"Let's get back to Phil and Diane. Phil's been having a hard time finding work, and Diane wants him to talk to her about his fear, his disappointment. And Phil wants Diane to trust him that they'll get through this, ideally without having to keep discussing feelings." Joe, a sandy-haired marriage counselor in khakis and a sweater, is speaking to an audience of troubled couples. Men are dinosaurs, Joe says. But it's not all their fault. They've been raised to be strong and unemotional and to project invulnerability. "Nobody needs us to hunt wild animals for food. Nobody needs us to cut down trees to build shelter," he says. The audience laughs and nods in all the right places.
But Joe is sweating now. "Since the 1960s, women's roles have shifted radically," he continues, taking a drink of water, as his wife begins to look worried offstage. "And as their roles have changed . . . so have women . . ." He's struggling to pull the words together. "They're expecting us to . . ." Joe collapses onstage as the audience gasps and his wife runs to him.
House begins, "38-year-old man, spikes a fever and collapses during a speaking engagement. E.R. checks out blood volume, cardiac function, and autonomic reflexes. All normal." House brings Joe's case to the team, which once again includes Chase, whose limp is nearly gone. He's surprised that House didn't add a psych symptom: "Patient makes a living telling men to be more like women."
In fact, House thinks that Joe's philosophy makes perfect sense, except that it's impossible. "Evolution does not work that way. You can't talk legs onto a fish," he says. The real cynic is Adams, who thinks that Joe is just playing to his audience. "Women are by far the biggest consumers of the self-help industry."vTaub suggests that Joe might have a pulmonary embolism; he wants to do a pulmonary angiogram, but Adams thinks since Joe doesn't have risk factors for an embolism, they should start with a D-dimer test. "Less invasive than the angiogram," Taub agrees. "Good idea."
Everyone's being awfully polite this morning, and it doesn't escape House's attention. He announces that he's looking for a new "No. 2," someone to fill Foreman's old job, but before he even gets started, his "wife," Dominika, walks past the office, beckoning him. She's started her own Ukranian food truck business in Atlantic City, but her - their - Green Card interview is in four days: "They come to the apartment, they ask questions about marriage, vacations, family history, what side of the bed each sleep on."
House seems a little hesitant, considering they've never taken a vacation, he knows nothing about her family, and the side of the bed he likes to sleep on is "top." "Can it be that genius doctor is afraid to take on a silly government apparatchik," Dominika says, smiling. She decides she'll make him an offer he can't refuse.
"How long've you been doing seminars?" Taub and Adams are preparing Joe's test in his hospital room. "Marriage counseling, just the past couple of years," Joe tells them. "Before that, I did corporate coaching." Adams pointedly suggests that Joe shifted with the market. "There's nothing cynical about my husband," Joe's wife, Marlene, contends.
But Joe's heard it all before: "What guy thinks men should be more like women? A macho jerk who got a big wake-up call, courtesy of three drunks who beat the crap out of me outside a sports bar in Milwaukee." This would explain the broken wrist in Joe's medical history. Joe says that those "morons" did him a big favor, explaining, "I realized I'd sacrificed my health because I couldn't back down from an argument, over football. Meeting Marlene was the final piece of the puzzle. She changed my career, my diet. She gave me a whole new direction in life." So, about that diet change?
"I need my apartment key back." House wants to give Dominika the key Wilson has, but there's a snag: "You're an ex-con. If you get caught perjuring yourself to Homeland Security, you'll end up back in jail," Wilson says. How does he plan to not get caught when he and Dominika barely know each other? "And why? Dominika gets a Green Card. What's in this for you?" "This is what men do for the women that they pretend to love," House says. And also there's the $30,000 she promised him if they pass the interview.
"D-dimer came back normal. Rules out pulmonary embolism." Taub gives House Joe's lab results. Adams adds that Joe's "spiritual overhaul" came roughly three years ago. "He also went off gluten and red meat. Unfortunately, that doesn't explain any of his symptoms." She's come around on her cynicism as well: "What this guy believes is making him a better person. He's going against his baser instincts."
