House M.D. Episode 7.08 Small Sacrifices

Ramon Silva struggles up a desolate hill carrying a heavy wooden cross on his back, praying to himself, followed by a small procession of men. They stop, and Ramon lies down on the cross and allows the men to tie his hands and feet to it. One man places a giant nail in the middle of Ramon's outstretched palm, and raises a hammer. He's hesitant, but he slams down the hammer. Ramon's body arches in pain, and another man hammers a nail in his other hand. Slowly, the men lift the cross and Ramon, impaled, is upright and facing the blazing sun. He's in agony, but he smiles . . . and starts spewing blood from his mouth. The men look at each other, frightened. "Get him down!"

"What have you got against chickens?" House greets Cuddy as he walks into the hospital. "One got choked last night thanks to you."

"33-year-old male with hemoptysis, fever . . ." Cuddy is all business unless House is ready to apologize for lying to her about a previous patient, something he has no intention of doing.

"Puncture wounds are from a crucifixion." That gets House's attention, but he'll take another shot at defending himself: "I lied to save my patient's life. I didn't lie to you; I lied to my boss . . . either of those arguments working yet?" Nothing. He and Cuddy begin to walk their separate ways, until he says "Guess I don't have to go to the wedding on Saturday."

The prospect of House bailing on accompanying her to the wedding of the hospital's chairman of the board turns Cuddy around. "I'm not going to stand him up," she says. "And neither are you!" House continues toward the elevator, telling Cuddy he loathes weddings and their "seven levels of hypocrisy, but since there's a chance he might be able to get her drunk enough to have sex with him, he'll agree to go as long as Cuddy doesn't consider it an admission of guilt. "Bit too much honesty?"

Upon entering Ramon's room with Chase and Masters, House already has a theory to run by Ramon and his daughter, Marisa: "Either you're crazy, or you're atoning for something naughty and you're crazy."

Ramon begins his story. "I'm not atoning for anything. Marisa was diagnosed with terminal brain cancer, Stage IV glioblastoma. When the doctors said she had two months to live, that's when I made my bargain. With God. I told him I would nail myself to a cross every year he kept her alive."

House isn't seeing any reason yet to abandon his "crazy" theory. "So how did that negotiation go? You low-balled with ear-piercing and God countered?"

But Ramon is undeterred. "Three weeks later, she was cancer-free. And that was four years ago."

"Pontius Pilate: misunderstood oncologist," House responds.

Ramon's heard the skepticism before. "My ex-wife thinks I'm crazy, too," he tells House. "She moved out the first time I did this."

House is glad Marisa has at least one reasonable role model in her life. Marisa wants to know if House believes in God. "I did, but then I grew my curly hairs." Then how was she cured? House's answer: she was misdiagnosed in the first place. "Causal determinism: we are hard-wired to need answers." But the problem, House says, is that when there's no logical answer, humans will settle for stupid ones. "Ritual is what happens when we run out of rational."

Former seminary student Chase has had enough of House: "If you're done mocking him, we need to prep for an LP." House thinks it'll make God's day to see Ramon with another hole in him.

When Wilson opens the door to his office to begin his work day, he finds House at his desk. House wants to know why Wilson's late. And whether a Stage IV glioblastoma could disappear in three weeks. Wilson says he hit a piece of rebar on the way in and got a flat tire, and it's highly unlikely Marisa's cancer could have disappeared that quickly. House isn't buying the flat tire story at all, and says he thinks Marisa actually had a misdiagnosed cyst. Wilson is sticking with the flat tire story, despite House's skepticism. And he says there's a possibility Marisa had a spontaneous remission. House wears him down on the flat tire story and Wilson caves: he was late because he was buying an engagement ring. "I'm going to propose to Sam at the wedding." It's immediately evident why Wilson chose to keep this news from House. "That is the second-stupidest thing I've heard today. You don't need to buy her a new ring. Isn't the first one good for all-you-can-marry?"

Wilson chooses to deflect by bringing the topic back to House's own stupidity: "I assume you haven't apologized to Cuddy yet?" Wilson tells House to apologize even if the apology is a lie. "There's a lovely symmetry to it. A lie got you into it; a lie gets you out of it." And that gives House an idea . . .

