you.

House: Yes because if you knew, you couldn’t do any of those things.

In this scene, we learn that Thirteen not only lost her mom to Huntington’s disease, but that she is also at-risk for the disease herself. House assumes that Thirteen has tested positive for HD, which is why he says that the development of her disease is “inevitable.” If one is at-risk for HD, the chance of inheritance is 50%. However, if one does have the gene for the disease, the individual will present symptoms if they live long enough, usually between the ages of 30 and 50 years.

House cannot fathom why Thirteen would not want to know, which is a common phenomenon for individuals who did not grow up affected by the disease. As a physician, House should be more sensitive towards Thirteen’s hesitancy to test. However, in the context of the show, this attitude aligns with House’s oft politically incorrect and unprofessional commentary.

Later in the show, we see House obtain a water bottle from Thirteen in order to test it without her consent. We can assume that he tested her saliva; however, most genetic tests are done with a blood draw. Towards the end of the episode, Thirteen walks into House’s office with an envelope in her hand.

Thirteen: What the hell is this?

House: Looks like an envelope with the results of a genetic test for Huntington’s inside.

Thirteen: Did you look?

House: I thought it would be fun to find out together.

Thirteen: I don’t want to know.

House: No, you’re afraid to know.

Thirteen: I might die. So could you. You could hit by a bus tomorrow. The only difference is that is you don’t have to know about it today so why should I?

House: I don’t have to know the lottery numbers, but if someone offered them to me, I’d take them.

Thirteen: You spend your whole life looking for answers because you think the next answer will change something, maybe make you a little less miserable. And you know that when you run out of questions, you don’t just run out of answers. You run out of hope. You glad you know that?

Thirteen walks out and House throws the envelope in the trash.

As mentioned before, the character House is insensitive to the traumatic effects of growing up in a Huntington’s disease family. No one should be coerced into discovering his or her HD status. Explicit consent from the at-risk individual is required. Additionally, it is highly recommended that the at-risk individual see a genetic counselor before undergoing the genetic testing process to better understand one’s rights during the testing, as well as have an opportunity to see a psychologist and a neurologist in order to identify potential barriers to genetic testing. Again, HD is traditionally tested through blood samples, not a spit swab.

Season 4; Episode 15: House’s Head^

House reprimands Thirteen for getting distracted by her personal life while treating one of their critically wounded friends. He finds her later in the bathroom where he confronts her from the next stall.

Thirteen: You’re right. I’m screwing up.

House: Why are you screwing up?

Thirteen: I didn’t even like her.

House: Did you hate her?

Thirteen: Not enough to want her dead.

House: Was that guilt? That just leaves fear? Young woman dying. Young doctor dying in fact. That sound familiar?

Thirteen: Yeah. I am at-risk for Huntington’s. I’ve dealt with it.

House: By not getting tested. Dealing with it by not dealing with it? It’s clearly working beautifully.

Thirteen: You are the champion of not dealing with your problems.

House: My grandson gave me a mug that says that. Okay, enough hand holding. Deal with it, get back in there or pack up your stuff.

Thirteen: You’re screwing up this case worse than I am.

In this dialogue, we see a continuation of coercion from Dr. House, who wants his employee, Thirteen, to undergo genetic testing. It appears that Thirteen may be experiencing concentration difficulties, which could be an experience of Huntington’s disease or another issue all together. However, Dr. House does have a valid concern that one of his doctors might be jeopardizing other patients due to an unknown illness. Thirteen, however, may be fearful of her personal reaction to genetic testing and may not feel comfortable enough to discover her gene status, despite the consequences it may have for her employment.

Season 4; Episode 16: Wilson’s Heart

In this episode, through visuals, we see Thirteen test herself for Huntington’s disease alone. She receives a piece of paper that says “Huntington’s disease…Pos”, meaning that she has tested positive for the mutant huntingtin gene. This means that if she lives long enough, Thirteen will begin to experience symptoms of Huntington’s disease and any children that she may have will also have a 50% chance of inheriting the disease. This scene has no dialogue and is overplayed by a song. We do not discover her reaction to the genetic testing results at this point.

