What is it with every serious unexplained illness involving the inability to breathe? At least it seems that way on almost every episode of House. You can have purple pee, brittle bones in your inner ear, and brown and yellow spots on the soles of your feet. But unless you can’t quite catch your breath – I mean, really can’t catch your breath – it’s not that serious. Sorry, I just have this thing where I like to think crazy crap like random pulmonary embolisms and a collapsed lung can’t happen to me, but these make-believe Princeton Plainsboro patients make me think otherwise. Speaking of patients, this week’s poor sap is a young prima ballerina whose dancer boyfriend has a back spasm and drops her during rehearsal. The fall triggers an attack of breathlessness and she’s rushed to the hospital.
Amber is still haunting House and he’s scared to leave his apartment. Foreman tries to force him back to the hospital to discuss the new case. At first, it’s not working; then, Foreman tells him Cuddy’s going to fire him unless he gets his ass back on the job. At PPH, the team brings him up to speed: no tumors or punctures in the lungs, no bruising, no signs of trauma, no STD’s. Supplemental oxygen doesn’t seem to be increasing her blood O2 levels a significant amount and her lungs keep collapsing despite the insertion of a chest tube. Amber keeps distracting him and it’s starting to get noticeable to the others. She suggests dehydration hiding an infection but House is ignoring her and trying to come up with his own really wrong theories. Finally he listens and sends the team to administer IV fluids and antibiotics.
House interrupts Wilson telling a patient he has kidney cancer to reveal that he’s hallucinating (of course one crisis trumps the other, and we all know which one). He tells Wilson he thinks it might be sleep apnea but Amber knows he doesn’t really believe that. He requests observation in a sleep lab and asks Wilson to oversee his team. Wilson asks who he’s seeing and hearing. Rather than reveal it’s dead Amber, House tells him it’s dead Kutner.
Antibiotics don’t seem to be helping Nutcracker and her lungs are now collapsed, making testing for pneumonia near-impossible. House suggests transtracheal aspiration (a form of medically-approved waterboarding). Amber is especially impressed. Foreman balks at the radical nature of the test and House falters. Wilson is nearby to validate the insanity of the suggested procedure, but to also assure him that it’s not quite beyond-House crazy. Foreman is left suspicious.
Foreman and Taub perform the transtracheal aspiration on Nutcracker while her boyfriend gently holds her hand. The docs insert a tube through a hole cut in her throat and pump water into her lungs and she quickly freaks out because it feels like she’s drowning. When she wrenches out of Taub’s grip, her skin peels away and she’s hurried to the Burn Unit. For the next several hours, it continues to slough faster than the team can replace it with artificial skin. House tells Foreman to keep focusing on the lungs because they probably caused the reaction. Toxic epidermal necrolysis is a one in a million side effect of antiobiotics, but House is sure that he triggered it. He orders swabs of her skin to confirm.
House tells Wilson that he feels guilty for possibly causing the skin sloughing. He fears that guilt may be a symptom of multiple sclerosis but the tests are negative. Another way to test would be to apologize to the ballerina – if he feels better afterwards, then he’s just feeling a simple emotion (something strange only to House and robots); if he feels nothing, then that means there’s something wrong with the limbic portion of his brain. He apologizes to Nutcracker but he feels nothing in response. It’s got to be MS.
A mass is discovered in Nutcracker’s liver and House orders a biopsy but the patient’s skin is too thin; a transjugular liver biopsy will prevent her from bleeding out so they proceed. While on the table, her heart goes into A-fib. The team considers whether the defective heart caused the lung issues or vice versa. Maybe an MRI of the heart is needed to detect minute abnormalities. But how can they perform a clean scan when the heart of a living person is constantly in motion? Foreman is suspicious of Wilson’s constant presence during differentials and deduces that House doesn’t trust himself for some reason. House sends Wilson away to prove a point but it only makes Amber more vocal. She tells him that apnea, infection, and now MS have been ruled out so the only diagnoses left are severe mental illness or drug addiction – either way, he’ll probably never be able to practice medicine again. She grabs a knife and slices her wrist open. House realizes that she’s trying to tell him to temporarily kill the patient to get the MRI done.
