Co-workers Russ and Valerie walk with their boss to a private plane en route to a business presentation. They argue over an issue. Suddenly, Russ gets sick and vomits on Valerie's shoes. He seems to be drunk. Then Valerie is overcome by ear pain.
Foreman presents Valerie's case to the team. He tells House that she is really hot, so he should take the case. House accepts because he is intrigued that Valerie's husband is not as attractive as she is...and that she is hot. House suggests it is not her ear but her heart that is the problem. Valerie has recently switched to a raw food diet. His cell phone rings and he avoids the call.
Wilson finds House sleeping in his office. House is avoiding Wibberly, whom knew House from med school. During his rehab treatment, House was asked to send a letter of apology to someone he had hurt. He sent it to Wibberly because House switched papers with him. Now Wibberly wants to drop by.
Valerie's co-worker, Russ, accuses her of poisoning him at the airport. They act like they were lovers. Russ was recently hospitalized for paranoia, and he is escorted out of her room. Valerie is shaken up and comforted by her husband. Thirteen wonders if something is odd about the situation.
House talks to the team on speakerphone from Cuddy's office. They think that Russ poisoned Valerie, but Thirteen disagrees. Since she is the only one to disagree, Foreman tells Thirteen to give the patient beta-blockers as ordered by House.
House defaces framed photos in Cuddy's office by replacing the face of Lucas for that of a baboon. He's interrupted by Wibberly. Wilson told Wibberly where to find House. House learns that Wibberly never became a doctor and got a failing grade on the paper that House had switched.
Before Thirteen administers the beta-blockers, she suggests to Valerie that she undergo another test. Thirteen is running an MRI on Valerie and shows Foreman that Valerie does not use the emotional part of her brain. In other words, she is a psychopath. House comes to Valerie's room to tell her the news. At first she acts offended, but then admits that she did poison her co-worker after having an affair with him to steal his ideas. Valerie says she only married her husband for money. She makes it clear that she really has no conscience.
With two rare conditions in one patient, House knows there has got to be a connection between the psychopath and cardiac arrhythmia. However, psychopathy is genetic, not a symptom. Foreman suggests that Tertiary syphilis fits. House tells Thirteen to rule out Wilson and Hashimoto's diseases. Foreman follows House onto the elevator to ask him to discipline Thirteen for disobeying him with the MRI test. House says that it is Foreman's problem to deal with.
Cuddy approaches House and is upset that he cut up the picture her father had taken of her when he was still alive. It was her only copy. House feels terrible.
House enters the clinic room where Wilson is treating a Hispanic patient's bloody thumb. House speaks to the patient in Spanish. He wonders if Wibberly has an agenda. He visits Wibberly at home. Wibberly seems content in his life, but has to move because he can no longer afford his mortgage.
Taub and Thirteen prepare to test Valerie for syphilis. Valerie warns Thirteen that she will get her fired and sue the hospital if Thirteen tells her husband anything. When Thirteen takes her arm to administer the test, Valerie claims that Thirteen has broken it. Her arm is actually broken.
The team discusses the developments between Thirteen and Valerie. Tests show that Valerie's bones are brittle. Ruling out Syphilis, Foreman estimates that Valerie has lymphoma. House agrees and orders radiotherapy treatment. House is annoyed at the poor performance of Foreman and Thirteen since they are back working together.
Thirteen speaks with Valerie's husband in the hallway and suggests that they could check for environmental toxin. She advises him to look into the details of the weekly landscaping class that Valerie told him that she attended. This was to cover her weekly trysts with Russ.
House administers a radiotherapy session. Valerie tells him she has observed that he is similar to her in disposition. Valerie's husband enters her room and accuses her of lying about the landscaping class. Thirteen is stunned as Valerie easily makes up another lie to cover herself. She manipulates her husband into hugging her. Valerie looks up at Thirteen from the hug with threatening eyes.
Valerie tells Cuddy to fire Thirteen or she will sue. Cuddy agrees to remove Thirteen from the case for her own protection against the patient. Valerie antagonizes Thirteen and asks if she is going to cry because that's the one expression she can't mimic. Thirteen accuses her of calling the medical board and putting in a complaint of sexual harassment against Thirteen. Foreman angrily tells Thirteen to not play into Valerie's hands. He finally apologizes for firing her earlier. He hopes they can work together.
Foreman gets a page and finds Valerie covered in blood. Something is wrong with her liver and blood flow is spilling into her esophagus. She is rushed into the operating room. Valerie's confused husband watches and asks Foreman if she was truthful with him. Foreman doesn't answer. The team tries to diagnose the latest symptom and they realize that Valerie needs a liver transplant. They cannot get her one without a diagnosis.
Wilson visits House's office as he is writing a check to cover Wibberly's mortgage. Wilson questions why he isn't as kind to Cuddy. Wilson notes that Cuddy was in love with House for years. He thinks it's easier for House to be good to a stranger in order to deal with his guilt.
Thirteen asks Valerie's sister why she offered to be tested as a donor considering how awful Valerie is. The sister explains that their father was abusive when they were young and that Valerie protected her. She was twelve years old when her personality changed. Thirteen tells House that the psychopathy is therefore a symptom and it is not genetic. House realizes that Valerie's raw food diet with nuts that are high in copper have aggravated the dormant symptoms of Wilson's disease. Thirteen reminds him that they already ruled that out. There is one more sign to look for.
House and Thirteen enter Valerie's room with nail polish remover. House removes the nail polish from Valerie's thumbnail and sees that her nail is blue, confirming that Valerie cannot process copper. She will get better with Chelation therapy. Thirteen goes to get the equipment and tells Valerie's husband that she is using him for money. Since the love is real for him, he believes that is enough.
At his home, Wibberly refuses to accept House's money and admits that he actually got an A+ on House's paper. He did go on to be an orthopedic surgeon, but ruined his career with a gambling habit. Wibberly figured House would be the same bastard he always was, but he is not. After House pushes him to take the check, Wibberly asks if this is really about himself.
The treatment has improved Valerie's health and she can be considered for a liver transplant. Valerie tells her husband that he is pathetic and she rejects him. Thirteen thinks this is a sign that Valerie's brain is working better and that she is feeling something. Valerie is now engaged in feelings, which hurts her emotionally. She begins to cry.
Thirteen finds Foreman trying to read Taub's case notes. He congratulates her on the diagnosis and she sits with him to help decipher Taub's handwriting. House approaches Cuddy's office, but Lucas is in there with her. He returns to Wibberly's house and slips the check under the man's door.