(We see a kid's pool party going on, but from a rather fuzzy point of view, all the sounds seem to be amplified - turns out we're seeing it from the eyes of a man - Richard. Scene now shifts to a man sitting down watching the party a little further away from the pool in the shade. There's a woman operating a barbeque)
Arlene: Mark? Mark! Mark, please ask your father if he wants a burger. I know, you're defending the free world, please ask your dad if he wants a burger.
[The boy approaches his dad; he's wearing swimming trunks and is playing with a water gun]
Mark: Dad? [The boy keeps talking but we only hear the sound of static.] Dad? Mom wants to know if you want a burger.
[The man is unresponsive and the boy walks away.]
Mark: Mom, I don't know what he wants, you ask him.
[The woman approaches the man.]
Arlene: You want a burger? [She mouths "okay" but we can again, only hear static.]
[From the man's point of view, we now see him moving the controls on his wheelchair so that he is by the edge of the pool. He seems to look at the pool for a moment before controlling the wheelchair straight into the pool.]
(Scene starts with a silhouette of someone running - this person turns out to be House! There are lots of lovely shots of his lean lanky body sweating and jogging along to 'Feel Good Inc' by the Gorillaz. He stops for a while and we see the scar from the gunshot in the previous episode on his neck, he feels his pulse and smiles happily.)
(Scene shifts to the hospital that morning, in Cuddy's office - Wilson and Cuddy are looking at patient files stacked on the table; in front of Cuddy there is an open bottle of water.)
Cuddy: The guy drove his wheelchair into a pool, House would love that!
Wilson: He'll be bored. It's a great visual but it's diagnostically boring. What about post-hair transplant aphasia guy?
Cuddy: Infection throwing clots, House will shoot it down and call you an idiot.
Wilson: Oh, well we wouldn't want that.
Cuddy: What about yoga girl?
Wilson: Has a good hook.
Cuddy: Should we lead with it?
Wilson: His first day back, might want to flex his sarcasm muscle; maybe we open with one of the weaker pitches.
[House suddenly bursts into the office, still in sweaty T-shirt and shorts from his run - Cuddy and Wilson stare.]
Cuddy: You ran here?
House: It's just... 8 miles.
Cuddy: Why did you...? [Holding the bottle of water.]
House: Why does a dog lick its - [He takes the water from her hand and starts to drink it. Yes he's just drinking her water.] what's a workplace acceptable euphemism for testicles?
Wilson: Because he can.
House: What have you got for me boss?
Cuddy: I thought you said you needed 8 weeks of rehab. You should have been back here?
House: [He puts down the water and picks up a file.] If I'd come back sooner, I'd only be able to run 6 miles. I never would have made it in. What have you got for me?
Cuddy: You're completely pain free? The ketamine treatment can wear off.
House: It's been 2 months. It's not wearing off. What have you got for me? [He picks up one of the files and starts looking through it himself.]
Cuddy: It can take as long as--
House: Why are we having this discussion? Want to hear me thank you again? Thank you Dr Cuddy. Not just for removing the bullet, but thank you for putting me in a ketamine-induced coma and changing my life. Happy? I am.
Wilson: Middle-aged man: had hair transplant about 2 months ago--
House: Infection throwing clots, you're an idiot. [Cuddy throws a smile at Wilson.] Except you're not an idiot, [House looks at Wilson and then Cuddy.] and she's holding a file for a 26-yr-old female, what have you really got for me?
Cuddy: Girl was doing an inverted yoga pose, neck snapped, paralyzed from the neck down except the x-rays show no evidence of spinal injury. And she's cute.
House: Oh, well played sir! [He grabs the file off Cuddy but continues to read the one in his hands.] What about Stephen Hawking trying to do the 500 butterfly?
Wilson: Forget it - brain cancer, brain surgery - there's nothing left to diagnose. I would take the other one.
House: Hmm... I'll take them both.
[Wilson furrows his brow in confusion and he shares another look with Cuddy.]
(House exits the clinic with the files and starts walking across the lobby. Wilson catches up with his briefcase and they walk together up the staircase.)
Wilson: You don't think he had brain cancer?
House: Of course he had brain cancer; even oncologists don't screw up for 8 years.
Wilson: So if there's no diagnostic issue why are you taking the case?
House: Treatment can be interesting.
Wilson: Not to you.
House: I've changed.
Wilson: No, you haven't.
House: No, I haven't.
Wilson: Then why are you taking the case?
House: Guy tried to kill himself.
Wilson: The guy had cancer, he's a lump; he hasn't been able to touch his wife, speak to his kids.
House: He's been in that chair for 8 years, his muscles have atrophied. Maybe I can help him with the pain. Isn't that enough of a reason to want to help?
Wilson: Not for you.
House: I've changed.
Wilson: No you haven't.
House: Then why am I taking this case? [He suddenly sprints ahead of Wilson and runs off.]
(House has changed into more proper work clothes and walks into the office with the files.)
House: Let's start with the cute paraplegic.
Cameron: Welcome back!
