"I have been in labor for over a dozen hours, Justine, I have to yell!" Abbey is in the final stages now, and wants to make sure her twenty-something daughter catches every moment of her sister's birth on camera. But Justine isn't eager to get any close-ups. "It's your baby sister!" Abbey screams. Justine is disgusted. "It's my mother's vagina." But when the newborn arrives, camera angles are the least of their concerns, as alarms sound and doctors scramble to save the child.
It's near the end of the day, but House wants the team to immediately begin work on the eight-hour-old baby's breathing problems. Foreman starts off: "Immature lungs"? Nope, the baby is full-term, and she's been given surfactant. Her lungs are fully developed. They don't get any further when Cuddy walks in and grabs House for a private conversation.
"My nanny called. Her daughter has a dance recital tonight. She can't work late." Cuddy gets nothing from House. ". . . And I have a Board meeting tonight." "That's a problem," House says. Cuddy tries again: "My mother can't come. She has a cooking class." But House isn't going to make this easy. "You've really got a problem." Finally, she says, "If only there were some mature adult in my life who could pinch hit in emergencies like this ..."
House tries to beg off, even invoking the sick newborn whose case the team is studying, but Cuddy says she knows he can direct the team via phone. Rachel will be asleep the whole time, so she just needs someone to be with her in case of an emergency. And House owes her: he still hasn't hired a female doctor to replace Thirteen. "Fine. Out of the goodness of my heart. Which will make you happy. Which will make you desire me more. Which will turn into more sex."
Back in the differential, Taub says that Abbey's baby's father was a sperm donor, with no history of asthma. House wants them to think outside the lungs. Chase mentions the liver enzymes are elevated. "When the liver fails, it stops producing proteins, specifically the ones that keep your plasma inside your blood vessels and outside your lungs," House says, and sends them off to check her liver. All except Foreman, who he keeps behind and orders to hire a new, female doctor. Foreman's pretty pleased with himself now: he's been anticipating this. He's interviewed doctors all week, and he's narrowed the field to two candidates. "Narrow it down to one. Before Cuddy starts withholding sex." House stares down Foreman's smug grin.
Sprawled out on Cuddy's couch in front of the TV with a bowl of popcorn, House is telling Cuddy on the phone that Rachel is sleeping and she's fine. And he's been checking every ten minutes (he hasn't been checking every ten minutes). With Cuddy satisfied, he heads to the kitchen and forages for a while, until he finds a container of juice. But when House shuts the refrigerator door, there's the supposedly sleeping Rachel, who wants some juice. "Your mom says no. Because she's mean. If it was up to me . . ." He sends her back to bed, but the two-year-old instead races around the dining room. Definitely an emergency: House calls Wilson for a consult.
At the hospital, the doctors - including Dr. Cheng, the pediatrician from Abbey's delivery - are hovering over the infant, Kayla, as Taub explains to Abbey that liver problems can cause breathing problems. Maybe an abscess, so they're looking for it with an ultrasound. If they can find and fix it, she'll be ready to go home by the end of the week. Taub narrows in on the echogenic area of the liver, but Foreman doesn't see the thick walls expected with an abscess. Abbey wants to know if she can help; she hasn't yet been able to hold the baby. Dr. Cheng says they can draw Abbey's blood when they're done with the ultrasound to see if she can donate to Kayla. They reposition the baby to get a better look, but determine it's definitely not an abscess. Chase says it looks like dilated bile ducts.
The team phones House to tell him he was right about the liver. House wants to know if there are any masses causing an obstruction, at the same time trying to keep Rachel calm and quiet. Foreman also takes the opportunity to attempt to introduce House to his new hire: Dr. Christina Fraser, but he gets as far as "She's a Board Certified . . ." when House cuts him off and addresses the new doctor: "Nice to meet you. You're fired." Dr. Fraser is House's "lesson" to Foreman. "That whooshing sound is the air being let out of his ego." House tells Taub it's his turn to find a new doctor. Dilated bile ducts could be congenital, meaning there's a stricture in the ducts themselves: Caroli's syndrome. The team balks at House's suggestion that they perform surgery on a newborn with liver failure, one who's also oozing blood from every puncture site. But House tells them it's the only way to save her.
Wilson has arrived at Cuddy's, with Chinese food, and sees Rachel on the couch. House grabs his coat and gets ready to leave. "Cuddy'll be back in an hour and ten minutes. I'll be back in an hour and five." Wilson can't believe it: "You're not going to leave a two-year-old, unattended." "True. I'm leaving her with you, a responsible adult," House says, as he heads out the door. Wilson follows him out, and it's a game of chicken to see who will actually leave the child alone. "Not my problem," Wilson says nonchalantly. "Since objectively you care more about leaving a child alone than I do, it kind of is," House tells him. Wilson is at his car now, opening the door. "Objectively since I never accepted this responsibility, it kind of isn't." But House is getting on his motorcycle, not showing any signs of giving in. "True. And yet it is. Because you're you." Wilson blinks. "Fine. You know what I can do? I can call a babysitting service for $15 bucks an hour. Then call Cuddy and tell her who's watching her kid and why." That gets House to shut off his engine and agree to stay - if Wilson stays, too.