Meanwhile, the team is in the lab running tests on Ramon and talking about the upcoming wedding. Except Taub, who has other things on his mind. "What's it mean when somebody takes their cell phone into the bathroom when they're taking a shower?" Foreman provides the somewhat obvious answer: "Means they don't want you to check their calls, emails, or texts?" And Chase piles on: "If you're talking about your wife, it means the chickens are coming home to roost."

Only Masters is confused, so Chase fills her in on Taub's repeated, supposedly past, infidelities. And there's more. "She has a meeting today at 1:30, at a hotel," Taub tells them. "I'm going with the chicken thing," Masters says, under her breath, before announcing: "Negative for toxocara, bacteroides," and everything else they tested for. "So," Chase wonders, "what looks like an infection but doesn't test like one?"

Taub thinks maybe it's related to animals. Ramon works in a timber mill, specializing in stables, barns, and stalls: rhodococcus equi, helped by the open wounds from Ramon's yearly crucifixions.

Taub and Chase inform Ramon of their findings, and tell him it's easily treatable with antibiotics. "Does it make your teeth fall out?" Ramon wants to know. And he holds up an incisor between his fingers. Back to the differential.

"Fever. Coughing up blood. Coughing up teeth. Either God sweetened the deal with a no-flossing clause, or . . ." House is waiting for the team to come up with something. Radiation sickness? Kaposi's sarcoma? "Heavy metal poisoning fits," Chase says. "Canned tuna, sushi, lead paint." House orders the team to search the home and test Ramon. But Taub begs off.

"I can't. I have a . . . personal errand to run," he tells House.

"Trying to catch your wife cheating?" House asks.

"Why would you say that?"

"Missing mojo, posture's slumped, expression defeated, didn't try to back up your theory and Chase told me. Go. Find your mojo."

House finds Cuddy at the nurses' station. He's dressed oddly. In a dark suit and tie, looking uncomfortable. He wants a patient file - but not Ramon's; he wants Marisa's file.

"Ask your patient," Cuddy tells him.

"He thinks I only want it to debunk his faith," House says.

"And why would he think that?"

"Because he's strangely perceptive for an idiot."

But Cuddy isn't going to violate patient confidentiality, and why is House dressed like that? House says that it's his "dressy casual," so he can attend the wedding rehearsal dinner with her. "What do you think?"

"You look like Wilson. It looks weird," she says, and House seems dejected. "Well, you knew I'd think that. Which makes me wonder why you look disappointed." It doesn't take her long to figure out House's plan. "You knew I wouldn't like it, but you thought I would say I liked it. That's what this is about. You're trying to trap me into lying to you." So much for that.

Chase and Masters are searching Ramon's place. Is Masters OK with breaking and entering now? She tells Chase she asked Ramon's permission. "The reason we don't ask permission is we're afraid the patient is going to hide something. But our patient hasn't been home, lives alone, doesn't have any help, and he has no motive to hide anything."

In fact, Ramon's apartment is nearly empty. No canned tuna, no sushi, no computer, no television. But there's a Bible. Chase and Masters debate the medical efficacy of prayer, until Masters finds a photo of Ramon and Marisa, but in the picture Ramon is significantly thinner. "I guess worry is good for the waistline," Masters says. But Chase, eyeing the lack of any real food in the apartment, has another theory. "It's not worry. It's starvation. His tooth didn't fall out because of heavy metal poisoning. It fell out because of malnutrition. That means Taub was right about the rhodococcus equi after all, he just didn't know why.

House walks to Wilson's office, which, strangely, is locked. Wilson says he's busy, but when it becomes clear House isn't going away, Wilson lets him in. "Cuddy got me the daughter's file," House says. "Well, not Cuddy exactly. Her signature. Well, not exactly her signature." He wants Wilson to look over the file, but Wilson can't, because he's busy reviewing Sam's files in preparation for a review she has scheduled at her hospital with her supervisor. If he doesn't help her get ready, then she can't go to the wedding, where Wilson plans to propose. "And now you have 60 seconds to berate me for that, and for helping my girlfriend with her homework."

