Just another ordinary day in the Princeton Plainsboro clinic. There are sick people, bored people, couples coughing, babies burping, doctors striding the halls in slow motion. There are people in pain, those just there to complain. And then there's him, a quiet, unassuming gentleman in a muted business suit. A man almost not there but who still stands out in the crowded waiting room. Yet he sits patiently.
Thirteen fends off an obnoxious man demanding a refill on pain killers for his "migraines" (yeah, right), only to be forced to deflect Foreman soon thereafter. However, Foreman brings good news: he's consulting on clinical trials involving a new Huntingdon's drug and he'd like to see her participate. So, why does she refuse?
Our gentle friend rises from his seat and enters Cuddy's office looking for her. He's greeted by our favorite anti-people person rummaging through Cuddy's desk drawer; he quickly and rudely turns him away. Guess he doesn't appreciate that - the quiet man pulls out a gun and re-enters the office with several hostages, including Thirteen, a nurse, and six people from the waiting room.
Last Shot has been to sixteen doctors over the past two years, none of whom have been able to diagnose his particular constellation of symptoms: dificulty breathing, chronic fatigue, skin rashes, stomach pain, insomnia, and heart palpitations. He demands someone tell him what's wrong or he's gonna start shooting. House begins his examination. Rather than rely on the pile of medical files Last Shot brings with him, House gets his own history by asking questions and assuming the patient is lying. Why wouldn't an armed hostage taker and potential mass murderer be a liar too?
Since they're barricaded in Cuddy's office, House has to improvise some testing methods without adequate equipment. To test lung capacity, he borrows a lighter from a teenage hostage (poor kid almost gets blasted reaching for it in his pocket) and then asks Last Shot to try blowing out the flame while holding it at arm's length. He wheezes heavily with each exhalation. House thinks he might have pulmonary scleroderma (thickening of the lungs), but they need to give him propofol to prove it.
The phone rings. It's Cuddy. Last Shot puts her on speaker phone and announces that no one's leaving the room; he'll only let Cuddy personally deliver the drug. Alone. While waiting, he'll just hold his gun to the back of Nurse's neck. Cuddy brings him a syringe. And right before House can administer the contents, Last Shot wisens up. Oh, no. Give a little of that to somebody else first. The man with the "migraines" is the only one in the room (besides Nurse) who isn't sick or currently on medication that may interact badly with the propofol, so he's the lucky recipient of a dose that promptly knocks him unconscious. Plan A to disble hostage taker fails miserably. Last Shot is incensed; to show he will not be screwed with again, he shoots one of the hostages, a young businessman, in the leg.
The Princeton S.W.A.T. team arrives at the evacuated hospital clinic. Cuddy informs them she heard shots fired and can no longer make contact with the room - Last Shot keeps ignoring or hanging up the ringing phone. S.W.A.T. takes over and by the look of their long-range rifles, they mean business.
House pages all new and old team members who aren't taken hostage. Once they're asembled together, he begins a diagnostic differential. Chase is disgusted by Last Shot's tactic at getting a diagnosis for his illness, so he walks out. The rest stick around and relay ideas: Foreman - chronic lung infections; Thirteen - lung cancer; Cameron - nerve damage causing diaphragm malfunction; Kutner - a heart defect leading to poor circulation. House tells the team he'll be drawing Last Shot's blood and asks Foreman to test it for infection and cancer. He instructs Cameron to comb through the patient's medical records to check for past medications that might've messed with his heart, and he sends Taub and Kutner to Last Shot's home to search for neurotoxins. When Last Shot freely gives up his address, House realizes that this may, in fact, be his last shot - it's a diagnosis or the big bang. Or prison, whatever. He's just never going home again.
