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"Known Unknowns"
House episode
Episode no.Season 6
Episode 7
Directed byGreg Yaitanes
Written byMatthew V. Lewis & Doris Egan
Original air dateNovember 9, 2009 (2009-11-09)
Guest appearances
Episode chronology
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House season 6
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"Known Unknowns" is the seventh episode of the sixth season of House and 117th overall.[1] It aired on Fox on November 9, 2009. The team tries to diagnose a teenage girl while House is away at a medical conference with Wilson and Cuddy. At the conference House finds something out about Cuddy.

Plot

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After a wild night out, a teenage girl named Jordan (Anna Attanasio) is brought to Princeton Plainsboro with severely swollen appendages. The team must work to diagnose Jordan, who is less than honest about what happened the night she fell ill. House suspects she is suffering from rhabdomyolysis and the fall caused crushed muscles which released toxins that caused swollen joints. But the CT shows no signs of trauma, so House goes in and gets Jordan to pretend to play the drums. Her hands are very weak. House notes that her chart shows low potassium, and rhabdo elevates potassium levels, meaning her potassium had to be extremely low the previous night. This means she can't have climbed stairs, meaning there was no fall. House says something else is causing her low potassium and rhabdo.

Meanwhile, Cuddy, Wilson, and House spend a weekend away from the hospital to attend a medical conference. During an 80s party at the convention, House and Cuddy are dancing and talk about their past at Michigan. They mention how they first met, and the night they slept together. House tells her that the next morning he was going to see her and see where things would go from there, but he got a call from the Dean of his first medical school and found out that he was expelled. After that he didn't see any point to go see her. She leaves him in a haste and later lets him know through Wilson that now she is a mom and she needs someone reliable. When House in turn offers Cuddy to babysit he finds out that she is dating the private investigator Lucas Douglas (Michael Weston) from season five, who is taking care of Cuddy's daughter in place of the babysitter.

Jordan's friend, Phoebe, tells Cameron and Chase what they did the previous night, stating they followed comic book creator Jeffrey Keener (Marcus Giamatti), including going to a restaurant in the building. The food makes Foreman suspect she could be bulimic, which would account for all her symptoms, so Cameron starts her on nutrition supplements and they do a barium swallow to check for mallory weiss tears. However the barium swallow shows no tears, ruling out bulimia. During this test, she has cardiac tamponade - she bleeds around her heart. The team puts her on antiarrythmics. House notes that since her blood pressure dropped during the barium swallow, it can't be a chronic condition. Foreman notes that this leaves just infections and toxins.

As Jordan's condition worsens, she becomes unable to distinguish fact from fiction. Foreman finds this is caused by a bleed in her brain that's affecting her thalamus causing her to lie. Phoebe tells Foreman that he's been told all the places they went. She says the only time they weren't together was when Jordan went to get ice. However, Phoebe only woke when Jordan returned, so the team has no idea what Jordan really did, or how long she was gone for. CCTV tapes show she was gone for only five minutes, and she returned from her trip holding Keener's journal. Cameron and Chase go to Keener's room and ask to search his room for toxins, but he insists she never arrived at his room. This causes Cameron to suspect that Jordan may have been drugged by roofies and raped by Keener. They start her on flumazenil to reduce the effect.

She soon starts to bleed behind her kidneys, so Foreman gives her blood transfusions. Cameron notices that this is similar to a toxic reaction, so they need to find out what toxin is causing it. Cameron suggests drugging her with amobarbital to suppress her thalamus. However, she continues to lie even on the amobarbital. She starts losing blood faster than the team can transfuse. An online search done by Cameron shows that Keener travels with his dog so they treat her for rickettsia.

At the medical conference, Wilson feels remorse after having performed euthanasia on a terminally ill cancer patient by intentionally having told the sequence to the patient's PCA machine to a coworker loud enough for the patient himself to hear, allowing the patient to administer himself a morphine overdose. Wilson plans to give a speech about the incident, although it may severely harm his career. However, House drugs Wilson and makes his speech during the convention in another person's name (instead of Gregory House or James Wilson, House goes by the name Phillip Perlmutter for the whole medical conference). While arguing about this, House has an epiphany about Jordan's condition.