Chase: Hey!
Cameron: You look...
Foreman: Healthy.
[Chase gives House a pat on the shoulder, then realizes a second later that that was really rather too chummy. House gives him a weird look.]
House: Quad with no broken neck, struck me as odd.
Cameron: Uhh... you could take a whole 2 minutes to ease into being back.
House: Taken a whole month to ease back, 8 weeks is the maximum rehab time for a gunshot wound to the stomach and neck. So, go. [He takes a drink from the fridge and starts drinking.]
Cameron: We heard they never found the guy. There's no new leads?
House: What? You think he might have shot this patient too? Would explain her symptoms...
Chase: Could be MS.
House: See? It's not so difficult.
House: It's not MS. She had no symptoms before she climbed on to her head. Unless she's been upside-down for the last 10 years, MS ain't it.
Foreman: Could be transverse myelitis, swelling in the disk choking off nerve function.
Chase: MRI's negative for that.
[House's gaze is caught by the stain of his blood on the carpet from when he was shot in the last episode. There are signs that they tried to wash away the rather large blood stain, but it is still very visible.]
Cameron: The leg looks fine. You totally pain free?
House: When did this turn into 'what did you do over your summer vacation'?
Foreman: It's a little weird to discuss the case while you're staring at your blood on the floor.
Cameron: I asked Cuddy to replace the carpet.
House: No, I like the carpet. What did you do over the summer?
Cameron: [Enthusiastically.] I--
House: Re-do the tests. [He walks away from her.] Let's see if the source of the problem is in the limbs or the spine. Do an EMG. [The Ducklings prepare to walk out.] Whoa, whoa, whoa! Got a whole other quad to cover; this guy's still got fluid in his lungs.
Cameron: You don't think that's from the pool he drank?
House: Give him an O2 mask. His leg muscles have atrophied, tendons have shortened from disuse causing intense pain. Tendon surgery will make him more comfortable.
Chase: Comfortable? [Raised eyebrows from the Ducklings.]
House: Scoot.
(Scene shifts to Richard in surgery, Arlene and Mark are watching from the observation deck.)
Arlene: Thanks for being here.
[Camera pans out to reveal...]
House: Not a problem.
Mark: My dad wouldn't kill himself.
House: You haven't spoken to him in over 6 years.
Mark: I know my dad.
Arlene: Mark, the doctor's just trying to--
Mark: He wouldn't kill himself.
House: Fine. I'm wrong. You obviously have a better understanding of this man who drools in front of your TV set 24 hours a day.
Arlene: Dr. House...
Mark: Look, he must have been confused. It must have been an accident.
House: Hope it was a suicide attempt. If he was trying to kill himself then he knows how miserable his life is, means there's still something there to kill; means your dad's still there.
[Cameron walks in after a knock.]
Cameron: Sorry, need you.
Arlene: [Quietly.] Thank you. [She hugs her son.]
[House and Cameron walk out and continue across the hospital corridors.]
Cameron: We were doing the EMG but we never got past the insertion of the conduction pin. Did she just say thank you?
House: I loaned her some money. What went wrong?
Cameron: Nothing went wrong.
House: Nothing went wrong then something went right.
Cameron: You're not going to tell me why she thanked you?
House: You're not going to tell me what went right?
Cameron: You did something for which she is grateful and you're... embarrassed?
House: For you. Saw you coming up, thought you were a 14-yr-old boy, I set her straight.
Cameron: I'm not telling you what went wrong - or right, until you tell me why she said thank you. [She stands with hands on hips.]
House: Ohhh, you got me. You know I need to know, I'm so going to fold. Except you're forgetting, there's one thing I can do now. [He casts a curious glance at something behind her, she turns to look and he quickly runs off, she laughs and follows.]
[Scene quickly changes to Foreman and Chase talking to Yoga girl, who's name is Caren.]
Foreman: It's either that or a reflex response.
[We hear the sound of House running up before he slides into view.]
House: What happened?
Foreman: Ok, this is Dr. House. House, this is Caren--
House: Pleasure's all mine, what happened?
Chase: When we inserted the conduction pin, she flinched.
House: [To Cameron as she walks in.] She flinched! Did you hear?
Caren: Does that mean I'm getting better?
House: How big is a flinch? Bigger than a twitch? Smaller than a spasm? [Chase inserts the pin again so House can see the flinch.] You smoke?
Caren: Socially, a lot.
House: You do yoga and you smoke?
Caren: I know it's hypocritical but--
House: Not at all, the world sees your legs, no one's checking out your lungs. [He goes and checks out Caren's handbag.]
Cameron: How would smoking cause--
House: It wouldn't, just needed a lighter. [He takes one out, goes to the bottom of Caren's bed, holds a foot in his hand and turns on the flames right under it. She screams and jerks her leg away and he stops.]
Cameron: House!
Caren: My god!
House: [Gives the puppy dog eyes.] The case was looking so promising.
Caren: Hey, I'm not faking.
House: You moved, therefore you can move. Get this lunatic out of here before she bores again.