"You don't want to propose at a wedding," House says. "Emotions running high, people on edge. You want to try somewhere like a Buddhist temple. Or an aquarium. Or a Buddhist aquarium. That only took ten seconds. You can spend the rest of the time on my file," he tells Wilson, as he walks out the door.

Taub beats his wife home so he can check her laptop. But he only beats her by about ten seconds because she walks in while he's doing it. "Hey, uh, you left your laptop on," he says.

"Saw you today," Rachel tells him, not seeming angry at all. "At the hotel. Were you checking up on me?" Taub admits that he was, and when she asks him if he's satisfied, he says yes. But doesn't she want to know why this all started? "That makes me think you don't want to talk about this, which makes me think . . ." Rachel interrupts to tell him he's being paranoid, so Taub tells her he saw her take her cell phone into the bathroom that morning.

"I made a new friend. Online. In a support group," Rachel tells him.

"A guy?" Taub asks.

"Yes.

"A support group for what?"

"For people with unfaithful spouses."

Back at the hospital, Masters wants to know why Ramon didn't tell them he was starving himself. He says he wasn't really doing it on purpose; he's on a tight budget and he thought his diet was OK. Masters says that he seems to be feeling much better than before, at least. "Not really, my legs are killing me," Ramon says. But he's smiling. He tells her on a scale of 1-10 his leg pain is about a 9 1/2, so why is he smiling? "I'm not smiling," he tells Masters, smiling.

"Leg pain and pseudobulbar affect. He's feeling one emotion while unknowingly expressing another one." House and the team surround Ramon's bed. "Classic case of 'neurohycatia.' Two days of anticholinergics, and you'll be walking out of here," House says. "Really?" Ramon asks. "No, I just made that up to see your reaction. Diagnostic test." Ramon smiles and laughs.

"This is awesome," House says. "33-year-old carpenter presenting with narcissism, delusions of grandeur, hallucinations." Taub points out that Ramon hasn't had any hallucinations. "I'm not talking about him. I'm talking about Him, with a capital OMG."

"You want us to do a differential on Jesus?" Chase asks. Masters is up for it. "Hears voices, thinks he's the son of God - probably schizophrenic." House is suggesting that Ramon's religious extremism is actually a symptom. Foreman agrees a neurological disorder would explain his delusions. House orders an MRI of his brain. "Let's see if we can find God."

Cuddy's heard that House got Marisa's file. "I forged your signature," he tells her. She reluctantly thanks him for his honesty, but House has something else on his agenda: her upcoming 45th birthday. Except it's her 43rd birthday.

"43? Are you sure?" House asks.

"Very," she says, as they enter her office.

"How could I make such a mistake . . . in reading your HR file? Oh no, wait, I didn't. And boom goes the dynamite! Scores are tied, we are even steven."

"You're right. I did lie. To HR, not to you. When I first applied for the VP admin job I was 29 years old. I knew I'd be taken more seriously if I were in my early thirties, so I added two years to my age."

"You lied to make yourself OLDER? Were you lying about being a woman?"

"Even if you can trap me, do you think I'll suddenly embrace the value of lying?"

"My point is you already have. I just need to prove it."

Chase, Masters, and Taub are performing Ramon's MRI, and Taub tells them there's nothing to do with chickens roosting going on at home; his wife met someone in a support group for cheating spouses. "I've heard of that group," Chase says. "It's called irony." Is she cheating on her spouse with someone from a cheating spouse support group?

But then Masters finds multiple dense legions on the MRI of Ramon's brain. "It looks like MS," Chase says. Could the MS have been hiding behind the malnutrition? "MS attacks the immune system. No system, no symptoms," Chase says. But now that they're feeding him he's got both his system and his symptoms back.

House is adjusting the IV bag in Ramon's room. "How are you feeling?" he asks Ramon. Ramon laughs, smiles, and then hoarsely answers "terrible."

"Obviously," House says. "Where are your friends? Still casting lots for your clothes?" But Ramon says all he asks of them is that they pray for him. House tells him he has lesions in his temporal lobes, and when that happens people tend to have strange experiences. "Like hauntings, alien abductions, past lives . . ."

