Homer's Triple Bypass

"Homer's Triple Bypass" is the eleventh episode of the fourth season of the American animated television series The Simpsons. It originally aired on Fox in the United States on December 17, 1992. In this episode, Homer suffers a heart attack due to his very poor health and diet. Dr. Hibbert tells Homer that he needs a triple bypass, but the Simpson family resorts to discount surgeon Dr. Nick after learning how expensive the operation would be in a regular hospital.

The episode was written by Gary Apple and Michael Carrington and directed by David Silverman.

Plot
One evening while eating dinner in bed, Homer seems to be having heart problems but is not concerned. The next morning, Marge makes him oatmeal for breakfast but he rejects it in favor of bacon and eggs, despite the chest pains he has been feeling. Driving to work, he hears an irregular thumping noise, and is relieved when a gas station mechanic tells him the noise is coming from his heart, not his car.

At work, Mr. Burns observes Homer eating and sleeping on the job, so he berates and threatens to fire him for his gross incompetence. The stress is too much for Homer who eventually has a heart attack. Homer is then taken to the hospital, where Dr. Hibbert informs him and Marge that Homer needs a coronary artery bypass surgery, which will cost $30,000. Hearing this, Homer has another heart attack, and the fee rises to $40,000. Marge and Homer both worry they will not be able to afford the operation. Homer manages to obtain an insurance policy, but has another heart attack as he is signing the contract, which causes it to be immediately revoked. He then approaches leaders of various religious communities, hoping they will give him money, without success.

Finally, he decides to be treated by Dr. Nick Riviera, who will perform any operation for $129.95. Dr. Nick rents a tape to learn how to perform this operation, but another program has been recorded over parts of the tape. In the operating theater, Dr. Nick does not know how to operate on Homer, but Lisa, who has been studying cardiology, calls down instructions from her place in the viewing gallery. The operation is a complete success.

Production
The idea for "Homer's Triple Bypass" was pitched by James L. Brooks. However, the writers disagreed with the choice of such a heavy topic. The episode was not written by a member of the show's regular staff due to the show suffering from a depleted writing team after the third season ended. It was scripted by freelance writers Gary Apple and Michael Carrington, who were hired by Brooks. Carrington would provide voice work for later episodes, such as "I Love Lisa" (as Sideshow Raheem), "Homer and Apu" (as a comedian), and "Simpson Tide" (as Homer's drill instructor). Apple and Carrington decided to have a scene where Lisa and Bart visit Homer before his surgery and were unsure of how to do it, so they approached Brooks, who made up the entire scene on the spot. Originally, the surgery was supposed to be performed by Dr. Hibbert, but it was later changed to Dr. Nick.

The episode's production staff decided that David Silverman would be able to make the episode funny, so he was selected to direct it. He went "all out" and did his best to make Homer's grimaces as humorous as possible, to keep the episode at least somewhat lighter in tone. Silverman added some special touches: for example, when Homer has an out of body experience, his foot was still touching his body to signify that he was not dead. A doctor acted as a medical consultant for the episode.

The episode was to have concluded with Homer eating a pizza in his hospital bed following the operation, and with Marge asking a nurse where the pizza had come from. This reflects the earlier flashback scene where Grampa Simpson watches Homer as an infant, chewing on a slice of pizza in the hospital. Out of concern that it was making light of the unhealthy lifestyle that had caused the infarction, the episode instead concluded with the family visiting Homer while he is recuperating in intensive care.

Cultural references
The opening sequence of the episode is a parody of American reality show Cops; it was not in the original animatic and added later because the episode was too short to fit in its required 22-minute length. When Homer is performing a sock-puppet show to Lisa and Bart, he uses Akbar and Jeff, characters from Matt Groening's weekly comic strip Life in Hell. Homer follows behind the house that was the birthplace of Edgar Allan Poe, which was placed in the episode by David Silverman. During this scene Homer starts to hear a heartbeat, a reference to Poe's "The Telltale Heart". The scene where Homer sings "O Holy Night" in a church as a boy is based on the film Empire of the Sun.

Reception
In its original broadcast, "Homer's Triple Bypass" finished 16th in ratings for the week of December 14–20, 1992, with a Nielsen rating of 14.3, equivalent to approximately 13.2 million viewing households. It was the highest-rated show on the Fox network that week, beating Married... with Children.

Warren Martyn and Adrian Wood, authors of I Can't Believe It's a Bigger and Better Updated Unofficial Simpsons Guide, called it "a cautionary tale that gives Dr Nick his biggest chance to shine." They also praised the "cloud goes up, cloud goes down" line. IGN noted that the episode "introduced fans to one of the show's more endearing background players, Dr. Nick." Krusty's line "this ain't make-up" is one of Matt Groening's favorite lines from the show.

Nathan Rabin writes "A crisis brings out the best in everyone in 'Homer’s Triple Bypass', especially Homer. The episode’s superb writing, voice acting, and animation don’t just make an animated sitcom about a man on the brink of death palatable; the make it consistently hilarious and ultimately quite moving."