By Sara M
A band hangs out in a recording studio. They're all waiting for their guest horn player to arrive, one "John Henry," who Special Guest Star Brandy claims is the best trumpet player alive and is sure to make their recording great. Her bandmates are dubious that he's coming.
Cut to the inside of a limo, where the man who must be John Henry makes a gravelly-voiced request to be taken to the studio. His female companion, who may or may not be his manager, says she thought John Henry wasn't doing any sessions for a while. "Let's find out," he says cryptically.
Back at the studio, Brandy's only bandmate with speaking lines sings a little tune about how John Henry is not coming to their session. Brandy overacts her anger at this so much that you'd think the song was about the morality of Hitler's policies. And then John Henry is wheeled into the room. "Am I late?" he asks. He's two hours late, actually, which is kind of a dick move, but I guess fictional trumpet legends in wheelchairs can make their own schedules. John Henry starts to play along with the recording, but doesn't get very far before he's gasping for air and dropping his trumpet on the ground. Oh no! Now Brandy's music career will NEVER get back on track! Things have just gone from bad to worse ever since Beyoncé went solo.
Cuddy -- and, one would assume, the entire viewing audience -- are shocked when House actually requests to be put on a case. His interest has nothing to do with John Henry's musical talents (and I will be referring to him by his last name, "Giles," so as not to get confused with the steel-driving folk hero) and everything to do with the mysterious leg paralysis Giles has had for the past two years. Cuddy tells House to hold his infectious-disease-investigating horses: Giles is being treated for pneumonia, and only for pneumonia. His doctor back in Los Angeles is treating the paralysis. So there's nothing for House to do here. House points out that Giles's doctor, Marty Hamilton, has done just about everything to Giles except fix his legs. Cuddy takes great delight in informing House that Hamilton already called to ask for House's team's help. "By 'team,' I don't mean you," she says gleefully. It turns out that Foreman did his residency under Hamilton, and Hamilton would like someone he can trust taking care of his patient. House limps away to figure out how he can hijack this away from Foreman and start killing Giles to make him better.
One of the benefits to his new lead position is that Foreman gets to stand up and write on the Transparent Pane of Symptoms while everyone else has to sit down and tell him things. House reacts to his demotion to Cottage status like a stubborn little boy, all putting his legs up on the table, tipping his chair back, and saying he has nothing to report from the microbiology lab. Foreman tells him to go wash Foreman's car. "Oh, this is fun!" says House, who will not be washing anyone's car. Foreman orders the Cottages to do some stuff. Chase and Cameron get up to leave, but they are stopped by House's outstretched legs, an impenetrable force field for timid little kiss-asses. House says he wants to talk about Giles's paralysis, and Chase and Cameron obediently sit right back down. Foreman says it's been already diagnosed as ALS (a.k.a. Lou Gehrig's Disease, a.k.a. Not Good At All). House calls this a "disease of exclusion," since there are no tests for it. The diagnosis is made once everything else has been ruled out, and House has not ruled everything out. He wants to do an MRI. Foreman says that the diagnosis has been made and the case is closed. House gets to his feet and limps over to the Transparent Pane. A power struggle over who gets to hold the marker commences, and House seems to have the edge until Foreman reminds everyone that this is his case and that he is going to follow Hamilton's instructions. So there.
Never let it be said that famous patients don't get special privileges, as Giles plays CDs on his own personal stereo. (Please don't bother emailing me about how when you were in the hospital this one time, they let you have all manner of electronic devices.) Foreman draws some blood. Giles turns the music off because he likes to have his deep discussions in silence. He asks if the pneumonia means that his ALS is getting worse. Foreman says it looks like it. Giles wonders if he'll die in New Jersey or make it back to L.A. Wow, both of those choices suck. He'd better hope he dies on the plane ride. Foreman says that an MRI might give them more information, but Giles ain't buying it. You don't do MRIs for pneumonia. Foreman admits that it was House's idea, and Giles has actually heard of House because he apparently reads medical journals when he isn't playing his trumpet. "Obsessive sunnuvabitch?" he asks. Foreman says that is House indeed. Giles asks Foreman who's right: Hamilton and the ALS diagnosis, or House and the not-ALS diagnosis? Foreman reluctantly says that "everything points to the ALS." In that case, says Giles, he will not consent to the MRI and he would like to sign a Do Not Resuscitate order. Way to get a second opinion, there, champ.
