Heavy

A girl doesn't want to go to school today. She claims she doesn't feel well, but Mom ain't buying it, since her daughter doesn't have a fever. So the girl reveals that the real reason she doesn't want to go is because everyone there hates her, just like she hates herself. Mom talks down to her daughter by referencing Dr. Seuss's Green Eggs and Ham, saying that the kids who makes fun of her simply don't know her, and will like her once they do. This would make young Jessica the annoying stalker Sam I Am, which isn't exactly the most flattering comparison. Speaking of not flattering, the girl playing Jessica has been saddled with some prosthetic chipmunk cheeks to make her look fat.

Jessica goes to school, where she is forced to jump rope in front of her entire gym class, thereby handing the bullies an opportunity to make fun of her on a silver platter. Seth -- who probably makes fun of Jessica to distract his peers from criticizing his long, golden curls -- is the worst of the lot, and is sent off to do laps while Jessica complains that her arm and chest hurt. She struggles to jump rope in slow motion, and her hoity-toity school playground has that springy stuff on the ground instead of the hard-ass pavement I spent my youth playing on, so it looks like Jessica is so fat that the ground wobbles every time she lands on it. Her subsequent collapse sends seismic waves through New Jersey, and the gym teacher rushes over and immediately figures out that his ten-year-old student is having a heart attack. He's a better doctor than House, who would have diagnosed and treated Jessica for depression, pneumonia, and fibromatriculosis before coming up with the correct diagnosis. Gym Teacher tells the 911 operator to "send the damn ambulance," and the rest of the class does not go "ooo-ooo-ooo-oooh!" like my fifth-grade class did that time our music teacher said "whoopdee shit."

House leaves a Clinic exam room as the loudspeaker asks a "Dr. Becker" to dial an extension, as if Ted Danson needed any more reminders that if only his character had been addicted to Vicodin instead of cigarettes, he could have gotten an Emmy. Cuddy walks up and tells House that they need to talk, and House tries to throw her off by mentioning infections of various sex organs. It doesn't work, and Cuddy orders House to fire one of his Cottages, per Vogler's orders from the last episode. House says he has every intention of doing so, but will need to complete their performance evaluations first, which could take one thousand million years. Cuddy gives him a week.

House limps into the elevator, where he finds Cameron, patient referral in hand. Back in the meeting room, Foreman cannot believe they're dealing with a ten-year-old with a heart attack. Heart attacks are old-people problems! Cameron says that the ER did test after test, and Jessica did, indeed, have a heart attack. So if the department of diagnostic medicine's fortune ever reverses and they find themselves with an open position, there's a gym teacher they might want to consider hiring. Chase points out that their patient is "morbidly obese," which, I'm sorry, but unless she left half her body weight in her backpack, she didn't look exactly morbidly obese to me. Heavy, sure, but I've seen morbidly obese children, and she was not one of them. Foreman says it takes a few decades for morbid obesity to kill you, and Chase says that he'd try to kill himself if he were "that fat." Yes, I'd imagine the rate of suicides in "morbidly obese" ten-year-olds is extremely high. Try thinking like a doctor and not a schoolyard bully, Chase. Everyone settles on a diagnosis of Metabolic Syndrome X, which is a really bad-ass name for a disease; it can cause heart attacks in patients with high blood pressure, and morbidly obese people do tend to have high blood pressure. The Cottages get up to start treatment, and House casually mentions that he is going to be firing one of them by the end of the week. Foreman assumes that House is playing some kind of mind game with them, like his very own version of Punk'd; this show really likes Ashton Kutcher, doesn't it? Cameron doesn't think this is a trick, a suggests that they all pull together in this time of trouble. Chase prefers the every-man-for-himself approach. Foreman agrees with Cameron, saying that the last thing he wants to do is get House off by playing into his little Cottage v. Cottage contest.

