"The Patuxent River Naval Air station near D.C. was commissioned in 1943 by John McCain's grandfather." House rubs his ankle monitor while staring intently at his computer screen. "I'm thinking of going hang gliding," he tells his confused team, before launching into a case.
"What looks like kidney disease but isn't?" House quizzes the team about the new case. "And where's Chase?"
"Root canal and Buerger's," Taub answers. "The first one was regarding Chase. Root canal, if done correctly, doesn't look like kidney disease." But Foreman shows up with a different case he thinks that House won't be able to resist: "Patient had an idiopathic anaphylactic reaction. It stumped two ER docs and an immunologist from Johns Hopkins." It's not enough to pull House away from the kidney case that has him stumped, though.
"Patient went from asymptomatic to fried kidneys in less than a year," House says. "Stumped three internists and a department chair from Harvard." Foreman isn't ready to give up on his case: it's a 14-year-old girl, and the attacks are intermittent. And House's case? "A four-year-old boy, consistently at death's door."
With that, Foreman knows he's lost, and he walks away. Or at least he starts to, until Adams looks at the file. "This patient died five years ago." Foreman turns right around to hand House the teenage girl's file.
"I didn't say which side of the door he was on," House says. "The fact that he's dead makes it more interesting! Four-year-olds do not die of Buerger's."
After Foreman's gone, Taub argues that they should take the teenager's case. "Shouldn't we be trying to maximize what we can save here? 14-year-old? Your freedom? Our asses?" House thinks it over, then hands Taub the 14-year-old's file on his way out. "Save your asses."
"She was in a car accident when she was two; she only had minor injuries but her father died," Park reads from the teenage girl, Iris', case file, in the outer office. But something that long ago probably would be relevant. Iris became ill at her 14th birthday party. Could she have been opening a present that triggered the reaction? Chase finally arrives and learns about the "pissing contest" between House and Foreman. Adams reads that the last thing Iris ate was strawberry cake, but all the allergy tests were negative.
"Do you like your dentist?" Park asks Chase. "I'm still going to my pediatric one. What's your dentist's name?" Chase is surprised, and mutters "Williams," looking down. "What if it's not an allergic reaction?" Adams wonders. "Hereditary angioedema or systemic mastocytosis could mimic anaphylaxis." But the complement studies were normal, and there were no skin lesions.
Wait - how can Chase not know his dentist's name when he just saw him this morning? Park takes a look at Chase's hands. "You had a manicure! This is fresh. You weren't at the dentist. Why would you lie about that?" Turns out it was to avoid having this exact conversation, or so Chase claims.
Adams notes Iris' elevated blood pressure. "What about pheochromocytoma?" she asks. "Or an anaphylactoid reaction, which could be triggered by certain opioids," Taub says. But the tox screen was clean, and Iris says that she doesn't use drugs. And what Chase is saying doesn't add up for Park.
"You've had your hair cut three times since I've met you," she tells him. "You can't be embarrassed about a manicure. There's got to be a deeper reason." Ignoring Park, Chase says that he and Park will check for pheo and run an expanded opioid panel. "You see what the patient says about drug use when her mother's out of the room," he tells Taub and Adams.
"I need to ask you about something personal," Adams asks Iris. "Are you taking any drugs?" Iris is adamant that she never takes drugs, only vitamin C sometimes. She was opening a Magic 8 ball - "the joke gift, not the cocaine" - when she had her attack. "Is that it?" she asks Adams, petulantly.
Outside the room, Taub explains to Iris' mom, that there are some drugs that could explain Iris' reaction. "Iris has always been a moody girl," her mom says. "And now that she's a teenager, it's gotten worse. So, for the past few months I've been giving her something to relax her. Diazepam. I tell her it's vitamin C. Being normal is very important to Iris. She couldn't handle the thought of being on meds." That would explain it, Taub tells her. She may still be moody, but if they keep her off the drugs, she'll at least be healthy. But then suddenly, Iris gags and throws up in her room. "Or it's something else," Taub says to her mom.
"Need to DDx a patient with you." House seeks the counsel of Wilson, who's wondering why he isn't using the team. "According to Foreman, they're only for DDx'ing people who are still alive," House says. "Foreman will find out you're taking this case and he'll bust you. But you know that. Which means . . . you want to go back to jail? Because it's the one place you're unable to indulge your self-destructive habits."
