Who's the Jerk in this episode? Who isn't? House and Co.'s patient is a teenage chess prodigy who's a total asshole. He also might be my favorite patient this season. He calls Foreman gay, calls Chase "Doogie," and tries to have sex with Cameron. Everyone assumes that his awful personality is one of his symptoms, which also include headaches, rage attacks on the only hot chess player I've ever seen, and multiple organ failure. But when the symptoms don't add up, House decides to take the kid's assholishness off the list of symptoms, and that, combined with the strange way the kid holds chess pieces, shows him that the kid has hemochromatosis -- too much iron in his body. Which they didn't help too much when they made him eat a bunch of hamburger as a diagnostic test. But it's treatable, so the kid will live to torture his long-suffering, weak-willed mother another day. Meanwhile, Foreman's job interview is sabotaged, and everyone blames each other as to who did it. Of course, House is the real culprit, and Chase figures this out and urges him to tell Foreman he wants him to stay at PPTH. But when House goes to (possibly) do that, he sees Foreman in the lab, testing the kid's bloodwork for something Foreman doesn't think he has but is testing for anyway because House told him to, and he believes in House more than himself. And for that, House decides that all Foreman deserves is an all-nighter on test whose results are now irrelevant.
We open in the middle of a speed chess match. Several speed chess matches, actually, as we see rows of tables occupied by teenagers who wish they had friends. At one table in particular, we see a particularly obnoxious kid telling his opponent that he's lost the game when he's barely had the chance to play. The kid insists on not giving up, and the obnoxious guy sighs and taunts him some more. They play for a while, and shots of people slamming the timer thing always look cool. Finally, the obnoxious kid starts singing the familiar refrain of "na na na na hey hey hey goodbye" as he slides his bishop into a place from which his opponent cannot escape. His opponent, by the way, has got to be the most attractive man ever to play the game. Gracious, too, as he lays down his king and extends a hand for the obnoxious kid to shake, telling him good game. He starts losing his patience when the obnoxious kid merely glares at the extended hand. But something's clearly wrong, as the ominous music starts up and the obnoxious kid stands and looks pained. Suddenly, he grabs the chess timer and brains the hot guy with it, follows him to the floor, and beats him some more. Blood everywhere! Kids stand and gasp while the adults pull the obnoxious/homicidal kid away from the hot/dying kid. The slyer players take advantage of the distraction to move their pieces into more advantageous positions on their boards. The proctors tend to both kids, as one is bleeding profusely and the other screams that his head feels like it's going to explode.
When we come back, Chase is examining the obnoxious kid, who's named Nate, checking his eyes and asking him if his head still hurts. "Are you a moron?" Nate asks, pointing out how obvious it is that he's still in pain. Nate's pathetic mother stands in the corner and ineffectively tells her son to be nicer. He isn't, asking Chase if he still has theme birthday parties and saying that his trouble concentrating in school is limited to wanting to suck on his French teacher's boobs. Don't say that in front of your mom, Nate. By the way, props to the casting department for Nate -- the actor looks exactly like an asshole teenage chess prodigy should. Chase asks Mom if Nate eats sushi, believing a parasite to be the cause of his head pain, but Mom says her son was a vegetarian until a few months ago and his behavior hasn't changed since his new diet. Mom adds that ever since her darling son became a teenager, he's been a total asshole. She claims that no matter how much she yells and punishes him, he still acts like this. Yes, well, I do believe the phrase "box his ears" was created just for boys like Nate, Mom. I don't endorse physical punishment for children...usually. Nate, meanwhile, is sarcastically crying about his mother's woes of raising the worst kid ever while Chase stares at him disbelievingly.
"I hate this kid," Chase mutters as he writes "rage" down on the Whiteboard O'Symptoms. Or maybe that's just Chase's personal feelings journal, since I thought Chase wasn't allowed to write on the whiteboard. House immediately says that he likes Nate because Chase hates him. That, and the fact that Nate broke the cliché -- he didn't beat the crap out of a guy who beat him; he beat the crap out of a guy he already beat. Cameron mentions that Nate has pain in other parts of his body, but Chase discounts those as being from the seventeen other fights he's gotten in this semester alone. What the hell school does Nate go to that allows that? My high school suspended your ass off for one physical altercation and expelled you for the second. Cameron suggests a personality-altering concussion, but Chase says the MRI was clean, as was Nate's tox screen. Foreman starts to speak up, but House interrupts to do some sarcastic fake crying a la Nate, saying this could be the last time Foreman suggests an adrenal gland tumor. Sure enough, Foreman suggests it, but House says it doesn't explain Nate's personality disorder. Foreman doesn't think Nate has a personality disorder other than being a teenager. Oddly, House is convinced that Nate does, even though he himself acts like Nate all the time and that's not a symptom of anything other than being an asshole, right? Or maybe he thinks Nate's chronic cluster headaches are what makes him act like he does, just as House's chronic leg pain is his excuse for acting like he does, even though from what we've been told, House acted like an asshole before anything happened to his leg. Cameron doesn't think it's headaches, pointing out that the ER already gave Nate steroids for cluster headaches, and since those didn't work, he must not have them. Or, House says, the steroids just aren't working. He suggests something else: blood thinners and something called "transcranial magnetic stimulation." "Don't you dare touch that acerbic wit," he warns them. Aww, House has a favorite little patient. Maybe he'll actually meet this one!
