A Coast Guard helicopter hovers over the ocean. A Cuban refugee named Marina Hernandez sits in the cabin, wrapped in thermal blankets and shivering from hypothermia. An officer struggles to save her husband Esteban from the choppy water below, but Esteban refuses to let go of Marina's suitcase. With the chopper running low on fuel, the officer dunks Esteban which forces him to release the suitcase before pulling him to safety. On board, Esteban screams in Spanish that Marina's medical records are in the suitcase and that Dr. House needs to see them. Esteban watches helplessly as the suitcase floats away.
Cuddy tries reaching House, but he is no longer answering his cell phone because he has become "world famous." Instead, House watches from a distance as Foreman attends a going-away lunch with the nursing staff.
Later, Chase and Cameron go over Marina's admission exam while Foreman checks his email. House saunters in to see where they are. Since Fidel Castro emphasizes medical care in Cuba, House figures that Marina has already been filled with antibiotics. He rules out simple diseases like parasites or infection and requests an MRI. He also wants the team to check Esteban for any symptoms caused by being stranded at sea. They can subtract those from Marina's list.
Chase observes that Foreman isn't going to leave. This piques House's interest. Chase thinks Foreman doesn't want to leave and that House doesn't want to let him leave. He assumes House will cave, just like he did with Cameron. Foreman obviously wants something from House, so Chase suggests he try telling Foreman what he wants to hear.
Foreman discovers that Marina has Multiple Sclerosis. They should start her on interferon and see if she improves. Esteban complains that Cuban doctors would have spotted MS. Marina cries in pain. When Foreman rotates her forearm as a test, her bones snap in a spiral fracture. House suspects bone cancer because metastatic tumors would explain the abnormal MRI, kidney damage, cotton mouth and double vision. House orders a PET scan to see what else the cancer is breaking. Convinced it's not cancer, Chase argues that House is stupid to think that Foreman will forget the last three years and stay there if House starts agreeing with him. House ignores him and again asks for the PET scan.
Chase finds House in his office and starts talking about Foreman again. House cuts him off and fires him. He explains that Chase has been there the longest. Either he has learned all he can or hasn't learned anything at all. This means that it is time for a change. A stunned Chase shuffles out of the office.
Foreman and Cameron perform the PET scan but don't find any signs of bone cancer. Chase comes in to break the news that he has been fired. Suddenly, Chase sees a hotspot by Marina's humerus on the scan.
Cameron and Foreman barge into House's office, demanding to know why he fired Chase. Then Cuddy enters, kicks out Foreman and Cameron and asks the same question. She orders him to rehire Chase. House calls Chase and asks about Marina's PET scan. Chase says that there is a blood clot in the arm. House doesn't hire him back.
Foreman informs Esteban that Marina will need an angiogram to confirm the presence of a clot. Esteban demands to see House, but he has left for the evening. Foreman gives Esteban House's phone number and instructs him to keep calling because House doesn't always pick up. Foreman smiles at his prank.
The next morning, Foreman and Cameron perform the angiogram in the middle of arguing about Chase's firing. An exhausted and angry House comes in, questioning whether Foreman gave Esteban his home number. After he leaves, Foreman marvels that House would stay up all night listening to the phone ring rather than talking to a patient for five minutes. Cameron notes that a trick like that makes Foreman worse than House. All their bickering stops when Marina goes into V-Tach. Although her EKG flat lines, Marina keeps talking to them. She loses consciousness and the doctors begin CPR.
The doctors are still working on her three hours later. They have yet to start bypass surgery because House fears the clot will break loose and head for the brain. Foreman explains the situation to House and Cuddy together. Cuddy immediately okays the bypass. As the doctors rush Marina into surgery, Esteban finds House relaxing in his office. House is disinterested, but Esteban emotionally pleads that he looked him up because he has a reputation for fixing people when other doctors have given up. Esteban questions why House is just sitting there and not tending to Marina. House thinks for a moment and then heads into the OR.
House has the surgeon turn over Marina's non-beating heart but there is nothing physically wrong with it. He asks the surgeon to shock the heart, but seven attempts don't revive it. The surgeon is merely keeping bypass going until Esteban can say goodbye. Marina's heart simply won't start. She's dead.
House retreats to his office in an attempt to figure out why the heart won't start while the bypass is still keeping Marina's brain alive. Cameron and Foreman argue that it's over, but they realize House doesn't want to tell Esteban because that will mean House failed.
Cameron goes to meet Chase at a nearby bar. She tells him that everything will work out in the end, but Chase has already come to grips with the firing. He figures it probably is time for a change.
Late that night, Cuddy finds House in his office and asks when he plans on telling Esteban that Marina is dead. Cuddy wonders whether House was hoping for a storybook ending, but House argues that he honestly doesn't care. He just wants to know what the problem is. House tracks down Esteban in the chapel and informs him that nothing seems to be working. He can say goodbye to Marina before House removes her from bypass.
Esteban apologizes to his wife, kisses her one last time and House begins shutting off the machines. Esteban leans down to hug his wife and feels her heart beating. House explains that it is just residual blood flow. Esteban grabs House's hand and places it on Marina's heart. House flicks on the EKG and sees that her heart is beating normally. Her eyes open and she regains consciousness. House is shocked. Esteban thinks it's a miracle.
Three hours later, Foreman reports to House and Cameron that Marina is still stable. Her blood pressure, EKG and kidney function are all normal. House thinks about the angiogram and wonders if human error wasn't to blame. Maybe it was divine error. A congenital heart defect in an artery would be susceptible to inflammation. This causes arrythymia, which causes angina and clots. They will need another angiogram to be sure.
The procedure begins and House injects the dye into Marina's heart. The right and left coronary flow both look normal, which makes House worry that this test is about to go bad. Cameron spots something odd on the monitor. Marina has a third ostium. Humans should only have two. This third one is causing inflammation, is becoming infected and sending out clots. This is everything that has been plaguing Marina. After one more surgery she should be fine.
That night, Chase opens his apartment door to find Cameron on his stoop. They kiss and head inside.
Wilson meets up with House in the doctor's lounge. Foreman enters and the room freezes. House says he wants Foreman to stay on because he is an important part of the team and he needs him. Foreman agrees, but says he doesn't need House. House tries to argue that he just solved a case by predicting a never-before-seen heart defect even though Foreman gave up on it. Foreman points out that House is only happy for now. Soon he will be jonesing for the next case to come along. Foreman doesn't want to solve cases. He only wants to save lives. House becomes angry, and yells that Foreman only cares about himself and his ego. This is the reason he dragged out his quitting over three weeks. Foreman looks at House and then simply walks out.
House retreats to his office. Cameron is waiting for him with her resignation letter. House asks if she expects him to break down and ask Chase back. Cameron smiles and says she expects House to make a joke, move on and be just fine. But she says she will miss him.