House is avoiding clinic duty and hiding out in one of the exam rooms by playing toy cars on a makeshift race track cobbled together with medical supplies. Cuddy interrupts and enters with a new patient, the 35 year old female head of nursing at an area old age home. The patient tells House she had colds all winter and has been feeling run down lately. Suddenly, she falls to the floor in a full-on seizure. House calls for Cuddy to return to the exam room and she notices that the patient is urinating on herself. And the pee is neon green.
House begins to brief the team but Taub is late for work. When he finally arrives, he apologizes but has serious attitude; he doesn’t get why they’re wasting their time on the case since obviously the patient has late onset epilepsy and a penchant for drinking too much St. Paddy’s Day beer. House ignores him and sends the team to search the patient’s home and office for toxins.
Kutner and Taub visit the nursing home. Kutner worries about Taub’s earlier reaction, but Taub is hesitant to reveal his reasons for arguing more than usual with House. Taub finds a bottle of methylthioninium chloride (a.k.a., methylene blue, an Alzheimer’s disease drug that can change the color of urine after ingestion). Back at Princeton Plainsboro Hospital, Taub tells House that he thinks the patient has Munchausen’s and is just looking for attention. House disagrees and claims the green pee has to be phenol toxicity. House sends Taub to search the patient’s home for carbolic acid, although he later admits to Kutner that he’s just trying to disprove Taub’s fake seizure theory.
House visits the new patient to induce another seizure with a handheld strobe light. Being a nurse, she knows exactly what he’s trying to do; within seconds, her eyes roll back and she begins to convulse. When she stops moving, House picks up her arm and holds it above her. He then lets go to see whether it will fall limply on top of her head. But to avoid whacking herself in the face, the big faker freezes her arm in mid-air. She apologizes for pretending to seize, but she’s just desperate to get treated because she’s dying. How does she know? Because a cat told her. Hmm.
Taub is on his way to the patient’s home when he bumps into an old high school classmate in the patient waiting area. He’s at PPH to get treated for a fall that left him dizzy. Taub helps him dislodge a calcium deposit in his inner ear. To thank him, the classmate, a wealthy CEO for a medical device company, invites him out to party at a club he owns; Taub refuses, telling the guy he’s married and thus living a boring life. Why is he feeling so sorry for himself?
After getting kicked out of PPH, Pussy Galore returns with the psychic cat in question. She tells a weird tale based on a true story: the cat is a pet at the nursing home and has a habit of sleeping beside residents that are about to kick the bucket; the day before, the kitty jumped up next to her on her office couch and now she’s certain she’s also going to die. House isn’t convinced, even when she collapses to the floor. Foreman runs to her side and listens to her breath sounds through a stethoscope – she’s having a very real bronchospasm (can’t fake that).
House and Cuddy watch a videotape of a news story about the cat. Cuddy is unimpressed and tells him he has 24 hours to diagnose Pussy or let the kook go. During a differential, Foreman suggests that the cat could be carrying and spreading dangerous larvae. House is smoking a cigar and hinting at Taub to check the trashcan where he finds an empty cigar box addressed to him – a gift from his grateful classmate. House goes on to spill the beans to the whole team that Taub is miserable because he lost a lot of money last year on the stock market, a tidbit of info he picked up by snooping into Taub’s online portfolio.
The team uses a scope to check for worms in Pussy’s lungs, but she’s clean. House brings the team to the hospital room of a pair of coma patients. He opens a drawer in the room and frees Death Cat. He brings it close to one of the patients and the poor man breaks out in hives (he has a cat allergy). Then Death Cat jumps to the bed of the other patient and lies down (uh oh, somebody notify his family). Foreman suggests an airborne allergy in Pussy Galore, so House orders a methacholine challenge (a breathing test typically used to diagnose asthma).
Cuddy comes across a dirty litter box in House’s office and confronts him. She tells him to get rid of Death Cat and his owner. House brings Pussy Galore outside in a wheelchair as if he is discharging her. Instead, he blows smoke in her face until she starts wheezing. She tells him she’s superstitious because her stepson died choking on his school snack and she’s still looking for meaning in his death. When a rash breaks out on her neck and House detects wet lung sounds, he determines its time to readmit her.
House tells the team that Churg-Strauss disease (an inflammation of the blood vessels) fits her symptoms best. He orders Thirteen to put Pussy on steroids and Taub to clean the litter box. Taub refuses and leaves in anger. He heads straight to his classmate’s office for a drink and chat. He confesses that his life is less than stellar right now, but his friend can’t really relate because he loves his job. He shows Taub the prototype of a surgical tool and Taub provides some feedback. The guy’s so impressed with T’s advice that he breaks out an aged bottle of booze, probably to celebrate an impending job offer.
