"Get up, House." A guard wakes House up in his cell in the middle of the night. There's a "VIP" visitor waiting to see him. "Dean of Medicine from your old hospital." House asserts his right to refuse any visitor: "Tell the Dean that I don't want to see her." "He said you'd say that," the guard answers. Now House is curious. "He?"
The guard leads House to a visitor room, where, sitting at the table with a laptop and a familiar dour expression is Dr. Foreman. "I can get you out of here," Foreman says. Foreman pulls out a judge's order. "For your immediate release," he says.
Now House is just confused. He had eight months added to his sentence, and that was just two months ago. It's a "conditional parole." "The condition being," Foreman says, "that you're employed by me." But is it really a good idea for House to go right back to his old life? House isn't sure.
Foreman confidently opens the laptop and shows House the screen. "Your patient is two lungs in a box," Foreman says, as House looks at a pair of lungs being artificially inflated inside a glass box. The lungs will only be viable for 12 more hours. "No pulse, no body, no ability to answer questions. It's your perfect patient."
Foreman springs House and explains the case. The donor is a college kid who died after a motorcycle accident. Asystole in the ER, with no pulse, no blood circulation, and his other organs were destroyed. But the lungs don't need circulating blood, just access to air.
"Surgeons had the recipient on the table when they realized the lungs had increased airway resistance," Foreman explains. "Team closed her up, put the lungs in suspended animation." They have 24 hours to fix the lungs, 12 of which have already passed. "We still have no clue what's wrong."
House enters the hospital and surveys the lobby, taking notice of a new painting: "Blues and greens. Calming with a hint of nurturing. Totally offsets the stench of suffering and death." It doesn't take House long to assume his former role of superior and hand a file to Foreman, who suggests he can just take it himself to his office. "I completely understand, and almost respect, your desire to appear to be Dean of Medicine, given that your title is Dean of Medicine. On the other hand . . . seriously?"
Foreman has some ground rules, though. "You break the law, you go back to jail. Scam extra Vicodin, back to jail. Without my authority, make the hospital look bad, back to jail. I own you." "Yes, massa," House says.
They walk toward House's office, but he's surprised to see a doctor sawing a cast off a patient in the outer office. "Ortho needed more space," Foreman says, leading him away. "Where's my stuff? What about my team?" House asks. Taub, Chase, and Thirteen have all moved on in the last year. "Here's your new office," Foreman says, showing him a closet-sized room. "And there's your new team."
House sees Dr. Chi Park, a shy, young, Asian-American doctor in thick glasses sitting in a corner. "Hi," she tentatively greets House. He immediately leaves.
"Dr. House!" Park chases House down the hall. "Dr. Foreman assigned me to this case." But he isn't interested in another department's "sloppy seconds." "It's 3 a.m. If Foreman had called you in from home, you wouldn't have pressed clothes, coiffed hair, and makeup, which means you were already here in the hospital." She says that she was on-call for neurology.
"If that were true, you'd be working right now, and unavailable to help," House tells her. "Which means that you're hanging out in the hospital pretending to work. Which means you're not just a reject, you're a cowardly reject who is trying to hide her rejectedness from someone." She says she's not a reject at all, but it's true she can't go back to neurology: "I punched my attending."
The two of them walk to the room where the lungs are being kept and looked after by Dr. Ron Simpson . . . and Wilson. Simpson explains the case as Wilson tries to avoid making eye contact with House. "ARDS, secondary to trauma, is our leading hypothesis. Fi02 is 93 percent-" "PRISON!" House interrupts loudly, and looks around the room. "Sorry, I thought I heard everyone else think that. I was in prison, you see. It was a long time ago, but you're curious." "Sorry, Dr. House," Simpson sighs. "Welcome back."
With that out of the way, House gets back to the case. "Any alveolar exudate?" Simpson says that the lungs are dry, so House rules out ARDS. "It's tick-borne disease season. Ehrlichiosis causing bronchiolitis. You'll appreciate that I left the 'idiots' subtextual," he says to Wilson.
But the blood work was clear. "And we 'idiots' treated with broad-spectrum antibiotics," Wilson tells him. House suggests cocaine, but Simpson says the tox screen was clean. "Dead men don't pee. Tox screen tests for metabolites in urine. Coke never got past the lungs. Also explains the motorcycle crash . . . idiots."
