A Dutch slave ship is pounded by waves and gunfire as it tries to navigate to shore amid a heavy rainstorm. The slaves are sick, and the crew believes they'll only be allowed to dock if they dump the "cargo." The shackled men are taken above deck, one by one until the entire ship is rocked by a canon blast. A huge hole blows opens in the slave quarters, sealing the men's fates . . .
In the present day, newlyweds Niles and Lulu are sailing leisurely in the Bermuda port where the doomed ship wrecked nearly 200 years ago, hoping their kids, Julie and Roger, are bonding while scuba diving around the wreck. When they surface, Julie has found a bottle with mysterious contents, but when she tries to hand it to her mother, it breaks apart, cutting Julie's hand in the process.
"Why aren't you guys in my office?" It's 8:00 a.m., but House is already at work and has tracked down Foreman, Taub, and Masters in the doctors' locker room. "Sixteen-year-old girl. High fever, vomiting, blood shot eyes." This somewhat mundane set of symptoms fails to get the doctors' attention. "Let see . . . did I leave anything out? Oh, yeah: smallpox."
Masters points out smallpox was eradicated more than 30 years ago. "So were hush puppies. But have you checked out your local hipster coffee shop lately?" Foreman's still not impressed, as smallpox isn't known to exist anywhere other than labs and bio-weapons plants. House tells them that Julie was diving near the wrecked slave ship, which was intentionally sunk because of a smallpox epidemic onboard. How could the virus survive the water? The airtight bottle Julie found contained "old-school inoculations: scabs of the infected people."
Taub doesn't believe that the virus could survive 200 years, but House is insistent and orders that Julie be isolated and given baseline blood draws for smallpox antibodies. He also wants the entire family vaccinated.
Ever the pragmatist, Foreman wants to also test for the "21st century suspects: varicella, measles . . ." "Feel free to perform whatever unnecessary tests you want, Foreman," House says. "Slavery was abolished years ago."
Meanwhile, Julie's mother, dad and brother are quarantined and separated by glass from Julie. Taub and Masters don biohazard suits in order to perform tests on her. "Why the hell do you guys have us quarantined in here?" Julie's mom asks. Taub tells her they're just taking precautions, but he won't say against what exactly. Julie is equally confused, so Taub tells her she might have tetanus from the glass jar. But her mom knows the shot she's being given isn't for tetanus.
"It's really not worth getting into, because the odds are astronomical," Taub says, trying to diffuse the situation. Julie really wants to know, and when Taub still hesitates, Masters says, "smallpox."
She tells the family that the vaccine will prevent them from getting it if they don't have it, and lessen the severity of it if they do. "But it's a billion to one, so I don't want you to panic." Too late; Julie's mom is beside herself.
House is seeing patients in the clinic, which is a surprise to Cuddy since he's not scheduled to be there. "I had some free time," he says.
"Don't you have a case?" Cuddy asks him.
"Then don't worry about it," and she takes his clinic patient's file from him.
"Are you a Stepford doctor?"
"If you're busy, you don't need to be down here."
House can't believe what he's hearing. "You're serious."
"Yep. Get outta here." And Cuddy walks away, leaving House to wonder what is happening.
Wilson is in the hospital room of a six-year-old chemotherapy patient, Eve, and her mother. Her mother wants Eve to be brave for her treatment, even though she doesn't have her favorite stuffed animal. But Wilson's attention is snagged by a text from House: "What I need is more important than what you're doing." Wilson suggests that the mother go home and get "Lamby" while he deals with "a very sick man."
"I think she knows." House tells Wilson that Cuddy must know about the blood test he faked for his last patient. He thinks that's why she let him out of clinic duty.
"She's also probably never ordered the pasta special in the cafeteria - would that also have some special paranoid message to send you?" Wilson asks. But House doesn't think that it's just his imagination. Wilson advises him to "say nothing, to no one, about anything."
In the lab, Taub tells House that Julie doesn't have smallpox, but the blood work suggests some other infection. But House has other things on his mind. "Masters, have you got a boyfriend?" She says no, but he presses on. "Would you ever be extra nice to a theoretical boyfriend if you were really mad at him?" When she tells him the only reason she'd be extra nice is if she was really angry and just wanted him to go away so she wouldn't have to deal with him, he calls her a "passive-aggressive bitch," but at least he's done asking personal questions.
"What about Foreman's unnecessary tests?" Julie is negative for both varicella and measles, seemingly leaving them with nothing on the table. But House has an idea: "Patient's a diver. Under increased pressure, everything in the blood gets scared, panics, runs, and hides . . ." Taub gets where he's going: the smallpox antibodies might be in her joints. House orders a tap on her knee, ankle, shoulder and "any other joint in her smallpox-ridden body."