Cameron explains Metabolic Syndrome X to Jessica's mother, who isn't all that thrilled with the treatment options of diet and exercise, since Jessica apparently eats right and exercises every day, and has seen several nutritionists and done what they instructed. Whatever's wrong with Jessica, she insists, doesn't have to do with her weight. Cameron says that the only way they'll know that for sure is to do the slightly dangerous test on Jessica that will rule out Metabolic Syndrome X.

Down in the Clinic, House has yet another "morbidly obese" patient complaining of heartburn. House makes the mistake of assuming that she's pregnant, thereby earning him a lecture from the woman about how women are supposed to have curves and her husband likes the way she looks, so House can take his magazine-model ideas of what a woman looks like and give her some goddamn Pepcid AC! House insists that the patient is pregnant, despite the fact that she has been pregnant six times already and House has been pregnant never, and despite the fact that her husband has had a vasectomy and they always use condoms. House says he'll get her some heartburn pills and draw some blood for a special heartburn test that is obviously actually a pregnancy test.

Jessica doesn't want to do the weigh-in for the test. Chase is not sympathetic, because he hates fat people. Foreman, on the other hand, tells Jessica that he used to be fat, too, and that all the kids made fun of him. Then he hit puberty and grew half a foot and wasn't fat anymore. Jessica gets all hopeful that this could happen to her, too, especially since her mother is tall and Jessica's short for her age. She steps up to the scale to get weighed.

Later, Chase snarls at Foreman for telling their patient that she can "grow out of" obesity, even though the girl does have the right-about-to-grow heaviness look to her. Chase prefers the tough-love approach to slimming down, which is to make fun of the fat person until she gets off the couch and stops eating crappy food. Cameron says she's sure Jessica gets enough of that attitude from everyone else, so she doesn't need it from some pretty-boy doctor, too. Cameron thinks people should be happy with however they look, as long as they're healthy. Chase points out that Cameron weighs all of ninety pounds, so that's easy for her to say. True.

Wilson and House shuffle through the cafeteria buffet line and talk about who's getting fired. House's new plan is to sexually harass Chase and Cameron and call Foreman a "spade" (which he says out loud right in front of another black hospital worker, because House has no concept of sensitivity. Fox, however, does, which is probably why House didn't go with the more realistic and inflammatory n-word) so that none of them can be fired without exposing the hospital to a pricey lawsuit. "You are uniquely talented in many areas," Wilson begins, and what areas he speaks of depends on whether or not you buy into the Wilson-House secret sex or not. He finishes by saying that House is not a good politician, and that it would be stupid for him to go up against Vogler. "Separate or together?" the cashier asks them. "Together," says House, and your interpretation of that line, again, depends on your interpretation of their relationship. House then walks out, leaving Wilson to pay for both of their lunches. Ha!

The Cottages perform the test on Jessica, who complains of being thirsty, which means a seizure or respiratory arrest is right around the corner. They're too busy making bets on which one of them is going to get fired to take much notice of Jessica until she starts telling everyone off and trying to remove all the medical tubing. As we go to commercial, Jessica's screaming obscenities, which is pretty cool.

The Cottages sort of apologize to Jessica's mom for inducing the hypoglycemia that made her daughter get all awesome. Jessica's mom is just a little bit annoyed at the fact that instead of paying attention to her daughter, the doctors were "bickering" and "placing bets." Cameron gives the apology another go, hoping a sensitive woman's touch will smooth things over, but Mom tells her to "save [her] pathetic insincerity for [her] boyfriend." Apparently, hypoglycemia crankiness is contagious. Chase, who's standing behind Mom, makes a hilarious "oh, SNAP!" eyebrow raise as he wonders if having the smackdown laid upon one by patient relatives is one of the criteria for getting fired. House limps up to defend the Cottages, saying that while Cameron is pathetic, she is also very sincere, and also that the lab results show that Jessica's bitchiness was not caused by the test. They don't know exactly what did cause it yet, but it's not something that can be cured by simple diet or exercise.