Season 5; Episode 1: Dying Changes Everything^

Thirteen: Why is everyone leaping to conclude a strong career woman has been made sick by her strong career? Let’s not be twelve; it’s insulinoma in her pancreas; it’s making her hyperglycemic.

House: Great. Now everyone knows.

Dr. Taub: You knew the patient had cancer?

House: Is that what she said?  I thought she said, “I am suddenly irrationally defending a woman’s strong career even though in reality, she’s just a glorified grunt because I’m trying to convince myself that it’s okay not to have a life because I don’t have a life and I was tested for Huntington’s and my lifespan’s been cut in half.”  I’ve been waiting two months for her to say that.

Associate doctors follow her out the room.

Dr. Cutner: Are you okay?

Dr. Foreman: Could be years before you see any symptoms.

Dr. Taub: Why wouldn’t you tell us?

Thirteen: I don’t have Huntington’s.

Dr. Cutner: Are you lying to us…because it’s none of our business?

Thirteen: If it’s none of your business then I shouldn’t have to answer these questions and I wouldn’t have to except House doesn’t want to answer questions about Wilson.  He’s deflecting his own problems on to me.

Dr. Cutner: Are you deflecting now?

Thirteen: Time for the B12 cocktail and my life lesson.

Later, while discussing a case that requires aborting a high-risk pregnancy:

House: This has nothing to do with her genitalia and everything to do with your genetics.

Thirteen: You told me to get tested.

House: I didn’t know it was going to color your every medical opinion and every personal opinion.

Thirteen: You didn’t think a death sentence would…

House: People die. You, Amber, everyone. Don’t act like you just figured that out. I gave you a diagnosis. You don’t like it? There are exits on every floor.

Later, while trying to determine a reason for patient’s continuing ailments:

Dr. Taub: I know this is none of our business but if House thinks your Huntington’s is affecting you the maybe your really have…

Thirteen: It’s not that I have…

Dr. Taub: You’re desperate to do this without him. You’re trying to cure her. You’re trying to prove.. (Dialogue is cut off by another conversation)

Later, in conversation with the patient:

Patient: You’re not like me. Maybe you have wings.

Thirteen: I have Huntington’s chorea. Dozen years or so my nervous system, my cognitive skills even my emotional balance, they’ll all start to fray. I won’t be able to fly. I won’t be able to walk. I won’t be able to breathe.

Patient: And you want to make sure your life matters.

Thirteen: I don’t want it to just be tightening bolts and following instructions. I want something to be different because of me.

Patient: I am…not just because you saved my life. I’m applying for a job at a foundation, running the finance division. I mean, I don’t know if I am going to get it, but if I don’t, there are other foundations.

Later, in conversation with House:

House: I like you better now that you are dying.

Thirteen: I was wrong.

House: You took a shot.

Thirteen: She’s going back to work for that idiot. It’s pathetic.

House: You thought something would change?

Thirteen: She almost died…because of that job. Yeah I thought…

House: Almost dying changes nothing. Dying changes everything.

Thirteen begins to struggle with a separation of work and personal life. She is desperately trying to dismiss her disease among her colleagues, but is clearly distraught during her work shifts. House continues to be insensitive to Thirteen’s situation and threatens firing her if she continues to be distracted in her job. Unfortunately, one of the major issues facing Huntington’s disease is loss of employment. While the Genetic Information Non-Discrimination Act protects employees from genetic discrimination in the workplace, it is difficult to protect employees whose quality of work is deteriorating due to the disease. For more information on GINA and workplace challenges, visit http://hdsa.org/living-with-hd/gina/

Season 5; Episode 5: Lucky Thirteen^

In this beginning of this episode, we learn that Thirteen has engaged in risky sexual behavior with multiple partners and has experimented with drugs. During one of her sexual encounters, her partner begins to seize and is rushed to the hospital. House meets her at the hospital.

