Senator Gary Wright speaks at a fundraiser, but stumbles through the end of his speech. Then he struggles to converse with a supporter. Wright vomits on the man's suit before collapsing and tumbling down a flight of stairs.
Vogler gives the Senator's case to House. He also notes that if House was a team player from the start, then he wouldn't have to fire Cameron or Foreman.
Vogler wants House to give a speech at the National Cardiology Conference next week where he is to extol the virtues of Eastbrook Pharmaceuticals' new and more expensive ACE inhibitor. Eastbrook is owned by Vogler.
House chafes at the request. Vogler says he is to make the speech and examine the Senator, or else he will have to fire one of his proteges.
House and Foreman examine Wright, but Foreman does all the work. The man has a big scar on his tongue, which Wright explains happened when he was six and fell off the swings.
House doesn't buy that explanation, pointing out that tongues heal fast. Then House notices that Wright has no reflexes when Foreman taps him with a mallet. House orders an MRI and a lumbar puncture, telling the Senator to cancel his travel plans.
The LP results are negative for infection and the MRI is fairly clean. There is, however, a low intensity spot inside the Broca's area of the brain. House tells the team that the lesion could either be nothing, a brain tumor or an infection.
He orders surgery. He also lets the team know that none of them will have to worry about their jobs. House doesn't go into further details.
Cuddy is angry at House for attempting a risky brain biopsy based on a spot on an MRI. It could cause permanent neurological damage. House argues that a tumor is just as bad, but Cuddy says that neither of them can make that call.
They lay out the situation to Senator Wright, explaining that it could be something or it could be nothing. Wright asks what the voters will think. House becomes intrigued when he hears Wright stutter while asking the question.
Surgery begins. Afterwards, the biopsy shows that there is no tumor or bacterial infection. Yet Wilson becomes quite concerned as he examines the biopsy and finds toxoplasmosis. This means that Wright has full-blown AIDS.
Foreman and House explain to Wright that toxoplasmosis is a fairly common fungus that people can get from eating undercooked meat or touching cat feces. It usually responds to treatment and it only causes lesions when a patient's immune system is not functioning. The doctors think he has AIDS.
Wright angrily denies the possibility. House informs him that the toxo drugs will fight the fungi, but it's going to be nasty. Wright firmly orders House to give him the toxo drugs, test him for HIV under a false name, and then run a test for cancer. Wright again proclaims that he does not have AIDS.
Cameron comes across an email press release announcing House's upcoming speech and reads it to Chase. They're shocked that House would do this. House enters and explains his deal with Vogler.
He tells them that Foreman is testing Wright for leukemia, but he needs Chase and Cameron to rush the Elisa test for HIV. Cameron thanks him for agreeing to give the speech, but House presses on.
Foreman administers the test by injecting Wright in the back, and he says that they can wait until the HIV test results return. Wright claims not to be lying because black politicians can't lie and nobody gives them the benefit of the doubt.
House gives Wright the results of the Elisa test. It's positive. His T cell count is so low, he is close to death. They will need to contact his sexual partners.
Wright insists that he's only had two girlfriends since his wife died and that he used condoms. House tells him to come clean and admit to homosexual relations. Wright chides House for being so cynical and never believing in people. House draws some more blood from Wright.
The next day, Wright tries to get out of bed, but his foot is numb. Cuddy thinks the antiretrovirals aren't working, and she prods House for not seeing that Wright is just going to get worse. House is more concerned with why Cuddy is spying on his case.
House tells Wright that the antiretrovirals are not working because he doesn't have AIDS. The test returned a false positive, which happens one time in five thousand. Wright's relief is erased when House says that he is still dying, only now they don't know why.
House convenes the team outside, away from Cuddy. Foreman notes that Wright is losing control of the muscles on his right side, his brain is getting foggier and his T cells are still in the single digits. What could be causing this? House orders a full body scan.
Wilson asks House if he ran a second AIDS test because he suspected a false positive. House claims that it is standard procedure, which Wilson knows he doesn't care about.
House admits that he was moved by Wright's insistence that he didn't engage in risk behaviors. Wilson mocks House's first bout of actually believing in people. Wilson then wonders if being near the ultra-nice Cameron is rubbing off on House. He then realizes that House has an interest in Cameron.
A CT scan on Wright reveals five slightly enlarged lymph nodes and a cyst in both his liver and right kidney. Cuddy orders all this to be checked out. Vogler enters, handing House his notes for the speech.
House criticizes Vogler for undermining him in front of his staff. Vogler retorts that they already know that House is undermined. House pulls Chase into his office for a speech. He asks Chase how they can work together with Chase constantly reporting on him. Chase responds that he had no choice.
Foreman performs the multiple biopsies on a sedated Wright. He finds that both cysts are benign and that all the lymph nodes are clean. House suspects hairy cell leukemia and wants to biopsy Wright's spleen.
Everybody resists. Chase insists that the spleen will bleed too much and Cuddy believes that, because of the Senator's condition, this procedure could cause sepsis and death. Foreman says that Wright's brain is turning to mush. They have to do it.
House approaches Cameron in the lab and tries to inquire as to why she would like him, but it goes nowhere. They bicker about House's personal issues and he leaves.
Foreman approaches Wright to get a consent signature for the biopsy, but Wright now has a hacking cough. Foreman says they don't need consent because they can't perform the biopsy. He tells the team that Wright's breathing is severely impaired.
His stain indicates pneumocystis carinii pneumonia, which is another killer fungus consistent with hairy cell leukemia. Yet with respiratory distress, they can't biopsy because Wright's blood won't clot. How else can they diagnose hairy cell? House wonders what other symptoms a patient with hairy cell would have. Chase and Cameron suggest virii like HTLV and interleukin-2. House orders tests for both.
Foreman shows House the test results. Wright is negative on all virii. It's not hairy cell. House notices that Wright is positive for Epstein Barr.
He rushes into Wright's room and removes his oxygen mask. Wright begins gasping for air. House says that he knows the tongue scar is from an epileptic seizure. Wright says he hasn't had a seizure since he was six and has not been on medication since he was ten. House asks if the medication was phenytoin, which Wright confirms.
House bursts into his office and tells the team. Wright took phenytoin. This, along with the Epstein Barr virus, is associated with common variable immunodeficiency disease. The body can't fight off fungi.
House posits that Wright contracted this as a kid. Yet recent stress, like giving big speeches, triggered its reemergence. Cameron doubts it, but House orders an IV immunoglobin. If Wright improves, House is right. If House is wrong, Wright is dead.
Foreman inserts the IV. The medicine begins to drip. After some time, Wright improves greatly. He'll need medication for the rest of his life, but he will be fine.
The time comes for House's big speech. He dispassionately reads a one paragraph statement about the drug. Vogler stops House and tells him that wasn't enough. House returns to the microphone and praises Vogler as a brilliant businessman. House then congratulates Eastbrook and Vogler for smartly tweaking their ACE inhibitor just slightly enough to win a new patent and make millions more.
That night, House is at home ignoring his phone when Cameron drops by. She tells House that he won't have to fire anyone because she's leaving. This is the only way she can deal with her feelings for him.