Back to the drawing (white)board! House points out that now would be a great time for one of the Cottages to come forth with a brilliant idea about what Jessica's problem is, because he figures that as long as everyone's thinking it, he might as well just say it. And also because he's an asshole. Chase suggests a blood clot, which Cameron shoots down for being more likely to cause a stroke than a heart attack. "No, you're wrong," Chase says curtly. And then they bicker back and forth while Foreman rolls his eyes and House watches with glee. Cameron wins the argument after forcing Chase to say that their ten-year-old patient's blood clots could have been caused by liposuction, which is ridiculous and undermines anything non-ridiculous Chase said before that. Even House won't roll with that. "Thank you," says Cameron, who is much cooler when she's feisty. House suggests that diet pills could have caused Jessica's problems, and assigns Chase and Cameron to give Jessica blood-thinning agents for the clots they don't know for sure she has, and Foreman to find Jessica's diet pills.

House sucks down a couple of Vicodins, but the sweet bliss of a system drug infusion is ruined by the appearance of Foreman. House tells him that while Foreman is on the right track, House's Vicodins are not diet pills, so Foreman might want to extend his search a bit. And then House puts his pill bottle in a little case on his bookshelf, which I have to imagine is filled with tiny little pill-sized beds with linen sheets for all his little friends. Foreman isn't here looking for diet pills, though; he wants to tell House that doesn't like the way House is handling the firing situation. House asks what Foreman thinks House should do, then, and I think House's question might actually be sincere, and that his gross mishandling of all this simply comes from his inability with human interactions as opposed to his ability to be a total asshole. He then asks Foreman straight out whom House should fire. Foreman doesn't want to answer until House says he'll fire Foreman. Then Foreman says Chase. Not because of the angiogram mistake or because Chase has plenty of money without a job, but because he doesn't think Chase "appreciates" the job, no matter how much he may want it. House says he didn't think Foreman would pick anyone at all.

House and Wilson de-elevator (drink!) as House says that when something like his job is at stake, Foreman is not quite the "rise above the fray" guy he tries to be. Wilson suggests that House quit and let all three Cottages stay. Except not really, since then they wouldn't have a boss and I don't know if their fellowship would exist anymore. And didn't all three of them say they chose to work at this hospital in order to study under House? Would there even be a department of diagnostic medicine without him? House appears not even to consider the option anyway, as his Clinic patient-with-curves' test results just came back and she's not pregnant, meaning that she's Wilson's newest patient. Wait, Wilson's a doctor? With patients? When did that happen?

Foreman asks Jessica's teacher, whose classroom is designed like a kindergarten room as opposed to a fifth-grade one, if he can talk to Jessica's friends. Teach says that Jessica doesn't have any friends because she's fat. And, I mean, come on. I'm sure it's not easy being the fat kid, but when it comes down to it, kids tease each other for any and all physical differences. I got teased for being short. Other girls were teased for being tall. Kids were teased for being fat, and kids were teased for being skinny. And yet, we were all able to create and maintain friendships. Being an outcast is more a mental thing than physical, I think. It's the "weird" kids whom no one can relate to for whatever reason that usually find themselves friendless. Then again, maybe Jessica's class is really small and every other kid in it has no physical defects whatsoever, making her the only person who remotely stands out and, thus, a target. I doubt it, though. Teach says that all fifth-graders have an assigned eighth-grade buddy, so Foreman might want to try talking to Jessica's.

Vogler checks in with Cuddy on House's progress, because making sure his one rather arbitrary order is followed is much more important than whatever else the chairman of the hospital board has to do. Cuddy says that she gave House a week, and that he will do what he is told. Vogler doubts it, and then sees Cameron walk by and moves on to her. He introduces himself and asks whether House is trying to "stir up" antagonism against him by telling them that Vogler is forcing House to fire one of them. Because I'm sure that without House's mental manipulation, all the Cottages would be totally cool with Vogler and understanding of his decision to ruin one of their lives. He tells Cameron that he will do whatever he can to help whichever Cottage gets the axe. Cameron coolly thanks him and walks away instead of asking if that help will include a gift of one hundred million dollars.