But when they walk inside, it looks like a popcorn-and-Chinese-take-out-container bomb hit the living room, with Rachel happily sitting in front of the television. Even worse, it looks like she's eaten . . . something. Wilson is able to pry her mouth open and pull out a quarter. But how many coins has she already eaten
The doctors are operating on Kayla at the hospital, but they don't get far before her blood pressure drops. Dr. Cheng is the attending NICU, and she's able to briefly stabilize her. "Nice," Taub tells Cheng. But ultimately they're forced to stop. "Liver problem alone is not gonna mess with this baby's BP," Foreman says, as he, Chase, and Taub exit the surgery room. "Whatever this is, it's got to be affecting her heart." Heart plus liver could equal tuberous sclerosis. Or a vascular malformation in the liver causing both problems, Foreman suggests. The best treatment for vascular malformation is surgery, but that appears to be out. "So what do you guys think of Dr. Cheng?" Taub asks. Chase says Taub's wife wouldn't want him thinking about Cheng at all, but Taub is actually asking what they think of her as a doctor. Chase just shrugs and suggests they give steroids, an antiangiogenesis agent and dopamine to the baby. Might work just as well as surgery. Taub turns to Chase: "So, what was that shrug? A 'Dr. Cheng could work' shrug, or a 'House is going to crush you for even considering you' shrug?" Another shrug. "House is going to hate anyone we hire," Chase says. "Because he doesn't want to hire anyone." And if Taub abstains, House will just mock him for being a wuss. He's screwed. "Unless," Taub says, "House feels like hiring her is his idea."
"She opened up a Chinese food bag, to eat money. What an idiot." House is unimpressed with Rachel so far. Wilson tries to calculate how much change could have been left out for her to ingest. "With tax, the change should have been $.68 cents. There's only $.58 cents out there. There's a dime missing." House thinks it's probably no big deal. Kids swallow things all the time. "Absolutely," Wilson agrees. "Unless it gets stuck in her intestines and causes a blockage, which could kill her." Just then the door opens: Cuddy's home. Wilson tells House he's got to tell Cuddy what happened, or else he will. House says Wilson's the one who left coins out within the grasp of an unsupervised child. But Wilson wants no part of whatever's about to transpire, and starts climbing out the window. "Rachel needs to be monitored for 24 hours to see if the dime passes. You know, just make sure she doesn't die." House can't believe it. "You're telling me to do the right thing, while climbing out a window?" And then Wilson's gone. House opts not to tell Cuddy about the coinage. Though he does offer to stay the night, which surprises Cuddy.
At the hospital, Taub is checking on Kayla, while Abbey sits in a chair nearby. She says Justine took off a while ago. They haven't been close, but she tells Taub it's getting better. Taub notices the baby's getting pinker, a good sign. Very good. Kayla starts to cry. Justine walks in the room just as Abbey is allowed to hold her baby for the first time. "Technically, it's your second time," Justine says. Abbey looks at her. "I didn't mean . . ." "I know, mom," Justine tells her.
Taub visits Dr. Cheng in the MRI room to tell her it was a vascular malformation after all. He begins to sell her on the merits of working on House's team. It's starting to sound pretty good to her: "No more kids, no more parents. One case at a time instead of seventeen? Set up the interview."
Cuddy is fast asleep, but House is wide awake, and when he hears something from Rachel's room he bolts out of bed. An inspection of Rachel's diaper reveals nothing out of the ordinary. Later, Cuddy leaves for work, but House sticks around to keep an eye on Rachel. The team calls to tell him they didn't do the surgery he ordered. "It's not Caroli's syndrome," Taub says. "Dr. Cheng spotted a . . ." But House interrupts him. "I know about the Jew, the black, and the croc hunter, but when did we get our Asian persuasion on?" Taub tries to tell House that Cheng spotted the vascular malformation, but House isn't buying it. He says the baby's ALTs were three times the normal level, evidence that the liver damage is too extensive. In short, Cheng is an idiot. Taub is forced to walk back his lie: "In fairness, it wasn't completely her idea . . . more of a Foreman kind of thing." Foreman's not thrilled with this revelation, but he tells House that they did, in fact, treat for a vascular malformation, and she got better. "No she didn't," House says. "Call me when she crashes again."
