House in the House!

(heheh... heh... okay, well, if you saw the last post, you'd get it, oh, and then if you followed me on twitter, you'd know that I'm kinda weird about House... anyway...)

Last night's show... wait, um, possible spoiler alert, if you have some sort of space-age device that allows you to watch the show long after it airs, and maybe you haven't seen it yet....

Anyway, last night's show focused much more on House's doormat-y best friend, Wilson, whose compassion and dedication to his patients nearly cost him his liver.


It brought up a lot of interesting dilemmas concerning ethics and boundaries and compassion and guilt and the role of the doctor/healer/therapist.

On the one hand, Wilson (head of the oncology department, and while we rarely see him in professional action, we know that he has a sensitive nature, but a very hard time saying no to people) has a gift for his ability to listen, and in one highlighted case, he saved a patient from certain death, all because he noticed what this patient didn't say. (This patient, normally effusive about his grandkids, didn't mention them during a follow-up exam, indicating depression to Wilson, which caused him to reexamine said patient and found cancer in his lungs, which was immediately removed.. just so you can dig how attentive Wilson is.)

On the other hand, another patient whose cancer was in remission for some years and was now forever bonded in gratitude and friendship to Wilson, and through a series of unfortunate events, found himself at risk of losing his liver and dying within 24 hours. Given that Wilson was heading his case, this 'friend' demanded, in the presence of his ex-wife and daughter, that Wilson give him a part of his liver.

It was only right, after all.

But I'm a doctor, Wilson said.

Well, then, I'm firing you as my doctor, he said. Now you're just my friend.

But you're a doctor, the hospital administrator said. And, I didn't make you head of oncology because of your availability of body parts. (ooo, good one!)

You're a doctor. And you're a doormat, offered House, in his usual helpful way. And besides, if you die, I'll be alone.

Leaving Wilson to feel responsible for yet one more broken human, while he struggled alone with guilt, and the duties of love and friendship, and doctor-ness, and "The Right Thing To Do", while he went ahead with handing over a piece of his liver anyway, thereby saving the guy, who went on to make insensitive decisions with his redeemed life that disappointed Wilson in the end, but that's a WHOLE 'NUTHER story about generosity and expectations....

So yeah. Where is that line?

Boundaries are necessary. Dammit Lists are life-saving. Clearly-defined roles and appropriate behavior as doctors and therapists and parents and employers and passers-by cultivate a much-needed sense of security in our society as we go about our business of living and trusting.

But we're all human. Ultimately equal and fragile and mortal in the grand scheme of things.

Granted, I doubt any of my clients or friends would have the audacity to ask me to hand over an organ, like this guy did, sparing me this particular moral dilemma.

But what if someone needed my liver - really, only a piece of it - or another vital item in my possession which they would die without - could I possibly weigh the value of my life over their own, and still be able to sleep at night?

And as a doctor, if I took a vow of "do no harm", and was committed to doing everything in my power to preserve life, and, well, technically this would be in my power, wouldn't I be bound to do this?

Again, I ask, where is that line?

Was Wilson really a doormat? Or a saint?

And what of the myriad non-internal-organ sacrifices I choose or not choose to make in my practice - those concerning fees, and time spent on days off, and listening ears, and small favors?

I suppose, ultimately, it's up to us as individuals and what we can or cannot live with. What drains us, what energizes us, what allows us to feel that we were of service without feeling depleted or deprived ourselves.

Whether it's guilt that informs our decisions, or service.

I think for Wilson, it was a bit of both. Being compassionate by nature, he felt good about the choice he made. But having had past experiences of loss in which he believed he 'could/should have done something', and an expectation of saving more than just his ballsy patient's life, we can assume that he had some hope of redemption with this act. 

To take a stab at answering my own question, about the elusive line, perhaps it depends a lot on our own inner store of resources, and about which well we're drawing from when we give of ourselves to help others.

Or maybe it should, rather than a static definition of appropriate boundaries.

What do you think?