House M.D. Episode 7.06 Office Politics

Even in a tight race, with the election just days away, New Jersey Republican Senator Hal Anderson doesn't want to run a negative, anti-immigration ad against his opponent, John Moreno - despite the pleadings of his insistent campaign manager, Joe Dugan. "I'm telling you, this ad wins you the election." "Absolutely not," the senator tells him. But before they can continue, Joe starts scratching at his arm, and when he rolls up his sleeve they see several red lesions. "Maybe I should call a doctor," Joe says, somewhat absentmindedly. Fortunately Hal recognizes the gravity of the situation. "Better call an ambulance."

"What's that smell? Onions? Peppers? Oh, I know: it's a sausage fest." Cuddy tracks House down in the clinic to tell him she's done waiting for him to find a female doctor for his team, so she hired one herself: Martha Masters, a genius third-year medical student who graduated from high school when she was fifteen and has PhDs in both applied math and art history. "Which would be incredibly useful if my next patient is an Escher drawing - those things are seriously screwed up," House says.

But Cuddy isn't offering a suggestion. Martha is hired, whether he likes it or not.

"Patient is Joe Dugan, 42, political consultant." Taub starts the differential on Hal's campaign manager in House's office. "Presents with palpable purpura and ALT and AST are through the roof." House is ready to dismiss the case as just a rash and liver damage, but Foreman wants him to reconsider, since Senator Anderson personally asked that House's team take the case. "Black guy campaigning for the opposition. Does Obama know about this?"

Martha Masters appears at the door of House's office and knocks timidly on the glass. He reluctantly lets her in and introduces her to the team, and vice versa. "Martha M. Masters. I'm Dr. House. This is the rest of the team: Boring, Bimbo, and Bite-Size. Martha enjoys quadratic equations and Italian frescoes, and her turn-ons include learning to be a doctor." The team is confused. She's a med student? House explains that Cuddy thinks she's some kind of genius.

"Say something brilliant," he tells Masters.

Masters is caught off-guard, saying, "Oh, I don't . . ."

Test time, House-style: "Capitol of Azerbaijan.""Baku." She's still not sure exactly what's going on, but is willing to jump in.

"Year Beethoven died.""1827."

"20th decibel of Euler's number.""Six," Masters answers, giggling. "It's my favorite constant."

"She's like the Internet, with breasts. Oh no wait, the Internet has breasts." And with that, House sits and the differential on Joe continues. Foreman explains that liver damage would explain the rash and the cryoglobulins they found in his blood, but there doesn't seem to be an explanation for the liver damage itself. No signs of drug or alcohol abuse, and test for hepatitis A, B, and C were all negative. Meanwhile House starts quizzing Masters again, only this time it's about monster trucks. She seems thoroughly confused now and isn't saying anything at all.

"Hate to steal the spotlight from Small Wonder over here," Taub says. "But what about toxic exposure?" Chase suggests tetrachloroethylene, pennyroyal, and sassafras oil, and House sends them off to search Joe's house for chemicals. And he offers Masters some advice: "If you want to stay on this team, have an opinion."

Foreman, Taub, and Masters arrive at Joe's house, but only Masters seems impressed with the massive residence. "Cool! Tudor Revival architecture. Steeply pitched asymmetrical roof over the entrance. But it doesn't have the half-timbering over the façade." Taub still doesn't get why she's here. "Doesn't say anything about medicine, can't shut up about architecture. Great." Masters says she's intimidated by House - such a "legend" - that she finds it hard to talk . . . a problem she doesn't have around "ordinary people."

She eyes Foreman picking the lock. "Dugan didn't give you a key?" Foreman tells her that if the patient knows they're coming, he could hide something relevant. He and Taub walk in the door, but Masters stands in the doorway, not sure if she's ready for breaking and entering. "Are you a vampire?" Taub asks her. "It's okay. We're inviting you in." "But our patient didn't. I can't do this. I'm sorry." And Taub and Foreman go inside.

Taub continues to complain about Masters while they rifle through Joe's kitchen drawers. Foreman says they should give her a chance: she's fresh, with no baggage, and no bad habits they have to re-teach. Taub whines that since she's not a doctor, one of them will have to supervise every procedure she does. But Foreman thinks he knows the real reason Taub doesn't like her: "Is this attitude about her not having an M.D. after name? Because I wonder if it has more to do with her being a brainiac. I'm not thrilled someone else might be the smartest person on the team now. I can only imagine how you feel." And just then he finds what might be causing Joe's problems: a jug of unpasteurized cider.

