Okay, I was just playing last week. When I said the overly-dramatic preview of this week’s episode better mean someone was dying, it was just a joke. I didn’t really think the folks at FOX were gonna take it to that level. But more on that to come. In the meantime, Meat Loaf guest stars as a middle-aged obese man dying of heart failure. His friends come to his bedside to say their tearful goodbyes. After they depart, he excuses his nurse so he can be alone with his wife. He apologizes to her for choosing work over taking her on her dream vacation to Rio de Janeiro. She tells him tenderly that she loves him. Just in time for her throat to close. Hubby musters his last bit of energy to scream for help.
House, Taub and Foreman meet in the office for the differential: 54 year old woman with acute respiratory failure; no anaphylaxis, lung issues or tracheal lesions; and her tox screen is clean. House dismisses it as a case of sleep apnea in an overweight patient (but shouldn’t you be asleep for that?). He questions why Kutner and Thirteen are missing. Taub tells him Thirteen is with a patient and Kutner is home nursing his sick dog, but House knows he’s lying; he thinks it may be out of guilt from stealing Kutner’s credit for solving the “locked-in” case. Taub ignores him and moves back to the current patient – he tells House that she visited her sister in Hawaii about six months ago, just before her husband got sick. Foreman thinks she could have picked up melioidosis (a bacterial infection found primarily in tropical climates) and passed it on to her husband. House tells them to start her on IV fluids and cyclovir. Thirteen enters and tells them they can’t treat her because she’s demanding to be released to be with her Chubby Hubby – since she got sick, his ticker seems to be getting better. Taub comes up with the clever idea to bring him to the hospital so she will be more likely to stay.
The treatment seems to work on Mrs. Münchausen (you’ll understand later why this name), but her husband’s condition deteriorates again. Kutner still hasn’t shown up to work and House is getting impatient with Taub’s lies (T tells him that Kutner probably met some chick at a comic book convention). House demands they find Kutner so he can fire him. Taub’s pager goes off but it isn’t K – it’s Mrs. Münchausen; she’s having severe chest pains. When Taub rushes to the room, he finds hubby on his feet. The Yoyo Duo’s health conditions keep see-sawing between gravely ill and supernaturally strong.
Foreman and Thirteen go to Kutner’s apartment to try and find out where he’s gone. They knock on his door but get no answer. Thirteen pulls out a key, probably one that House got cut long ago to sneak in and snoop. The couple enters and finds the apartment seemingly empty and quiet. Foreman checks Kutner’s voicemail and appointment book, but he has no messages or meetings. Thirteen turns around and in the doorway to Kutner’s bedroom she sees an arm, a leg… and a gun. Foreman and Thirteen rush to the room and find Kutner on the floor with a gunshot wound to the right temple, blood pouring from his head. They try to resuscitate him, but his body is cold. Foreman calls an ambulance, but it’s too late. Way to pull the rug out, FOX! Where the hell did this come from?!
Back at PPH, the team gathers in solemn silence. House questions them. Was there any clue? Was Kutner crying out for help? Why didn’t they figure out something was wrong before it was too late? Of course he doesn’t say any of this with a hint of guilt; he actually blames the rest of the team for not stopping the unnecessary death. Foreman suggests they pass their current case on to another doctor, but House isn’t hearing it. Neither is Taub, who doesn’t appear all too disturbed by Kutner’s suicide. Cuddy offers them grief counseling and time off. They remain shaken and silent. House tells the team polyserositis (Familial Mediterranean Fever) fits Mrs. Münchausen’s symptoms the best and orders a round of indomethacin.
Taub leaves to conduct the treatment while Foreman and Thirteen decide they want to visit Kutner’s parents to pay their respects. House offers to join them. Mrs. Kutner shows them a picture of the sweet-faced six year old Indian boy the suburban Caucasian couple adopted so long ago. House tactlessly blames the Kutners for a phantom ethnic identity crisis that allegedly caused their son to off himself (truly bad, even by Greg’s standards). Foreman angrily dismisses him, sending him back to the hospital to tend to their new patient.
Taub meets House as he gets off the elevator to tell him that the indomethacin isn’t working, but he ran a hormone panel on Hubby and he seems to be getting better. House wonders why Taub hasn’t yet asked about his visit to the Kutners and any insight he might have gathered concerning the suicide. Taub brushes it off and says suicide isn’t always a cry for help – some people just want to take care of business. House reminds him (and us) that Taub was once in Kutner’s shoes; was his attempt a quiet SOS or simply failure to launch? Taub deflects once again back to the case and tells House nothing seems to fit. House thinks it can only mean one diagnosis.
