I’m normally a nice person. I try to always say “please” and “thank you.” I think seriously about volunteering and almost never forget to recycle. And I like making people feel good with a kind word. But sometimes I just want to tell that chatty granny in the house slippers who keeps striking up conversation in the bread aisle to shut the hell up! I, like most of us, have a very effective filter that prevents me from mouthing off and getting myself killed. When a normally nice book editor in the House universe finds himself telling his wife, colleagues and star author what he really thinks, they’re concerned. When his nose starts bleeding and he collapses, they know for sure something’s wrong.
House’s team is excited by the case because frontal lobe disinhibition is a disorder from the medical history books – a man named Phineas Gage was unlucky enough to have his head impaled by a railroad spike and lived for the rest of his short life with a huge hole in his skull and a crappy personality. According to the MRI, our Mr. Not-So-Nice Guy has no such structural damage. Thirteen suggests a tumor in the nasal cavity, so House sends Kutner and Taub to shove a scope up the patient’s nostril. The scope reveals nothing, but Not-So-Nice has a field day insulting Kutner’s bedside manner, Taub’s humongous schnoz, and his wife’s commitment to her non-profit job. Later, insults turn to come-ons when he meets the ladies – let’s just say the guy’s fantasies involve a Cuddy-Thirteen hot fudge sundae and mirrored ceilings.
House wants to spend some quality time with his best bud at the monster truck rally, but Wilson can’t. Actually, he doesn’t want to. He says that monster trucks have never really been his thing; he’s just tolerated them for his friend’s sake. House doesn’t believe him and breaks into his office to snoop in his calendar. He finds that Wilson has an appointment marked off on the day of the rally. When he confronts him about his lie, Wilson admits that he has a date to play racquetball with Taub. He covered it up because he didn’t want House knowing he was spending time with someone else and he didn’t want to hurt House’s feelings by making plans to do something that House is no longer able to do. He was just being nice.
Foreman and Thirteen perform an MRI to check for brain damage that may have been missed during the earlier scan. They find a spot on the cingulate gyrus in his anterior cortex but the region is too close to the brain stem to biopsy. Foreman thinks it could be neurosarcoidosis (inflammation and abnormal deposits in the tissues of the nervous system). Thirteen agrees that a round of steroids should clear him up. Instead, Not-So-Nice Guy goes into kidney failure and they rush to get him on dialysis.
In-between checking the size of his nose in his reflection on a spoon and fending off House’s nasty looks and incessant questions about Jews in sports, Taub proposes chronic lymphocytic leukemia or diabetes as possible causes for both brain and kidney dysfunction. Foreman tells him the white blood cell count was normal. Kutner suggests a congenital metabolic disorder that just happens to be cropping up really late. House tells them they should test for peripheral nerve damage in Not-So-Nice Guy’s daughter – she has an auditory processing disorder that may indicate hereditary neurological problems. House decides to punish Taub by having him run blood glucose tests every two hours all night long.
Kutner performs the nerve test on Not-So-Nice Guy’s daughter. He makes the mistake of telling the girl that if she does well, then Daddy will do well. But I don’t think he actually explains to her what she’s supposed to do. He increases the intensity level of heat and waits for the girl to tell him she feels it, but she stays silent. Then she screams. When Kutner and Not-So-Nice Guy’s wife rush into the room, they discover the girl’s skin is burned. She admits she didn’t speak up because she wanted to do a “good job” to help Daddy. Good job, Kutner.
After a long night drawing blood, Taub reports to the morgue to update House. Of course, why not the morgue? House tells him to give his patient assessment while hitting a ball against a wall. To shut him up, Taub picks up the racket and starts bravely playing House’s game. But he’s completely terrible. He finally gives up and admits that he’s never actually played racquetball with Wilson and won’t be playing with him in the near or distant future.