House against points out that biology makes this impossible. "That's the kind of lapse that could take you out of the running for team leader," he tells Adams. Just as Park is throwing her own name in the ring (after hearing about the $50 a week raise), House has an epiphany about Joe: "This spiritual overhaul - did it come after a physical overhaul? A major injury of some kind?"
"Did those dudes bend your ball sack like Beckham?" House is quizzing Joe on the beatdown that led to his new direction in life. By way of experiment, House first drops something and makes Adams bend over and pick it up, then does the same thing with Chase. Both times, Joe never took his eyes off House. House thinks what Joe actually had was a hot flash. "Those guys kicked your guys hard enough to do lasting damage. "Do a blood test to confirm, and start hormone replacement," he tells Chase and Adams, leaving Joe and Marlene stunned. "It's no wonder that you think women are so great. You've basically been one for these past three years."
"Test confirmed House is right. Low testosterone explains all your symptoms. They should go away with replacement therapy." Taub is going to give Joe a high dose, explaining that Joe's personal physician may reduce the dosage over time. Marlene casually asks if the shots will increase Joe's libido, saying it's not that she's been unsatisfied, "but it's usually me that initiates things. Sometimes I think that maybe you aren't that attracted to me." Taub assures her there should be an increase in Joe's sex drive, but no sooner does he give Joe the shot than Joe realizes he urinated on himself. "I don't think you're going home just yet," Taub says.
"It's not a plumbing problem. Means it's probably neurological." Chase gives House the lowdown, while also quizzing him on the names of Dominika's three brothers. House isn't having a lot of luck remembering the details of her life. "I find it hard to remember things that I don't give a crap about," he says. Park thinks that maybe Joe's testicular damage just set the stage for something worse: "Multiple sclerosis causes incontinence and progresses faster in men with low T." House is sufficiently impressed to give her the leadership position. Of course, she was the only applicant. "Have your underlings do an LP, and get a craniospinal MRI to check for plaques associated with MS. I will go tell Foreman about your promotion."
Suddenly, Chase and Adams are interested in the job. "I just feel like it should go to someone with more seniority," Chase says. Taub thinks the position is meaningless, since House is a dictator. "It doesn't have to be meaningless at all," Adams says. "The right person could turn it into something. Get the department running smoothly." Chase has an idea who Adams thinks that right person should be.
"So, if these proteins are in my spinal fluid, that means I have MS?" Joe is concerned as Taub and Adams perform the LP, but he's even more concerned about the effect the testosterone shot is having on him. "It's making me feel kind of different, amped." What if his big, meaningful life change was nothing more than a chemical reaction? "Loss of testosterone could have been a factor," Adams says. "But think of it as a catalyst. It got you to reevaluate. Now you know what's important. You can choose to hold on to that."
"Just tell House to drop the whole 'Team Leader' thing. It's the only way it'll go away." Chase is prevailing upon Foreman to put a stop to House's latest game. But Foreman thinks it might not be a bad idea to impose a little structure, and have someone on the team with a some accountability. "As long as it's not Adams," Chase says. "She sees the whole thing as an opportunity to remake the department in her image. Or Park, for obvious reasons. And Taub's got the kids. He's pretty busy."
"Are you seriously angling for a job you mocked as fake the whole time I had it?" Foreman asks. Chase claims not to want the job. "You just don't want anyone else to have it," Foreman says.