It turns out that Jordan has vibrio vulnificus caused by the vibrio in the oysters Jordan had the previous night. She has hemochromatosis, which gave her a unique susceptibility to vibrio, which was what caused her swollen joints. However, this got attributed to bulimia so she got supplements that had iron in them. The iron stressed her liver, causing the bleeding. This led to more blood transfusions, giving her more blood, causing even more bleeding. The team starts Jordan on high-dose ceftazidime for the vibrio and chelate for the hemochromatosis. Jordan also admits that she never plucked up the courage to knock on Keener's door, so she left his notebook on his doormat. Keener never lied. Later, Wilson also admits that it was irrational to sacrifice his career because of his remorse and thanks House for being a good friend.

Towards the end of the episode, Chase confesses to Cameron that he killed Dibala. The episode ends as Cameron reacts in shock.

Music

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Reception

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The episode was the most watched show on Fox TV that week with 13.31 million viewers.[4]

References

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Revisions and contributorsEdit on WikipediaRead on Wikipedia

Known Unknowns

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from Grokipedia
"Known Unknowns" is the seventh episode of the sixth season of the American medical drama television series . It first aired on Fox on November 9, 2009. The episode was directed by and written by Matthew V. Lewis and Doris Egan. In the episode, a teenage girl is admitted to with severely swollen hands and feet after a night out; her condition deteriorates as she becomes combative and dishonest about her activities, complicating the diagnosis. Meanwhile, , Cuddy, and Wilson attend a medical conference where personal secrets from House's past are revealed, and tensions arise in Cameron and Chase's relationship.

Production

Development and writing

The episode "Known Unknowns" was written by Matthew V. Lewis and Doris Egan, with direction by , and it originally aired on on November 9, 2009, as the seventh of the sixth . The script drew inspiration from established medical cases linking hemochromatosis—an inherited disorder causing excessive iron absorption—with heightened susceptibility to severe infections from , a bacterium often contracted through raw consumption, which the writers adapted to heighten dramatic tension in the diagnostic process. A central thematic element integrated into the writing was the concept of "known unknowns," borrowed from U.S. Secretary of Defense Donald Rumsfeld's February 12, 2002, press briefing on uncertainties surrounding Iraq's weapons of mass destruction, which the scriptwriters employed to underscore the protagonist's professional diagnostic ambiguities and interpersonal secrets. Key script decisions included weaving the subplot of one team member's confession into the ongoing narrative arc from earlier episodes involving a political figure's treatment, thereby exploring ethical repercussions within the post-season 5 team reconfiguration. Additionally, the writers incorporated a dilemma centered on a colleague's involvement in , building on prior season explorations of end-of-life to frame personal moral conflicts.

Casting and filming

Michael Weston reprised his role as the recurring guest star Lucas Douglas, portraying Cuddy's boyfriend in a manner that heightened the interpersonal tensions between the characters of and Cuddy during production. The episode introduced guest stars including newcomer as the patient Jordan and as Jeffrey Keener, the comic book artist, both delivering their initial performances in the series. Filming occurred primarily on soundstages at 20th Century Fox Studios in , , while the medical conference sequences were shot on location at Lake Arrowhead Resort in , , offering a scenic outdoor contrast to the confined hospital sets.

Plot

Medical case

In the episode "Known Unknowns," the central medical case revolves around , a 17-year-old admitted to Princeton-Plainsboro after collapsing with severe swelling in her limbs and torso the morning following a night out at a party. Her symptoms include edematous extremities, joint inflammation, low levels, and subsequent complications like skin lesions and organ stress, initially suggesting acute distress from her activities. The diagnostic team, under Dr. Gregory House's direction, begins with differentials including potentially triggered by partying-induced muscle breakdown, bulimia-related imbalances, and allergic reactions to food or substances encountered that night. Tests such as , screens, and barium swallows rule out muscle trauma, eating disorders, and common infections like , shifting focus to environmental exposures and rarer pathogens. Considerations of and heavy metal toxins are explored but dismissed, leading to the realization of dietary risks—specifically, raw consumption at the event. The final diagnosis emerges as septicemia, a severe bacterial exacerbated by undiagnosed hereditary hemochromatosis, which caused and heightened susceptibility to the pathogen. Treatment involves aggressive antibiotics like high-dose ceftazidime to combat the infection, iron-chelating to reduce excess iron from hemochromatosis, wound to remove necrotic tissue from emerging bullae and , and diagnostic confirmation through revealing iron deposits. House's methodology highlights navigating "known unknowns," where ambiguous symptoms mask interconnected conditions, prompting iterative questioning of the patient's history despite her . ultimately survives, stabilizing within days, though her recovery underscores the dangers of adolescent , including dishonest accounts of risky behaviors like consuming potentially contaminated . House's leadership in steering the diagnostics through these uncertainties proves pivotal to averting fatality.

