CUADERNOS DE LA FUNDACIÓN DR. ANTONIO ESTEVE Nº 35 The Holmes in House: A Consulting Detective Goes Back to His Roots Lisa Sanders MD The doctor turns his piercing blue eyes to the route to this deduction for several weeks and strangely discolored middle aged man seated nearly a dozen pages. When Watson begs for an before him. Peering over his long, thin nose, the explanation, Holmes traces the observations and physician had the look of a predator examining thought process which makes this, like all deduc- prey. “Unfortunately,” he informs the man coolly, tions, seem so simple, at least in retrospect. “you have a deeper problem. Your wife is having an affair.” “Here is a gentleman of a medical type,” he tells “What?!?” the man exclaims, astonished by the eager Watson, “but with the air of a military this strange and unsought diagnosis. The doc- man. Clearly an army doctor, then. He has just tor casually twirls his cane as he considers his come from the tropics, for his face is dark, and patient, who had come to see him with skin the that is not the natural tint of his skin, for his wrists color of a carrot, but complained only about a are fair. He has undergone hardship and sickness pain in his back following a vigorous golf game. as his haggard face says clearly. His left arm has “You’re orange, you moron,” he explains irritably. been injured. He holds it in a stiff and unnatural ”It’s one thing for you not to notice, but if your manner. Where in the tropics could an English wife hasn’t picked up on the fact that her hus- army doctor have seen much hardship and got band has changed color, she’s just not paying his arm wounded? Clearly in Afghanistan.” attention.” Arrogant, observant, intelligent; a little testy, This is the first exchange between Dr. Gregory perhaps, but a master of deduction, who clearly House and a patient who’s come to him for help has a flair for dramatic revelation – though per- in the first episode of the Fox Television program, haps a little less ruthless. The parallel between House MD. And right from the start we are tipped the two was not accidental. Show co-creator, off to the link between House and his inspiration, the most famous consulting detective of all time, and executive producer David Shore, acknowl- Sherlock Holmes. edged the intentional homage from the start. From our initial encounter with the character, “Anytime one says ‘puzzle’ and ‘brilliant deduc- House establishes himself as an observant, intelli- tion’ in the same sentence, one can’t help but gent, arrogant man. Prickly, even rude at times, he think of the great fictional detective Sherlock is nevertheless a master of deduction, equipped Holmes and his trusty sidekick, Dr. Watson. And with a ruthless flair for the dramatic revelation. indeed, Holmes - and the real-life physician that Those familiar with the Canon will hear echoed inspired him, Dr. Joseph Bell - were very much in this meeting the reader’s first encounter with inspirations for ‘House’.” (Zap2it, Kate O’Hara, the detective in A Study in Scarlet. Within minutes January 2005) of his introduction to future amanuensis, Dr. John Watson, Holmes announces, “You have been in Echoes of the Canon are frequent within the Afghanistan, I perceive.” He does not reveal his show. The lead character’s last name, House, -13- The Holmes in House: A Consulting Detective Goes Back to His Roots is a synonym of Holmes (a near homophone to In my column, called Diagnosis, I tell the story of HOMES). House has only one friend, James Wil- a patient with mysterious symptoms who seeks son, a parallel to Dr. John Watson. House plays a doctor to discover their cause. I take readers the piano, the guitar, the harmonica; Holmes dis- into the diagnostic process and reveal the clues tracts himself with the violin. House takes Vico- and deductions that lead the doctor/detective to din, Holmes, cocaine and both occasionally inject discover the pathological processes causing the morphine or a derivative. Holmes was killed – at patient’s illness, and point the way to treatment least temporarily -- by Professor James Moriarty; or even cure. House was shot and nearly killed by Jack Mo- It’s hard to remember, but at the beginning riarty. Irene Adler was, to Holmes, The Woman. of this century - before House was a household The first patient we see House save is named name - diagnosis was not a topic of popular dis- after her - Rebecca Adler. House pretends to cussion. Indeed, if you look at what was in the have cancer to achieve one of his aims, a clear media and entertainment world as an indicator reference to the story “The Adventure of the Dy- of what was popularly or widely known, a diag- ing Detective” where Holmes pretends to have a nosis wasn’t a Holmesian process but a simple deadly infection to catch his man. answer to the complex question presented by Holmes and Watson refer to everyone by the patient. In these shows diagnosis was merely their last names. So too do House and Wilson. a springboard to the rest of the story. In programs Holmes and House also share an unconven- from Dr. Kildare (1961-1966), to Marcus Welby tional personality and, a certain brusqueness of (1969-1976) to ER (1994-2009), you may have a manner, particularly when deep into an interest- patient who comes to the doctor or hospital with ing case. Even in their spare time there can be some type of symptoms but the focus of the dra- seen similarities. Actor Hugh Laurie once likened ma occurs before or after the cause is revealed. House’s obsession with television, video games, The diagnosis itself is a one liner that gets you and popular music to Holmes’ habit of listening from one scene to the next. to classical music or reading dull monographs for For example, in ER, one of the longest run- hours on end in order to relax his mind while pon- ning medical series, one of the ER doctors tells dering a case. a patient, ”I have the results from your blood ex- ams. They show you have leukemia.” No fuss, no muss. Blood is taken, a test is performed, the an- A doctor inspires a detective who inspires swer, leukemia, is revealed, and the story returns a doctor who inspires a show. to what it’s really about. In these shows diagnosis House MD, ran on Fox Television from 2004 to is like math. Fatigue and abnormalities found on 2012. It was one of the most popular television blood tests equal leukemia. In fact, the diagnosis shows of the decade. Indeed in 2009, it was the of this type of cancer is usually far more complex most watched television show on the planet with than that. Were there clues in the physical exam: a reported 51 million viewers. Along the way the a certain pallor in the face and eyes? an enlarged show garnered three Emmy’s (Best Script, Best spleen? perhaps there was some weight loss? Directing, Best Make up), four Golden Globes None of it is important or even particularly myste- (Best Actor and Best Dramatic Series – twice rious when the diagnosis is just one small com- each) and a Peabody. Plus awards from the ponent of a different human drama. Screen Actors’ Guild, the Writer’s Guild and many Actually, I think doctors liked to portray their People’s Choice Awards. profession that way. The crisp precision of the It is said that success has many fathers, and science of illness and the certainty of diagnosis here I will make my bid for at least a small piece of is a counterweight the art of dealing with the that paternity, alongside Sherlock Holmes. Since complexities of human behavior and emotion. 2002 I have written a monthly column for the New The simplicity of this fictional representation of York Times Magazine about medical mysteries. the process disguises the uncertainty that sur- -14- CUADERNOS DE LA FUNDACIÓN DR. ANTONIO ESTEVE Nº 35 LA MEDICINA EN LAS SERIES DE TELEVISIÓN rounds all but the most basic diagnoses. To ac- Indeed, one might well say that House is the knowledge this intrinsic lack of precision seems doctor Holmes might have been had Conan Doyle to make doctors uncomfortable. lived in the 21st century. It would have been im- The first two years of medical school do noth- possible for Holmes to be a physician at the end ing to contradict the impression that I - and many of the 19th century when first penned by Conan of my fellow students - had about medicine. That Doyle. Joseph Bell, the doctor Conan Doyle there is a science to it; a precision and accura- modeled his character after, was admired for his cy that puts it in the same class with all that we remarkable skills as an observer, his mastery of learned on the way to med school and in those the ephemera of his time – the local geology, re- first two years: chemistry, biology, anatomy, phys- gional accents etc,- his powerful deductive rea- iology. That it is well defined, well understood – in soning and his flair for the dramatic. Despite his short, a science. mastery of these fundamentals of diagnosis, they That impression falls apart in the third year of were virtually useless at that time. What good medical school when students are taken out of were these skills at the end of the 19th century? the classroom and put into the clinic and hospital The science of medicine then was rudimentary.