Musical savant Patrick Obyedkov needs his father to help him button his tuxedo in a theater dressing room. Dr. Obyedkov introduces his son, explaining that an accident 25 years earlier caused Patrick to have neurological disabilities. Patrick begins to play the piano perfectly, but it then turns frantic. The muscles in his hands and arm have fully tensed. His fingers start to bend backwards.
House pages the team at five am. Cameron is the first to arrive, but when Foreman and Chase hear that the patient is a 35 year-old savant with dystonia, they're ready to go back to bed. House comes in, and his interest in the case means that they all must stay. Patrick had been a 10 year-old boy with no prior musical training. After a car accident, he suddenly became a genius pianist. Foreman argues that savantism is just one of those mysterious things, but House orders new labs -- CBC with platelets, chem panel, thyroid and adrenal function tests. They are to look for anything.
As he examines Patrick, Foreman quickly learns that the patient has trouble telling left from right and he repeats whatever people say to him. House has a piano wheeled into Patrick's room for another test. After he plays, Patrick mimics every note and movement. House asks Patrick to close his eyes then mashes the keys. Patrick perfectly identifies the cacophonous notes. With the hand fixed for now, Foreman and Dr. Obyedkov want Patrick discharged. House wants him to remain, and he orders Foreman to schedule a functional MRI of Patrick's brain.
The doctors strap Patrick into the FMRI machine. They play some classical music but nothing flashes in the brain. Foreman observes that listening and playing are two completely different neurological processes. House asks Patrick to pretend his leg is a piano and to play it. As his fingers dance on his leg, the FMRI begins lighting up and Patrick's heart rate rises without the limbic system activating. House tells Foreman that they need to get Patrick into surgery immediately.
As Foreman scrubs up for surgery, Cameron mentions that she found an airline ticket in House's mail. He is going to Boston. She wonders about an opening for a Division Chief of Infectious Diseases at Harvard. Foreman notes that it isn't like House to be ambitious, but he did notice House testing blood in the clinic. However, basic medical clearance for employment would require a cholesterol and glucose check.
Since they know that House would never tell them the truth, the doctors decide to borrow one of his favorite moves and break into the subject's residence. Chase and Cameron go to his apartment. Chase asks if she wants to have a go on House's bed. Cameron thinks this isn't the time, but her smile indicates that it's a definite possibility. Chase comes across a phone bill with multiple calls to a 617 area code. He dials and reaches Massachusetts General Hospital.
Back at the hospital, Foreman is snaking a catheter through Patrick's femoral artery toward the heart. Patrick's heart rate begins accelerating to 160, then 210. Foreman has to break out the paddles to save him. The doctors discuss Patrick's heart attack during surgery. House thinks a sudden bleed might explain both the attack and the dystonia, so he orders a colonoscopy and an upper endoscopy. If that doesn't show anything, they can also perform an enteroscopy to look at the small bowel.
Tipped off by Chase and Cameron, Cuddy calls Mass General and tells a Dr. Medick that she's not letting House go without a fight. Dr. Medick assures Cuddy that they aren't interested in hiring him. Cuddy asks if House might be a patient. Indirectly answering her, Dr. Medick says that neither he nor Dr. Kupersmith can stand House.
Cuddy tracks down Wilson and finds out that Kupersmith's specialty is brain cancer. Cuddy ticks off some symptoms, wondering why House isn't showing any signs of cancer. Plus, he hasn't told anybody. Wilson explains that symptoms take time to show and that most cancer patients keep the news to themselves because they don't want every conversation thereafter to revolve around cancer.
Cameron catches up with Wilson. He tries to avoid the talk, but Cameron states that if she needs to start looking for work, then she has a right to know. Wilson finds House in his office later and artfully works brain cancer into the chat. House winces, claiming that it's nothing. Wilson asks to at least see his chart, wondering why House wouldn't come to him. Chase interrupts with a surgical report. House was right -- Patrick had a bleed behind his kidney, but there's no cancer or ruptured arteries that would cause it. House ignores this report as he stares at Chase. He knows the cancer news is out. Wilson claims that he only told Cameron.
House gathers the team to confront the cancer question and he assures them it's not an issue. The team asks him for some blood to double check with tests, but House is only interested in discussing Patrick's case. Why are his seizures getting worse? House suggests ceasing the anti-convulsant medication to let the seizures really kick in. Maybe that will direct them somewhere. Cameron worries that multiple seizures will only damage Patrick's brain. House points out that the man's brain isn't in prime condition anyway. When Patrick gets worse, they can run a PET scan.