Character subplots

In the episode, a significant unfolds at a medical conference attended by House, Wilson, and Cuddy, where interpersonal tensions reveal deeper emotional layers. House discovers that Cuddy is with Lucas, a , prompting jealousy and subtle attempts to undermine it, such as probing questions during casual interactions. This revelation ties into their shared past romantic history, including a during medical school that House never followed up on due to his impending expulsion, highlighting his lingering feelings and reluctance to commit. Wilson grapples with profound guilt stemming from euthanizing a terminally ill in season 5, an act he now contemplates confessing publicly through a conference speech on . As he prepares to expose the practice's prevalence in , intervenes decisively, drugging Wilson to prevent career-ending repercussions and delivering the speech himself under a to shield their . This act underscores House's protective loyalty, framing Wilson's decision as a compassionate necessity rather than a moral failing. Meanwhile, Chase's confession to Cameron about murdering Dibala, the African dictator from the episode "The Tyrant," severely strains their marriage, as Cameron processes the revelation in stunned silence without immediate reconciliation. This disclosure, initially mistaken for , exposes the ethical fractures in their relationship and foreshadows ongoing conflicts. Foreman assumes a minor but pivotal role in leading the diagnostic team during House's absence, reflecting his ongoing adjustment to leadership responsibilities following Lawrence Kutner's suicide at the end of season 5. His contributions to the team's problem-solving efforts, such as questioning witnesses and coordinating tests, illustrate a subtle evolution in his confidence amid the power vacuum left by House's temporary unavailability. These subplots serve as emotional counterpoints to the central medical case, with the team's distractions amplifying personal vulnerabilities while provides remote guidance via phone.

Music

The episode "Known Unknowns" incorporates several licensed songs to enhance its atmosphere, selected from rock and pop genres. "Stadium Love" by Metric opens the episode, setting an energetic tone during an initial party sequence. "" by Metallica appears later, accompanying a moment involving a and rhythmic interaction. At a themed 1980s party, "The Safety Dance" by plays prominently, capturing the era's playful and nostalgic vibe. The episode closes with "Time After Time" by , underscoring a tender slow dance between characters. These tracks were licensed to evoke themes of youthful risk and uncertainty, aligning with the episode's exploration of the unknown. In addition to licensed music, the original score by composers Jon Ehrlich and Jason Derlatka provides ambient support throughout, including subtle cues that tie into the title's philosophical motif without direct lyrical references. No licensed songs explicitly named "Known Unknowns" are featured.

Soundtrack integration

The in "Known Unknowns" employs upbeat tracks during party scenes to underscore the irony of youthful exuberance masking impending medical crisis, aligning with the episode's of "known unknowns" in risky . For instance, Metric's song "Stadium Love" plays over the opening sequence as the teenage Jordan and her friend wait in line for a , establishing a vibrant, carefree atmosphere that sharply contrasts with Jordan's subsequent collapse from swollen limbs. Similarly, Men Without Hats' synth-pop hit "The Safety Dance" energizes the 80s-themed party where and Cuddy interact, heightening the thematic tension between perceived safety in social revelry and the unpredictable perils of health and relationships. Subtle swells in the original score, composed by Jason Derlatka and Jon Ehrlich, accompany key diagnostic revelations, amplifying House's process of navigating intellectual uncertainty. During a pivotal test, Metallica's high-energy rock track "Fuel" is used as House prompts Jordan to mimic drumming on a video, revealing hypokalemia through her physical response; the song's driving rhythm mirrors the urgency of the breakthrough while underscoring the episode's motif of hidden dangers emerging from routine actions. Derlatka's score, known for its minimalist tension-building cues throughout the series, here provides understated emotional layering without overpowering the dialogue-driven diagnostics. Songs with ambiguous or reflective lyrics further reinforce the Rumsfeld-inspired theme of unpredictable consequences, bridging personal and medical uncertainties. Cyndi Lauper's ballad "Time After Time" accompanies House and Cuddy's at the , its about support amid confusion echoing their evolving dynamic and the broader unpredictability in the patient case. This integration ties the to the narrative's core, where music not only punctuates scenes but illuminates the elusive "unknowns" in human vulnerability. In comparison to earlier seasons, "Known Unknowns" shifts toward and 80s pop for its youth-oriented subplots, diverging from the classical motifs often featured in House's personal moments in prior installments. This evolution reflects the episode's focus on and modern social risks, using contemporary sounds to differentiate it from the more introspective, orchestral elements in seasons 1 through 5.

