All In

An elementary school class takes a journey through the heart of someone, who must have taken way too much LSD before he decided to let visitors in, because that is the trippiest thing I have ever seen. Seriously, I think all the epileptic students had to stand outside. The bright flashing, moving, pulsing lights are supposed to be blood vessels moving through the circulatory system, and despite its inadequacy as a children's learning tool, I do think that the visual effects department should consider implementing this into their Magic School Bus close-ups. It's more realistic than those computer graphics. The class settles in some heart chamber or something and one bug-eyed little moppet, named Ian, raises his hand to both ask a question and state his need to go to the bathroom. The teacher allows him to ask his question, which is "Wheres the bathroom?" I hate this kid already. The teacher assigns some kid who's desperately in need of a haircut and an attitude adjustment to bathroom buddy duty, much to his obvious displeasure, probably because he knows how easily one can get lost in this dimly-lit, mazelike exhibit, never to be seen again. I can't imagine what kinds of visual aids they employed in the life-size large intestines. The teacher suddenly screams in pain and clutches her pregnant belly. I guess her baby hates listening to precocious kids who don't know their place as much as I do. The teacher sinks down to her knees, where she notices blood pouring down Ian's pantleg and onto his shoes. "You're bleeding!" she tells the oblivious Ian as we see that the back of his pants is a lot messier than the front. The entire female audience of the show sympathetize with Ian's situation and make mental notes to stock up on Always, with Wings, which afford the extra leakage protection you never know when you'll need.

PPTH's Clinic has gotten itself a richer clientele, judging by its red carpets and tables filled with hor d'oeuvres. Oh, I see -- this is just a black tie benefit thing for the usual lower class of people who come through the Clinic's doors, who will apparently be spending tonight sick and helpless since their usual one-stop shop for their health needs is closed for a black tie benefit. How ironic. And honestly, is the middle of an active hospital really the best place for one of these things? Can you really enjoy crudits off a counter where some crackhead lost his lunch not three hours ago? Do the screams of nearby patients in horrible pain mix well with the three-piece orchestra?

House is having a good time, anyway, while he smokes a cigar in what I'm sure is a non-smoking area (that area being "the entire hospital") and fingers his stack of poker chips. Why poker chips? Because he's playing in one of those poker tournaments that black tie benefits so often feature. And yes, ladies, he is wearing a tux and he looks very dapper indeed, despite not having shaved for the event. Wilson and Cuddy are also playing, and they too look very nice in their tux and gown, respectively. Cuddy, especially, looks radiant, because she is awesome at everything. Except being a doctor. She's not so hot there. "My stack's bigger than your stack," she tells House as she calls Wilson's bet. No surprise, House prefers to play the mental aspect of poker, and regales the table with a factoid about gorillas, who, it turns out, have proportionally smaller testes than humans do. Ah, but do the really hot female gorillas occasionally have testes hidden in their abdomens? "Then you probably have an edge over a gorilla, but not over me," Cuddy says, seemingly revealing to the viewing audience that she is, in fact, a transsexual. No one notices the revelation, though, because House's gorilla tale has successfully ruffled Wilson's feathers as it somehow relates to fidelity, something Wilson hasn't had much luck with lately. While Cuddy impatiently prods House to make a freaking decision with his cards, he close-talks at Wilson and then waves his phallic cigar in the guy's face. Because we couldn't afford extras for this scene, we don't get to see the no-doubt furious looks on the faces of the rest of the table, which is a shame, because if Evil Nurse Brenda were there, I'll bet she would have stuck House's cigar up his ass by now.

