"I wanna go on the merry-go-round, but this time, all by myself!" Six-year-old Emily pleads with her dad, Simon, to let her ride the carnival's carousel alone. Simon hesitantly agrees, as long as she promises to hold on tight. He dutifully records the ride with the camcorder as she passes by: once, happy and smiling; twice, now looking a little dizzy; three times, is her nose bleeding? By the time Simon can think, the ride has circled again -- only she's not on her horse anymore. "Stop the ride!" he screams, leaping onto the moving platform. He sees Emily lying motionless, her face bloodied. "Help me!" he yells.
"Is that our precious little bundle of tumor? They grow up so fast, don't they?" House walks in on Wilson staring at his scan while he waits to talk to his cancer doctor. Wilson doesn't want House there, but a little thing like that's not going to slow House down. "How many times have I told you I wanted to be alone, and you've made yourself a pain in the ass?" he asks. "I owe you."
Wilson reluctantly agrees to let House stay - regretting it immediately as House opens a bag and begins to elaborately prepare a drink for himself on the coffee table in the doctor's office, paper umbrella and all. "What are you doing?" Wilson asks, incredulously. "My best friend has cancer. Cut me some slack. Also: Spring Break. I'm on vacation."
"House taking time off is a bad sign." Taub isn't dealing well with House's absence, but he doesn't have long to try to convince the others because Foreman arrives with Emily's case. Also with Emily's mother, a doctor. The team eyes her suspiciously as she drops the banker's box of Emily's files on the table. "Six-year-old with a nose bleed and breathing problems. She was born with a rare mutation of A-T," Foreman tells them.
"Emily has a unique variant on both of her ATM genes," Emily's mother, Elizabeth, continues. "Her disorder mimics A-T, but not all of the symptoms." Elizabeth is a developmental geneticist, and Foreman says she's an expert on Emily's condition. The team is clearly skeptical that Emily's mother should be involved in her case, even more so after she immediately dismisses Park's suggestion that this might just be the natural progression of Emily's disease. "It's not. A-T patients have a life expectancy of 20 years. Emily is only six. It's something else," she says, hastily.
And she's no more willing to consider Adams' idea that Emily might have suffered head trauma from falling off the carousel. "If the diagnosis was easy, I wouldn't need you people," Elizabeth says, while rummaging through Emily's files. But she realizes she's being rude. "I'm here because according to Eric, you're the best," she says.
Park suggests Wegener's granulomatosis, and Elizabeth thinks that's a good fit. "But she can't have x-rays. A-T makes her hypersensitive to ionizing radiation. I'll get her prepped for an MRI." She leaves, as the team stares at Foreman, wondering what just happened. "She knows more about her daughter's genetic condition that any of you," he says. "She'll be an asset." Foreman makes it clear he's not making a request: "Use her."
"The tumor's spread to the surrounding tissue. We're going to have to shrink it before we remove it surgically," Dr. Kondo tells Wilson, who's more concerned about how exactly they're going to do that. It'll be a conservative approach: daily radiation treatments for three weeks. "And if it doesn't shrink enough after that, we'll add the chemo-" "And if it hasn't shrunk enough after that, I'm dead," Wilson interrupts. There's a 75 percent chance that the radiation will be enough, but Wilson doesn't want to take any chances.
"I want the radiation and the chemo concurrently," Wilson says. And he wants a second opinion when Kondo suggests they go with his original plan, so as not to stress Wilson's immune system. "I've seen you recommend this exact same treatment dozens of times," Kondo says. "We're done here," Wilson tells him, getting up to leave. "I'll look for a doctor with some actual balls."
"It was a merry-go-round. She's a kid, Liz. We were having fun. You should try it sometime." Simon and Elizabeth are arguing in Emily's patient room while she sleeps when Taub and Adams come in to take her to the MRI room. "She's six. Not you," Elizabeth snaps back, and gives Emily a stuffed penguin as she wakes up."Ugh, I'm done." Wilson pounds back one more shot over a makeshift game of Battleship and pizza with House. "Good, now that you're sufficiently buzzed, what was the reason behind your freaking out on Kondo?" House asks. So there's Wilson's second opinion: "Kondo was right. You should be in Radiology right now." Every minute he waits, the tumor grows larger. "Stop screwing around and do something about it." "Good idea," Wilson says. "I think I'll start with spending Spring Break on my own," he tells House, getting up to leave.
"I was only pretending to be asleep. Do you think that's dishonest?" From the MRI chamber, Emily admits to Taub and Adams that she overheard her parents fighting earlier. Taub quickly tries to make up a story about how sometimes his daughters do that, "but they know that sometimes when it seems like Mommy and Daddy are fighting, it's really only because they're worried about you." "And does your wife ever want a divorce?" Emily asks. Hmm. "No, everything's fine at home," Taub says, quickly. "Hold still now. No more talking."