Abbey is singing to Kayla when Justine comes back. Justine is having a hard time watching her mother so close with the baby. "You're different with her. It's OK. It's good. It's just . . . I can't help thinking: where was this mom when I was growing up?" The baby feels wet, but when Abbey gets up to take care of her, she and Justine see it's actually blood
House realizes he's got to be proactive about the dime situation, so he again enlists the help of Wilson, this time to smuggle Rachel into the hospital, and keep the whole thing from Cuddy: "You see a double-wide tuchus coming this way, you scream like a girl." They take Rachel to a small room to perform an ultrasound to find the coin. Taub calls House to say he was right about it not being a vascular malformation, since the baby's bleeding again, and they really need his help. But Wilson finds something on the screen. House takes a look but says it's just an irregularity. "It's a dime," Wilson tells him. "Or a pocket of air," House suggests. "Yeah, with FDR's face on it," Wilson says. Suddenly Taub is at the door. He's tracked them down. House meets him outside the room. "Her liver failure's getting worse. You were right. Now what?" House is more interested in why she initially got better. Taub says after the transfusion, they gave her steroids, dopamine, and the antiangiogenesis agent. Maybe the steroids helped because she has idiopathic hepatic fibrosis? Wilson calls House back in, leaving Taub with no answers. The dime is right in the middle of the colon. "Prime location for pooping out," House says. Some laxatives to help it on its way, and she should be fine.
House is hit with an idea: hook Abbey up to the baby for a direct blood transfusion. It works. Kayla seems cured, but Taub and House know a blood transfusion isn't really a cure. So what's really happening?
"Our patient," House begins, "can either go through life with the world's longest umbilical cord, or we can discuss the differential for 'magic blood.' " Taub calls over Dr. Cheng for her opinion. "Either the mom's blood is special, which would mean it's treating something specific, which means the baby has a disease. Or, mom's blood is just blood, and it's replacing something the baby is missing, which means the baby has a simple deficiency." House mulls it over. "Given the liver failure, deficiency of clotting factors, enzymes or vitamins are most likely." Cheng's suggestion: hook the baby up to someone else and see if she gets better. Turns out Taub is O Negative, so he volunteers. House gets a call from Wilson and walks away, but calls Cheng to come with him. He says the team seems to like her, but he'll have to test her. "Let's say, two-year-old swallowed a coin 20 hours ago. She's going to be fine, right?" Cheng says that if there's no obstruction, then a laxative should work. Just don't wait too long: her bowel could become ischemic, or worse, intussusception. Give it six hours; after that, it's not coming out on its own. This is not reassuring House. "Then what do I do? I mean, what do you do? It's your test." She says at that point you'd have to go in with a scope and get it. Cheng wants to know if she passed the "test." House says it's up to Taub whether or not to hire her.
House meets up with Wilson, who's got Rachel up on the counter in the men's room, giving her a laxative. House says they've got six hours, then the scope. But Wilson says not only is that dangerous, Cuddy will be home from work by then, and there's no way they could hide that from her. "I could offer to baby-sit again, let her have the night out," House says. "Sure, that won't raise any suspicions," Wilson tells him. Suddenly, House notices Wilson's radiation dosimeter badge in his bag, and asks to borrow it. He takes it into a bathroom, scratches off the identifying code and manipulates it until it starts showing a positive reading.
Meanwhile, Taub's blood isn't helping Kayla. This means there's an infection. They know it's in her liver, so they'll get a sample and go from there. "I had this baby because I wanted to be a special mom," Abbey says. "But not this way."
Cuddy comes into House's office with the mysterious news that a dosimeter badge in radiology turned positive. Could be a CT scanner that's leaking, or spilled vial of thallium somewhere, and she doesn't even know who's badge it was since the code was scratched off. Cuddy has to work late, and wants House to baby-sit again. He feigns objection. "Two nights in a row?! I have a life, you know." But of course he'll do it.
Taub and Foreman start Kayla's liver biopsy, with Abbey watching anxiously. Taub slowly pulls out the syringe: it's solid black. "That looks awful," Abbey says. "Is that from the infection?" Taub and Foreman look at each other. "No," Foreman says. "It means we were wrong. It's a melanoma." Abbey doesn't understand: how could she get skin cancer if she's never been outside? "You have," Taub tells her. Taub checks Abbey and finds a mole under her index finger nail. A biopsy shows it's melanoma.
House thinks it's interesting that Abbey's melanoma spread to the baby in utero, which means it's metastatic, which means it's late stage. Yet Abbey appears to be healthy. "Clearly something's going on in mom's blood that's treating her melanoma as well as her baby's," Foreman says. Antibodies? If her immune system was fighting the melanoma it never would have spread. Which means it's fighting something else, and the melanoma cells are getting caught in the cross-fire. So what's mom's immune system really shooting at? Taub says scleroderma can causes cancer-fighting antibodies. But Chase says so can Churg-Strauss or any autoimmune disease. Or infections that cause granulomas, Dr. Cheng suggests, like TB or mycobacteria. House tells the team to test her blood, and start with autoimmune disorders.