Finally, House raises, Wilson folds his crappy cards, and Cuddy goes all in as the Only Working Doctor in PPTH mutters in her ear that one of her patients, young Ian, has come to the ER (after an inexplicable five-hour gap between his bloody pants and this nighttime benefit thing) with bloody diarrhea and coordination problems. Cuddy actually knows who Ian is, although that isn't so impressive when you consider the fact that he's probably her only patient, and dismisses the case as gastroenteritis with dehydration. Um, excuse me?! Did she just write off a six year-old with blood pouring out of his ass as a simple stomach infection? Are you kidding me, Cuddy? House isn't so quick to dismiss the case, and asks the doctor if anyone bothered to scan Ian's head for his coordination problems. Cuddy thinks House is just using this to get her out of the game and orders him, while she triumphantly sucks at her drink, to call her or fold. He folds. Cuddy drags her winnings over to her side and brags that she just bluffed House out of the hand. "You might want to spend a little more time paying attention to your cards and a little less timing staring at my breasts!" she smirks. "They don't match, either," House simply says, throwing Cuddy into a tailspin of insecurity. She nervously looks down for a quick symmetrical breast-check. House leaves to "get some air," and Wilson commits a serious poker table no-no and looks at House's folded cards: two aces. Looks like he folded for reasons other than his poker game.

It should surprise no one that House's fresh air constitutional takes him right to Ian's bedside, although I would have been happy enough if everyone just went with Cuddy's orders to give the kid fluids and we never heard from him again and got to spend the rest of the episode watching those three play poker with their nice clothes and personalities. House moves his finger from side to side and asks Ian to follow it with his eyes, revealing that Ian's got a very bad case of CGIeyeitis. Ian's mother, played by an actress I remember from All My Children, asks House when they can expect to see Cuddy, and he responds that Cuddy is totally drunk off her ass tonight, so probably not for a while. Oddly, they do not seem reassured. Then, House takes his pain pills, and we remember that he's the only one whose substance abuse issues should cause impaired doctor abilities. And yet, he's the best doctor there. Go figure. For another test, House tells Ian to grab the handle of his cane, and we see that House doesn't hate his handicap enough to not use it as a cool way to accessorize, because the cane is black with a silver handle to match the fancy affair. Or, maybe this is just his new cane since Wilson ruined his old one. Whichever, Ian reaches at the air instead of the handle, and House gravely informs his parents (the father, by the way, played by a badly-aging Mackenzie Astin) that their son's brain is no longer in full control of his muscles.

House goes to his office and opens a drawer. At the bottom, below his various gadgets, a harmonica, and what should be a nudie magazine but is just some medical journal, he finds a thick patient file for Ester Doyle.

We finally get to see the Cottages when we return to the benefit, where Chase is telling some woman about his recent adventures with a Great White shark that are totally fictional. The woman doesn't care that she's being played by a guy who exudes weaselly sleaze, though, because he's hot and I can't really blame her. House strolls up to interrupt the fun by telling the girl all about Chase's anal fissure problem and encounters with a shemale (Cuddy's been busy tonight, I see!) until the woman leaves disgustedly, and Chase accuses House of "screwing" with him, as if this hasn't been every single interaction those two have ever had since the show began. House says that he needs Chase to focus on a new case, and not on the thought of getting laid, and orders him to get Cameron and Foreman and bring them to the meeting room.

The Cottages arrive to find House writing on the Whiteboard O'Symptoms, asking them what a six-year-old and a seventy-year-old have in common, when it comes to diseases. Cameron jumps right in while the guys check their watches. Apparently, they both have a hot benefit honey waiting for them downstairs. They're even more put out when they look over the two case files and realize that one of them is from twelve years ago and the other is Cuddy's patient with what seems to be a cut-and-dried case of gastroenteritis and certainly not the kidney failure House is writing on the board. House assures them that the kid will soon be suffering from kidney failure, since his disease is the exact same one as Ester's and will therefore progress the same way. And then House spins around to get a look at Cameron in her hot dress-wearin' glory. He takes a second to gasp at her beauty. I didn't know that Jennifer Morrison got to write for as well as act in this show. How nice for her!

House gets back to the case, saying that, twelve years ago, when the Cottages were wearing Frankie says Relax! T-shirts (and looking really strange doing it, since that would have been 1994, not 1984), he was treating a patient with the same initial symptoms Ian has now. The patient died in less than twenty-four hours. Chase thinks House is being ridiculous, as does the rest of the group when House orders them to do a colonoscopy on a six-year-old. They're looking for purple papules that are the hallmark of Erdheim-Chester disease, which is extremely rare and which House is sure both Ian and Ester have. He doesn't know for sure in either case, though, because he never got the chance to do an autopsy on Ester. Amazingly, House writes her name on the board, showing that he only makes an effort to know the names of the people he didn't cure. Not much of an effort, though, as he spells her name "Esther" and her file claims it's "Ester."

