[Opens with a teenaged boy and girl making out on a bed.]

Pam: What d’you say now?

Keith: I don’t know.

Pam: You said your dad wouldn’t be home for an hour.

Keith: I know, but it, it, you know –

Pam: Don’t you love me?

Keith: Of course, you know I –

Pam: Come on.  Let’s do it.

Keith: All right. [They resume kissing.]

Pam: Where are they?

Keith: Nightstand. [Pam reaches over and pulls something out of the drawer.]

Pam: Gentlemen, start your engines. [She waves… car keys!]

[Cut to Pam and Keith, speeding down the highway in a Porsche.]

Pam: I SO want this car!  Woo hoo!!  [They are laughing and shouting.  Keith starts to cough.  As Pam is recklessly passing a car, she looks in the rearview mirror and sees that it is spattered in blood, which Keith is coughing up.]

Pam: Oh my God, you’re bleeding!

Keith: [looking at the road] Look out!  [Pam slams on the brakes, and the Porsche slides under the trailer of a large truck going through an intersection  The car stops on the other side of the road, just in time for a bus to crash into it.]

[Well, that was all exciting!  Opening credits.]

[Cut to Keith’s room in the hospital.  He’s pretty bandaged up.  Pam and Keith’s dad are standing over him.

[Cut to the hospital pharmacy.  House is waiting impatiently; the pharmacist is on the phone.]

House: What lie are they telling you? [Pharmacist gestures for him to wait.]

Pharmacist: [on phone] Okay, yes. [We see that the pharmacy shelves are missing some drugs.]

House: Come on.

Pharmacist: [still on phone] All right, thank you. [He hangs up.]  Okay, pharmaceuticals were delivered this morning, but shipping accidentally sent the box with Vicodin to research.

House:  Hmmm.  That’s a tough one.  If only we had some way to communicate with another part of the building. [He picks up the phone for the pharmacist, Cameron walks up.]

Cameron: 16-year-old MVA victim.  He’s been in and out of the hospital for three weeks with internal bleeding, no one can find the cause.

House: Internal bleeding after a car accident, wow, that’s shocking! [to pharmacist] Let me talk to shipping, I speak their language.

Cameron: It’s been three weeks –

House: [to Cuddy, who is at the clinic desk] Your hospital doesn’t have my pain medication.

Pharmacist: Shipping says it’s going to be an hour. [Cuddy comes to the phone.]

Cuddy: This is Dr. Cuddy, what’s going on?

Cameron: The crash didn’t cause the bleed.

House: Right, the bleed caused the crash.  Blood got on the road, it got all slippery. [to the room] Anyone here got drugs? [everyone looks at him, one clinic patient raises his hand]

Cameron: She saw his blood, she got distracted, and she crashed his dad’s Porsche.

House: Dad loved that.

Cameron: He was –

House: Don’t talk.

Cuddy: It’s gonna be an hour.

House: Well, thank God you took control.

Cuddy: If you can’t wait one hour to get your–

Cameron: Kid’s got hemolytic anemia. [House and Cuddy turn to look at her.]

Cuddy: Kid?  How old? [takes chart]

House: He must have inherited it.  He’s gonna die.  My condolences.

Cameron: It wasn’t inherited.  The problem’s outside the red blood cells.

Cuddy: This is impossible.  A 16-year-old doesn’t get hemolytic anemia –

House: Give her back the file; you have bigger problems to tend to, like my meds.

Cuddy: Elevated indirect bilirubin, low-serum haptoglobin…

House: He’s got meningitis.

Cuddy: [looks at chart] Uh… no.

House: Artificial heart valve.

Cameron: No. [House looks at the chart himself.]

House: Get everyone in my office.

[Cut to the his office.]

House: Kid’s gonna be dead in a matter of days if we don’t figure out why his red blood cells are disintegrating, so differential diagnosis, people.

Foreman: Well, it’s not environmental.  Dad hired a company to clean the house, maid washed all the clothes, and bought hypoallergenic sheets and pillows.

Chase: You want us to recheck?

House: No.  If it’s environmental he’ll get better just from staying here.

Foreman: It could be an infection.

Cameron: No fever, no white count.

Foreman: Well, he’s 99.2.

Cameron: Barely above normal.

Foreman: But above.  His body’s reacting to something. [While this is happening, House is looking at his watch, shuffling papers, resting his head on the clear white board, etc.]

Cameron: We could account for the lack of fever and white count if it’s lupus.

Chase: Drugs’ll fit just as much as lupus.  Meth’ll cause hemolytic anemia.

Cameron: A lot of meth.

Foreman: He also doesn’t seem the type.

Chase: Because his dad drives a Porsche?  Rich kids do drugs just like poor kids.

Foreman: Didn’t mean to offend you.

House: Okay, so it’s infection, lupus, drugs, or cancer.

Cameron: Cancer?

House: Why not?  Great meeting. [He starts to leave.]

