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The reason why this week’s episode of House was one of my favorites this season wasn’t just because it starred hip hop artist and extraordinary actor Mos Def (although his presence did make me very happy). It was because the episode was clever, artistic, and broke from formula. I know, I know, some of you may be thinking, “But I’m sure I’ve seen this before.” And you’d be right. Telling a story from an immobile protagonist’s P.O.V. isn’t new. M*A*S*H did it back in the day, ER usurped it for an ’05 episode starring Cynthia Nixon, and more than one horror and sci-fi movie or show has dabbled in it, including Tales From the Crypt and Alfred Hitchcock Presents. Doesn’t make it stealing and it damn sure doesn’t make it any less cool. First-person perspective is a great cinematic technique for drawing one’s audience closer into the lives and hearts of a show’s characters, and it works just as well each and every time it’s done.
Our patient opens his eyes to find himself in a hospital bed. He calls for assistance. His doctor stands over him and begins to speak, just not to him. He tells a nurse off-screen that they can prepare to harvest his heart for donation. Now our patient cries out, screams for help. He wonders why no one can hear him. Just when his resolve starts to dissolve, a voice from the next bed tells the doctor that his patient isn’t brain dead. The voice is familiar; it’s House. He’s been involved in a motorcycle accident and is being treated at Middletown General Hospital. Despite his injuries, he can’t help but poke his nose into this intriguing case. House tells the Middletown doc that the patient has locked-in syndrome, a condition in which the afflicted maintain all their mental faculties but can’t move their bodies at all. He proves this mini-diagnosis by asking the patient to blink his eyes to answer questions (one blink for “yes” and two for “no”). Can you hear me? Do you understand? Are you in there? Blink.
After recovering from the shock of almost butchering a live patient, the Middletown doctor explains to Scared Stiff that he was in an accident and we flash to the scene: he is riding a bicycle on a quiet suburban street, approaches an open car door, tries to squeeze the break but his body refuses to react, and he crashes. Of course, House is able to discern that it wasn’t the accident that caused the locked-in syndrome but the other way around: there are no cuts or bruises on Stiff’s palms indicating that he didn’t try to (or couldn’t) protect himself during the crash. Scared Stiff has a beautiful wife who cries at his bedside. She tells him God will help them through this and asks whether he wants their two children to see him. He blinks twice – he doesn’t want to give them nightmares.
House summons Foreman, Thirteen and Kutner to Middletown for a differential. Thirteen suggests a tumor and House steals Scared Stiff’s paperwork to order an MRI. They place a really cool pair of goggles on his face that creates a calm scenario for him to experience while squeezed up inside the noisy MRI machine. The goggles transport him to a beach scene where he’s sitting beside House overlooking the ocean and watching his kids playing nearby in the sand. He admits to House that he’s not sure if he believes in God but he knows that some force brought an expert diagnostician to the hospital bed right beside him. Later that night, House tells him that the MRI revealed a small lesion in his central pons but the Middletown doctor is treating the patient’s condition as an infection – the antivirals he’s pumping into Stiff’s body may complicate matters. And they do. They cause the patient to have a seizure, seemingly proving House’s diagnosis. If it’s cancer in the brain stem causing paraneoplastic syndrome, it can be treated with plasmapheresis (the removal, treatment and return to circulation of blood plasma). Middletown doc disagrees but Stiff’s wife asks him if that’s what he wants. Blink.
House has Scared Stiff transferred to Princeton Plainsboro for treatment and further observation. From his frozen body, the patient does some observing of his own: Cuddy affectionately fingering House’s fresh scars (yes, she digs him); House messing with Taub by telling him he now accepts his prior resignation (he doesn’t…or does he?); House and Wilson bickering in the elevator like an old married couple about House’s trip to Middletown to purchase a guitar (actually, he was visiting another pain clinic to score more meds…or was he?). While Taub and Kutner are in Stiff’s new hospital room with him, they notice something unsettling and excuse themselves; when they return with the rest of the team, they start theorizing causes (alcohol, drugs, Macchiavi Bignami disease) but they don’t specify what’s wrong. It’s only later that we learn there was blood in his urine. He undergoes a painful and humiliating catheter insertion by Thirteen (he can only scream in his head, poor bastard). Despite his initial objections, his wife insists on bringing their children to see him. They miss their daddy terribly and don’t shrink back in fear when they see him. Stiff is grateful and loves having them by his side. But Thirteen cuts the visit short; he can’t understand why until she leans over him to wipe away the tears he can’t feel falling down his cheeks.
House asks Chase to biopsy Scared Stiff’s brain stem. For the procedure, he’s sent back to his happy place on the beach while the surgical team drills a hole in his skull. Then he’s woken up to answer some test questions. 2 + 2 = 5? No. Blink, blink. Are these two lines parallel? Yes. Blink. Is more than half of the pictured circle shaded? Sure, it is. It’s filled in three-quarters of the way. Chase asks him again. Yes, of course it’s more than half-way shaded! Chase calls his name. Stiff tries to blink but can’t. The biopsy reveals damage to the myelin sheath for the nerves responsible for controlling his ability to blink.