Foreman and Chase do the colonoscopy. While poor Ian gets to hear all this, Chase tells Foreman about how come every time someone comes in with Ester-like symptoms, House assumes it's Erdheim-Chester and makes them run all kinds of horrible tests before it turns out that the patient doesn't have Erdheim-Chester or anything remotely serious at all. Outside, Cameron tells Ian's parents that they're testing Ian for something that they're sure he doesn't have. Shouldn't they be in the room holding Ian's hand while two strangers shove a camera up his ass? Foreman sees something that could be a purple papule. Chase argues that it's just a blood blister, and that he doesn't think they should bother with it. Foreman wisely ignores him and does a biopsy.

Over in the lab, Cameron checks the growth under a microscope while Chase paces around, still hoping to be done with this so he can go back to the party. Cameron tells him that while his swimming with sharks story is good, she doubts that woman is waiting for Chase; this gets Cameron a laugh out of Foreman. Apparently Chase has used that line on both of them before. House limps in and asks them what the colonoscopy came back with. It wasn't one of House's purple papules after all -- just Chase's blood blister. I'm sure it still sucks to have blood blisters in your colon, though. House looks at the slide himself and has to admit that there's no Erdheim-Chester there. But he won't give up; he just figures they're looking for something else. A kidney biopsy is on his roster of painful and seemingly unnecessary tests, especially since Ian's kidneys are thus far perfectly healthy. Chase snaps that Ian isn't Ester and that this is a waste of time. "You're testy when you don't get any fuzz," House retorts in a line that I can't believe got past the censors.

House and Chase enter Ian's room. Chase tells the parents that their kid was negative for Erdheim-Chester. Everyone is relieved, until House shows off Ian's catheter bag, which is filled with brown urine. Chase has to admit that things don't look good for Ian's kidneys after all. Worried glances are exchanged around the room for five minutes before we finally go to commercial.

On the Whiteboard, Ian's newest symptom matches Est(h)er's. House asks what, besides Erdheim-Chester, could have killed Ester and is currently killing Ian. Chase suggests E. coli, which House rejects because he tried it with Ester and it didn't work and he's still certain that they have the same thing. Several suggestions are thrown out for not matching both cases until Cameron hits on lymphoma. House pauses at this and looks disappointed in himself, because it's a good explanation for both cases that he never checked for when Ester was around. He sends the Cottages off to test Ian for it. Cameron mentions paging Cuddy about her patient's progress, which House, of course, orders her not to do. Instead, he'll have Wilson "keep her busy" at the poker table.

Wilson gets a call. House tells him to keep his answers "short and discreet" because he doesn't want Cuddy to know that he's on the phone and make her suspicious of what he's doing. Then House asks whether Cuddy is still playing poker, and Wilson answers in a ridiculous covert operations spy voice, that "the chicken is still in Picadilly Square." Cut to a shot of Cuddy immediately becoming suspicious and knowing exactly who is on the phone with Wilson. House asks Wilson how Cuddy is doing in the game. "The patient's on life support; we're about to pull the plug," Wilson answers in his slick coded language. "Are you talking about me?" Cuddy asks indignantly. She is ignored, and they continue their coded medical speak. House determines that Wilson is holding two hearts with two more hearts on the board and Cuddy is displaying bluffing body language. House tells Wilson to go all in, and he does. Cuddy immediately calls. She has two pair. The river card comes. It's not a heart. Wilson loses the hand and Cuddy's got some chips to play with again. Which is exactly what House wanted.

Ian goes into the MRI of DOOOM! He fidgets a lot.

Out in the hall, Cameron is assigned to parent duty again. They don't understand why Ian is still being tested for stuff when he doesn't have that Erdheim-Chester thing. They also want to know what's going on in this other case they've heard talk of. So Cameron has to tell them that there was another case twelve years ago, but that they never figured out what was wrong with that patient. Because she DIED. I see Cameron is taking some baby steps towards delivering bad news; while she's not quite up to telling people that their family member has died, she is now able to tell them that someone else died twelve years ago. Go, Cameron!

