Originally aired: Sept 19 2006
Written by: David Foster
Directed by: Laura Innes
Transcribed by: Kat (spellingwitch
) & Justine (panda_chibi
Betaed by: Heather (nozenfordaddy
) & Dorothy (houses_vicodin
)DISCLAIMER: We don't own "HOUSE." It's owned by FOX and NBC/Universal, and produced by Heel and Toe Films and Bad Hat Harry Productions. This transcript is unofficial, and should UNDER NO CIRCUMSTANCES be copied or distributed, especially for commercial use.
(Scene opens in a research lab, rats, surgical equipment and a doctor all appear over the background of J.S. Bach’s "Cello Suite No. 1 in G Major, Prelude".)
Doctor [To the lab rat he’s just plucked from a cage.]: You're not gonna make this easy, are you? [He picks up a syringe.] Unfortunately; as much as I admire your spirit, je ne sais rien.
[He puts the rat to sleep, starts autopsy recorder.] Subject anesthetized with .5 cc of sodium pentobarbital. Transfected with human hepatic cancer cells; underwent six rounds of intra-abdominal treatment with DS-22.
[He uses scalpel to start cutting.] Vertical incision through the rectus sheath opens the abdominal cavity. Incision extended into [Coughs.] thorax. [Coughs again, loosens collar, appears to be having trouble breathing.]
Liver appears normal in color, no apparent scarring or [Coughs as he turns liver over.] – Damn it! Cancerous tumor is still present, on the right lobe. 1.12 cm in diameter. No reduction.
[Coughs and begins gasping. Picks up another rat but drops it; continues wheezing and gasping. Falls to knees. CGI of liquid in his trachea emptying into his lungs and filling them. He passes out with eyes open, looking dead; the rat he dropped falls onto his chest and begins nibbling at his lower lip.]
(Scene opens on the conference room in the morning. He pushes door open with his cane. The ducklings look at him puzzled that he's using the cane again.]
House: 71 year old cancer research specialist. Minor tremors, localized melanoma removed 2 years ago, cataracts. And he can't breathe. Also, disregard the facial lacerations. They're creepy, but unfortunately irrelevant. [He winks.] Don't you wanna know why?
Cameron: You… have your cane.
House: No, why the lacerations are creepy. He was about to dissect one of his lab rats when he collapsed. The little vermin seized the day, so to speak and went medieval on his ass. [The Ducklings stare at him with frowns.] What, my fly open?
Foreman: So the… the pain's returned.
House: There was no pain, he was unconscious. I'm guessing, because he wasn't able to breathe.
Cameron: We're talking about you.
House: Obviously. I'm obviously not. What is it with you people? I don't use the cane, you're shocked. I use the cane…
Cameron: We're just concerned.
House: About the wrong person. I can breathe. Ezra Powell on the other hand, is gonna die.
Foreman: THE Ezra Powell???
Chase: The researcher? The guy who wrote that textbook?
House: *That* textbook, THE textbook.
Cameron: Wait - there's actually another doctor you admire?
House: I… admire lots of doctors. 'Course most of them look a lot better in knee socks than Ezra Powell, but seeing as they can all breathe.
Chase: Oxygenation is through the floor and lungs are full of fluid. Gotta be his heart; could be amyloidosis. [He holds up the chest x-ray.]
Foreman: Or his lungs; probably from using and inhaling toxic chemicals in his lab. [Camera focuses on House, grimacing in pain.]
Chase: It's not the lungs. Chest x-ray is clean.
Foreman: So's his EKG, it's not his heart.
House: You're being too nice. [He looks up at them.] Outside the hospital he can't breathe, inside the hospital he can. Means we help, at least enough to screw with our test results. The source of the problem's either in his heart or his lungs. So all we gotta do is stop helping, put a little pressure on him, and see which gives out first.
Chase: At 71, we get his heart or lungs to give out we might not get 'em to give in again.
House: That's why we're gonna do it in a hospital. Put him on an incline treadmill and do a stress EKG. [He grabs a donut and limps into his office with the cane.]
Foreman: So much for the admiration.
(Scene changes to a procedure room; Cameron is helping Powell start the stress test.)
Cameron: Let's get you started. [Powell can't quite get out of the wheelchair.] I'll turn your oxygen up.
Powell [Getting on the treadmill.]: I… I worked with Williams on the first protocol for this machine.
Cameron: Everyone still uses it.
Powell: Except for Williams. He died four years ago.
Cameron: I'm sorry.
Powell [Nodding.]: He was 84. He died parasailing. He was always [Gasps.] an idiot.
Cameron [Smiling.]: You okay? [Powell begins to walk.] Hang in there. You know the protocol’s only a few minutes.
(Inside the viewing room watching Cameron, Powell and the monitors.)
Foreman: His heart rate's flat. We don’t get it past 130, we're not gonna see anything.
Chase: And if he falls and breaks a hip, we're not gonna see anything
Either; except an increase in our malpractice insurance.
Cameron [Joining them.]: I figured House might go back to the pills, but if he's using his cane he's right back to where he was before. Maybe even worse.
Chase: Luckily he'll handle it in a stoic, grown-up fashion -- he'd never take it out on us. [Foreman nods.]