House lies on his floor and loses himself in a world of music, listening to some of Giles's greatest hits on vinyl, the way they were meant to be heard. Foreman enters and informs House that Giles just signed a DNR. House says that most people who think they have a terminal degenerative disease would do the same, but that if he were the lead on this case, he'd be giving Giles some intravenous immunoglobulin therapy, which would cure Giles if he had multifocal motor neuropathy. Foreman says thattGiles doesn't want any treatment. House says that a DNR doesn't mean you can't treat a patient while he's still alive. But if Foreman's planning on doing nothing, he might as well hang on to that DNR, because the signature on it will be worth a lot of money soon. You know, because Giles will be dead.
Foreman walks out of House's office and immediately calls someone to order the immunoglobulin. Aw, he loves House just as much as the other Cottages do!
Clinic time! A patient's "little guy" is having problems standing up lately, and it would like some Viagra. House finds it annoying that his patient insists on referring to his penis in the third person, and says that Viagra is not the best idea for someone who is cheating on the diabetes he doesn't want anyone to know he has. House says that the guy's hands and feet show signs of diabetes-caused nerve damage, while his pants show signs of multiple powdered donut ingestion. House has to cut the insults short, though, as he gets a page for a Code Blue in Giles's room. He gives the patient a prescription for the Viagra, saying it won't kill him any more than the heart disease he gets for ignoring his diabetes will, so he might as well go out having fun. Did House just give that guy a death sentence on a prescription pad? Well, all I could find out in a brief online search is that for men with untreated diabetes, Viagra "may not be the best match for your other health needs," so I don't know. But as we'll soon see, House isn't the most respectful guy in the world when it comes to medical ethics.
Over in Giles's room, Giles gasps for air while the Cottages tend to him. Machines beep all over the place. Chase says that the only way to save Giles is to "intubate him -- stat!" I think the "stat" went without saying, but it doesn't really matter since Giles's DNR prevents them from doing it at all.
Meanwhile, in a random elevator, Giles's manager/girlfriend/whoever is bringing her client/boyfriend/whatever a whole bunch of brand-new CDs. "Someone likes music!" a doctor says. I can't believe that guy went to school for an extra eight years.
House enters the room and sees the Cottages standing around while their patient dies. Foreman says that the immunoglobulin House recommended has put Giles in respiratory failure. "WE did this," he says. "We killed him." House says that no one's dead yet, grabs the intubation gear, and shoves a tube down Giles's throat to the mild protests of Foreman. Wow, this is like the first time we've seen House do hands-on doctor work except for those autopsies. Cool. House gets Giles artificially breathing as the woman walks in. "What did you just do?" she asks. "He saved his life," Cameron tattles.
Back at the office, House says the fact that the immunoglobulin therapy made Giles worse means that he doesn't have multifocal motor neuropathy. "Now, what's really wrong with him?" he asks. "What's wrong with you?" Foreman says. Oh, so many things. Foreman says that Giles had a legal document forbidding them from intubating him. House responds that he was hoping Foreman would be a good enough doctor that his patient wouldn't need to be intubated. Ouch. Furthermore, Giles may not have been mentally competent when he signed the DNR because his low thyroid levels were "making him sad." "His thyroid levels were a little --" Cameron starts, all ready to jump to the defense of her rule-flouting boss. She always did fall for the bad guys. Foreman cuts her off and yells at her not to defend him. House says that Giles signed the DNR to prevent a "slow, painful death" from ALS. But it was the immunoglobulin that put him in respiratory distress, so House feels pretty good about his decision. Then again, he felt good about recommending the immunoglobulin. Foreman says that this is all because House won't allow his mistake to kill a patient. Au contraire, says House. This is Foreman's case, so officially, it's Foreman's mistake that almost killed the patient. He accuses Foreman of not wanting to "look bad" in front of his old boss. Foreman changes the subject to the fact that House assaulted Giles. "I won't do it again," House says. "Yes, you will!" Foreman immediately responds. House says that is true, and therefore this debate is pointless. Foreman looks to the other Cottages for support, but Chase is really interested in his shoes and Cameron is looking at a pretty bird right outside the window. No support will be forthcoming. Foreman storms out in a huff.