Chase offers fifty dollars to the Cottage who treats "the brat" so he won't have to. Cameron The Kind tells him not to hate on the kid, who's acting out only because he's sick. When asked, however, she does not step up to take the case. Foreman offers to do it, since treating the kid now will leave him free and clear for his job interview this afternoon. Cameron offers him a "peer recommendation," for which Foreman thanks her. He looks to Chase for his offer of a peer recommendation, only to have Chase say that Cameron's should be enough. Ha ha ha! That's what you get for telling people you hate them, Foreman! Meanwhile, Cameron had better be plotting the awesome peer review she's going to write in which she details the time when Foreman stole her article and the other time he stuck her with a needle that was possibly infected with a fatal disease. Foreman just shakes his head like he has nothing to do with the fact that Chase doesn't like him.
Foreman waves a magic magnet wand over Nate's head while Nate complains of overall body pain that the painkillers he's been pumped up with aren't helping to alleviate. Like Chase, Foreman assumes the pain is from fighting and does absolutely nothing to investigate it further, which is a big old THIS WILL BE IMPORTANT LATER sign to me. Nate Houses that Foreman should "tell [his] homies to quit stomping on" him. Foreman can't wait to leave this job and go to a new one where he won't be subjected to racist comments from both his boss and his patients. Nate then asks Foreman if people watch what they say around him. "Because I'm black?" Foreman assumes. "No, because you're gay!" Nate says. And while I don't know if mouthing off to the guy trying to cure you and waving some crazy magnet thing over your brain is the best time or place to say something like that, I have to admire Nate's commitment to his asshole persona. As for Foreman, well, he does like to wear those light blue ties and purple shirts.
Nate's Mom watches the proceedings from the hall, not sure whether to be happy or sad that her asshole son is sick. Chase tells her that if Nate is suffering from chronic cluster headaches, that could be the reason why he acts like he does. If they can treat the cluster headaches, Nate's mom might get an awesome new son. She is beyond thrilled, and then feels guilty for clearly hating the person her son is now. Chase is very understanding, though, and Mom opens up to him that she thought she was a bad mother, either for raising such an awful son or for hating him or both, and she hated herself.
The morning, however, Chase tells House that the TMS and blood thinners didn't work, so Nate doesn't have cluster headaches after all. Cameron, who also thought Nate's body pain was something to consider, suggests hemochromatosis, but House immediately rejects that, since it wouldn't explain the personality disorder. Meanwhile, Foreman is sulking in the corner and refusing to contribute to the conversation. When prompted by House, he will only suggest "the thing that Cameron said" and cross his arms childishly. I think he needs a box around the ears, too. House washes his Vicodins down with a strange-looking bottle of some liquid and says that if the normal and abnormal cluster headache treatments didn't work, then they'll just have to try something else instead of, say, giving up on the cluster headache theory already. Cameron says the only other treatment is brain surgery, to which House yells at the silent Foreman to back off. Cameron and Chase exchange "what's he up to today? Who cares?" glances as House says there's another treatment for cluster headaches.
With that, House leaves the office. Foreman chases him down the hall, angrily calling out to him. Apparently, Foreman's precious job interview yesterday was cancelled -- by Foreman. Except that Foreman didn't cancel, which means someone pretending to be him did. I like how House makes reference to Foreman's homies just like Nate did. They're just two peas in a pod! Foreman thinks House deliberately sabotaged his interview. House denies it, but Foreman doesn't think anyone else at PPTH is capable of being that kind of "petty, socially repressed ass." How about Nate? I think it was Nate. House suggests Ashton Kutcher, which might be a reference to the fact that Foreman has the same name as Topher Grace's character on That 70s Show, which Kutcher was also on. That, or House just likes saying "Ashton Kutcher."
House and Foreman get off the elevator (drink!), and Foreman tells House to tell him if he wants him to stay at PPTH, not sabotage his interviews. Furiously, Foreman says he's been totally professional about this, giving two weeks' notice, working hard on cases, and scheduling interviews outside of work time. "You have no right to screw with my future," Foreman concludes. Oh, but wait -- faced with a sulky, whiny Foreman during differential diagnosis sessions, House admits that he wasn't the one who sabotaged the interview. "I only sabotage people I consider worth it," he explains.