Cameron asks House to sign a letter of recommendation she wrote in his name because she is applying for a job at Penn. House brings up the cancer and Cameron pauses. They move closer to each other and suddenly begin kissing. While their lips are locked, Cameron reaches into her pocket for a syringe. House, sensing the movement, grabs her hand. She pleads that they need his blood for tests. House directs her to his file in the records room. Everything they would want is in there.
Cameron finds the CAT scan in House's file and takes it to Foreman. He spots a six-centimeter mass in House's dorsal midbrain extending into the temporal lobe. The brain cancer is inoperable. Foreman figures that House has less than a year to live. The team continues poring through House's file, noticing that he has a consent form for a drug trial. However, it's not a cancer treatment but a drug used to treat depression in cancer patients. The procedure involves implanting drug-eluting chips into the pleasure centers of the brain.
House brings the team Patrick's PET scan, which reveals several more hot spots in no distinct pattern. The left brain is working harder than the right. Cameron pronounces bleeding in the brain. House goes to perform an angiogram to look at the vasculature in the brain. House notices tiny dots. The MRA confirmed small collections of blood throughout the white matter of Patrick's right hemisphere. That could be trauma, an aneurysm, cancer or autoimmune disease. They will need a biopsy of all parts of the brain. The team argues that House can't just randomly pluck out pieces of a patient's brain. Foreman suggests an internal EEG. An external test can get confused, but an EEG from inside the skull would reveal exactly where to biopsy. It's risky, but worth it.
Later, Foreman finds House alone in Patrick's room. Before he hands over the test results, Foreman wants to discuss something personal. Despite House's attempts to drive everybody away, Foreman still likes him. He turns back to the patient's EEG. There are no electrical abnormalities. What it did show is that Patrick's entire right hemisphere is brain dead.
House mentions that Patrick is left handed and can still speak, so perhaps the right hemisphere still has some random neurons firing. House and Foreman head to Patrick's room with a small electronic piano. Foreman covers Patrick's right eye and asks him what's on the table. Patrick identifies the piano. Foreman then covers the left eye and asks again. Patrick has no idea. House plays a few bars of a tune and then spins the piano around to Patrick. He plays it perfectly. The doctors exit. In the hallway, House argues that Patrick's right brain has always been damaged. Yet this is irrelevant to the current issue. Foreman realizes this means the problem is autoimmune and they can begin treatment.
Chase finds House in his office and asks to chat. House sighs at another emotional moment. Chase ignores him and hugs House. Then he says that Patrick is responding to treatment. Unfortunately, now comes the next step. House rings Cuddy's doorbell in the middle of the night. House lets her know that Patrick has Takayasu syndrome, which Cuddy points out is manageable with steroids. House wants a hemispherectomy since the right side of Patrick's brain is basically useless. It would stop the seizures. Cuddy responds that they will need to ask Dr. Obyedkov about his son's treatment.
House appeals his idea to Dr. Obyedkov. With the right brain removed, the left brain could stop compensating and function on its own. Patrick would begin learning new things but would lose the ability to play the piano. Dr. Obyedkov argues that Patrick is doing fine and that he doesn't mind taking care of his son. House counters that he has made Patrick into a trained monkey, but that this procedure would allow him to grow into an adult. Is Dr. Obyedkov is afraid to let him go?
Dr. Obyedkov asks his son if he's happy. When Patrick merely repeats his father's words, Dr. Obyedkov picks up the phone to grant consent for the procedure. The hemispherectomy is performed successfully.
The doctors study a scan of House's brain, hoping to get him approved for a clinical trial. Unfortunately, he is negative for protein PHF and thus doesn't qualify. Suddenly, Chase notices something odd on the scan. They rush to House's door and announce that he doesn't have cancer. There was an abnormal presence of IgC and IgM in his brain, plus a gumma, which is usually found in the liver. House mentions that he doesn't have syphilis because his VDRL was negative. The team did a new test, which means that House got a false negative. House pauses and asks if they sent the results to Mass General. When they admit they did, he calls them idiots.
It wasn't his file. House tells them that the real patient is in the Witherspoon wing of Princeton-Plainsboro. They can tell the man's wife that he's not dying of cancer but is cheating on her. The doctors angrily ask if House was faking cancer. He wanted the doctors at Mass General to think he had cancer so that he could take part in the drug trial that places an implant in the pleasure center of his brain. Exasperated, Cameron asks House if he faked cancer to get high. The doctors stumble away in shock.
The next day, House does a follow up on Patrick. He doesn't respond to House's verbal cues, but then Patrick buttons his own shirt and smiles.