Pussy pees again – this time in the toilet and this time in a shade of brown. But there’s no blood or fecal matter present. Foreman points out that the urine may not actually be brown – if the methylthioninium chloride never left her system, its green pigment may have mixed with something present in her system that’s purple in nature, producing a brown tint. House thinks it could be strep bovis infection from colon cancer and he orders the patient be given a pill cam to check for polyps. After the team disburses, he corners Taub to find out where his head is at – is he a weak-willed coward, afraid to keep living in a lesser tax bracket and trying to get fired, or is he just planning on quitting?
House brings Pussy to the coma patient’s room. Death Cat is curled up peacefully beside him, but the patient is still alive. Pussy still insists something bad is going to happen. House likens her obstinate faith in Death Cat with that of the congregation of a 19th century nut job preacher who predicted the Second Coming over and over again. Each time he brought his followers to the open field to await Christ’s arrival, they waited in vain. But his followers believed in him all the more. House decides to continue his experiment with Death Cat by heading to the pediatric oncology ward. But Wilson ruins the fun by stopping Death Cat from selecting one of the cancer kids.
The pill cam doesn’t pick up any images of tumors in Pussy’s intestines, but Kutner suggests that it could be a flat lesion and House agrees that it could be skin cancer that’s metastasized to the intestines. He tells them to look for melanomas. Later that night, Kutner calls House at home to tell him they didn’t find cancer but they did find spider veins on the patient’s back. House diagnoses Cushing’s disease, a non-fatal pituitary gland tumor, but Kutner isn’t finished – the real reason he’s calling is that Pussy may, in fact, be dying; after more than a year of remaining stable, the coma patient has passed away. Just as Death Cat predicted!
The following day, the team returns to work to discover the cat is missing. As they search the hospital grounds, they discuss whether the source of the Cushing’s is the kidneys or the brain. Suddenly House begins to struggle for breath and collapses. Kutner leans over him and House coughs up what looks like blood all over him, but it’s really just cranberry juice – what an ass! It’s payback for leaving his office door open and letting Death Cat escape. He tells Foreman he should get Chase to do a venous sampling of Pussy Galore’s brain to look for Cushing’s.
Taub meets with his rich classmate for lunch to discuss a job, but the guy tells him he can’t hire him without an MBA. Taub offers to invest instead, but his classmate tells him the minimum price is $2 million! But then he feels sorry for Taub and offers to work out a deal at a lower fee. It’s a shame when it doesn’t even pay to be a doctor anymore.
House becomes even more obsessed with finding out whether Death Cat is real. He goes to the morgue to perform an autopsy on Coma Guy. During the procedure, Chase and Foreman tell him Pussy Galore went into cardiac arrest on the operating table but she survived the venous sampling. Slightly elevated adrenocorticotropic hormone (ACTH) levels confirm that the Cushing’s is in the brain. Drugs can treat it and removal of the pituitary gland would be even more effective, but the surgery is especially dangerous. House sends Chase to present the case to Pussy and ask for her decision. When Chase speaks with her, she insists on having the surgery.
Taub decides to quit. House refuses to accept his resignation and tells him he’ll come crawling back. And when he does, he better bring donuts.
House retreats to his office to mull over the case. The case of Death Cat. What is causing him to seemingly predict impending deaths? House pops in the videotape to search for clues. Death Cat comes out of hiding and enters House’s office. He jumps up onto House’s desk and lays across the warm keyboard. Eureka! The common thread between the patients whose deaths were “predicted” by Death Cat is that they were all warm, either feverish or wasting away and being artificially warmed by electric heating blankets. What could cause Cushing’s-like symptoms, flushing, but no central obesity? A corticotropin-producing carcinoid tumor of the intestine (say that three times). Since it wasn’t detected by the pill cam, it must be in the appendix. House stops the pituitary surgery and saves another life.
Taub has been waiting at his classmate’s office for 15 minutes or more to discuss his investment. Impatient, he approaches a secretary to ask for his whereabouts. She tells him that he no longer works there. How can that be? He’s the CEO! Nope, he was just a temp! But Taub went to school with him! Right? No, again – the guy was a crook who conned Taub into believing they’d attended high school together. Now, he’s in police custody. Good thing Taub didn’t hand over his seed money yet – now he’ll have enough change to go buy those donuts.
House visits Pussy Galore’s room to gloat. She still sees reason in everything that has happened to her, including the fact that Death Cat chose to reappear and sit on House’s warm keyboard at the exact right moment. She then tells House she researched the preacher House had told her about earlier. That preacher’s name was William Miller and he came to found the Seventh-Day Adventist Church, a major Christian denomination with many followers still faithful today.
House returns to his office to play with his toy cars. He sits on his chair and finds it wet. He yells for Kutner and accuses him of making the cat pee on his chair. But he doesn’t punish him. Thirteen is impressed that Kutner stood up to House and survived. Kutner is even more impressed with himself, especially considering it wasn’t cat piss. Ew!
Coming Up: Next week is a rerun, but the next new episode will feature one of my favorite rapper/actors, Mos Def! Excited!
