Cuddy:  Dr. Riley is throwing up; he obviously can’t lecture

House:  You witnessed the spew, or you just have his word for it?  I think I’m coming down with a little bit of the clap.  I may have to go home for a few days.

Cuddy: [laughing]  Dr. Riley doesn’t have a history of lying to me.

House: You said this is the fifth time he’s missed a class this year!  Either he’s dying or he’s lying.

Cuddy: I’ll give you two hours off clinic duty.

House: Fine, I’ll have Cameron do it.  She loves inspiring the inspired. [He starts to walk off.

Cuddy: You’ll do it.

House: [turning back] Why is it always me?

Cuddy: Because the world hates you.  Or because it’s a class on diagnostics.  Pick whatever reason feeds your narcissism better.

House: I’m not doing it.  [He leaves, stops at the door, and walks back in.]  You’re supposed to stop me.  Renegotiate. 

Cuddy: Hmm, and you were supposed to keep on walking.  Sorry, I guess we both screwed up.  Go on, do it again.

House: I’ll do the lecture for four hours off clinic.

Cuddy: Two.  I know you’d rather spend a couple of hours listening to yourself than listening to patients.  Class starts in twenty minutes.  [House leaves into the lobby of the clinic.]

Brenda: Dr. House, there’s a patient.

House: I’m outta here, take it up with Cuddy.

A voice: Gregg.  [House turns at the clinic doors to see… the infamous Stacy, waiting with a bunch of papers and x-ray films.  She walks up to him; House looks… well, it’s hard to describe.  Run over by a bus sounds good.]

House: Hi, Stacy.

Stacy: How’re you doing?

House: How am I doing?  Well, the last five years have been like… you ever see those “Girls Gone Wild” videos?

Stacy: Your life’s been like that, or your life’s been spent watching them? [They both kind of smile.]  I have missed you.

House: Is that why you’re here?  [Stacy shakes her head.]

Stacy: I need your help.  [She hands him the films; he limps over to the clinic desk to take a look.]

House: Who am I looking at?

Stacy: My husband.

House: Who is suffering abdominal pain and fainting spells.  No sign of tumors, no vasculitis.  Could be indigestion, or maybe a kidney stone.  A little one, can pack a lot of wallop.

Stacy: Did you think I wasn’t going to get married?

House: Not to someone so poorly endowed.  This guy’s pancreas is pathetic.  [He walks off, Stacy follows.]

Stacy: There is no kidney stone, no indigestion.  Three hospitals, five doctors, not one of them found anything.

House: Well, maybe there’s nothing to be found.

Stacy: Right, you suddenly trust doctors, love puppies and long walks in the rain.

House: The walks are out.  [Stacy grabs his arm.]

Stacy: I was around you long enough to know when something’s not right.  Mark’s had personality changes, he’s acting strange, disconnected…

House: Interesting.  It means there’s either a neurological component or he’s having an affair.

Stacy: No affair, no nothing!  He’s sick!  I know you’re not too busy; you avoid work like the plague.  Unless it actually is the plague.  I’m asking you a favor.

House: I’m not too busy, but I’m not sure I want him to live.  It’s good seeing you again.  [He leaves, and Stacy is holding back tears.]

[Opening credits!]

[Cut to a lecture hall.  House is sitting on the stage, not doing anything.  There are maybe 20 people in the room, waiting for him to speak.]

House: Three guys walk into a clinic.  Their legs hurt.  What’s wrong with them?  [A student – let’s call him Keen Student – raises his hand.]  I’m not going to like you, am I?

Keen: Most likely cause of leg pain is muscle strain.  Apply heat and rest affected areas.

House: Statistically, you’re right.  Very good.  My experience: over half of leg pain is musculoskeletal, generally from excessive exercise.  Twelve percent is varicose veins brought on by pregnancy, and most of the rest is the result of vehicular accidents.  I said three people.  That’s six legs.  So, you’ve got three hurt jogging, two in collisions, and one of the legs is pregnant. [Some chuckles.  Another student – let’s call her the Caring one – pipes up.]

Caring: What were they doing when pain presented?

House: I have no idea. [Enter the third student: the Rebellious one.]

Rebellious: You didn’t ask?  You didn’t take a history?

House: Of course, but all that told us was what they said happened.  Person A, farmer, says he was fixing a fence. [Cut to a visual of the farmer.]  Tightness of the ankle, loss of muscle control. [The farmer groans and collapses.]  Person B, volleyball practice.  [Cut to a girls’ volleyball team, where there is one middle-aged man playing with them.  He dives for the ball and falls on the ground, clutching his leg.]  Coach figured it was a pulled muscle.  And C, [cut to a mini-golf course] we’ve got Carmen Electra.  Golfing.  [Her ball makes it into the golden Buddha, and she goes, “Yes!”]