House: I’ve been waiting for you to spiral out of control since your HD diagnosis, but this was more than I could hope for.

Later, the team discusses what could cause the patient’s symptoms. Thirteen says it was due to alcohol and ecstasy.

Dr. Taub: Wait, were you doing ecstasy?

Thirteen: That’s not diagnostically relevant.

House: It is if we are trying to diagnose how deep of a spiral you are on.

Later, in conversation with Dr. Foreman

Dr. Foreman: The thing you didn’t want House to find in your apartment, I found it.

(Thirteen stuffs a piece of paper in her pocket.)

Dr. Foreman: With a CAG count this high, it means you have less time than you thought. It’s understandable that you’re upset, it doesn’t mean you have to self-destruct.

Thirteen: It’s not noble for you to protect me from House if you’re just going to judge.

Dr. Foreman: There are things you should be doing: working out, improving balance and coordination…

Thirteen: Yeah, sounds like a blast. I’m having fun. Cramming as much fun into my life as I can.

Foreman: You are doing drugs, staying up all night, having sex with strangers

Thirteen: Sounds fun to me.

Later in this episode, House fires Thirteen for her drug use. Before he asks her to leave, he tells her to talk to her partner about life-threatening illness since Thirteen is in a similar position. This illness explains the patient’s earlier seizure. Thirteen, as we can see, is very much struggling with her diagnosis and is having difficulty finding healthy coping mechanisms.

House: Controlling women is as close as you can get to controlling what is going to happen to you.

Thirteen: And here I thought I was just into boobs.

House: Instead of getting sweaty with a stranger, why don’t you try taking it to the next level? Play God. Tell the girl that she has ten years to live. She has LAM (a lung disease).

Thirteen: Ok.

House: This is not a test. You’re not getting your job back.

Thirteen: I know what it’s like to get this type of news. She shouldn’t have to get it from you.

Later, in conversation with terminally ill patient after revealing that she has less than 10 years to live:

Thirteen: I know you’re scared.

Patient: I don’t know what I feel.

Thirteen: You’re going to be numb for a few more days. Then you’re going to go home and cry for a few weeks. And then you get angry. Start telling yourself that nothing matters anymore. Start doing stupid things. Maybe you go out to bars and pick up a bunch of women

Patient: You’re…

Thirteen shakes her head yes.

Patient: How long do you have?

Thirteen: Maybe a little more than you, maybe a little less. I’ll race you.

Thirteen struggles to maintain a healthy lifestyle, experimenting with risky behaviors of sex and drug use. As a result of her drug use, House fires her as he cannot have his doctors using drugs. While unusual to see HD patients engage in such high levels of risky behavior, it is not unheard of for HD patients to experiment with drugs, sex and alcohol. It is crucial that individuals affected by HD seek the support and help they need, whether it means reaching out to a physician, support group or professional therapist.

Season 5; Episode 9: Last Resort^

Dr. Foreman: Got a minute?

Thirteen: No.

Dr. Foreman: I’m consulting on a trial involving some CNS compounds.

Thirteen: While it’s true that no sometimes means yes, in this context…

Dr. Foreman: One’s a new Huntington’s drug. Phase 3 trials are showing real results delaying neuronal degeneration. Probably get you in.

Thirteen: No thanks.

Dr. Foreman: Are you doing anything about your disease, any type of program?

Thirteen: Nope, nor am I looking for a consult.

Thirteen is not interested in participating in clinical trials, despite the potential benefits to her health. It can be difficult for individuals to participate in clinical trials as it is a reminder of the presence of their disease and its progression. However, for those looking for a mechanism to cope or get involved with the research process, participating in clinical trials can be a very meaningful way to contribute. For more information on clinical trials and how to get involved, visit http://hdsa.org/hd-research/enroll-in-a-clinical-trial/

Later in this episode, Thirteen offers to take drug as part of a deal in a hostage situation in the hospital. House chastises Thirteen for risking her life, despite the fact that she says her life is essentially over. House even accuses Thirteen of making poor decisions as a result of degeneration caused by Huntington’s disease.