Simpson calls for treatment, but House says that if the diagnosis is wrong, the treatment will destroy the lungs. "I'd call you idiots, but at this point I'm starting to doubt whether you understand what I mean by the word." House turns to Park: "Kato! Get Black Beauty and meet me out front." They're going to look for the crash victim's drug stash to confirm the diagnosis.
"Since an 18-year-old with 'organ donor' on his license is not a cancer patient, I'm figuring the recipient is a lifetime member of the Wilson Cares Too Much Club," House says to Wilson as they exit the room. He figures Wilson must be the reason he is out of jail. "Doesn't quite make up for never visiting . . ."
But Wilson tells him that it was all Foreman's idea. "I wasn't convinced until Simpson failed three times." House won't believe that Wilson doesn't still care about him. "I was wrong. I went to prison, I paid the price." So he's a changed man? "I said I was wrong. I didn't say I changed. I haven't. Neither have you." "Analyze it however you like," Wilson says, "we're not friends anymore."
Wilson enters the recipient, Vanessa's, room, and adjusts the nitro to help relieve her angina. Her sister, Theresa, is sitting by her bedside. "Sis and I have been talking, trying to remember how many hospital sleep-overs we've had," she says. Vanessa recalls it began with her mastectomy in 2001. "God I miss my boobs. They were spectacular." Theresa laughs. She asks Wilson if there's a chance they'll find another donor. "It's unlikely," he says. "Especially since with the extent of the emphysema, she needs a double-lung." But he lets them know that the hospital brought in a "consultant" to help on the case. "Do you know him? Is he good?" Theresa asks. Wilson chooses his words carefully. "He is an excellent doctor."
"We probably shouldn't be turning up unannounced like this," Park says, as she and House arrive at the victim's house while it's still the middle of the night. "Their son just died." House points out the bright side: "They're probably up weeping." Also it turns out they have something in common: "We both assaulted our bosses. It's like we're twins. OK, I'll go first: my boss dumped me. And yours - what? Called you his China doll? Joked about what a crappy deal you got for Manhattan? Assumed that you have a huge penis? I have no idea what flavor you are, so I thought I'd just cover the spread."
"My mom's Filipino, dad's Korean, and my boss grabbed my behind." "Behind what? Oh, grabbed your tushie. So now you're pretending to be on-call so that your overly protective boyfriend won't find out that you got groped." She says that she doesn't have a boyfriend. "It's my parents. If they found out what I've done, they'd be mortified." How would her parents know her call schedule? She lives with them. "Right," House says. "No issues there."
"I told you, my son didn't do cocaine!" The teenager's father tells House, as he starts upending the boy's room. "Druggies are not known for their honesty. Trust me on this one," House says, as he pops some pills. Mr. Weathers angrily says his son, Steve, was an athlete who took good care of himself. Park thinks that they're about to get thrown out, while House is rummaging through a closet. "Nope. His son's dead. The only way that has any meaning is if we fix the lungs and transplant them. Doesn't matter how much we piss him off as long as we find something." And he tells her to go talk to the dad.
Steve was at a party that turned into an all-night poker game in a friend's basement. Meanwhile, House finds a glasses case, but in all the sports pictures, Steve's not wearing any glasses. "He just got them a couple of weeks ago," Mr. Weathers says. He was having headaches, Mr. Weathers tells him, as the door bell rings. "You're right," House says. "He was not doing cocaine. He had a brain tumor."
House tells him not to bother with the door. "It's for me," he says, rolling up his pant leg to show an ankle monitor, flashing red. "Turns out, they monitor these monitors." He's escorted away by the police, leaving Park alone in the doorway."I thought the bracelet was decorative. My aunt had one just like it. Wait a minute . . ."
House is back at the hospital, thanks again to Foreman, who isn't pleased: "You're allowed to be at the hospital. You're allowed to go home. That was made clear." "The dead kid's house was on the way to my apartment . . . assuming I got lost twice," House says. Foreman is fed up. "Those consultants in my office are only costing the hospital a hundred bucks every minute I keep them waiting. Why didn't you just tell me what you were doing?" He might have cleared it in advance with the cops. "It's the word 'might' that bumps me. But I'll run it by you next time," House says. "Getting you out jail," Foreman says, "was not a popular decision with the Board. I need you to solve this. And I need you to do it without making it look like I can't control you. For both our sakes."