Mom and Dad are called into the MRI booth to talk Ian through the MRI so that he'll stop fidgeting. Can't they just tie the kid down instead? That's so much easier, faster, and doesn't force us to watch a Sad, Poignant Moment of parents trying to reassure their kid that he'll be fine and hide the fact that they're just as scared as he is. "Mommy, are you crying?" Ian asks. She says she isn't, and she's right. No tears will fall from her eyes, because she's not a very good actress.

"Good coffee -- cheaper than Prozac!" reads the placard on the meeting room's coffee pot. Maybe so, but most of the people who use that room would probably be better off with some Prozac. Neither is available, though: the coffee pot is empty and so is the bag of grounds, much to House's displeasure. The Cottages rush in to report that they found a small mass on the base of Ian's brain, which seems to confirm the lymphoma diagnosis. Chase disagrees here, though, because the blood tests he just ran didn't show any lymphoma. So now we have a mass that will cause pituitary failure, just like what Ester had, but no lymphoma.

House leads the Cottages to the hospital coffee shop. It's closed for the night, but that won't stop House, who destroys the lock with a few well-placed whacks of his cane and helps himself to the freshly-brewed coffee the place apparently keeps on tap for any nighttime intruders. The place Ian's mystery disease will hit, if Ester's example is correct, is the liver. House wants to start treatment to try to slow it down, but, as Cameron points out, they have no idea what they're treating him for. House loses it for a second and knocks some loud plates off the counter in frustration while he yells at them to "treat him for everything!" And since that never actually works and always makes the patient worse, I'm sure it will be a rousing success this time around.

House calls Wilson again. The poker table has turned for Wilson, and he is now faring quite poorly against Cuddy. But now that House wants Wilson to do well (and therefore keep him and Cuddy playing), he gives Wilson some winning advice after expertly figuring out that Wilson is holding a middle pair by the pitch of Wilson's voice. House also knows that Wilson's hand beats Cuddy based on how she's drinking her seltzer, and advises Wilson to go all in. He does. Cuddy folds. House hangs up. Playing poker with House is a lot like that SNL sketch where everyone gives Sherlock Holmes presents and he figures out what's in all of them without having to open them.

While Chase and Foreman dose Ian with every drug that will prevent liver failure, House watches from outside. Obsession! Chase comes out and tells him that the treatment seems to be working, although Ian's platelets are dropping. House says that this is a good thing, because it tells them something Ester's case did not. Suddenly, Ian goes into respiratory distress. House leaves to write some more on his Whiteboard.

Thanks to his treatment, Ian has ended up at the same place Ester did in an even shorter time, having skipped over the liver and spleen symptoms and gone right to the respiratory failure. That was Ester's last stop before she died. Now that the Whiteboard is useless to him, House dramatically knocks it to the ground, taking out a lamp and everything. It's a good thing House doesn't lose that many patients, or else PPTH would be spending half of its money on replacement lighting for his office instead of windows.

Ian is still dying. His parents are still bland. The Whiteboard has been lifted back up. House wants to know which one of their treatments accelerated the disease's progress. They know that interferon can affect leukemia, which gives House an excuse to call Wilson.

Wilson's still at the poker table playing the longest heads up game ever, and Cuddy is sick of House calling in and ruining her game. She says as much, and House says this means that she's vulnerable and that Wilson should go all in. Wilson responds that "the party is over in less than three hours." Cuddy picks up on this right away as coded poker talk that Wilson either has three of a kind or he's holding threes. She bets five hundred on that, and House impatiently orders Wilson to go all in or else he'll tell everyone in PPTH that Wilson wears toenail polish. I doubt that anyone there would listen to House or really care that much about Wilson's toe care regimen, peculiar though it is, but Wilson is sufficiently frightened by the threat to go all in immediately. Cuddy calls and shows him her trip nines, confident that she has Wilson beat. Wilson obnoxiously shows that he doesn't have threes of any kind at all: he has a straight. That conspicuous three hours mention was his clever way of throwing Cuddy off the track. Wilson's back in it to win it for about three seconds before House tells him that if he doesn't get his oncologist butt up there, a six-year-old will die.