Caren: I'm not faking!
[Foreman gets a cynical look on his face.]
(Change to night time the same day - there's now a second floor built above the lobby that has a balcony too. House is leaning on the balcony overlooking the lobby, watching people walk in and out.)
[Wilson walks up to join him.]
Wilson: I heard you were watching surgery with a patient's family. Talking to a patient's family. It's because of your hallucination, isn't it? After you were shot? You chose life; you decided you wanted meaning, so you took a case with no mystery. Something any doctor could do. A case with no upside except the satisfaction of helping another human being.
House: She thanked me.
Wilson: And... you felt nothing.
House: Wasn't even sure what I was supposed to feel.
Wilson: It's like your leg, its atrophied. Keep working it, the feeling will come.
[Cameron walks up to them.]
Cameron: Sorry, need you, again.
House: Told you to get rid of her.
Cameron: It's a good thing we didn't. Tightness in her chest, she can't breathe, it could be pleural effusion.
House: Right. Either that or she's holding her breath like a 4-yr-old.
[Scene change back to Caren who is gasping for breath; Chase and Foreman lift her into a sitting position as House enters holding a great big needle. He hides it from her view as he crouches at the bottom of her bed to talk to her.]
House: Relax. I'm not going to burn you again. I'm going to STAB YOU! [He brings out the needle suddenly, trying to scare her. Caren continues gasping for breath.] Look, either you're faking, or you've got a pleural effusion - that's a build-up of fluid around the lungs which is very serious - and I would have no choice but to stab you in the back with this needle and suck all the fluid out of you. [Caren looks terrified, but continues gasping for breath.] So--
Cameron: We should give her a local.
House: That would defeat the point of me being nasty. [He stands next to her with the needle.] Ready? [He raises his arm and pretends to strike until he notices a distended jugular vein on her neck.] Down.
Foreman: But she can't breathe if she's down.
House: Down!
Foreman: She can't breathe--
House: Down! Down, down, down! Come on! [He pushes her to lie flat on her back again before he spears the needle straight into her chest to the surprise of the Ducklings, and starts drawing out blood. Caren's breathing becomes easier.]
Foreman: That's not a pleural effusion.
Cameron: Problem's in her heart.
House: Can't fake that.
(Scene changes to the next day; Chase is now the one drawing the blood from Caren who is on a ventilator.)
[Scene shifts back to the Diagnostics office.]
Chase: Had to relieve the pressure 3 times in the last 2 hours. So either we figure out what's causing blood to build up around her heart or I follow her around with the needle for the rest of her life.
Cameron: Echo was clean, no structural abnormalities.
Foreman: Could be an infectious process. TB?
Cameron: Or vasculitis would also explain the effusion.
House: But not the paralysis. Let's assume that she wasn't faking it.
Cameron: She moved, therefore she could move. She wasn't paralyzed.
House: Ehh... doesn't mean she was faking, could have been a delusion. Now, either she was faking, and coincidentally got a real cardiac problem at the exact same time, or it's a delusion and the fake paralysis is a real neurological symptom.
Foreman: You're thinking vascular tumor on her spine?
Cameron: Her platelets are normal.
Chase: And she's been scanned up and down, it's all clean.
House: So, open her up, and find it. [He bounces the ball he normally plays with on Chase's head - to Chase's annoyance.]
Foreman: So what do you want us to do? Start at her neck and just keep cutting down her spine until we stumble on something?
House: That should work. [He tosses the ball back to Chase before walking out the door.]
(House is checking Richard with a stethoscope while Arlene watches on.)
House: His heart rate's a little high.
Arlene: Should I be worried?
House: Probably just means he's still in discomfort from the surgery. I'm going to up his morphine a little.
Arlene: You've been so nice to us.
House: That's the job.
Arlene: No, I mean all the other doctors, all they did was obsess on the... the cancer, the treatment, the damage... just trying to fix him. You're the first doctor that's ever given a damn about the quality of his life.
House: His heart rate's come down, the morphine worked I was right.
[He quickly walks out of the room. Cameron, who has been eavesdropping from behind the door, joins him.]
Cameron: What a touching moment. That's why we become doctors. For those rare moments when our hearts are warm--
House: Would you like to get a drink?
Cameron: Are you serious or are you just trying to change the subject?
House: No, I'm serious. I drink, you drink. We could do it at the same time, same table. Do you eat? We could do that too. I mean, if the answer's no that's cool but... [He waits for her response as they stop in front of the elevators.]
Cameron: No, I... it's just... you're just coming off the surgery and you're not yourself yet and I work for you and even though last year's... [Frustrated sigh as House starts smiling smugly.] you're smiling! I'm saying no and you're smiling!
House: Oh, don't take it personally. Its just coz you're full of crap. You have no interest in going out with me. Maybe you did, when I couldn't walk and I was a sick puppy that you could nurture back to health. Now that I'm healthy, there's nothing in it for you.
Cameron: You are not healthy. [House continues smiling.] Cuddy wants to see you.
