When you see a guy sign a letter, “I’m sorry…” you know things can’t be good.
House returns from hiatus with a young father and husband in chronic pain trying to commit suicide by sucking carbon monoxide in his garage. He’s seen seven different specialists over three years without any diagnosis or relief so the only thing left for him, he thinks, is death. His wife disagrees and takes him to Princeton Plainsboro.
At first, House thinks Hurtin’ Like Hell’s act is just drug-seeking behavior – kinda hard to get high if you’re dead though, right? Cameron, who brings the case to the team in repayment for doing House’s budget, points out that the guy’s medicine cabinet was full of goodies so he didn’t need to be hospitalized to get drugs. Thirteen thinks it could be fibromyalgia (widespread muscle and connective tissue pain) but is quickly smacked down by Cameron. Foreman jumps to his girlfriend’s rescue (one kiss and he’s ready to marry the chick) but Cam isn’t having it.
Taub latches onto the attempted suicide and infers the pain is psychological, inspiring a deep, philosophical question: which came first, the agony or the tailpipe? House orders a pain profile to rule out psychosomatic pain and a search of Hurtin’ Like Hell’s home to check for toxins. Taub interviews the patient, his wife, and their son to determine his mind set and level of pain. The wife remarks that her husband seems to get worse while interacting with others – sounds a lot like another “patient.” Yes, I’m talking about House.
Foreman and Thirteen go to Hurtin’ Like Hell’s home for the search but end up talking about themselves and their aborted attempt at romance. Thirteen’s been avoiding Foreman since they swapped spit for fear of getting too attached to someone she actually likes and taking him on a short journey that can only end badly. While giving Forman the brush-off, Thirteen finds some quail meat in a refrigerator in the garage; wild quail can cause rhabdomolysis (skeletal muscle breakdown and toxic cellular leakage).
Back at PPH, Taub isn’t convinced of Thirteen’s conclusion. According to the pain profile, Hurtin’ Like Hell is excessively concerned about his physical health and unable to sleep; therefore, he needs antidepressants and everything will be all good. Which medical school did this clown supposedly graduate from? House ignores him and sides with Thirteen – in his state (still popping Vicodin for his own ever-present agony), who knows if he actually agrees with the rhabdomolysis diagnosis; he just doesn’t want to believe it’s all in Hurtin’s head. He orders the team to push IV fluids, check his urine, and perform a muscle biopsy. He can’t take the pain anymore and leaves early.
During the muscle biopsy, Hurtin’ Like Hell grabs his arm and goes into cardiac arrest. The team finds a pulmonary embolism which rules out both pain in the head and funky quail. The team is at a loss, but House isn’t answering his phone or pager. When he finally calls back, he sounds like crap but already knows about the embolism. How does he do that? Kutner suggests Trousseau’s (a cancer syndrome) to explain the blood clots and multifocal physical pain. House orders them to check Hurtin’s chest, abdomen, and pelvis for tumors.
A hi-res scan doesn’t show cancer but does reveal edema in the intestines and air in the intestinal blood vessels. Kutner thinks it might be a blockage in the superior mesenteric artery. Since House still won’t answer his phone, Foreman orders an angiogram. When House finally arrives at the hospital, his team proudly announces they’ve solved the case. But House has another theory: Hurtin’ Like Hell has devised a very unique method of suicide by blowing air into his own IV. Guess who’s right?
House and the team meet with Cuddy at her home (why?) where she tells them to get a grip on their suicidal patient or else, all while diapering and blowing kisses at a very obvious doll (guess FOX can’t risk the increased insurance premiums if Lisa Edelstein dropped an actual baby). Thirteen blurts out non-motor seizures as a possible cause of Hurtin’ Like Hell’s problem and Foreman follows with McArdle’s (a glycogen storage disease). House agrees with…both. He orders an ischemic forearm test.
During the test, Kutner and Taub ask the patient to grip a tennis ball as hard as he can and report on the pain level. Suddenly, a burst of pain jumps from his left arm to his left leg, something he claims has never happened before. Taub thinks it must be a brain issue so House goes to Cuddy for permission to chemically decapitate the patient with a shot of lidocaine to the brain stem. When Chase administers the anesthetic, Hurtin’ Like Hell happily reports a significant drop in pain – 4 out of 10. But House isn’t satisfied: if the problem is in his brain, there should still be 10-plus level pain; while if the issue is peripheral (in his body), there should be no pain at all. So, it must be something else entirely. But what?
Well, why should Daddy have all the fun? Shortly after the pain-less procedure, Hurtin’ Like Hell’s son collapses in agony in the hospital hallway. Is it genetic? Nope, House figures out quickly that the kid’s a damn good actor – his screams were just a distraction so his father could swallow a bottle of rubbing alcohol. The man is just too determined to die.
Why can’t they come up with a cause for his pain? Maybe it’s nothing at all. At least nothing they can see anymore. House thinks the pain could stem from continued drug use after an injury long-healed: opioid-induced pain. The only cure is to take Hurtin’ Like Hell off the drugs and torture his body into rewiring itself. The prospect of no drugs rightly terrifies the poor guy, but what choice does he have? House wouldn’t do it if he was lying in Hurtin’s place, but it’s a good thing he’s not the patient, right?
Back home, an encounter with a burst pipe, a plumber who won’t fix it, and an “accidental” cooking fire gives House his eureka moment – I’m waaaaayyy too lazy to explain all that.
House returns to the hospital and puts Hurtin’ Like Hell back on the pain meds because the detox isn’t working. His wife has had enough and instructs House to stabilize her husband so she can bring him home to die. And House agrees. Wait, what happened to eureka?
My bad! The plumber scratching his balls gives House the inspiration he needs to solve the case – only House would connect testicles with epilepsy, painful but treatable.
Now that we know what’s wrong with this week’s patient, let’s wrap up the less-important storylines:
1. Foreman switches the schedule of one of his most improved patients in the Parkinson’s clinical trial so that she’ll bump into Thirteen and encourage her to look on the bright side of life (and maybe drop her panties in the process); seems to work until Foreman finds out his new girlfriend is on the placebo, and he can’t very well tell her that, can he?
2. Wondering why Taub kept harping on Hurtin’ Like Hell’s fascination with suicide? Seems he may have tried to off himself with insulin back in the day.
3. Cuddy’s a foster mother to Jingle Belly’s secret baby, Rachel. She struggles to get herself together for a DYFS state home inspection. Although she passes the visit with flying colors, she’s still disappointed that she isn’t a better mom in her own mind. So she approaches Cameron…and offers her her job!
4. Oh, and I just remembered where I know Hurtin’ Like Hell’s face from: he was Naomi Watts’ baby daddy in The Ring!
Next Week: Cameron’s the new Cuddy and House tries to decapitate another patient.