Wilson is proud of his deduction, but House denies it. "Yeah, it's much more likely that I'm taking this case because I miss showering with Cro-Magnons than that I actually happen to find it interesting." He relates the case to Wilson: when the four-year-old's kidneys died, they transfused, and then his lungs died. And then he died. "What if the chicken was the egg?" House wonders. "What if the lung involvement came first? Lupus?"
Wilson doesn't want to help him, though, because he thinks it's a bad idea. "If the kid had a rash, or some circulation issue . . ." House continues, then checks his watch. "Damn!" he says, startling Wilson. "Sorry, just realized I'm late for my anger management class," House says as he walks out the door.
"Traffic, for sure. Taxes, definitely taxes." An instructor is writing "Temper Triggers" on a blackboard in a cleared-out auditorium, empty but for a small circle of bored-looking adults slouching in their chairs. House seems to be focused on a man to his right. "I lose my temper when someone suggests that a handful of pop-psych catchphrases can control our most seminal, intractable and natural reaction to a dead child. Am I right, Emory?" he says to the man. "They blew it, didn't they? They missed your son's rash. The faint one, on his cheek."
Emory says that his son didn't have a rash, and he'd like it if they could move on to someone else now. "Was he sensitive to sunlight?" House asks. "Cold fingers and toes?" "No!" the man yells, as the instructor tries to regain control of his class.
Later, as they're all gathering their things to leave, House tells Emory that he believes his son had Wegener's granulomatosis, and he wants to examine the boy. "You're a bit late for that, you ass," Emory says, walking away. House wants consent from Emory and his wife so he can get an exhumation order. "Ex-wife," Emory says. "And you'll never get her consent. New hub, new kids, she wants nothing to do with Drew's death. Or me."
House knows that he's angry about his son's death, but he also believes that he's angry because he doesn't know why he died. "People need answers," House says. Emory tells House is son is in a crypt in St. Jude's Cemetery.
"Feeling any pain or cramping here?" Adams is examining Iris while her mother watches. She says a bit, but also on her chest. "Breast tenderness," Taub says. "Have you been having regular periods, Iris?" "Not really," she answers. Adams and Taub look at each other. Taub wants to run a pregnancy test. "Iris isn't sexually active!" her mom says. "She doesn't even have a boyfriend." But pregnancy could explain all of her symptoms, even unpredictable allergic reactions. "But, how can I be pregnant, if I've never even had sex?" Iris asks. Then suddenly she looks scared. "My arms! I can't move my arms!"
"At this rate, I'm going to need to pick out a plot for myself." House is ambling slowly behind an elderly groundskeeper at the cemetery. "Thanks to your generous donation, you have all morning," the man says, though he does need to know the exact procedure House intends to perform on the remains. "You ever hear of the North American Man-Dead Boy Love Association?" he asks. The old man wants House to observe the grounds with decorum. "So, you're taking bribes to plunder graves, and I need to show respect?"
But House isn't going any further unless he tells the old man why he's there. "I think they got the cause of death wrong, and if I find a hole in the cartilage of his nose, then that means I'm right." The man shows House into the crypt, toward the sarcophagus, and then he leaves.
It's dark inside, and House only has a small flashlight. Just as he finds the boy, his phone rings, the sound amplified in the small room, scaring him. "You owe me a new pair of pants," he says, and puts the phone on speaker.
"She is pregnant. Test came back positive," Adams tells him, as he tries to pry open the sarcophagus. "Cerebral tumor?" Taub asks. "Vasculitis?" Adams wonders. "MS," Park says. House hears the whoosh of air releasing and lifts the heavy cover. "I gather from the silence that Chase isn't there," House says.
Back at the hospital, Chase has just walked in but doesn't let on to House, saying, "I'm here." "I assume you concur with the diagnosis?" House asks, and Chase has to scramble to figure out with what he's concurring. "Absolutely," he bluffs. Whoops. "Even though there are three diagnoses?" House asks. "And MS and vasculitis usually get better with pregnancy."
Chase tries to cover: "Yeah, I was saying I agree with the other one," while Park stands up to get a better look at him. "He's had his eyebrows waxed!"