(Scene changes to Cuddy's office.)
Cuddy: You've been back at work 24 hours and you're already playing hide and seek in a woman's spine.
House: Who won the pool?
Cuddy: There's no tumor. Her platelets are normal, scans--
House: What's the worse that can happen? I paralyze her. She won't even notice.
Cuddy: Her lawyers might. You're not doing the surgery. And lower the morphine on your other patient.
House: [Sits down in the chair opposite Cuddy.] Fine, I'll lower it. If you'll let me do the surgery.
Cuddy: What? You want a trade? We're not swapping a couple of goats for your help putting up a barn.
House: You want something, I want something. We compromise. It's the grown-up way to resolve our differences.
Cuddy: There already is a mechanism for that. It's called the employer-employee relationship. I get what I want, and you don't.
(Scene changes to night-time the same day; House is back on the balcony over the lobby. This time he has a bunch of grapes. He alternately eats some and throws others into the bin attached to the back of the trolley that the cleaner is using while cleaning the lobby downstairs. The cleaner is unaware of House's presence.)
[Wilson approaches once more.]
Wilson: You tried to swap?
House: Ran a few more tests, came back negative, surgery's on. [The next grape he throws does land on the cleaner's head. House quickly and guiltily shuffles back out of view from below, leaving Wilson standing there alone. Wilson does an apologetic hand gesture and turns back to face House.]
Wilson: You really don't give a crap, do you?
House: Does that make me evil?
Wilson: Yeah.
House: The girl's life is at stake, what we're talking about with the guy--
Wilson: What we're talking about is the reason you took the case; to help someone.
House: Too bad for them.
Wilson: Too bad for you. The reason we crave meaning is because it makes us happy. The first level of happiness is--
[House rolls his eyes and walks away.]
Wilson: I'm not going away. [He immediately follows.]
[Scene cuts to House observing Caren's surgery from the observation deck above. Wilson is still following him.]
Wilson: The fifth level of happiness involves creation. Changing lives.
House: Sixth level is heroin; seventh level is you going away.
Wilson: You're saving lives, which is tantamount to creating lives but all you're taking away from this, is the game. You don't have to listen to them thanking you, you don't have to change the cases you take or even how you handle them. You just have to know that you made a difference.
[House has been busily observing the surgery. A nurse had to remove the nail polish off one of Caren's big toes to clip something on it, House quickly moves to intercept the procedure, leaving Wilson on the observation deck sighing.]
[House bursts into the surgery.]
Surgeon: House, you're not--
House: I'm not an idiot. [To nurse.] Move.
Surgeon: House, leave her alone.
House: Close her up, you wanna know why?
Surgeon: The room's no longer sterile.
House: True, it's not the most interesting reason. [He shows the Surgeon Caren's big toe which is has a very ugly cracking yellow nail, and the area around the nail looks bruised and bleeding.] That is not a sexy big toe. You'd never put that in your mouth.
Surgeon: What the hell has that got to do with--
House: Told you it was interesting; it gets even better.
(Scene cuts to Caren sucking orange juice out of a straw from a plastic cup Foreman is holding up for her.)
Caren: Scurvy?
Foreman: Yeah. Drink.
Caren: Like what sailors get when they don't eat right?
Foreman: Aye, aye. Your arms and leg tissues are choked with blood. Makes it hard to move. Also damages your hair and toenails.
Caren: But I'm on this great diet, lots of protein, lots of--
Foreman: [Holds up another cup when she's finished with the old one.] No vitamin C. Now drink.
Caren: Well... thank you. And thank Dr House.
Foreman: Send him a note.
(Scene changes to Richard's room.)
Arlene: The uh... nurse changed his morphine, I thought you were worried about--
House: It's just post-op discomfort. He's ready to go home.
Arlene: So he won't have any pain?
House: Eventually.
Arlene: Thank you.
House: Everything else will be the same.
Arlene: Well, you took away his pain and that, that changes a lot.
House: Why don't you put him in some sort of... facility? Some place without a pool.
Arlene: Yeah. I could dump him there, except he's my husband. He's my son's father.
House: Right. Kids need a dad; someone to play catch with. Talk about girls.
Arlene: Mark's learned that you don't have to abandon someone just because--
House: Get a dog.
Arlene: I'm taking care of him for the same reason you helped us.
House: Some guy shot you and you hallucinated?
Arlene: I have a responsibility.
House: So he's just an anchor weighing you and your family down, sapping your energy, wasting your life - that's the meaning you take from this?
Arlene: I want to take care of him.
House: You enjoy this?
Arlene: I can't abandon him.
House: So you don't want to take care of him. Taking care of him doesn't fulfill you, make you happy. But not taking care of him would make you miserable.
[Arlene makes a little sound of acknowledgement then moves to Richard's bedside to move him into the wheelchair all by herself.]
Arlene: Okay, here we go.
[Richard lets out some grunting noises as she attempts to help him off the bed. House comes to stand by the bedside.]
Arlene: I don't need your help, I've done this a million times.