Thirteen: I’ll take it. [refers to experimental medication that the captor wants somebody to test out for his own illness]

House: This is a level of risk beyond anonymous girl on girl action.

Thirteen: They’re patients, I’m a doctor.

House: With a degenerative, drug unfriendly illness.

Thirteen: Everything’s not just some fascinating character flaw.

House: This is a genetic flaw. This is your Huntington’s speaking. This is you waving a white flag at the world.

Thirteen: Yeah, if I have a shortened life span, another reason why I’m objectively the right choice.

Later in the episode

House: You’re the coward. You’re so afraid of death. You just want to counter it, it gives you the illusion of control.

Later in a desperate encounter with the captor who has taken patients and doctors hostage, the man is attempting to force Thirteen to take more drugs to help him discover what is wrong with his health.

House: She has HD…this could screw up her liver.

Thirteen: Chances are slim. Chances of him shooting us on the other hand…

House: Don’t.

Captor: How long do you have to live?

Thirteen: 8, 10 years

House: Killing her is your chance to get personal?

Captor: Huntington’s does…doesn’t have a cure?

Thirteen: No.

Captor: So if we get out of here…

House: If she were clinging to hope, she wouldn’t be taking more drugs.

Captor: Not knowing what was wrong with me made me miserable. Maybe that’s insane. Doing this, yeah: Insane. But I had something to gain. You can’t take risks with no upset at all.

House: I can’t decide which is riskier: taking crazy risks or taking advice on crazy risks from a crazed risk taker.

Later in conversation

Thirteen: You really don’t feel bad about killing me?

Captor: Not if you don’t feel bad about killing yourself.

Thirteen: I don’t want to die.

Captor: Yeah you do. You just don’t have the nerve to actually do it. You just want it out of your control. Well, it is, ‘cause I’ve got a gun.

Later in the episode, Thirteen is recovering from her risky intake of drugs by going on dialysis. At this point, Thirteen has changed her mind about her participation in clinical trials with Dr. Foreman.

Thirteen: About that Huntington’s drug trial.

After a traumatizing experience as a hostage and drug guinea pig, Thirteen realizes that she does want to make an effort to extend her life as long as possible. She decides that she will take up Dr. Foreman’s offer regarding the clinical trial.

Season 5; Episode 10: Let Them Eat Cake^

In this episode, we learn from Dr. Taub that Thirteen started clinical trials at the beginning of the episode. At the clinic, Thirteen has flashbacks to her mother after seeing an HD patient in the clinic and is very visibly distressed. In the next scene, she is doing a finger speed test with Dr. Foreman. The dialogue is interrupted by Dr. Foreman’s instructions for the activity at hand.

Thirteen: Are there a lot of other people in the trial?

Dr. Foreman: There are people who already started it at Mercy so it’s pretty full. Stop. One more time.. No talking

Thirteen: I shouldn’t be here. It’s nepotism. I know the guy running the drug trials so I get a spot.

Dr. Foreman: You have Huntington’s so you get a spot. Stop. One more time. Just the fingers, no mouth.

Thirteen: The point of this thing is to improve neural cell longevity, which doesn’t matter much before symptoms so you should give my spot to someone…

Dr. Foreman: Shut up. Stop. You can stop feeling guilty. Your best tapping rate was .004 taps per second. It means your nerves are starting to degenerate.

Due to Dr. Foreman and Thirteen’s relationship, Dr. Foreman feels more inclined to inform Thirteen of her results. In most clinical trials, the clinicians will not reveal the results and often record it in a method that allows the participant to remain anonymous. It is unfair of Dr. Foreman to give Thirteen her results without her permission and consent.

In a later scene, Dr. Foreman arrives at Thirteen’s house as she missed her next clinical trial appointment.

Dr. Foreman: You never showed up.

Thirteen: Get out of my house.

