"How long has your daughter had trouble breathing?" House is listening to the labored breathing of a scruffy teenage girl in the clinic, while her father watches, indifferent. "About a week now," he guesses. "The best dads wait two or more," House chides him. She was at another clinic just five months ago, for strep throat, where she was given amoxicillin. But the teenager claims this isn't a serious condition: "I checked online. It's asthma or something." "'Or Something' is the number one killer of teens with no medical degree," House says. As for getting the asthma inhaler she was hoping for: "Sorry, hospital policy specifically prohibits me from giving meds to unrelated homeless people pretending to be father and daughter."
House has figured them out from her "dad's" ill-fitting pants and the fact that she didn't react at all just then when he said they were unrelated. Caught, the two start to leave. "Since you're the brains of the operation," House says to the girl, "you might want to stick around." "What, so I can get busted by Social Services?" she asks. "No, so you can stop bleeding out of your ear," he says, getting up to check her out. She hasn't had any recent injuries, no pain, no tenderness, no fever. House is intrigued. "Pay the man. He's late for a trashcan fire," he says, and she grabs two beers from her backpack to give to her fake dad. "Would you tell me what's going on? What's wrong with me?" she asks House. "I have no idea," he tells her. "I will be admitting you under the name: Gloria Estefan."
"Why'd you ask to meet us 30 miles away from the hospital?" Taub and the team walk in to a small diner to meet House, who promptly props up his ankle-monitor-free leg on the table. "Because I can," he says, happily. "Also, Chris Christie's blog says that the pancakes here are the best."
So, on to the 18-year-old with the bleeding ear and breathing problems: "CT confirmed no skull fracture, and looking at her confirmed she's not 18," Adams says, rejecting House's plan to admit the minor without a legal guardian. "We need to call Social Services." But the girl told House if they report her, she'll bolt. Regardless of her age, living on the streets has made her vulnerable to malnutrition, drug use and HIV, any of which could explain her symptoms, Taub suggests. Chase says that she checked out for all of those, as he and the rest of the team see Foreman entering the diner, with the married woman he's been seeing, Anita. House feigns surprise. Apparently the location wasn't pancake-related after all.
"Hi, Dean Foreman!" House yells, snapping a picture of the two of the them with his cell phone, before Foreman leaves her at the counter to join the team at a booth. "Are you not going to introduce us because we're married? Oh no, wait - that's her," House says. Foreman claims that the woman is a pharmaceutical rep and this is purely a working breakfast, as the rest of the team tries to get back to the case.
"Pneumococcus is pretty common among the homeless population," Adams says. "We should find out if she's been vaccinated." House doesn't expect the girl to be honest about any vaccinations, but he wants her started on ceftriaxone for pneumococcus regardless.
"When I was your age, I ran away." Back at the hospital, Adams is attempting to bond with the teenager, "Jane Doe," while Taub prepares her treatment. "Lived on my own. At the time it seemed . . ." The girl interrupts her: "Let me guess. Life with mom and dad was kind of a drag, so you just ran away and lived with friends and partied with guys you knew your parents would hate? And then when you got tired of being a rebel, you just went home. Being homeless isn't a vacation for me. And I'm not acting out. My life at home sucked, so I got the hell out of there."
The girl says that she doesn't want to be crammed in with a bunch of "messed-up" kids in group homes, or go to foster homes she thinks would only want her because she'd be a meal ticket for them. So why does she have a history schoolbook in her backpack? "I don't plan on being homeless forever," she says.
"Hello, good sir. My brother, the general here, got the Green Apple Quick Step." House is confronted with two Civil War reenactors in an exam room in the clinic. House checks the calendar. "One of us is in the wrong time zone. And if it's me, I need to talk to a stockbroker and anyone from the Kennedy family. In that order." The soldier explains that his brother has diarrhea and he needs to be better for a battle tomorrow. House notes the lack of authenticity in going to a modern clinic and seeing a Yankee doctor. Despite questioning the sanity of the "general," House hands him some medicine. "The Confederacy thanks you, doc," the brother says.
"Got House's phone, deleted all photos of you and Anita." Chase gives Foreman the good news as he sits down at a table in the cafeteria with Foreman and Taub. "An affair?" Taub says. "Never knew you were such a tramp." Foreman laughs. "Neither did I. But Anita, she's fun, smart, not looking for anything serious. It's pretty perfect." Except for the guilt he feels about Anita's husband.