House: Here, let me...
[They let Richard back down against the pillows.]
House: Do that again, make that sound.
[He leans in close to Richard's mouth and listens to the grunting sounds.]
Arlene: What was that?
House: That... was talking.
(House bursts into the Diagnostics office with a box filled with files on top of his skateboard.)
House: You guys are lousy doctors. You're in such a rush to make the patient feel better you forgot to check what was wrong.
[He pushes the box on the skateboard across the table, Chase grabs the box and he grabs his skateboard back.]
Chase: Yoga girl walked out of here 2 hours ago, you fixed her.
House: Not her, the other guy.
Cameron: He had brain cancer; they removed it 8 years ago. His condition's been the same ever since.
House: Until last night, he spoke.
Foreman: What'd he say?
House: Guhhhhhhh.
Chase: He grunted?
Cameron: You want us to dissect 8 years of medical history with grunting in the differential?
House: Sounds good. Call me when you're done.
(Scene change - House is trying to balance himself on his skateboard which is perched on a low stone bench outside in the university somewhere. Wilson is standing a little off centre watching him.)
Wilson: You're fabricating a mystery because you're bored.
House: I am not bored. [He attempts to do a trick where he pushes the skateboard down from the stone bench to the ground, while attempting to stay on it. He falls off.] Damn it.
Wilson: You didn't tell the wife it was only a grunt?
House: Of course not, because then she would never have consented to a bunch of dangerous tests. I don't remember you being this bitchy.
Wilson: The Vicodin dulled it, in the sober light of day I'm a buzz kill. You're giving false hope to a family that's been wrecked. Don't torture them, let it go, tell the wife it was only a grunt, tell her to go home.
House: Can't let her down like that, pumped her up with too much false hope. [He attempts the trick again and this time, he sticks on the skateboard.] Oh! I stuck that primo! How rad am I? [Wilson's only reaction is to look resigned.]
[Scene changes to House continuing to skate down a busy pathway; some girls walk past him and one looks back at him. He smiles back at her before suddenly grabbing that same old spot on his leg - it seems the pain has come back. He picks the skateboard up and keeps walking.]
(Scene shifts to the Ducklings in the corridor outside the Diagnostics office. It looks like late evening outside, they look tired and have the files strewn all over the floor.)
Foreman: 2002, patient had dry eyes.
Chase: Dry eyes plus a grunt, it all makes sense.
Foreman: He had neurological issues.
Cameron: I get hay fever, I put drops in my eyes, I don't go to a neurologist.
Foreman: Dry eyes could indicate an autonomic dysfunction; goes on the board.
Chase: What about coughing or boogers. Should we include boogers?
Foreman: I'm happy we're doing this, I'd much rather do this than lengthen some guy's tendon. Patient's headaches increased. Doc scanned his head, found a tumor.
Cameron: You like wasting your time?
Foreman: I'm learning.
Cameron: To do what? Reconsider solved cases because you don't want to deal with the real world? He's pushing when there's nothing.
Foreman: Cameron, you are an excellent doctor, you'll get lots of tearful thank yous from grateful patients.
Cameron: Yeah, am I such a bitch for wanting that?
Foreman: No, it's not a bad thing, but it's not why I'm here. I took this fellowship to learn from House.
Cameron: He's teaching you to be a masochist. [Foreman smiles.]
Chase: Dry eyes, goes on the board.
(The next shot we see is of the whiteboard, with about a gazillion different symptoms on it dating back 8 years - the next day.)
[The Ducklings all look worn out and exhausted.]
Foreman: In 8 years the patient experienced 214 symptoms, many of them repeating.
House: Any patterns?
Chase: Fever plus frequent urination could mean prostatitis.
Foreman: Or a urinary tract infection.
Chase: White count was normal, no infection.
Foreman: If you add pain into the mix, fever, frequent urination could indicate a kidney problem.
House: I like it.
Chase: No, creatinine and BUN were both normal.
House: Not the kidney part, the pain part. Abdominal pain plus all that stuff could equal a pancreatic cyst.
Cameron: Perfect, you managed to pick the one symptom he never had. Abdominal pain.
House: It's the first symptom on the board. Grunt.
Cameron: Grunting isn't pathognomonic for abdominal pain.
House: No, traditional diagnostic marker is compression of the diaphragm, vibration of the larynx leading to the audible sound 'I have a pain in my abdomen'.
Cameron: Richard's symptoms are culled from 8 years of medical history. They're not patterned. These are random individual events over time.
House: Illnesses have incubation periods. Do an upper endoscopic ultrasound.
Foreman: His throat will collapse, muscle degeneration in his neck won't tolerate the scope, it's an automatic trach!
House: You're talking about him like he's an invalid.
Chase: Yeah, we're insensitive.
House: Does he drool? Can he hold his neck straight? Does he choke on his food? His neck's fine, his throat's not going to collapse. Cameron, get consent from the wife.
(Scene changes to Chase performing the upper endoscopy on Richard while Foreman watches.)