Cameron: Shouldn’t we narrow it down before we finish?

House: My leg gave us ‘till 11:15.  I’ll talk to Wilson about lymphoma, [to Cameron] ANA for lupus, [to Chase] radioimmunoassay for drugs, [to Foreman] and you… you test for whatever you thought it was. [He leaves.] I’ve got a date with a pharmacist.

[Cut to Cuddy, in her office.  From her office she can see House impatiently picking up his Vicodin.]

House: Come on, come on, come on, come on… [As soon as House gets the bottle, he dry-swallows a couple pills.  Cuddy catches up to him on his way out the clinic doors.

Cuddy: You know, there are other ways to manage pain.

House: Like what, laughter?  Meditation?  Got a guy who can fix my third chakra?

Cuddy: You’re addicted.

House: If the pills ran my life I’d agree with you, but it’s my leg busy calendaring what I can’t do.

Cuddy: You’re in denial.

House: Right, I never had an infarction in my leg, no dead muscle, no nerve damage.  Doesn’t even hurt. [he presses the button for the elevator]  Actually, it kind of tickles.  The chicks dig this. [raises cane]  Better than a puppy.

Cuddy: It’s not just your leg.  You wanna get high!  You’re doing what, 80 mg a day?

House: Oh, that’s way too much!  Moderation is the key.  Unless there’s pain.

Cuddy: It’s double what you were taking when I hired you.

House: ‘Cause you’re twice as annoying.

Cuddy: I can’t always be here to protect you.  Patients talk.  Doctors talk. [elevator doors open]

House: About how big your ass has gotten lately?  Not me, I defend it.  You got back.  [They walk into the full elevator.]

[Cut to House and Cuddy walking out of the elevator.]

Cuddy: You can’t go a week without your drugs.

House: No, I don’t want to go a week without the drugs, it’ll hurt.

Cuddy: No, you can’t.  If you’re just getting off pain medication, it will hurt, you won’t be having a great time, but you’ll make it.  If you’re detoxing you’ll have chills, nausea… your pain will magnify five, ten times.  You won’t make it.

House: Well, I guess we’ll never know.

Cuddy: I’ll give you a week off clinic duty if you can go a week off narcotics.

House: No way!  I love the clinic.

Cuddy: You love the pills.  Two weeks.

House: Pills don’t make me high.  They make me neutral.

Cuddy: A month.  [A pause.  House reaches into his pocket and pulls out his Vicodin.]

House: You’re on, mister. [He throws the pills to Cuddy, who looks positively giddy.]

[Cut to Cameron, who is taking a family history from Keith’s dad.]

Dad: Drugs could cause this?

Cameron: Cocaine and meth are very hard on the blood system.  Has he had any erratic behavior?

Dad: No, but… [looks over to where Pam is sitting by herself] She was in rehab in the 9^th grade.  She’s supposedly clean now, but –

Cameron: She obviously cares for him.

Dad: Yeah, what she cared about was the car.  Anniversary present from my wife.  We drove it up north to watch the leaves change.  She was dead a year later.  Cancer.

Cameron: I’m sorry.  Mr. Foster, we’re going to test Keith for drugs.

[Cut to Chase with Keith.]

Keith: I don’t do drugs.

Chase: It’s not that we don’t trust you, but… [he pulls one of Keith’s hairs with tweezers]

[Cut to the lab.]

Cameron: [voiceover] His hair will tell us any drugs he’s taken in the past sixty days.  It’s kind of like rings on a tree.

Chase: Negative.

[Back to Cameron and the dad.]

Cameron: Have you been sick?

Dad: No, nothing.

Cameron: Have you been out of the country?

Dad: We went to China, but we got all of our shots before we left.

[Cut to the Keith, being scanned.]

Cameron: [voiceover] It could be an infection.  We’re going to give him a gallium scan just to be safe.  We inject a radioactive isotope into his bloodstream, and we check to see if there’s inflammation anywhere in the body.

[Back to Cameron and the dad.]

Cameron: Has he ever complained of any joint pain?  Sensitivity to light, rashes…

Dad: No, no, nothing.

Cameron: Any relatives ever been diagnosed with lupus?

Dad: I don’t even know that that is.

Cameron: In simple terms, the body becomes allergic to itself.  The immune system attacks healthy cells in the circulatory system and destroys them.

Dad: Would it be treatable?

Cameron: It can be manageable.

[Cut to the lab.]

Cameron: [voiceover] We can test for the antibodies.  95% of patients with lupus test positive for ANA.

Foreman: Not cloudy.  Negative.

[Back to Cameron and to Dad.]

Cameron: What about bruising? He ever complain about tenderness under his arms or his groin?

Dad: I’m not sure he’d tell me if he did.  I guess I really don’t know what’s going on in his life.

Cameron: He’s a teenager. [Pause] What type of cancer did your wife have?

Dad: Pancreatic.

Cameron: It’s his lymph nodes we’re concerned about.  We’re going to do a biopsy to check for lymphoma.