House confronts the couple in their hospital room and tells Mrs. Münchausen she has hypertrophic cardiomyopathy (her heart is too big and too strong). If they can induce a heart attack, it will kill off some of her cardiac muscle and cure her. Chubby Hubby is shocked at the suggestion, so House admits he was lying to get Mrs. M. to tell the truth: that she’s been faking her symptoms in sympathy for her husband and to get them to spend more “quality” time together. And she confesses! But then she’s stricken with a real symptom: a painful disintegration of her leg muscle.
Foreman and Thirteen return to PPH just in time for the new mystery surrounding Mrs. Münchausen’s case. However, Foreman is still angry at House’s behavior at the Kutners’ home. To avoid talking about the suicide (and thus remembering his own), Taub directs them all back to Mrs. Münch; it could be multiple sclerosis. House orders an MRI to check for MS as well as an echocardiogram on Chubby Hubby to really determine if his heart is on the mend.
During the MRI, Mrs. Münchausen tells Thirteen that she doesn’t believe her husband loves her as much as she loves him because he never spent any time with her or showed her any affection (sound familiar, Remy?). At least not until she got sick (or pretended to get sick). While speaking, her final sentence trails off and Thirteen hurriedly removes her from the scan. Her spleen has ruptured and she must have emergency surgery to stop the internal bleeding.
Meanwhile, Taub performs the echo on Chubby Hubby. Hubby expresses his remorse for not treating his lady the way she deserved all these years. He vows that if he’s truly going through some kind of spontaneous remission, he’ll take her to Rio and make up for all the other mistakes from his past. Unfortunately, the echo reveals that Hubby’s heart walls are barely moving – he’s still dying.
House is baffled by the case…of Kutner’s suicide. If it’s not his Anglo parents, then maybe some clue lies with one of his friends. Calls to all of them reveal nothing. With a little digging, House finds some dirt: police records show that Kutner was charged with indecent exposure once. Maybe he’s some filthy, child-molesting flasher who could no longer live with his own perversions. Or maybe not: Cuddy tells him that Kutner streaked a football game during college. House remains frustrated, but Cuddy recognizes that this is his way of grieving. She goes to Wilson, who surprisingly has not yet tried to comfort his friend. Wilson tells her that he can’t handle House and the suicide of a colleague simultaneously (too heavy). Cuddy tells him that House stepped over the line by blaming the grieving parents. He’s left speechless.
Mrs. Münchausen’s spleen rupture crosses out MS. During the operation, Chase tells Taub to go home and grieve his friend’s passing. Taub continues to be ice cold and refuses to leave; he tells him he’s waiting to conduct a biopsy to check for rheumatoid arthritis. Chase notices liver scarring and nixes the RA idea. It means whatever is the matter with Mrs. M. is spreading.
Wilson meets House at Kutner’s apartment. House is examining every wall, every corner, for some clue. Any clue. Wilson realizes that House isn’t mourning Kutner; he’s actually trying to solve the mystery of his death. Period. House confirms this by stating that he believes Kutner was…murdered! Wilson has heard enough and leaves the scene.
The following day, House meets with Thirteen and Taub at PPH. Thirteen wonders aloud where Foreman is, and House tells her he decided to take Cuddy up on her offer for grievance leave. She wonders why he didn’t tell her himself. House shoots down autoimmune hepatitis and amyloidosis as possible diagnoses. Then he turns around the whiteboard so they can read his hypotheses: Money. Power. Drugs. Jealousy. Revenge…? House is much more interested in discussing motives for Kutner’s murder, but Thirteen and Taub refuse to entertain him. So, he surrenders and offers Alpha-1 Antitrypsin Deficiency (an inherited disorder that causes lung and liver disease) as a possible diagnosis for Mrs. Münch – he orders them to run her AAT proteins.
As Taub is drawing Mrs. Münchausen’s blood for the AAT protein screen, she asks whether she can donate her heart to her husband if she dies before him. Taub tries to dissuade her from thinking about it, but she knows that the situation is dire for both of them. Although Chubby Hubby’s been rejected by donor banks in the past, she hopes that the hospital can bypass regulation and allow her organ to go to whom she explicitly designates.
Thirteen visits Foreman at his apartment. He is sullen and in no mood for company. He apologizes for retreating to his place without telling her, but he explains that he’s accustomed to working through his problems on his own. His lack of emotion and connection with her reminds her of her conversation with Mrs. Münchausen during the MRI when she told her how unaffectionate her husband was to her through years of marriage. Thirteen accepts defeat and walks away.