Suddenly Emily is screaming in pain, and the doctors rush in. The tips of her fingers are purple. "I want my daddy! Where's my daddy?!" Emily cries.
"We were able to restore circulation to her hands and feet before any permanent damage set in," Taub tells the team later. Chase suggests primary Raynaud's, maybe set off by the cold in the MRI room. Adams thinks that the stress of hearing her parents argue could have contributed as well. "Unfortunately, she's heard a lot worse than that before. It's not stress," Elizabeth says. She has an idea: heavy metal poisoning. Simon moved into an old apartment building recently.
"I'm sure he has no idea what the insulation's made of, what kind of paint," she says. "He's a good father, but when it comes to Emily's health . . . I'm going to get his keys and check for environmentals." Chase tells her that lupus is a better fit. "I don't mean to pull rank here, but I am her mother," Elizabeth says.
So is she there as a doctor or as a mother? "As a doctor, I need parental consent. See above. While I'm gone, please start her on chelation therapy," she says, as she walks out the door. That's just about enough for Chase. "She's the mother. So let's treat her like any other mother: we break into her house."
"I think we just hit the environmental mother lode." Chase and Adams find a basement lab full of dangerous chemicals and drugs in Elizabeth's home. And there's a gated off section with a child's bed and toys right in the middle of it. Adams finds a small refrigerator full of bottles of a strange drug: "You ever heard of LEX-2?" "Read about it," Chase says. It's an experimental drug that can supposedly override DNA errors in the ATM gene. He looks at Adams. "Doesn't mean she's giving it to her daughter. Anyone studying A-T would be researching it." "How?" Chase asks. "See any lab rats down here?"
"You don't want a second opinion. You're already on your fifth." House finds Wilson in his office and tells him he knows about all the doctors Wilson's already seen. "And every one of them has given you the same advice. You're nuts. You don't just want chemo. You want a dose so high there's a one in three chance it'll kill you outright."
House has worked out that Wilson kept it from him because he would put a stop to it, meaning Wilson's already found someone to do it. "But who would be that stupid?" he wonders. "I'm thinking that the who is you." He finds Wilson's stash of meds. "Where exactly were you planning on killing yourself? Because I don't think Foreman's going to let you do it here." He was going to do it at home. He's been stockpiling meds. House takes a pocket knife and prepares to slash a packet of liquid medicine.
"No!" Wilson screams. "I'm still healthy," he tells House. "Why not go the extreme route now when there's a better chance of surviving it." Because statistically, the treatment he wants has about the same chance of killing him as his cancer does. But Wilson has lost patients over the years to cancers with high survival rates. "I am not going to die slowly in a hospital bed under fluorescent lighting, with people stopping by to gawk and lie about how I look. Even a small chance of that happening is too big a chance for me!" House puts down the knife. "You're an idiot. And the odds say you're going to die. I'll do it at my place."
"The only environmental factors we think caused your daughter's illness are the ones you shot her full of." Chase has brought the experimental drug he found at the home to Foreman's attention. "I tested the drug. This is what I did, for a living, for ten years," Elizabeth says. "She's your child, not a guinea pig," Adams says.
Elizabeth says she tested it on herself first, with no adverse effects. "A trial of one is basically irrelevant," Foreman says. But she maintains the drug helped her daughter survive worsening respiratory problems, and the drug won't be approved for at least another five years. "What was I supposed to do?"
Foreman tells her that there's a reason for FDA requirements. The current LEX-2 study, due to be published next month, has been suspended: the research team linked the use of LEX-2 to renal failure in mice and rats. Elizabeth is shocked. Chase wants a renal biopsy for Emily to check for damage. "Hopefully it's reversible."
"To stupidity." House lifts a cocktail to Wilson, who's prepped for his super-concentrated cancer treatment in House's apartment. But not before House runs through an encyclopedic litany of horrific side effects Wilson can expect in the next couple of days. "Every pain sensor in your body is firing at the same time, until agony isn't even a word or a concept. It's your only reality. You hallucinate. You dream of death. And then the race begins. Can your body claw its way back in time before the hostile organisms and parasites claim your permanently. Win, you live. Lose, you die." But Wilson still wants to go through with it.
"Kidney number one looks good. Which means we'll probably take the biopsy from two." Chase is performing the ultrasound on Emily while she and her father watch. She even gets to work the controller. But then her chest starts to hurt, and she coughs up blood. "Definitely not her kidneys," Chase says.
"I promise this'll taste just as good coming up as it did going down." House brings Wilson some food, as he's fully hooked up now to IVs, surrounded by medical equipment on House's couch. "If things go wrong, I just want you to know-" Wilson begins. "If you're going to say that you've always been secretly gay for me, everyone always just kind of assumed it," House interrupts.