Wilson and House talk to the Curvy Clinic Patient, who has a thirty-pound tumor. They take their precious time informing her that the tumor is benign, which is just a little cruel, and try to schedule her for surgery. But Curvy doesn't want surgery, because it will leave her with a huge scar and she won't be able to wear a bikini. I have to imagine that, as attractive as those natural womanly curves may be, the lumpy, beachball-ish bulge of a thirty-pound growth on an ovary would be something anyone in her right mind would like to get rid of. This is ridiculous. Tumor Lady accuses Wilson and House of trying to trick her into having "cosmetic" surgery because they can't accept fat people in society. If the tumor is harmless, she'd rather stay the way she is, since her husband is into the BBW look. She storms out of the room, and Wilson and House agree that her reaction was not what either of them was expecting.

Foreman talks to Jessica's buddy, who, of course, hates Jessica because of her fatness. She says she caught Jessica taking "drugs" one day, which Jessica claimed were diet pills given to her by her mother, but "Buddy" says they could not have been, since Jessica is too fat for diet pills.

Back at the hospital, Mom denies ever having given her daughter diet pills. From her bed, Jessica says that she did, in fact, take diet pills that she got shoplifting from the local CVS or wherever. "Why would you do that?" asks Clueless Mom. Jessica says she is disgusting and ugly, and just wanted to have friends. Hey, maybe no one wants to hang out with her because she feels so sorry for herself. That's got to get annoying after a while. Foreman says that it was the diet pills that caused Jessica's problems, and that she'll be fine. Except that it wasn't, and she won't.

Cameron thinks it's very sad that Jessica was so desperate to fit in that she almost died. Chase isn't quite so sympathetic, since he's busy pouring House some coffee like a little kiss-ass and spitting more hateful comments about fat people and how they need to stop eating. Cameron and Foreman both deny that eating causes fatness, Cameron saying that you wouldn't fault a cancer patient for getting cancer, so why fault a fat person for being fat? I don't exactly agree with that particular sentiment, and neither does Chase, who thinks that Americans are all junk-food-eating television watchers. He might want to read the latest stats on his home country, since I know that Britain is having a lot of problems with childhood obesity, and I expect Australia is similar. Before Foreman gets a chance to show everyone how above-it-all he is by leaving the room in a huff, his pager goes off, followed by everyone else's.

The Cottages sprint to Jessica's room, where she is complaining of pain and bleeding. Cameron lifts her shirt to reveal bloody and black sores all over Jessica's chest. Now she'll never have friends!

After the commercial, House and the gang try to figure out what caused Jessica's sores. The most likely theory is that warfarin, one of the two blood-thinners they gave Jessica earlier, had the unfortunate side effect of skin necrosis. Chase gave Jessica the warfarin, and Cameron gave her the heparin. House asks Cameron if she also gave Jessica warfarin by mistake, which would explain the reaction, and Cameron is adamant that she did not. House asks Chase whether he saw Cameron prepare the heparin injection, and Chase says he was too focused on saving his job-- I mean, "preparing his own injection" to notice what Cameron was doing. House orders drugs to counteract the supposed warfarin overdose, and the Cottage walk out to the hallway, where Cameron and Chase argue heatedly until House comes out to yell at them to worry more about their patient than about themselves. Seeing as he is the one who created this hostile, competitive atmosphere in the first place, he really shouldn't complain.

Vogler wanders into Jessica's room as Foreman finishes administering the anti-warfarin medication. Vogler picks up Jessica's chart and reads the "warfarin-induced skin necrosis" diagnosis off of it, like, how is that even legal?! Aren't Jessica's medical records confidential? And, assuming she's in the ICU, he shouldn't even be allowed in her room at all! One hundred million dollars sure does buy you a lot of inaccuracies for the sake of advancing the plot these days. Vogler figures out pretty quickly that Jessica's current condition was caused by the doctors instead of by her heart thing, and then goes to work psychologically manipulating Foreman into turning against House, saying that House hates everyone and thinks he's better than they are. Foreman simply says that he respects House, but that he really wants to keep his job, and then Chase walks in. Secret meeting over, Vogler walks out. Chase tries to act cool and nonchalant when he asks Foreman what Vogler wanted from him, and Foreman lies that Vogler just wanted to know what warfarin was.

