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.
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?
“ The AVM 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. ”
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.