House asks the remaining Cottages what Giles's new lung problems are symptomatic of. For shits and giggles, Chase suggests vasculitis. Cameron suggests a big word that I'm not going to bother looking up, and then a woman enters the office, dressed in what would be professional business attire if the blouse wasn't completely unbuttoned. House says it was very thoughtful of Cuddy to send him another stripper, and he has got to stop greeting women like that if he wants a second date. The woman apologizes seductively, hands House an envelope, and leaves. Cameron opens it and says it's a restraining order, which means that woman was the Sexiest Officer of the Court ever! It also means that House can't get within fifty feet of Giles, and that he will be facing criminal assault charges. House's response to this is to order Cameron to use some of Giles's leftover blood to test for P. Anka, apparently believing that the presence of a '50s teen idol who resurrected his career with swing covers of famous rock songs could be the major culprit in the jazz musician's inability to play well. Oh, I'm sorry -- he said C-ANCA, which stands for antineutrophilic cytoplasmic antibodies, the presence of which indicates Wegener's granulomatosis. A biopsy of Giles's lung mucus stuff will confirm the diagnosis, and House has Chase get on that, along with having Giles moved to the second floor ICU, which just happens to be directly above the clinic, thereby legally prohibiting House from doing his job, not like that ever stopped him before. You have to hand it to the guy, though: he really knows how to turn lemons into lemonade. A bad leg means you get an unlimited supply of Vicodin, and pending criminal charges mean you don't have to deal with impotent diabetics!
House has never been happier to answer Cuddy's page, as her current position in the lobby of the ICU allows him to revel in his court order against entering it by standing in the hallway and screaming at her. Meanwhile, she's discussing some no doubt upsetting test results with grieving family members, so, great timing there, House. Cuddy is always on to House's tricks, and immediately sees that House is using his legal troubles to get out of clinic duty. "Cute," she says. It is, though. House says that Cuddy has all the time in the world to lecture him, seeing as he is legally forbidden from tending to either his clinic duty or to his patient. Cuddy doesn't have a lecture, though: she says she knew House was insane when she hired him, and set aside part of the hospital's annual budget for the legal expenses he was sure to incur. House says that's great, and that he might as well push his luck by asking Cuddy if she can get some of those tests run on Giles. Cuddy says that Hamilton is flying in today, and that she doubts he'll be receptive to any diagnostic testing since the reason for his visit is to pull the plug on his patient. House says he'll need a lawyer.
We go to a courthouse, where House has filed to keep Giles on life support. He feels so strongly about it that he even wore a tie. The judge, your typical cranky old guy, is confused as to why the man House is accusing of assaulting is the same man he wants to keep alive against his own wishes. House stands up to explain that the assault was a "medical" tube that saved Giles's life. Judge Curmudgeon orders House to sit down and let his lawyer do the talking. House actually apologizes for being "way out of line" and follows orders. He must feel very, VERY strongly about this. Judge Curmudge gets his facts straight as we see the court audience rudely talking amongst themselves. Wilson is also there, of course, sitting in the very front row. The case is this: if Giles is allowed to die, House's sixth amendment right to face his accuser will have been violated. Judge Curmudge cracks a smile and calls this reasoning "clever." Giles's attorney doesn't agree, and stands up to talk about precedence and other legal things that we don't need to hear, so we cut to Wilson and House having a whispered conversation. "Why are you doing this?" Wilson asks, and surely this attempt at reasoning would have been more effective BEFORE they entered the courtroom. He points out that even if House wins the case, he won't gain anything. House says he will gain time to get a proper diagnosis for Giles, and he really wants to listen to the courtroom action right now, thank you very much.
So we go back to House's lawyer, who is arguing that Giles's thyroid issues might have made him incompetent to make a DNR decision. Judge Curmudge points out that House's own staff was present for the signing and didn't have a problem with it at the time. At this, House can stay polite no longer! "My staff are idiots!" he says. Judge Curmudge orders House to sit down again. House does. Three seconds later, he's standing up and talking again. Judge Curmudge threatens to find House in contempt if he interrupts again. House says he's sorry, but that he has some very important medical issues to discuss with Judge Curmudge that should be addressed as soon as possible. You see, he noticed that the Judge's fingers have signs of "clubbing," which is a symptom of a heart problem. He advises Judge Curmudge to see his doctor as soon as possible, since he could drop dead at any moment. Giles's lawyer asks if they can get back to the case and does some more arguing, but Judge Curmudge is a little distracted.