House finds Cameron in the lab, where she's aggressively trying to prove that she didn't do anything wrong. But she still has no idea what could have caused the necrosis other than a warfarin overdose. House tells her to let him know when and if she gets a clue, and Cameron angrily says that she is the only person who supported House when he screwed up. He asks her why she would do that, and Cameron answers that she's not "insanely insecure," and I think she included one too many "in"s there, possibly even two. She calls House a "misanthropic son of a bitch" incapable of trusting anyone, which is sure to help her keep that job. House asks her whom she would fire, and Cameron says that she would just cut everyone's pay so that they could all stay employed. House accuses her of finding a solution that makes everyone happy (except for the people who might not want/be able to afford a pay cut), when the real world doesn't work that way. Cameron, in turn, accuses House of stalling and refusing to face the issue.

House enters the Clinic, where Tumor Lady's husband is waiting for him. House denies that he is House in order to avoid human interaction, and enters Cuddy's office.

Vogler and Cuddy are having a meeting, because that's all they ever do when Vogler isn't running around looking at people's confidential medical records and probably assisting on complicated surgeries. House says that he has come to a decision: he and his three team members will each take a 17% pay cut, thereby allowing them all to continue working there for the same amount of money as if one of them had been fired. House says it's "win-win." Cuddy loves it. Vogler does not. He says that this isn't about the money, but about knowing that House will do whatever Vogler asks House to do, because the domination of one freaking doctor on an entire hospital staff is just that damn important. Cuddy looks sick, perhaps realizing for the first time that the new chairman of the board has some weird control-freak issues that she'll be stuck dealing with for the rest of whoever's tenure lasts longer. House leaves.

Tumor Hubby was not convinced by House's denials, and demands to know what is going on with his wife. House says that physician-patient confidentiality prevents him from telling the husband anything, unless, of course, the husband has one hundred million dollars. Husband says that he knows about the tumor, and that he wants his wife to have the surgery, even if it means she'll be skinnier and have a scar. He wants House to talk to his wife again and convince her to have the surgery. He shows House pictures of their six kids, which doesn't affect House in the slightest until he gets a good look at the pictures. He tells the husband to send the wife back in, and takes the pictures with him into the elevator.

Back in the office, the Cottages report that Jessica's necrosis is getting worse. Cameron "I told you so"s that it's probably because they're treating Jessica for the wrong thing, but since she still doesn't have an alternate explanation, House ignores her. Wilson, who is suddenly there, says that if the necrosis doesn't start to get better by the end of the day, they'll have to remove it before it spreads and kills her. Why is he telling them this news? Did Vogler fire the entire dermatology department?

Foreman and Wilson tell Mom that if the necrosis doesn't start getting better in a few hours, they have to do some amputatin'. A radical mastectomy before poor Jessica's breasts even got a chance to really exist.

House looks over some nasty pictures of necrosis, which may or may not be his screensaver, until Cameron enters, demanding to talk. House immediately goes for his pills as Cameron asks him if he is pursuing this diagnosis-based-on-her-mistake thing because he's just looking for a chance to fire her because he "can't deal with [his] feelings for [her]." House: "[pause, exasperated sigh] I believe that you were the only one to express feelings." That's true. And grow up, Cameron. And, of course, shut up, Cameron. Don't you dare be all sassy and cool this episode and then ruin it with this boss-crush personal bullshit emotional woman crap! Cameron takes a few cheap shots at House's lack of friends, then volunteers to quit to make things easier for everyone. House says that sounds fine. I agree!

Tumor Lady is back, and House shows off those pictures of her kids, including one with blue eyes, and the other with green eyes. Since Tumor Lady and her husband both have brown eyes (and House apparently doesn't think that anyone in the world wears color contacts), that would mean that at least two of their children don't belong to the husband. Shouldn't this B-plot have taken place a few episodes back? House asks Tumor Lady if she doesn't want to have the surgery because she's afraid that all the other men she's sleeping with won't find her attractive anymore. If that's the case, Tumor Lady will be happy to know that men will have sex with anyone, including skinny ladies with hot surgical scars. Tumor Lady says she'll go through with the surgery. That was just stupid.