Keen: Whoa, you treated the Baywatch chick?

House: The Baywatch thespian.  And no, I’ve gotta disguise the identity of each of the patients and I got tired of using the middle-aged man.  Carmen seemed like a pleasant alternative.  Also, she’s apparently quite the golfer.  [He stands.]  Now, in less than two hours, one of these three will get tossed out of the hospital because they were faking it to score narcotics, and one will be very close to death.  Any guesses on which is which? [Silence.]  Okay, I say we start with the farmer.

[Cut to a clinic room.  The farmer is lying on the bed, looking very much… like a farmer.  Straw in his mouth and everything.  House is questioning him.]

House: Did you hike to the fence, and how far?

Farmer: Yes, it’s about half a mile from my farmhouse.

House: And where’s the pain localized?

Farmer: It started just above my ankle and it’s radiating up.

House: So, what should we do first?  [He turns, and Keen Student is standing right next to him.]

Keen: Family history?

House: Indicative of leg pain?  That’s a very short list.  Any history of bone cancer, osteogenesis imperfecta or multiple myeloma?  [The farmer shakes his head.  Caring Student pops up.]

Caring: Could be a blood issue.  We should run a CBC and a D-dimer.  [Enter Rebellious Student.]

Rebellious: And get an MRI.

Caring: MRI or a PET scan?

Rebellious: If the problem’s vascular, he’s better off –

House: Bzzt!  Sorry, thanks for playing.  Patient’s dead.  You killed him.  [The students look and sure enough, the farmer’s dead on the table.]

Keen: We had no time to run any tests; there was nothing we could do!

House: You had time to look at the leg.  [They look down, and the leg (and the overalls, and the whole farmer garb) is now the property of one Carmen Electra.  She takes the straw out of her mouth and smiles.]

[Cut to the classroom.]

Caring: I thought we were starting with the farmer’s case first.

House: We are.  But if we’re going to look at a leg…

[Cut to the clinic, again.]

House: I need you to take off your pants.  [House stands in the corner with a smug look on his face as Carmen takes off the overalls.  She gets back on the table, playing with her hair as she does so.  House looks at the wound, and then looks out as he proclaims --] Puncture.

[Cut to the classroom]

Caring: Snakebite.

House: That would be my guess.

Rebellious: Farmer didn’t know he had been bit by a snake?

House: That’s what he said.  Sudden shooting pain, tall grass, never saw a thing.

Keen: What kind of snake?

House: You want me to tell you what kind of snake it was from the shape of the hole in the leg?

Keen: How are we supposed to know what kind of antivenin to use if we don’t know what kind of snake it is?

House: Oh, there are people to find those things out.

[Cut to Foreman and Chase, walking to the farm.]

Chase: Shouldn’t we wait for the Humane Society or something?

Foreman: The guy might only have a couple of hours.  [They open the gate, but close it again as a dog comes up barking at them.]

[Back to the classroom.]

House: And while we wait for the Humane Society to show up, what say we check up on the volleyball player?

[Cut to Cameron as she checks up on the volleyball man.]

Cameron: You have tendonitis.

[Cut to the classroom.]

Caring: How old is this person?  I mean, it’s not really a 40-year-old man on a girls’ volleyball team, right?

House: It’s a leg.  A leg is a leg is a leg.

Caring: Well, I was just worried that –

House: Would you worry about her more if she was younger?

Keen: Obviously we should care about our patients no matter what age –

House: Yeah, right.  I saw the way you were looking at Carmen.  She’s mine, stay away.  [Chuckles from the class.]  Would you operate on your mother?

Caring: Of course not.  I’d be too nervous; couldn’t be objective.

House: Then why are you so anxious to treat every patient like they’re family?  The actual patient is 16.  Here’s what happens when doctors care to much.

[Cut to Cameron, talking to the now-16-year-old-female volleyball player.]

Cameron: I need to know everything about you.  [As the camera pans out, we see the player’s entire family is in the room with them.]

[Cut to Cameron talking to House in his office.]

Cameron: I went back three generations: no history of cancer, Parkinson’s, or any other degenerative condition.  But there’s this boy at school, and he’s on the boys’ volleyball team, and they made out at a party, and now he won’t call her back, and this friend of hers at school said this boy didn’t like her and never did.

House: You got all this from an examination of the knee?

Cameron: I think she’s depressed.

House: She doesn’t have tendoni—

Cameron: She has tendonitis.

House: She’s depressed about having tendonitis.

Cameron: She’s depressed for the same reason she has tendonitis.

House: Not the boy.

Cameron: No, the boy’s a jerk, she knows that, and yet she’s depressed.  I found a nodule.