Powell [Panting hard now.]: I can't. I… I gotta stop.
Cameron [Through the intercom from the viewing room.]: Just a little longer.
Foreman: His heartbeat's only 90. I'm gonna increase the incline.
[Cameron goes into the procedure room with Powell.]
Powell: I gotta stop. I… I… I gotta get off.
Cameron: You're doing great, just a little faster, okay?
Powell: I don't need a cheerleader, I need oxygen.
Cameron [Pushes stop button on the treadmill.]: Stop, this isn't working.
(Exiting elevator on the first floor.)
House: His heart rate barely got above 90.
Cameron: He can't breathe, there's too much fluid in his lungs.
House [Extremely sarcastic and animated.]: REALLY!? He's got FLUID in his lungs, whatever are we gonna do?? Oh yeah, now I remember. [Hands results back to her.] Put him on a treadmill and run him like one of his rats on a wheel.
Cameron: He can't run, he can hardly walk.
House: It's 'cause he's not trying hard enough. If he was, his heart rate would go up.
Cameron: Exercising with a lung full of your own bodily fluids tends to hurt.
House: They don't call it a stress test for nothing. Do it again.
Cameron: He's drowning!
House [Entering clinic.]: Then pull him outta the pool, and… Do. It. Again.
[Powell's room, he's having his lungs aspirated by Chase.]
Powell [Coughing]: I'm assuming this isn't your idea of a long term solution.
Cameron: We need to get rid of the fluid in your lungs, so you'll be able to do the test.
Powell [Nodding.]: To see if it's my heart, or my lungs.
Powell: My money's on both. [Sighs.] I've been in and out of the hospital for the past year. I'm old. And sick. I'm getting older and sicker. Not a very interesting differential, but… [Grimaces in pain as the needle goes in.] Oh!
Chase: I'm in. [Tight shot on the syringe and Powell grimacing.]
(In the Clinic. House has a tongue depressor in a bald guy's mouth and is shining a light in. A young blonde teenager, presumably the bald guy's daughter, is in the room watching.)
Dad [Talking despite the tongue depressor.]: You don't need a $400 handbag.
House: It's kinda hard to check your throat when you're flapping your gums around.
Dad [Around tongue depressor.]: Oh… sorry.
Daughter: But it's for the fall formal.
House [Substituting for Dad, in a faux fatherly voice.]: He doesn't care if it's for the presidential inauguration.
Dad [Agreeing around the tongue depressor.]: Uh huh.
Daughter: But I'm using Marissa's old dress, it's free.
House [In Dad voice.]: Yeah, you know what else is free? The roof over your head, the food you eat, [The girl frowns at House.] your phone, your computer. [He takes the tongue depressor out of Dad’s mouth and addresses him.] How long have you been congested?
Dad: All week, ever since we got back from Fresno.
House [Feeling Dad's glands.]: Fresno. That's in France, right? See the Parthenon?
[The girl leans back against counter and smiles at House.]
Dad: Uh, California. I've got no appetite, I'm aching all over, I'm weak...
House [Pushing 2 fingers on the guy's forehead sinuses and interrupting.]: Does that hurt?
House [To daughter.]: Does his voice always have that unattractive nasal tone?
Daughter [Laughs.]: Totally.
House [Smiling at her slightly.]: I'm gonna take that giggle as a no. Fever, aches, weakness, loss of appetite. [Daughter is smiling at House again.] You been having any anal sex with I.V. drug users lately?
Dad [Offended.]: Of course not, I'm married.
House [Nods.]: You think she might've been having--
Dad and Daughter [Simultaneously, and shocked.]: NO!!
House [Nods.]: It's probably a rhinovirus. [He starts filling out a prescription.]
Dad: What's that?
House: Cold. [He hands him the slip of paper.] Take this 4 times a day, and stay off airplanes. Flying cesspools.
[House goes to leave, juggling the file, the cane and the doorknob; he drops the file.]
Daughter [Rushing over to help him pick up the papers.]: Oops! [Straightening up and beaming at House as she hands them back.] You dropped something. If there's anything else you can think of, please call.
[House stares at her. At this moment Cameron runs up and looks between the two of them.]
House [Turning to Cameron.]: Yes?
Cameron: He's… too old and weak.
[Daughter is still beaming at House and arches her eyebrows at him. Cameron gives her a look. House looks from one to the other and starts to look awkward. With one last look at the girl he leaves, closing the door behind him.]
[Back in the procedure room Powell is doing the test on a machine where you use the arms to pedal instead of the treadmill.]
Powell: Yeah, this is way better. This'll work. [Grunts.]
Cameron: Just try.
House [In the viewing room.]: There are 20 words to describe chest pain -- burning, squeezing, stabbing, tearing -- each one diagnostically useful. For that you have to thank Dr. Powell's textbook. There are no words to describe degrees of what he's feeling right now -- shortness of breath. If he'd worked on those issues, there would be. Because he never would have given up until he had an answer.
Cameron [Assisting Powell.]: This isn't working.
[House comes into the room with them.]