House heads right for Cuddy, interrupting her meeting with some random woman to tell her that she is an "EVIL CUN...ning woman." While the random woman stands there, not sure where to look, House continues that this is a "massive turn-on." And that's all the follow-up we'll get about whatever weird flirty date thing they had going on before it was torpedoed by the presence of Honey last week. House acknowledges the other woman in the room with a "you girls can gossip later," but she stays around, looking very interested in the conversation when Cuddy asks House what he's talking about. With his strange bottle still in hand, House accuses Cuddy of sabotaging Foreman's job interview, then tells the random woman that he was trying to throw her out of the room, "but in a polite way." By assuming that two women together would be gossiping? Very polite. Instead of standing her ground, the woman just collects her gossip charts and leaves.
Cuddy says it looks like House is off the anti-depressants, and I'm not sure if that's a good thing or a bad one. I don't know if I liked House being all loopy and mugging all the time, but it was nice to see him acting a little lighter and maybe enjoying life a little more. Cuddy asks House if Foreman thinks she sabotaged his interview, and House reassures her that he's the only one who thinks it was her, only because he knows that it wasn't him. Cuddy asks what possible motive she could have for doing that, and House gets her to admit that she doesn't want Foreman to leave PPTH and is preparing to offer him something that will make him stay, pending board approval. Cuddy says it wasn't her and foolishly turns her back to House. He gets up a little too close to her, and she turns back around, asking him what's doing. He claims to be looking for a "tell" that will prove she's lying about not sabotaging Foreman, but I don't know how many tells you have in your ass, which was where he's looking. Cuddy sends him away, telling him to send a "Nurse Unger" back in. Nurse Unger, eh? More like "Nurse NOTBRENDA"! I'm starting to think she's never coming back, you guys, and it makes me sad. I mean, can you imagine what she would have done if she were the one in Cuddy's office when House came in? Decapitated him with a well-placed manila folder papercut, to be sure.
On his way out, House tells Cuddy the real reason for his visit: to get approval to give a sixteen-year-old magic mushrooms for cluster headaches. Man, what is it with House and bad headaches and hallucinogens? First we have LSD for migraines and now magic mushrooms for cluster headaches! What's , peyote for eyestrain? Anyway, Cuddy says no problem, and House leaves. Of course, she chases him back out, saying that she was being sarcastic, like there's any point to doing that with House. Will you ever learn, Cuddy? House says a court transcript won't show sarcasm, although if anyone has experience with saying things for court transcripts, it's Cuddy! House says his crazy idea has medical merit: there's a chemical in 'shrooms that will cure Nate's cluster headaches. Cuddy asks him if he's considered the "severe paranoia" Nate will experience as a side effect. She does not mention any of the other side effects Nate will experience, many of which are a lot of fun. So I've heard. House thinks it's better for a Dean of Medicine to order the 'shroom treatment than a doctor with a history of drug abuse, saying it will "take the stink off if the patient decides to put on a cape and fly off the roof." What-ever, 'shrooms. PCP makes you bust through windows without needing a cape, according to That Afterschool Special With Helen Hunt. Ridiculously, Cuddy agrees to the treatment, as long as it's low-dose and "tightly controlled," and Nate's mom signs the consent form. "Party on, Garth. And don't stand in Foreman's way. It's just wrong," says the guy on his way to giving illegal drugs to a teenager to treat headaches we aren't even sure that he has.
Nate could not be more thrilled about this new course of treatment, kind of like how I felt when I found out my wisdom tooth surgery would involve laughing gas. Those five minutes were some good times, followed soon after by several days of swollen cheeks, pain, blood, and more pain. Nate urges his mom to sign the consent form so he can begin trippin', but she's understandably hesitant. "I went to college, I know about mushrooms," Nate's mom reveals. She's a lot cooler than I gave her credit for. Not that drugs are cool, it's just that uptight, cardigan-wearing, spineless moms didn't seem the type to do 'shrooms. "A friend of a friend shot himself in the foot," she continues. What is this, 7th Heaven? Bring on the drugs! Nate orders her to sign the form, even stooping to calling her by her first name, Enid. Chase says that they'll be monitoring Nate to make sure he doesn't flip out, although the way he's gritting his teeth when he says this would make me question just how dedicated Chase is to making sure Nate doesn't harm himself. When presented with the other option for Nate -- brain surgery -- and with Nate saying that the pain is getting worse and he "needs...'shrooms...NOW," Enid signs the form. Cue the trippy music!