So Wilson joins the significantly less-fun party, already in progress, and checks out some slides of Ian's blood. He tells them that Ian has no sign of blood cancer and that, even if he did, interferon wouldn't affect him that way. So now we have a kid dying in about two hours and still no clue what he's dying from. Wilson suggests Kawasaki disease, which is shot down because it doesn't affect the elderly like Ester. Wilson doesn't care about Ester; they have one case that seems to fit the symptoms perfectly. Even House has to admit that it looks good, although he lets himself still be right that Ian and Ester are connected by saying that Kawasaki must affect the elderly now. The tests to confirm the disease take too long to perform, so House says that they'll just have to go looking for it in Ian's heart, where it "lives." I also hear that you can find Kawasaki in the garage of someone who wants a bike really bad but doesn't want to pay for something nice.

On the way to Ian's room, Wilson accuses House of going all Captain Ahab on Ester's mystery disease, as he, like Chase, has seen House do this before. "Obsession is dangerous," he warns. House sends him back to his poker game.

While Cameron and Chase do an ultrasound on Ian's heart, his mother asks Foreman if Ester was in pain when she died, since Mom has apparently given up and thinks that dying of multi-system organ failure has a possibility of being pleasant.

Cameron and Chase don't find Kawasaki's in Ian's heart, but they do find a very small mass. This is easy to see, since the real human heart doesn't look anything like that model one in the pre-credits sequence. House checks the mass out and says that Ester didn't get one of those before she died, probably because she was older and died before the disease could progress this far. He wants to do a biopsy on Ian's heart.

House does the procedure himself, which is always fun to see. Except when he sucks out at it like he does this time, hitting the wall of Ian's heart and putting him in cardiac arrest. After, like, ten shocks with the defibrillator -- so many that even Chase the perpetual defib guy asks him how long he's going to keep up this exercise in futility before calling it -- Ian's heart comes back. How stupid do you think they all feel when something like that happens? I wonder if they start thinking about all those other patients they called after only five shocks and whether they could have saved their lives if only they kept zapping them until something good happened. Now that Ian's back among the living, House tries to continue the biopsy, figuring that they might as well, since they're already there. Chase protests that Ian's been oxygen-deprived for eight minutes and probably has brain damage. House doesn't care. As long as he solves that twelve-year-old mystery, he's cool with leaving a dead body and a brain-damaged kid in his wake.

Of course, the Cottages aren't so cool with it, but they make suggestions of diseases Ian could have anyway for, like, the fourteenth time this episode. When you don't have patient's houses to break into or weird family histories to explore, you have to repeat a few things. The session is interrupted by Cuddy, who had to leave her poker game when Ian's parents finally wised up and called her about the madman killing their son. She snaps at the Cottages for not thinking to inform her about this, and House defends them by saying they were told that Cuddy was okay with this, which isn't true. Go House. Cuddy says that she's had enough of this, and doesn't agree with making a kid brain-damaged so that House can finally let Ester go. Cameron seems surprised that even Cuddy knows who Ester is, while Chase is definitely not. I have a feeling this stand-off has happened before. This certainly has: Cuddy pulls House off the case, saying that he's not allowed to touch Ian and can go home and ride his motorcycle and brood in a dark corner or something.

Obviously, House isn't about to do that. He asks them if they have any more diseases to add to their list of seven. Foreman tells him to drop it because Cuddy is right. "No, she's not!" House snaps, sounding kind of childish. Chase, his head in his hands, laments not calling Cuddy in the first place. "I'm surprised you didn't," House snaps at him. Ouch. Cameron does not get yelled at because she's wearing a pretty dress. House whips out the tumor he pulled out of Ian's heart and says that if they can't go near Ian, they can at least go near this. Cameron says that they should be able to get three tests out of that. Three tests for seven diseases. They'll have to narrow it down "Maternity"-style to the three most likely diseases to test for.

The first test will be for histiocytosis. Looking not unlike the Crachit family over Christmas dinner, the Cottages hover over the tiny piece of heart mass and cut a section off. They put some chemical stuff on in and look at it under the microscope for the red reaction that will indicate a positive result. It doesn't happen. Test 1: FAILED!