Chase: Open. [No response. Chase has to pry Richard's jaw open and spray the sedative into the back of the throat.] I need you to swallow. [Again no response; Chase closes the patient's mouth and squeezes his nose, forcing him to swallow.] Sorry about that. Here we go. [He starts feeding the scope into Richard's mouth.] Passing through the lower esophageal sphincter into the atrium of the stomach. [He turns on the ultrasound.] There's the tail of the pancreas.
Foreman: Looks clean.
Chase: Moving medially, the body and the head of the pancreas look clean.
[Suddenly Richard starts choking on the scope.]
Foreman: Get it out, get it out!
[Richard's teeth have clamped on to the scope however.]
Chase: It's stuck, I can't move it. His throat's collapsed. [Alarms start beeping and Foreman quickly gets the equipment to do a tracheotomy.]
Foreman: Vitals all over the place. We're losing him.
Chase: Cutting.
(Scene cuts to Ducklings sitting together outside in the university while House skates around on his skateboard in front of them.)
Chase: We trached him, endoscopically removed the probe and he's breathing again. So, all in all, great idea.
House: Get a look at the pancreas before the world ended?
Foreman: It was clean.
Cameron: Which means barring anything else, meaning you, he can go home tomorrow.
House: This man nearly died. How can you discharge him?
Cameron: His throat collapsed because of what we predicted.
Foreman: You stick something down someone's throat, they gag, spasm, which he did. It took us a half an hour to get that thing out.
House: Except that our patient's throat was sedated. Which means the brain should have sent a signal not to do anything. This could be cancer, or some bizarre neuro-degeneration, even a new type of vasculitis--
Cameron: Stop it. [She stands up and stands in his way so he can't skateboard past her.] You're enjoying this.
House: I find it interesting.
Cameron: It's interesting only if you're right; if you're wrong we're torturing this guy to amuse you.
House: [Turns to Foreman.] Half hour to remove the probe? [Foreman nods.]
Cameron: House.
House: It's not a spasm. His throat didn't collapse, it locked down. Brain is supposed to tell every muscle in the body to relax and contract at the same time, this muscle was only contracting which means a signal from the brain was not getting through.
Foreman: There are no lesions on his brain, nothing to interrupt the new orders.
House: All it takes is one wire down.
Foreman: You have no evidence of any wires down.
House: A few micro-tumors on the meninges, suddenly you're choking to death.
Chase: You want to look at the lining of his brain? The amount of contrast material you need to pump up there just to see it--
Foreman: He will bleed into his brain!
House: No, he won't.
Cameron: Because that wouldn't be interesting. You can get permission this time.
(Scene changes to House talking to Arlene.)
House: The brain is enclosed in a sac called the meninges--
Arlene: Does this mean that the cancer's back?
House: No, no, no, no.
Cameron [Walking up to them suddenly.] House!
House: If we found cancer, it wouldn't be the original cancer. It'd be new.
Arlene: So what, more surgery? More radiation?
House: Might not be the worst thing. If this isn't just ancient history then maybe it's something we can correct. Might even get some brain function back.
Arlene: He could get better?
Cameron: No!
[House and Arlene look up at Cameron.]
House: But understanding what you're saying would be nice. Maybe you can figure out ways to communicate.
Arlene: Thank God he spoke to you. [She takes the consent form from him and is about to sign it.]
Cameron: Mrs. McNeil, the test to do this is very risky. He could die.
Arlene: He's already dead. [She signs the form.]
(Scene changes to Richard being prepped by Chase before going into the MRI machine; Foreman is in the little office behind the computer.)
Foreman: Chase, go slow.
Chase: Already injected it into his spinal canal. Next stop, his brain. [Richard is sent into the MRI machine.]
[Checks are done and we see the scans on the screen in front of Foreman.]
Foreman: Contrast material entering into the fourth ventricle. No parenchymal bleeds.
Chase: Blood pressure's high. But it's holding.
Foreman: Meninges are intact, no bleeding.
[Chase gets Richard out of the MRI, but upon inspection...]
Chase: Oh, God. Foreman, get in here! [Richard has been bleeding out of his ear.]
(Next shot is a beautiful one of House sitting alone on a stool in the middle of a room plastered with scans from the MRI.)
[Enter the Ducklings.]
Chase: Surgeon repaired the CSF leak.
Cameron: You're lucky he didn't die.
House: I'm lucky? He's the one who didn't die.
Cameron: We told you he'd hemorrhage.
House: Told me he'd bleed into his brain, not out of his ear.
Cameron: You've got to drop this.
House: We're missing something.
Foreman: We did a dangerous test and something bad happened, that's all this is.
House: [Gets off the stool and starts looking at the scans up close.] Give me a tour of the brain, Foreman. Walk me through the scans. 1998, what happened?
Foreman: 5 cm grade 4 astrocytoma between the parietal--
House: Nothing. Next, a speck on the superior temporal region.
Foreman: It's a regrowth, benign.
House: Star thingy next to the Rathke cleft.