In-A-Gadda-Da-Vida, honey, Nate is lying in bed and smiling, having a grand old time inside his own head. When Chase foolishly attempts to have a conversation with him, Nate calls him "Skippy the Bush Kangaroo" before admitting that he is not in pain right now. Cameron says that must mean that the treatment worked, which means that Nate had cluster headaches after all. Super-awesome cluster headaches that only respond to drugs, but cluster headaches all the same. Nate interrupts Cameron to tell her that even with all the colors and light trails he's seeing, he can tell she's hot. "She's making me horny!" Nate announces while Cameron kind of looks flattered. Chase tells Nate to deal with it, but Nate says it's not fair of them to get him stoned and then "not close the deal," sounding a lot like a future rapist. Chase gets pretty ticked off, but Cameron tells him to be more understanding, since the kid's mind is a bit drug-addled at the moment. Nate interrupts to say that Cameron will regret saying no, and proceeds to open his gown to show her why, because women always go for that line. Chase rushes over to cover the kid up and protect Cameron's innocent eyes, which are at least a little curious, since she pretends to avert them while sneaking enough of a peek at Nate's deal to want to see more. Chase thinks she's pulling another "flirt with the underage kid to make Chase jealous" move, but she actually noticed that Nate has "undersized testes," and she apparently had to move things around to get a better look, judging by Nate's sigh of pleasure that I really didn't need to see. They should have made Chase do the touching. Why give Nate what he wants?
Cameron gives HIPAA the middle finger as she loudly announces Nate's tiny balls to House and the rest of the PPTH lobby. House, meanwhile, is looking around the nurses' station for a dime he dropped on the floor, which a woman who appears to be Nurse NotBrenda is happy to provide to get him away from her. Chase, House, and Cameron continue down the hall, with Chase saying that House's theory that a vascular problem was causing Nate's cluster headaches no longer matches Nate's symptoms. House asks what causes rage, headaches, personality changes, and hypergonadism. Well, maybe Nate just has tiny balls and is really insecure about it, leading to the rage and the personality change. I can't explain the headaches, though. Meanwhile, Cameron wants to know where Foreman is. House just says Foreman's mad at him, but he won't say why. Cameron supplies some token medical information that getting beaten up at school could have given Nate a blow to the head that caused some lesions on whatever part of his brain has an effect on the size of his testes before asking House what they're going to do when Foreman leaves. House reminds her that he is in control and doesn't feel like telling her anything other than that he's dismissing her lesion theory, since it would give Nate a fever he doesn't have. Meanwhile, Chase doesn't think they need to hire a third fellow, saying, "The two of us can handle it." You mean, you can handle it, Chase. This season, you've been the only Cottage to solve any medical mysteries, and more than once, you solved one that House couldn't. Meanwhile, Foreman and Cameron killed a young woman and an old man, respectively. House tells them to biopsy Nate's pituitary gland, but to make sure everyone knows that he was right about the cluster headaches.
But Nate doesn't care who was right about what so long as he doesn't have a brain biopsy. He wants more 'shrooms. His mom immediately gives her consent for the procedure over Nate's protests, because she says she can't take Nate anymore. Nate tells her to stop with the "melodramatic pandering" and to go get herself "coited," like, who's melodramatic now with the Shakespearean/Victorian England terms? Enid displays an expression that's either anger at being spoken to this way or wonder about what "coited" means. Chase goes to get a sedative, but it turns out he won't need one, as Nate's eyes start rolling back in his head. He does manage to offer Enid to Chase before he passes out. Chase takes a look at Nate's gums and finds them looking jaundiced.
After the commercial, Chase says that they're trying to treat Nate, but his liver is shutting down fast. House says he'll be dead before Foreman's last day, which Foreman reacts to with a sulk. House adds liver failure to the list of symptoms, and Chase says liver failure could cause all the other symptoms. House points out that the liver failure came after everything else, so unless Nate's liver is traveling in a time machine, Chase's theory doesn't work. But who cares about Nate and his quickly approaching death when there's Foreman to deal with? House devotes precious time to telling Foreman to contribute, and Foreman guesses it might be Wilson's disease. But tests results have already ruled that out, along with other common causes of liver failure. Foreman gets a page from Cuddy and House lets him go, seeing how Foreman isn't helping them anyway. He turns back to the remaining Cottages and says that if they've ruled out all the bad things Nate could be putting into his body to destroy his liver, they'll have to move onto the good things. Chase tells them that Nate just started eating meat a few months ago. Cameron doesn't see how meat could cause any of Nate's symptoms, but House can think of one way: Ornithine Transcarbamylase Deficiency, a rare genetic disorder where the body lacks a certain enzyme that helps break down nitrogen in the body, causing liver damage. House tells them to "run a Hamburger Test," which is not, as you'd expect, a test named after the German doctor who created it, but simply making Nate eat a lot of red meat and seeing what happens to his ammonia levels. If he has OTC deficiency, what they're doing is basically poisoning him, but who cares?
