Firefighters are called to the residence of George Hagel, a 600-pound man who has died. As a team of firefighters tries to lift George's body, somebody in the room passes gas. That somebody is George. The chief checks and finds that George still has a pulse.
Cuddy brings George's file to Chase, Foreman and Cameron. House isn't in yet. Cuddy informs the doctors that George is in a coma, but his blood sugar is normal, his cholesterol is lower than hers, his tox screen was clean and there's no sign of trauma. The team is astonished by this news. Cuddy wonders where House is.
Well, he's in a holding cell at the police station. Frustrated, he tells Tritter to let him go. Tritter suggests arraigning him instead. Finally, Wilson appears and posts House's bail. House meets Wilson outside and Wilson immediately hands him a bottle of pills. House assures Wilson that he's innocent and Tritter just wanted to punish him.
The doctors are mulling over George's case and House's whereabouts when House suddenly pops into the office. House quickly orders the team to start treating George for Pickwickian Syndrome. Foreman counters that George's CO2 and oxygen stats are normal, but House points out that they're only normal for an average-sized person. House also wants a detailed medical history. Search his house and talk to his neighbors if you need.
George's neighbor, Sophie, allows Cameron into George's apartment. She surprised by how tidy and orderly the place. The place also has a high-end kitchen, including a wine cellar. Sophie informs Cameron that George loves cooking and frequently prepares four-course gourmet meals for himself. He also has prostitutes visit on occasion.
House is working clinic duty when he spots Tritter in the lobby. Tritter says he was merely bringing Cuddy up to speed on the arrest. Conspicuously popping a pill before Tritter, House advises him to quit while he's ahead. Tritter eyes up House, then leaves. Foreman and Cameron approach with the information that intubation and steroids have had no effect on George. Thus, they're ruling out Pickwick's. House suggests blood clots in the brain and orders either an MRI or a CT scan. Problem is, those machines have weight limits well under what George weighs. House suggests that they just start treatment then.
Knowing that blind treatment could possibly kill George, the team tries to MRI him. Cameron thinks it'll work if they just get his head inside the machine, but Foreman worries that George will break the table, ruining a million-dollar machine. Adamant that George deserves the same standard of care as anybody else, Cameron assembles a team of nurses to hoist George onto the table. Incidentally, she lies about George's weight to get them to help.
Cuddy finds House in his office and hands him contact information for the best defense lawyer in the county. The moment she leaves, House crumbles the paper and throws it out. Elsewhere, the doctors find nothing out of the ordinary on George's MRI. As they begin to weigh their options, George comes to life and starts screaming. As Foreman and Chase struggle to pull him out, the MRI bed breaks with a loud crack.
House and the team reconvene to discuss what they know. They don't know much. A calm, but angry, Cuddy enters asking about the machine. House blames his staff for disobeying his orders to start treatment. Cuddy isn't buying it, but Cameron pipes up and admits what happened. Foreman wonders about hormones. Acute adrenal insufficiency could possibly cause a coma. He wants to do an ACTH stimulation test and check George's skin for acanthosis nigricans. Cameron, focusing on the prostitutes, wants to run a full STD check. Chase suggests doing nothing, and if George doesn't get worse, figure it was a hematoma that dissipated. House considers, then decide to go with all of the theories.
Foreman and Cameron begin their tests on George, who insists he's fine. Every doctor he's ever seen has checked his hormones, then his blood pressure. And the results are always the same. He asks the doctors when he can leave the hospital. Foreman and Cameron finish the tests, then report back to House that the skin exam and ACTH stimulation were normal, and the blood and urine were negative for chlamydia, herpes and syphilis. House is intrigued by the mystery, but Foreman then reports that George is asking to be discharged.
House shuffles over to George's room, where he finds him eating dinner. House tells George that he awoke from a coma caused by an unknown condition and wanted to leave the hospital. So either George isn't in his right mind or he knows what the condition is. House guesses at various conditions, but George angrily insists that he doesn't know what's wrong. He's not depressed, he just doesn't want to stay there. House gets a cell phone call and leaves.