Kutner approaches Not-So-Nice Guy to perform a thyroid reuptake scan, but the patient is more concerned about why his daughter is burned. Then he and his wife get into it over their daughter’s condition; he apparently doesn’t believe there’s anything actually wrong with her. After calling the little girl a daydreaming loser, she runs crying from the room. Not-So-Nice Guy tries calling after her but he starts to cough. Kutner discovers that he has fluid-filled lungs and a fever of 103.
House tells Kutner to get a very detailed patient history and he sends Taub on a different mission: to invite Wilson to lunch. Taub tells Wilson the jig is up and then later tells House that he confessed his betrayal to Wilson. But he also comes bearing gifts: print-outs of Wilson’s e-mails. Some of the messages are addressed to a doctor at New York Mercy Hospital, an oncologist who specializes in suicidal tendencies in cancer patients. Wilson wouldn’t travel out-of-state for treatment when he can get the best care at Princeton Plainsboro, so that means he must be depressed. House tails him and finds that he’s been taking walks in the cold without a winter coat. Weird way to commit suicide. Wilson is upset that House is constantly over analyzing him and asks that he just leave him alone.
Kutner finds out that Not-So-Nice Guy’s wife recently took in a stray Rottweiler. The beast likes to piss territorial boundaries all over the living room and drink juice out of the patient’s cup. Kutner thinks it could be Weil’s disease (a bacterial infection associated with wild or domesticated animals). House orders him to administer antibiotics. The doxycycline starts to work, but Foreman explains to Not-So-Nice that the brain damage is permanent. Rather than accept that, Not-So-Nice visits House’s office and begs him to operate. Even if surgery costs him his life, he’s willing to risk it to get his family back. House asks Chase to perform the neurosurgery so Not-So-Nice isn’t forced to live the rest of his life miserable and alone, chasing away all who love him. In essence, living the rest of his life as House, Jr.
While observing Not-So-Nice Guy’s surgery, Wilson finally tells House that his long-lost schizophrenic brother was picked up on the street and is currently the recipient of three hots and a cot on the psychiatric ward of Mercy. He hasn’t seen him in 13 years and is afraid of how he’ll react when they’re face-to-face again. House steps out of character and offers to join him for his first visit.
Not-So-Nice Guy comes out of surgery. Thankfully, he can breathe on his own and knows who and where he is. However, he’s still a dick and his body temp starts going haywire. The team is at a loss, so they perform a full body scan which reveals a small abdominal aneurysm, cyst on the pleura surrounding his lungs, and a density in the liver. Multiple arteriovenous malformations could be the culprit but they need to perform individual angiograms to know for sure. In the meantime, they try to reach House for his input but he isn’t answering his phone.
At New York Mercy, House can’t help but continue over analyzing his friend until Wilson explains why he would punish himself by walking in the cold without a coat. Turns out Wilson ignored a call from his sick brother while in med school which immediately preceded his brother’s escape to the streets. He feels terrible guilt over the way his brother’s life has turned out and is fearful of the anger and resentment his bro may still be harboring all these years later. It explains why Wilson has spent almost an entire lifetime being an exceptional people-pleaser. This is a breakthrough, a pivotal moment in Wilson’s life, and House is there to help and guide him through it… Yeah, right. House veers off topic and finds eureka! Wilson leaves him to bask in his diagnostic glory moment and goes off to see his brother alone.
Not-So-Nice Guy has Doege-Potter Syndrome, a form of tumor-associated hypoglycemia. The lung cyst the team found on the body scan was actually a benign fibroma. The fibroma is secreting human growth hormone which in turn is lowering the patient’s blood glucose levels. Removal of the tumor should correct everything. Maybe not his marriage or the damage to his child’s self-esteem. But at least the poor sap won’t be another House. Ah, Greg, often imitated but never duplicated. We love you to bits but can only handle one at a time.
Wilson meets House on the elevator and tells him about his visit with his brother. It wasn’t at all what he expected. Actually, it was pretty anticlimactic. They were strangers to each other. House and Wilson kiss and make up, agreeing to be just as cantankerous/honest and weak/kind as they’ve almost always been.
Next Week: A woman claims a black cat has predicted her death and she’s not even on the psych ward. At least, not yet.
