House M.D. Episode 7.11 Family Practice

Cuddy and her sister, Lucinda, are clothes shopping in a high-end boutique while their mother, Arlene, offers helpful suggestions, such as "If you're going to dress like an Italian hooker, at least let it be this year's Italian hooker." When a sales girl drops by offering Champagne, Arlene is quick to say yes, even though her daughters protest that it's not even lunch time. Then suddenly Arlene catches her breath and puts her hand over her chest. "My heart's doing that weird thing again," she says. "Beating?" Cuddy asks. "That's normal for humans." But Lucinda wants Cuddy to take Arlene seriously, so she dutifully marches to her mother's side and takes her pulse. Cuddy's face drops. "What? What is it?!" Arlene asks. Trying to maintain a calm exterior, Cuddy tells her that they need to go the hospital.

House has gathered the team in the morgue, to eat chips and watch cartoons. But only Masters is confused. "Is anyone going to tell me why we're in the morgue?" Chase and Foreman explain that House is hiding from someone, though they don't know who exactly. When Cuddy bursts through the door, they get their answer. "She needs a doctor," Cuddy tells House. He sighs, "Yes, just not me."

House thinks that Arlene is just a 65-year-old woman with high blood pressure. "What about the macrocytic anemia?" Cuddy asks. It's borderline, he says. "The lab equivalent of imaginary. Which, by the way, matches the rest of her medical history." Cuddy doesn't believe her mother has psyched herself into atrial fibrillation. House argues what she needs then is a cardiologist - and that neither he nor Cuddy should be on the case. "You know all that ethics stuff that I don't give a crap about. It suddenly makes sense." She won't be able to make rational decisions if she's emotionally involved. "You know this will be a disaster," House tells her. But she's near tears. "This is my mother." The team looks at House, wondering what he'll do.

House is standing next to Cuddy, with a white lab coat and a smile, explaining cheerily to Arlene that her treadmill test went well, no chest discomfort or ischemia. "The abnormal rhythm will probably resolve itself; if not, a daily pill will keep in under control." But Arlene wants to know if it's connected to her other symptoms. "Which other symptoms, mom?" Cuddy asks, confused.

Exasperated, Arlene tells them it's all in her file. House's cheery attitude is fading, as he holds up her thick folder. "There are 15 years of clinic visits in this file." Arlene smiles. "I don't want to be a bother, but isn't this what you do for a living?" House gives in and checks out her history: "So, we're looking for a disease that lasts a decade and a half, causes constipation, diarrhea, flu, cold, dizziness, rashes, back and joint pain, heart feeling 'weird,' kishkas feeling wobbly, one actual hip replacement, and which has eluded detection by years of blood work, X-rays and MRIs. Well, one thing does pop to mind . . ." But Cuddy wisely cuts him off. "We'll monitor you," she tells Arlene. "And we'll give you a thyroid test. And House's team will do a home search for environmental toxins."

"No radon, no mold, no lead in the pipes." Masters and Taub are searching Arlene's home, though Taub cares less about lead in the pipes than in finding Cuddy's high school yearbook. "Cuddy won't let House see the yearbook, so he figures there's something to hide," he tells Masters. While rummaging in Arlene's drawers, Taub lets out a yelp. He's found some photographs, but not of Cuddy. He shows them to Masters:

"Is that Cuddy's mom?" Masters asks, cringing. "Certain ... parts of her. And certain parts of some muscular Hispanic gentleman."

"Should we consider STDs?"

"I think we just caught one looking at these photos."

But Masters has found something else: a mysterious medicine bottle.

Back at the hospital, House explains to Cuddy that the bottle contains a Mexican herbal medication for stomach problems. "But only in the sense that lead chromate is an herb and poison is a medication." Cuddy thanks him and says she'll start a chelation IV to flush the lead from Arlene's system. "You know," he starts, hesitantly. "It's not the only thing they found in her home." He tells her about the photos, backed up by entries in Arlene's diary mentioning a contractor named Jesus. Cuddy's shocked, but not upset. "Go, Mom," she says, and kisses House on the cheek.

