This week, the team treats a man who has a brain problem that is making him say whatever comes to mind out loud. It's sort of like how House is all the time, except this guy has something wrong with his brain to blame it on. Also, Wilson is acting mysterious and evasive and House enlists the help of Taub to solve the case.
This week's patient is Nick Greenwald, book editor who suddenly starts insulting people at a dinner party. Kumar presents the case to House by comparing him with Phineas Gage, perhaps the most infamous patient with personality change and frontal lobe disinhibition in history. Luckily for Nick, he didn't have to undergo the whole railroad spike driving through his forehead thing. When they bring him in Nick presents as sober with a nosebleed, and an inability to control his tongue, he also collapsed at dinner. Thirteen thinks that he might have a well-placed tumor in the nasal cavity that is causing him to be a jerk to everyone, especially his wife.
Kumar and Taub perform a test that involves sticking a scary looking tube up Nick's nose. He tells Taub that he has a big nose and Kumar that his cheerfulness is creepy. After the test, Kumar tells House that their patient doesn't have nasal cancer. Unfortunately he still says everything that comes into his head. House and Wilson get into a philosophical nature about whether the guy is a jerk because of all the horrible, impatient thoughts he has or if his nice guy personae that he's worked to create all these years is who he really is. Kumar comes up with an awesome Harry Potter analogy that House wishes he had dreamed up (The sorting hat was going to put Harry in Slytherin but Harry chose not to be so his true nature was a actually Gryffindor). But It doesn't really matter what Nick's true personae is because if he keeps on the way he's going he won't have a marriage or friends.
During an MRI they find a spot in his brain, but they can't take it out to biopsy it because it's too close to the brainstem. Foreman theorizes that it might be neurosarcoidosis. They give him steroids for it, and theoretically if they are right his symptoms should start going away within a few hours. But then Nick's kidneys starts failing.
Kumar thinks that Nick might have some kind of genetic disease that is affecting his brain and his kidneys. Kumar goes off to test his daughter for peripheral nerve damage that would indicate some kind of neurological problem. House makes Taub test for diabetes, which is a long shot but it means he has to draw blood every few hours and stay awake all night so House wants the test done anyway.
When he is prepping the nerve test for Nick's daughter Marika, Kumar tells her that if she does well on the test it can help her dad. Unfortunately she takes it to mean that she needs to endure as much pain as she can. She ends up not telling Kumar that her hands hurt until they are burned. It's unhelpful medically, and now Nick is understandably pissed that the doctors burned his kid.
The blood tests that Taub did all night came back negative for diabetes, but he still thinks there is something wrong with Nick's endocrine system. So the team does a thyroid reuptake scan. Meanwhile, Nick is busy alienating his wife and daughter with his inability to keep from saying whatever comes to his mind. He tells his daughter that she is 'below average' and what his wife has been passing off as an 'auditory processing disorder' just means that Marika is not the sharpest crayon in the box. She leaves, crying and his wife doesn't know how much more of this she can take.
While his wife and daughter are on their way out the door, Nick develops a fever and his lungs start filling up with fluid. It appears that he had an infection that the steroids have brought to the surface. Kumar does a more thorough history and finds out that Nick's wife recent rescued a Rottweiler that may have passed on a bacterial infection to him.
The bad news is that even though they can cure the infection, they can't fix the damage it's caused in his brain. They also can't operate to remove the damaged portion of his brain because it's too close to the brain stem and one wrong move by the neurosurgeon could kill him. Physically, Nick will be fine but he will still not be able to control what he says which means his marriage probably won't be.
Nick confronts House in his office and begs him to do the surgery anyway. If he has to choose between possibly dying and living with his inhibited condition all the time he would like to take the chance. House recognizes that if Nick doesn't have the surgery he will lose his family, alienate his co-workers and push away any friends he has remaining. It all sounds a little familiar for House.
House asks Chase to do the surgery. Chase points out that he's not a neurosurgeon (what? There is a surgery he can't do?) so he couldn't do the surgery even if he wanted to. House argues that Chase's boss is a neurosurgeon and would probably do the surgery if Chase talked him into it. When Chase asks House to tell him why he cares about this particular patient so much, he explains that Nick will looks his family and alienate his coworkers and any friends that he might have. It's a quality of life issue. Chase agrees to talk his boss into performing the surgery.