House meets Park in the morgue to review Steve's body. Park can't believe House would knowingly violate his parole and disrespect Mr. Weathers after he'd been gracious. He pulls back in mock fear of a punch from her. "Disciplinary hearing should be fun," House teases. "That and the subsequent lingering black mark on your record." She says that she's not worried. House begins to feel around the body for a tumor, which he says will be quicker than an MRI. And he's got Park figured out: she's going to leave the hospital. Otherwise, there's no way she wouldn't be worried about a hearing. "I had a video interview with Chicago yesterday," she says, sighing. "It went well."
House pulls out a sample and hands it to her in a tiny vial. "My money's on rhabdomyosarcoma. Chicago has a great program. And you're a dumb-ass. Running away from home is a time-honored tradition. But you're not doing it to flee your parents. You're doing it to protect them. That's an insult to everything teen prostitutes have worked for. Time to grow up and come clean." "You're right," Park says. "I should just drive my car into the living room and tell them."
"Didn't it turn out that he'd stolen the hot dog cart?" "No, borrowed. Bobby was very insistent on that point." The two sisters are laughing and reminiscing when Wilson comes in. Vanessa's chest pain is gone. Wilson asks about Bobby, but Vanessa says they aren't in touch anymore. "And don't even pretend like you're not relieved," Vanessa tells him. "You never liked him." Wilson says Bobby is a fun, great guy, "just not a great influence." Theresa says that "colossal drunk" is a better description.
Wilson notices Vanessa's catheter bag is empty, even though she's taken in a lot of fluid. That means he'll have to reduce the nitro, which in turn will bring back her chest pain. "We don't have any choice," Wilson says. "The nitro is dropping the blood flow to your kidneys. They're shutting down."
Wilson heads toward his office, and hears Celine Dion's "My Heart Will Go On" getting louder and louder. It's House playing the music in Wilson's office.
"This is so our song," he says. Wilson shuts the music off. "I want to be understanding. It's your first day back . . ." House interrupts him. "See? I smell empathy. Why don't you ever remember the good times? Like, when I gave you that necklace and you just dumped it into the ocean. What were you thinking?" But Wilson says for every good memory, "there's a slew of bad ones."
Park arrives to tell them that paraneoplastic syndrome is out. Steve didn't have cancer. The mass House found in Steve's arm was coagulated plasma, from an IV leak while he was in the emergency room. "I even did a complete MRI. No cancer anywhere. We've got nothing," she says. House thinks that even though it wasn't a tumor, the plasma could have messed with the lungs. "But every unit of plasma can have up to 25 contributing donors. We'd need to track down all of them," she says. "Still, not as bad as a thousand people going down in a gigantic boat, right?" House notes.
"No, you can't leave the hospital." Foreman lays down the verdict to House. "You asked me to ask you - was that just so you'd enjoy saying no?" House asks. Foreman doesn't trust House, not outside the walls of the hospital. "Fine," House says. "then give me a team I don't have to put in quotation marks. Give me Chase, Taub, Thirteen." But Foreman tells him there's no money to pay them. "We only have Park because she's on Neurology's tab. You are making minimum wage here." And he throws House out of his office.
"Number 3 went to a baseball game, day before he donated." House has Wilson and Park researching all the donors and checking in via phone. Could peanuts eaten at the game have caused the problem, if Steve was allergic? "Nice," House says to Wilson, who still denies their friendship. "I'm not doing this for you. I'm doing it to help my patient."
House passes by what used to be his office and spots his whiteboard. But when he tries to snag it, a nurse tells him Foreman warned them about House, and told them to call if House tried anything. "I'd like to do that," the nurse says, smiling. House settles on the next best thing: he shuts the white blinds of the office and writes on the glass on the opposite side, as Park calls.
Donor 6 was in Thailand, in a region endemic with dengue fever. House notes that and other clues on the board, as Wilson and Park continue to call about what they find. Park thinks she may have an answer, when she finds one of the donors living with other homeless men near an underpass undergoing a new paint job. "They scraped off the underpass probably because it contains lead."