In Arlene's room, Cuddy asks about the Mexican folk remedy. Arlene says a "friend" uses it, but Cuddy knows better. Just for medical reasons alone, she should have told her she was sexually active. "At my age," Arlene says, "he's more the active one." Cuddy turns to her sister, sitting on a nearby couch. But it turns out that Lucinda already knew. "She's been giving me lousy advice about it for five years," Arlene tells Cuddy. Jesus is married, but Arlene doesn't see how anyone is getting hurt. "Hold on," Cuddy says. "Five years? Why didn't you tell me about it?" Arlene says they don't have that kind of relationship, which clearly hurts Cuddy to hear. "Does that really surprise you?" she asks Cuddy.Foreman is helping Taub move in, and as Taub is unpacking, Rachel stops by. "Hi. I'm sorry - I just wanted to drop off some mail, and talk to you about something." They step into Taub's bedroom, and he tries to take her hand. "Chris, that's not why . . . we've got to move on." Taub can sense that she has already moved on, but she won't talk about it. She's there with an offer: she knows he's worried about money, so she arranged for Taub to try out to be a part-time medical consultant at her brother's law firm. "Wait, with your brother? Have you completely forgotten the last time I saw him?" Rachel says that was five years ago, and he'd just found out about Taub's affair. "He broke my nose and then called me the most horrible person he'd ever met," Taub says. Rachel looks at him. "He shouldn't have broken your nose."

House walks into Arlene's room with his cell phone in his hand. "You know," he says, "texts, calls, and emails all go to the same magic device these days. You've only got to send one." Then it's even weirder that it took him so long to come to her, she tells him. "Yeah, it's a crazy mystery. It's not like I've got a department to run," he says. Arlene has been consulting the Internet, and now she believes that lead poisoning wouldn't have caused all of her symptoms. "True, but it could cause the five percent that are real," House tells her. She can't believe it: "You think I'm a hypochondriac?" "Well, let me answer this way: maybe you're imagining that I think you're a hypochondriac," House says. She holds up her hand to show that she's shaking. "It's a side effect of these arthritis pills. Read the label." But he has already read the label, because he was the one who typed it up. "Right before I slapped it on a bottle of sugar pills." She's incredulous. "You printed a fake label, just to prove that I'm a hypochondriac?" "Did it work?" House asks. "It got you fired, you schmuck," she tells him.

Later, in Cuddy's office, Cuddy tells House it took her an hour to persuade Arlene to go with another doctor. She wanted to leave the hospital altogether. But the way House sees it he helped her by humiliating her. "If I hadn't, she'd have diagnosed herself with six new forms of cancer. She'd never leave." Before Cuddy can admonish him for his juvenile behavior, she gets a call from Arlene's new doctor. Arlene is in atrial fibrillation. Cuddy leaves - but not before telling House he's still on the case. "She just can't know about it," Cuddy tells him.

The next day, House catches up with Arlene's new doctor in the hallway. "Top of the morning, Dr. Kaufman! Here's the deal: you copy me on all the imaging, I'll have my guys run all the lab tests . . ." But Kaufman's not having any of it. Arlene specifically told him not to let House near the case. "Listen, Kaufy, you are perfectly competent, bordering on good even. But you know I'm better. If you want we can pretend it's because I've got a team and more resources. Either way, you'd be crazy to ignore my advice." But Kaufman knows House wouldn't be able to stop at just advice. He'd cut Kaufman out entirely, going behind him to Cuddy. And if something happens, Kaufman's still the doctor on record. "Please, stay away from my patient," he tells House.

Back in House's office, House and the team are sitting at the table while House unveils a receiver, and they can hear the voices of Cuddy and Arlene. "You bugged the room?" Taub asks. "I absolutely, without apology, will admit that someone may have allegedly done so," House says. "I guess we can pass unethical and skip straight to illegal," Masters says. "Not according to the recent Supreme Court case of Bite vs. Me," House answers.