Taub thinks that it isn't Foreman's job to protect their marriage, which seems a little strange coming from him. "Aren't you supposed to be pointing the finger at your own life as a cautionary tale?" Foreman asks. But Taub sees it differently. If he hadn't cheated, he might still be married, but he wouldn't have his two daughters, Sophie and Sophia. Then he gets to thinking. "Which means I wouldn't be preparing for their visit this week by child-locking all my cabinets, padding table corners and getting rid of every single magazine." Why can't he just hide the porn in an underwear drawer? "Magazines go away so I won't ignore my children." He knows he has to pay attention to them, and he wants to, "but they're just so boring," Taub says, reluctantly.
Adams calls in with word from Jane Doe's school: they've done a bunch of vaccinations, including pneumococcus, so they'll have to take her off the ceftriaxone. It's not a total loss: she registered for school under a fake name, but the address is real. Or, at least, it's the address to a foreclosed house.
Adams and Park are investigating the home where Jane is registered. Lots of food and water on the shelves, plus beer. "She eats well, goes to school, makes good grades?" Park wonders. "She's a homeless girl who's captain of the volleyball team." But they do find a lot of mold underneath the sink.
"You went to my school! Now that they know, they'll report me." Jane is furious when she finds out what happened. Adams is attempting to give her medicine for a possible fungal infection, but Jane starts getting up from her hospital bed. She doesn't get far, quickly crumbling to the floor. "I can't feel my legs!"
"So, what causes an ear bleed, breathing problems, and our runaway's inability to run away?" House asks the team, whom he's assembled at a rifle range. "I've been waiting to do this for months," House says, as he aims his rifle at a clay pigeon and pulls the trigger. "Sights seem to be off on this," he says, inspecting the rifle after he misses.
Adams wants to call Social Services on Jane. They didn't call before because they thought she might leave, but now they know she can't. House doesn't even want to discuss it, as he misses another shot. "Does anyone have an opinion on our patient's medical condition?" Taub suggests endocarditis with septic emboli. "I'd turn around and shoot you, but apparently I'd miss. No murmurs, no Osler's nodes," House says to Taub. "You've never done this before, have you?" Park asks. "No, I have not. But all the time I had my ankle-monitor on I was furious that I couldn't," he says.
"Vasculitis fits," Chase says, and House agrees. "Start treatment with steroids. If she's lucky, she'll be free to flee again." Adams still wants to call Social Services, though. So House makes a bet: if she makes a shot, she can make the call. Of course, she hits the clay pigeon.
"She responding to corticosteroids?" Taub asks Adams, as she leaves Jane's room. She is, and she seems strangely OK with the Social Services woman. "Maybe she's tired of living on the streets after all," Adams says. But Adams notices something strange about the woman talking to Jane: high heels on a social worker?
"Hiring a hooker to pretend to be a social worker?" Foreman has called both House and Adams into his office. He's already called Social Services to tell them about the mistake, and given Jane's description to the cops so they can track down her parents.
"You should have told me you were treating an underage clinic patient," Foreman says. House claims that he was giving Foreman "the gift of deniability." Now Foreman wants to give House the gift of additional clinic hours. When House balks, Foreman leans back confidently. He knows House doesn't have anything on him, so he'll have to do what Foreman says. "Check your phone," Foreman tells him, knowing Chase deleted the incriminating pictures. But as it turns out, House has more than just the cell phone pics: he's got pictures of Foreman and Anita kissing, at dinner, at a nightclub.
"How I miss the sweet smell of sticking it to the man," House tells Wilson of his win over Foreman at the nurse's station. But Wilson, like Adams, thinks House is actually protecting Jane. "You admire this girl. She had a horrible home life, so she went out on her own. She's your road not taken." And Wilson says that House will prove it himself, when Jane's parents show up and he tries to protect her from them.
"The sound I make is moooo." Taub is playing with animal hand puppets and his two daughters. All three of them look bored. Taub spots a book under the couch and starts to read.
"I heard the nurses talking, you called Social Services for real." Jane is packing up when Adams and Taub reach her room the next day. She claims that her mom abuses her, but Taub says if that's the case then Social Services won't let her go home with her mom. Just then the social worker arrives, with a middle-aged blonde woman. "I'm Ellen Rogers, Callie's mother," she says. "You haven't been that for two years," Callie/Jane says. "I promise things are different," Ellen pleads, but Callie is not impressed. "Wow, two sentences in and you're already making promises." Callie starts to cough, and soon she's spitting up blood.