Foreman reports to Cuddy, who makes him an offer she doesn't think he can refuse: doubling his salary and giving him his own diagnostic group to lead. WHAAAAAA? Come on, Cuddy! Why are you rewarding a guy whose shitty diagnostic medicine skills recently killed a patient with his own diagnostic team that PPTH doesn't even need? They have House, and he costs them enough money and hospital resources, as has been previously established. And yet, Cuddy promises Foreman "complete autonomy," which didn't work when the Brits promised it to the Americans during the Revolutionary War and doesn't work now. Foreman sneers that when he eventually gets a case he can't solve, it'll go to House, like, way to trust your abilities there, Foreman. House doesn't go around assuming that he'll get a case he can't solve, does he? Cuddy says Foreman can let the patient die if he doesn't want to go to House -- he has that choice. Wow, this seems like a deal that certainly has the patients' best interests at heart. Fortunately, after some thinking and a bit of the sad music theme I really like, Foreman rejects the offer. Cuddy can't believe it and asks him why. "Because he's evil," Foreman says. Cuddy says if he's basing that on House sabotaging his job interview, he shouldn't. House didn't sabotage the interview -- Cuddy did. Foreman turns and leaves the room, but Cuddy calls him back saying that she didn't really sabotage the interview. The fact that Foreman believed her when she said she did, though, means that he still had some faith in House. That's not enough for Foreman, who says that if it wasn't House who did it, was someone at PPTH. "I can't work here," he says, like he's above that kind of thing.
The hamburger test starts with three hamburger patties being presented to Nate, who disgustedly says that this doesn't look like a medical test. He tells "Doogie" (oooh, burn on you, Chase!) that if he wants Nate to eat meat, he should get him something good, like steak or roast beef. Enid volunteers to bring him something from home, an edge to her voice suggesting that she would have no problem putting a little bit of poison in there as well, but Cameron says it has to be something prepared at PPTH. Nate refuses to eat anything prepared by "five-dollar-an-hour immigrant cooks in hairnets." Would you rather they didn't wear hairnets? Chase snaps and tells him to shut the fuck up. Nate seems surprised by the outburst, making me wonder if this is the first time anyone has said that to him. Chase follows this up with a threat to tie Nate to the bed and shove the hamburgers down his throat if he doesn't eat them voluntarily. Nate calls his bluff, but it's not a bluff at all, as Chase starts calling the nurse in with a full set of body restraints. "Yes, doctor!" we hear her respond instantly, like being called to a room with a full set body restraints isn't momentous enough to even give her pause. Nate decides that Chase is serious and starts eating. See, Enid? Parenting isn't that hard. All you have to do is take a stand and show your child you won't back down.
Meanwhile, Cuddy marches over to Wilson and accuses him of being the one who sabotaged Foreman's job interview, saying that if it wasn't her and it wasn't House, then it was someone trying to protect House, which leaves Cuddy with only two people in all of PPTH: Wilson, and "the weird night janitor who wears his pants backwards." Um, okay...WHY HAVEN'T WE SEEN THIS AWESOME CHARACTER?!?! How DARE they mention a character with such possibilities in passing without even showing him to us? I DEMAND an episode devoted to this person, if not an entire spin-off! If Grey's Anatomy can give one to that woman, then surely there is a place on the Fox schedule for a Weird Night Janitor Who Wears His Pants Backwards. He could solve mysteries or something. I don't care what he does as long as he's there and House occasionally stops by to visit. Oh, better yet -- Evil Nurse Brenda teams up with him, and they travel across country and encounter various interesting people. Like Highway to Heaven, but with a lot less God and a lot more pants being worn backwards and Evil Nurse Brenda's homicidal rage. I can't wait for the origins episode where we learn why the night janitor wears his pants backwards. I think that will be insightful, but also touching. I suggest noted character actor Dan Hedaya for the role.
I guess I should get back to recapping shows that exist outside of my own mind. Wilson says he wants Foreman to leave PPTH, thinking that House needs someone to stand up to him. No one else will, Wilson points out: "Cameron's in love with him, Chase is afraid of him, and I enable him." Cuddy tries to say that she stands up to House, but we all know that's not true, and Wilson cuts her off at the knees by pointing out that her idea of putting limits on House includes authorizing magic mushrooms for teenagers. "House is a six-year-old who thinks he's better off without parents. A few tummyaches after dinners of ice cream and ketchup might do him some good," Wilson says in a speech that he's totally been rehearsing in his head all day while waiting for someone to actually talk to him. Cuddy thinks Wilson's lying, since if he was the enabler he claims to be, he'd be enabling House to keep Foreman as an employee. Then again, if the result he wanted was for Foreman to leave, that's what he got, since, as Cuddy says, that interview sabotage pretty much guarantees that Foreman's leaving. Wilson reacts to this with some smell-the-fart acting.