The second test will be for tuberous sclerosis, after sarcoma is rejected even though it's more likely because its test is less reliable. Even though, on this show, no tests are reliable, ever. The Cottages run the test and wonder what will happen for the twelve years if they don't solve this case tonight. I imagine House will be writing both "Esther" and "Eeean"'s names on the Whiteboard. Test 2: FAILED!

One test left, and the Cottages are fighting with each other. Foreman wants to test for sarcoma. Cameron protests that its markers would have also shown up in their sclerosis test and didn't, and then she and Foreman fight over whether the tumor cells looked like muscle or fat under the microscope. If they can't figure out a seemingly simple thing like that, then I don't think Ian has much of a chance here, guys. Chase sighs and says that he wants the final test to be for neurofibromatosis simply because "the other choices suck worse."

House takes a minute out of the sixty or so Ian has remaining in his life to sit at the kid's bedside. I guess he's committing Ian's face to memory, since he's figuring he'll be needing it for the twelve years of obsession. Cuddy enters the room behind him, and House knows she's there before she even says anything. "You want me outta here?" he asks. "You come up with anything?" she asks, her insistence that he not work on or go near her patient worn down in the face of Ian's imminent demise. "No," House sighs. He leaves the room. Cuddy looks totally helpless. We see this look a lot on Cuddy when she takes House off cases and then has to solve them herself.

House and Wilson meet out on their shared balcony. House doesn't want to talk, but Wilson has great news to share: he won the poker tournament! Not too surprising, seeing as how only three people were playing in it and two of them were called away to do medical stuff. But anyway, apparently there was a fourth player named Berman and Wilson played him by sitting on his great cards and waited for Berman, figuring his opponent didn't have anything and wouldn't call him, to make a big bet. Wilson called Berman's all in and turned over pocket aces. "I nailed his ass!" Wilson says. I'm sure that he did. I hope his toenail polish didn't get in the way. House smiles at Wilson's victory and probably the mental image of Wilson nailing someone's ass, and then gets all serious because he has an Idea. "The aces were hiding all along," he mutters, cryptically.

House orders the Cottage to test Ian for Erdheim-Chester a second time. "The disease lied," he says. "Diseases don't lie!" Cameron says. EVERYBODY LIES, Cameron, even single-celled beings! When they did the colonoscopy on Ian, House says, the disease hadn't yet reached his GI tract (despite causing all that bloody diarrhea), and therefore it didn't show up. But it's there now. The Cottages don't want to waste their last test, but they don't have a choice either.

The Cottages test the final piece in a procedure that I've been informed via an email from a pathologist was ridiculously inaccurate and lacking in proper histology procedures. This was no surprise to me, since I assume that any and all medical things I see on this show are totally inaccurate and suggest that everyone else do the same. But anyway, the slide is positive for CD68, and therefore, Erdheim-Chester. House is so happy that he punches a wall, startling the Cottages. Hey, he's got twelve years of relief to get out, there, guys; let him vent. Plus, he loves being right. "Start the treatment," he orders. The Cottages go off to do that, although I'm not sure exactly what they're going to be doing, since there doesn't seem to be any standard treatment for Erdheim-Chester at all and everything I saw said that the disease was fatal in just a few years. Of course, they also said that Erdheim-Chester was an adult-onset disease, so whatever.

So the Cottages treat Ian with some magic drugs as House plays the piano left in the Clinic from the benefit. Ian is cured and is not even brain-damaged. Everyone is happy, especially Cuddy, who would have had her ass handed to her if he had died from what she thought was gastroenteritis and dehydration. Wilson finds House at the piano and they share a look of longing. I am so pissed off that the scene of House and Cuddy sharing a piano bench got cut out of this montage.

As workers clear the benefit stuff away to prepare the Clinic for another day of patients with strange penis issues and goldenrod snot, Wilson and House take advantage of the free poker table and play a game. Wilson tells House that the Erdheim-Chester was just a good guess and that House got "lucky." Actually," House says, "the barnacle is the lucky one, because its penis is proportionally larger than any other animal's." It seems that House writers are more steadfast in their quest for accuracy when it comes to animal wangs than medical stuff, because this is correct: the barnacle can't move, and has to rely on a penis up to twenty times its own length to travel around and find something to mate with. Good times. The guys crack up and discuss more animal kingdom factoids, like how white whales have six-foot long penises, as we fade out.