But soon they're hearing more than just medical talk from the room. "Dr. Kaufman's single - did you know he went to Harvard Medical School?" Arlene asks. "Mom, stop yenta-ing for one minute!" Cuddy says. But Arlene is undeterred. "If you want gloomy and unable to commit, then stick with the goyisha one." Masters says that she can't work with House if he's going to do this, so House agrees to shut the stream off and get updates from Cuddy. When Chase suggests Arlene might have leukemia, House must reluctantly agree. "I was really hoping for a different diagnosis. One that Kaufman hadn't already come up with. He just started a bone marrow biopsy." When Masters realizes that they don't have anything to do, House sends her down to admitting to search for a new case. But as soon as she leaves, he calls the boys into his inner office for a differential diagnosis. Foreman is confused. "Uh, we just did it." "No," House says. "We just did the fake one. Why do you think I let the Truth Fairy know about the bug? I was testing her. She failed. She's still a narc."

House says thiamine deficiency makes more sense than leukemia. "You think she's an alcoholic?" Taub asks, and House tells them the story of when he drugged Cuddy's mom. "When I had dinner with Arlene, I mixed her gin and tonic, and . . . I'd run out of the tonic so I substituted sleeping pills. The next morning she assumed the blackout was from the drinking. How many old ladies are used to passing out from boozing? The answer is: the boozers." House says that they'll have to slip her the thiamine pills, but Foreman says they need to consult Cuddy.

When House tells Cuddy about his theory, she can't believe it. House tells her the treatment is easy, safe, and won't interfere with Dr. Kaufman's biopsy. He puts a bottle of pills on Cuddy's desk. "I put them in an antacid bottle. Tell her it's for stomach problems," House says. But Cuddy wants to talk to her mom about it first. "Of course," House says. "Absolutely. You'll ask, she'll deny, you'll push it, she'll get offended. You'll be exactly where you are now, except it'll be harder to treat her. You've absolutely got to do that." Cuddy doesn't think her mom will lie to her. "We have our issues, but since dad died, we tell each other the truth when asked directly. It's important to us," she says. House reminds Cuddy, "Addicts lie." She grabs the thiamine pills and goes to see Arlene.

Cuddy wants Lucinda to step out of the room while she talks to Arlene alone, but she only succeeds in worrying Arlene. "Why? You're scaring me, Lisa." So Cuddy tells her that they believe her drinking is causing the heart problems. And she's done some investigating on her own. "Patsy and Ann told me you lost control last week at the museum luncheon." Arlene is upset that she's been talking to her friends behind her back. "We're all concerned," Cuddy says. "Just tell me honestly: how much have you been drinking?" Arlene is adamant. "I may be your patient, but I am still your mother, and I am telling you I am not a drunk." Cuddy knows House was right. She gives Arlene the thiamine pills, telling her they're antacids.

House finds Cuddy later on a bench near the lobby. "If something like that comes up again, just do what you need to do," she tells him. "And keep you out of it?" he asks. "Yeah, I am being a coward. Which is exactly why doctors shouldn't treat their own family. Congratulations. You were right, as usual," she says, and walks away.

Taub is meeting with Rachel's brother about a potential job. "The hitting you," he tells Taub, "was not optimal. I was going through my own divorce at the time. I've had years of therapy. Now, when I get mad I do some deep breathing, squeeze my stress ball." He says he does a lot of medical malpractice insurance cases, and he needs a non-testifying expert. He'll offer Taub one case as a tryout. "If you kick ass, I put you on retainer. Average fifteen hours a week. It's 50 a year." "50 what?" Taub asks. $50,000 a year. "I'll take it," Taub says. As he's getting ready to leave he sees a picture of an injured boy. "That's a case I'm about to settle. I rep a giant pizza delivery company. Driver hit that kid, messed up his legs." But Taub sees more damage than just the legs; there's evidence of a micro-bleed in his brain. Rachel's brother insists the boy is fine, and Taub should stay out of it. It's a multi-million dollar case. We're settling in two days. Lay off it, OK?" Taub agrees that it's probably nothing.

Later that night, Cuddy calls House back to the hospital: Arlene spiked a fever. House was wrong about the thiamine deficiency, and wrong about the alcoholism. House says that it's looking more and more like leukemia, but Cuddy says Kaufman's biopsy showed no sign of cancer. "So, there's a bright side," House says. "Kaufman was wrong, too." Cuddy just shakes her head and walks away.