"Deals with God?" Ramon asks. "You didn't come to see if I was better. You came to see if your medicine has turned me into an atheist." Ramon tells him faith isn't a disease. "No, of course not. On the other hand, it is communicable and it kills a lot of people." Suddenly Ramon starts coughing, but when House brings him a glass of water he's unable to take it. He can't move his arms.

House is being fitted for a suit in his office, while the team reviews Ramon's case. Chase doesn't think it's MS, but Foreman says paralysis is a symptom of MS, along with leg pain and pseudobulbar affect. But he's getting worse on the prednisone, so Chase thinks it can't be MS. AVM? Cerebral infarction? House says he has MS, "but not the friendly, Mr. Rogers MS. This is the weird guy in the panel-van kind." Marburg MS.

"He'll be dead in two to three days at the most," Masters says. House agrees. "That's unless we can get someone to nail themselves to a cross as soon as possible. Or, stem cell treatment." It's an experimental but promising treatment, their best shot.

"It would be," Chase says, "if it wasn't embryonic stem cell treatment." He doesn't think Ramon would ever consent to that. House is a little annoyed that Chase would say that in front of Masters, because now there's no way of tricking Ramon into doing it, but he orders them to confirm Marburg.

Wilson again is surprised to find House in his office, reading his files. Wilson says Marisa's case checks out. Her type of cancer doesn't usually respond to chemo, but they gave it to her anyway and just got lucky. "So," House says. "Either God intervened, which is a lazy explanation. Or we just don't know why, which is no explanation."

But Wilson is fine with no explanation as long as he can get his files, chair, and desk back. House gets up, but tells him, "Your woman is fudging the facts. In five of those cases, the stated doses don't explain the radiation damage." Wilson says sensitivities vary, but he knows they don't vary by that much. "I asked her, point blank, about this. She said the dosages were accurate, and that she had done nothing wrong."

House says that morally she didn't. In each case, the patient was terminal, and she increased their doses to try to save their lives. "She's a sap, but she's perfect for you."

"I hate rehearsal dinners almost as much as I hate weddings." House is thumbing through a magazine in a chair while Cuddy finishes getting ready for the dinner. "The only reason these two are getting married is to throw an obnoxious gala to make the rest of us feel unworthy. Even though we know in two years the lawyers are going to be fighting over the Bentleys."

"That'll make a lovely toast," Cuddy says.

"She's got looks, he's got money. One of them is bound to run out."

"I give it 19 months," she says.

"That's very specific."

"No-fault divorce in New Jersey requires couples to live at least 18 months apart. I'm actually only giving it a few weeks."

"Woah. I thought I was supposed to be the dark one."

"Not today."

But just as they're at the door, House's phone rings. Ramon is refusing treatment. "And you care?" Cuddy asks. "No, but it's an excuse you can't argue with." She'll have to go stag.

"Accepting this treatment is an insult to God. I can't expect him to keep our deal." Ramon is adamant. House points out that technically he already broke their deal; blood tests revealed loads of ibuprofen. He's not really suffering like Jesus did.

"He didn't take myrrh, the Tylenol of ancient Rome. And his nails went through his wrists, not through his palms. Palms are for sissies. And what about the 39 lashings, and the beatings, and the crown of thorns? What you go through is closer to a bad manicure than a crucifixion."

Ramon says it's not about the pain, it's about showing God his faith. "If he asks me to die for my daughter, I'll do it gladly." House thinks he's just worried that if they find a cure, it'll cost him his faith, and he'll be like everyone else.

"Alone and afraid"? Ramon asks. "You're right. I don't want that."

"He needs to see his daughter," Masters tells House after they leave Ramon. "He needs to see 'Inherit the Wind,' " he tells her.

But Masters has an idea: "And tell her he's dying because God doesn't want him to take his medicine."

"Get her in here," House says.

"You don't have to die," Marisa tells her father. "Not if you take their medicine." He says it violates God's laws. "But God doesn't want you to die! He doesn't want anyone to die. He's all about love."

Ramon thinks her outburst is coming from her mother, but she says it's all her. "I'm the one who almost died. I know what it's like. You're my daddy, you can't die." Ramon just smiles at her and says "I wish I didn't have to."