Powell: Dr. House…
House: Please don't get up. I'm sure you're very busy. [He gets a syringe from a cart.] I'm just gonna try and speed things up a little.
Cameron: Is that Epi? That's not the protocol.
House [Injecting into Powell's IV.]: No, the protocol, is what you tried to do and failed each time. [All are staring at him like he's mad. The machine starts to beep as Powell's heart rate increases.] Over 100… now we're getting somewhere. How's it look, Foreman?
Foreman [Through intercom.]: No EKG changes.
House [With raised eyebrows.]: Then we push harder.
Cameron: House, you're gonna kill him.
Powell [Gasping.]: No, he's right, let him -- let him do it.
House: See? That's why he doesn't have to wear knee socks.
Cameron [Firmly.]: He can't breathe.
[House injects part of a second syringe of Epi into the IV and the monitor starts beeping wildly.]
House: 130. [Powell looks scared, and like he can't breathe.] The magic number. Nothing here. Foreman?
Foreman: Still no sign of blockage.
House: Which means it's not the heart. So it must be the lungs. [Goes over to the cart to put the syringe down, not to get another syringe to calm the guy.] See? That wasn't so hard, was it?
[Cameron gets it and comes over to inject.]
Powell: No! Just -- give me the rest of the epinephrine.
Cameron: The test is over, it's okay, we're gonna stabilize you.
Powell: No! [Grabs her arm, then more softly.] No. Just let me die.
Cameron: You're not gonna die.
Powell [Gasping.]: Yes, I a-am.
Cameron: We'll find a treatment.
Powell [Staggered.]: I don't wanna live like this. Please. I'm begging you. [Gasps.] Kill me.
[Cam's eyebrows raise and she looks at him sympathetically.]
(In House’s Office)
Cameron: He says no more tests. He wants to die, and he wants us to help him do it.
House [Walking past her with his red mug into the conference room.]: And I want to play a little game I like to call ‘Block My Spike’ with Misty Mae.
Cameron: He's thought this through; it's not an impulsive decision.
House: Neither is mine. He's depressed. He'll feel much better after we cure him.
Chase: He's seen all the tests we've seen. Even if we figure out what was causing the lung damage, it's too late to reverse it.
House: You can't know that without knowing what's wrong.
Chase [Firmly.]: It's his call.
Foreman: So what do we do? We put a plastic bag over his head and get it over with?
Chase: No. We give him a syringe full of morphine. [The others turn to look at him.] Every doctor I've ever practiced with has done it. They don't want to, they don't like to, but that's the way it is.
Foreman [Shaking his head.]: I haven't, I won't.
Cameron: I couldn't do it either.
Chase [Incredulous.]: You just said we should respect his decision.
Cameron: Respect it doesn't necessarily mean we honor it.
Chase: Right. Just means we talk about it. [Pause.] At some point, do no harm has to mean allowing nature to take its course, not stubbornly standing in the way of it.
[House is pacing, chewing on a coffee stirrer, and listening.]
Foreman: Sticking a metal syringe into a plastic I.V. line and pumping in a lethal dose of morphine is not letting nature take its course. Not according to the state of New Jersey.
Cameron: So it's better we allow him to slowly suffocate in his own plasma?
Foreman: Whose side are you on, senator? First respect his wishes, then invade Iraq, then get the troops home. Make up your mind.
House: Wow. [The ducklings snap to attention.] Certainly a lot of interesting things to consider. Stress EKG rules out the heart, which means something's gotta be attacking his lungs. Mycoplasmas or strep pneumo, which probably means it's too late to do anything about it. We could try levofloxacin.
Cameron: Coming up with a new treatment isn't gonna do us any good unless we convince him it's worth trying.
House: Oh, come on. He's old, and sick, and tiny. We can do whatever we want to him.
[Everyone’s beepers go off at once, and they exchange grim looks.]
(In Powell's room, a nurse is helping him back into bed as the ducklings enter.)
Cameron: What happened?
Nurse: I don't know. Must've fallen out of bed and got the nasal canula wrapped around his neck somehow.
Cameron: Ezra, what are you doing?
Powell [As the nurse adjusts his oxygen]: I don't wanna live hooked to machines, too weak to wipe my own ass.
House [Coming into the room behind the others.]: Why would you wanna wipe your own ass when you can have someone do it for you?
Powell: You're wasting your time. There must be other patients you could actually help.
House: No, all services rendered on a first-come, first-served basis.
Powell: I won't consent! To any more tests. And if anyone tries to so much as touch me, I'll press charges for assault.
House [Nods.]: Okay well you heard the man; he wants everyone to leave him alone. [To the nurse.] Why don't you go first. [Nurse stares at him.] GET OUT! [She glares at him, but leaves. House sits on the bed.] You came to me, I didn't come to you.
Powell: I figured you'd have the guts to do what had to be done, if it came to that.
House [Looking at him shrewdly.]: We're nowhere near that. It's time to test your lungs. [He uses his cane to grab a breath meter from the bedside cart, and puts the hose end into Powell's mouth. Powell struggles.] Breathe! You have to exhale sometime.
Foreman [Rushing over.]: Stop!
Cameron [Pulling on House's shoulders.]: House, you're hurting him.