House is stuck in Clinic duty, where his patient is a man old enough to know better with severe sunburns all over his face and torso after spending the day working on his boat with his son. He's not concerned with the burns so much as the strange white circles in the middle of them. He fears all the chemicals associated with boat-working-on are to blame. House tells him to lie down while he asks the son if Daddy likes to drink a lot and then pass out in the hot sun while supposedly working on his boat, all without applying sunblock. The kid nods. House whips out a syringe and pushes the plunger in, shooting water all over the dad who is at this point the human embodiment of Homer Simpson. "D'oh!" he says. Bart laughs, and House offers him the syringe watergun in exchange of the one dollar and forty-one cents he guesses he has in his pocket. Bart eagerly ponies up, and Homer asks House how he knew how much money Bart had. House places the coins on Homer's chest, and they all match perfectly with the white spots. Looks like someone tossed money on Daddy's chest while he was sleeping it off. "Why you little--!" Homer says. House finds a Canadian quarter in the change and demands the syringe back. Bart returns it, and House looks ridiculously outraged that the kid tried to cheat him like that. Hee!
House exits the exam room and practically runs into the Cottages, who report that the hamburger test didn't produce a change in Nate's ammonia levels. Foreman contributes this time, and House welcomes him back to work. Foreman apologizes for taking his personal problems out on their patient, although if any patient deserves it, it's Nate. House graciously accepts the apology and has a few more diagnostic tricks up his sleeve. He suggests that diabetic steatosis is killing Nate's liver and tells them to starve him overnight and test his blood sugar. That's always fun. Chase worriedly says they could set off another rage attack that way, but House shrugs and says he's sure Chase can "take him." No, he can't.
And neither can the nurse they unwisely send to Nate's room to collect the urine sample after a night of starvation, who almost has her head taken off by an IV-pole-wielding Nate. "Honey. Please. Don't," Enid halfheartedly attempts to parent. Chase and Foreman rush in and try to calm Nate down, saying they just need a urine sample and this will all be over in a few hours. "You want your sample? Here's your damn sample!" he says, and sure enough, we cut to the floor between his legs where a stream of pee soon collects. That's immediately followed by a stream of blood.
When we come back, Cameron voiceovers that Nate's bloody piss was caused by kidney failure, and he'll be on dialysis for the rest of his life. Fun! House says there's not much of that life left if they don't figure out what's wrong with him. Cameron pulls HIV infection out of her ass, but Chase discounts that right quick, refusing to believe that anyone would sleep with Nate. Foreman wonders if the elevated levels of uric acid in Nate's pee are important. Chase doesn't think so, saying they fed the kid meat and his kidneys are done, so uric acid would be a normal occurrence. House tells him to do a blood test on any curable conditions related to the elevated uric acid anyway, and Foreman unwisely says he will until he has to leave for another job interview. I think he wants them to get cancelled if he's going to announce them, knowing that someone at PPTH is using that information against him. Hell, maybe Foreman's the one sabotaging his own interviews and accusing House to throw everyone off the scent. Personally, I think it's Chase...although he doesn't strike me as caring enough about Foreman one way or the other. Cameron's probably too busy on her third draft of Foreman's peer review (now with pink pen ink and kewl stickers!) to do it, and it can't be House or Cuddy since they accused other people. So that leaves Wilson, I guess.
Foreman takes blood from Nate, although not without first shooting him up with a sedative before Nate can make too many gay jokes. Enid sort of has a problem with Foreman unnecessarily knocking her son out, although I think that's mostly jealousy.
Cameron can't take the elevator without having her ride hijacked by a nervous Wilson, who tells her that he's about to be fired by Cuddy for sabotaging Foreman's interview. Cameron sees right through his pathetic lie and even more pathetic acting job and figures out that Wilson was trying to get Cameron to admit that she was the one who sabotaged the interview. Wilson grouses that Cameron would've fallen for it three years ago. Wilson says that he's just using Cuddy's logic that whoever screwed up the interview did it because she cares for House. Which leaves THE WEIRD NIGHT JANITOR WHO WEARS HIS PANTS BACKWARDS! Bring him in for questioning, I say, since Cameron denies having anything to do with it, unconvincingly saying she doesn't care about House. Then she does some smell-the-fart acting, which I guess is supposed to mean "thinking about who could have sabotaged the interview."
Cameron and Chase test Nate's blood. Cameron takes advantage of the opportunity to ask Chase if he's the one who screwed up Foreman's interview, and did so just because he doesn't like Foreman. Chase reacts with outrage and hurt that Cameron would think so low of him. And yet, he still gives Cameron his weekly reminder that he likes her and wants to see more of her, albeit through gritted teeth. "See you Tuesday!" Cameron says cheerfully. Ha! I bet she's been waiting all week to try that out.
Chase and Cameron go to House with their findings: a partial deficiency of the hypoxanthine-guanine phosphoribosyltransferase enzyme, which could cause Kelley-Seegmiller syndrome, and if these doctors and scientists are going to keep naming conditions after themselves, could they at least make sure to have names that are easy to spell? I don't think that's too much to ask. Anyway, Cameron doesn't think a partial deficiency is enough to give Nate the disease, nor does she think his symptoms match up with it. House thinks she doesn't want to believe that her patient has a degenerative neurological condition. The proof seems to lie in the fact that patients with Kelley-Seegmiller self-mutilate when stressed, and House knows a great way to make this happen.