House convenes the team in the room of a comatose man, asking for a DDx. Chase starts. "OK, what disease can turn Cuddy's mother into a coma patient named Stewart." House says they've been fired from Cuddy's mother's case, so they're moving on. "OK, pop quiz, hot shots. I chose Vegetable Stew for a reason. You've got 60 seconds. No hintsies." The team pores over Stewart's case file, with House not offering a word of assistance. It doesn't take long to solve the mystery. His pupils are fixed and dilated; he was an addict, found with an empty bottom of phenobarbital next to him. It was an overdose. But they can see by House's expression that there might be another answer. Masters excitedly says glutethimide - he had a prescription filled last year. "Could mimic fixed and dilated, without the brain death," she says. House starts to give a thumbs-up that she might be right, but then she continues, "Except, he'll just get better on his own, so why would you take this case?" Chase says House doesn't care about the treatment as long as the case is interesting. Masters says that she'll do a blood draw, with glutethimide on the tox screen. House and the boys leave her to it.

As they walk through the hall, it's clear Vegetable Stew was just a rouse to ditch Masters so House can continue on Arlene's case. "Aren't there other ways of keeping Masters occupied?" Foreman asks. "Not according to my sexual harassment seminar," House says. They step into an empty room, and Taub suggests perhaps it isn't simple hypochondria. "She said she gets a lot of rashes, add the fever - sounds like autoimmune. SLE?"

"Congratulations! You can think exactly like a semi-competent internist," House says. "Kaufman's starting her on prednisone." House says the heart problems were first, so Foreman suggests endocarditis. "With no murmurs?" Chase asks. House says that's usually a late sign. "Kaufman's prednisone will suppress her immune system," Foreman says. "It could kill her." Taub tells House he's got to tell Kaufman, but apparently Kaufman's infectious disease specialist has already been trying. "He can't convince him - you think I've got a better shot?" But House has a plan: switch Arlene's medications. "We get a solution of broad spectrum antibiotics; stick it in an IV bag marked for prednisone. Kaufman can only be there a few times a day. Tell Arlene you're from the pharmacy, switch them out." "This is nuts!" Foreman says. "It's way too complicated." But House says it's just hanging an IV bag. "If the attendant doesn't know what she's on, the risk of drug reaction . . ." House is getting more agitated and cuts him off. "We know how he's treating her! We bugged the room!" Foreman says it's about more than just medicine; these are ethical and legal violations. "She's dying!" House yells. Foreman is equally adamant. "That doesn't mean we should all go to jail to save her!"

He calms down and tries another approach. "You're losing control, because this is your girlfriend's mom." Chase asks if House wants them to run it past Cuddy, but House tells them what Cuddy said about leaving her out of it and just doing what needs to be done. "Look, I know what I'm suggesting is completely screwed up. That's because the situation is completely screwed up. Do it or you're fired," and he leaves. Foreman tells Chase and Taub that if they stick together, he can't fire all three of them. But Chase is onboard with House's plan: "I think it's endocarditis, and I think the prednisone will kill her," and he starts writing the prescription.

Taub and Foreman wait in House's office while Chase makes the switch. "Am I a horrible person?" Taub asks. "I used to win awards for volunteer work. I went to Guatemala and fixed cleft palates. Now I'm sitting back, letting Chase do our dirty work." Foreman says they're doing the right thing by staying out of it. But Taub doesn't know what's right anymore. He tells Foreman about the kid whose picture he saw in Rachel's brother's office. Foreman talks him out of that, too: "A) radiologists, experts, unlike you, said no bleed, B) you yourself said it was probably nothing, C) you've got no doctor/patient relationship, D) you'll lose your consulting job, E) your ex will kill you, F) I'm running out of alphabet here." Just then Chase walks in. Foreman asks if he did it.

But Chase says just as he was walking in with the bag, Lucinda saw him and recognized him from a charity event the year before, so there's no way he could make the switch. "One of you two's got to do this," he tells Taub and Foreman. But Foreman met Arlene at the same benefit, so it falls to Taub. "Come on, don't ask me. I don't even know if I believe it's endocarditis . . ." but just then he gets a text on his cell phone. "Damn it, it's Rachel's brother. He wants me to check out some new case." Taub says he has to go, because it's a tryout and he needs the job. "So you're just going to ditch us, run off, and work on some other case?" Foreman asks.