House: You're hurting me. [They let go, Powell begins to cough, spitting out the meter.] Fine; you don't help us, we don't help you. [House faces him and speaks slowly.] Your lungs slowly fill with fluid. You gasp to catch every breath but never can. Every breath is petrifying. It'll be slow, painful; torturous.
Powell: We don't choose our birth, and we don't choose our death.
House: What if you could? How 'bout we make a deal? Give me one more day. If I don't find out exactly what's wrong with you by then, I help you die.
Cameron: House! [Foreman shakes his head.]
House: 24 hours. Come on, it's not gonna kill you.
Powell: Ha. [Nods.]
(Cut to hallway.)
House [Looking for ideas.]: Old guy. Lungs. Fluid. Go.
Foreman: You canNOT help him kill himself.
House: Of course I can. Chase says we do it all the time. [Chase rolls his eyes.]
Cameron: Cuddy's not gonna let you…
House: Enough! You don't want me to kill him. Fine. Here's a big shock; I don't wanna kill him either. How do I not kill him? By you guys doing your job. We have 24 hours to figure out what's wrong with him. [Impatiently waiting for ideas from the ducklings.] Tick tock, tick tock.
Chase: I'll draw cultures. Pneumonia; should be bacteria in his blood.
House: It's gonna take longer than 24 hours.
Chase: Not if I spin down the sample. Separate off the buffy coat, then gram stain for bacteria.
House: [Nods.] Great. Do an amylase, D-dimer, C-reactive peptide, get a urine, and do a bronchial sputum while you're at it. [He indicates Cameron.] You check his home and lab for radiation and toxins. [He indicates Foreman.] And do a bone marrow biopsy.
Foreman: All of that in 24 hours?
House: Nah. Whatever you don't get done you can finish at the autopsy.
(Long montage sequence of the Ducklings at work: Cameron examining Powell’s house, and lab; the other two taking samples, doing tests, cultures; all three doing research reading, waking each other up when they doze off, drinking coffee.)
House [Coming into lab with a bagel the next morning, in laughing tone.]: Wow. You guys look like crap. [They say nothing.] Whaddya got?
Chase [Very tired voice, looking at his hands.]: Purple dye on my fingers.
House: What'd the bone marrow biopsy show?
Foreman: Don't have the results.
House: What? What've you been doing all night?
Cameron: JELLO shots and wild sex, what else? [House looks shocked, then narrows his eyes suspiciously at Cameron.]
Foreman: No bacteria in the blood cultures. We still have some cooking, but so far, nothing.
Chase: Nothing in the urine.
Cameron: Lab was clean enough to do surgery in, because well, they *do*. There was no sign of viruses or fleas on any of the rats.
[House's phone rings.]
House [Answering it.]: Yeah. -- Who? – Well… tell her to call the clinic. Then tell her to leave a message, and I'll get back to her. [Cameron frowns suspiciously, obviously having an idea of who is on the phone.] Then tell her to leave a personal message. [He hangs up.]
Cameron: Who's that?
House: Your protégé. What are these?
Cameron: Dictation tapes. He records everything.
Cameron: Because he's a diligent researcher?
House: Or he's losing his memory.
Cameron: A lot of people dictate their notes.
House: Yes, we could assume that, and we'd have nothing. Or we could assume it's a symptom, in which case whatever's in his lungs, is also in his brain. Unless you got something more promising.
Cameron: I'll go get an MRI of his head.
House: Keep testing 'til you find something. I'm going to my office to rest for awhile. [They all glare after him.]
(In the MRI room.)
Powell [Being helped by Cameron onto the platform.]: It's been a long time since I took an anatomy [He coughs.] class, but I'm pretty sure you're moving farther and farther away from my lungs. Running out of places to look aren't you?
Cameron: Doesn't mean we're gonna stop looking.
Powell: No, not for six more hours.
Cameron: You want us to fail?
Powell: No, but you will.
(Meanwhile back in the lab with Wilson and House.)
Wilson: No abnormal nuclei means no leukemia; he a drinker?
House: Not according to the history.
Wilson: Which means yes, he drinks, which gives us a nice mundane explanation for the acellularity.
House: Or he's telling the truth. Which means fungus is still on the table.
Wilson: But your entire view of human nature gets destroyed. [He shrugs.] Six of one, half a dozen of the other.
House: Bad news fast. Good news you can take your time.
Cameron: Head is clean. You were wrong, his faculties are intact.
House: Too bad. If his brain was addled, we wouldn't have to listen to anything he says.
Wilson: Hand me the 10% KOH.
Cameron: It's 4 o'clock; we have nothing to tell him.
House: Then we have no reason to talk to him. We still haven't ruled out fungus.
Wilson: Yup, we have. No buds, no hyphae.
House: [Sighs.] Okay. Next procedure; we sneak in, turn back the clock. [Wilson smiles, Cameron looks forlorn.]
(Powell’s room, House enters followed by all the ducklings.)
Powell: Whole team. Must [Coughs.] be bad news.
House: Nope. Bone marrow biopsy revealed multiple myeloma. [Chase and Foreman exchange looks.] It's not good news, but there are some treatments. [Cameron is staring at House] We have to draw some blood…
Powell: What about my breathing?