Court adjourned, House removes his tie as quickly as he can. Wilson congratulates him on winning the case, but says he didn't notice any clubbing on the judge's fingers. House says he didn't, either. You'd think a guy so obsessed with fixing what he believes is a wrong diagnosis wouldn't be so quick to hand one out to someone else.
House limps into the pathology lab, where Chase informs him that the biopsy didn't tell them anything. House immediately orders them to treat Giles for the Wegener's they have no proof he has. He sees this as simply a geographical problem, in that the medicine and the patient are in two different locations. Cameron and Chase, on the other hand, take issue with the ethics, not to mention the fact that they could lose their licenses. I bet they' wish they'd been more supportive of Foreman now.
Apparently, Chase and Cameron read the part of the court records where House called them idiots, because he's all alone when he sneaks into Giles's room with the IV bag. He sets it up, but a guy walks in on him before he can sneak back out. The guy introduces himself as Marty Hamilton and says he and "Greg(g)" should talk outside. Whoops.
House and Hamilton enter House's office. House says he gave Giles medicine for Wegener's. All smiles, Hamilton praises House's medical abilities and says that he already checked Giles for Wegener's and the blood tests were negative. Giles has ALS, Hamilton is going to pull the plug on him, and Giles is going to die. Everyone has accepted that except House. Foreman enters the room and gives Hamilton a warm reception. He apologizes for the whole DNR debacle, but Hamilton says it wasn't Foreman's fault. The two start chatting away about old times until House interrupts to say that no plugs are being pulled because he has a court order. They can't kill the guy who pressed charges against House: "Judge said so." Hamilton, still all smiles, informs House that Giles dropped the charges, making House's court order useless and causing a Rapid Smug Transfer from House to Hamilton. "He doesn't have to die," House says. "[Smirk]," says Hamilton.
It's unplugging time! House and Wilson get to watch from outside the room, while Foreman, Hamilton, and some of Giles's friends hang out around his bed. House says that if Giles does have Wegener's, having the tube pulled will kill him. Giles nods that he's ready to die. Girlfriend/Manager/Whoever whispers that she'll miss Giles, and kisses him on the cheek. Hamilton pulls the tube out, to the great annoyance of House. Manager Lady cries. Giles cries...and then he breathes. "It's not Wegener's," House says. "Wrong again."
Back at the office, Wilson exposits that Giles is stable, but that his arm is paralyzed. House wonders why he's still alive. Wilson says it's because Giles is stubborn. Foreman says it's because House is stubborn, and that his Wegener's theory was wrong. Cameron says that Giles's continuing paralysis only supports the ALS diagnosis. House says it would, provided that the arm paralysis is connected to Giles's legs. Cameron thinks for a second, and then says that the arm paralysis could have come from a stroke. This earns her a glare of betrayal from Foreman, although I don't know what he expected from her. House orders an angiogram on Giles, which he's apparently free to do now that that pesky restraining order is gone.
Hamilton smilingly leaves Giles's room. The patient is alone. This is exactly what House has been waiting behind a nearby pillar for, although I don't know how he explained that to the nurses. Then again, I don't think this hospital has any staff members besides the ones who appear in the opening credits. Giles is none too pleased to see his latest visitor. House says that Giles should be more grateful to the man who saved his life, even if House was the reason why it was in danger in the first place. Giles points out that his life sucks now, and that it will only suck more. House says that's true, but that he really, really wants to figure out what's wrong with Giles. He's prepared to offer him a deal: if Giles does end up having ALS, House will kill Giles himself. Sound fair? Giles isn't too hopeful, and he doesn't like being someone's lab rat. As far as he sees it, he can't play his trumpet anymore, so life isn't worth living. House says that there's more to life than playing the trumpet. Giles there isn't when it's your "thing," which House should understand since he is similarly obsessed with his work. And that's why both Giles and House are all alone in the world, each too obsessed with his "thing" to get married and start a family. You miss out on everything, but you're great and you're happy. Until it's over. House shows his agreement with Giles's philosophical ramblings by disconnecting him from the ICU room, grabbing the bed, and pushing Giles down the hall to the MRI.