Chase claims that he's met a woman who likes well-groomed men. "All over?" House asks. No response. "I assume from the silence that Chase has had a Brazilian," House asks, as he examines the dead boy. There's no hole. "The question is: is this really about a woman, or is it about something more profound?"
Chase has another question: could Iris' symptoms be caused by an STD? "HIV-related mononeuritis multiplex." House wants them to test for HIV and do an MRI to rule out tumors. House looks at the boy's decaying fingers and thinks maybe he found something.
"Blood work was negative for HIV. All the money's on tumor." Taub checks in on Adams and Chase in the MRI booth while Iris is having her procedure in the other room. Adams wants to know if there's any truth to House's theory that there's more to Chase's new grooming habits, like the Brazilian, which he says hurt "a bit." "I'm vain and shallow," Chase claims, matter-of-factly. "And you weren't before?" Adams asks. "The girl I was seeing wasn't. There's nothing profound here," he says.
Taub scans the monitors. "No tumor, either. It's not her brain," he says. They pull her from the MRI chamber, and she tells them her arm is sore. "Paresthesia's gone," Adams said, as Taub pulls up the girl's sleeve. Her upper arm is black and blue with bruises.
"Could the bruising be caused by physical trauma?" Chase wonders, as he walks with House and Taub down the hall. But it's unlikely Iris could have injured herself in bed. A blood disorder? Vitamin K deficiency or scurvy? "Boys, do a home search," House says. "Girls, do lab tests."
As the team disperses, Foreman appears, and he's curious about where House's been. "Picking up dry cleaning, filling up the tank, violating the dead. You don't believe me, call the monitoring company." Foreman already did that. "Unfortunately, the Patuxent River Naval Air station was GPS testing and disrupted the signal, at the exact same 45 minutes you weren't here." "If I'd known I had 45 minutes of freedom, I'd have gone hang gliding," House tells him. "I admire the creativity," Foreman says, "but what happens when the stunt doesn't work? Think you're going to have to pay off a bet? Think I'm going to triple your clinic hours? I'm going to call your PO, and you're going to go back to jail."
"There's Mees' lines on his fingernails, so now I'm thinking heavy metal poisoning." House is still obsessing over the four-year-old's death in the cafeteria line with Wilson. "You're an addict," Wilson says. "And I'm an idiot for thinking that your addictions were limited to pills, anti-social behavior, and sarcasm. You're also addicted to puzzles. You show all the classic behaviors. Lying, neglecting responsibilities, and you can't stop, no matter devastating the consequences."
But working on a case is his job description, not a parole violation. "Your job description is doing what Foreman tells you to do," Wilson says.
"Before we get started, I just want to thank you all for agreeing to relocate." House has convened the anger management group in a coffee house. He immediately calls away Emory for a private moment. He leads Emory out the back . . . which leads almost directly to the house Emory shared with his ex-wife, where she now lives with her new family. "She finishes work at 4, picks up her new kid at 4:15. Gives us about 20 minutes." In the backyard, House spots a table. "Some kinds of pressure-treated wood can contain arsenic," he says, as he gets a sample.
"We shouldn't be here," Emory tells him. But this is the only way he's going to get his answer. "How'd he look?" Emory asks, near tears. House thinks for a second about how to answer. "Peaceful," he says.
"Vitamin K deficiency's a bust. Fridge has more spinach and broccoli than a farmer's market." Taub and Chase are searching Iris' home. And Taub thinks he's caught Chase out in a lie. He's had more than one Brazilian wax, and he knows they hurt more than just "a bit." "They hurt all your bits," Taub says. "It's my dark secret. What's yours?"
"I had the nails and eyebrows done, but that's it," Chase says. "I just needed to create a distraction. I met a TV producer at a dinner. She asked me to appear on a medical segment. Screen tests were yesterday and shot it today." Taub can't believe it. "You're a TV doctor? When's it air?" "Two hours ago," Chase says. "Otherwise, I'd still be lying."
Taub finds the Magic 8 ball toy Iris was opening when she had her attack. He shakes it up. "Will anyone believe Chase is an actual doctor?" He looks at the ball. "'Don't count on it.'" Meanwhile, Chase finds something more interesting: a drawer with a false bottom. He pulls it out, and they find love letters from the boyfriend she claimed not to have and some extreme pornography, with sadomasochism and bestiality. "Sweet kid," Taub says.