Back at the hospital, Foreman tells House the cider could be tainted with E. coli, causing Joe's liver to shut down. And Taub wastes no time tattling to House about Masters' refusal to illegally search Joe's house. "What is your problem with her?" House wants to know. Foreman reiterates his claim that he's intimidated by her intelligence. "Why would that bother Taub? He's been working with people smarter than him for a long time." No, House thinks it's just that "perky, new girl" is making Taub feel old. As for Joe: House orders aztreonam and plasmapheresis.

Taub and Masters are preparing for Joe's plasmapheresis, and Masters wants to tell Joe about the break-in. They couldn't tell him before because he might hide something, so now there's no reason not to, right? But Taub says no. She doesn't understand. "How can we ask our patients to trust us, if we're not honest with them?" Taub points out the flaw: "How can we ask the patient to trust us, after we tell him he can't trust us? Fine. Tell him. Clear your conscience. Because that's what's important."

Joe is still trying to manage the senator's campaign from his hospital bed, dictating talking points via two cell phones. Masters advises him to slow down, but he says it's a busy week. Awkward silence and glances between Taub and Masters. Will she tell Joe? "Aren't you curious how we came up with this diagnosis?" But it turns out Joe already figured out they must have broken in to his house, and he doesn't seem to be too bothered. "Medicine's like politics. At the end of the day, all that matters is results." Masters rejects that, saying integrity, honest, and respect matter, while both Taub and Joe give her a condescending smile. "Have you ever thought about running for public office?" Joe asks. "Because I would love to have someone like you . . . as an opponent." As Masters launches into a speech on diminishing American voter turnout, Joe suddenly drops both phones, paralyzed.

In House's office, Chase wonders if it's a transient ischemic attack, and maybe the clot broke up before they could find it. Joe was temporarily paralyzed, but he's regaining mobility and speech. House wants to know what causes rash, liver failure, and clots - and why Masters tried to rat out Taub and Foreman. "I was clearly trying to honor my ethical obligation," she tells him, and continues with the differential. "Portal vein thrombosis could be caused by Wilson's disease." House congratulates her on her first diagnosis by throwing confetti all over her. "Hooray! You popped your cherry. Diagnostically speaking, of course. Unfortunately, first time always sucks." House says it's not Wilson's. A neuroendocrine tumor? Doesn't make sense without a diminished mental capacity or loss of judgment, Taub tells her, and suggests disseminated intravascular coagulation.

House isn't done berating Masters for her behavior: "Rules are just helpful guidelines for stupid people who can't make up their own mind. You obviously don't fit into that category, so why put yourself there?" Before she can answer, Chase tells them she's right about a neuroendocrine tumor - if you factor in the inflammatory, anti-immigrant ad that he wanted the senator to run, which was just leaked online, as a "loss of judgment." "You're arguing Dugan's politics are a sign that he's mentally compromised," Foreman asks. But no, Chase is saying his tactics suggests the mental impairment.

With two potential diagnoses, House orders a CT from Joe's neck to his abdomen to look for neuroendocrine tumors, and a D-dimer and fibrinogen to check for disseminated intravascular coagulation. One last question for Masters: "If lying to a patient would save their life, would you do it?" She tells him no, and he says she's lying. "If your grandma gave you a really crappy tea cozy for Christmas, would you tell her you liked it?" She says that's different. "So you lie when it doesn't matter, but you won't when it does. How'd you get so screwed up?"

House finds Cuddy in the hallway and asks how mad she'd be if he fired Masters. "Very. Unless you had cause. Real cause. Cause that a human being would consider cause." House gives up on that, but still wants to complain about her. "She's got principles. She's like the love child of Einstein and Mary Poppins." Cuddy says it'll do them all good to have someone around who doesn't see the world in shades of gray. "I gave this a lot of thought. She deserves a chance. A real chance."

"House is gonna fire me." Masters is pacing in Cuddy's office when she arrives. Cuddy reassures Masters her position is safe, but Masters is convinced it's not going to work out. "I'm not good at working with other people," she tells Cuddy. "Growing up, my whole life, really, I spent a lot of time by myself. No one in high school wants to hang out with a kid who's three years younger than them." But Cuddy points out that she chose medicine, a team activity, a bold move outside of her comfort zone. Cuddy really wants her to stick it out, at least for this case. "House doesn't care if you're a team player, or how ethical you are, or how high your IQ is. It's all about the cases. You help him crack this one, you two are going to get along just fine."