"You know." House confronts Cuddy in her office. "Of course I know," she tells him. "Oh, thank God. I thought I was just being paranoid."
She didn't say anything to him because she wanted him to come to her and apologize.
"I can't apologize if I haven't done anything wrong." Lying to her face? He was just doing his job - saving a patient's life.
"I don't want to go all 'Godfather' on you, but this was business. I wouldn't lie to you about something personal." But Cuddy doesn't want him to lie to her at all.
"I can't compartmentalize my life like that," she says.
"Well, maybe you should practice, because it comes in handy."
Taub is performing the painful joint tap on Julie's knee, but suddenly stops, startled. "What?" Julie asks. "What is it?" Under Julie's knee he sees a raised rash. "I'm sorry," he says. "I have to call the CDC. I think you do have smallpox."
The doctors search Julie's body for other smallpox signs, while she wonders if she's going to die. "I mean, this is what terrorists want to use, to kill everyone, right? Like, there's no cure."
Taub tries to tell her about possible treatments, but House is more blunt: "Bottom line, it's 30 percent fatal. Which means your chances of being OK are about the same as a basketball player's chances of making a free throw." Unless Masters finds dark, purplish skin blotches, which would indicate hemorrhagic-type smallpox, a much more dangerous condition. "In which case her chances are more like Shaq hitting a free throw."
Masters doesn't find any purple skin, but she does find another rash under Julie's arm. But it's just a regular rash. "What does that mean?" Julie asks House. "It means it's not smallpox."
Wilson and Sam are in the cafeteria debating House vs. Cuddy. "Are you saying you see House's side?" Wilson asks. "It's not even a side. It's a fictional construction."
But Sam thinks Cuddy should know by now that House lies. It's how their relationship works. Does that mean he and Sam can lie to each other? "No, we have a different relationship. Lying was never a part of it. Theirs is built on it." But before they can continue, Wilson is paged: the nurse caring for his young chemo patient was called away, and he's got to go sit with her. Then they both hear an announcement from the hospital intercom system:
"Attention. Until further notice, all hospital entrances and exits will be restricted. Princeton Plainsboro is under total lockdown."
As House and the team are working on Julie, the CDC arrives: "Please, step out the room," announces Dr. Broda, head of infection control. He tells House the protective suits he and the team are wearing aren't adequate, but House says it doesn't matter since Julie doesn't have smallpox. Broda says the new rash doesn't necessarily mean she doesn't have smallpox; he wants to airlift blood and tissue samples to Atlanta. They'll have the DNA results in 18 hours.
Back in House's office, Masters still wants to go over Julie's symptoms. "It's not smallpox, she's not dying, and it's not our case," Taub tells her, as he sits back with a newspaper. But Masters doesn't think they should just wait around for 18 hours until they hear back from the CDC. Can't they spend time discussing a disease that looks like smallpox but isn't? Chase suggests molluscum contagiosum, but they don't have access to Julie anymore to compare legions to differentiate.
"But we do have access to the other patients," House says. "The ones who died of the same thing in 1793." He's got a copy of the slave ship's captain's log from a museum in Bermuda. How are they going to find someone who speaks Dutch in the middle of the night in the Netherlands? "Oh, you can always find someone."
He finds "CY3ERLOVERS," a Dutch Webcam porn site. "Ohhh, yes," a sexy, scantily clad woman says. "My name is Geerte. Are you handsome, sexiest American man?" "I would say that I am, yeah," House starts. "I want you to translate something for me."
"Why you want I translate? I do topless, toys and -"
"Just do the translation!" Masters yells.
Taub tells House the hospital has translators on call, but he's already got his credit card out for Geerte. He tells Masters to email her the file, and she translates the log detailing the sickness. On July 14, he boarded the ship with two trunks and his cat . . . "Go ahead and skip to the part where people get sick," House says.
Geerte continues reading: "The passenger has a fever, shaking, and red eyes. Ew. Also, African man made go in his pants."