House: Associated hyperviscosity syndrome; gummed up the blood vessels in your lungs.
Powell: Dr. Chase said my calcium is normal.
House: Mm. We call him Dr. Idiot. [Chase rolls his eyes, Foreman crosses his arms.]
Powell: There's no M-protein in my urine.
House: Odd presentation.
Powell: So odd that Dr. Cameron doesn't believe it either. [House turns and glares at her.]
House: Just give me 12 more hours.
Powell: We had a deal. No more tests.
House: Fair enough. Give me six more hours. [Powell purses his lips.] Listen; there is no evidence that you are terminal.
Powell: You a man of your word or not?
House: No, as a matter of fact, I'm not.
Powell: Fine. Then discharge me. [House looks beaten.] My lungs will slowly fill with fluid, I'll gasp to catch every breath, but never can.
Every breath will be petrifying. It'll be slow, painful; torturous. You really gonna let me die like that? [House looks around and leaves.]
[Cut to House brooding in his office. Footage that we have seen from ‘Meaning’. Not even the same outfit. Poor edit/continuity.]
[Chase and Foreman sitting pensively outside the office, brooding.]
[More House brooding.]
[Cameron brooding in Ezra’s room. Shot goes to Ezra, face twitching in pain.]
[Last House brooding shot. This time, a close-up on his face.]
[Chase and Foreman see House leaving his office.]
Foreman: Where you going?
House [Yells over his shoulder.]: Nowhere.
[Chase and Foreman look at each other then decide to follow.]
(Cut to Ezra’s room. House walks in, soon followed by Chase and Foreman. House walks over to Ezra’s bed and lays down his cane followed by a small kit.)
House: Everybody who can walk should get outta here. [House takes morphine and a syringe out of the kit.]
Cameron: You can’t do that.
House: Can’t do what? Administer a prescription painkiller to a patient who’s in pain? Go. Make sure somebody sees you downstairs in the cafeteria.
Foreman: I can’t let you do this. [He walks over to House, who is filling the syringe, to stop him.]
Ezra: [Gasping in between words.] Either I die in pain or I just die; that’s what the argument is here.
Foreman: No it’s about whether you die or we murder you.
House: [Holding up syringe, while talking to Foreman.] What’s gonna happen here is that someone’s getting a butt-load of morphine. I’m not sure exactly who at this point. [Foreman takes a moment to think it over, and then leaves the room in a huff.]
Cameron: I can’t be a part of this. [She leaves the room as well.]
[House looks at Chase, who looks back for second, then goes over to the door, closes it, and shuts the blinds.]
Ezra: [Quietly, to House.] Thank you. [House gives a quick nod.] I’ve always wondered exactly what was on the other side.
House: Nothing. [House injects the morphine into Ezra’s IV. Ezra flatlines. House and Chase stand there solemnly for a few moments. Then House looks at his watch. House grabs the bed and pulls it away from the wall.]
Chase: What are you doing?
House: Getting a laryngoscope. [House grabs a laryngoscope.] Don’t just stand there, help.
Chase: But you told him –
House: [Interrupting.] Yeah. A little something I like to call a lie. Bad I know, but it’s way further down the list than murder. [He intubates Ezra and starts to pump the ambu bag.] He’s unconscious. No more whining. I’m gonna keep testing him. [Chase looks confused and indignant.] Go get a ventilator, not gonna do this all night.
(Scene opens with Ezra on ventilator, House’s voice over the image.)
House: We can legally assume that he’d consent to whatever a reasonable person would consent to. [Cut to House’s office.]
Cameron: And a reasonable person would obviously consent to being put in a coma against their will just to satisfy your curiosity.
House: [Fake exasperation with a *hint* of real exasperation.] I try to kill him, you’re mad. I don’t kill him you’re mad.
Cameron: All he wanted was some dignity.
House: Were you in that room with him? Was he wearing a tux while he was choking on his own plasma? Keep doing the tests. Take your time, do it right. Go. [Turns to look at the MRI.] Get to work. [House studies the MRI for a couple of seconds, obviously expecting the ducklings to go do his bidding.] Wait! [He turns in his chair. Ducklings haven’t moved, and House is a twinge embarrassed for yelling, but tries not to let it show.] Cameron, why’d you do these cuts so far down on this MRI of his head?
Cameron: I wanted to get his brain-stem and his C-spine, make sure his diaphragm wasn’t paralyzed.
House: You also caught the top of his lungs. There’s scarring. [Cameron is staring at him.] You do know that you can’t really pierce me with your stares.
Chase: Lung scarring along with the bad bone marrow points to an autoimmune disease. Could be pulmonary fibrosis.
Foreman: Or Lupus.
House: He can kill himself after we get him better. Start him on an IVIG for the Lupus, and get a colonoscopy. Lupus could be hiding there.
[Chase and Foreman turn to leave, but notice that Cameron doesn’t move. House looks up, and noticing this also, looks at her.]
Cameron: I can’t do this. [She leaves.]
House: Drama queen.
(Cut to Ezra’s room. Chase and Foreman are in there doing colonoscopy.)