House and Emory are inside the home now. House busies himself in the kitchen getting samples, and Emory nervously checks out the place. He steadies himself and takes a quick drink before opening the door to what used to be his son's room, but now just looks like someone's cluttered home office. He starts crying when he sees the marks on the door frame where they charted Drew's growth. When House finds him, he's sitting next to an opened box of Drew's things. "This is all that's left," he says. "One box in the bottom of a closet." House finds a set of plastic fake teeth that Drew used to wear. "Made in the People's Republic of Lead Paint," House notes, sticking it in his pocket. Just then they hear a motorcycle pull up into the driveway. They hurry out the door and back to class.
"I met him at school. He was the only boy that liked me." Confronted with her lies, Iris confesses to her mom, Chase, and Taub. But she still claims she hasn't had sex. "Oh, come on, Iris! You're pregnant," her mom says. "So I'm just lying about everything?" Iris asks. "Well, you lied about the boyfriend, you obviously lied about sex, and this . . . garbage," her mom says, throwing the porn tapes down.
Iris says that they are her boyfriend's and she's just holding them. "What else don't I know?" her mom demands. Iris curls up into a ball. "He came here last night. He told me I should leave, but I didn't want to."
It was the boyfriend who gave her the bruises. Her mom wants to call the police, but Iris says she won't tell them anything. Suddenly, her vision is getting dark. "It's getting hard to see," she says. "What the hell is happening to me?!"
"Rubbing alcohol, vinegar . . . not sure what this is." House has a set of chemical tests lined up on his coffee table, to test the plastic teeth. "Aren't there actual medical tests?" Emory asks. "Dead patients usually get a lower standard of care," House says. But the tests are all negative. It looks like House was wrong about the heavy metal poisoning. Emory looks at the stuffed zebra he brought from the house. "He used to call him 'Deezer.' He couldn't say zebra. Made up his own words for everything. We called them 'Drewisms,'" Emory says, taking another swig from the bottle he's been carrying around. "How did your ex-wife do it?" House asks. "How come she's not angry and miserable?" Emory shakes his head. "She treated it like it never happened. She never even cried. Not even at his funeral. I was a mess, and she just sat there like a statue." House is starting to put the pieces together.
"We have a problem." Wilson catches Foreman as he's about to get on the elevator. Foreman sighs. "Does it limp?" Why does Foreman care if House works on another case? "Because next it'll be three cases, then four. Then animal cases, and ghost cases. Then animal ghost cases. Assuming, of course, we are talking about House." Foreman thinks House will come around. He has a lot more to lose than Foreman does. "He's not going to put himself back in jail over a dead kid." "He's an addict," Wilson says. "And he will put himself back in jail over a puzzle."
"Halfway through the perimetry exam, her tunnel vision went away. She can see perfectly." Park delivers the news back in House's outer office, but House and Taub are busy watching something on a laptop. Chase suggests TIA. "The word 'transient' is right there in the name." But it's hard to concentrate when House and Taub are giggling over on the couch. Chase knows what's about to happen.
House flips the screen around to show the team the "Doctor Down Under" TV segment, with Chase in full Crocodile Hunter gear, in an exaggerated Australian accent, giddily talking about celebrity plastic surgery. "So, you just wanted to look pretty on TV?" Park asks. "The question is: why did he want that?" House asks, as he checks his watch. "Clinic time." He wants the team to MRA for TIA. "I thought you only had clinic on Tuesdays," Adams says. "Oh, you're right," House answers, as he continues out the door.
"Hi! I'm here for the free flu shot. I got a call saying . . ." The perky woman in exam room one greets House when he walks in. "And I'm here to find out why you didn't care about your first kid." It's Emory's ex-wife, Mickey. "What do you know about my first kid?" she asks, confused. "Didn't even squeeze out a single tear at the funeral," House says. "Where are you getting this?" she asks. "Couldn't wait to squeeze out a brand-new replacement kid -"
But that's enough for Mickey, and she slaps House. He sighs. "Damn it." Mickey tells him he had no right to say those things. "No, I deserved the slap," he says, "but I was hoping that you weren't capable of it. Apathetic hyperthyroidism. Kidney involvement could be genetic. Definitely causes apathy. I was hoping that your lack of emotion was a symptom of something you could have passed on to your first son."