Foreman and Chase are watching Joe's CT. Foreman thinks they should give Masters some tips on working with House, but Chase thinks the entertainment value outweighs that option. "Like watching a bunny hop into a buzz saw. Repeatedly." Joe, meanwhile, is ready for them to admit they're wrong: "This tumor you're looking for, you're not going to find it. My judgment is completely sound." Chase is still skeptical. Was he trying to damage Anderson's campaign by leaking the ad? Joe won't cop to leaking it, but he says it will actually save Anderson's campaign, not sink it. "That commercial, everyone sees through it," Chase tells him. "You're just trying to play to people's fears." Just because Moreno favors amnesty-" "He doesn't," Joe says. "You know that picture of him with the Mexican flag, that seems to be from a pro-amnesty rally? That's from an Amnesty International speech, protesting the imprisonment of priests in Oaxaca. Yes, you did just prove that that ad is even more disgusting than you thought. You also proved that ad is effective. Do you still think my judgment is off?"

But Foreman says there's no tumor, which just leaves the DIC. He finds Taub still poring over blood tests: "I guess when you get on in years it takes a little longer to run a few simple blood tests."

"This whole 'Taub is an old man thing' kind of rings hollow considering I'm in better shape than you are," he says, challenging Foreman to a basketball game after work.

Back in Joe's room, he's talking with the senator about the leaked ad. He knows it was the senator who leaked it, since there were only two copies. "I don't care that you did it. I just want to make sure it worked." Apparently it did: "This morning's tracking has me within two points," Anderson tells him. Foreman and Taub arrive to tell Joe that the DIC test was negative, but maybe he was exposed to a toxin while campaigning. They start listing campaign stops when Taub notices that there's blood in his catheter bag. His kidneys are failing.

"So this guy spends his entire life campaigning against bleeding hearts, and it turns out he has one." House leads the continuing differential back in his office. Masters helpfully points out that bloody urine is a kidney issue, not a heart problem. "Yeah, if I say something inaccurate, assume it's for comic effect. Then laugh. Because it's funny." House thinks TTP makes sense, but Chase says Joe's platelet count is normal. Masters suggests Henoch-Schonlein purpura. Taub tells her HSP doesn't cause clots, but Foreman says that it can - and the vasculitis would explain the kidney problem. When Masters says they treat with chemotherapy or steroids, House objects. "We treat with chemotherapy."

Masters is confused. "I said chemo.""But then you said 'or.' The road to dead patients is paved with 'ors.' Chemo is the more effective treatment, which means it will confirm our diagnosis more quickly.""I agree, but there is another option.""There are lots of other options. There's bloodletting, crystals, prayer . . .""Another medically accepted option.""Which is both less effective and less scary, so the patient might just choose it. Unless of course we don't mention it him.""We can't withhold information. If we explain both the benefits and the risks of each treatment I'm sure Dugan will choose chemo."

But, as House predicted, when given the option, Dugan chooses steroids. Anderson begs House to try and persuade Joe to take the chemo instead. "Would that I could. But ethics dictate that it's his decision. So all I can do now is return to my office, knowing that even as my patient endangers himself, my integrity remains unblemished." Joe is adamant. He wants to start on steroids right away.

On the basketball court, Taub and Foreman will play to 11 by ones. Foreman is so confident that he's going to beat Taub that not only does he let him have the ball first, but he lets him shoot (and make) two shots from the free throw line uncontested. Maybe Taub isn't so out-of-shape after all. They battle for shots, back and forth, until Foreman is up 10-7. Foreman maneuvers past Taub for a layup that bounces around the rim . . . and then falls through the net. Taub can't believe it. "Seriously, you're going to beat me with that?" But they're both gasping for breath at this point. "I was wrong," Foreman says. "You're not so old. Now all we have to do is figure out why Masters is making you feel insecure."

Masters bursts into House's office to tell him she saw that Dugan was about to be administered the wrong medicine. "The wrong medicine is the right medicine," House tells her, and she catches on. Masters threatens to tell Dugan that House disobeyed his wishes, but House stops her. "I don't mind your morality in theory. But in practice you're risking my patient's life. So you're fired." And if she tells Dugan, he'll get her thrown out of medical school, any way he can.

Later, in House's office, Foreman tries to convince House that firing Masters was a mistake. It's good to have someone around to keep them all in check. "We're like the frogs who've been in the pot for a while. We're used to the heat." But Taub argues things have been going fine without "Pippi Longdivision." Chase tells them Dugan developed pulmonary edema, which rules out HSP. Maybe an infection? Schistosomiasis? Except Dugan hasn't been out of the country in years, House points out. "Who needs to travel when you've got a giant fish tank, loaded with tropical fish, tropical snails, carrying tropical bacteria, like schistosomiasis." House tells them to go to Joe's place and bring back some samples.