House wheels a chess board into Nate's room and introduces himself as "Dr. McCaney," as if he even needs to employ the a silly nickname like certain other medical shows do. He does not! And Nate doesn't want to play chess, being on the verge of death and all. But House shoots him up with adrenaline and challenges him, so Nate chooses the white side ("age before cripple"), and the game begins. House has unwisely decided not to use a foam-padded chess timer. The two play, being sure to trade insults along the way. House says that arrogance like Nate's needs to be earned, and asks Nate what he's done to earn his. Nate says he can walk, unlike some people. House points out that he doesn't bleed out of his penis. At least, not right now. Sometimes he does. The game continues, and House puts Nate in check, then says there's a thin line between a tortured genius and an "awkward kid who can't get girls because he's creepy." To be more specific, I'd say that thin line is about the width of however much space is separating Nate and House right now. Nate figures out that House is up to something and asks him what it is. House says he's trying to stress him out. Nate says he isn't feeling very stressed right now, apparently due to House's shitty chess-playing skills. So House goes for the psychological manipulation, informing Nate that no one likes him and he's dying. And he's in check again. Nate starts breathing heavily, but that seems to be a ruse as the game continues...and Nate laughs as he moves his queen into a position that seems to put House at a distinct disadvantage. "Care to lay down your king?" he asks, saying there's no way for House to win at this point. Nate claims he has checkmate in like four moves. He tells House to save what's left of his dignity now and lay down his king. And then Nate starts having a seizure. House just rolls his eyes and says, "aw, crap," as he moves the chessboard out of the way so the nurses can get in and work. While they do, he lays down his king.
When we come back from break, House is studying the chessboard and announcing that he hates Nate. Foreman says he loves him, then. Yeah, well, it's easy for Foreman to love him, since Nate is strangely never conscious when Foreman's around. While House tries to find a way out of Nate's checkmate, Cameron says that Kelley-Seegmiller does not cause seizures. House asks Foreman if he gave his interviewer House's name as a reference, and Foreman says he most certainly did not. Wise choice, Foreman. I wonder if he gave Dr. Smiley's name. For that matter, why doesn't Foreman just call Dr. Smiley and take that job offer?
Everyone makes their way into the differential diagnosis room, where Cameron wonders if they're dealing with two different illnesses. Chase agrees, saying that no one illness can cause all of those symptoms. Maybe, Chase says, Nate's hiding something. Cameron asks why Nate would do that. "Because he's evil!" Chase suggests. This offhand remark gives House an idea, though, and he crosses out the personality disorder from the list of symptoms. If being evil is Nate's real personality and not a symptom, then the remaining symptoms are consistent with Foreman's suggestion of amyloidosis. There's some bickering back and forth between the two over whether or not Foreman refuses to accept that Nate's personality is his real one and not a symptom because Foreman wants to believe that all people are good, and we've had that conversation many times on this show. House tells them to do a biopsy to confirm the diagnosis and look for the marrow donor they'll need if it's confirmed. Those rapid-footsteps sound you hear is Matty running far, far away.
Chase tells Enid what's going on, saying that amyloidosis can be fatal. Is that relief I see fighting its way onto Enid's face? Chase says they're looking for a bone marrow donor right now, and Enid says that when she first found out that Nate was sick, she was relieved, even happy. But now it turns out that Nate could be fatally ill, and even if he gets better, he'll still be an ass. Life sucks for Enid.
Foreman takes a nerve out of Nate's foot for biopsy. Nate complains of feeling hot and tells "Dr. X" that he knows how hard Foreman's worked to save him. "It's all right," Foreman says, thinking an apology or a thank-you is coming his way. But no! Nate continues: "You really suck at this." "We're doing our best," Foreman says, trying hard not to murder Nate with his bare hands right there. "That's sorta my point. Your best really sucks." True, but...again, this might not be the best time to point that out.
House gets a delicious CHOMP candy bar out of the vending machine. Foreman appears in his totally not gay pink scrubs and says the biopsy was negative for amyloidosis. And with Nate's new fever, Foreman's thinking he's got an infection instead, which would make this a bad time to give him a marrow transplant. Just ask Lupe! Oh, wait -- you can't. Cause she's dead. By the way, my spin-off with Evil Nurse Brenda and the Weird Night Janitor Who Wears His Pants Backwards will also include the Ghost of Lupe, who appears in the beginning of the episode to give them their mission for the week and then sporadically throughout the episode to dole out wise advice as needed. I swear, if Fox doesn't make this spin-off, then I will make it myself and put it on YouTube! This shit is GOLDEN! Anyway, House tells Foreman to biopsy somewhere else on Nate to find the amyloidosis. Foreman doesn't want to, and House says Foreman can either put up a futile argument before being forced to do what House wants or just give up now and do what House wants. Foreman chooses the latter, which tells House that he's not ready to leave House's wise teachings. There was a third choice, House says -- a "Third Way," let's call it, in honor of the departing Tony Blair. That was to defy House and start treating Nate for the infection Foreman thought he had. But obviously, Foreman trusts House's judgment more than his own. Or at the very least, he'd rather House be responsible for being wrong than be responsible himself. Either way, House has a very good point.