Taub shows up at a house in the suburbs, and when a forty-something woman answers the door, Taub can see a boy behind her, in a wheelchair. "Are you Timothy's mom?" he asks. She says yes but wants to know what this is about. "My name is Christopher Taub. I'm a doctor at Princeton-Plainsboro. I saw your son's file. I think he might have a very small bleed in his brain." Timothy's mom is understandably confused. "Wait, you saw his file at . . . How do you even know who we are? I've never met . . ." Taub cuts her off. "Your son could die of a brain hemorrhage. He needs a cerebral angiogram today. Get in your car and meet me at the hospital."

Back at the hospital, House is berating the male members of his team. "Another pop quiz: how many idiot doctors does it take to switch an IV?" House says the longer they wait, the more the prednisone is destroying her immune system. "Forget playing pharmacist. Mom naps every afternoon. Wait by the room. When she falls asleep, get the sister out somehow."

It seems like Masters might have figured out what's going on, and she pays a visit to Cuddy's office. "So, um, you know how you had us consulting, and then stopped having us consult? Well, I think the stopping might have . . . stopped. House put me on this weird case where there's no treatment. I think maybe to distract me. And they've been acting odd." Cuddy thanks her and says she'll look into it. But before Masters leaves, she tells Cuddy: "Because I'm worried that he's switching your mother's medications. I checked with the pharmacy. Dr. Chase got prednisone and antibiotics for my coma patient, which wouldn't treat him, but could treat conditions that cause heart failure."

Cuddy confronts House in his office. "You told me to keep you out of it!" he yells. "Do what I needed to do! What the hell did you think that meant?" Cuddy says this isn't just a few more vitamin pills, this is life-threatening. She wasn't expecting this. "Only because you intentionally weren't thinking about it because you don't want to make any tough decisions," he says. "Are you completely sure it's endocarditis?" she asks. But House knows that she knows he can't answer that. "Endocarditis fits better than the alternatives," he says. "We're having a little trouble hanging the right IV. The fastest way is with your help."

When Cuddy goes to her mother's room to switch the IVs later, she asks why Lucinda isn't there:

"She's got a family," Arlene says.

"I've got a family," Cuddy reminds her.

"Three kids and a husband - that's a family."

"You're always tougher on me than Lucinda, why is that?""I'm not!"

"I was thinking about when you made me run for yearbook editor. I didn't want to. I didn't have a social life my whole senior year. You let Lucinda do whatever she wanted."

"We're debating 12th grade - now?"

"Like anything's changed."

"What do you want, Lisa? Do you want to hear I love you both the same? Of course I do."

"OK," and Cuddy starts to walk out.

". . . But times like this, when we argue, it reminds me I have more in common with her. She's nicer to me. I love you both, but I like her more than you," Arlene tells her.

When Taub walks in the door, Foreman tells him he tried to call three times. "My phone wasn't exactly on. I figure I'll be getting some angry calls once radiology sends back the angiogram." But Foreman says they already did - and hands Taub an x-ray. "This is what you saw. It's an anatomical variant of the skull, bone in proximity to a blood vessel." "There was nothing wrong with him," Taub realizes. "That was reason G," Foreman says. "That's . . . good news for him," Taub says, but he knows he's made a huge mistake.

Cuddy is called to Arlene's room for an emergency. She's having an allergic reaction. "Doesn't make any sense," Dr. Kaufman says, as he helps Arlene with an oxygen mask. "She's on prednisone, how could she get an allergic reaction?" Cuddy bites her lip: she knows how.