Chase: Scar tissue from the biopsy.
Cameron: House every speck is not a suspect, its years of surgeons digging around in his head. Let him go.
House: Re-do every blood test he's ever had. Re-scan his head.
Cameron: No. [House turns around to look at her.] He's been sick and suffering for 8 years, I'm not going to help you make it worse; I'm not going to help you make it interesting.
House: That's ok, Foreman's better at that stuff than you are. We need 5mm cuts through the occipital and hypothalamic regions.
Foreman: No.
[Everyone looks over at Chase who looks undecided for a moment.]
Chase: How many millimeters? [House looks at Cameron like, 'this is why he's bee around longer than anyone else.']
(Scene cuts to Cuddy's office.)
House: I can help him.
Cuddy: That's it? That's your argument?
House: Seems like a good one.
Cuddy: If I thought for a second you wanted to help him, you'd have carte blanche. You're doing this because it's fun.
House: Does nobody in this hospital have anything better to talk about than my motives? My motives have nothing to do with the case.
Cuddy: Your motives have everything to do with your judgment.
House: For the first time in years I've got no opiates in my body, now you question my judgment.
Cuddy: 24 times a year you come storming into my office spouting that you can help someone. Only you never say those words, you say something like his pancreas is going to explode because his brain is on fire! You come here with medicine, not with platitudes.
House: I didn't want to bore you with the details.
Cuddy: There are no details, you've a hunch. House, you don't use hunches, you always have reasons. This hospital doesn't exist for your whims. I'm sorry. As of 7 am tomorrow morning, I'm sending your patient home.
(Scene cuts to House entering Wilson's office.)
Wilson: The answer's no. Cuddy called 30 seconds after you left and said you'd try an end around.
[House looks a little shocked but closes the door and goes to the balcony door while Wilson continues his work. House plays with the switch for the light in Wilson's office to Wilson's annoyance, but House looks very morose as he continues to stare out on to the balcony.]
House: My leg hurt.
Wilson: [Looks up suddenly.] How bad?
House: Enough that I'm telling you.
Wilson: Did it go away?
House: Ached for a while. First time I felt anything there since the surgery.
Wilson: But it went away?
House: It was muscular, it was some cramping. [Wilson smiles.] What are you smiling about?
Wilson: You're 40 something years old, you've been running God knows how many miles a day, fallen a hundred times off that skateboard and you're shocked to have some soreness?
House: Just give me a prescription.
Wilson: For Vicodin? House, people get aching joints, cramps, they put on an ice pack, they take some ibuprofen.
House: I know what the pangs of middle age feel like.
Wilson: No, you don't, because you've been stuffing vicodin every 5 minutes since you turned middle age.
House: The surgery didn't work.
Wilson: Don't play me.
House: You think this is a scam?
Wilson: I think you want me to feel sorry for you and either do the end around on Cuddy or give you the drugs. [He takes his pad of prescription slips and puts it away in a drawer under his desk deliberately to make his point.] Either way, you get the high you think you need. [House resignedly is about to leave the room.] House, your surgery worked, you're fine. It's just going to take time for it to feel good.
(Scene changes to night time, House is jogging again until he reaches the University. He tries to get a drink of water from the water fountain but it doesn't seem to be enough to quench his thirst or the heat of his body. He spots the much bigger fountain and decides to jump right into it and stands under the spray while he recovers his breath. He stands looking very puzzled for a moment before it's obvious he's just gotten an idea.)
(Scene changes to Cuddy sleeping, she wakes up suddenly hearing a noise. She quickly slips out of bed, turning on the lights and goes to the window to check where the noise is coming from when suddenly House pops up, scaring her. She turns away to calm herself down.)
House: [Whispered.] Come on. [He gestures for her to open her window so he can talk to her.]
[She draws the curtains and opens the window.]
House: Circumventricular system sends his cytokines, releasing the early stages of the immune response but CDOS releases prostaglandins that reset the hypothalamic set point upward, unless it's countered by antipruritic therapy. [He's panting as he says this obviously having run to Cuddy's house.] So yeah, his brain's on fire. The suicide attempt was not a suicide attempt; he drove that wheelchair into the pool because he couldn't regulate his body temperature. He had hypothalamic dysregulation.
Cuddy: And you discovered this when you stepped into the university pool? [She fetches him a towel and hands it through the window.]
House: Fountain. I can cure him.
Cuddy: Cure him? Even if the fountain proved anything, fixing hypothalamic dysregulation isn't going to regenerate brain.
House: No, but if the scar tissue on his hypothalamus is resting against the pituitary, the adrenals would shut down. Addison's disease.
Cuddy: You didn't see any scar tissue on his MRI, his CT scan--
House: His brain is functional.
Cuddy: His temperature's normal. There is nothing wrong with his hypothalamus or his pituitary!
House: I can make him walk! I can make him talk!
Cuddy: This is a wild guess! That came to you because you were... sweating.