Mickey figures out that House knows Emory. "He wants to relive this. I don't," she tells House. "Emory is a wonderful man. Never afraid to show his emotions. Which is great, most of the time. But when Drew died, it overwhelmed him. I vowed I wouldn't let that happen to me."
"So that's why you left him?" House asks. "I left because of his eyes," she says. "He had Drew's eyes." "Who used to babysit Drew?" House asks. "My father," she says. "His place or yours?" he wants to know. Mickey is close to losing it. "There are two types of people. Those who can move on and those who can't. My father keeps up a good front, but he's just like Emory. You need to leave him alone." "So, he has two types of people inside of him . . ." House says, thinking.
"MRA was normal." House knows the results before Taub even gives them, breezing past the team to Iris's bedside. "I found out where your boyfriend lives," he tells her. "When I paid him a visit, he took off, right in front of a car." She tells him he's lying. "He's down in the ER right now," House says. "Shut up you lying sack of crap!" she yells. "How do you know I'm lying? How do you know your boyfriend's OK?" House asks. "'Cause I'm right here, you dick," she says.
"Iris has dissociative identity disorder, also known as multiple personality disorder." Chase and Taub are explaining Iris' condition to Iris and her mother. "It's the mind's response to a severe trauma. When a person experiences something that's too difficult to accept, it will create alternate personalities that don't have to accept it." The doctors think it could have started with the car accident that killed her father.
"I was two," Iris says. "I don't remember anything. These personalities that I'm supposed to have, where are they?" Taub explains that they only come out when she's afraid or anxious, which is why House told her her boyfriend was hurt. "But if there's no boyfriend, where did the bruises come from? The pregnancy?" her mom asks. They think she must have hit herself. "And the pregnancy," Taub says, "doesn't take a boyfriend, just a boy. You may not be aware of half the thing's you've done." The diazepam was masking it, and when they took her off, it was more apparent.
"We need you to help us with something," Chase says. "Different alters can have different apparent symptoms. Allergies, parasthesia, vision loss, changes in blood pressure . . ." Some of her symptoms are physiological, and some are psychological. "So there's something wrong with her, in addition to the multiple personalities?" "Yes," Chase says. "But we won't know what until we access her alters, and compare their symptoms." They'll put her under hypnosis.
"Foreman's not going to back down." Wilson is in House's office trying to convince him that Foreman can be as stubborn as he is. "Eventually, you'll screw something up. Which will be bad news for both of you, but only one of you will be in prison." Instead of skipping out again, House decides to stay and try to come up with an answer in his office. He thinks he's got something, but it means another off-campus trip.
"Yes, sir. Yes, I know I told you that I had a chiropractor's appointment, but I got a flat. So don't send out the Marines. I should be on the road in a few minutes." House hangs up with his PO as walks to the front door of a small house and rings the bell. An older man answers. "Dr. James Wilson, County Coroner," he identifies himself. "I'd like to ask you about your grandson, Drew." Mickey's father invites him in and makes tea for them. "What did he do when he was here? Where did he play? What did he eat?" House asks. Mainly TV and biscuits. No sidewalk chalk, no finger paints, no sand box. House can hear the front door opening. "Are you expecting someone?" he asks. "What do you mean?" the man asks. Just then Mickey and her new husband rush in. "Dr. Wilson, my ass!" Mickey's father yells."I told you to leave him alone, you son of a bitch!" Mickey screams at House. Her husband pulls back and punches House to the ground.
"Who am I talking to now?" With the lights turned low, Chase has Iris under hypnosis, with her mother and the rest of the team in the room. A small child's voice answers: "Nobody." "You must be somebody," Chase says. Iris, as the child, says she's too little and nobody sees her. "Nobody knows I'm here." Her blood pressure spikes. "What is it?" Chase asks. "My arms," she says, nervously. "Can't feel them?" Chase asks. "It's OK, we can fix that. Do you hurt anywhere else?" She says she doesn't now, but sometimes she does when she eats strawberries. "And when I remember." "You remember being hurt?" Chase asks. "I remember everything," she says. She pictures the broken glass and blood from the car accident, her father saying, "It's going to be OK," before dying right in front of her.