Cuddy gathers all the doctors in her office. She switched Arlene back to the prednisone, and her breathing is normal again. But the atrial fibrillation and fever are back. Taub says the reaction had to be the antibiotics they gave her. Cuddy paces the room. "He doesn't know that she got worse on the antibiotics but now he's thinking endocarditis and put her back on the antibiotics that almost suffocated her. What do we do?" House says they've got to push through. Endocarditis still fits, but it's got to be fungal. "We have to switch Kaufman's antibiotics with amphotericin B." Foreman has had enough. "I don't know if you're right. I don't care. But we are going to end up killing this woman if we keep confusing her attending with these secret meds." He tells House giving her the amphotericin B is dangerous. "It's a poison - that's why it kills fungi. It'll give her fever, chills . . ." House says she's already got those, and the meds will help them hide it. Cuddy tells them she doesn't think she can take a risk like that. "Well, then you shouldn't have let her fire me!" House yells. But he can see she's distraught. "Look, all you have to do is switch the IVs again." Foreman, Chase, and Taub agree Cuddy shouldn't do it. "I'm so sorry I got you guys into this," she tells them. "You should go."

They leave and Cuddy sinks into her desk chair and puts her head in her hands. House tells her that he's right. "I know, and I'll do it, but . . ." she begins, but she looks up and sees that Masters has come into her office. Knowing that they're busted, they hand over Arlene's file. Masters agrees that fungal endocarditis fits, but she says they have to tell Arlene. Cuddy looks at her, incredulous. "I don't want to tell her, not at all," Masters says. "But the patient is the highest priority." House intervenes. "I'm kicking you out of your office," he tells Cuddy, and she gets up to leave.

Masters knows she's in for it. House walks over to her and says, "If you tell anyone, I will get you thrown out of med school, and I will destroy your career." But Masters has considered that already. She stands firm. "Lying about me won't work. Everybody knows your reputation." House admits she's got a point. "But I won't have to lie," he tells her. "Buried in your coma patient's big, big file is a form that doesn't allow treatment without the express consent of the relatives." Masters is confused. "You drew blood," he tells her. "That's not just a screw-up; that's a criminal assault." She argues that he told her to do that. Nope, he never said a word during the entire DDx. Masters looks like she's about to cry. "You set me up? Why?" "Because this patient is the highest priority," House tells her. She gives a faint smile and a nod. Then immediately bolts for the nearest restroom to throw up.

Taub is finishing up at a urinal when Rachel's brother sneaks up behind him and smashes his face into the wall. "You made her think I was hiding her son being sick! She scuttled the settlement. She reported me to the Bar! I've got to deal with that crap now. I will sue you for slander, for tortious interference, and anything else I can use to destroy you," he says, as Taub is writhing on the ground in agony. "Oh, and my sister says: stay out of her life, you failure."

Masters is standing at the door of Arlene's room, asking Dr. Kaufman if she can speak to him and Arlene alone. Cuddy shoots her a look, but she knows it's over. Moments later, House has been called in the room and Dr. Kaufman is pacing angrily. "I'm skipping the credential committee," he tells House. "I'm going straight to the state board and reporting you for . . . what you've done is so off the spectrum, I don't know there's a specific name for it." Cuddy tries to get him to calm down, but he says what she did was actually worse. "He's an insane lunatic. You're the dean of medicine!" Arlene jumps in to say that they're all fired from her case, including Kaufman. "I'll never get away from House or my daughter if I stay here," she says. "Transfer me to Princeton General." Cuddy says she shouldn't make a decision like that now, when she's so ill, and so angry. "You lied to me and betrayed me. Do you think I really care what you consider a good idea anymore?" Arlene asks. Cuddy says that she'll get the ambulance, and walks out. House follows, but not before turning to face Masters: "Happy?" he asks her.

Cuddy is pacing and crying in her office. "I can't believe it. What just happened?" she asks House:

"You just killed her," he says."Are you blaming me? This is all because you're so arrogant, you goaded her into firing you.""Actually, my mistake started a little after that, when I agreed to your brilliant scheme to keep me on the case after she'd fired me off it."

"She would have left the hospital."

"Only because you would have let her. Like you did just now."

"You think I can control her?"

"I don't know. I've never seen you try."

"I have been rebelling against this woman my entire life."

"This is what I've seen. She insults you: you complain to me. I drug her at dinner: you never let her know. We slip her medicine: happens behind her back. You never confront her. And it pisses me off."

"Are you taking this personally?"

"She leaves, she dies. One day, maybe a week from now, maybe a year from now, you're going to decide the man sleeping next to you killed your mother. Get me my patient back!"