Foreman asks about the captain and crew, but Geerte says the log only shows the African men were sick. House then rules out smallpox. "Airborne transmission means it's an equal opportunity killer. We're looking for a disease that discriminates." Taub suggests sickle cell anemia, but Chase says maybe a vitamin D deficiency from lack of sunlight could have weakened their immune system, making the men more vulnerable to malaria or dengue fever. Foreman points out nothing they've suggested explains the pustules. Masters has an idea: the slaves wouldn't have had access to clean drinking water like the captain and crew: scrofula. The rest of the team look at her, puzzled. "That's what they called cervical TB lymphadenitis in the 1700s." "Scrofulicious," House says. "That's what they called annoying in the 1700s." But she's not wrong. "They died for nothing. Those slaves could have led long, fulfilling lives, mowing my ancestors' lawns." House grabs Foreman for a private chat in the hall. He wants Julie tested for TB, but Foreman says they'll never be able to get access to her. "That's why we don't think it's TB. We think it's meningococcal disease, which could kill her before the results come back." Then when Foreman has access to Julie, he can run the TB test. But why couldn't House say all that in his office? "In front of the narc? As if."
Outside Julie's room, Foreman is explaining to Dr. Broda that they think the rash under Julie's armpit is actually petechial spots, possibly indicative of meningococcal disease. "There haven't been any seizures, no stiff neck . . ." Dr. Broda says. But he agrees to take a look himself. Foreman has to think quickly: "I can wear your gear. I'll take every necessary precaution."
Broda isn't going for it: "You come to me with a weak diagnosis. I even offer to investigate, but that's not good enough. What's really going on here?"
Before Foreman can answer, Broda sees Julie's father wobble and then collapse in pain. He says it's just a headache, but his eyes go bloodshot, and he starts bleeding from his nose. "This is not meningococcus," Broda tells Foreman. "You're not getting in here."
House thinks the dad's new symptoms are "cool" and thinks his headache is actually head pain - caused by a bleed in the brain from TB. Foreman says that they'll need to do a CT scan, but how, since the CDC won't let them move the patient? This time, House corrals Chase for a private talk outside his office. Chase thinks that whatever House is planning won't work since he's no better liar than Foreman. "Sure you are. You're descended from convicts." But he's not suggesting lie, anyway, just a bait-and-switch. "You propose that we don't have to move him if we do a pneumoencephalograph." Chase is confused. "A sixty-year-old technology that killed patients?" But that's exactly what House is saying. Then Chase will offer to compromise on the CT . . . But Chase still doubts he'll be able to fool Broda. Just then, Masters appears in the hallway:
"You don't trust me."
"Going behind your back works better when you're not facing us."
"Instead of whatever lie you're going to tell Broda, why don't you just tell him the truth? If we're honest and reasonable -"
"...people of all races and creeds will live together in peace and harmony..."
"How'd your first plan work out?"
House has to admit she has a point. He agrees to let her talk honestly to Broda. But he tells Chase as soon as Masters is denied, he should go ahead and do the bait-and-switch.
Wilson is talking to his six-year-old chemo patient, Eve. "They won't let your mommy back in the hospital, because of an emergency downstairs. But we have to get started."
Eve says she can't do it without her Lamby. Lamby holds her hand during her treatments. "Well, you could hold my hand," Wilson offers. "That won't work," Eve says.
Sam, who'd been standing in the doorway, offers some words of wisdom: "Well, sometimes we have to do things that we don't want to do. You have to go to school. You have to eat your vegetables. You have to take your medicine. You have to."
Sam and Wilson both realize she's being less-than-helpful, so Wilson sends her to the gift shop to see if she can find Lamby's cousin.
Masters tells House that Broda agreed to CT the dad's brain. "I pointed out that either we're right and he's a hero for ending the crisis, or he's right and he gets to be the first person to look at a brain infected with smallpox." "Good work," House says, and they walk to the dad's room. They watch the doctors wheel him out for the CT.
"So, I guess honestly is the best policy," Masters says."Why'd you say that? Seriously. To establish your viewpoint, as if I didn't already know it? Or to demonstrate some weird, cross-generational solidarity with Cuddy?"
"Actually, I was just trying to fill the awkward silence."
But then the doctors bring Julie's dad right back in. "Why'd you stop?" House asks, walking up to Broda and the dad without any protective gear. "He does not have smallpox!" But Broda says he does, and points down to the patient: "It itches," the dad says. "He's just developed pustules," Broda says. "He's now too dangerous to transport. Get out of the hallway."
"Dad's vitals are in the toilet. He's got full-blown smallpox," Foreman tells House. And the daughter's pustule count is up, while her vitals are down. "It means I was wrong. But, to be precise, I was right before I was wrong." House and Foreman are satisfied that the case is solved so their work is done. But Masters doesn't understand why they're giving up. She heads off to see Broda.