Wilson says he just wants House to know he appreciates the risk he's taking. "Pumping a human being full of lethal chemicals in your living room. If I die, it probably won't go over well with your probation officer." That won't be an issue for House: "I've already identified a couple of spots to dump your body if this goes south." Wilson's having muscle spasms in his hands already, one of the first of the many nasty side effects he can expect.
"I just always thought when I got old I'd have a wife or kids to look after me." It's later in the day, and Wilson looks and sounds pretty bad. He's sweaty but shivering under a blanket. "You have everything you need right here," House says. "We both do." He pulls out a large syringe and shows it to Wilson. "Painkiller: industrial strength. Level: awesome." He snaps it next to Wilson's IV bag and hooks himself up as well. "We're on vacation," he tells Wilson, before releasing the meds. "Ah, that is nice, Wilson says, as they both lay back on the couch.
"Kidneys are fine. I don't think we're looking at side effects from the LEX-2," Chase says, back in the office. As Taub is suggesting a pulmonary embolism, all the doctors' pagers go off. They race to the lobby to see Simon checking Emily out. "I'm taking her to Mercy. Everything you people have done has just made her worse," he says.
"You don't have the right! We have joint custody," Elizabeth says. "Where was my right when you were treating our daughter like a lab rat?" Simon yells. "She'd be dead if I hadn't!" Elizabeth argues.
Chase stops their arguing. Emily is covering her ears to drown out her parents. Chase wheels her away so Taub can fill Simon in. "We believe Emily has a clot in her lungs. If you leave now, she could die before her new doctors are even up to speed." Simon is devastated to learn that the clot could have formed after her fall from the carousel. "Now, can we stop blaming each other and do the right thing here?" Elizabeth asks him.
Simon can't believe she's trying to equate the two, even though Elizabeth says she was trying to save Emily's life. "What's her best friend's name? What's the name of her favorite teacher? Why does she hate that stuffed animal you gave her? She's been having nightmares about penguins all month."
Elizabeth doesn't know any of that, but she knows all the specifics of Emily's illness, much more than Simon does. "What about the variant in her E14/ATM intergenic promoter region? Because that's what's killing your daughter, unless I can find a way to reactivate it." Simon is frustrated and distraught, but he knows Elizabeth is probably Emily's best hope. "Just make her better," he tells her.
"You don't look too good, mister." Wilson wakes, looking and feeling miserable, to a small boy in the apartment. Who is it? "You don't remember?" The boy asks. It's one of Wilson's pediatric oncology patients, who died of a cancer with a high survival rate. "You promised me I'd go home again, Dr. Wilson. You said it wasn't my fault. If I didn't do nothing wrong, why did I die?" Wilson starts crying. "I don't know. I shouldn't have done this. Am I dead?" "Not yet." It's House. The boy was just a hallucination. "It just feels that way."
"Good news: Emily's lungs are clear. No clot." Park and Taub check review Emily's lung scan with Elizabeth hovering. "And bad news," Elizabeth says. "We still don't know what's happening to her." Emily's eyes are jaundiced. There's liver involvement now.
"We did find a blockage in her hepatic vein, which is restricting blood flow to her liver." Taub fills the team in on Emily. As they bat ideas around, Elizabeth now wonders if this really is just the end result of Emily's disease. "She's unique. One screwed up gene from each of us. I shouldn't be here."
After she leaves, Taub brings up advanced Lyme disease. "It fits everything but the nose bleed," Chase says. But why is it attacking now? What's changed? "Elizabeth has," Adams says. "She stopped giving Emily the LEX-2. It's an aminoglycoside antibiotic. It's what was keeping the Lyme in check." Chase wants to start her on amoxicillin.
"You lied. It doesn't taste better coming back up." Wilson is pasty white and heaving into a bowl while House tries to comfort him. His white blood cell count is down to 1,000 and still dropping. "I need more morphine," he says. They've been out for eight hours; House has been using his own meds since then. He assures Wilson he has enough for both of them and then some. "Just remember: they're a gift. So it's rude to keep throwing them up. Found that out with those candlesticks you got me."
House walks to the kitchen and empties his Vicodin bottle. He's only got a small handful left. He wants to take one for his own pain but decides to keep it for Wilson, and instead he chugs from a bottle of booze.
"We think it's Lyme." Chase and Adams see Elizabeth and Simon in Emily's room. Adams explains that Elizabeth wouldn't have seen any signs if the LEX-2 was keeping it in check. But Emily's never even been in the woods. "Yes, I have," Emily says. "With daddy." Simon comes clean.