"Iris, why didn't you ever tell me?" her mom asks. Iris says that the accident was her fault. "I was crying, and he couldn't drive," Iris, now awake, says, in tears. "No, no, honey. You were just a baby. It wasn't your fault," her mom tells her. Suddenly the team notices blood on Iris' sheets. They pull back the covers and see Iris' whole pelvic area is soaked in blood.
"It wasn't a miscarriage. Tests show she's still pregnant." The team is going over the symptoms of Iris, the little girl and the boyfriend on House's whiteboard. "OK, cross out everything that doesn't appear in every alter," Chase says. "When she opened her Magic 8 ball, it triggered her switch to a personality with a strawberry allergy," Taub says. They're left with pregnancy, vaginal bleeding, and elevated blood pressure. It could be preeclampsia or an ectopic pregnancy. They need to do an ultrasound.
"I'm not seeing an embryo in the fallopian tube." Adams is looking at the monitor while Chase performs the ultrasound. "I'm not seeing an embryo anywhere," he says.
"Which idiot did the pregnancy test?" House wants to know. Adams did one, Chase did one, and Taub did one. Three separate tests came back positive. And what happened to his eye? "I grabbed Park's ass," he says. "Exoplanets. We can't actually see them, but we infer their existence because of the effect they have on the stars they orbit." Chase gets it: "A pregnancy test only infers an embryo's existence because of elevated hCG levels." "Which could also be caused by choriocarcinoma, which affects the placenta, mimics pregnancy, and causes elevated BP and vaginal bleeding," Adams says. Specifically, occult choriocarcinoma. Iris has cancer.
"Mom or dad?" Wilson sees House's black eye when he walks in the doctors' lounge and figures out what he's been up to. "Mom, dad, and mom's dad," House says. "The good news is it made me realize that you were right. I can't drop it. But now that I accept that, I feel much less conflicted." Which isn't exactly what Wilson was hoping for. "Two trains are about to collide, and I'm trying to talk them out it."
But House is busy going over Drew's case to himself. "I feel like I'm missing something." Wilson doesn't want to hear it. "If you don't want to listen to me, then I don't want to listen to you," he tells House. "That is so fifth grade," House says. Wilson agrees. "And you know why? Because I'm just as bad as you. I knew this would fall on deaf ears, but I just kept talking and talking and talking." House doesn't appear to be entirely listening . . . but he does tell Wilson that he's right, just before getting up to leave.
Mickey is cleaning when she sees her son playing in the front yard ... with House. "Ray! RAY!" she screams for her husband as she races out to get her son away from House. "Leave him alone! What are you doing to him!" Emory is with him. "I asked him to meet me here for a family reunion," House says. "I know what killed your son." "You don't get it, do you? I don't care what killed him!" Mickey says. "It's called Alport Syndrome," House tells her. "It's a genetic condition characterized by kidney failure, bronchial myomas, Mees' lines, and deafness." "Drew wasn't deaf," she tells him, as her husband runs out to attack House.
"It's a genetic condition," House says. "Genetic! Your father has the gene. So do you. It was grandpa's slight deafness that gave the game away. You're apparently asymptomatic. You still pass the gene on to your children. Plural."
"You're lying," she says, pulling her son closer to her. "He has high-frequency hearing impairment, and so did Drew. That's why Drew made up his own words, because he couldn't hear properly. It's OK. Now that we know what it is, he'll need treatment, but he'll live." They hear police sirens; the cops are here for House. Mickey is crying. "I miss him, too," she tells Emory. House walks over to the cop car and gets in the back seat.
"She's responding well," Adams tells Iris' mom, as Iris sleeps peacefully.
"Cuddy threatened him with clinic duty. I thought threatening him with jail would be different." Foreman is pacing in his office, talking to Wilson, while House waits outside. Foreman wants to send House back to prison. "He saved two lives!" Wilson argues. "Which means it's too late for me to back down," Foreman says. "It's no longer my choice. It's just me telling him he can get away with anything. I have to send him to prison." "Your job is to keep this machine running," Wilson says. "It's your choice to make House a useful tool or a monkey wrench. Cuddy's way didn't fail, because she didn't try to control House, she managed him. She knew better than anybody what a tool he could be."
"What would Cuddy have done?" Foreman walks out to talk to House. "Ten clinic hours," House says. "Cuddy's not here anymore," Foreman says. "You've got 30."