[Cut to Keith’s room.  Wilson is poking him under his arm.]

Wilson: Okay, you feel this?

Keith: No.

Wilson: Good. [He begins to cut into his arm.]

Keith: I have cancer, don’t I?

Wilson: We’re just testing.

Keith: That’s what they told my mom.

[Cut to the lab.  Wilson is looking at the biopsy through a microscope.]

Wilson: Definitely not cancer.

[Cut to outside Keith’s room.]

House: Nothing?

Cameron: Nothing.

Chase: Negative for drugs.  ANA was negative, gallium scan was clear…

House: Yeah, I got that from the “nothing”.  Where’s his hematocrit?

Foreman: Thirteen.

Wilson: Drops any lower he’s not going to have any red blood cells to bring oxygen to his body. [While he’s saying this, House grimaces and puts his hand against the wall to steady himself.]  He’ll suffocate with his lungs working perfectly.

Foreman: You okay? [House nods slightly.]

Keith: Excuse me, someone?  Help, please?

House: [as the Ducklings enter the room] Polite for a dying kid. [He starts to limp off.]

Wilson: How long has it been?

House: I’m fine.

[Cut to Keith’s room.]

Keith: There’s something in my eye, up top.

Chase: Which eye?

Keith: [points to left] This one.  What’s happening?

Chase: It’s all right.  Just, look down for me?  [He looks into his eye with a pen light.  We see that Keith’s vision is getting dimmer and dimmer.]  It’s clear.  There’s nothing in it.

Keith: It’s getting worse!

Cameron: Is it fuzzy, or –

Keith: No!  It’s dark!  I can’t see!

[Cut to a later time.  Foreman is closely examining Keith’s eye, and sees a clot in it.]

[Cut to Cameron, Chase and Foreman walking into the office.]

Foreman: It’s a retinal clot in the left eye.

Cameron: Coumadin would dissolve the clot, fix his eyesight.

Chase: You can’t use bloodthinners, he’s got internal bleeding.  Fix the eye, you kill everything else.

Foreman: Surgery’s out for the same reason.

Chase: We have two hours to figure this out.  Either we restore the blood flow or he loses the eye. [House walks in from his office.  He does not look as earlier.]

House: Forget the eye.  Tell him to use the other one to look on the bright side.  The clot tells us something.  It could help us figure out what he has, which could mean he gets to live. [The three of them are staring… Chase openly curious, Foreman with disgust, Cameron with something like pity.]  Differential diagnosis, people.  How does internal bleeding suddenly start clotting?

Chase: It makes no sense, they’re opposing processes. [Wilson walks in.]

Cameron: It can happen in lupus.  Increased platelet count can cause blood clots.

Wilson: ANA was negative.  It’s not lupus.

House: This is true.  But why are you the one saying it?  What are you doing here?  I thought we ruled out cancer.

Wilson: I was lonely.

House: Well, go see Cuddy.  She needs a friend.

Wilson: That’s funny, she said you might need one.

House: That’s why you’re here?  She wants you to keep an eye on me, make sure I don’t cheat.

Wilson: No, I want to make sure you don’t start firing shots from the clock tower.

House: I’m fine.

Cameron: What’s going on?

Wilson: [while working on the crossword] He hasn’t had Vicodin in over a day.

Foreman: Does your leg hurt?

House: You ever been shot?

Foreman: There’s gonna be side effects.  Insomnia, depression, tachycardia –

House: Withdrawl symptoms.  Not applicable.  The only side-effects I’m going to have are some pain and thirty days of freedom. [Pause.  Interestingly enough, now Cameron looks disgusted.]  Am I the only one who’s concerned about a dying kid?  If it’s not lupus, what else?

Chase: Most likely candidate for throwing a clot is infection or cancer.

Wilson: Checked the biopsy twice, it’s not cancer.

Foreman: It’s not an infection.  Gallium scan didn’t reveal anything.

House: Okay, what hides from a gallium scan?  [He turns to see… a beautiful woman stretching in his office!  Ooookay.  The rest of the ducklings continue the conversation as though they don’t see her.]

Chase: Cardiac.

Cameron: Right.  Clot slips off, travels through the artery, and gets backed up in the eye.

House: I’m sorry, I wasn’t paying attention.  What happened?

Foreman: It’s an infection.  In his heart? 

House: Great.  Echocardiogram for the heart and IV antibiotics for the infection, stat.  [Chase, Cameron and Foreman leave, Wilson walks over.  Now, there’s another person who can see the woman.  Yes, indeed.]

House: Is it my birthday?

[Cut to right outside House’s office.]

House: I’m not lonely, my leg hurts.

Wilson: She’s a real masseuse.

House: She’s five hundred dollars an hour, minimum.

Wilson: She’s hot, so she’s a hooker?  What kind of pathetic logic is that?

House: The envious, jealous, I-never-got-any-in-high-school kind of logic, hello!