Foreman: Ascending colon’s clean.
Chase: Moving into the sigmoid.
Foreman: Sure could use a little more help around here.
Chase: [With slight sarcasm.] She’s doing what she believes in.
Foreman: Yeah. If she was acting on principle, she’d be in here trying to stop us. All she’s doing is running away from the principle so she won’t have to feel uncomfortable facing it.
Chase: And if you were acting on principle, you would have called the cops when you thought House was killing the guy.
Foreman: [Ignoring Chase.] Better hurry up.
[Quick cut to Nurse Brenda watching Chase and Foreman working.]
Foreman: I don’t think she’s gonna have a problem deciding what to tell Cuddy. [Ezra’s heart monitor starts beeping.] O2 sats 89 and dropping.
(Cut to hallway outside of House’s office. House is leaving his office. As he’s exiting, Cuddy intercepts him.)
House: Thought you were only supposed to put on a pound a week during your last trimester.
Cuddy: [Sighs.] I’m not pregnant. I heard about your little stunt with Dr. Powell.
House: [Makes a drawn out whining sound.] Not really a stunt. More of a trick, a ruse, a hoodwink.
Cuddy: A lie.
House: Ok. Lying is sometimes good, right? Like when you’re trying to teach someone a lesson about humility, or something. All I’m trying to do is save his life. He’s not gonna learn anything; I just thought the same principle might apply.
Cuddy: It does.
House: I coulda just let him die.
Cuddy: Not gonna get sued for keeping him alive.
House: Well, we could; we completely disregarded his wishes.
Cuddy: Do you want me to disagree with you? [Turns to House, they stop walking. Sarcastically.] Want me to yell at you?
House: It is comforting.
Cuddy: We’re doctors: We treat patients, we don’t kill them.
House: [Raises voice, speaking into her lapel pin as though it is a microphone.] How right you are, Dr. Cuddy! We also don’t pad our bills, swipe samples from the pharmacy, or fantasize about the teenage daughters of our patients, either.
Cuddy: True, better be true, and you’re a pig.
[House goes to leave, Cuddy lightly grabs his arm to stop him, and he turns back to face her.]
Cuddy: I’m sorry about your leg.
House: Yeah. [Walks away.] We really should spend some time talking about that. [Cuddy sighs.]
[Foreman has appeared at the end of the hallway; House walks over to him.]
Foreman: The IVIG made him worse. O2 stats plummeted.
House: [Sighs.] So we know it’s not Lupus. What else could it be?
Chase: Idiopathic pulmonary fibrosis.
House: Gonna need an open lung biopsy to confirm. [House goes into a lounge; Chase and Foreman follow.]
Foreman: So, now we’re going to operate on the guy?
House: Unless you’ve invented a new way of doing an open lung biopsy.
(Shift to House walking over to a shower area where we find Cameron sitting.)
House: When you searched Dr. Powell’s office, did you find a copy of the January, 1967 Massachusetts Medical Journal?
House: I just figured, if you’re not doing any work, you might like something to pass the time. Centerfold’s a killer. [House walks away, leaving Cameron curious.]
(Cut to House’s office. House is throwing his ball against the wall with his cane.)
House: [Fake cheering of an audience. Wilson enters.]
Wilson: How’s your leg?
House: It hurts. [Sighs.] It’s gonna keep on hurting. You gonna keep on asking?
Wilson: How’s Ezra Powell?
House: Resting comfortably.
Wilson: Hmm, that’s not what Cameron says.
House: I hate practicing medicine in high school.
Wilson: He’s not asking you to help him kill himself; he’s just asking for help. The disease will kill him.
House: I know what he was asking for; I just said ‘no’.
Wilson: You’ve done it before. Plenty of times.
House: To patients that I knew were terminal.
Wilson: [Annoyed.] Oh, give me a break. This has nothing to do with saving a life; you just can’t bear the thought of a patient dying before you’ve been able to figure out why.
House: If we’re gonna keep refusing to cure patients just to rein in my ego then we might start having a little problem with patient recruitment. [House’s pager goes off.]
Wilson: [Snidely.] Worried about meeting your one patient a week quota?
House: [Leaving.] I’m a cripple, remember. Accommodations must be made.
(Cut to Ezra in surgery - Chase and Foreman operating)
Chase: Sample of the left lobe isolated, and removed. Clamp. [Cut to House watching surgery from above. Cameron walks in.]
Cameron: Why’d you have me look up that article?
House: Didn’t you find it interesting?
Cameron: He injected newborn babies with radioactive agents just to see if they had urethral reflux.
House: He was curious.
Cameron: He didn’t even tell their parents he was doing an experiment.
House: He wasn’t doing anything his peers weren’t doing.
Cameron: His peers at Tuskegee and Willowbrook?!
House: He ignored the rights of the few to save many.
Cameron: So you’re okay with what he did.
House: Doesn’t matter what I think. It’s what you think that’s relevant.
Cameron: Because, if I think less of him, I’ll help you more? You’re wrong. The fact that a patient did bad things doesn’t change anything. He still deserves to have some control over his own body.
House: If he had control of his own body, he’d be dead.