Nick survives the surgery but the inhibition is still there when he wakes up. His temperature keeps going up and down which indicates that the brain damage is spreading. It doesn't make sense with the bacterial infection diagnosis. Luckily House has an epiphany and realizes that the cyst the team found on Nick's full body scan is actually a fibroma and he has Doege-Potter Syndrome (sorry, no wikipedia for that one kids). His body apparently overreacted to the fibroma and began creating antibodies and attacking itself. Once they take out the fibroma, Nick will be fine and he can go back to being a happy hypocrite again.
As he's packing up and signing his discharge papers, Nick apologizes to Taub for telling him he has a big nose. He is not sure if his wife will forgive him enough to come and pick him up from the hospital, but she does. As she wheels him off to the car he asks her how Marika is doing, she replies that kids are resilient and things will be ok.
A Little Bit of House & Wilson
When House asks Wilson to go to a monster truck rally with him and he declines, House becomes suspicious. Wilson claims that he doesn't like Monster trucks very much, and that he's just been tolerating them all these years because House likes them so much. House doesn't buy it though. He thinks Wilson is hiding something. There's no way someone can not like monster trucks.
Later when House is helping himself to Wilson's lunch in the cafeteria, Wilson lets it be known that he is still a bit insulted by House's slights at his general niceness. House has insulted his personae, but House reassures him: it's not that he thinks Wilson is hiding and inner core of darkness, he just thinks that Wilson has no inner core. House believes that Wilson just acts however the person he is with needs him to act. The argument escalates when House forces Wilson to admit that he's playing racquetball with Taub and that's why he can't go to the monster truck rally. But House is still not convinced.
House forces Taub to play racquetball with him in the morgue and learns the truth: Taub lied about playing racquetball with Wilson because he thought it would be good for Wilson to owe him a favor. And also, he learns that Taub is terrible at racquetball.
But now House has turned Taub as a spy for him- a sort of double agent, if you will. House makes Taub ask Wilson out for lunch. While he is in his office, Taub goes through Wilson's email and finds out that Wilson is meeting with a Dr. Joan Gonzales on monster truck rally night. Through some google assisted detective work, House finds out that Dr. Gonzales is a specialist in depression and suicide among oncology patients. Hmmm...is Wilson depressed?
House goes looking for Wilson and finds him returning from a walk outside (in New Jersey, in early March) without his coat on. The mystery deepens for House, who notes that Wilson probably went for a walk because he needed to think, and also he probably left his jacket behind on purpose. Wilson blows up at House and yells him that every out of the ordinary thing that he does, or small detail of his life he chooses not to share is not intended as a challenge for House to try and figure out the puzzle.
Wilson eventually feels bad for his outburst and comes to apologize to House. By this time House has figured out that Wilson was not meeting with Dr. Joan Gonzalez, he was meeting with Javier Gonzalez, a nurse in the psych ward at New York Mercy hospital. It seems that Wilson's brother was found sleeping in the lobby of an apartment building in Manhattan and the cops took him to the hospital. Wilson is on his way to New York to see his brother for the first time in over 15 years. House asks him if he wants some company.
When they are in the waiting room at New York Mercy, Wilson spills his guts to House. One night when his brother was in college and Wilson was in med school, Wilson decided to go to the library and study instead of taking a late night phone call from his brother. That night Wilson's brother ran away, leaving his meds behind and he has been homeless ever since- Wilson has been feeling guilty ever since.
House begins to give Wilson a rationalization of the event and explain why he doesn't need to feel guilty. But before he even really gets going on his speech, he has an epiphany about his case and calls the team. Wilson ends up walking into the room to see his brother while House is still on the phone. Well, at least he came to the hospital with him, right?
Back at PPTH, House asks if Wilson is ok. He is, and he'd like House to meet his brother next week. Wilson thought that seeing his brother again would change everything and it would either be wonderful or terrible. But it seems that after all these years, Wilson and his brother are just strangers. It's fairly anticlimactic for Dr. Wilson. But that's better than terrible.
House: "The interesting question is: Why? Why do you think the world will end in destruction and chaos if you're not there to save it?"
Wilson: "Because when my parents put me in the rocket and sent me here they said, 'James you will grow to manhood under a yellow sun.'"