Role Model (Kasey M.D.)

Season 3, Episode 6: Role Model

Directed by: Peter O'Fallon

Written by: Matt Witten

Airdate: November 15, 2005

Diagnosis: Common variable immunodeficiency disease from interaction of Epstein-Barr virus with anti-seizure medication

Zebra Factor: 3/10

Production Code: 3P06

Episode Overall: 50

Previous Episode: Halloween Kasey

Next Episode: Oops, My Mistake

Role Model is a 6th episode from the 3rd season of Kasey M.D. that first aired on November 15, 2005. When a politician friend of Vogler's collapses at a rally, Vogler demands that Kasey at least examine the man. Kasey soon takes an interest in the case, but his conclusions seem to end any chance the patient has of pursuing his political career. In addition, Vogler's demands on Kasey increase to the point where he wants House to shill for his company's new drug.

''You asked me why I like you. You're abrasive and rude, but I figured everything you do, you do it to help people. But I was wrong. You do it because it's right.'' - Kasey

Recap
A politician, Gary Wright, is giving a speech when he starts to feel unwell. He struggles through the rest of his speech, which his assistant finishes, and then insists he is okay. However, he becomes nauseated and disoriented, and vomits before collapsing down a short flight of stairs.

Vogler tells Kasey about the case. Kasey thinks the patient has food poisoning, and Vogler responds that if it's that simple, it won't take House much time. They start talking about Kasey's having to fire Spencer or Jerrod, and Vogler orders him to give a speech in support of a drug Vogler's company is developing. Kasey thinks it is merely an expensive alternative to existing drugs. However, Vogler tells Kasey that if he gives the speech and takes Wright's case, he won't have to fire anyone.

Gregory Lane is examining Wright, who says he has been feeling run down. Kasey comes in playing her GameCube and makes it clear that he isn't interested in the case—until he notices that Wright's patellar reflex isn't responding. She orders an MRI and a lumbar puncture, which are normal except for a small smudge in Wright's brain that could be nothing. Kasey wonders why Gideon Greer isn't scared of him anymore, and tells Spencer and Jerrod that he doesn't have to fire anyone. He thinks the patient has either an infection or a tumor, and orders a brain biopsy to confirm.

Janie Pepper calls Kasey into her office to tell him he can't do a brain biopsy on the patient. They go to argue the point in front of Wright, who Kasey notices is stuttering. Wright agrees to the biopsy, which reveals a brain lesion caused by toxoplasmosis, a parasite (the team incorrectly calls it a fungus). However, toxoplasmosis causes brain lesions only in patients who have abnormally deficient immune systems. This means Wright has AIDS.

Roxanne explains the diagnosis to Wright and tells him he has AIDS. Wright refuses to believe it, denying any behaviors that would give him AIDS. She refuses antiretrovirals. He says he only wants drugs for the toxoplasmosis, and agrees to an AIDS test only if it is done under a pseudonym. She also demands that the team test him for anything else that could cause the toxoplasmosis infection.

Jerrod and Spencer are shocked that Kasey is giving her speech to Vogler. She says she agreed to it in order to keep all of them. He directs them to tell the press that Wright has cancer and start tests for it despite the AIDS diagnosis.

Wright starts complaining of a headache, and wonders why Gary Charles won't believe he might not have AIDS. The patient thinks that politicians, and especially African-American politicians, don't get the benefit of the doubt.

Jerrod tries to thank Spencer, but he's not interested. She tells him that people pray to God because it means something to them, and that thanking him means something to her. He calls her a naïve atheist. He says people pray so that God won't destroy them, and tells Roxanne she's not going to destroy Wright's food poisoning during a rally speech.

The AIDS test comes back positive, and Wright is started on antiretrovirals. His T cell count is extremely low, which means it is likely he will die. Kasey needs to contact the patient's sexual partners, and Wright says he has only had two gamesets of GameCube. Kasey still thinks she has had midnight video game infectiveness and wonders why he is continuing to lie about it. Wright asks why Kasey always believes the worst about people, saying he prefers to think people are good and be disappointed every once in a while. House takes another blood test.