Cameron: Some control. We can withhold treatment without killing him.
House: No you can’t! You either help him live, or you help him die; you can’t have it both ways. [Chase looks up at House from the operating room and shakes his head.]
House: Well I guess it’s not IPF. [Ezra’s heart monitor starts beeping.]
House: Well, maybe he’ll die right now. Make everything easy for all of us. [He leaves and Cameron is alone in the observation room.]
(Cut to the operating room.)
Foreman: Heart rate’s fast.
Chase: BP’s low. [House takes stethoscope from random surgeon, then checks Ezra with it.]
House: No breath sounds on the right side; he’s dropped his right lung. [Removes stethoscope.] Air’s building up in his chest, compressing his heart. [House makes an incision in Ezra, and places a chest tube in him, which re-inflates the lung.]
Chase: Heart rate’s decreasing.
Foreman: BP’s stabilizing. [House sews up Ezra to hold the tube in place. While doing this he accidentally hits his right hand. There is no reaction from Ezra. Again, House prods - purposefully, this time - and there is still no response. House goes to test Ezra’s left foot.]
Chase: What are you doing? [House prods Ezra’s left foot, and it twitches.]
House: Withdraws from pain stimuli on the left side, but not the right.
Foreman: Those are just reflex arcs; he’s under anesthesia.
House: Or he’s lost sensation in some places.
Chase: Or the hypoxia from the arrest stunned his CNS.
House: Only one way to tell. Do some ATA sensory evoked potentials.
Foreman: We can’t do that while he’s in a coma.
House: Only two ways to tell. Get a hammer and check his deep tendon reflexes.
Chase: Won’t work. He needs muscle relaxants to be on the ventilator.
House: [Long blink, thinking.] Only one more way to tell. Pupillary reflexes.
Foreman: All that tests is the brainstem.
House: See, I was right; only one way to tell. Do some ATA sensory evoked potentials.
Foreman: I just said we can’t do that while he’s in a coma.
House: So wake him up. [House leaves.]
(Shift to a close-up on Ezra’s face; he’s sleeping. He opens his eyes blinking a few times. The camera goes to House, whose image is fuzzy at first and then becomes clear.)
House: Don’t go towards the light. You’ll fall and break your hip.
[The ventilator is removed from Ezra’s mouth, and he coughs for a few seconds, and then looks around confused.]
Ezra: What’s happening? I --
House: You took a little nap.
Ezra: No, I… I told you I didn’t want --
House: [Interrupting.] Sorry, little deaf in one ear. Your bone marrow was hypocellular; we ruled out lupus and pulmonary fibrosis, but it looks like it could be attacking your nerves.
Ezra: So, this is all a waste, a huge fail… [Gasps.] failure. Impossible, you’re Gregory House.
House: We need to attach some sensors to your skin.
House: Look, we can’t do what you want; we’ve assigned a nurse to watch you so you can’t do it either. So, you might as well just let us do the test.
Ezra: No. I wanna be discharged.
Chase: You can’t be discharged; you’ve got two chest tubes in.
Ezra: Then take them out!
House: Oh, get over yourself. The ventilator puffed up your lungs; you’ll be fine for a few hours. Just let us run the tests. [Ezra rips off some leads that were attached to him.]
House: Ok. But first, let’s clean you up a little. [He grabs a glass of water and splashes a few drops of it on Ezra’s chest.] That feel nice?
Foreman: [Curious.] What are you trying to prove?
House: Just cleaning him up. What’s it look like? [He walks over to the end of Ezra’s bed, lifts up the sheet and sticks his head behind it.] Pay no attention to the man behind the curtain. House runs his thumb down Ezra’s right foot, and there is no reaction. He does the same to his left, and this time the foot twitches.]
Ezra: Get out!
House: Okay, I’m going already. Can’t you see I’m a cripple? [House leaves.]
(Cut to hallway, Chase and Foreman following House.)
Foreman: Ok, so you got me curious.
House: I was right; whatever is attacking his lungs is attacking his nerves.
Chase: You got that by splashing ice water on him?
House: No sensation in the left leg, abdomen, right arm. Technology’s overrated.
Foreman: That means the clean MRI of his brain means it’s just affecting the peripheral nerves.
House: And bone marrow.
Chase: Kawasaki’s would explain the kidney failure.
Foreman: Or lymphoma.
Chase: Or sarcoidosis.
House: All potentially treatable. Question is which. We need to catch the little bastards in the act. What’s the largest organ?
House: We need to get a piece. [House leaves them standing there.]
Foreman: Sure, we’ll just wait until he leaves his room without his skin, sneak in, and take a piece. [Chase snickers.]
(Cut to the conference room; where Cameron is, again, just sitting.)
House: I want you to get a skin sample for a biopsy.
Cameron: And I wanna get a foot massage from Johnny Damon.
House: [Walking towards the desk.] Kawasaki’s disease, lymphoma, and sarcoidosis are all treatable.
Cameron: And it could be a hundred other things that aren’t treatable. You have no idea.
House: But you do; you know everything.