Foreman and Dr. Smiley have lunch and talk about Smiley's recent successes. Smiley asks if Foreman enjoys working with House. Foreman says that "enjoy" isn't quite the word. Smiley asks if Foreman is seeing anyone, to which Foreman says he is, "kinda sorta." Smiley wonders if she would like L.A. It's hot as hell and the air is dirty! Who wouldn't like it?
Chase and Cameron are looking over the results of Giles's MRI or angiogram or whatever House made him get, when Foreman walks in and announces that Smiley just offered Foreman a job in L.A. He'll be a partner, not a fellow, making three times as much money and getting all kinds of other benefits, like working with a guy who gives a shit what Foreman thinks. On the other hand, he has a commitment to Princeton. He's not sure what to do. Chase and Cameron say they would stay with House; Chase doesn't need the money and Cameron "[doesn't] hate" (i.e. "is in love with") House. Foreman says he can't believe they don't have a problem with what House did to Giles. Chase interrupts the moral grandstanding because he just found the clot that's been causing Giles's arm paralysis. House was right after all, and that kind of takes all the air out of Foreman's argument. So he just says that it wouldn't hurt for House to learn a "little" humility.
Of course, the humility-ignorant man in question is standing right behind him when Foreman says this, and makes his presence known by asking about the MRI results. Cameron says it's a clot, and Chase says they can treat it. "Do it," House says. He takes a minute to flash them his most unhumiliated smile, and walks out.
Foreman gives Giles the news about the clot, adding that the medicine they'll use to treat it could damage his lungs. Giles doesn't want to do anything that could take away his air, and refuses treatment. House runs in and stabs him with a needle filled with the medicine anyway. Okay, he doesn't...this time. Foreman thinks for a second, and then suggests a surgery that will pull the clot out. The surgery will either cure Giles's arm or it will kill him, making it a win-win situation, really. Giles is on board.
Chase and Cameron are suited up and performing the surgery, which Giles gets to be awake and aware for because it involves his brain. Chase will be doing the surgical aspect of the surgery, while Cameron will be asking the patient how he feels and expositing technical details while the Magic School Bus Cam shows us a thin wire snaking through Giles's brain, grabbing the clot, and pulling it free. I bet Chase is good at those grabby-arm arcade games, too. Cameron informs Giles that the surgery is over and successful. Giles is disappointed. He was really hoping he'd be dead by now, goddammit.
Foreman's in House's office, apologizing for the earlier humility remark. House says he doesn't care for apologies. Foreman says he was really rude. Again, House doesn't care. He says that Dr. Smiley's much-lauded humility is fake. Real humility means self-doubt, so it's only important for people who are wrong a lot. Foreman points out that House has been wrong about everything in this case, and then gets all apologetic-looking for stepping out of line like that. But House loves it when he gets as good as he gives, so he just smiles and says that self-doubt doesn't help when you're right. And then his beeper goes off, and they're off.
House and Foreman walk to Giles's room, where Dr. Smiley congratulates "Greg(g)" on a surgery well done. Giles just woke up and his arm is better. Surprisingly not into giving himself a pat on the back today, House just points out the presence of a phone in Giles's room and asks that the time they have something to tell him, they use that so he doesn't have to leave his chair. Awkward blocking ensues as House goes out of his way to give Giles a pat on the leg as he leaves. Giles says he just felt that. We go to commercial before House can yell at him for ignoring his request about phone communication.
Chase and Cameron follow House into the meeting room. He says that Giles has feeling in his calves, but that they have no idea why.
Meanwhile, Dr. Smiley tells Foreman he's sure it's the experimental ALS drugs he prescribed that caused Giles's condition to improve.
House says that the only way to figure out what's helping Giles is to take him off everything, and then test each medication one at a time and see which one makes him better. It's preferable to keeping him on all the medications, most of which can be toxic if given unnecessarily.