"Is there any way to take the edge off?" Vanessa pleads with Wilson to help with her chest pain. He assures her they're working on the lungs and should have an answer soon. Wilson sees House, and they sit in the lobby. Wilson asks about the chelation. "Reverend Moon started it about twenty minutes ago. You missed lunch," House says, offering him a sandwich from the cafeteria. "Thanks. Lead exposure's a nice diagnosis. I hope it pays off." House is confident that it will. "Even if your patient dies, someone will get the lungs." Wilson is taken aback. "You really haven't changed. But I've given up red meat," he says, tossing the sandwich in the trash.
Foreman checks in on Park as she starts the fourth round of chelation. "Is House OK?" he asks. But she has no idea. "Are you sure bringing him back was a good-" "No," Foreman answers.
Just then Park sees an Asian-American at the door, holding a plastic food container. "Dad? What are you doing here?" He says he got her text, asking him to bring her some food. Park is confused. "I went by Neurology. The secretary said you were on leave." Park quickly says she's consulting on this new case. Her dad looks in and sees the lungs in a box. "Looks very complicated. You can help with that?" he asks. Suddenly the lungs start to crash, and she runs in to help Foreman. "Chelation's making it worse! Which means we were wrong about lead," she says. Foreman relaxes the vasospasm with a calcium channel blocker, and the left lung pinks up. But the right middle lobe stays white. They killed part of the lung.
House and Park walk toward Dr. Pinto's office, the new home of House's former chair. "One dead lobe means four live ones," House says. "Means enough to transplant, with a side order of dead tissue that we can test." Park agrees that makes sense, "unlike you stealing my phone." "Until your parents know, you'll never see that punch for what it really was: your February 4th." She looks at him, confused. "Sri Lankan Independence Day." "I told you I'm Korean-Filipino," she reminds him. "And I told you I wasn't listening. By my actions."
Park thinks violence isn't the right way to deal with conflict. "It was a moment of weakness." Maybe violence isn't a character flaw, but her character. "Embrace your inner bitch." And House wants Park to help him steal back his chair, but she refuses. She tells him she found some of the plasma they used on Steve, but it was negative for all the other exposures. "Sarcoidosis could be inflamed by the treatment," House says. Park says the ACE was negative, though. House tells her that the chair is his and it's her job to help him. "My job is to assist you in curing the lungs," she says. House argues that the chair will help him do that, but she's not going for it.
She wonders if there might have been other heavy metals on the bridge, like beryllium or asbestos, while she watches House try to scoot the chair out of the office. But the chelation wouldn't have made the lungs worse. House can't get the chair past the door, but that gives him an idea: "Maybe the problem isn't the heavy metal from outside. It's inside. It's not leaving the body like it's supposed to. It's stuck." He thinks it's iron, and Steve had hemosiderosis. He tells her to stain the dead lung tissue for iron.
"She can barely catch her breath," Theresa tells Wilson, as Vanessa struggles to breathe. Wilson listens to her lungs and tells her that her small airways are collapsing, so she's not getting enough oxygen. "I'd like to try forcing an oxygen-rich slurry into your lungs. It should open up the airways and buy you some time until the lungs are ready." Vanessa says that fluid in the lungs sounds like drowning, and she doesn't want the pain. "No, I'm done."
House has a new hiding place: a bathroom, where Wilson finds him reading a magazine and waiting for test results. "My patient signed a DNR. She's giving up. Looks like someone else will be getting the lungs. Making this yet another interaction with you in which I get nothing." House doesn't know why it's his fault that Wilson can't handle his patient.
"She said she's done," Wilson says. "I spent half an hour trying to change her mind, but she'd made her decision. I accepted that. It's called respect." There's always another angle, House tells him. "Hold her hand, get the sister to beg, stick your fingers in your ears and pretend you can't hear. You do whatever it takes." "Oh - whatever it takes?" Wilson says. "Thanks, House, I hadn't thought of that."
"I spoke to the head of neurology in Chicago. Gave you a good recommendation," Foreman tells Park. Did he tell them anything about the incident? "Lawyers say I'm not allowed to. Works out well for everyone." Wait, why is that good for Foreman? "I'm a talented physician," Park says. "Top two percent of my class. I'm an asset to this hospital - an asset you're about to lose to Chicago!"
Foreman is confused: "You applied for the job. You asked me to recommend you." She says that her supervisor should be the one to leave; he touched her first. Foreman can't discuss any of that before her hearing. "But if you're having doubts about Chicago, I can call them back." "No, thank you," she tells him, quietly, looking back at her microscope. Suddenly she sees something strange on the slide: white blood cells. "Classic presentation of infection," Foreman says. How did they miss that?
