A father and son both present with overlapping symptoms including back pain, urinary retention, cardiac arrhythmias, kidney dysfunction, and psychosis. The diagnosis is ultimately variegate porphyria, a genetic metabolic disorder triggered by lidocaine in the father (from wound treatment) and antihistamines in the son. This diagnosis is the central mystery of the episode and drives the plot, revealing their biological relationship.
Also known as: Bladder dysfunction
An early presenting symptom in Driscoll, causing urinary retention. Initially investigated as a separate condition before being recognized as part of the larger porphyria diagnosis.
Also known as: PAT
Driscoll develops severe tachycardia (heart rate 170) requiring multiple doses of adenosine and diltiazem drip. This cardiac complication was a significant symptom that helped narrow the differential diagnosis.
Also known as: Psychotic break
Driscoll becomes violently psychotic, believing medical staff are trying to kill him and choking a doctor. Required restraints and Haldol. This neuropsychiatric symptom was later recognized as part of his porphyria.
Also known as: Seizure
Landon develops seizures as the porphyria progresses, indicating neurological involvement and disease progression requiring urgent treatment.
Also known as: Kidney failure
Both father and son develop kidney dysfunction with low sodium causing severe muscle cramps. This complication is serious enough that liver transplant is discussed as potential definitive treatment.