And now, House and Foreman walk down a hallway. House says it's his treatments, not Smiley's, that are making Giles better. Therefore, House will no longer be giving Giles any drugs.
For, like, the third time, the not-giving-the-patient- drugs-that-are-helping-him theory is argued, this time by Wilson as he and House hang out in an empty exam room and watch GH on House's handy-dandy portable TV. Dr. Smiley dashes in and asks if he can "have a word" with "Greg(g)." House asks "Marty" if it can wait for a commercial, since he and "Jimmy" are very invested in the newest sizzlin' summer storyline. Smiley doesn't want to wait. He needs to know what drugs House put Giles on. House won't tell, and if Foreman tells Smiley, House will never let Foreman out of his contract so that he can work in L.A. That's right; House knew about the job offer all along, based on his magical powers of deductive reasoning that Smiley, while a "polite twit," is not an "idiot," unlike everyone else in this episode, according to House. Smiley repeats that he needs to know what House took Giles off of, because he needs to put him back on it.
A few smacks with a metal clipboard confirm that Giles's legs have lost feeling again. House grabs Foreman and they go to work.
House and the Cottages, all reunited again, march down the hallway. House says that there is some good news: Smiley looks bad and House looks good. These things are very important. He puts Giles back on the steroids, potential lung problems they can cause be damned, and orders yet another MRI. Chase and Cameron spring into action, leaving Foreman and House to have a discussion.
Giles gets another MRI. Chase and Cameron gossip about whether House will let Foreman out of his fellowship contract. Cameron says she's sure House will, since making Foreman stay would be akin to admitting that he needs Foreman around. And unlike T-Boz, Left Eye, and Chili, House is too proud to beg. Cameron turns back to her computer monitor and lets out an "oh my god" because she just beat her Minesweeper personal best. But will she ever solve the beginner level in less than ten minutes?
Meanwhile, House wants to know whether Foreman thinks Dr. Smiley is a better doctor than House is. Foreman doesn't really feel like feeding House's ego today, so he refuses to answer. House says it's an important question, because Foreman should work for whomever he personally believes is the better doctor. Foreman says it's not just about that; he also has to choose between working for a nice guy or a guy who "mocks and abuses" him. House does not deny the mockery charge, but he argues with the abuse claim. It isn't abuse to hold people responsible for their mistakes. Foreman says that Smiley forgives and moves on. House says that's not true; Smiley didn't forgive anything Foreman did to Giles. He just blamed it on House when, ultimately, it was Foreman's fault because he's the one who gave Giles the immunoglobulin. And while House thinks Foreman's giving Giles the immunoglobulin was "great," and that Foreman should feel great about it, he should also feel like crap because it ended up being the wrong treatment. Smiley, on the other hand, just does his job and figures that, whatever happens, happens. "He sleeps better at night," House says. "He shouldn't."
Chase and Cameron rush in with the MRI. They just found an arterial venous malformation in Giles's spine: that's what was causing the paralysis, not ALS. It didn't show up on any of the MRIs because the scar tissue around it blocked it from sight. House's steroids shrank the scar tissue down, making the AVM visible and winning it the Hide and Seek MVP trophy. All they have to do now is remove the AVM and Giles will walk again, not to mention learn a valuable lesson about the importance of seeking a second opinion. Foreman gives House a loving smile. He's not going anywhere.
And now it's time for a cheesy surgery/healing/physical therapy montage, all set to jazz music!
House pops a Vicodin on his way out of work for the day. He's so obsessed with that job that it's still daylight when he leaves. Giles exits a nearby elevator with the help of his shiny new cane. He's being discharged today, and his limp is the only reminder of those two years of unnecessary paralysis. House bets Giles fifty bucks House can race him to the curb. Louis Armstrong comes on the soundtrack as Giles gives House a little present: his trumpet. House is touched, because he doesn't know that Giles dropped it on the floor in the beginning of the episode. Giles's one condition is that House never play it. House smiles. Giles asks how many Vicodins he takes a day, and House's smile fades. "I'm in pain," House answers. "Yeah...aren't we all?" asks Giles. The two limp out of the hospital and talk about the best cane stores. Foreman walks past and House says he'll be seeing "Eric" tomorrow. Dude, I can't believe they didn't bring Brandy back.