At a family barbecue, Arlene McNeil watches in horror as her husband Richard, drives his motorized wheelchair into the pool and immediately sinks to the bottom.
On a beautiful fall day, House jogs through a park. At the hospital, Cuddy and Wilson discuss whether or not House would be interested in Richard's case. A sweaty House bursts into the office, boasting that he ran eight miles to work. Aware that the ketamine treatment can wear off , Cuddy wonders if he's feeling any pain. House declares that it's been two months pain-free and he thanks her for the ketamine-induced coma. He looks over the case files and decides to take on two. One is Richard's case. The other involves a 26-year old named Caren who became paralyzed when she snapped her neck during a yoga pose. X-rays show no evidence of spinal injury.
Wilson questions why he took Richard's case even though there is no diagnostic work to be done. House is intrigued by the suicide attempt and claims that's he is now a changed man. Wilson doesn't buy it. House barrels into his office and starts discussing the cases before his staff can get into the niceties on his return to work. He becomes distracted by a spot of blood on the floor. It is his blood from the gunshot wound. He stares at it for a few moments, and then orders his staff to redo the tests on Caren and add an electromyogram. He then calls for an O2 mask for Richard so that he can perform tendon surgery on him. Richard's leg muscles are atrophied, and House wants to make him more comfortable.
As Richard undergoes surgery, his son Mark insists that his father would never try to kill himself. House scoffs that the boy cannot know a man who hasn't spoken for six years. House points out that if he did in fact try to kill himself, then that means he's still present in mind. This reassures the family.
Cameron witnesses Arlene thanking House. She is incredibly curious to know what Arlene was thanking him for. Does this mean House has changed? House, of course, says nothing.
House learns that when they inserted the conduction pin for the EMG, Caren flinched. He picks up a lighter and holds it to Caren's foot. She screams and jerks her foot away. Caren insists that she's not faking, but House instructs his team to discharge her.
Later that night, Wilson asks House about observing Richard's surgery with the family. Wilson realizes that the hallucination House had in his coma made him realize he wanted his life to have meaning. So he took an easy case to simply make a family feel better. Although House doesn't deny this, he says he felt nothing when Arlene thanked him. Wilson advises him that his emotions, like his leg, had atrophied from disuse. He just needs to keep rehabbing his emotions. Before any further introspection can take place, Cameron comes to get House with a new issue involving Caren. She is struggling to breathe.
Strolling into her room, House informs Caren that she's either faking it or she has pleural effusion. If she does indeed have fluid building up around her lungs, House will have to stab her in the back with a very big needle. House holds up the needle for Caren to see it, but she continues gasping. House notices something and has the team hold the patient down. He jams the needle into her chest. As he pulls up the plunger, the syringe fills with red liquid. They realize that Caren's problem is in her heart.
The next day, the team discusses Caren's case. House wonders if the paralysis was a delusion, indicating a neurological problem. Foreman recognizes that he's leading up to a vascular tumor in her spine, but Cameron and Chase point out that the platelets are normal and Caren has been scanned thoroughly. House wants them to open her up and find the problem.
House notes that Richard's heart rate has elevated. Deducting that he's still in pain from surgery, House ups his morphine. Arlene thanks House for actually caring about Richard's quality of life. Every other doctor has just wanted to fix him. House thinks about her words and leaves the room. Cameron, who has been observing from the hall, confronts him when he comes out. She's all too eager to remind him about his past cynicism in the face of her optimistic hope. House changes the subject by asking her to dinner. Once again, House is in control of the relationship.
Cuddy summons House into her office to complain about the planned random search of Caren's spine. House tries to barter with her, but has no success. Yet after a few more tests turn up negative, the exploratory surgery is scheduled. The surgical team preps Caren, and House sees something from the observatory. He bursts into the OR and shows Caren's big toe to the surgeon. The nail is dark, corrugated and splintered. House has a clue.
Caren sits up in her room sipping orange juice as Foreman checks on her. He reveals that she had scurvy, which causes the arms and legs to fill with blood, making movement difficult. Caren talks about her modified Atkins diet and Foreman says that has given her a lack of vitamin C.
House makes one last check on Richard as Arlene prepares for discharge. She again thanks him and House advises putting Richard in a facility. She says she can't abandon Richard. When she goes to lift him from his bed, Richard makes a low, guttural, gurgling sound. House asks Richard to do it again. House announces to Arlene that Richard is talking.
House enters his office carrying a box overflowing with eight years of medical files on Richard. House tells the team Richard grunted last night, then instructs them to review Richard's history with the grunting in mind. House then goes outside to skateboard but feels a twinge of pain in his leg. He immediately stops riding and walks back inside.
After poring through the files all day, Cameron, Foreman and Chase have written down the 214 symptoms Richard has experienced in the last eight years. Looking over the extensive list, House thinks that abdominal pain plus everything else could mean a pancreatic cyst. Cameron quickly points out that abdominal pain is one symptom that Richard never had. House counters with the fact that Richard could never vocalize the symptom. He orders an upper endoscopic ultrasound.
Chase and Foreman prepare for the procedure. Before inserting the scope, Chase asks Foreman to bring the crash cart closer, figuring they're going to need it shortly when Richard's throat closes on the scope. Chase slides the scope down into Richard's stomach and they see that the pancreas looks clean. Before they can continue, Richard's throat does indeed close. They perform an emergency tracheotomy.
Reviewing the details of the procedure, House tries to figure out why a sedated throat would collapse. He realizes that the muscles actually locked down. Since the brain is supposed to tell muscles to contract and relax at the same time, something was blocking a relax message from the brain to the throat. Cameron stops House and begs him to let this case go and stop torturing Richard to satisfy his own curiosity. House thinks about a few microtumors in the meninges of Richard's brain and considers looking at the brain lining.
In the CT room, Chase injects contrast material into Richard's spine and slides him into the scanner. He is forced to stop the test when he notices blood trickling from Richard's ear.
The team finds House in a light board room, surrounded by eight years' worth of x-rays and scans. Chase reports that a surgeon repaired Richard's CSF leak. House asks Foreman to walk him through the brain scans throughout the years. House then wants to do five millimeter cuts through the occipital and hypothalamic regions. While both Foreman and Cameron refuse to keep putting Richard through risky tests, Chase is still up for it.
Despite House's persistence, Cuddy decides to discharge Richard the next morning. That night, House goes for another run. Dripping with sweat, he jumps into a fountain to cool down and the water gives him an idea. He rushes over to Cuddy's house and pounds on the window in the middle of the night. She rouses from her sleep and opens the window to find House immediately launching into his theory. Richard's brain is on fire because of an imbalance. He drove his wheelchair into the pool because he couldn't regulate his body temperature. He had hypothalamic dysregulation. Cuddy refuses to allow any more treatment -- not even a simple cortisol shot that House claims will prove his theory.
The next morning, Arlene and Mark wheel Richard out of the hospital. But Cuddy stops them before they reach the door and injects Richard with cortisol. She then looks into Richard's eyes waiting for a reaction, but there is none. Suddenly, Richard goes into spasms. He moves his arm and undoes the seat belt on his wheelchair and slowly stands. Cuddy tears up as she watches the family's joyful hug.
Cuddy is about to track down House to tell him what happened when Wilson stops her. Calling it a lucky guess, Wilson says it's more important for House to learn to be reined in.
Late that night, alone in the hospital, House sneaks into Wilson's office. He finds Wilson's prescription pad and writes himself out a scrip for Vicodin.