"You bet $100 on a turtle race?" House has the team assembled for yet another formerly off-limits activity: gambling. "I paid Mr. Chips $5 to take a dive," House says, as they watch two turtles in a ring hardly moving at all. "The bleeding stopped on its own, she got worse after being on steroids, so autoimmune is out," Adams says. But where is the blood coming from? "If the bleeding is in her gut," Adams says, "it could be Zollinger-Ellison. Acid reflux causes asthma, and the acid erodes the stomach, causing the bleeding."
The turtles are moving now, with Mr. Chips in the lead. Park bets House $100 Mr. Chips beats House's turtle, Franklin. After a surprisingly dramatic finish, Franklin comes in first. "Mr. Chips' owner only feeds him on apples and bananas. Nowhere near enough vitamin A," House tells Park, demanding his payment. "And do an upper endoscopy to confirm for Zollinger-Ellison." He wants the mom to give consent first, which Adams objects to: "Ellen shouldn't have consent if she beat her daughter." "It doesn't matter if she beat her daughter," House says. "It only matters if Social Services says she beat her daughter. Good thing you made it all official!"
"Will the endoscopy be painful?" Ellen asks Adams as she signs the consent form. "Is that an issue?" Adams pointedly asks, then remarks that as with any medical issue, there will be some discomfort. "I never meant to hurt my daughter," Ellen tells Adams. So why does Callie say she hit her? "I'm a drug addict, and I've been a lousy mom. Especially since my husband died. He was closer to Callie than I was, and I missed him so much. It was too hard, and taking oxy just made things easier. Right up until it made me lose my daughter. I hurt Callie a lot. But one of the only things that I can feel OK about is that I never hit her."
"Didn't peg you as the midday fun kind of guy. So glad I was wrong." Anita arrives at Foreman's apartment for a rendezvous. But he hasn't called her there for fun: he tells Anita about House's pictures. "He's threatening to tell your husband." Foreman thinks that they need to stop seeing each other. "Not necessarily," Anita says. "I told my husband about you." Foreman is stunned. Anita's husband has noticed that she's been in a better mood lately, so she told him that it was because of Foreman. "And he was OK with that?" Foreman asks. "Not initially. It was a pretty tough conversation. Neither of us was ready to give up on the marriage, and I am not ready to give up this," she says, going in for a kiss. "You don't have to feel so guilty anymore." But Foreman still looks troubled.
"You didn't need to shoot yourself. I could have given you a Section 8." One of House's Confederate soldiers is back in the clinic, with a nasty foot wound. "We've hit the drills pretty hard," he says, curiously sans old-timey Southern accent. "By the fourth round, my hand went numb. The gun slipped." It's his brother, Sheldon, who's the real stickler for authenticity, and he never drops character while in uniform. "Sheldon and I had a big falling out years ago. We only really starting talking again because of the reenactments. They gave me my brother back."
"Your mom didn't hit you, did she?" Adams asks Callie as she wheels her into a room for the endoscopy. Callie admits that she didn't. "People understand getting hit more than they understand what my mom does." Callie took on the parental role as her mother slipped into addiction. "I had to get a job. Double shifts just to keep the power on. Keep food in the house. I couldn't tell you how many times she nearly OD'd and I had to clean her up and put her in bed." So she figured that if she had to be the grown-up, she'd do it on her terms. "Your mom knows she messed up," Adams says. "She's determined not to do it again." But Callie knows her mom will feel that way only until things get tough. "And she has to start using again."
"Do you think people can change?" Adams asks Chase, as they perform the endoscopy. "No, but I don't think that's going to change your opinion, because people don't change." They spot an ulcer high in Callie's esophagus, which immediately starts bleeding. It's not Zollinger-Ellison.
"Cauterized the ulcer, stopped the bleeding." Chase gives House and the team the rundown in the outer office. "What if she didn't get this from being homeless?" Adams wonders. "What if she got it from her mom? Alcohol-induced esophagitis." That would explain the esophageal ulcers and her other symptoms. Then why haven't they ever seen her drunk, drinking, or suffering from detoxing? "Her blood pressure's been elevated. Could be the DTs," Adams says.
