Carly, a 30-something female CEO, is in the middle of a confident pitch to the board when she starts trembling. Suddenly, she can't move her leg.
House gives his verdict to the team: paralysis and severe pain in the right quad. Cameron wonders if she has the same clot in her thigh that House had. House orders an angiogram to test for a clot. If that test is clean, then she'll be given an MRI to check for spinal pressure. If that one also turns out negative, then they will biopsy the leg. Chase oversees Carly's x-ray. While he flirts with the technician, Chase doesn't notice that the machine took a shot of Carly's left thigh.
Meanwhile, Cuddy announces that Edward Vogler, a large donor to the hospital, has been made the new chairman of the board. Vogler wants to make the hospital a cutting-edge research center where people without a prayer could go for help. The hospital will have a blank check to fight Alzheimer's, cancer, MS, AIDS and other such diseases.
House sees a young patient named Ricky van der Meer who suffers from a sore throat. Yet what's more interesting is that the boy's father had knee surgery a year ago and hasn't been able to speak since then.
House checks in with Dr. Simpson, who operated on young Ricky's father. All Dr. Simpson has to say is that Mr. van der Meer received $1 million for a malpractice settlement when they couldn't find a thing wrong with him.
Cuddy catches up with Dr. House and tells him that Vogler wants him to start wearing a lab coat. House scoffs, complaining that Vogler will now start using the hospital's patients for clinical trials. They will be treated like lab rats who are pressured into treatments that are bad for them but good for study.
Cuddy realizes that all Vogler is doing is upping the ante on House's game. House thinks Vogler will ruin the hospital.
In her room, Carly is in severe pain when Foreman arrives to tell her the tests were negative. She screams in agony.
House reconvenes with his staff. Chase announces that her angiogram shows no signs of neurogenic or myopathic abnormalities. Foreman says tests for trichinosis, toxoplasmosis and polyarteris nodosa are negative as well.
House asks Wilson about a possible bone scan to check for underlying cancers. Wilson warns him to keep his head down until Edward Volger is settled in.
Wilson stops by to see Carly. There is no cancer in her bone, but she might be having referred pain from cancer in another part of the body.
Carly's mom died young from cancer, and she rejects Wilson's suggestion of a colonoscopy. Carly refuses to be examined. Wilson then presses for a very expensive virtual colonoscopy. She relents.
Wilson lets House know that there's no colon cancer according to the virtual scope, and that Carly doesn't want a physical scope. House wonders what Carly is so embarrassed about.
He reconvenes his staff and notices something odd about her x-ray. Chase angioed the wrong leg. House sees Jenny's signature on the report and realizes exactly what happened. He orders Foreman to do a new angio.
Foreman is administering the new test when Carly complains that she can't breathe. Her lungs fill with fluid. Foreman performs a thoracentesis to drain the fluid and results on the fluid should be back from the lab soon. On the plus side, the angio revealed no clot.
House is distracted, staring at a board with Carly's symptoms listed. He erases everything and writes, "Psych symptoms: Withholds pain, control, shame."
House then looks in on Carly as she sleeps. Examining her leg, he notices seven half-inch cuts in a perfect row on the thigh. She's a cutter.
House catches up with Wilson at lunch. Besides hinting that Carly has a broken heart, he is reluctant to tell him more. With new management practices, Wilson would be obligated to tell others.
Chase and Cameron approach with news. The thoracentesis has revealed a congestive heart transplant. Carly needs an actual new heart.
Vogler questions Cuddy on what the Department of Diagnostic Medicine is. It's House's department. Vogler thinks it's a financial black hole, requiring $3 million a year to treat one patient per week. Cuddy argues that House saves one patient per week. Vogler asks why House isn't wearing his lab coat. Doesn't he respect Cuddy?
House tells Carly that she needs a transplant. She points out that she's a runner, but House counters that she's a high-powered bulimic. Since scarred knuckles are unseemly, she's been using Ipecac, which caused muscle damage. This created the pain in her leg and destroyed her heart. She admits that she does it three times a week.
House tells her that he has an emergency meeting with the transplant committee to see where Carly would fall on the list. Normally, she would be ranked high because she has about a day to live. However, the bulimia makes her a risk, like a suicidal patient. Would House lie to the committee?
She asks what he wants. He wants to know whether she really wants to live or die. She breaks down and says she doesn't want to die.
Later, House stands before the committee, which Vogler is observing. Cuddy asks if Carly has any exclusion criteria. Wilson subtly tries to shake House off, but he says there are no exclusionary causes.
Cuddy warns him of disciplinary action for subverting the committee. He denies any outside factors.
After the meeting, Wilson yells at House for his diversion. House gets a page that transplant surgery is getting underway.
In the office, Chase wonders to Foreman and Cameron why House would put Carly on the transplant list before the test results came back. It seems odd. Chase is also worried that he's going to be fired. Chase does some snooping around and finds a bottle of Ipecac in Carly's purse.
Cameron tells House that van der Meer has been on steroids. She also questions whether House will fire Chase, but House says he merely wants Chase doing everything he can to protect his job now that Vogler is looking to make cuts. House hears from the surgeon that Carly had a textbook operation.
House checks in with van der Meer. He knows that being intubated during knee surgery paralyzed van der Meer's vocal cords, but he also knows that his new treatments have healed him. Van der Meer shakes his head. House confides that he won't have to give the settlement money back and van der Meer admits that he can speak.
House sits with Carly as she wakes up and warns her not to screw this up. He's relaxing in his office when Vogler enters. He wants answers about Carly's bulimia. They found the Ipecac in Carly's purse. House notes that, since he has full tenure, Vogler would need full board approval to dump him.
With Wilson and Cuddy on his side, that's impossible. They might as well learn to live with each other. Vogler admits that he has a point. Just before leaving, Vogler mentions that it's actually easier to get rid of a board member than it is to dump a doctor.