He walked through the entrance of Princeton Plainsboro Hospital with a huff and a look of disdain. He glanced down at his leg, hating the every day pain that came with it. Suddenly he heard a familiar voice call his name, "House."
Not today… House thought. He started heading for the elevator, willing his leg to help him pick up his speed. He made it inside the elevator and right before the elevator doors closed, a hand stopped it. Lisa Cuddy walked into the elevator with a look of frustration directed at House. They waited until the elevator doors closed and Cuddy started, "House, I need you to teach some incoming medical students about kidneys."
"But, my leg hurts," House sarcastically replied.
"House, you haven't caught up on your clinic hours. If you do this, then you won't have to worry about clinic hours ever again."
"Pinky swear?"
"House, I will fire you. Its not too late to get our $100 million back." House knew he had lost. It had taken Wilson, Cuddy and other members on the board to keep House and remove Vogler. There was no one he despised more than Edward Vogler. So House replied, "What time?" with a pained expression.
"In 5 minutes. Don't be late."
"You knew I would accept because you would have a substitute immediately. But I'm willing to forgive because I'm such a nice person." House created what he thought was a puppy dogface. The elevator doors opened and House headed to the lecture hall.
House walked in and handed each student a number. "Hello, I'm Dr. Gregory House and I will talking to you about the kidney. Each of you will receive a number as I lack the care and effort to remember your names. First off, does anyone know what the kidney does?"
A woman with long brown hair raised her hand and House called on her, "Yes, thirteen. Please tell us what the functions of the kidney are. Enlighten us."
"The kidney is responsible for the processes known as excretion and osmoregulation. Excretion is the process in which the waste products of metabolism are removed from the body. Osmoregulation is the control of the water balance of the blood, tissue, and cytoplasm of an organism. The kidney also eliminates nitrogenous waste in the form of urine. And obviously, humans have 2, but only need 1, " the woman eloquently said.
"Very good. Now I am going to explain the entrance of blood in the renal artery to the exit of the filtrate, out the ureter and how this is filtered out the renal vein. First, the blood and its molecules are moved into the glomerulus."
"What's a glomerulus?" A voice asked.
"How do you not know what a glomerulus is? You're a medical student! For any other ignoramus in here, a glomerulus is an associated ball of capillaries that is part of a nephron, which also consists of a single long tubule. Continuing on before four interrupted, the force of pressure due to movement from a large tube into small tubes causes all of the small molecules and 20% of the water from the blood to move into the kidney tubule. Pressure of blood in an arteriole going into small capillaries and then into a small venule facilitates crude removal. The porous nature of the glomerulus enhances the process of crude removal because the pores are big enough to let any molecules through. The basement membrane, which filters out large molecules, acts as a crude filter allowing smaller molecules to pass out of the glomerulus into Bowman's capsule, which is a cup-shaped swelling around the glomerulus. So the blood cells and plasma proteins remain in the blood while 20% of the water and most of the molecules leave the blood and form the filtrate. Any questions so far?" The room remained silent, so House continued on, "The remaining molecules are pushed into the proximal convoluted tubule and crude removal of water and molecules is occurring due to osmosis, diffusion and active transport. I should hope you all know what those processes are. If you don't, what are you doing here? Anyway, half of the food molecules, water and minerals are moved back into the blood by diffusion and the remaining nutrients are moved into the blood by active transport. The nephron filtrate is moved into the descending loop of Henle, which is permeable to water but not to salt or if you prefer its actual name, sodium chloride. The water is moved out of the tubule into the interstitial tissue and eventually into the blood. The filtrate moves into the ascending Loop of Henle and salt is able to diffuse out, but the water is not so it remains where it is for now. Active transport occurs to remove the sodium chloride out of the last part of the ascending Loop of Henle. The filtrate continues through the Distal Convoluted Tubule and here there is fine-tuning of minerals and pH under the direction of mineralocorticoid hormones, which affect the membrane permeability that was mentioned previously. The filtrate is pushed into the collecting tube and as the filtrate moves down through the outer medulla, the salt is moved into the medulla by active transport. The filtrate is then moved into the inner medulla where more water is able to return due to osmosis of the interstitial tissue and eventually into the blood. Now can anyone explain what ADH is and its purpose?"
"ADH is a antidiuretic hormone which maintains homeostasis of water in the body and the blood by increasing the permeability of the membrane of the collecting tubule to the degree needed. Blood continuously moves until it is in the renal venule, " thirteen spoke up.
"Very good, thirteen. Now, the renal vein brings the blood back to the heart and the blood is brought from the heart via the renal artery. The renal pelvis is the collecting region inside the kidney, takes in the substances. The ureter is tube fed by drainage from the renal pelvis and from there is goes to the bladder and eventually the urethra where it will be excreted and removed from the body. Good. Now we're done. I need my guitar," House said somberly as he limped towards the door.
"We'll see you next week for the central nervous system lecture right?" four asked.
"Wha—Yeah that'll definitely happen." House walked out the door and headed for Cuddy's office.
"He was being sarcastic wasn't he?" The remaining students groaned in exasperation.
"Okay Cuddy. I taught the little students. No more clinic hours."
"House, go do your clinic hours until you get off work. That should help you catch up."
"Aw, but you pinky sweared."
"Now, House."
"Okay, but get this, I'm not doing a lecture on the central nervous system. This isn't going to be an every day routine," House said as he placed his hand on his door, getting ready to exit. "Now I know everybody lies. You just gave me justification for it." House said as he headed out of the office and out of the hospital to his house. House got home and headed for his guitar. He strummed the tune, "Enjoy Yourself (It's Later Than You Think)" with a knowing smile on his face. And for once in a long time, House forgot about the pain in his leg.