"Mildly elevated BP could put her at risk of a berry aneurysm," House says. "Weak blood vessel in the brain, gets pounded on by elevated BP, causes it to expand and contract. Causes the symptoms to come and go." Adams thinks both alcoholism and berry aneurysm are both valid theories and that they should talk to Callie and her mom about them. "Why?" House asks. "We discussed it right here. Go tell them she needs a cerebral angiogram to locate the aneurysm, and surgery to repair."
"Brain surgery? When?" Foreman and Adams tell Callie and Ellen they want to get Callie into an operating room in an hour. But Callie can tell Adams isn't onboard with the decision. "I think your symptoms are the result of alcohol abuse," Adams says. Callie tells her she's not an alcoholic. She uses beer as payment sometimes, like with her fake dad, and she occasionally has a beer with her friends. "That doesn't mean I have a problem," she says, defiantly. "I want the surgery." However, Ellen has the final says. "I'm not an addict," Callie tells her mom. "That's what I always said to you, Callie, but I had a problem," Ellen says. "I'm nothing like you!" Callie yells. "Tell them to do the surgery." Ellen needs a few minutes to think it over.
"The patient asked me what I thought!" Adams is trying to explain what happened to House back in the outer office. "I pay you to think, inside this room. Outside this room, I pay you to parrot," House says. He thinks she turned a medical decision into an extension of her own baggage. "You told the mom something you want to believe, because you don't want to believe that this girl might be doing fine, parent-free. Which also happens to be what the mom wants to believe." He thinks Ellen's "guilt-colored glasses" are affecting her judgment.
"You must be Dr. House," Ellen says, as House plops down on a bench in the lobby and pops some pills. "I save my appearances for when parents are on the brink of doing something incredibly stupid. Your daughter has a berry aneurysm. She needs surgery." If she won't let Callie or House make the decision, then she should just leave. "She hates you," he says. "It's actually not such a big deal. There's plenty of kids who hate their parents. What makes it a big deal is that she should hate you."
House tells her Callie is better off without her. "So let her be better off without you." He's going ahead with the surgery, whether or not Ellen consents. When he gets up to leave, she can see he's left his pill bottle behind. He's almost to the elevator when she stops him. "My daughter's care is my choice. And so is this," she says, handing him back the pills. "Treat her for alcoholism."
"Why would Anita tell her husband about our affair?" Taub has invited Foreman and Chase over to help with his daughters, but Foreman is still confused about Anita. Chase thinks that she must have just gotten sick of lying. "Look at it this way: now the sex is both commitment- and guilt-free." Foreman rationalizes that now he knows he's hurting the husband - before the husband knew about it, he wasn't really being hurt.
"Social Services' report came in on your mom," Adams says to Callie later that night. "Let me guess: she passed with flying colors. She always does," Callie says. Adams tells her about the pills House left for Ellen and how she gave them back. But Callie is still mad at her mom for taking Adams' word over her own about the drinking. "She's your mom, and for the first time she's acting like it," Adams says. "It's a little late for that," Callie tells her.
"I heard you went head-to-head with the mom." Wilson catches up to House in the elevator the next morning. "You're protecting the girl." He even tested her, to see if she could get her back on drugs and out of Callie's life. House maintains the only thing he was protecting was his diagnosis. And the drugs were just to show Adams that Ellen hadn't changed. "Taking a principled stand against idealism," House says. But Callie is stable now, so maybe Adams was right and it's alcohol-related? "I hope so, considering it's what we're treating her for," House says. Wilson can't believe what he's hearing. "You hope you're wrong, for the sake of the patient?" House quickly clarifies: "I hope I'm right, but the aneurysm bursts without killing her. Call me a softie."
"Your patients love you, because you're empathetic." When Wilson gets to his office, he's surprised to find Taub in there. "But you don't love all your patients?" Taub asks. "Of course not," Wilson says. "I'll bet some of them bore you. But you fake an interest in them because you need to, right? And if you do it long enough, it becomes real?" Taub is really grasping here. But Wilson tells him that the interest is real. "Really? Because you realize they're not dull, it was just your misinterpretation of them?" Wilson tells him it's all about common ground. "You find one thing you both like or hate. John Woo movies, romance novels, kale. Sometimes the best way to connect with someone is stop thinking about them, and focus on yourself."
"I told him because it was the right thing to do." Anita is trying to explain her decision to Foreman at the diner. She doesn't think that it changes anything between them. "It sort of does for me," he says. He doesn't want to stop seeing her - he just wants her to tell her husband that they did. "And then go back to sneaking around behind his back?" she asks. "Why would you want to do that?" "I don't know," Foreman says. "This just feels wrong." Anita looks confused and angry. "I think I'm going to go," she says, leaving him at the booth.