Cuddy races out to Arlene's ambulance and opens the doors. She threatens to call security in order to get Lucinda to leave. Cuddy sits next to her mother's gurney. "I asked you before why you were tough on me . . ." she starts, but Arlene again says she wasn't. "You were, and I know why. You see something in me that you didn't see in Lucinda and you didn't see in you. A type of ambition. A type of brains. That's why you rode me. You made me yearbook editor, summa undergrad, AOA in med school. The only time I ever see light in your eyes is when you hear me talking about my job. The reason you keep coming to see me in the clinic is because you trust me. You trust my medical judgment. So here it is: if you transfer to Princeton General, you'll be treated well, and you'll die. If you stay here, with House, you'll be treated badly, but you'll live. I don't care if I have to slash the tires of every ambulance in this bay, Mom, I am not letting you leave my hospital."

Cuddy and the nurses are helping Arlene back into her bed in the hospital. Cuddy asks how she's feeling, and she says she's a little dizzy. House says her heart's still weak from the infection. "If you're so great, how come you're not running your department anymore?" she asks him. House and Cuddy are confused. "That's what he told me," Arlene says. House thinks back: "Two days ago? I said that I didn't have a department to run - I was being sarcastic." Arlene argues that he wasn't. "Right, because people who are talking can't tell if they're being sarcastic," he says. "That doesn't make any sense, of course they can," she says. "You weren't."

Now House and Cuddy are a little worried. He tries a test: "I love A-Rod. He's sooo modest, and I highly respect the paintings he has of himself as a centaur. Question: Do I like A-Rod?" Arlene says, "Yes, whoever he is." Arlene can't recognize sarcasm. It's a problem in the right parahippocampal gyrus, which House says means no central nervous system involvement before the fever. "I was wrong about the endocarditis," he says. Just then Arlene starts to fade, "I don't, I don't feel good," and she passes out. Cuddy calls for a nurse, but House is just standing there. "Do something!" Cuddy tells him. "I am," and he steps back to let the nurse get to Arlene. "House!" Cuddy yells. "The fever was hypothalamic - that means brain, heart, anemia, allergy. You hear that what do you think?" But Cuddy can't think. "Heavy metal toxicity," House says. Cuddy doesn't know how that can be since they treated her for lead poisoning. "She got better, then she got worse," House tells her. "She never stopped being poisoned." House grabs surgical gloves and a blade. Cuddy asks what he's doing. "You really want me to stop and explain?" he asks. He cuts into Arlene near her hip. Arlene groans, but House has found was he was looking for. "There it is - look at that," he says to Cuddy, pointing at black spots in the muscle of Arlene's hip. "Metallosis," he says. "Her artificial hip weared and teared way too much. It's cobalt poisoning." House says they'll need to start chelation again.

Taub is staring out the window as the rain pours down, and someone knocks at the door. It's Rachel. "I thought you didn't want to see me," he says. Foreman called her, and explained what happened. "I didn't know that you thought that little boy had a bleed in his head. I will kill my brother if he messes with you anymore." "What do you care?" he asks. "Chris, you were a crappy husband, but you are a good person."

Masters is packing her locker when House comes in. "Once again you are unfired," House tells her. She just laughs. "Why?" "You sold me out," House says, "even though you knew you were going to get thrown out of med school. That's just . . . kind of impressive." Now Masters doesn't know what to think. "I keep my job if I stand up to you. I keep it if I don't. I don't buy it." House says, "When Cuddy was protecting me before, she was protecting a doctor. She's now protecting a boyfriend. The hospital's not going to put up with that for long. So, I need you to protect me from doing something that Cuddy will regret. See you bright and early tomorrow." Masters hangs her lab coat back up in her locker.

Cuddy visits her mom in her room the next day. She wants to keep her removed hip replacement, "so I can mount it on the wall like a moose head." And she's been on the Internet again, she tells Cuddy. "Says here cobalt can cause rashes, dizziness, and stomach problems. You still think I've been imagining the whole thing?" Cuddy admits that she might have a point, and asks how she feels. "You know, a little dizziness, some pain . . ." and she takes Cuddy's hand in hers.