"I should have told you," he tells Elizabeth, "but I know how you feel about it. I grew up hunting with my dad. I wanted to share it with my daughter. At least once." Instead of tearing into Simon, Elizabeth says they can't protect Emily from everything. "I assume you'll need a lumbar puncture to confirm?" she asks the doctors.
"Did you lose a contact?" House sees Wilson crawling on the living room floor; he's ripped out his IV and monitors. He's just trying to get to the bathroom.
"An oncologist with cancer," Wilson says, almost deliriously in agony now. "Of all the things that could be killing me. It's like the universe giving me the big middle finger. Why me?! I was always telling my patients not to torture themselves because there's no answer. It's cruel advice. They were just trying to make sense of what was happening to them, and I'm there telling them not to bother? I should have spent my life being more like you. Should have been a manipulative, self-centered, narcissistic ass, who brought misery to everything and everyone in his life."
"You'd still have cancer," House says. "Yeah, but at least I'd feel like I deserved it!" Wilson says.
"Do you think my parents will get back together?" Emily quizzes Chase and Adams while they perform the LP. Her parents only fight about her. "That's because they care so much," Adams says. "So, maybe when I die, they'll get back together," Emily wonders. Suddenly her arm goes limp; she can't move it. Her monitors are beeping. She's having a stroke.
"Your heart rate's up. BP's tanking," House tells Wilson, over the sound of his own monitors beeping loudly. "White blood count's at 500. We have to go to the hospital now." Wilson won't go. "I don't have the equipment or the meds to handle this," House tells him. "No," Wilson says. "Win or lose. Win or lose, that was the deal." "That was the deal when there was an 'or,'" House pleads with him. "You can't win this."
"No, I'd rather die here," Wilson says, crying. "Not in an ambulance. Not in a hospital. Please. You can't do that to me. House, please promise me that you won't do that to me. Promise me." "OK, I promise," House agrees.
"Stroke. Blockage in her hepatic vein. Coughing blood. Trouble breathing, Raynaud's . . ." Chase is listing Emily's symptoms while he and the team try to figure out what's wrong. House isn't returning calls or texts. "We're on our own here, so just give me some theories we can use," Chase says. "Hematologic malignancies. A-T patients are more prone to that form of cancer," Park says. Could cancer really present and kill her in three days? That gives Chase an idea. "Not cancer. But a tumor could act like a clot. An atrial myxoma. Primary heart tumor."
He explains later to her parents: "The swinging motion of the myxoma intermittently blocked the flow of blood through the right atrium. Inflow blockage stagnated the hepatic vein, which clotted and caused liver failure. Outflow blockage caused Raynaud's phenomenon and stroke. Pieces of the tumor broke off and lodged in the lungs, causing Emily's breathing problems and the coughing blood. We'll remove the tumor surgically, and hopefully the biopsy reveals it's benign."
"You really look like crap," Wilson, who himself looks like death warmed over, is handed a glass of water by House the next morning. "Been fighting a cold lately," House jokes. "Seven-to-ten days for the swelling to go down, then we rescan and schedule the surgery."
Wilson starts to remember some of the things he said about House the night before. "You talked a lot," House cuts him off. "I stopped listening after you confessed your fear of dolphins." Wilson asks House for one last favor: help him to the bathroom.
It's clear House is in pain as Wilson leans on him for support. "I thought you said you had plenty of Vicodin," Wilson says. "Everybody lies," House tells him. "So, the way I felt, you feel that - what, most of the time? Really does suck being you, doesn't it?" Wilson asks. "At least I don't have cancer," House answers.
"The tumor was benign." Chase and Adams tell Simon, Elizabeth, and Emily the good news. Also they were able to remove all of it. "Does this mean I'm not sick anymore?" Emily asks. "No, honey," Elizabeth explains. "The tumor didn't cause your genetic condition. You're still sick." "But we never let that stop us before, right?" Simon says, laughing. Soon Emily is smiling, too.
"So what do you want to do when we get out of here?" Simon asks. Chase recommends a local aquarium, which sounds good to Emily. "Me too?" Elizabeth asks. "Can she come with us?" Emily asks Simon. "You know Mommy never has to ask," he says.I'll see you at lunch." Wilson and House get off the elevator at the hospital and head their separate ways. Watching Wilson walk away, House smiles.
In his office, Wilson sees that his laptop is open and on. Puzzled, he sits down and touches the keyboard. Suddenly music starts playing and a series of images begins to rotate on screen: it's Wilson, unconscious on House's couch, posed in various positions with bikini-clad women in Hawaiian leis. Wilson starts to laugh. In some, Wilson is wearing sunglasses; in others, he's cradling a ukelele or a bottle of booze, or he's wearing a blonde wig or a sombrero. Now Wilson is cracking up looking at the pictures. House managed to arrange a Spring Break after all.