House is still trying to get out of Nate's chess trap when Chase stops by to blame him for sabotaging Foreman's job interview. House denies it at first, but Chase is smarter than the average Foreman and says that everyone in the opening credits cast is blaming each other for Foreman's interview thing. And who, among them, would be most likely to enjoy an environment of paranoia and mistrust? And who was the one who touched it all off by accusing Cuddy? House asks why he would even bother trying to deflect the suspicion off of himself in the first place, and Chase has an answer to that, too. Foreman wasn't going to do any work if he knew House sabotaged him, and House needed Foreman to work. Not like Foreman's doing any work worth saving anyway. "Sometimes, I forget why I hired you," House says, smiling and sinking back in his chair. Chase says House screwed Foreman over and gained nothing, but House says Foreman wouldn't have been happy at the hospital he was interviewing at. Too bad he'll never get the chance to find that out for himself. Chase tells House to tell Foreman he wants him to stay. House says there's no point to that. Foreman will still leave. Chase says it would show Foreman that House isn't evil. "He needs that," Chase says, rapping a chess piece on the table. House stares at the chess piece and the way Chase is holding it...and he has his Great Epiphany. He grabs some chess pieces and leaves.
House heads for Nate's room and says it's time for a rematch. He tells Nate to pick a chess piece to start, threatening to remove what could very well be an important IV bag if he doesn't. Nate picks a hand and takes the piece, using his index and middle fingers to hold it. House grabs his thumb and pulls it backwards. Nate whimpers in pain, and Enid stands up and yells at House to stop, like she isn't enjoying watching that a little bit. House makes sure to point out how much he is enjoying it, then says that Nate has an unusual way of holding chess pieces, due to the joints in his thumbs being formed abnormally. Could this be related to the joint pain he was complaining about earlier that everyone chalked up to being from all his playground fights? Everyone except Cameron, that is, who was also the person who suggested hemochromatosis...which House is now saying Nate has. As the Magic Schoolbus Cam illustrates, Nate's body can't remove excess iron, so it builds up, eventually causing joint pain and organ failure. His vegetarianism kept him relatively excess-iron-free for most of his life, but when he went back to eating meat, and especially after he had to shovel hamburgers down, the iron started building up. Way to shut down his kidneys permanently, Hamburger Test.
"His personality issues?" Enid asks, ever so hopeful. Sorry, House says, those have nothing to do with iron and everything to do with Nate being a horrible person. Meanwhile, who was the asshole lab person who didn't test the iron levels in Nate's body? Wouldn't someone do that as part of an exhaustive look at what could be going on there? I don't think it's standard procedure, but you'd think that with Nate on death's door for unknown reasons, they would have done every blood test in the book trying to figure out what was wrong with him. Anyway, House slices Nate's hand open and lets him bleed the iron away, meaning that, in the end, Nate may have gone "medieval" on the hot chess guy, but it's medieval medicine that will save him. It also makes Nate like the only person medieval "medicine" has ever saved. House says that Nate will need dialysis for his kidneys and regular blood drainings for the rest of his life, but at least now that life will be a long one. "My condolences," he says to Enid, who cries, although I'm not sure if that's from joy or sadness. Just to get the last word, House leans over and tells Nate how he would have gotten out of his little chess trap and won the game after all, but Nate says he knew about that out all along. "I was bluffing," he says, "and that's why you lost." "Jerk," House mutters, while the nurse he called in like fifteen minutes ago finally moseys into the room to take care of Nate's bleeding. I guess the nursing staff likes Nate as much as everyone else does.
House makes one last stop before he leaves for the night: the lab, where Foreman is hard at work. House hesitates, appearing to prepare himself to be not evil and ask Foreman to stay. But then, instead, he asks Foreman if he's looking for amyloidosis in Nate's biopsy. "Yeah. Still nothing," Foreman says, refusing to learn even after House so much as told him that he doesn't want an employee who blindly follows his orders without challenging them. So now, House has two choices here: he can tell Foreman he wants him to stay, or tell Foreman he wants him to quit. Instead, he chooses a Third Way and orders Foreman to run the test again. Foreman will stay up all night doing this unnecessary test without even realizing that he's taken -- and failed -- the only test that mattered.