"Your grandmother's kind of sexy." House hangs a black-and-white drawing of a dour old man in a Russian fur hat in his living room, as Dominika explains that the picture is actually of a famous Ukrainian poet. Together they move House's coffee table so she has room to do her dance aerobics. "Fun, and good for the butt!" she says. No time for that, though, as Park arrives to help them study for the interview. "You have a limited amount of time to learn a ton of uninteresting facts. Welcome to my wheelhouse." Seems like maybe Park is currying favor for that Team Leader position.â¨â¨"Do you really think this guy's going to Hulk out once the hormones kick in?" Adams and Taub are watching Joe in the MRI chamber from the booth. "Some male lizards do push-ups to attract mates. When scientists gave them extra testosterone, they did push-ups until they died," Taub says. So masculinity is ingrained and irrational? "By extension," Adams says, "you're also saying femininity is enlightened and rational. It's the way we should all be. Guys just aren't capable of it." So far the MRI is clean, so it doesn't look like MS. "Something's wrong," they hear Joe say. "I'm seeing double."
"Smile! It's your honeymoon." Park is helping House and Dominika stage candid photos in House's office to flesh out their history. "So, what causes double vision on top of all the other symptoms?" House asks, between poses. Meanwhile, Chase has brought in a video game system for House, and Adams is wearing an unusually low-cut top, efforts to influence House's decision. "What happened to not letting House get to you? You're like lemmings," Taub says. "Marching off the cliff of competitive humiliation." He thinks Joe has myasthenia gravis. "Extraocular muscle weakness leads to double vision, atonic bladder leads to incontinence. Could have been triggered when his T got really low."
"Smooth," House notices."You let the rest of them compete, tear each other to pieces, then you swoop in with the save. Start the patient on IVIG and plasmapheresis." When the others leave, Taub speaks to House alone. "You think you want this, but it's a bad idea. Everybody was playing nice, and in your world nice doesn't solve cases. But after what happened, a little bonding is a good thing. We still have ideas. We still argue. Maybe it could work better if we appreciate each other." House calls Taub's own manliness into question. "Studies have shown that raising kids lowers testosterone levels in men. "The more involved you are, the lower it gets." "Right, having kids has neutered me," Taub says. "Or maybe it's helped me finally grow up."
"How're you feeling?" Adams asks Joe. "As long as I keep my eyes closed I feel pretty good. Really good, actually. I've got energy. I feel confident, clear." When Marlene comes in with a hamburger for Joe, he not only comments on how good she looks in her jeans, but he tells her he wants to move ahead with a business decision he'd been putting off.
"Vadir is the brother she worries about the most, ever since Lupa passed." House and Dominika are using Wilson's office to practice their upcoming interview, with Park standing in as the interviewer. "Sorry, but this is the closest we could find to the cold, soulless offices of a government bureaucracy," House tells Wilson. As he's about to leave to try and a place to work, Wilson can't help but overhear House's detailed answer about one of Dominika's high school friends. "Wrong," Wilson says. "The right answer is the wrong answer. No husband would pay that much attention to his wife's friend dramas." He's not happy about it, but he'll help House and Dominika prepare.
"So, are you going for this Team Leader thing?" Park asks Chase. She tells him he deserves it, because he's got much more experience, though she does have medical school debt and her parents need the money. "If you're going to game me, you'll have to do better than that," Chase says. Meanwhile, even though Joe says he's seeing clearly now, Park notices that the whites of his eyes are actually yellow. It's jaundice.
"So much for myasthenia gravis." It's back to square one for the team. Adams announces, with some extra authority (and while doing some light bookkeeping for House), that she's fairly sure Joe has sarcoidosis. Chase says that's a long shot. And Taub still thinks Joe might have myasthenia gravis. After all, his vision did get better. "Liver problems could be a sign of celiac," Adams admits. "He's been back on gluten since he's been in the hospital. Yesterday, he had a burger." But Chase doubts that Joe has two unrelated diseases, in addition to the low testosterone. Park says it's Lyme disease. Absent a better answer, House orders antibiotics to treat for Lyme.
"I asked the nurse for an extra pillow. That was half an hour ago." Joe is fidgety and anxious as Chase is setting up the antibiotics. "It's a pillow. I mean how hard can a pillow . . . Listen to me, I'm being a jerk." Chase thinks it's good at least that he noticed and adjusted. When Marlene arrives, she tells Joe she was surprised he changed the terms of an upcoming deal, to give her more money and better billing, even though it might risk the whole deal. "It'll be fine," he assures her.