"You don't have to, daddy! Just take the medicine! You always tell me to take the medicine, please!" Marisa cries. Ramon tells her one day she'll understand. "I'm never going to understand that. If God could do this, I hate God." Ramon laughs and smiles at her.

Chase and Foreman are at the wedding bar. Chase is having a great time girl-chasing, but Foreman isn't interested. "I'm not here to be your wing man," he tells Chase.

"I'll be your wing man this time."

"I didn't come here to get laid either."

"Then don't. Talking to beautiful women isn't nearly as interesting as watching Taub not talking to his wife." And off Chase goes.

Sure enough, Taub and Rachel appear to be having a perfectly miserable time. "I went through your emails," Taub tells her. "There's nothing in there that's inappropriate. We're friends, Chris." She can tell him things that she can't tell Taub. But Taub doesn't understand. Why can't she tell him about her new job, or coloring her hair, or how she felt when her mother died?

"I want to know those things," Taub says.

"He's easy to talk to," she tells him. "He's open and honest. He makes me feel safe." Taub says it sounds like an affair. But he lives in Oregon and Rachel says she's never even met him.

"You are having an affair. An emotional one," Taub says. Rachel can't believe he's equating what she's doing to what he's done. "I've done terrible things to you, and I deserve all of this, and more. But you can't pretend that what you're doing isn't hurtful." Rachel walks away.

House and Cuddy are talking on the dance floor. He tells her she looks stunning. "Just to be clear: this whole little act isn't going to work. I need an apology, not flattery," she answers. House says it's not an act and he's discovering a love for weddings he never knew he had.

Chase has persuaded Foreman to mingle with two ladies near the chocolate fountain. It's his turn to be wing man, telling them Foreman is his boss. One lady in particular is impressed, and Foreman leaves to get her a drink.

Masters is in Ramon's room. "I'm sorry about your daughter," she says. "I never meant to hurt her." Ramon says he was as surprised as Masters was that Marisa couldn't change his mind. "I didn't tell you the truth, when I said I'm not afraid to die," he says. Masters repeats his belief that he's going straight to heaven. "That's what I believe, but I'm human," he says. "So you know you may be wrong. How could you do what you just did?" she asks him. "It's why we have beliefs. So we can still see the right thing to do. When we're blinded with doubt and fear, our beliefs define us. If we lose them, who are we?"

Taub finds Rachel and apologizes. She says she's not being selfish. Her friend makes her feel better about herself and their marriage. But Taub says he feels betrayed, and wants her to cut contact with him. She refuses. "Is this revenge?" he asks. "I don't know. But I do know that it's something I need right now," Rachel says. Now Taub walks away.

"What would you wear?" House asks Cuddy. She says she's a sucker for the white gown. "Traditionally, for young, first-time brides," House says.

"Well, I may not be young, but I'll be first time," she says. House cocks a half-smile. "That is a lie." He's caught Cuddy off-guard with his revelation. "You were married before. 1987, for six days. Your knowledge of New Jersey divorce law made me suspicious so I looked it up." She asks if this was all a trap. He'd prefer to use the word "inveiglement," but yes, it was a plan. "The point is I lied to you, you lied to me, I forgive you." And he waits for her to do the same. Instead, she's clearly hurt. "Well played," and she leaves.

"You're tired, aren't you? All those files?" Sam sees Wilson with his head in his hand. He tells her he's just thinking. He looks at the new married couple: "If those two even have the slightest chance of making it, then we have to be a sure thing. And we've already made our mistakes." He gets down on one knee with the ring box in his hand. "And I've come to realize, that I love you even more than I thought I did. Sam will you marry me again?"

She's happy, but shocked. What made him realize he loved her more than he thought he did? Wilson's not sure how to answer. "Everything you've done. Your work, your . . . sense of morality." He draws her in closer. "The five cases," he says. "I not only agree with what you did, I admire it."

But Sam says she didn't do anything. "You already asked me about the files, and I told you the truth," she says. He tells her he's on her side, but Sam can't believe what he thinks she did, and walks away.

By the time Foreman gets back with the drink for his lady friend, she's gone. And her friend is gone, too. Both of them left with Chase. Foreman pours her drink into his and gulps it down.