House: Ah.  Problems with the thyroid gland causes depressed mental state, can cause inflammation of the tendons.

Cameron: [nodding]  I’ll run the tests.

[Cut to the classroom.]

Caring: So, because she took such an extreme interest, she found out the person had a thyroid condition.

House: No, because she took such an interest she discovered a tiny nodule.  Which, in reality, signified nothing, but gave us no choice but to put a person with tendonitis through an expensive and painful test.

[Cut to the volleyball player getting a needle injected into her neck.]

[Cut to the classroom.]

House: Here’s how a well-adjusted doctor handles a case.

[Cut to House, examining Carmen the golfer, who has no pants on still.  He hits her knee with a hammer.]

Carmen: Can I put my pants back on now?

House: I’d rather you didn’t. [Caring Student shows up.]

Caring: Which Carmen Electra is this?

House: First one.  The golfer.  [Enter Keen Student.]

Keen: Then why isn’t she wearing pants?  [House gives him a look.  Like, duh!]

House: [to Carmen]  You have decreased reflexes in your patellar tendon.  Anyone?  [Rebellious Student has shown up.]

Rebellious: Slipped disc?

House: Could be.  How bad does it hurt?

Carmen: [deadpan] It hurts really, really bad.

House: Yeah?

Caring: It doesn’t seem real.  Is she the one faking?

House: Oh, for God’s sake.  She’s here to play out my fantasy, not because she’s Meryl Streep. [Caring Student and Carmen both give him a look.]  Fine.  [Carmen disappears, and we see a man in his late 30s, now known as Late 30s Man.]

Late 30s Man: What the hell is wrong with me? [He’s rocking and clutching his right thigh.]  Do something!  [He collapses on the table in pain.]

Caring: Too much pain to be a slipped disc.  Could be herniated and impinging the nerve root.  [The students have to almost yell to be heard over the man’s groaning/yelling.]

Keen: Or it could be referred pain from his groin.

House: Sir, are you getting pain anywhere else? [The last part is almost drowned out.]

Keen: He’s curling; it’s not the back.

House:  Sir, where are you getting pain?

Late 30s Man: Help me!

House: Oooh.

Rebellious: He’s not going to tell us anything if we don’t get him out of pain.  Give him 50mg of Demerol.

Caring: We have no history, he could be allergic.

House: [holding up the syringe] What do I do?

Rebellious: We can’t diagnose him while he screams.

Caring: Better than killing him with pain killers, then – [While she is speaking, the man grabs the syringe from House and sticks it in his leg.]

House: Apparently, he’s not allergic.

Late 30s Man: Thank you, I feel a lot better now. [The syringe drops from his hand.]

[Cut to the classroom.]

Caring: We screwed up.

House: No, you did exactly what his attending did.

Rebellious: And that was the proper way to handle the case?

House: Yeah.

Rebellious: The guy used him as a dealer!

House: You’re going to see a lot of drug-seeking behavior in your practice, and there’s a reason: it works.  Meanwhile, back on the farm…

[Cut to the farm, where the Humane Society has caught a snake.]

Chase: [on his cell] Yeah, timber rattlesnake.

[Cut to the farmer’s hospital room.]

Cameron: Four vials of the CroFab antivenin.  Hey, how you doing?

Farmer: All right.

Cameron: [taking the vial from the nurse] Thank you.  This will start making you feel better really fast.  [She starts to push the antivenin; 5 seconds after she starts the farmer starts to choke.]  He’s having an allergic reaction, bag.  [She starts to ventilate.]  Paddles and epi.

Nurse: But his heart’s fine—

Cameron: It’s not going to stay that way.  [The monitors start to beep.]  Paddles!

[Cut to the classroom, which has more people than when we last saw a full shot of it.]

House: What say we take five?  Get some coffee, go pee.  [He leaves.]

[Cut to the lounge area outside the classroom.  House and Wilson are sitting there.]

Wilson: You didn’t think she was going to get married?

House: She asked me the same question.

Wilson: And… what?  You’re not gonna treat him?

House: There’s probably nothing wrong with him.

Wilson: Oh, sure, that makes sense.  She’s just using the old “sick husband” routine as an excuse to get back in touch with you.  You think this is easy for her?  The only reason she’d be anywhere near you was if she was desperate.

House: So I should help her because she hates me.

Wilson: She doesn’t hate you.  She loves you, she just can’t stand to be around you.  [The keen student shows up.]

Keen: Uh, Dr. House?  It’s been almost six minutes. 

[Back to the classroom.]

Keen: Found him.

House: The volleyball player was responding to the anti-inflammatories as you’d expect in a case of tendonitis.

Rebellious: Whoa, whoa, whoa, whoa.  What about the snakebite guy?  I don’t really care about the volleyball player.