"These are such pretty flowers you buy for me . . . every Friday from Japanese florist." Dominika is running through some last-minute prep details with House. There's a knock on the door. "Dr. and Mrs. Gregory House?" a drab, depressed looking man asks. "Nate Weinmann, U.S. Immigration."
"Give him time." Back at the hospital, Chase is reassuring Marlene that Joe is basically going through puberty again, and it'll take some time for him to adjust. She pulls out a laptop. "I tracked down a video from one of Joe's coaching seminars, from before I knew him," she says. It's a very, very different Joe. "I'm hearing a lot about the value of compromise," says the Joe in the video, with slicked back hair and a power tie. "We don't live on Sesame Street. We live in the real world. The business world. If you're not a winner, you're a loser." Is this the real Joe? "I never would have gone out with the guy in this video," she tells Chase.
"Uh, let me see. That would be August - no, no, July. Because, I remember it was right after our half-anniversary, and I forgot to put a gift in her suitcase, and I've never heard the end of that one." House is laboring to answer a question about a trip Dominika took recently. "So, everything looks good in here," Weinmann says. "I'm just going to step out and get a corroborating interview from one of the neighbors . . ." Oops. Dominika hadn't thought of that. "It's middle of the day," Dominika says, trying to appear calm. "I think everybody's at work." But he says it's just a formality. "And you will be on your way to permanent status."
When he leaves House's apartment, he eyes someone who looks like they're just getting home. "Excuse me," Weinmann says, "Do you know Dr. and Mrs. House?" It's Wilson, and he confirms the relationship, while putting on the strangest accent. It's all going well . . . until the real occupant of the apartment shows up. "You're that guy who plays noisy video games with House on Saturday nights!" "There's a simple explanation," House insists. "Be in my office tomorrow at 10," Weinmann says.
"The patient's shown zero improvement," Taub tells House via speakerphone. "Where are you?" "Oh just chilling. U.S. Citizenship and Immigration. Waiting on my fraud interview with my wife and my attorney. No big." Taub is still convinced it's myasthenia gravis and celiac disease. "The change in diet has to be significant." House's lawyer makes him hang up, but as soon as he does, Wilson calls. "You need to save yourself. I was up last night, trying to find another angle, but I can't. Tell Immigration you were in love with Dominika, but your marriage fell apart, and that's why you haven't been living together." But then she'll be deported. "There's no getting out of this," Wilson says. "The best you can hope for is that you don't go back to jail." It's time for the meeting. House tells Wilson to tell the team to give Joe's antibiotics more time.
"I drew a line in the sand, and I won. We should be celebrating." Joe's aggressive behavior is becoming more of an issue for Marlene. "Are you seriously busting my chops because I made one little move without you?" he asks, belligerently. "How about stepping aside, and letting me be the man in the relationship for a change!" Adams notices that Joe hasn't finished his sandwich. "I'd like to do one more test."
"The testimony of one angry, nearsighted neighbor shouldn't outweigh all other evidence." House's lawyer is doing all he can in the meeting with Weinmann. "We acknowledge the neighbor thing was a mistake, but that doesn't mean that all the other documentation should just be thrown out." Weinmann isn't buying a word of it. "USCIS will be denying Miss Patrova's Green Card application. You'll be referred to immigration court for deportation proceedings. And we're going to inform your parole officer about evidence of fraud. So, unless anybody has anything else to add . . ."
Dominika looks to House, who says nothing, and then to Weinmann. "Please, I am begging, do not send him back to jail. Maybe we have not lived together all these . . ." House's lawyer quickly chimes in to advise House not to continue. "This man and I, did we marry for love? No. But this past week, we have a lot of fun, working really hard to fool U.S. government. It was fake, but it felt real. Maybe because it'd become real. This man, my husband, I want to stay with him. But if I cannot, please send me away and let him be free."