Wilson: She’s a legitimate masseuse, come on. [looks at her]  God, she’s beautiful.

House: Because she’s beautiful I should do it?  What kind of pathetic logic is that?

Wilson: The envious, jealous, I’m-married-and-I-can’t-do-anything logic! [Woman comes over.] Hello.

House: Hi.  Listen, I’m, I’m sure you’re really good at whatever it is you do –

Woman: Dame su mano. [Translation corner: means “Give me your hand.”  When House doesn’t understand, she grabs it.]

House: Hey, no, let go of my hand.

Wilson: She doesn’t speak English.

Woman: Shhhh…

House: Ow! Ow… ah… ah…. oh, my God. [Woman looks happy.  And if Wilson’s looks could take people’s clothes off, this show wouldn’t be TV-14.] Bueno.

Woman: Take off your clothes.

[Cut to Keith’s room.  Chase is doing the echocardiogram.]

Chase: [looks at the untouched food] Not a fan of the stroganoff?

Keith: I’m not hungry.

Chase: The antibiotics can cause nausea.

Keith: So can the food.  Shouldn’t you be looking at my eye?

Chase: The blood clot isn’t life-threatening.  We’re focusing on figuring out the cause of your problems.

Keith: So the blindness will be permanent, won’t it? [Chase nods.]

[Cut to the masseuse leaving House’s office.]

House: Thank you.

Woman: Bye. [Chase walks up.]

House: I had a massage.

Chase: Looks like you had a masseuse.  Help the pain?

House: I’m fine.

Chase: I know.  Kid’s echo was normal, no sign of any vegetations on heart valves.

House: Never met a diagnostic study I couldn’t refute.

Chase: And the antibiotics aren’t doing anything.

House: So, double the dosage.  70mg.

Chase: That’ll box his kidneys for sure!

House: Oh, you’re right.  Save the kidney.  The guy we transplant it into will be grateful.

Chase: Also, I have an idea for his eye.

House: Nothing we can do about his eye.

Chase: He’s got a clot in his retinal –

House: Read the memo.

Chase: If we remove some of the liquid from the eye itself, the Vitreous humor, it might make some extra room around the retinal artery.

House: If the artery expands, the clot might move out on its own.  That’s very creative.  Why didn’t you mention this before?

Chase: Well, I didn’t think of it before.

House: You should have.  [As Chase walks away, House leans back against the wall.]

[Cut to surgery. Chase is working on Keith’s eye, and is sticking a needle in it.]

Keith: This isn’t going to hurt.

Chase: Your eye’s numb.  You’ll only feel pressure.  [A second needle enters.  CGI shot of the needles in the eye.]  Give it a minute. [Keith’s vision begins to clear.]

Keith: I can see.

[Cut to Keith’s room.  Pam walks in and kisses his hand.  Keith takes off the eye patch covering his left eye.]

Keith: I can see you.

Pam: I heard!  Congratulations.  [She leans in to kiss him.]

Keith: Don’t.  I haven’t brushed my teeth in two days. [She kisses him anyway.  Aww.]

Pam: Ah, I’m so scared they’re not gonna find out what’s wrong with you.

Keith: No biggie.  I’m fine.

Pam: I feel so bad about this.  It’s all my fault.

Keith: No.  No, it’s not.

Pam:  But your father.  He hates me.

Keith: He’s just pissed about his car. [She leans in to kiss him again, but he pushes her back just in time to vomit all over her shirt.]

Pam: Help, help help! [Dad rushes in.]

[Cut to the bed being wheeled to ICU.  House meets them in the hallway.]

House: What’s wrong?

Cameron: AST is 859, we’re getting him to the ICU.

Chase: ALT and GDT were in the tank.  Our antibiotics –

House: Would not have caused this.

Dad: She must have given him drugs.

Pam: I wouldn’t do that!

House: It’s not drugs!  His liver is shutting down.

Dad: What?  What does that mean?

House: It means he’s all better.  He’s ready to go home.

Dad: What?

House: What do you think it means?  You can’t live without a liver, he’s dying!

Dad: What is your problem?

House: Bum leg, what’s yours?

Foreman: Hey, we don’t have time for this, let’s go.

Cameron: His son’s dying and you’re mocking him?

House: It was a dumb question.

Cameron: No, it wasn’t.

House: You’re right, it wasn’t.

Cameron: Is proving Cuddy wrong worth all this? [She leaves.  House has to lean against the wall again.

[Cut to the diagnostic office.]

Foreman: You know, House shouldn’t even be here.

Chase: Because he said something inappropriate?  If we sent him home every time he did that, we wouldn’t need this office.

Cameron: He’s in pain.

Foreman: What does the man have to do to piss you off?

Cameron: He’s been without pain relief for seventy hours –

Foreman: Exactly!  He’s detoxing, can’t you see he’s out of his mind?