Chase enters Vogler's office to ask why Vogler's been talking to the other Cottages. Vogler says that if House fires Chase, Vogler will need another source, because knowing the ins and outs of a department of three freaking doctors is just that important to him. Even the smallest hospitals have a staff of thousands, and more than half of those people have nothing to do with medicine, but with the financial stuff. Is there some parallel storyline we're not seeing here, where Vogler is putting the screws to the leader of the billing department, a renegade who follows his own rules but always gets the job done right in the end? Or the laboratory's Special Chemistry department, who will stop at nothing to get results for their tests, even if they have to lie to do it? Or the ER Admitting nightshift, who will get timely care for all patients, even if they have to fudge some stuff on the records to get people seen? This is ridiculous and contrived, and I'm not going to recap it in any more detail than to say that Vogler tells Chase that he'll keep him around as long as he needs him, and that if he can get one of the other Cottages to turn, he won't need him anymore.

It's been three hours, and Jessica hasn't gotten any better. Foreman and Chase want to start the surgery. House asks whether anything else could have caused Jessica's symptoms besides the warfarin. The Cottages pause, and House tells them just to say the first thing that comes into their heads. "She's fat," says Chase. Well, at least he's being honest about something this episode. Foreman snaps that he's had enough of the fat jokes, and Chase says that he's wondering if the obesity is a symptom of Jessica's problems, not the cause. What causes skin necrosis and obesity? Foreman suggests vasculitis, because it's his turn, and then House notices that Jessica's mom is kind of tall. Chase says that Jessica's dad is tall, too. Where is Jessica's dad, anyway? Did Vogler instill a new one-relative-visitor-only rule just to show whoever's in charge of hospital visiting hours that he's the new boss around here? House says that Jessica is short, indicating stunted growth. Cushing's fits all of Jessica's symptoms, except for the fact that it hasn't shown up on any of her blood tests. House says that the cortisone levels indicative of Cushing's could just be cyclical, and weren't in the bloodstream when the tests were taken by sheer coincidence. So now they're faced with two choices: if they treat Jessica for Cushing's and she doesn't have it, she'll die. But if she does have Cushing's and they don't treat it, she'll lose her breasts unnecessarily and still be sick. House orders an MRI, hoping to see something on it that would cause the hypercortisonism of Cushing's.

Foreman and Chase talk about Cameron, who apparently went home early, as they do the MRI. Then they find a tumor on Jessica's pituitary gland.

Foreman explains the surgery to Mom. They'll go through an incision in Jessica's upper lip into her brain, where they'll cut up the tumor and take it out. Once removed, Jessica's problems will all be magically solved.

Jessica's surgery is a success, and she is wheeled out of the hospital. Foreman gives her a hug on her way out. Fat people unite!

Some time later, which I have to assume isn't too much later, since House had to fire a Cottage by the end of the week and all three Cottages are still there, Jessica comes back for a check-up, looking thin and beautiful. "You look fantastic!" Chase exclaims. Asshole. Jessica smiles, because now that she's thin, her life is totally awesome and she was just voted class president and then Seth fell in a mud puddle and everyone laughed at him!

Cuddy and Vogler are standing in House's office when House enters. Cuddy asks him who gets the boot. "Chase," says House. "Chase stays," says Vogler, as he plays with House's thinking ball. House has to pick someone else. House refuses. The bad-ass funk guitar of Jon Cleary starts in as Vogler steps up to House and tells him to pick someone else, or the whole department will go. Cuddy just looks at House and follows Vogler out of the office like a puppy dog. I guess if Cameron's quitting, someone has to pick up the weak woman slack.

Jon Cleary continues into a montage. Chase watches Vogler walk by. Cameron writes out her rsum. Foreman also watches Vogler walk by, but in a different part of the hospital. Vogler sure does walk a lot. House twirls his cane and thinks.