"I just want to look at the rash under her arm to see if it's mature," she says to Broda. He says she can look through the glass. "I need to be closer. If the pustules are at a different stage . . ." But Broda isn't letting her near Julie. They'll have the results back in eight hours. "If it's not smallpox, you can be the first one in there," and he walks out of the room.
Masters looks through the glass at Julie, lying in bed, miserable. She tries to get Julie to sit up so she can see under her arm, but when she does, she notices that Julie doesn't have any legions on the soles of her feet.
"Eve? Guess who came by the hospital for a visit?" Wilson found "Lamby," or so he says. Eve is thrilled, until she starts to add it up. "How come Lamby can be here but Mommy can't?" And she's not buying Sam's story that Lamby was dirty so they gave her a bath. Eve throws the doll at Wilson.
"Julie doesn't have smallpox." Masters finds House asleep in his office. "Did I just dream the part where I finally agreed it was smallpox? Well, if what I thought was reality was actually a dream, then the reverse . . . oh my god, I had a threesome with Beyonce and Lady Gaga!" Masters points out that Julie doesn't have pustules on her palms or the soles of her feet, but House says the dad does. So how does he have smallpox and Julie doesn't? Masters doesn't know, but House has an idea: "We gave it to him."
House and Masters track down Taub and Foreman in the locker room. Taub is skeptical. "So, therefore your theory is: you asked me to take the dad's blood, but I accidentally injected him with smallpox." Yes, that's what House is saying, although it was technically it was the vaccinia virus that the vaccine is made from. "Same symptoms as smallpox, but only half the calories and almost none of the lethality."
Foreman says he sounds like an anti-vaccine crank - you don't get full-blown symptoms from a vaccine this quickly. "You can if you're immunocompromised." He says the dad had kidney cancer six years ago, and House thinks it's back. "Shot his immune system, made him vulnerable to the vaccinia, which will get better on interferon. So, if he responds to the treatment, that proves he doesn't have smallpox." Except they still don't know what the daughter has.
House pleads his case to Broda. "What's more likely? He got smallpox the day after we immunized him for it, or he's sick from the vaccine itself?" But Broda wants proof the kidney cancer is back. House says if he gets better on the interferon, that's all the proof he should need. "I'll put on one of your fancy space suits, and I promise I won't kiss him on an open sore."
"You know who Janet Parker is?" Broda asks him. "In 1978, she was working at a university in England. Someone in a research lab in the floor below screwed up - some smallpox virus managed to float up through the vents into the room where she was working. She died four days later. The last known person to die from smallpox. And the person in charge of the lab was so destroyed, he killed himself."
Broda isn't going to open the door for House, or anyone else. But then House notices something: blood in the dad's urine bag. Broda says that isn't proof of kidney cancer; his kidneys are shutting down because of the smallpox.
House is adamant: "If smallpox was causing the kidney failure, the blood would be brown. It's red - because the kidney cancer is back, and this is not smallpox." But Broda won't budge. "I'm not opening that door." "Well, that makes one of us," House says, as he walks through the protective glass door to see the patient.
"Hey, you're insane!" Broda yells.
"But I'm right," House says back, as he gives the dad the interferon.
"I hope you are. Because I can't let you out now," Broda says as he re-seals the door.
Cuddy brings by a protective suit for House. She's not thrilled with him. "This is what happens when you have no respect for authority. No respect for anything."
But House thinks there's more going on. "You don't think it's a little much to use the threat of death to win a totally separate argument with your boyfriend?" She says that she doesn't care about any arguments right now; she just wants him to survive. House is convinced that he's not in danger and doesn't want to wear the suit.
Just then Julie's mom calls him over to look at the dad - he's getting worse, and he knows it. House says that the interferon takes a while to work, but privately he tells Cuddy: "Tell Broda that I'm increasing his oxygen. Get my team down here.
Sam visits Eve in her room. "Hi," but Eve won't even look up at her. "You're mad at us, aren't you?" Eve says she is. "Well, you have a right to be. We weren't honest. You might not notice yet, but sometimes adults mess up. Can I tell you something, and you keep it just between us? I'm not great with kids. I love them, but I get scared that I'm going to do the wrong thing and then . . . I usually do. That's what I did with the lying. And I'm very sorry about that. The reason why I did the wrong thing was because I was trying to get you to do the right thing. Your mommy and your Lamby both really need you to get better. So, do you think that you could be really brave and do the right thing?" Eve says she'll try, much to the relief of Wilson, who's been listening at the door.
"Fever's way up. Stats are way down. Pustules are still spreading." And the interferon's not working. The team breaks down the dad's condition for House, who has now decided it would be prudent to wear the bio-suit. But he still doesn't think it's smallpox. Foreman is equally convinced it is. "House, you screwed up going in there."