"We thought it was the salt pork. But all the menfolk been eating it, and we're the only ones that's sick." Now both Confederate brothers are back in the clinic, violently heaving into trash bins. Sure enough, Sheldon is still in character. House gives their uniforms a once-over. "Which one of you is the cheap bastard? Your uniforms aren't wool. They're polyester - cheap polyester, which gets processed with a heavy metal called antimony. You wear badly processed polyester all day and night, for days and nights, and you get antimony poisoning. Which causes your diarrhea and your numbness in your hands," he says to each brother. "And your collective vomiting." It turns out Sheldon cheaped out on the uniforms, and soon they're at each other's throats. "Brother against brother: now that's authentic," House says.
"I know you don't want me here, but they had banana muffins downstairs. Reminded me of our St. Pete's trip." Ellen brings the bag of muffins to Callie, as Adams is changing her IV. "Remember? We used to walk and get some every morning at that bakery." Callie won't even look at her mom. "I guess," she says. Ellen starts to walk away.
"Were you high on that trip?" Callie asks. "Not when we were together," is all Ellen can say. "I used to wait until you went to bed." Callie tells her she can stay, and she even takes a bite of the muffin. "Not bad." But almost immediately she passes out. "What's happening?!" Ellen asks. "Is this from the alcohol treatment?" Adams tells her she was wrong. "A berry aneurysm must have just burst."
"Aneurysm must have leaked, instead of burst." House is watching Adams and Chase from the observation deck. The temporal lobes and ventricles are clear. Even after injecting the dye, they can't find an aneurysm. Callie starts to crash on the table. House calls Adams away to come with him, while Chase orders pressors to raise her blood pressure.
"What causes bleeding issues, breathing issues, paralysis, loss of consciousness? What are we missing?" Taub, House, Park, and Adams are back in House's office. The pressors will only give them a couple of hours to figure out what's wrong with Callie. Adams mentions the trip to Florida a few years ago. Could it be dengue fever or cholera? "Great ideas," House says, sarcastically. "If dengue fever and cholera laid in wait for two years before suddenly . . ." And that gives him an idea.
"Did your daughter go swimming in Florida?" House finds Ellen on a bench outside Callie's room. "In a lake or a pond or an Everglade?" Ellen remembers a canal near her mother's house. "Come with me," he says, walking away. "Don't want to explain this twice."
"Your daughter has ascariasis." House interrupts Chase and the other doctors treating Callie, along with Ellen, to tell them about Callie's condition, caused by a parasitic worm found in feces. The eggs ended up in Callie's intestine when she went swimming. They were asymptomatic until at some point when they were knocked loose. When they hatched, the worms got to work all over, causing problems with her lungs, her ear and her legs. "The worms got agitated by the steroids we gave her, which started them on their journey to the esophagus. And ultimately to the heart. A few pills of mebendazole, she'll be fine."
"She's feeling much better." Ellen and Adams head toward Callie's room the next day. But when they get there, Callie is nowhere to be found. Adams sees a note Callie left for her mom. Outside the room, Adams tells House that Callie agrees with him that people don't change. "She said when her mom slips again, she didn't want to be there. She'd rather remember her like she is now." "Smart girl," House says. Adams tells him he got the ending he wanted. "I was only looking to solve the case, not their lives. I don't care if the people who work for me are screwed up. In fact, I even encourage it. But absolution - you do that on your own time. Or not at all. Because clearly you suck at it."
Taub struggles to pass the time with his toddlers. Then when he sees a sports magazine on the coffee table, instead of just reading it to himself, he reads to the gils, complete with sound effects. "This is Terrell Owens. People call him T.O. You know what sound he makes? 'Waaaah, waaah, waaah.'"
"Working late? Husband have her tonight?" House sees Foreman is still at the hospital as he's ready to leave. "Every night. She broke it off," Foreman tells him. "I'm not really an affair guy after all." House doesn't think that's it: "You just lost interest once it stopped being an affair. That's why you're relieved. But don't worry. It's not going to end here. You just have to get your adrenaline fix somewhere else. If that doesn't do it anymore, then you just escalate things somehow." House tosses back a handful of pills. "At least, that's what I've been told." Foreman laughs. "I'm not like you, House." "True," House says. "No limp."