House: [walking in] That’s what they said about Manson.  Do you want to continue talking about me or should we discuss what the liver damage tells us?  [No answer.]  I was born in a log cabin in Illinois –

Cameron: Hemolytic anemia doesn’t cause liver damage.  Add the fact he’s coughing blood, you’ve got three of the indicators of organ-threatening lupus.

House: It’s moving too fast.  Could be hepatitis-E.

Foreman: There’s only been one case of hep-E originating in the US since --

House: Its history.  Since he’s been in and out of the country four times in the last year…

Cameron: You really think he’s got hep-E?

House: No.  I think the lupus is way more likely.

Cameron: All right.  Then let’s start him on IV Cytoxan and plasmapheresis.

House: No, we should rule out hep-E.

Foreman: You just said it wasn’t hep-E.

House: I said lupus was way more likely, but if we treat for lupus and it is hep-E.

Chase: He’s toast.

House: Exactly.

Cameron: But there isn’t a treatment for hepatitis-E.  Either he’ll get better on his own or he’ll continue to deteriorate.

House: Yeah, I went to medical school, too.  Start him on solumedrol. (sp?)

Cameron: If he’s got hep-E that’s only going to make him worse!

House: Not as much.  Goldilocks, people.  It won’t hurt him so much that it’ll kill him, and it won’t hurt him so little that we can’t tell.  It’ll hurt him just right.  And if it does nothing…

Chase: We’ll know it’s not hep-E and start treating him for lupus.

House: Now watch me do it while drinking a glass of water.

Foreman: What do we tell the dad?  “We think your kid has lupus, so we’re gonna treat him for hepatitis-E?  And oh yeah, if it really is hep-E, we’re not actually giving him hep-E medication, so it’s gonna make him worse, not better?”

House: You think he’ll go for that?

Cameron: So you want us to lie?

House: No.  I want you to lie.

Cameron: Why me?

House: Because he trusts you.

[Cut to Chase, Foreman and Cameron in the hallway.]

Cameron: This is a mistake.

Foreman: This is a lawsuit.

Chase: Hep-E is possible.  House always pulls these stunts and he’s right more often –

Foreman: He’s delaying treatment because of a one-in-a-million chance that even he doesn’t think is the problem.

Cameron: I don’t want to lie to him.

Foreman: Then don’t.

Cameron: And get fired?

Chase: Like he’s going to fire you, he loves you. [elevator dings]

Cameron: I’ve got to do something, the kid needs treatment. [Cameron goes into the elevator, but holds the ‘door open’ button.]

Foreman: Treat him for lupus.

Chase: That will get you fired.

Cameron: You really think House is losing it?

Foreman: Yeah. [He leaves.]

Chase: He’s fine.  He knows what he’s doing.  [Chase leaves.  Cameron stops holding the button and the doors close.]

[Cut to House in his office.  He’s sweating, breathing heavily and on the whole looks a real mess.  He picks up a pestle from the back table and slams it on the table.  After banging it on the table a few more times, he slams it down on the fingers of his left hand.  He smiles.]

[Cut to outside Keith’s room in the ICU.]

Cameron: We’re recommending a drug called solumedrol.

Dad: For hepatitis?  Did that show up on his blood tests?

Cameron: The tests are never 100% accurate.

Dad: Well, then all the other tests could be wrong, too.  This could still be an infection or cancer.

Cameron: Um, they don’t fit any of the most recent symptoms.

Dad: Well, what, just hepatitis does?  I know, I know, I know, you can never be sure.  When Linda was in the hospital, the doctor told us there was this aggressive experimental treatment which might extend her life by two or three years.  We figured if there was any hope at all that we could have her with us a little while longer, it would be worth it.  3 weeks later, she was gone.

Cameron: I don’t think it’s hepatitis.  I think your son has lupus.

[Cut to a clinic exam room, Exam room 1, I believe.]

Wilson: [looking at x-rays of House’s hand] I think it’s broken.  What did you do?

House: Accidentally closed the car door on it.

Wilson: No.  Door would have broken the skin.  This looks like something hard and smooth smashed it.

House: I want my lawyer.

Wilson: The brain has a gating mechanism for pain.  Registers the most severe injury and blocks out the others.  Did it work?

House: Well, my hand hurts like hell.  Yeah, I feel much better.

Wilson: Huh.

House: Don’t splint it.  I want to be able to bang it against the wall if I need to administer another dose.  Just… tape it up.  [Cuddy walks in.]

Cuddy: Why did you tell Cameron to lie to Mr. Foster?

House: [to Wilson] Make it tight will ya.

Cuddy: Answer me.

House: Nothing I could say is going to change how you feel, and nothing could come out of your reaction that is going to change what I plan to do, so I prefer to say nothing.

Cuddy: So, that was you just saying nothing.

House: Uh-huh.

Cuddy: The guy is furious.

House: And scared.

Cuddy: So, what are you going to do?  The father’s insisting on the lupus treatment.

House: Yeah, Cameron told me and I told her to tell him no.