"Infection was right after all," House says to Park. The transplant team treated for infection, but it was hiding in the lungs' cells. "Obligate intracellular organism!" Park realizes. "I'm thinking Brucella, but to wipe that out, you need special ops." Park looks at him, confused. "An intact immune system," he explains. Isn't that what white blood cells are? "A part of the immune defense force. Like the infantry. Those lungs need the Air Force, Marines - antibodies raining down from above." She's still lost. "Antibiotics and IVIG." "Did you use metaphors for your old team, or do you just think I'm particularly stupid?" Park asked. "No," he says. "They were stupid, too."
"What are you doing here?" Theresa races toward the door when she sees Vanessa's ex, Bobby, coming in with Wilson. He's there to see Vanessa. "She asked me to come - right, doc?" But actually it was Wilson who invited him. "When Vanessa was ready to quit chemo, Bobby was the one who got her to do one more round." Theresa reminds him that he also got her drunk afterward. "Hail, hail, the gang's all here," Vanessa says, weakly, from her bed. Bobby goes to her and she takes his hand.
"Vanessa's going to do the lung slurry," Wilson tells House, who's found a new place for some alone time: a CT scanner bed. "You were right to push me. I needed that. Thank you." So, does that mean they're back to normal? "It was good advice. Just came here to say thank you." As Wilson is leaving, House says, "I like you. I have fun with you. Now if you can honestly say that you don't like me, that you don't have fun with me, I can accept that. But, just do whatever you have to do to get over this. Punch me in the face, kick me in the nuts. Either or - both seems excessive." "The thing is, House, I don't like you," Wilson says, and leaves.
House checks in on the lungs and finds they're discolored. "Means we were wrong about infection," he says. "Wrong about autoimmune, cancer, heavy metals, genetic issues." "We're close to the point of no return," Simpson says. House needs ideas, fast. "Maybe we're just out of time," Park says. "We're out of time when we're out of time. When they die or she dies," House tells her.
House is bouncing a ball and thinking when he notices some of the staff celebrating a birthday at the nurses' station. He watches a nurse blow out candles and has an idea. "The lungs are a smoker," he tells Park. But Steve wasn't a smoker. House remembers that Mr. Weathers said Steve was at a poker game. "Who plays poker without cigars? Even if he didn't light up himself, it was a rainy night, the windows were closed. All parents think their kids are special. These ones were right. At least his white blood cells were special. They had an on-switch for reacting to smoke, but no off. When he inhaled small amounts of smoke, small problems, no one even noticed. Big amounts of smoke, it's enough to trash a lung. As soon as he breathed in all that cigar smoke, he was a dead man. The motorcycle accident was an unnecessary dramatic flourish."
Park gets it: "Eosinophilic pneumonitis." "I was right," House says. "Not about anything medical, but my metaphors were perfect. We need to hit it harder. We need to carpet bomb. Blitzkrieg. We need the nuclear option." "At some point you're going to say we need to radiate, right?" Park asks. "See? Metaphors work," House says.Later, Park watches the lungs under radiation, beginning to turn pink again. "It's working," she tells Foreman, who's just walked into the booth. "He did it. I'm not going to Chicago." That means she'll have a disciplinary hearing. "I know." She picks up the phone to call her parents.
In the surgery room, Simpson transplants the donor lungs to Vanessa. Later, Theresa and Wilson watch Bobby comforting Vanessa after the surgery. "Thank god you called him," Theresa says. "Wonder what happens now?" Wilson says that Vanessa can handle it.
"House, got something for you," Foreman calls to House as he's walking out the door. He leads House to his old office, which has House's name stenciled on it again. And Foreman found House's things in storage. "This is all you get. Ortho still has the outer office." "Well, that sucks. Where are Chase, Taub, and Thirteen going to sit?" "You're welcome, House," Foreman says, and leaves.Soon after, as House is surveying his new/old office, Wilson walks in. He heads straight over to House, looks him in the eye and socks him in the jaw, landing House on the floor.
Massaging his hurt hand, Wilson asks, "Dinner later? I'll pick something up." "I've heard about a good new vegetarian place," House says. "Screw that. I want a steak. I'll meet you at your place at eight," Wilson tells him. House helps himself up with his cane and sits at his desk, happily putting his feet up and leaning back.