The call was about House's apartment, which has been ransacked. As he looks around, he sees Tritter in his hallway with two uniformed officers. Tritter coolly informs House that they're executing a search warrant. Tritter holds up an evidence bag full of pills and estimates that it must hold over six hundred Vicodin. Most DAs would say that shows intent to traffic. House scoffs, pointing out that each pill is held in a prescription bottle. Tritter agrees, but theorizes that if House is so unprofessional and unethical, maybe it's possible that some of those bottles are in other's names. Or came from forged prescriptions. Or simply stolen. But House has nothing to worry about, right?
The next morning, House instructs his team to send George home. Cameron resists, but House is more interested in tracking down Wilson and finding out what he told Tritter. Wilson assures House that he merely told Tritter he prescribed the Vicodin.
As George is wheeled out of the hospital, Cameron makes a last gasp attempt to convince him to stay. George explains that he simply loves food. Whatever is going to happen, will happen. George stands from his wheelchair and prepares to walk out of the hospital as Cameron begs him to sit. George takes a few unsure steps and then collapses through a plate glass wall.
Foreman, Cameron and House gather. Foreman explains that disorientation and loss of balance could mean a neurofibromatosis. House mentions that that's inherited, claiming one of his diagnoses was correct. Cameron argues that the disorientation isn't a key symptom. And she would know because...she gave George three grams of phenytoin. She didn't think he should be discharged and knew that would force him to stay.
Looking at the discharge report, House notices that George didn't eat his breakfast, which seems odds for him. Coma, fever and loss of appetite stem from Chagas. Cameron is doubtful, as George hasn't been out of the country before. House points out that his food has. House wants a sample of George's CNS to determine which bugs are in his brain. But since George is too big for an LP, they'll have to drill into his head. After some badgering from Cameron, George agrees to the test.
During the test, Foreman prods George's brain and George begins screaming that he can't see. The nurses struggle to hold him down. After the procedure, Foreman and Cameron inform House that there's no inflammation in the optic nerve and the retina is intact. There was also no sign of Chagas. House wonders if they missed a tumor in the MRI. Or perhaps it's diabetes, as evidence by the blindness and coma. He wants them to test George once more.
Cameron tries to give George some glucose water to drink, but he angrily slaps it away. They argue until George says that he's been fat all his life, but sick only recently. If she wants to look for a disease that has nothing to do with his size, he'll help them. Otherwise, leave him alone.
House meets with his new lawyer, Howard Gemeiner. Howard advise a plea bargain, which House has no interest in. So Howard quotes House his exorbitant fees, which House reluctantly accepts. When House returns to the hospital. Cameron asks how things went with the lawyer. House is disappointed that his secret is out. Moving on, Foreman says tests for MS were negative and Cameron says tests for diabetes were unperformed.
House barges into George's room and accosts him about the diabetes test. House tries to forces the glucose drink on George, who strenuously resists. As they struggle, House notices George's fingers. He limps out of the room. Cameron and Foreman follow. House orders x-rays of George's hands and feet. Then a bronchial test, a sputum cytology and a CSF check for anti-hu antibodies. House thinks George has lung cancer. When the doctors are skeptical, House asks if they've felt George's fingers. His hands are clubbed.
They take x-rays and are stunned when they realize House was right. George has ossifying periostitis on the ends of his fingers. After the tests are analyzed, Cameron enters George's room to tell him they've confirmed small cell lung carcinoma. That caused a paraneoplastic neurologic syndrome, which in turn caused the coma and blindness. It's inoperable, but radiation treatment is available. However, that will only buy him a few months. A year at the most.
In Wilson's hotel room that night, Tritter is asking Wilson if he really wrote all of those prescriptions for House. Wilson admits that House can difficult, but he truly is in pain and needs that medicine, which is why Wilson prescribed it. Tritter pulls out a few scrips and shows them to Wilson. He points out that the signatures on some of them look different from others. Tritter notes that Wilson looks surprised. Covering, Wilson says that sometimes he gets bored and signs his name differently. Tritter tells Wilson he'll give a second to reconsider his answer. Because if he's lying, they'll find out. Wilson sticks to his story. Tritter thanks him and leaves.