Cuddy: Well, you can’t just sit back and let the kid die.

House: Neither can the father.

Cuddy: So that’s your plan?  You’re gonna play chicken with the kid’s life?

House: Well, he’s the dad.  I should win easily.

Cuddy: Take the week off.

House: What, ‘cause I lied to a patient?  I take risks, sometimes patients die.  But not taking risks causes more patients to die, so I guess my biggest problem is I’ve been cursed with the ability to do the math. [Cameron walks in; it’s a veritable party in the exam room!]

Cameron: I told him that you wouldn’t treat him for the lupus until –

House: What did he say?

Cameron: He said he wanted to transfer Keith to another hospital.

Cuddy: He’s not stable enough, he’d never make it through the door!

Cameron: That’s what I told him.

House: And that’s when he caved.

Cameron: Yeah.  He agreed to do it your way.

House: Two plus two equals four.

[Cut to Keith’s room.]

Chase: If it is hepatitis-E we should begin to see a marked decline in liver function tests within the hour.

Dad: Why bother explaining it to me?  It’s not like I have any choice in the matter.

Cameron: If there’s no hep-E we’ll start treatment for lupus immediately.

Keith: [looking down] Ouch!

Chase: Keith?  What’s wrong?

Dad: What’s happening?

Keith: Get off!

Chase: Keith?  It’s Dr. Chase, where does it hurt?

Keith: Jules, no! [He starts to mimic pushing something off of his chest.]

Cameron: He’s hallucinating. [Chase and Cameron try to keep his arms down.]

Dad: Is this from the medicine?

Chase: We haven’t started the medicine.

Cameron: Keith, we’re in the hospital.  Keith, there’s nothing on you.

Dad: Keith, Keith, Keith! [He shakes him slightly, and then strokes his hair.]  You okay, buddy?

Keith: I think I wet the bed.

Chase: Don’t worry about it, it’s fine.  Let’s get you up.  [They turn him over to find a massive amount of blood on the bed.]

Dad: Oh, God!

Cameron: He’s had a major bleed. Bright red blood per rectum.

Keith: I didn’t mean to, I’m sorry.

Chase: He’s going into hypervolemic shock.  Pressure’s 60, heart rate’s 140.

Cameron: We need an angiography, stat!

[Cut to Keith’s room, where we see he is receiving a transfusion.]

[Cut to the diagnostic office, where Chase, Foreman and Cameron are talking to a down-but-not-quite-out House.]

Foreman: Angiography revealed major upper and lower GI bleeding, severe hemodynamic compromise, and liver failure.

Chase: He’s also hallucinating.  Thinks he’s being talked to by someone named “Jules”.

Cameron: Hallucinations are a symptom of psychosis, which is the fourth diagnostic criterion.  It’s official.  This is lupus.

House: Who’s Jules?  Any mention of her in the medical history?

Cameron: It doesn’t matter what he’s hallucinating about, it matters why!  It’s lupus!

House: There’s no need to get snippy.  This kind of lupus takes years to get to this point, it’s been a week.

Cameron: Yeah, and a 16-year-old kid shouldn’t have hemolytic anemia, or be bleeding out of every orifice, but he is.  We had an opportunity to treat this, instead we diddled around with hepatitis-E and now it’s too late.  He needs a new liver.  We screwed up.

House: You’re saying I screwed up.

Cameron: Yes.

House: Then why didn’t you just say that?

Foreman: You gonna just blame this on her?

House: Did you agree with my recommendation to treat for hep-E?

Cameron: No, I didn’t.

Chase: And she made herself quite clear.

House: And then she went and lied to the father.  That’s why you’re angry.

Cameron: Yeah, I trusted you.

House: You always trust me.  Big mistake.  Lupus is a bad diagnosis.

Chase: It’s the best diagnosis we’ve got.

House: That doesn’t make it good.

Foreman: No, it just makes it this kid’s only chance to live. [small pause]

House: Put him on the transplant list.  And make sure Cuddy knows, see if she can do anything to get him close to the top. [He stands slowly and walks into his office.  Chase and Cameron leave.  Foreman waits, and follows House.  House, meanwhile, is throwing up in a trashcan.  He looks up and sees Foreman.]  Cafeteria.  Stay away from the sushi.

Foreman: And what happened to your hand?

House: Got stuck in a drawer.

Foreman: Yeah, right. You’re going through withdrawl.

House: No, I am going through pain.  Pain causes nausea.

Foreman: I took this job to work with you, not cover your ass. [He reaches into his pocket and takes out House’s Vicodin, which he puts on the desk.]  Your Vicodin.

House: And your solution is to give me drugs.  It’s interesting.

Foreman: No.  Now I’m covering my ass.  Take your pills before you kill this kid. [He leaves.  House grabs the bottle, opens it with one hand, and spills the pills on the desk.  He picks up one pill and…. does he take it?  We DON’T KNOW!  Argh!]

[Cut to Keith’s room.]