The S.W.A.T. leader calls in to check on everyone. In the middle of the conversation, Last Shot hangs up the phone and his ears perk up as if he hears something. He does. He tells a female hostage to open the window blinds. Out of fear or maybe due to whatever contagious sickness brought her to the clinic in the first place, she throws up all over Cuddy's floor. Thirteen steps in and opens the blinds. There are two S.W.A.T. team members right outside the window ready to take him out. Last Shot yells at them to back off or somebody else is gonna get it, and they obey. Plan B to disable hostage taker fails miserably. House finds the incident very interesting; hyperacusis (abnormally acute hearing) means that his condition is most likely nerve-related. Thirteen suggests nerve palsy. House tests the theory by asking the patient to perform a couple of facial exercises; they reveal left-side facial weakness. House diagnoses post-herpetic neuralgia but Last Shot demands proof. House tells him that there is a test but it hurts like hell if he's wrong. When S.W.A.T. calls back, House asks that they send in 200 mcg of capsaicin. S.W.A.T. Leader negotiates a deal freeing two of the hostages; Migraine Man and and the shooting victim, Bloody Businessman, are released along with Last Shot's medical files and blood samples.
Last Shot learns from the last incident with "medication," so he requests two syringes and requires someone else take the first dose. The Kid volunteers, but Nurse objects on his behalf because capsaicin can cause nerve and muscle damage. House starts off a weird domino effect of nose bending and the male half of a captured couple pulls the short straw, so to speak (bends the last nose, whatever). Husband Hostage refuses to accept the shot, so Thirteen says she'll take it. Heck, she's dying anyway, right? Immediately after the shot, she collapses on the floor in agony. It's Last Shot's turn, and he cries out in pain too - guess it's not herpes.
Taub and Kutner go to Last Shot's apartment and find pill bottles and medical bills laid out neatly for them. Last Shot was already expecting that someone (whether it be a doctor, police officer, or next-of-kin) would need to search his place; he really never expected to return home. Kutner feels a modicum of pity for him, but Taub refuses to feel anything. Kutner spies a photo of Last Shot and his mother on his school graduation day. He notices that Mama Shot has a droopy eye, fat face, and thick neck - all classic signs of an adrenal problem.
After testing the blood samples, Foreman rules out infection, leaving behind heart issues and cancer. Back in the room, Thirteen notices Last Shot has a distended jugular. When House checks his pulse, he finds that the patient's heart is racing. They'll need to get paddles into the room to stabilize his cardiac rhythm but he'll need to surrender his gun - the electric current will cause all the muscles of his body to contract, including his trigger finger. Last Shot refuses. Husband Hostage suggests they wait him out until he drops dead and Last Shot suggests Husband Hostage take a bullet or shut up. House tries a carotid massage but it doesn't seem to be working quickly enough. Thirteen comes up with the idea of slowing his heart rate chemically instead. She volunteers to fetch adenosine and Last Shot gives her 30 seconds or The Kid gets it.
While Thirteen searches for the adenosine, S.W.A.T. team members signal to her to head their way to safety. Will she escape? House thinks she might. In fact, he thinks she should. Nurse refuses to believe she would abandon them and leave The Kid to die because of her own desire for self-preservation. As they bicker and time ticks away, Last Shot starts to freak out. Nurse jumps before the gun to save The Kid, then begs for her own life. And right before he pulls the trigger, Thirteen re-enters the room. Last Shot tells Thirteen she has to take the adenosine first. She does and keels over from a dangerously low heartbeat. House administers the shot to the real patient and his heart rate returns to normal. House rules out a heart defect when he notices Last Shot is sweating profusely from one side of his face signifying a tumor pressing on his sympathetic nerves.
House pages Wilson for a consult. Wilson tells him to check his throat because lung cancer usually presents lower than the seventh nerve. House asks Last Shot to spit on the floor (this room is getting really nasty now), but he can't produce much saliva. Dry mouth means his parotic glands aren't working. Wilson tells him that if the glands are swelling, it's a Pancoast tumor that has metastasized. House feels a lump in Last Shot's throat and tells him it's cancer, but he needs unequivocal proof. He negotiates the release of two more hostages (Husband Hostage's pregnant wife and Vomiting Girl) in exchange for a trip to radiology.