Abbey can't believe she's the one making her baby sick. "I ate all the right foods, I read all the books, and the studies. I even hired a private detective to research each sperm donor. I just missed one big thing: my own cancer." "I'm sorry, mom," Justine says. "Not just for this, for what I said earlier. I was jealous and angry, and I lashed out. You were a great mom. You are a great mom."
Taub and Cheng are running through Abbey's blood tests. Negative for scleroderma. Taub wants to know what House wanted earlier, and she tells him about the "test" and House's claim that it's Taub's choice whether or not to hire her. Negative for dermatomyositis. Taub says House is just trying to set him up. If he wants Taub to offer her the job, then something's up. It's not lupus, either. Cheng doesn't understand all the subterfuge, but Taub says that House always has an ulterior motive. Negative for Churg-Strauss. It doesn't look like it's autoimmune after all. Time to scan for infections that can cause granulomas.
Wilson calls House to say Rachel's pooped three times in half an hour, but no dime. "All right, that's it," House says. "Time's up. Operation Valkyrie is now in effect." He grabs a scope, shoves it into a backpack and heads out.
Foreman and Taub are scanning Abbey. Lungs clear for granulomas. Foreman says whether or not it's a trap, he should hire Cheng. Of the three prospective candidates the team brought to House, she's the only one he's shown an actual interest in as a doctor. Taub sees something on the scan. "Oat cell lung cancer," Foreman says. She's got two cancers? Cancer treating cancer?
Foreman and Taub tell Abbey she's got lung cancer, and that the skin cancer is treating the lung cancer in a way. That's why she hasn't felt sick, and why the blood is helping the baby. It's treatable, though. She needs surgery and chemotherapy. "What about Kayla?," Abbey wants to know. Taub says she'll only need chemo. But why can't they just keep giving her Abbey's blood if it's helping Kayla? Once the tumor is removed, her body will stop producing the antibodies. Foreman says it would take another eight or nine days to completely eradicate Kayla's cancer cells with Abbey's blood. Abbey wants to do that, but Foreman tells her that while it's unlikely her cancer will spread in that amount of time, she could develop other serious complications, like blood clots. "What are the risks to putting my baby on chemo?," Abbey asks. "It could damage her brain or affect her development," Taub tells her. "But these risks are small compared to the risk that you would be taking by leaving your cancers untreated."
"I want to wait," Abbey says. Justine can't understand. "Mom, are you listening? This is way too dangerous."
"I'll take the risks. I want what's best for my daughter."
"I'm your daughter, too."
"She's a baby. You're an adult."
"So what? I don't need my mom anymore?"
"No, you never did. I wasn't there for you. And look at you. You turned out great."
"Oh, you don't know if I'm great. You don't know me at all. And I'm not going to let you martyr yourself for a two-day-old infant just because you feel guilty because you weren't around for me."
"I'm not martyring myself. It's nine days." Abbey tells the doctors she's going to put off the surgery, and Justine leaves the room.
Back at Cuddy's, Wilson wants to know why House brought over more Chinese food for a medical procedure. But House is more concerned that the new girl at the restaurant keeps forgetting to include the extra pancakes he always orders. He and Wilson look at each other - "Was she there when you picked up the food?," House asks. "You ordered extra pancakes? How much did they cost?," Wilson asks. They do the math and realize that Rachel couldn't have eaten a dime, because there was no extra dime. So, what did they see on the ultrasound? "Obviously just a pocket of air, like I said all along," House says.
Justine comes to visit her mom and bring some food. But she's not awake, and Justine can't rouse her. She runs for help.
"Massive pulmonary embolism," Taub says to Dr. Cheng in the cafeteria later. "She died in seconds." It probably wouldn't have happened if she let them do the surgery. But they can harvest her blood now, and treat the baby. "Pretty amazing case. Thanks for your help," he tells her. "I've thought about it, and I'd like to formally offer you the job." But Cheng has had her fill of House's team, Taub in particular. "I get that House is an ass, but at least he owns it." Taub says House is the one who made it a game; he didn't have a choice. "You're a grown man, Dr. Taub. You can make whatever choices you want. And instead of hiring me when he said you could, you chose to act like a paranoid, scared little kid. I hate kids. Goodbye, Dr. Taub."
In bed at Cuddy's, they can hear Rachel through the baby monitor. Cuddy goes to change her diaper, with the monitor still on. "What? How did you eat a dime?," House hears Cuddy ask. Now he's wide awake. And then a child's voice: "House."