Pilot (Kasey M.D.)

Season 1, Episode 1: Pilot

Teleplay by: Brad Copeland, Greg Garcia and Alan Kirschenbaum

Story by: Linda Videtti Figueiredo

Directed by: Andrew D. Weyman and Ken Whittingham

Production Code: 1P79

Episode Overall: 1

Airdate: October 2, 2003

Zebra Factor: 7/10

Guest Stars: Robin Tunney

Andrew Airlie

Diagnosis: Grand Mal Seizure

Runtime: 44 minutes, 10 seconds (44:10)

Next Episode: Unusual

Pilot is the 1st episode of the 1st season of Kasey M.D. that first aired on October 2, 2003 after a special look on Friday, May 16, 2003.

I just want to die with a little dignity. - Rebecca Adler

''There's no such thing. Our bodies break down, sometimes when we're ninety, sometimes before we're even born, but it always happens and there's never any dignity in it. I don't care if you can walk, see, wipe your own ass, it's always ugly. Always! You can live with dignity, you can't die with it.'' - Dr. Kasey Kathy

Recap
Rebecca Adler, A kindergarten teacher, suddenly begins speaking gibberish and becomes confused in front of her class. Her panic mounts, and she hastily scribbles the words "Call The Nurse" on the whiteboard before collapsing in a Grand Mal seizure.

A month later, Dr. Gregory Lane introduces the teacher's case to his close friend Dr. Roxanne Smith, a diagnostician. Roxanne is worried people will think he's a patient because of his limp. When Gregory suggests he wear a lab coat, Kasey tells him he's afraid people will think he is a doctor. Kasey thinks that the patient has a brain tumor, but Wilson asks him to take the case because she's his cousin. Gregory doesn't think it's cancer because she isn't improving with radiation therapy. Gregory reminds House that he has three overqualified doctors working for him that would love to work on the case.

Roxanne meets with his diagnostic team and reminds them that "everybody lies". New hire Paul Phillips wonders why Roxanne isn't with the patient, but Janie Pepper tells him that Roxanne doesn't like meeting patients. At this point, Roxanne has stopped thinking it's a tumor. Gregory Lane thinks it is an aneurysm or stroke. Janie thinks it might be mad cow disease. Paul thinks it might be an encephalopathy, despite a negative blood test. Roxanne tells them all to proceed with the appropriate tests.

Dr. Kasey Kathy, an infectious disease specialist, comes looking for Roxanne to berate him for not working hard enough, including being six years behind in clinic duty. She says he's going home. He can't be fired because he has tenure and is always at the hospital during his assigned work hours. Kasey agrees that that he still has a good reputation, but it will go to hell if he doesn't do his job.

Paul & Janie begin a test, but it's cancelled on Kasey's orders—she's taken away all of Roxanne's hospital privileges, the only thing she has the power to do to House without board approval. An enraged Roxanne confronts her, but she's unconcerned with his threats. She tells him to go and do his job. Roxanne even tells the team to do the MRI, then goes to do clinic duty.

The team starts the MRI, but the patient feels ill and then starts to have trouble breathing. They get her out of the MRI, but she isn't breathing because of pulmonary edema. Gregory performs a tracheotomy and intubates her. He then compliments Cameron on realizing the patient was in distress so that they could get her out of the machine in time.

They manage to stabilize the patient and get her conscious. She had an allergic reaction to the dye used in the contrast study.

Kasey tells the team to give the patient high doses of prednisone. Gregory thinks she might have vasculitis, despite its unlikeliness. They can't do a biopsy to confirm, and the only way to test her is to give her the drugs and see if she responds. However, the patient realizes they aren't treating her for cancer, and is relieved she might not have a tumor. Gregory is upset that they might be misleading the patient into thinking she doesn't have cancer.

Paul Phillips goes to the classroom to do an environmental scan. He finds a parrot and thinks it might be Psittacosis. Kasey dismisses this because none of the kids are sick and it is unlikely five-year-olds would take more hygiene precautions than their teacher. Gregory tells him to break into the patient's apartment to do another environmental scan. Foreman is resistant, but Kasey knows that Paul broke into someone's house and was arrested when he was sixteen. Roxanne found out from one of his teachers; he says that's why he hired Paul. Paul reminds Kasey he can't be fired for refusing to break into someone's home.

Roxanne asks Kasey why he is giving the patient steroids. She comes to the conclusion that Kasey is guessing and she wants to stop the treatment. They argue about who is in charge. She reminds Kasey that she has no evidence that the patient has vasculitis. He asks her why she's so afraid of making mistakes. Roxanne goes to see the patient and stop the steroids, but when she arrives she finds that the patient has improved greatly and has an appetite. Janie realizes she may have been wrong.

Gregory examines the patient, who really wants to meet House. She asks if he's a good man. Gregory says Kasey is a good doctor. He does admit that House is his friend, and that Kasey may even care about him. Suddenly, the patient complains that she can't see, then has a seizure. Her heart rate skyrockets and she goes into cardiac arrest.