Dr. Foreman: If I wanted to find proof that you were slipping back into your self-destructive pattern, confirm you weren’t worth my time. Instead, I found this. You followed all of my instructions to the letter. You’re probably better than any patient I have. So why are you the only one that can’t show up for appointments?

Thirteen: I came down, right after I was finished with the appointment with House. You were in your office with another patient. And there was another patient in the waiting room.

Dr. Foreman: Janet.

Thirteen: I’m well aware of what is going to happen to my body over the next 8 to 10 years, I do not need a visual reminder every time I walk into that place.

Dr. Foreman: That’s understandable. It’s human. And you need to get over it. You show up on time tomorrow or you don’t show up at all.

Thirteen is struggling with the presence of a symptomatic woman in the clinic, which is preventing her from making her appointments. Understandably, Thirteen wants to avoid these encounters as they are fairly traumatic to her and bring up old memories. However, she is allowing her struggles to prevent her from participating in meaningful clinical research that Dr. Foreman believes is helping her slow down symptoms. Sometimes, it is helpful to have a support system accompany an individual to clinical trial appointments. For others recently diagnosed, it may be too painful to participate. Their willingness to participate may be a matter of time and healing first.

In a flashback, Thirteen watches her mother get into a car from her window. She refuses to say goodbye to her mother. From the flashback, we can presume that this perhaps this is the last time Thirteen sees her symptomatic mother alive. She recounts a comment made by her father:

Thirteen’s Dad: Your mom is leaving. You’re going to regret this the rest of your life.

During the trial appointment, Thirteen sees the patient, Janet, who has sparked so many painful flashbacks.

Thirteen to Dr. Foreman: I’ll keep coming, but can you change my appointment time?

Dr. Foreman: I can’t. The schedule is full. You’re stuck with her, might as well get to know her.

Thirteen then has a flashback to ignoring her mother’s presence, but decides to acknowledge it, rather than bury it, and goes to help Janet who is struggling with her sweater.

Thirteen to Dr. Foreman: I lied to you the other night. That woman in the waiting room… She didn’t freak me out about my future. She freaked me out about my past.

Dr. Foreman: Your mother. It must have been horrible watching her die.

Thirteen: I wanted her to die. She just yelled so much and for no reason…just screamed at me in front of my friends. My father tried to explain to me that her brain was literally shrinking, that she didn’t mean it and it was the disease but I didn’t care. I hated her. I never said goodbye. And she died with me hating her.

Thirteen’s diagnosis is causing her to encounter painful and uncomfortable memories of her past. Janet, the woman in the waiting room, often sparks these flashbacks, making the appointments something Thirteen dreads as she fears encountering Janet. However, through conversations with Dr. Foreman and personal reflection, Thirteen attempts to reconcile her past and future, which we see through her personal and direct interaction with Janet at the end of the episode.

Season 7; Episode 1: Now What^

In this episode, the team asks Thirteen about her pending leave of absence from work, but she refuses to tell them her reason for it.

Dr. Foreman: Why are you going to Rome? I found the flight information in your locker.

Thirteen: I love how everyone thinks it’s so quaint and childlike of me it is to expect a modicum of privacy around here.

Dr. Foreman: Your flight’s tomorrow. What’s so urgent in Rome?

Thirteen: I hear they wanna tear down the Coliseum to build a karaoke bar.

Dr. Foreman: [A clinic] in Rome is planning on starting a Huntington’s trial.

Thirteen: Seriously, I live to sing.

Dr. Foreman: I know they’ve been doing fetal neural transplantation. I also know that their subjects have increased risk of intracranial hemorrhage. This isn’t the time to join a trial. This research is in its infancy; so is your condition.

Thirteen: You read my note, you go through my locker, and then you decide you want to round it off by lecturing me on my life choices?

Dr. Foreman: I’m worried about you.

Thirteen: Oh that makes it all right then?

It should be noted that any clinical trial, medication, or research presented on a television drama should be viewed critically. While some dramas will attempt to portray accurate information about clinical trials and their risk, one should always check with their medical provider regarding available trials in the area.