House: What if I told you the volleyball player had a sudden massive stroke?

Rebellious: Really?

House: No.  But that would make you interested, right?  What if her T4 came back low?  It’s not quite as interesting, but it has the benefit of being true.

Rebellious: You said the thyroid biopsy was a wasted test.

House: No, I didn’t.  I said she put a person with tendonitis through an expensive and painful test.  Apparently the patient had tendonitis and a thyroid condition.

[Cut to Cameron talking to the volleyball player.]

Cameron: We’re going to start you on Thyroxin.  It’ll make you feel better and level your moods.

Volleyball Player: Thank you.  [She takes the pills.]

[Back to the classroom.]

Rebellious: So, that’s it?

House: You were right the first time.  Snakebite guy’s way more interesting.  Gross, actually.

[Cut to the farmer, whose skin is starting to rot and peel off… yum!  The farmer looks in a lot of pain.]

[Cut to House’s office.]

Foreman: The patient responded to epinephrine and the allergic reaction was arrested.  Unfortunately, the patient continues to deteriorate.

Chase: Maybe the snake wrangler was wrong about the type he caught.

Foreman: He faxed us the venom tests which confirmed it’s a timber rattlesnake.

House: [looking at the tests]  No, it’s not.  Notice the volume?

Foreman: I skimmed over that and the gender and the coloring and skipped right to the name of the snake.

House: 200mg.  Our guy got bit less than four hours ago.  There’s no way a snake regenerates that much venom that quickly.

[Back to class.]

Keen: We’re supposed to know how fast snakes make their venom?

House: Nope.  Unless you’ve got a patient bit by one.  Then it might be helpful.  So what do we do now?

Caring: He must have been bitten by a different snake.  We go back and find it.

House: Or you go online and find there’s only three poisonous snakes in New Jersey: the copperhead, the timber rattler, and the coral.  The copperhead and the timber rattler both respond to the antivenins we gave the guy.

Caring: So we give him the antivenin for the other one.

House: Is that a question?

Keen: Well, we can’t just blindly give him another antivenin.  Especially after the first one almost killed him.  You said only three types of poisonous snakes commonly found in New Jersey.  But what if this is an uncommon one?

House: Very good.

Keen: We’ve gotta find the right snake.

House: No need.  Odds are, by the time you get back the autopsy results will tell you what kind of snake it was.

Keen: But you said –

Caring: So we do give him the antivenin for the other one.

House: Again, was that a question?  I asked what you would do.  It seems unfair for you to ask me what you would do.  Who gives the guy the other antivenin? [Half of the class raises their hands.]  And who goes looking for the snake?

Rebellious: I assume that one choice kills him and one saves him.

House: That’s usually the way it works at the leg turning black stage.

Caring: So half of us killed him and half of us saved his life.

House: Yeah.

Keen: But we can’t be blamed for –

House: I’m sure this goes against everything you’ve been taught, but right and wrong do exist.  Just because you don’t know what the right answer is – maybe there’s even no way you could know what the right answer is – doesn’t make your answer right or even okay.  It’s much simpler than that.  It’s just plain wrong.

[Cut to the farmer’s room, where the team is standing by the bed as Foreman is about to push the antivenin.]

House: [voiceovers] We gave the guy the antivenin.

Farmer: What if I’m allergic again?

Foreman: That’s why these people are here.  If you have a reaction, we’re ready to do whatever’s necessary to ensure your airway stays open and your heart keeps beating.

Farmer: My wife’s on her way in, can’t this wait?

Foreman: I’m sorry, it can’t.  [He begins to inject the serum, and nothing happens.  House nods, and leaves the room to be confronted by the Late 30s Man.

Late 30s Man: It hurts again.

[Class.]

Caring: He came back?

House: [taking some Vicodin]  On average, drug addicts are stupid.

Rebellious: I’d call the cops.

House: Good for you.  A lot of doctors wouldn’t risk their careers on a hunch.

Rebellious: It’s not a hunch, I mean, I know he wants drugs.

House: I believe drug addicts get sick.  Actually, for some reason they tend to get sick more often than non-drug addicts.  Luckily, you don’t have to play your hunch, there’s a faster way.  Actually, there are several.  My preference is urine testing.

Rebellious: But you already know he has drugs in his system.

House: That’s not what I’m testing for.

[Cut to a hospital room where Late 30s Man is lying.  House enters with a nurse.]

House: We’re going to put this hard, rubber tube up your urethra and into your bladder.  It might be a little uncomfortable.

Late 30s Man: Shouldn’t I be getting some kind of anesthetic?  [He groans as the nurse does her job.]

House: We’re concerned about allergic reactions today.

[Classroom.  House is looking through the drawers of the desk in the room.]

House: If the guy can handle a rod in his penis for half an hour, he’s really sick.