Last Shot ties the remaining hostages together and surrounds himself with their bodies to prevent a free sniper shot at his head. Then they shuffle down the hallway. Pretty smart. I wouldn't have thought of that; to be honest, I would make a lousy crazed gunman - they would've taken me out with the first sedation attempt. Last Shot holds his gun on the hostages the entire time he's undergoing his CT scan but the metal from the weapon causes a starburst distortion; he'll have to surrender it if he wants a proper diagnosis. At first, he refuses but then House convinces him otherwise. With the gunman unarmed, Nurse and Husband Hostage escape.
House performs the scan over again but doesn't detect any tumor. Last Shot is devastated that he'll have to go to prison not knowing what's killing him. Rather than end the standoff with unanswered questions, House returns Last Shot's leverage - his gun. Thirteen blasts House for being a coward - unlike Last Shot's curiosity about his own illness or even The Kid's reason for staying in the lab despite his chance to escape with Nurse and Husband Hostage, House's curiosity is based on a desperate need to know because he's too afraid to be wrong; he's too scared to be just another ordinary doctor. House comes back and tells her he's just arrogant, but she's the real scaredy-cat - she's so terrified of death and desperate to hold onto an illusion of control over her life that she's playing the martyr to make her end come even sooner.
House calls Wilson and the free team members for a new differential. This time it's Foreman's turn to leave the room in disgust. Taub throws out an unpronounceable disease name, but House dismisses it unless Last Shot's been to Cameroon (no). Cameron suggests Q Fever if he's had exposure to goats (no). Kutner thinks histiocytosis could explain the lung problems. Then House notices a new symptom: Last Shot appears to be losing his hearing in his right ear. Cameron thinks it could be Cushing's disease, so House asks S.W.A.T. Leader to send in dexamethozone. But S.W.A.T. is done with negotiations. Last Shot sends out The Kid and asks for the meds.
When the dexamethozone arrives, Last Shot demands Thirteen take the first dose yet again. House objects but Thirteen snatches the syringe and plunges it into her side. House then gives Last Shot the shot and checks his lungs. His breathing remains unchanged but Thirteen's heart starts to race and she spikes a fever. Her kidneys are shutting down. House tells Last Shot he needs to slap him (for diagnostic purposes, of course); when he does, he notices a slight twitch - a sign of calcium deficiency which would explain how his kidneys are unaffected by all the drug doses.
What could all the aforementioned symptoms plus anemia point to, and what would have such a long incubation period? Taub suggests leishmaniasis (a tropical disease caused by parasitic protozoa) but House rejects it. Cameron believes melioidosis (an infectious bacterial disease spread by contaminated water and soil) explains everything but House counters that the patient's never been to a tropical climate. Last Shot agrees - he's never been anywhere south of Florida. Wait a minute, it gets pretty hot and muggy in the Sunshine State. House is always right - every patient lies, even when they don't mean to.
House calls S.W.A.T. Leader and asks for drugs to treat the melioidosis. Negotiations are over, remember? Last Shot offers to free House if he can just get the meds. House doesn't want to leave because he knows Last Shot's gonna give the injection to Thirteen, but it will most likely kill her. Thirteen plays martyr again and tells House to get out while he has the chance. He finally agrees.
Last Shot and Thirteen have a face-off where they argue over whether she's truly afraid to die. She must be because she hesitates with the needle poised against her flesh. "Don't do this," she begs. He points the gun at her head. His hand starts to shake. She starts to cry. "I don't want to die," she finally admits. "I don't want to die." Last Shot grabs the syringe from her hand and plunges it into his arm.
BOOM!
The S.W.A.T. team detonates an explosive device that blasts a hole in the wall of the radiology lab. Plan C to disable hostage taker is successful. As they slap handcuffs on Last Shot and lead him away, House silently asks him how he's feeling after the meds. The grateful smile says it all.
After the ordeal, Foreman visits Thirteen in her hospital bed while she's hooked up to dialysis. She thanks him and accepts her place in the Huntingdon's clinical trial. Nothing like the feel of steel to make you love life.
Next Week: Cuddy's office is a giant mess after the hostage situation, so she moves in with House. First comes love, then comes marriage...