Cuddy has called Masters and House into her office. House argues that he gave her a chance, but she endangered Joe's life. Masters defends her decision to insist he receive the treatment he asked for. Is Cuddy going to make House keep her? Both House and Masters know that won't work. Masters starts to cave, but Cuddy stops her: "You will not quit this job!" House can't believe it. He wants her gone, and Masters wants to leave, so why does Cuddy care? "She's a potential star, and I want her in my hospital." "No problem, House says as he walks toward the door. "Just find her a different department."

At Joe's, now Chase has a theory about Taub's dislike for Masters: she was totally moral and uptight, which made Taub feel bad about his cheating. Foreman says he didn't like her from the moment he saw her, so that can't be it. No snails in the fish tank . . . but they see a light flicker toward them.

House picks up the phone in his office: it's Foreman. House wants to know what they found, because Dugan's going downhill. Fluid is collecting in his chest. But Foreman isn't calling with clues to Dugan's condition. He's calling because the three of them are in jail and want to know if House will bail them out. House tells Foreman he's busy and hangs up.

House finds Masters in a doctors' lounge, reading while the television shows a press conference from Senator Anderson about the leaked ad. "There you are," House says. "I was starting to think that my 'holier-than-thou-dar' was malfunctioning. Our patient's liver, kidney, and lungs are failing. I need you to help me figure out why." She gives him a hard time about the three doctors he hasn't fired today, but House informs her they're in jail . . . for prostitution. She gives in. "It all started in the liver, but where in the liver? If in the ducts then primary biliary cirrhosis -"

"Yeah, I don't need to hear your ideas. Just return the volley. Primary sclerosing cholangitis."

"Nope. His vitamin A level is normal."

"Gallbladder problems can affect the liver. Cholecystitis?"

But Masters is distracted by what she sees on the television. "Shhhh. He's talking about our patient."

". . . and thought he was a friend," Anderson is saying, shaking his head ruefully. "That is until he leaked this hurtful, hateful ad."

"I think he's lying," Masters tells House.

"Dugan violated my trust. And therefore I have no other recourse than to fire him from my campaign."

House watches Anderson wave on the monitor and has an idea. "Thanks for your help," he tells Masters. "Oh, and you're fired again."

House confronts Dugan about his boss's treachery. "He screwed you."

"It was a hell of a move," Dugan says. "Use the ad to shore up the base. Fire the extremist. Hold the center."

But House meant something else altogether. He noticed a red blotch on the senator's hand when he raised it: palmar erythema. And he was sweating heavily. House says the senator has hepatitis C, which would explain all of Dugan's symptoms as well. But Dugan denies ever having sex with Anderson, and denies ever having done heroin with him. The only other way he could have contracted it would have been by sharing the same straw to snort cocaine. Dugan protests - they tested for hep C when he first came in, and he was negative. House says the cryoglobulins in his liver hid the hep C. And the plasmapheresis got rid of all the associated toxins. "So, basically you've got a disease but there's no way to prove it. It's pretty cool, huh?" House injects him with interferon.

Meanwhile, Foreman, Taub, and Chase are waiting for Taub's lawyer, who promised Taub he'd be there "soon." Foreman thinks he's cracked the case of Taub's animosity toward Masters: he knew her already. Both Foreman and Chase assume it's something related to sex, but it turns out Taub interviewed her a few years ago for over an hour when she applied to Hopkins medical school, and she didn't remember him. "She remembers the 20th digit of some math constant, but she doesn't remember a guy she had a one-on-one meeting with."

"Great news! I've decided to re-hire you." House catches Masters as she's leaving for the day. Dugan isn't responding to the interferon. But she's not interested in being his sounding board. "Stop pretending you're not going to do this. As much as you hate me, you hate failing more."

"I didn't fail," she tells him. "You fired me, repeatedly."

"But if you walk away now, after I just re-hired you, that's quitting."

She's almost out the door, but turns around. "A German research study showed that 15 percent of patients with hep C were cured after contracting hep A. Of course, other studies have shown that up to 85 percent of doubly infected patients die very quickly. So, in theory, if we can find something that mimics hep A -"

House says there's one thing for sure that mimics hep A: hep A. And then he fires Masters again. Only this time she says no, and they both end up in Cuddy's office. House says the hep A can cure him, but Cuddy knows it also can kill him, to say nothing of the fact that it's not an approved treatment and exposes the hospital to liability. "That's an extremely cowardly position," Masters tells her, to the shock of both House and Cuddy. She wanted House to run the procedure by Cuddy, but doesn't want to compromise patient care just to avoid lawsuits. House is liking her more and more. Cuddy says if House really believes that's the only way to cure him, she'll go along with it, but they've got to be able to prove that he actually has hep C. House tells her he can't. "You'll figure something out. The two of you have a combined IQ north of 300." He's unimpressed. "That's also true of five morons." They leave Cuddy's office.