Reception

Viewership and ratings

The episode "Known Unknowns" aired on on November 9, 2009, drawing 13.31 million viewers and topping the network's ratings for the week while ranking among the highest-rated programs overall. The episode marked an increase from the previous episode's viewership due to its scheduling following a two-week gap. The episode was broadcast in international markets throughout 2010. "Known Unknowns" outperformed the season 6 average of 11.5 million viewers, a performance attributed to its compelling subplots amid the series' declining but still strong ratings that year.

Critical response

The episode "Known Unknowns" garnered generally positive reviews from critics, who highlighted its effective blend of interpersonal drama and medical mystery. The season overall holds a 93% approval rating on . IGN awarded it an 8.3 out of 10, commending the escalating tension in the Chase-Cameron marriage stemming from Chase's ethical dilemmas and the clever integration of ongoing subplots, such as House's complicated dynamics with Cuddy amid Lucas's reintroduction. Similarly, critic praised the episode for showcasing subtle character growth in House, particularly his vulnerable of feelings to Cuddy and his supportive intervention in Wilson's career crisis, which added emotional depth to their longstanding friendship. Mixed critiques emerged regarding the episode's structure and thematic execution. offered a tempered assessment, faulting the cold open's weak and the patient's case for feeling underdeveloped and disconnected from the central themes, though it appreciated the fun in House's scheme to impersonate Wilson at the and the solid chemistry between and . Sepinwall echoed concerns about the contrived return of Lucas as Cuddy's partner, viewing it as a missed opportunity to utilize the character more meaningfully, while noting inconsistencies in House's that undermined coherence. However, reviewers lauded the episode's exploration of "known unknowns" as a for hidden truths and regrets, tying the patient's to the characters' personal secrets, including Chase's of a morally ambiguous past action. The episode received no major individual awards or nominations, though its contributions to season 6's character-driven storytelling factored into broader recognition for the series, including a 2010 Primetime Emmy nomination for Hugh Laurie in Outstanding Lead Actor in a Drama Series. In retrospect, "Known Unknowns" has been cited in analyses of House's evolving regression—balancing fleeting maturity with habitual sabotage—and the handling of ethical confessions, with 2010s discussions appreciating how it advanced the Chase-Cameron arc toward dissolution while underscoring the risks of withheld truths. Recent overviews of the series, such as those examining interpersonal fallout in season 6, highlight the episode's role in deepening relational stakes without resolving them, contributing to the show's legacy of psychological complexity. Its solid viewership helped amplify these critical conversations at the time.

References

  1. https://www.imdb.com/title/tt1503411/
  2. https://www.imdb.com/title/tt1503411/fullcredits
  3. https://www.imdb.com/title/tt1503411/plotsummary
  4. https://tviv.org/House%2C_M.D./Known_Unknowns
  5. https://pubmed.ncbi.nlm.nih.gov/19349902/
  6. https://meridian.allenpress.com/aplm/article/125/8/1107/453157/Vibrio-vulnificus-Septicemia-in-a-Patient-With-the
  7. https://www.tvfanatic.com/house-season-6-episode-6-recap-known-unknowns/
  8. https://www.avclub.com/house-known-unknowns-1798207402
  9. https://www.givememyremote.com/remote/2009/11/11/house-known-unknowns/
  10. https://www.latimes.com/archives/blogs/show-tracker/story/2009-11-10/house-m-d-house-and-cuddy-return-to-the-80s
  11. https://www.imdb.com/title/tt1503411/locations/
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  13. http://www.housemd-guide.com/season6/607knownunknowns.php
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  15. https://clinic-duty.livejournal.com/34555.html
  16. https://www.wsj.com/articles/BL-SEB-13340
  17. https://www.tunefind.com/show/house/season-6/4281
  18. https://www.imdb.com/title/tt1503411/soundtrack/
  19. https://www.what-song.com/Tvshow/80/House-MD/s/251
  20. https://www.imdb.com/title/tt1503411/fullcredits/
  21. https://www.have-dog.com/house/
  22. https://www.tunefind.com/song/metallica/fuel
  23. https://www.jasonderlatka.com/
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  25. https://variety.com/2009/scene/markets-festivals/nfl-dominates-tv-ratings-again-1118011573/
  26. https://house.fandom.com/wiki/Known_Unknowns
  27. https://www.rottentomatoes.com/tv/house/s06
  28. https://www.ign.com/articles/2009/11/11/house-known-unknowns-review
  29. http://sepinwall.blogspot.com/2009/11/house-known-unknowns-truth-and.html
  30. https://www.imdb.com/title/tt0412142/awards/
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