Rebellious: Or he’s really jonesing.

House: There’s easier ways to get a hold of drugs.  Other hospitals, for example.  [He takes a mug out of the desk and sniffs it.  He starts to walk off.]  The volleyball player is not responding to treatment.  [He leaves to go to the water fountain, and yells back -- ] At least we think it’s not working on account of the fact she’s getting worse.  Can you still hear me?

Rebellious: No.

Caring: A little.

Keen: Not really!

House: [filling the mug]  Well, if you can’t hear me, how do you know what I asked?

[Cut to Cameron, who is preparing to insert an IV into the volleyball player.  She yells.]

Cameron: I’m sorry.  What did I do?

Volleyball Player: I don’t know.  It really hurts!

Cameron: I promise to be very careful.  [She gets ready to insert the needle, and the player flinches and yells as soon as the needle touches her skin.]  Susan!

[At the water fountain --]

House: Not her real name!

[Back to the volleyball player.]

Cameron: Susan, I barely touched you!  [She tries again, and the player screams.]

Volleyball Player:  Aaaah!  No, it hurts so much!

Cameron: I’m sorry, I’m sorry, I have to get this blood.  Just hold on.

[Cut to the Diagnostic office.]

Cameron: Hypersensitivity to touch.

Chase: Her calcium up?

Cameron: Lab over 16.

House: The question is why.  Likely suspects?

Chase: Parathyroid adenoma. 

Cameron: Kidney problems.

Foreman: Vit. D intoxification.

Chase: Hyperthyroid.

Foreman: Caused by our treatment?

[Back to the classroom.]

Caring: Whoa whoa whoa.  Can you please slow down?  [House takes a sip of water from the mug and spits it out.]

House: [slowly] The adenoma is most likely.  Check her PTH –

[Back to Diagnostics, where he’s still speaking very slowly.]

House: -- phosphorus, and ionized calcium, and do a technetium sestambi.  Okay, that’s enough about the volleyball player.  What’s up with the farmer?  [They all look at him.]

Foreman: What farmer?

House: Snakebite guy.  Oh, right, you guys don’t know about him.  He doesn’t get bitten until three months after we treat the volleyball player.  Luckily, it’s been well established that time is not a fixed construct.  [He walks over to the white board, which now has writing on it pertaining to the farmer.] His condition’s not improving; double the dosage.

Foreman: Already did.

House: There’s another antivenin, it’s not as effective, but –

Chase: Already tried it.

House: The first stuff, the stuff he was allergic to –

Cameron: Gave it to him with high-dose steroids.  Nothing’s working.

House: [to the camera] What does it all mean?

[Cut to the class.]

Caring: Wrong snake?

House: We tried every other antivenin we had.

Caring: We’re too late?

House: Yep.  He’s dying.  His wife’s here, finally found a babysitter.  Who wants to let him know?  Actually, I’m kidding.

Caring: He’s not dying?

House: Oh, yeah, he’s dying, but there’s no wife and kid.  Which is great.  Makes the “breaking the news” thing way easier.  Oh, yeah, one more piece of news.

[Cut to late 30s man, we see that the catheter is circulating a red liquid (mmm hmm!)]

[Cut to the class.]

House: The drug addict is peeing blood.

[Cut to a later point with the class.  House is fooling with yellow crayons, and drawing something.]

House: How do they teach you how to tell someone that they’re dying?  It’s kind of like teaching architects how to explain why their building fell down.  Do you roleplay and stuff?

Keen: Yeah, one of us gives the bad news and one of us gets the bad news.

House: And what do you have to do to get an A in You’re Dying 101?  They grade you on gentleness and supportiveness?  Is there a scale for measuring compassion?  This buddy of mine, I gotta give him ten bucks every time somebody says “Thank you.”  Imagine that.  This guy’s so good, people thank him for telling them that they’re dying.  [He looks at his picture.]  Eh, needs brown.  I don’t get thanked that often.

[Cut to House with the farmer.]

House: You’re dying.  In a few hours.  There’s nothing we can do except deal with the pain.

Farmer: Well, I need to go home.

House: You’re not going home.

Farmer: Well, my dog?  What will happen to my dog?

[Cut to radiology, where Cameron and Wilson are performing a PET scan on the volleyball player.]

Cameron: Her neck looks clean.  No adenoma.

[Cut to class.]

Rebellious: Wait, wait, wait.  The guy’s dying and all he cares about is his dog?

House: Any of you guys go the dog route in your improv sessions?  It’s a basic truth of the human condition that everybody lies.  The only variable is about what.  The weird thing about telling someone they’re dying is it tends to focus their priorities.  You find out what matters to them.  What they’re willing to die for.  What they’re willing to lie for.

[Back to the farmer.]