This episode also highlights major privacy concerns. Thirteen seeks privacy over her medical information, but her fellow physicians do not respect these wishes. While Dr. Foreman has good intentions, it highlights the difficult line family, friends, and caretakers walk in order to allow their loved ones or patients the autonomy they desire while balancing good decision making.

Dialogue continued:

Thirteen: So are you going to ask me about this Huntington’s trial and by that I mean give me your opinion?

Chase: No. there’s one thing though: Will you have sex with me?

Thirteen: What?

Chase: Well, all this trauma is making you run away. I was in it for the long game. Deadlines been moved up.

Dr. Taub: So you’re really leaving. How long are you gone for?

Thirteen: Depends.

Dr. Taub: The drug trial, sounds risky.

Thirteen: You don’t think I should do it. Message heard.

Dr. Taub: No, I approve. Living fast and dying young is crap if you have a chance of getting better. I say good for you.

Dr. Foreman: If I’m scared about this, I can’t imagine how scared you are. You shouldn’t be alone. If you want, I could fly over for a few days. Friends.

Thirteen: I appreciate that, but I think I’ll be okay. I guess we took the long way around to being friends.

In this episode, the members of the team are sharing their concerns and wishes for Thirteen as she prepares for her leave of absence. Thirteen is not pleased with the invasion of privacy and leaves.

Team: Where’s Thirteen?

Dr. Foreman: She’s not coming:

Dr. Taub: You mean she changed her mind?

Dr. Foreman: I called the hospital in Rome to see when she was scheduled for surgery.

Dr. Taub: Why would…

Dr. Foreman: Doesn’t matter. Point is she’s not even in the trial. Never heard of her. She’s been lying to us all day.

Chase: Well have you tried…?

Dr. Foreman: Both the phone lines have been disconnected. She’s just gone.

Season 7; Episode 18: The Dig^

In this episode, we learn that Thirteen’s absence can be explained by a prison sentence. House drives to the prison to pick her up at the end of her sentence. In the next few scenes, we hear disjointed conversations between House and Thirteen as we try to piece together the reason she was imprisoned.

House: So what did you do?

Thirteen: You figured out I was in jail but you don’t know why?

House: I’ve been busy.

Thirteen: Excessive prescribing.

House: Not that busy. I know you plead down to excessive prescribing. Question was, what did you do?

Later

Thirteen and House’s conversation takes an awkward turn after House discusses his break up with Dr. Cuddy. Ending the silence, Thirteen reveals the reason she was imprisoned.

Thirteen: I killed a man.

Scene ends abruptly.

Later

Thirteen: You’re awfully quiet.

House: Sorry, it’s just how I get around people who recently killed a man.

Thirteen: It wasn’t…you know I’ve had a pretty rough year. Do you think you maybe we could just give this whole thing a rest?

House: You killed a man! You plead out to drugs. Hit and run on under the influence. Guy who you kneed in the groin was your date who dropped the dime. [refers to an earlier scene where Thirteen asks House to make a stop at a residential home, where she mysteriously decides to knee the man who opens the door]

Thirteen: I’m asking you to let it go.

House: I really wish I was the type of person who could do that.

Later

House: So what did you do?

Thirteen: No more guessing?

House: I need to know. I can make some phone calls, we can speed up your medical board hearing. In the meantime, no one can stop me from hiring an assistant.

Thirteen: You were right this morning. I met a guy at a coffee shop, we went back to my place and he OD’d.

House: Damn, could have saved myself a job offer.

Thirteen: We both acted like idiots. And I ended up doing time. Guess he did more.

We soon learn that Thirteen’s confession is a lie. House accidentally catches Thirteen crying in their hotel room, forcing her to divulge more of her life story to House the next day.

Later

Thirteen: When I was ten or eleven, my dad used to take us to the county fair…what?

House: Who’s us?

Thirteen: My mom and I.

House: Your mom, who had advanced stage Huntington’s. You have a sibling that you’ve never mentioned. Why’d you slip up now?