House: Inject him with cortisol. The guy will have sex with his wife again, he'll hug his kid again. Hopefully that's the combination he was using, it'd be a shame if I'd cured a pedophile. [Cuddy smiles despite herself.] You're smiling, that's a bad sign.
Cuddy: [She nods.] You're high.
House: I told you, I haven't had anything in 3 months.
Cuddy: This is as high as you get. A theory that ties your case up in a neat little bow but you don't have a lick of substantiating proof.
House: [Sighs.] Your decision doesn't make any sense. There is no risk to a cortisol injection. If I'm wrong, big deal. He goes home a vegetable like he already is, but if I'm right--
Cuddy: This isn't about downsides or risk management. It is a big deal for you to understand the word no! I'm sorry, House. [She shuts her window and draws her curtains again, leaving House alone still outside her window.]
(The next day, House is sitting alone in his office in deep thought.)
[Wilson enters the office.]
Wilson: He's on his way out of here. Figure you'd be on your scooter racing down the halls to stab the patient in the neck with cortisol.
House: She was right to say no. I had no objective reason to think that I was right. Just needed the puzzle.
(Scene cuts to Cuddy watching from down the corridor as Arlene and Mark walk behind a nurse controlling Richard's wheelchair. They're waiting for the elevator.)
[Cuddy looks rather red-eyed when she suddenly makes a decision.]
Cuddy: Hold on a sec. [They stop.]
Arlene: Everything alright?
Cuddy: Yeah, it's just something I forgot. [She quickly takes out a needle and a piece of cotton swab. She tugs Richard's shirt down at his shoulder, swabs the skin and takes the needle out.]
Mark: What's that?
Cuddy: This is cortisol [She injects it into Richard quickly.] and it's to fight infection. [She finishes, and then gestures to Arlene to keep holding the shirt down.] Want to hold on to that? Just put a bandage on it.
[She puts on a quick plaster and looks at Richard a little warily. Arlene tugs Richard's shirt back into place as Cuddy tests Richard's pupil reflexes with a pen light. There seems to be no reaction at all.]
Mark: Is he ok?
Cuddy: [Softly.] Yes.
Arlene: Can we go now?
Cuddy: You can go.
[Cuddy walks back down the corridor completely dejected and the McNeil's walk into the elevator.]
Arlene: Excuse me. [To the person coming out of the elevator.]
[As the nurse is about to wheel Richard in however, Richard's arm twitches. He gasps in a breath and starts to move his hands to unbuckle himself from the wheelchair. Arlene watches this in shock and gets back out of the elevator.]
Arlene: Richard! Richard...
[Cuddy turns back to watch in shock as well as Richard puts his feet on the floor.]
Mark: Dad, you ok?
[Richard is actually attempting to lever himself out of the wheelchair and on to his feet. Arlene rushes up to him to help him.]
Arlene: Richard? Richard! Richard!
[Richard is practically on his feet though completely unsteadily, hugging his wife. She's crying in relief and happiness. Richard smiles and Cuddy starts to cry too.]
Arlene: Richard... you're... you're standing. [Richard makes a happy sound in response, nodding at what she said.]
[Richard turns to hug Mark and the whole family has a nice happy reunion.]
Arlene: [To Cuddy.] Thank you.
(A shot of House pacing in his office unhappily, completely unaware of what's happened.)
(Shot changes back to Cuddy talking to Wilson in the same corridor, but the McNeil's have already left by this stage.)
Cuddy: He got up. I have to go tell House.
Wilson: No. Cuddy, you can't tell him.
Cuddy: I have to tell him. He was right!
Wilson: Why did you do it? Why did you think he might be right?
Cuddy: Because he's House?
Wilson: Medically, what made you think he was right?
Cuddy: Nothing.
Wilson: He got lucky, that's all that happened. Telling him no was a good thing because next time he won't get lucky, he'll kill someone. Just because he was right doesn't mean he wasn't wrong.
[The wonderful theme song 'You Can't Always Get What You Want' by the Rolling Stones starts playing in the background.]
[Wilson and Cuddy stare at each other for a moment.]
Cuddy: I see him every day, I can't just...
Wilson: Everybody lies.
(Scene changes to night time, the music keeps playing. House is sitting alone in his office when he suddenly decides to walk out on to the balcony, across the wall and into Wilson's office. Wilson is long gone as House switches on the light, takes out Wilson's pad of prescription slips, takes up the pen and writes himself a prescription of Vicodin before taking that slip and putting the pad back where it was and switching off the lights.)
De retour à l'hôpital après son opération, House prend en charge deux malades. Le premier, Richard McNeil, est plongé dans un état végétatif en raison d'une tumeur au cerveau. Le malheureux est tombé dans une piscine avec son fauteuil roulant. La seconde, Karen, est une jeune femme paralysée à la suite d'une séance de yoga. Il semble que le docteur House ait réfléchi à son comportement passé avec ses patients. Il se montre en effet étrangement sympathique avec eux. Prévenant, attentionné, il veille au moindre de leurs désirs. Autour de lui, le personnel ne sait s'il doit se réjouir ou s'inquiéter.