House, Taub, Foreman, and Wilson are hanging back at the bar as the wedding winds down. House offers a salute to Chase and the "life of the bachelor." Taub says his marriage isn't over. "I thought she'd forgiven me for everything. But all those hurt feelings, they never went away." Suddenly, House has a thought. "I have one more test to run," and he leaves the three of them.

House goes to Ramon's room. "Won't be long now. You'll be staring down the yawning void before you know it." But that's not why he's there. He tells Ramon he ran a PET scan on Marisa. "I was wrong about her. She did have glioblastoma. And she still does. The cancer never went away." He says the CT scans that she gets every year never picked up on the tiny tumors that the PET scan picked up. He ran it twice; there's no mistake. "Looks like God broke your deal. I'm sorry. But I'm also right." "You're a bastard," Ramon tells him. But he also tells House he can do whatever he wants with him.

It's Monday morning, and Taub, Foreman, and Chase are running another MRI on Ramon. House told them to do one every 12 hours. Chase apologizes for abandoning Foreman, but says it was unavoidable; there was a threesome at stake. Suddenly Taub sees something on the screen. "Get House."

House brings in a film to Ramon's room. "Got something to show you. Your daughter's PET scan. It's clean. She's fine. My bad. Got her mixed up with Marion Silver. Marisa Silva - that's believable, right?" Masters is visibly uncomfortable with what House has done. "You tricked me!" Ramon is furious. "God didn't break our deal. I did. You led me into temptation, and I followed." House says God will probably punish Ramon for that, because if he didn't, well, that would make him wonder, wouldn't it? Ramon says he's sure God will punish him.

But House has more to show Ramon. He holds up his most recent MRI results. "It shows incremental improvement. You're getting better. Double-checked the name on this one. But it's not all good news. This patient is screwed," and he pulls up another MRI scan before continuing. "The technical term is 'dead as a doornail.' "

"Who is that?" Ramon asks.

"God," House says. "You broke your deal with him. Your daughter's fine, you're getting better. Nothing bad happened. Which can only mean one thing: there is no God. Of course, if your daughter gets hit by a meteorite today, I would have some serious egg on my face."

Ramon smiles and laughs. House assumes that means he's miserable. On the contrary, "It means I'm happy," he says. "It doesn't mean God doesn't exist. It just means he's truly merciful. My beautiful Marisa was right. God is all about love."

House can't believe what he's hearing. "Punishment is proof of God, and no punishment is proof of God. Ingenious argument." Ramon tells him faith isn't an argument.

House and Masters leave Ramon's room. She wants to know if everyone else knew about his deception.

"Everyone I could trust. So, yes." She knows that if he'd told her, Ramon would be dead, so why does she still want to tell the truth? "Either you're naïve, or you have scruples. I'm not sure which is worse."

Wilson comes home and finds Sam packing. "We had a fight," Wilson says. "We had one fight, and I admitted I was wrong. We can talk about it. We can get over it."

But Sam says it's about trust. Wilson suggests they see a counselor; it seemed to help her after their divorce.

"It did," she agrees. "And I think I changed a lot." "And I haven't?" Wilson says. "This is my fault?" Sam says she knows where this is all heading, and she doesn't want to go there again. "You're quitting, Sam. You're quitting. Again. So I guess you haven't changed that much." Sam leaves, without saying anything else.

"Good work today," Cuddy tells House as he enters her office. "I don't even think your patient's going to sue. Looks like everybody's happy."

House sits down. "I've been an idiot. I got this argument stuck in my head: if everybody lies then trust is not only unfounded and pointless it's fictional. But trust is not an argument that can be won or lost. Maybe I just have to suspend my cynicism and believe. Maybe it's time I took a leap of faith. I'm sorry. I won't lie to you again." "Thank you," Cuddy says.

It's late at night at House's apartment and someone is knocking on the door. It's Wilson: "Sam left me."

"What a moron," House says. "Too soon, I'm still in love with her."

"I meant you," House says. Wilson wants a drink, but House tells him Cuddy's coming over. He tells Wilson he apologized to her. "Good for you," Wilson says, as he gets up to leave. "Not really," House says. "I lied. Just took your advice. Too bad you didn't." "Good for you," Wilson tells him again, and he leaves.