House continues his self-diagnosis – sleep apnea and MS are out so here’s what’s left: infection, trauma and schizophrenia. Wilson thinks it’s definitely something much more familiar: drug addiction. According to a blood test, House has copious amounts of Vicodin in his system (what’s new?) and it must be damaging his brain. House admits that Amber is the real figment of his imagination. He really does want to get rid of Wilson’s dead girlfriend but he’d rather get zapped by ECT than undergo rehab.
Chase stops Nutcracker’s heart with shock paddles in order for the team to conduct the MRI but they only have three minutes before brain damage can occur. As the clock ticks down, they frantically search the scan for any abnormalities. Nothing. Nothing. Noth– Wait! Foreman thinks he sees a shadow by the aorta but it’s already seconds past the deadline. Chase runs to the machine, halts the scan and brings the dancer back to life.
House believes insulin shock could be the key to his problems, so he steals a vial and puts himself into a mini coma. When he wakes up, Amber is gone. He rejoins the team to gratefully get back to work. They inform him the heart shadow could be a tumor, lesion, scar tissue or abscess, but they can’t do another biopsy because the last time they tried she almost died. House visits the patient’s room to observe and think. From behind the pane of glass, he watches as her boyfriend holds her hand and strokes her forehead. He thinks that the guy looks too devoted. He must be guilty of something. If he cheated, he could’ve given his honey gonorrhea. Nutcracker tested negative for STD’s in an earlier blood test, but gonorrhea could have traveled to the heart and become walled off in an abscess. House orders them to test the boyfriend for the little g.
Relieved to be free from hallucinations, House goes out to a restaurant to celebrate his victory over insanity. Foreman calls him and confirms that the boyfriend has gonorrhea but the guy’s pissed because he claims to have been faithful. It seems to make sense that she would’ve given it to him since he shows no symptoms and she’s on death’s door. House is concerned that he sensed guilt in the boyfriend when there was none there. He thought he came up with that eureka all on his own. Then he hears unmistakable humming, and then soft singing. In a very effective and spooky scene, Amber returns, staging a weird lounge act that only House can see.
Wilson rushes to the restaurant to pick up House. He knows someone who can get him into a rehab facility a.s.a.p. They return to House’s apartment to pack. When Foreman calls to let House know Nutcracker is now septic, Wilson tells him that House is off the case.
The team is at a loss without House. They can’t remove the abscess without risking the patient’s death from massive blood loss. They’re ready to give up when they determine high dose dopamine could do the trick. During the operation, all seems to be going well until Nutcracker’s hands and feet start turning black from gangrene – the dopamine has cut off circulation to her extremities. She begs the docs not to amputate for fear she’ll never dance again. Without House, can they come up with another brilliant suggestion? Yes, courtesy of Taub: vasodilators to open the arteries in her fingers and toes. The surgery is successful and Nutcracker will recover. Alone. Her boyfriend was so disgusted that she was cracking somebody else’s nuts, he dropped the devotion and headed out.
House visits Cuddy’s office and tries to quit. She doesn’t take him seriously. Then he tells her about Amber. He asks for her help in getting clean so she calls her babysitter and follows him home. They spend the night together battling withdrawal, House sweating feverishly and lashing out in anger; Cuddy flushing pills and holding House’s hair back while he vomits. When the sun rises, they know they’ve made it through the worse part. Bitter, nasty House comes out to play and he tells her he knows she was only looking out for PPH’s cash cow. Cuddy tells him she’s wrong and proves it by revealing a secret: twenty years ago, she audited a class in med school only to be close to him. House looks around and realizes Amber is gone. He walks Cuddy to the door and they linger. Looking deep into his eyes, she asks if he wants to kiss her. He replies that he always wants to kiss her (smooth, very smooth). They kiss. And kiss again. And kiss some more! Clothes start coming off, House forgets his limp and the heavens open up. The moment we’ve been waiting for! Finally!
Next Week: The House season finale explores the aftermath of Houdy sex. Plus, a man can’t keep his hand to himself.