Thirteen: not everything means something

Later, in the same conversation

House: You don’t wake up in the middle of the night crying over a dead stranger. You confess to killing a man and then hide the details unless the details reveal more about you than the crime itself.  You plead down to drugs, you got a horrible genetic disease, and a sibling who is suddenly on your mind. You euthanized your brother. That guy back at the house was the doctor who wouldn’t help you cover it up.

Thirteen: The guy back at the house was my cellmate’s boyfriend who cheated on her when she was inside.

House: Well, I was right about everything else.

Thirteen: Congratulations.

Later

Thirteen: He couldn’t do it himself. He was…the disease had progressed too far. He was flailing, he didn’t have any control over his own body. He pretty much lost control of his mind too, but every once and a while he’d have a few seconds of lucidity. He turned to me and he said, “It’s time.” I hooked up the IV. I used gloves I knew they’d get me on the drugs, but they couldn’t prove who pushed the plunger. (Thirteen cries.) I put in the needle and he just got quiet and it was over. Then I was alone. And one day, I will be that sick and there will be no one there when it’s time. I didn’t expect compassion from you; I would have taken commiseration; Hell, I would have taken revulsion, any emotional engagement at all. It’s no wonder Cuddy broke up with you.

Later, House offers to kill her when she no longer wants to live with Huntington’s disease. This episode highlights very serious issues within the Huntington’s disease community. Due to the debilitating nature of the disease, some HD patients express intention to kill themselves before they lose control of their body and mind. While death with dignity is available in a few states within the United States, it is a global issue that is perhaps one of the most controversial aspects of living with HD. If you or a loved one are ever in need of support, the Huntington’s Disease Society of America a support guide for crisis management that can be accessed here.

Season 7; Episode 22: After Hours^

In the next episode, Chase discovers Thirteen had assisted her HD symptomatic brother with the attempt to end his own life. Chase responds.

Chase: You killed your own brother?

Thirteen: Yes, it was awful and devastating, but it wasn’t murder.  He was sick and he wanted to die and I promised I would help. Now, please stop pacing and help me find this thing.

Later

Chase: You promised your brother you’d euthanize him and you think you won’t feel bad about it as long as you keep your promise. That’s why you have this twisted obligation to keep all promises or your carefully constructed defense mechanisms could tumble down.

Thirteen: I saved my brother from a lot of pain.

Later

Thirteen: Darien had to shoot that kid. It was the right thing. Completely justified. But it didn’t matter. She destroyed her life trying to forget. I’m afraid that’s what’s going to happen to me.

Chase: You really should talk to someone.

Thirteen: I talked to a therapist. It didn’t help.

Chase: Well maybe you should talk to someone who isn’t a therapist.

Thirteen: Do you really think you have any idea of what it’s like to talk to with something like this?

Chase: Let’s grab a coffee

Chase is an example of a strong support system for Thirteen. Often, issues faced by Huntington’s disease patients or loved ones are challenging to confront on their own. Sometimes it takes a listening and non-judgmental ear to help these individuals, whether it be a loved one, close friend or professional therapist. Self-care is perhaps one of the most important core elements of health for those affected by this disease. For more resources on living with HD, visit http://web.stanford.edu/group/hopes/cgi-bin/hopes_test/managing-hd/

Summary^

Thirteen is one of the most well-known fictional TV characters to be affected by Huntington’s disease. Her story highlights the numerous challenges that face persons affected by HD. We followed Thirteen as she struggled with her decision to undergo genetic testing. We learned of her painful memories of her mother who also had the disease. And we understood the challenges that her community faced as they attempted to help her. House’s representation of the HD experience was accurate, but, at times, an overdramatized showcase of a devastating, stigmatized disease and the effects it has on friends, family, employers and the surrounding community. While it may not be the perfect method of educating the world about HD, House and Thirteen have done more to raise awareness of name recognition and symptoms than perhaps any other form of media to date.

KPowers 2015

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