House: Well, you must have a neighbor who –

Farmer: The neighbors don’t like him.

House: Then the Humane Society can take him in and –

Farmer: No, they won’t.  Maybe my aunt –

House: It wasn’t a snakebite, was it?

Farmer: I said I don’t remember being bit.

House: Sure you do.  Just not by a snake.  I assume that Cujo bit one of your neighbors awhile back.  You tell me that he bit you, and I gotta report it.  Cujo’s got a record, he gets the chair.  The good news is, you might just live.  The bad news is, your dog’s gonna die.

[Cut to Chase and Foreman, trying to wrangle with the dog using chairs.]

Chase: The guy risked his life to save this thing?

Foreman: I’ll hold him, you swab the mouth.

Chase: I think I’ve got a better grip here, you go for the mouth.  [He holds out a fist.]  All right, I’m odds.

Foreman: What, are you serious?

Chase: Come on.

Foreman: One, two, three!  [He puts out two fingers, while Chase puts out one.]

Chase: I don’t care if he’s scratching your nads off, don’t let go.

Foreman: Just do it!  [Chase tries to swab the dogs mouth, but pulls back.]

Chase: I say we let the guy die.

Foreman: I got his head, just do it!

[Back in the classroom, House finishes his picture.  He holds it up to the class to reveal… a brownish, orangish spot.  Really ugly color.]

House: What would you call that?  That’s tea-colored, right?  The guy who we thought was just after the drugs… what’s the differential diagnosis for urine that’s tea-colored?

Caring: Kidney stone.

House: Kidney stones would cause what?

Caring: Blood in urine.

House: What color is your pee?

Caring: Yellow.

House: What color is your blood?

Caring: Red.

House: What colors did I use?

Caring: Red, yellow and brown.

House: And brown.  What causes brown?

Caring: Wastes. 

House: Which means the kidneys are shutting down.  Why?

Caring: Trauma.

House: None that his history would indicate.

Caring: Could be damage done by the self-injection of the Demerol.

House: Treatment?

Caring: Heat and rest –

House: Other possible causes.

Caring: Infection.

House: Start him on antibiotics.  What else?  [She pauses.]  Come on, come on!

Caring: I – I don’t know.

House: You’re useless.  But at least you know it.  Blood tests show elevated creatine kinase, what does that tell you?

Rebellious: The trauma diagnosis is right.  He takes it easy for a few days, he’ll be fine.

House: You sure? 

Rebellious: The elevated CK rules out infection –

House: You know what’s worse than useless?  Useless and oblivious.  [He goes to the Keen student.]  What are they missing?

Keen: You know, it’s kind of hard to think when you’re in our face like this –

House: Yeah?  You think it’s going to be easier when you’ve got a real patient really dying? [to everyone] What are you missing?]

Cameron: [from the doorway] Muscle death.

House: Not your case.

Cameron: Nothing wrong with a consult.

Caring: Dying muscle leaks myoglobin.  It’s toxic to the kidneys.

House: Brilliant.  MRI his leg, see what’s killing it.

[Cut to the volleyball player going into the MRI machine.]

[Cut to the class.]

Rebellious: Why is the girl getting the MRI?

House: Because the neck scan revealed nothing and her doctor’s way more obsessive than she thinks she is.  [Cameron, sitting in the back, tries not to act like that was directed at her.]

Rebellious: But you said the guy needed the MRI.

House: Because Dr. Cameron back there said muscle death, not one of your said it!  Not one of this guy’s doctors said it.  They gave him bed rest and antibiotics, just like you guys would have.

Caring: Did he get better?

House: No.

Caring: Well, how long –

House: Three days.  It is in the nature of medicine that you are gonna screw up.  You are gonna kill someone.  If you can’t handle that reality, pick another profession.  Or finish medical school and teach.

Caring: Three days before they thought it might have been muscle death?

House: No, three days before the patient suggested it might have been muscle death.

[Cut to the volleyball player’s room, where Cameron is talking to her and her parents.]

Cameron: The MRI revealed an osteosarcoma: a cancerous tumor in your femur.  It needs to be removed surgically.  With chemo, she has an excellent chance of survival.  But I have to warn you, depending on how large the tumor is, and how ingrained it is, the surgeon may need to amputate your leg.  I’m sorry.

Volleyball player’s Mother: It’s okay.

[Cut to Foreman talking to the farmer.]

Foreman: Well, dogs’ mouths are pretty filthy, but they have natural antibodies to fight off most of the stuff.  We don’t.  That’s why dog bites can be so nasty.  The lab test of your dog’s saliva revealed a type of strep bacteria.  It’s commonly known as the “flesh eating disease”. We’ll need to operate immediately to remove the damaged tissue.  We may need to remove the leg.