"So what do we do now?" Masters asks him. "Considering the fact that I'm about to do something unethical . . .""Oh, right, yeah. I'm fired."

Back in House's office, he tells the men to come up with a false-positive hep C test. Chase says if they just test Anderson and he's positive, then that probably means Dugan has it, too. But House knows that won't be proof enough for Cuddy. Taub says one in every thousand hep C tests is a false-positive, so if they hit him with enough tests, maybe they'll get lucky.

It's getting late in the evening, but Wilson is still in his office when House drops by. "I have lied to Cuddy 10,000 times. How do you think she'd feel about 10,001?" Wilson says he already knows the answer to that. "You have two choices: be honest and face the medical consequences, or lie and face the personal consequences."

The next day, House is drawing blood from the senator in the clinic. He assures Anderson he won't tell anyone about the hep C, and he'll run the blood test under an assumed name. "Trust me, no one will ever know you were here." House has written Dugan's name on the blood vial.

House presents the positive hep C results to Cuddy. "Thank you," she says. "There was a time when you would have completely ignored my request. It means a lot that you respect me enough to do this." She believes House. "Now if you would only hire a new team member." "I'm on it," he tells her.

House finds Masters in the cafeteria. "How'd you like to come work for me?" He knows she wants to work for him, and if she can prove herself, then there won't be any more games. Or, at least, this game will end. Others may start. "You have my deeply flawed word." All she has to do is get Dugan to agree to let them give him hep A. And don't mention the part about the 85 percent mortality rate for the treatment. But she doesn't want to lie to him.

"You have a math degree, so let's see if you can follow along here. You lie to him, he definitely consents, he might live. You tell him the truth like last time, he might not consent, and he definitely dies. Remind me: what's so wrong about lying?"

She and House go to Dugan's room. She tells him that in some people hep A clears out the hep C. Dugan wants to know how many "some" is. She tells him a fair amount. Dugan wants a percentage. Backed into a corner, she tells him there's an 85 percent chance it will kill him. He protests, but she tells him this is his only shot, and both she and House believe that. "He faked a blood test in order to get you approved for this treatment. And then he tried to bribe me into lying to you about the risks. If either of those incidents came to light, he would be suspended, and probably lose his license . . . he's risking his career to give you this chance. He wouldn't do that if there was any other choice." Dugan consents.

"I did it," Masters says to House, as they walk out of Dugan's room. "And I didn't have to lie."

"And you feel good about that?""Yes""So I'm hiring an idiot.""You can pretend you wanted me to lie, but you didn't. You want the people on your team to challenge you; otherwise you'd just be a bully instead of a great doctor. You hired me because I don't compromise my principles."

"Or, I want a front-row seat when you wake up and realize how useless your principles are," House replies. "I don't want you to just lie to a patient. I want you to want to lie to a patient."

"It's not going to happen."

"See you tomorrow."

Masters walks into the doctors' locker room and finds Taub. "I hear Dugan is already responding to treatment." He starts to apologize for the way he's been treating her, but she interrupts him. "You interviewed me, right? For Hopkins?" Taub pretends he's just now realizing this. "Wow, that memory of yours." "I wanted to say something the first day. I felt really awkward about the whole thing." Taub is clearly relieved, but then thinks for a second and, almost under his breath: "Is this grandma's tea cozy?"

House officially hires Masters, with Cuddy watching him sign all the medical school paperwork. Meanwhile, Dugan watches newly re-elected Senator Dugan on television, thanking the voters. "We ran a positive campaign. A campaign about the dire issues facing this great nation." Dugan smiles. "There are many people who gave their all for this campaign. But there is one person that stands out among them . . . my beautiful wife, Loretta."

In the clinic, a nurse stops Cuddy and asks if she knows where the senator's records are. Cuddy tells her House was treating the campaign manager, not the senator. Why did she think the senator was the patient? She says House saw him in the clinic. Friday, around 3. The same time House ran a test on "Dugan's" blood that came up positive. Cuddy knows what House did. "Is everything OK?" The nurse asks Cuddy. "I don't think so."