Alone in his bathroom, House is in bad shape. He's scraped, bruised and clutching a bottle of pills.
Eight hours earlier: At the hospital, House gives Cuddy the book written by her great grandfather. She accepts it, but seems uncomfortable. House says it's a housewarming gift for her and Lucas.
A crane collapses onto a building in downtown Trenton. Cuddy heads over with non-surgical staff. House arrives at the site on his motorcycle. It is a disaster zone filled with emergency personnel and walking wounded.
House and Cuddy administer triage to the victims. Foreman tends to the crane cab operator, who dozed off on the job despite taking caffeine pills and coffee to stay awake. House thinks it might be the result of a neurological disorder as opposed to fatigue, so he sends him to PPH to be treated by the team. Cuddy makes House stay behind on the scene.
House calls Wilson in the crowded PPH ER and asks whether Cuddy and Lucas are having issues. House hears a sound coming from inside the rubble. He brings the search team captain to check if anyone is down there. They don't find any signs but House is sure that there is someone inside. He digs around by himself using his cane as a guide.
Suddenly, someone grabs his cane from beneath the debris. It is a 25-year-old woman named Hanna, whose leg is trapped under the collapsed concrete. She is in shock and is talking about her husband's birthday present. Hanna asks House to let her use his cell phone, but he tells her he can't get a signal beneath the rubble. She begs him to stay with her but House leaves to get help.
House checks in with Foreman, Taub and Chase regarding the crane operator. He orders an MRI to check for a space-occupying lesion in the man's brain. House goes back to administer Hanna an IV. The Captain of the rescue team tries to free her stuck leg, but they are concerned about further collapses.
House returns to the triage area to ask Cuddy about Lucas. She confesses that they're engaged. Cuddy initially thought that was the purpose of House's gift.
At PPH, the crane operator emerges from the MRI, bleeding from his nose and eye.
Back at the collapse site, the Captain, House and Cuddy surround Hanna. The Captain suggests amputating her leg because of the rubble. Hanna resists and House demands that they give it more time to rescue her. Cuddy insists that waiting may cause pinned crush syndrome that could poison Hanna. The Captain warns of gas leaks, fire and more collapses. House argues that amputation in that environment could be just as dangerous for Hanna. They decide to hold off on the amputation and give the rescue team more time to potentially remove more of the rubble and free Hanna's leg.
House takes a call from Foreman, who tells House that Thirteen is late. House wants the team to give the crane operator an x-ray venogram for sinus thrombosis. Despite Hanna's pleading, House must leave her.
As House climbs on his motorcycle to return to the hospital, Cuddy stops him. Hanna is panicked and is asking for him. Cuddy convinces House to stay, and he offers his cell phone to Hanna to call her husband. This raises her blood pressure, so House stops the call. Hanna notices that House's leg also hurts.
The Captain brings an airbag to lift the concrete off of Hanna. They start to pull her out, but this unleashes an explosion of rubble that slashes House's shoulder. Hanna struggles to breathe because her lung collapsed under the intensity of the blast.
Cuddy stitches House's shoulder wound. The Captain tells them that they can't try the airbag again for a while. Cuddy and House debate about amputating Hanna's leg, and then it turns personal. Cuddy thinks House is going against her diagnosis of amputation in order to punish her. House insults her choice of Lucas, and Cuddy tells him he needs to move on. She is sick of protecting him and is finished. He has lost everyone and has no one.
Cuddy explains the amputation to Hanna, who turns to House for help in stopping the procedure. House relents, agreeing with Cuddy that it is time to amputate. He explains that he hurt his own leg by avoiding amputation and almost died. The pain from it has ruined him and he is a changed man because of that pain. He reminds Hanna that she has a husband and love in her life and she does not want to end up like him. Hanna finally consents.
House performs the amputation without anesthesia, as Hanna screams in pain. The rescue workers pull her out to the surface. She is reunited with her husband and they load into the ambulance. Foreman calls House in the ambulance to tell him that the crane operator patient has fallen into a coma. House realizes that the man's blood pressure is spiking from stress. He has an arachnoid cyst on his lower spine. Sitting ten hours a day has increased his spinal fluid pressure.
Suddenly, Hanna's blood pressure drops in the ambulance and she can't breathe. House thinks that there is a clot in her lungs and pushes an injector into her lung to bust the clot. He checks her heart, but Hanna is worse. House realizes that she has a fat embolism from the amputation. There is nothing he can do.
The ambulance arrives at PPH and Foreman hurries to meet it. He finds that Hanna is already dead. House is angry, and Foreman tries to comfort him since they saved the crane operator's life. House snaps at Foreman that he did everything right and Hanna still died, which only makes him feel worse. House storms off.
Taub sees Thirteen leaving an envelope on House's desk. She says she needs some time off. Taub asks if she is okay and she replies that she is not.
House is at home in his bathroom and rips his medicine cabinet off the wall. There is a hole in the wall where two bottles of Vicodin have been hidden. He takes two pills in his hand and stares at them, miserable. He's a man giving up on life. Yet Cuddy comes in. She says she has broken it off with Lucas because she loves House and can't stop thinking about him. House protests that he is a mess but says she understands. Cuddy helps him off the floor and they kiss passionately, with hands entwined hands. House wonders if he is hallucinating. Cuddy reminds him that he didn't swallow the pills -- they are still in his hand. House tosses the pills away.