[Cut to Cuddy talking to the late 30s man.]

Cuddy: The MRI revealed a problem.

Late 30s Man: No kidding.

Cuddy: I’m sorry none of your doctors found it earlier; I’m personally going to oversee your treatment from now on.

Late 30s Man: You’re gonna cut me open, aren’t ya?

Cuddy: We may need to remove the leg.

[Cut to the classroom.]

House: His MRI showed that the leg pain wasn’t caused by the self-injection, wasn’t caused by an infection.  It was an aneurysm that clotted, leading to an infarction.

Foreman: [sitting with Chase and Cameron in the back] God, you were right.  It’s House.

[Cut to House, lying in a hospital bed.  Stacy is sitting next to him.]

Cuddy: We have to do the surgery.  The necrotic tissue has to be removed.  If there’s too much –

House: I don’t care what you find.

Cuddy: It may become necessary in order to save your life.

House: I like my leg.  I’ve had it for as long as I can remember.

Stacy: Honey, I love your leg as much as you do.

House: They’re not cutting it off.

[Cut to the classroom.]

House: Patient made the right choice.  Tell a surgeon it’s okay to cut a leg off and he’s going to spend the night polishing his good hacksaw.

Rebellious: Right, surgeons could care less about saving limbs.

House: Well, of course they care about their patients.  They just care about themselves more.  Which is not an unreasonable position.  Trying to maximize the tissue you save also maximizes the chances of something going wrong.  Which means you’ve gotta be extra careful.  Which is such a pain in the ass.

[Cut to Cuddy, House and Stacy.]

Cuddy: Amazing advances have been made.  Kids with prosthetic legs are running the 100-meter dash in twelve seconds.

House: Yeah, they’re just not as pretty.  Do a bypass, restore the circulation.

Cuddy: Amputation is safer.

House: For you, or me?

Cuddy: The blockage of blood flow –

House: Four-day blockage.

Cuddy: Yes.  It caused muscle cell death.  When those cells die, they release cytokines and potassium --

House: If you restore the blood flow instead of just lopping it all off, then all that crap gets washed back into my system.  The cytokines could cause organ failure, the potassium could cause cardiac arrest.  On the other hand, I may just get the use of my leg back.

Cuddy: The post-operative pain alone –

House: I’ll get through it.  I understand the risks, you’re in the clear.  Go schedule an OR.  [Cuddy leaves.]

Stacy: God, you’re an idiot.

House: I think I’m more of a jerk.

Stacy: I’m not being glib.  And I’m not being cute, I don’t want you to kill yourself.

House: I’m not gonna die.

Stacy: Oh, I feel completely reassured.

[Cut to the volleyball player and her family, who are waiting (praying?).]

[Cut to House, who is writing “Not this leg” on his left leg.  Stacy helps him to write “Not this leg either” on his right.]

[Cut to the volleyball player, in surgery.]

[Cut to the farmer, in surgery.]

[Cut to House, in surgery.  CGI shot as they remove the clot from his leg.]

[Cut to House and Stacy in a hospital room.  House is yelling in pain.]

House: I think they gotta up that morphine.

Stacy: The doctors say they can’t.

House: The doctors recommended bed rest and antibiotics.

Stacy: They screwed up, it doesn’t mean they’re wrong this time.

House: Sure doesn’t mean they’re right.

Stacy: Morphine will kill you.

House: I can handle it.

Stacy: You’re in pain, you’re not thinking right.

House: That’s why I need the damn morphine!

Stacy: Okay, I’ll talk to them.  [She leaves.]

[Cut to Stacy talking to Cuddy.]

Stacy: Oh my God, how much longer is the pain going to last?

Cuddy: It depends on how much muscle cell death there was.  He could be right, he could come out of this with almost full use of his leg.

Stacy: Or?

Cuddy: He could be in pain for the rest of his life.  There’s a third option, surgically.  A middle ground between what we did and amputation.

Stacy: He’s not big on middle ground.

Cuddy: Yeah.

[Cut to House, reading the printouts from the EKG machine.]

House: Nurse, Nurse?  I need more calcium gluconate.

Nurse: You just had 5 mLs.

House: Either your ass is getting whiter or my potassium is rising.

Nurse: I’ll talk to your doctor.

House: Well, you better make it fast, ‘cause I’m about to go into cardiac arrest.  You give me the dose, or I go into white count complex tachycardia.

Nurse: I could get in trouble –

House: Listen, it’s not a narcotic!  I’m not looking for a buzz.  You’ve got about twenty seconds.  [His breathing quickens, and the monitors all go off.]  I was wrong.  [Nurses and doctors enter, including Cuddy.]

Someone: What have you got?

Nurse: White complex tachycardia.

Cuddy: Who diagnosed –

Nurse: He did.