Later, Cuddy talks to House alone, with the glass separating them. He doesn't have a fever yet. "But when it does come, I assume you'll see the pettiness at being mad at me for lying," he tells her.
Suddenly the dad is writhing in bed, covered in pustules. "I'm not going to make it, am I?" he asks House. House tells him he should say goodbye to his family, and House wheels him over to the glass so he can be near his wife.
"I love you," he tells her. "You got to take care of my boy. Promise me." They tell each other, "I love you," and then he asks to speak to his son, Roger. "My baby boy. It's going to be OK. Lulu's going to take care of you. I'll always love you, Roger," and he closes his eyes and dies.
House tries to revive him, while his family watches in tears, but he can't save him. House looks at Cuddy. Is this his future?
Now House is stuck in a room with the smallpox virus, and his air is running out. Broda says they can give him another canister of air, but House knows when he changes canisters the virus can get in.
"Just move him!" Cuddy demands. Broda can't. House doesn't know why, since they don't know for sure he has smallpox, but Broda says they have to assume he does. There's another isolation room on another floor, but getting him there is the problem.
"So it's inconvenient. My having a chance at life is inconvenient." House is nearly gasping for air now.
The team is in House's office, and Masters still wants to "talk it through," because they don't yet have the official answer back from the CDC. Foreman says that it's pretty obvious what the dad died from. "Even if by some miracle it's not smallpox," Taub says, "there's nothing more for us to go on."
But then Masters gets up; she knows where she can get more information. She logs back on to CY3ERLOVERS and gets Geerte to read more from the captain's log.
"Gerrit seems distant and preoccupied . . ."
"Who's Gerrit?" Masters asks. It turns out Gerrit is the captain's cat. Taub says skip the cat, but Masters wants to know more about Gerrit. She asks Geerte if there's anything about the cat getting sick, but Taub says smallpox is exclusive to humans.
"Ship captains didn't have pets," Masters says. "Nothing and nobody went on those ships if it didn't have a purpose." The cat probably kept the rat and mice population under control for the captain and his crew, but it wouldn't have helped the slaves at all.
"What happened to Gerrit?" Taub asks Geerte. Geerte says he died. "Before he died, did he lose his fur?" Masters asks. "How did you know?" Geerte asks. Masters says mice don't carry smallpox, but they do carry rickettsialpox. "Which is treatable," Foreman says.
"Just start them on doxycycline," Masters and the team beg Broda, but he's unconvinced. "Based on a bald cat? You never heard of shedding?" He says if they shove her full of antibiotics, plus the antivirals, it'll suppress her bone marrow.
Masters says that if Broda would just look at the dead dad's body: small patches of black, dead tissue will prove she's right. "Eschars appear with rickettsialpox, but not with smallpox," she says. Broda says he would have noticed, but Taub says he hasn't been near the body in nearly a day.
Meanwhile, two men enter the dad's room to bleach the body and kill the virus. "Bleaching the body will destroy all evidence of rickettsialpox!" Masters tells him. "There is no evidence!" Broda says. "I'm not trying to hurt anyone here. I'm not lying to you. This is smallpox."
The team doesn't know what to do. Except for Masters, who runs past them and over to the glass and tells House to examine the body quickly, before they can bleach it. He doesn't want to go near it, but she explains her theory about the sick cat, and he decides it's worth it to check. But he can't do much with the heavy protective gloves he's wearing.
"Take them off!" Masters says.
"Says the woman standing behind two panes of glass," he responds.
"Do you believe me? Forget me - do you believe you? You think it's rickettsialpox, don't you? If it is, it's curable, and she's going to die unless we can prove it."
House looks at Julie, and back at Masters. "You really are annoying." And he takes the gloves off to examine the body. He's poking and moving the body around, trying to beat the men who're suiting up to come in, and just as they arrive, he finds eschars on the dad's body. "Start the girl on doxycycline," Broda says. "Right now."
The hospital is open again, and Sam and Wilson can reunite Eve with her mom and Lamby. "You were good with her," Wilson says.
"Only after being bad," Sam says.
"Maybe I should get a puppy."
"Yeah . . . or pregnant."
Julie wakes in her room and sees her mom overjoyed that she's OK, and Roger, still crying over the loss of her father.
"Buy you breakfast?" House asks Cuddy in her office.
"When I was dying, you realized a little white lie between coworkers wasn't such a big deal."
"Yeah, and that was true. When you were dying." And she walks out.