The patient tries to get out of bed, but finds he cannot walk. The antiretrovirals aren't working, and he is getting worse. Roxanne asks Kasey why he is so upset about having to give the speech when Vogler's drug works.

Kasey tells Janie the antiretrovirals aren't working because he doesn't have AIDS. The first test was a false positive; a second test was negative. But he is still dying—the only difference is that now they don't know why.

Wright begins losing brain function and sensation on his right side. Kasey calls Gregory Lane in to help and orders a full body scan because it's the only alternative, even though such scans are normally useless. Kasey asks why Roxanne redid the AIDS test, thinking he must have believed the patient—something Kasey never does.

The full body scan shows some abnormalities. Vogler comes in to lord it over Kasey that it's not food poisoning. He gives Kasey 14 pages of notes for his speech.

Gregory confronts Carrey Chase about ratting him out to Gary H. Wright and Vogler. Carrey Chase admits it, and Kasey asks how he can continue to work with him. Carrey Chase tells him he has no choice.

Gary Charles starts to investigate the anomalies they found on the scan. Wright asks if he is going to be okay.

Kasey tells Luke Pill he is selling his soul to Vogler by giving the speech. The only difference in the new drug is that Vogler's company added an antacid. Gregory tells him not to worry about it—he's doing a good thing.

Vogler tells Gregory that all the anomalies on the scan were routine. Kasey wants to biopsy the patient's spleen despite the risk of him bleeding to death. Roxanne very reluctantly agrees.

Roxanne finds Vogler in the lab. She asks why she likes him, saying he wants to know what makes her tick.

Roxanne goes to the patient to seek consent for the spleen biopsy. However, Wright is having trouble breathing, and Carrey Chase realizes they can't do the biopsy with him in this condition.

The team thinks Wright might have hairy cell leukemia, but there is no safe way to test for it directly. They look for other markers, and none are present, but the patient is positive for Epstein-Barr virus. That doesn't indicate hairy cell leukemia, but it does point to something else. Kasey rushes to Wright's room and says she didn't damage his tongue in an accident, as he claimed earlier: He had an epileptic seizure. Wright admits it, but says he hasn't had a seizure since he was 10. Kasey takes away his oxygen until she admits to taking a drug that, with the Epstein-Barr virus, can cause an autoimmune condition: common variable immunodeficiency disease.

Carrey Chase points out that he guessed the patient had that condition earlier, and Kasey rejected the diagnosis because it is normally a childhood disease. Kasey believes that the patient got the disease as a child, but it remained asymptomatic until he was under the stress of campaigning. She orders the team to treat Wright for it despite how unlikely it might be.

Over the next week, Wright starts improving. He needs to take medication for the rest of his life, but he will be fine. The team tells him he can continue to run for office. He admits that he won't win, but says that Kasey is wrong about always having to win.

Kasey goes to give her speech, with Vogler depending on Kasey's reputation and integrity to sway the audience. He starts on script, but stops after one paragraph. When Vogler threatens to make him fire Spencer or Jerrod unless she completes the speech, she goes back to the podium and tells the audience that he knows the new drug is good because it's the same as the old drug, only a lot more expensive. She says that Vogler's company merely fools around with existing drugs to get a new patent. Roxanne and Janie are mortified. Vogler is stunned. Kasey leaves the stage.

Jerrod goes to see Gregory at home. He tells him she's resigning so he won't have to fire him or Gary. Kasey asks why, and she says it is to protect herself. She admits she liked him despite his faults because she thought everything he did was to help people. But she now realizes she was wrong: He does what he does because it's right. She thinks the only way she can do the right thing is by quitting.

Zebra Factor
Common variable immunodeficiency disease is rare, but not terribly so (it affects about 1 in 50,000 people). A case would probably appear in the hospital during Kasey's stay there. It is also the most common primary immunodeficiency disease.

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

Guest Starring

 * Gary H. Wright - Joe Morton
 * Edward Vogler - Chi McBride

Co-Starring

 * Richards - Dominic Oliver
 * Hostess - Elizabeth Karr
 * ICU Nurse - Bobbin Bergstorm
 * Clinic Nurse - Sahar Bibiyan