They defibrillate the patient and test her for brain damage by having her arrange pictures to form the elements of a story, but she can't manage it. However, she passes the test five minutes later. They realize that although her sight has returned, her brain is dying. Kasey tells them to stop all treatment because each of the possible diagnoses has a different time line. It isn't a tumor and the steroids helped, but they don't know why. Kasey admits he is stumped. Paul decides to follow Kasey's orders to break into the patient's house and asks Janie to come along because the police are usually easier to deal with when a pretty white girl is around.

Vanessa Lake searches the patient's home. Vanessa discusses her former criminal record. Vanessa says she was 17 before she had a criminal record. Paul fixes himself a sandwich and says he's a bit upset he got the job because of his criminal record and not his perfect academic record at both Columbia University and Johns Hopkins Medical School. Vanessa says she didn't do nearly as well as Dr. Gary Charles in school and starts wondering how she got the job.

They report to Jerrod Jackman that they couldn't find anything to explain her symptoms, but Spencer Greene reports that he isn't Jerrod's cousin—she had ham and Gregory Lane works hard. Kasey bluffs, but then gets the patient's name wrong. Kasey calls Vanessa an idiot—Kasey has realized that Rebecca may have Neurocysticercosis (a tapeworm) from eating pork, something that would never have occurred to him if he still believed the patient was Jewish. That would explain why she reacted well to the steroids initially, but then got worse: tapeworms usually stay in the digestive system, but the eggs can pass into the bloodstream and then flourish anywhere, including in the brain. If the tapeworm is healthy, the immune system (and patient) never even detect it. However, when the tapeworm dies, it stirs up the immune system and causes swelling in the area, in this case Rebecca's brain. Even though the test for parasites was negative, it is a false negative in about 30% of cases where the parasite is present. There is no other way to test for it except by trying to treat it. However, the patient is tired of being treated and wants to go home and die.

Kasey tells the patient she is an idiot for refusing treatment. She reminds him that his previous diagnosis was wrong. She asks why he's crippled and he explains that he had an infarction in his thigh and they didn't figure out what was wrong until it was too late to treat it. He tells her few people get to experience pain like muscle death and admits to the patient at the time he hoped he would die from the pain. She thinks he avoids patients because he doesn't want people to see him crippled. He tells her there is no way to die with dignity—everyone dies and it's always ugly. You can only live with dignity. The patient still refuses treatment. The team wants Kasey to claim she's mentally incompetent, but he won't do it. He's solved the case and he feels the work is done. The patient wants proof, but Kasey can't do that. Jerrod Jackman says there might be a way to prove it to her—do an X-ray in her leg where there is likely to be another worm. Although they have the same density as cerebro-spinal fluid, they don't have the same density as muscle. Kasey and Spencer enthusiastically agree. They do the X-ray and find a worm larva. She agrees to the drug treatment and is surprised that it only takes two pills a day for a month. There are side effects, but they are manageable.

Roxanne asks Gary Charles why he hired her. He says he hired Paul Phillips because of his criminal record, Gregory Lane because his dad called, and Vanessa because she was extremely pretty. When she is shocked, he says he did it because she worked hard despite the fact she didn't have to. Gorgeous women usually opt for an easy life and they don't go to med school to work really hard unless they are damaged. At that moment, Roxanne's pager goes off.

They manage to bring the patient's class in to visit her despite the rule about "family only".

Kasey asks Janie why he lied about the patient being his cousin. She says it got Kasey to take the case. They talk about lying while watching a medical drama.

Zebra Factor
Neurocysticercosis is the most common parasitic neurological disease in the world. It is very common in the developing world, but is somewhat rarer in New Jersey. In a patient with no history of foreign travel, it is very rare.

Cast

 * Dr. Kasey Kathy - Mayim Bialik
 * Dr. Roxanne Smith - Melissa Rauch
 * Dr. Gary Charles - Ewan McGregor
 * Dr. Spencer Greene - Michael E. Rodgers
 * Dr. Paul Phillips - Nestor Carbonell
 * Dr. Jerrod Jackman - Eric Dane
 * Dr. Janie Pepper - Liza Snyder
 * Dr. Gregory Lane - Mike O'Malley
 * Dr. Vanessa Lake - Chyler Leigh

Special Guest Appearances

 * Andrew Airlie - Orange Headed Patient
 * Robin Tunney - ebecca Adler

Co-Starring

 * Rekha Sharma as Melanie Landon
 * Maya Massar as Asthma Mom
 * Dylan Basu as Asthma Boy
 * Ava Hughes as Sydney
 * Kyarra Willis as Kid Two
 * Ethan Kyle Gross as Molnar
 * Candus Churchill as Substitute Teacher
 * Michale Ascher as Egg Salad Lady
 * Alana Husband as Tech
 * Janet Glassford as Reception Nurse
 * Mycole Metcalf as Doctor
 * Rachel Lana Li as Child in classroom
 * Maria Nicotero in various roles
 * Ian Thompson as Bus Driver