Cuddy: Paddles!  Charge.

Nurse: Clear!  [They shock him, and he flatlines.]

[Cut to the classroom.]

House: The patient was technically dead for over a minute.

[Cut to the farmer, walking with a new dog.  He stops, and we see his prosthetic leg.  House is watching him, standing there in a white hospital gown.  The scene whites out and –]

[Cut to the volleyball game, where the volleyball player is playing a game.  House is standing in the stands.  The scene whites out as we hear the flatline monitor and Cuddy shocking him again.]

[Cut to the hospital room.]

Cuddy: He’s back.

[Cut to the classroom.]

Wilson: [standing in the back]  Do you think he was dead?  Do you think those experiences were real?

House: Define real.  They were real experiences.  What they meant… Personally, I choose to believe that the white light people sometimes see visions, this patient saw.  They’re all just chemical reactions that take place when the brain shuts down.

Foreman: You choose to believe that?

House: There’s no conclusive science.  My choice has no practical relevance to my life, I choose the outcome I find more comforting.

Cameron: You find it more comforting to believe that this is it?

House: I find it more comforting to believe that this simply isn’t a test.

[Cut to House and Stacy.]

Stacy: How bad is the pain right now?

House: It’s bad.

Stacy: It’s not getting any better.  If you were right, the pain would be subsiding.  You’d be getting better.

House: It’s just taking longer.

Stacy: No, it’s not.  We’ve got to let him cut the leg off.

House: It’s my leg.  It’s my life.

Stacy: Would you give up your leg to save my life?

House: Of course I would.

Stacy: Then why do you think your life is worth less than mine?  If this were any other patient, what would you tell them to do?

House: I would say it’s their choice.

Stacy: Wha – not a chance!  You’d browbeat them until they made the choice you knew was right.  You’d shove it in their face that it’s just a damn leg!  You don’t think you deserve to live?  You don’t think you deserve to be happy?  Not let them cut off your leg?  [They’re both near tears.]

House: I can’t, I can’t, I’m sorry.

Stacy: The pain alone is going to kill you.

House: I know, I know.  I need you to talk to the doctor.

[Cut to Stacy, sitting in a waiting area.  Cuddy walks up and sits with her.]

Cuddy: He change his mind?

Stacy: No.  He’s asked to be put in a chemically induced coma so he can sleep through  the worst part of the pain.

Cuddy: We can do that.

Stacy: What happens after he’s in the coma?

Cuddy: We’ll obviously monitor his condition closely, and if he can get through the next forty-eight hours without another cardiac incident –

Stacy: I meant, I’m his health-care proxy, I get to make medical decisions for him if he’s not able to.

Cuddy: You should talk to him about what he wants to do.

Stacy: I know what he wants, but if he’s out it’s my call, right? [Cuddy nods.]

[Cut to House’s room.  Cuddy’s inducing the coma.]

Cuddy: You’ll be out in less than a minute.

House: Thank you.  [to Stacy] Hey.

Stacy: Hey.

House: I’ll see you when I wake up.  We’ll go golfing.  I love you.

Stacy: I love you, too.  I’m sorry.

House: [going under] You’ve got nothing to be sorry about.  [Stacy gets up and walks over to Cuddy.]

Stacy: The middle ground you were talking about?

Cuddy: We go in, take out the dead muscle.  There’s still some risk of reperfusion injury, but –

Stacy: Give me the forms you need signed.

Cuddy: You’re saving his life.

Stacy: He won’t see it that way.

[Cut to the classroom.]

House: Because of the extent of the muscle removed, utility of the patient’s leg was severely compromised.  Because of the time delay in making the diagnosis, patient continues to experience chronic pain.

Caring: She had no right to do that.

Rebellious: She had the proxy.

Caring: She knew he didn’t want the surgery.

Rebellious: She saved his life!

Keen: Well, we don’t know that.  Maybe he would have been fine –

Caring: It doesn’t matter.  It’s the patient’s call.

Rebellious: The patient’s an idiot.

House: [half-laugh] They usually are.  Do you have a buzzer or something.  What time does this class end?

Cuddy: [at the doorway]  Twenty minutes ago.

House: I’m not doing this again.  [picking up the “World’s greatest dad” mug and walking toward Cuddy] And this guy is not the world’s greatest dad.  Not even ranked.  Who the hell lets their kids play with lead-based paint?  That’s why he’s always sick.  Find him some plastic cups and the class is all his again.  [He leaves, leaving behind a full room of shellshocked students.]

[Cut to House, walking to his office.  He’s calling someone on his cell.]

House: Stacy, it’s Gregg.  I’ve got an opening for ten tomorrow morning.  Make sure your husband isn’t late.  [He hangs up, and enters his office.]

[End!]