Cuddy finds House logged into Kutner’s email. He’s still convinced that Kutner was shot by someone else, so he’s digging for more clues. He tells her that a prime suspect would be the man who murdered Kutner’s biological parents. During the trial, Kutner testified against him and it would make sense that he’s found a way to get to the kid who put him away. Cuddy isn’t convinced, but I’m beginning to feel he might be right!
Taub and Thirteen are summoned to Mrs. Münchausen’s room for an emergency. She is seizing on the floor because she grabbed a syringe from the nurse’s cart and injected herself with whatever she could find. Thirteen thinks she was trying to feign illness again to get Chubby Hubby’s health back on the upswing. Taub tells her that Mrs. M. was actually trying to kill herself so her heart would go to her husband.
Taub tells House that Mrs. Münchausen’s AAT test was negative. Her failed suicide attempt has further damaged her liver and hastened her death – she now has about 24 hours before needing a full liver transplant, but the catch-22 is the team needs 48 in order to prove to the transplant committee she actually needs the operation. House tries to forge the paperwork to get her on the list for a transplant. Then he gets an idea: he approaches Cameron to use her hopeless romanticism to convince Chubby Hubby to donate a piece of his own liver. The expectation is that he’d never survive the surgery and they can take his entire organ instead.
Cameron talks to Chubby Hubby and explains that they must keep their strategy a secret from the missus because she’d never go for it. Since he’s already going to die, his death at least won’t be in vain if he saves his lady love. He agrees and signs the consent form. Cameron notices that his fingers have nodules. She tells House that she can’t perform the transplant because it seems poor Chubby Hubby has received a misdiagnosis. House doesn’t seem pleased at the news which puzzles Cam, until he reveals that the man who murdered Kutner’s parents died of an aneurysm two months ago. So, now what? Who else is on the shortlist of assassins?
Later, House visits Chubby Hubby and tells him that tests have confirmed his heart failure is due to a highly treatable fungal infection – he’s going to live! Um, Chubby? This is the part where you jump for joy. Say, “thanks”…? Nope, Chubby wants to refuse the treatment so he can donate his liver to his wife. He’s so adamant, in fact, he threatens to leave the hospital and immediately get hit by a car so they can retrieve his fresh liver from the PPH morgue. Thirteen won’t agree to what she deems an act of murder. Taub solves the dilemma easily enough: he wheels Chubby Hubby’s bed in to his wife’s room and tells her the straight deal. So, there you have it, sweetheart. Will you let your loving husband love you to death, his own death? Mrs. Münchausen immediately begins to shake. Upon closer examination, Taub discovers that she’s spiked a fever.
Mrs. Münchausen’s widespread infection is another piece to the puzzle but it doesn’t bring them any closer to solving the case. House rules out sarcoidosis and scleroderma. What are they missing? What is Mrs. M. hiding? Finally, House realizes what the diagnosis must be: an acute case of liar, liar, pants on fire.
House confronts the sickly couple and asks Mrs. Münchausen about her Hawaiian trip. Is she sure she went to the Aloha State? Maybe not. She confesses to House and her husband that although they had made plans to go together, she chose to visit Rio without him. His neglect made her seek the comfort of another man (no one Chubby knows, mind you) and she went with him to Brazil where she contracted visceral leishmaniasis (a.k.a., black fever) from disease-baring sand flies. The team tries to find a liver for Mrs. Münch but the damage is already done. She dies peacefully with her now-devoted husband by her side.
Kutner’s funeral is a traditional Hindu ceremony, his adoptive parents’ homage to their son’s culture. Cuddy invites Taub to join her but he refuses. Later, he collapses into tears on a bench in the hospital hallway. At the funeral, Thirteen searches for Foreman but he remains distant until they transport Kutner’s body to the crematorium. He then reaches out and takes her hand. At the end of the day, House is exhausted. The mystery of Kutner’s death remains unsolved. He searches Kutner’s apartment, looks through photographs for clues. He finds none. At PPH, Wilson approaches him, tells him that he understands he’s in pain; not necessarily for the loss of Kutner but because, despite his gift for perception, he never saw it coming. And neither did we. That level of helplessness is the most painful thing of all.
Next Week: Kutner’s death sends Cuddy and Cameron into a catfight over House. Plus, a crunchy granola protester gets a little crunchier than usual.