Turning to House, she says, "I love you." Weinmann is unconvinced, but he knows a judge might believe her. "I'm going to let you stay. But, for the next six months, I'm going to hold onto this file, and our investigators are going to show up unannounced at 6 a.m., 11 at night, and they better find the two of you sitting on the couch watching "NCIS," eating ice cream from the same spoon, or both of you will be sent to places far less pleasant than New Jersey." When they leave, House has to ask about what she said. "Don't worry," she tells him. "I'm much too smart to be falling in love with you. I will be needing extra shelf in bathroom."
"Abdominal biopsy showed flattened villi," Adams tells Taub in the lab. "Looks like you were right about celiac." Didn't Chase just get stabbed for doing a test House didn't order? Taub thinks she just did it to score points over Chase and Park. "We were right. I proved it, and the patient didn't bleed out. Why are you being a jerk about this?" Adams asks. But then they're both paged: Joe is having trouble breathing. It's not celiac.
"His breathing's stabilized, but his lung function is at 60 percent, and his liver is tanking," Taub tells the team. Plus, he has major celiac symptoms, but doesn't have celiac. Adams suggests a parasitic infection, strongyloides, which can damage the small intestine. Joe was in Puerto Rico recently, one of the only places in the U.S. where he could have picked it up. But the treatment is ivermectin. "If you give that to someone with liver problems, he could have seizures, or worse," Taub says. House gives the go-ahead.
"I was wondering if we overlooked a symptom . . . or something." House catches Taub watching one of Joe's tough-talking coaching seminars. "Adams and I both thought the patient could have celiac, but only she was willing to go out on a limb and run the test." "And now you're in here watching a motivational speech. Even your attempt to get your balls back lacks balls," House tells him.
Then Taub notices something: Joe's voice is much lower on the DVD than it is now. "If only there was a good reason for a professional speaker to be hoarse," House says. Taub looks deflated. House asks him to pull up a different video. In it, Joe clears his throat a couple of times. "You bailed too early," House says. "Now I get all the credit."
"Chronic hoarseness is a symptom of a condition called silent thyroiditis," House tells Joe. He's not hoarse now, but he was three years ago. The silent thyroiditis comes and goes, and is itself a symptom of polyglandular autoimmune syndrome type III. "PAS III attacks the body's own endocrine system, moving from gland to gland. It started in the thyroid, and probably helped along by your low testosterone, moved on to the gut." Where is caused celiac disease, or at least it would have if Joe hadn't been on a gluten-free diet. "Eventually PAS III attacks your thymus gland. You developed myasthenia gravis, which landed you in here. And you started eating gluten, which only made things worse." They'll treat everything with high-dose steroids, Taub explains. And the testosterone? "Kicked in the nuts is kicked in the nuts," House says.
"Over the past week, you've all had good moments and bad." House has gathered Park, Adams, and Chase in the lab for a final series of contests, since no clear winner has emerged so far. "Ready, set, suture!"
"What happens if I don't take it?" Joe isn't sure he wants to continue taking the testosterone. "I feel great. Faster, clearer, more like myself. But my marriage, my career, they're both built on me being somebody else." Taub tries to explain the risks involved. "Low testosterone can cause depression, problems sleeping. It's also been linked to conditions such as osteoporosis and diabetes. It'll make your life harder and more dangerous on top of all the meds you'll be taking." He'll take the risk. "I'm a better man without it," Joe says.
"Well, this certainly has brought more structure to the department." Taub rejoins the team as House is watching the contestants on the second challenge, running a test. "Really, I'm just excited for the wheelchair race," House says. "You were smart not to enter. Never in, never lose. And since you no longer have stones . . ." "I'll split the $50 a week with you," Taub offers. "Deal," House says.
When House gets back home, he takes a long look at the apartment, transformed by Dominika, who is doing dance aerobics in the kitchen. Flowers, pictures, a roaring fireplace, actual decorations. "Honey, I'm home!"