Cameron: Lupus is normally treated with medication, but in Keith’s case the disease is too advanced.

Dad: Because you lied.  Because House wanted to play games with my son’s life.

Chase: There’s no way to really tell what progression the disease may take –

Cameron: You’re right, and I’m sorry.

Dad: So what do we do?

Cameron: He needs a new liver.

[Cut to Cuddy’s office.]

Cuddy: There are over 15,000 patients on the transplant list.

Foreman: But how many are about to bleed to death unless they get a new liver?

Cuddy: In Jersey?  I’d say, uh, twenty.  2000 patients die each year because a donor liver can’t be found, that’s almost five a day.

Foreman: So he’s screwed.

Cuddy: I’ll see what I can do.

[Outside of Keith’s room.]

Dad: Could I donate part of my liver?

Chase: Sorry, you’re a different blood type.

Dad: So we just wait?

Cameron: I’m afraid so.

Dad: And hope for someone to die. [House walks up, although walk is too jaunty a term.  It is evident he didn't take the pills Foreman gave him.]

House: Who’s Jules?

Cameron: Dr. House, you should get back to your office –

House: Jules.  There’s no Jules in the history.

Chase: It was a hallucination.

House: Of what?

Dad: Our cat.  Does this matter?

Foreman: No, I’m sorry.  We’ll continue the transfusions and the treatment for the anemia and liver failure while we’re waiting for a donor.

Dad: How long can he wait?

Chase: Not long.

House: I don’t think this is lupus.

Cameron: I don’t think this is lupus.  Come on, let’s just go –

House: Your fourth diagnostic criterion of lupus is psychosis; this is just a kid missing his cat.

Chase: He was being attacked by an animal that wasn’t in the room.  That’s psychosis.

House: There’s a difference between psychosis and hallucination.

Foreman: So, if he was imagining a fake cat it’d be lupus, but since it was a real cat it’s not?  Take your damn pills.

House: Psychosis requires –

Dad: There’s no cat!  Jules is dead.

House: You have a dead family pet, and you never mentioned it?  Nice family history.

Cameron: Family history is asking about family members, meaning people related to the patient.  Let’s go.

House: How did the cat die?

Dad: Can you get him out of here?

Cameron: Dr. House, come on, let’s go –

House: What happened to the cat?

Pam: [from the waiting area] Old age.  She was fifteen years old.

House: When?

Pam: About a month ago?

Dad: Does this have anything to do with –

House: Where’d she sleep?

Pam: With Keith.

Cameron: This is not a cat allergy.

House: It’s not lupus.  Where is Jules?

[Cut to a grassy yard at night.  Chase is digging, Foreman is pontificating.]

Foreman: Four years of college, four at med school, two years of residency, another four of sub-specialty training, and where do I end up?

Chase: Talking instead of digging.  Come on, the ground’s frozen solid.  [Foreman starts to help dig.  They hit something hard.]

Foreman: What’s that?

[Cut to House, performing an autopsy on the dead cat.  He has trouble as his hands are shaking from the withdrawal.  Cameron watches for a bit through the glass walls.]

[Cut to the hospital main doors, where a cooler with a biohazard sticker is being brought in.]

Cuddy: Out of the way! [on her cell phone] We have the liver.  Prep OR 4.

[Back to House and the cat.  He finds a mysterious lump in the cat.]

[Cut to the operating room, where Keith is being gassed.]

Anesthesiologist:  All right, Keith.  Start counting backward from ten.

Keith: Ten… nine… eight… [He’s out.  The anesthesiologist nods.]

Dr. Hourani: Scalpel. [He’s about to cut, when House enters.]

House: Stop the gases.

Hourani: What the hell are you doing, House?

House: Saving a sixteen-year-old kid from a lifetime of immunosuppressant drugs and a very nasty scar.  This kid doesn’t have lupoid hepatitis.  He has acute naphthalene toxicity.

Hourani: Naphthalene.  You’re talking about mothballs.

House: Nope. [holds up tweezers] Termites.  They create naphthalene to protect their nests, which I’m assuming is rather large and is inside all four walls of his bedroom at home. [He tosses the tweezers on the surgical equipment.]

Hourani: And your assumption is based on what?

House: The autopsy I just conducted on his pet cat.

Hourani: Call Cuddy.  And security.

House: You are not removing that kid’s liver.

Hourani: NOW! [Nurse goes to call.  House coughs up some phlegm, and spits it on the surgeon.]  Have you completely lost your mind?!

House: No, but I have been feeling a little sick lately.  Achoo!

Anesthesiologist: There’s no way we can do this surgery now.

Hourani: You think?!

[Cut to a hallway.]

Foreman: You’ve already cost him his liver, don’t kill him too!

House: Why are you so eager to cut into a healthy kid?

Chase: Healthy?  He’s in the toilet!

House: He just needs some chicken soup.

Chase: I’m telling Hourani to re-scrub.  We’re doing this transplant.

House: No, you’re not.