After the team loses access to Scared Stiff’s only means of communication, Taub recommends a new way for the patient to “talk”: brain computer interface (BCI), a fancy headset that records brain waves. If he’s not already dead, it should allow their patient to move a cursor on a screen with his mind (up for “yes” and down for “no”). With much practice, Stiff shows everyone that he’s still “in there.” The team asks him questions about his health and latest travel destinations. Have you had any stomach pains lately? No - down. Have you traveled outside the country? Down. Have you traveled within the United States lately? His wife chimes in that he recently took a trip to St. Louis. Down. She still insists that he spent two days in St. Louis on business. Down. Down.
Further questioning reveals that Scared Stiff actually spent his time away from home at a friend’s house in town. When House finds out which friend, he sends Taub and Kutner to search the home. In the friend’s basement, they find resumes. Scared Stiff’s roofing business was tanking and he didn’t want to disappoint his family so he searched for new business opportunities and worked odd jobs behind their backs. One of his gigs was a temp position as a janitor at a factory that manufactures cell phone batteries. Upon inspection of the job site, Taub and Kutner find cadmium filings on the floor. They surmise Stiff must be suffering from heavy metal poisoning. They return to PPH to get him started on chelation therapy.
During his stay at PPH, Scared Stiff is visited often by the staff, not just for tests and examinations but also to be treated as a silent sound board. Foreman complains to him about Thirteen not wearing a bracelet he gave her as a gift and Taub expresses his frustrations and fears concerning his job. And poor Stiff can’t even tell them to shut up or get out the bed and run away! During an actual visit to take care of him, Thirteen notices that the epithelial tissue of one of his eyes looks inflamed. Ulcerative keratitis (a literal eyesore) means that it can’t be heavy metal poisoning.
Cameron stops by House’s office to place fresh bandages on one of his scrapes from the motorcycle accident. He tells her that the ulcerative lesions mean that Scared Stiff has a virus, either Varicella (chicken pox) or Behcet’s (an autoimmune disorder causing inflammation of the arteries). Cameron gives him the idea to check the patient for polys to focus their diagnosis on Varicella or lymphs to narrow down to Behcet’s. House wonders why he gave her her walking papers and she reminds him that she was the one doing the walking.
Foreman administers a lumbar puncture in order to collect and examine Scared Stiff’s cerebrospinal fluid but in the middle of the procedure, the patient flatlines. As the team rushes to save his life, Stiff returns to the beach. He gives in to the peace and prepares to die. In fact, he begs silently to die; he asks the team to stop fighting to save him, bids his family farewell and surrenders. He doesn’t die but stops looking for a reason to live. He just wants to rest. He wishes he could if it weren’t for that terrible itch in his foot. It’s so uncomfortable. That itch is getting really bad! He tries to get everyone’s attention by signaling with the BCI. Up, down. Up, down, up down. House asks him if something is bothering him. Up. Is it your eye again? Down. Down, down, down! Oh, it’s in your lower body. Is it your leg? Down. Is it your foot? Up! Does it burn? Down. Does it itch? Up!
The itch in Scared Stiff’s foot indicates liver failure. Thirteen suggests that liver failure itself can lead to locked-in syndrome. Foreman thinks it’s most likely sclerosing cholangitis (inflammation of the bile ducts of the liver). House orders a biopsy. During the procedure, Kutner notices that Thirteen isn’t wearing her bracelet and Foreman is shocked she ever wore it all. Once she finishes expressing her disappointment that Kutner pays more attention to her than her own boo, Thirteen explains that she doesn’t want piss and other fluids leaking on her nice jewelry. Kutner peers closely at her wrist and asks whether Stiff urinated on her; she responds that he did, during the catheterization. Kutner points out a nasty rash on her wrist where the pee made contact with her skin. He realizes that the patient probably has leptospirosis, a bacterial infection spread by the rats that were most likely hanging out with him in his friend’s basement. A test confirms the diagnosis and the team treats him with penicillin.
House confronts Taub and Kutner in the PPH mens’ locker room and asks who came up with the “eureka.” Without hesitation, Taub takes credit. Kutner gives him a nod and lets him keep the glory moment. After Taub exits, House lets Kutner know that he realizes Taub stole his credit. Kutner doesn’t mind and House is impressed – if Taub is willing to lie, that means he really does care about his job. Then he gives Kutner an invisible high-five for coming up with the wacky diagnosis.
The penicillin kicks in and Scared Stiff is able to move a finger, then his arm, and the rest of his body comes slowly back to life. He tries to thank House, tries to explain that God really did work a miracle by crashing the brilliant doctor’s bike in Middletown, but our Greg has already lost interest.
Wilson has been curious all episode how House found himself in Middletown in the first place. After lying about the pain clinic, House tells Wilson that he was looking up Foreman’s jailbird brother. Investigation soon reveals otherwise; there’s no record of him ever visiting Downstate Correctional Facility. When Wilson calls him on it, House switches his story again: he was really checking up on the woman Wilson’s been sleeping with, the one who works for his brother’s psychiatric hospital. Wilson falls for it and admits that he’s been seeing someone but is incredulous how House would find out. It’s because he didn’t. Wilson eventually finds out that House has been seeing a psychiatrist and is proud of his friend for taking that very important step. Until House reveals that it’s not working so he’s going to stop. House steps on the elevator; before the doors can close, Wilson tells him that he will surely end up alone. Don’t worry, Greg, you can always call me…
Next Week: It’s one of those “very special episodes” all series have at one time or another that defy description and deserve only an overly dramatic preview montage. After all that, somebody better die.