Cameron: I didn’t say that I -
House: [Slams cane down on desk.] Exactly! You can’t decide if we’re helping or hurting him; if he’s good or bad; or if you want paper, plastic, or a burlap sack. Do your damn job. [House starts to leave.]
Cameron: I’m not gonna lie to him.
House: Fine, tell the truth. Just get me a pound of flesh.
(Cut to Ezra’s room. Cameron enters.)
Ezra: What do you want?
Cameron: House wants to biopsy your skin; he sent me to get it.
Ezra: [With slight surprise.] Oh. And you agreed.
Cameron: I had nothing to do with putting you in a coma or any of the subsequent tests.
Ezra: Which brings us to now.
Cameron: I read some of your articles.
Ezra: There were a lot of them.
Cameron: 1967 Massachusetts Medical Journal. You radiated babies. Just like that. No forms, no questions, nothing. Who knows how many cancers you caused.
Ezra: I don’t know. What I do know is we discovered techniques that prevent fatal kidney failures in hundreds of thousands of other kids.
Cameron: You’re not sorry.
Ezra: I don’t regret what I did. Informed consent, patient rights - holds back research. [Cameron takes the tool to get the sample and slices Ezra, who groans in surprise and pain.] What the hell are you doing?
Cameron: Informed consent is holding back our diagnosis.
Ezra: Good for you. Finally standing up for something; acting on what you believe.
(Cut to clinic. House pops a Vicodin.)
Ali: Dr. House? [House looks over in surprise.] Hi, how are you?
House: Not as good as you think I am.
Ali: Don’t worry, I’m not stalking you. My dad just lost his medicine; he had to come back for another prescription.
House: Yeah, right. He’s moving it on the street, isn’t he?
Ali: [Laughs] Yeah, my dad, the meth kingpin. [House starts to walk away.]
Ali: Why haven’t you returned any of my calls?
House: [He stops and thinks.] I plan to. In a couple of years.
Ali: I was just calling to say ‘thank you.’ And to tell you how impressed I was; you diagnosed my dad by just looking at him.
House: Felt his glands, too. [Ali gives a slight laugh.]
Ali: Oh, there’s my dad; I gotta go.
House: Yeah. Me too.
Ali: [While walking away.] Oh, and, you really don’t have to wait a couple of years to return my calls. Just six months; till I turn 18.
[Turns around and we see her red thong, which House looks at, then raises his eyebrows and gives a slight smile. Then, an “Aha!” moment.]
(Cut to ducklings in lab.)
Chase: [At a microscope as House enters.] It’s not Kawasaki’s, either. What’s next?
House: Congo red.
House: What the hell else would I mean by ‘Congo red?’
Cameron: It’s not on the list.
Foreman: There’s no reason for it to be on the list.
House: An abnormal protein is building up inside the cells of his body; shutting down his organs one by one. Explains everything; the infiltrates on the x-ray, the bone marrow, kidney failure.
Foreman: We rejected amyloidosis, because it didn’t fit the first symptom we found. It would affect his heart.
House: It did.
Cameron: It wasn’t on the stress test.
House: We didn’t push him hard enough. [To Chase.] Add the stain; let’s find out.
Chase: Congo red added.
House: Change the polarization of the light, already. [Results confirm that it is amyloidosis.]
Cameron: That means it should be treatable.
Foreman: How the hell you pull that out of --
House: [Interrupting.] Not outta mine. I had a muse.
Chase: Oh, God. Protein type AA. [Everyone looks disheartened -- And House hands Cameron a candy bar.]
(Cut to Ezra’s room. House walks in with his poker face.)
Ezra: Dr. House.
House: You have amyloidosis; it’s in your lungs, kidneys, bone marrow, and brain.
Ezra: Why should I believe you now?
House: If I was lying, I wouldn’t tell you the subtype is AA. It’s terminal.
Ezra: Congratulations, you got your answer. [House looks so defeated, quite the opposite of Ezra’s slight smile]
(Medley of scenes: Ezra shaking in his bed; House, defeated in his office, pops a Vicodin; Cameron thinking in the lounge shower area. The music is Into Dust by Mazzy Star.)
(Cut to House’s office the next day. House walks in and goes over to his desk. There is a present sitting there. He unwraps it; it’s a calendar, ‘Fresno by night.’ He opens to the marked month, March, and it says ‘Six months… and counting.’ House rolls his eyes with a slight smile, and puts the calendar down. Cuddy walks in and shuts the door.)
Cuddy: Ezra Powell passed away last night. I’m sure you already knew about that.
House: [Shakes his head a little.] No. I just got in.
Cuddy: The nurse charted at 2 AM; he was stable. Breathing labored, but regular. And at 2:30 he suddenly stopped. [House is thinking.] You know anything about that?
House: If I did, would you really wanna know? [Cuddy nods and then leaves.]
(Cut to Ezra’s body being cleaned up. Mazzy Star's "Dust" starts to play.)
(Cut to Cameron in chapel, crying. You can see House next to her, barely in the shot.)
House: [Puts his hand on her shoulder.] I’m proud of you.
[House leaves. Show ends on Cameron’s grieved face.]
I could possibly be fading
Or have something more to gain
I could feel myself growing colder
I could feel myself under your fate
Under your fate