Chase: You said it!  If Keith’s symptoms had an environmental cause, they would have disappeared as soon as he got here.

Cameron: They’ve only gotten worse.

House: If the food here wasn’t one step below Riker’s Island he would’ve gotten better.  He’s lost fourteen pounds.

Foreman: Yeah, sure.  This is nothing but a dietary thing.

House: Naphthalene is a gas, a fat soluble gas.  The kid breathes it in, it gets stored in his fat cells.  Outside the hospital his body burned protein and carbs for energy, and the naphthalene stayed in fat.  But once the car accident put him in the hospital, and he started losing weight [CGI of Keith’s fat cells, full of toxin being freed], his body had to get its energy somewhere else.  It started to burn fat.  The floodgates opened, the poison poured into his system.

Foreman: So, getting away from the poison is what poisoned him?

House: Getting him away from his dad’s meatloaf is what’s killing him. [Cuddy and Keith’s dad walk up to House, very quickly.]

Cuddy: You wanna explain to me why you stopped the surgery? [Keith’s dad, beyond words, punches House in the jaw, who then falls to the ground.]  N – Oh, my God!  My God.  [Foreman and Chase run to restrain the dad, Cameron and Cuddy kneel to look at House.]

Dad: I want him locked up!

Chase: Hey!  Take it easy. [House touches his lip, which is bleeding.]

House: Your cat did not die of old age.  He died of massive internal bleeding and acute liver failure caused by naphthalene poisoning, the exact same thing your son has.

Dad: You lie to me, you mess up my son’s surgery, and now you expect me to trust you?

House: Give me twenty-four hours, we’ll pump your son full of calories –

Cuddy: That liver is going to somebody right now.

Dad: We’re doing that surgery.

House: [getting up slowly]  If you do the surgery, you’ll be killing a mother of four.

Cuddy: Father of three.

House: I was guessing.

Dad: Like you are now?

House: Naphthalene poisoning is the best explanation we have for what’s wrong with your son.  It explains the internal bleeding, the hemolytic anemia, the liver failure… it also predicts what’ll happen next.  If you do the surgery he’s gonna lay on that table for fourteen hours while his body continues to burn fat and release poison into his system.  Either way, I did you a favor.  He’s awake now, you’ve got a chance to say goodbye. [slight pause]

Cameron: I think you should trust Dr. House.

Dad: Give the liver to the other guy.

[Cut to Keith’s house.  Chase and Foreman are in his room, Foreman wielding a sledgehammer.  He starts to break a hole in one of the walls, which reveals a lot of termites.  Eeew.]

[Cut to Keith’s room.]

Cameron: INR is down, and his blood count is climbing.  It means you made the right call.  His liver is healing.  He’s gonna be just fine. [Dad hugs his son, and Pam grabs Keith’s hand.  The dad grabs Pam’s arm, too, and everyone is happy.

[Cut to the hallway outside House’s office.]

Wilson: You made it a week.

House: And won my prize.

Wilson: Congratulations.

House: Cuddy’s a sucker.  I would have done it for two weeks off.

Wilson: Yeah, it was a piece of cake.  You learn anything? [They’ve reached his office door.]

House: Yeah, I’m an addict. [He goes into his office.  Wilson follows.]

Wilson: Uh, okay.

House: I’m not stopping.

Wilson: There are programs.  Cuddy would give you the time.  You could get on a different pain management regimen –

House: I don’t need to stop.

Wilson: You just said…

House: I said I was an addict.  I didn’t say I had a problem.  I pay my bills, I make my meals.  I function.

Wilson: Is that all you want?  You have no relationships.

House: I don’t want any relationships.

Wilson: You alienate people.

House: I’ve been alienating people since I was three.

Wilson: Oh, come on!  Drop it!  You don’t think you’ve changed in the last few years?

House: Well, of, of course I have.  I’ve, I’ve gotten older.  My hair’s gotten thinner.  Sometimes I’m bored, sometimes I’m lonely, sometimes I wonder what it all means.

Wilson: No, I was there!  You are not just a regular guy who’s getting older, you’ve changed!  You’re miserable, and you’re afraid to face yourself –

House: [slams his cane down on the shelf] Of course I’ve changed! [pause]

Wilson: And everything’s the leg?  Nothing’s the pills?  They haven’t done a thing to you?

House: They let me do my job, and they take away my pain. [Wilson walks off, looking defeated.]

[Cut to the front desk.  Wilson is looking through a file.]

Cuddy: How’d it go?

Wilson: He admitted he’s addicted to the narcotics –

Cuddy: Well, admitting you have a problem is the first –

Wilson: -- and he says it’s not a problem.  Maybe it’s not.  What do I know?

Cuddy: What are you going to do?

Wilson: Nothing.  I’ve done enough damage.

Cuddy: Better hope he never finds out that that was your idea.

Wilson: He’d never believe it. [They leave.]

[End shot of House, just sitting in his office.]


The End