This week's patient is a sixteen year old factory worker who collapses onto some kind of steel assembly line thing and starts foaming blood out of her mouth. Dr. Kumar forms a special bond with her and tries to prove House's age-old 'everybody lies' mantra wrong. Also, the original three come together again to solve a case and it's a beautiful thing
Sophia is a sixteen year old who is emancipated from her parents. She also works in a factory and has a whole bunch of fluid in her lungs. The team thinks that she might have taken some bad drugs or she's pregnant. Dr.Kumar is indignant that these are the first two diagnosis that everyone comes up with, just because she's a 16 year old factory worker doesn't mean she takes drugs, ok?
Kumar performs an ECG on Sophia's heart while Thirteen and Taub check her apartment for drugs and toxins. Sophia insists that she hasn't doesn't do drugs, but Thirteen finds a bong under the sink. Kumar still insists that drugs are irrelevant to Sophia's diagnosis because there was no heart damage on her ECG, he thinks she's got vasculitis and she needs steroids. Everyone else thinks there is some kind of heart damage that the ECG missed and she should be on Beta Blockers.
Kumar has a heart to heart with Sophia and she still insists that she doesn't do drugs, so he gives her steroids, not the Beta Blockers that House told him to give her. Unfortunately for Kumar, Sophia has a psychotic breakdown right after. Oops. Fortunately for Kumar, it appears the psychotic breakdown was not related to the steroid treatment, which means it's a new symptom. So what causes lung failure and psychosis?
Next the team performs and MRI on Sophia to see if one of the arteries in her brain is in spasm, causing the psychosis. They don't find any spasms in her brain, but they do find out that she was lying about her parents dying, because her limbic region (that controls your imagination) was active when she was talking about her parents. Ladies and gentlemen I present you with the world's most expensive lie detector test. When confronted, Sophia tells Kumar that she just wishes her parents were dead because her dad raped her and her mom pretended that it didn't happen.
The team is taken aback by this revelation, and Thirteen wants everybody to just stop the diagnosis for a second and ponder how horrible this girls' story is. House and Taub focus on the medical facts, perhaps Sophia may have contracted and STD? Kumar feels betrayed, and points out that she could be lying about the rape. House suggests that maybe Sophia is just uber-stressed and that's causing all of her physical problems. Thirteen is in favor of putting her on anti-anxiety meds because even if House is wrong, Sophia could probably use them.
While Thirteen and Foreman are administering the anti-anxiety meds, Sophia's urine changes color to a dark brown color, which means she is not stressed. Or at least that her stress is not causing all of her physical symptoms. House thinks that the patient may have picked up arsenic from her pressure treated furniture, Foreman says to test her hair for it.
They find arsenic in Sophia's hair follicles, and Thirteen administers the treatment for arsenic poisoning, and tells Sophia that she will be able to go home soon. But she jumped the gun because Sophia starts having a seizure. They do a new MRI and find there are lesions on her brain which were not there three days ago. She had arsenic in her system, but it was not the real problem, in fact it was fighting the problem. So what does arsenic cure?
Acute Promyelocytic Leukemia is still treated with arsenic, according to Thirteen. The good news is they now know what's wrong with Sophia. The bad news is she's going to have to get a bone marrow transplant from her parents if she wants to live. Despite Taub trying manipulate her (by telling her he is dying of Huntington's and if he had a way to stop it he would- Thirteen is unimpressed), Sophia will not let them call her parents. Taub and Kumar try to find a match in the Bone Marrow Donor banks. Thirteen is pissed and goes to find Sophia's parents without her permission, because she likes to do whatever she wants and doesn't care about anyone else, remember?
We finally learn Thirteen's real name (Dr. Remy Hadley, if you care. I don't) when she shows up on Sophia's parent's doorstep. Only guess what, the real Sophia is hanging out with her dad eating popcorn and clearly doesn't have leukemia. The patient has been lying about her identity this whole time! Remember when House used to say "Everybody lies" all the time? Has he just stopped saying it because it's just a given?
Back at the hospital, Thirteen confronts fake-Sophia who still refuses to let them contact her parents. Taub and Kumar have found a partial match in the bone marrow bank, but it's not close enough. Thirteen thinks they should just go ahead and contact the parents anyway. But House has an epiphany, and deduces that the patient is lying about being raped based on her completely unemotional reaction to her diagnosis. Since she lied about one trauma to cover up being raped, House needs to figure out what is worse than being raped. I'm pretty sure the answer to that question is a resounding: "Nothing."
House finally goes in and introduces himself to the patient and gets her to admit that she wasn't raped by her father. But when she was young she was supposed to be watching her younger brother in the bath, and he drowned. This poor girl has been carrying around the death of her brother with her for years (and she's only 16, remember). House convinces her that in the end calling her parents won't make everything better or all of her hurt go away, but it will stop her parents from having to bury another child. Fake-Sophia calls her parents and there is a tearful and heartfelt reunion. She's going to be ok, physically.
And Jonah was Inside the Fish Three Days and Three Nights
Foreman has been asked to help run a clinical trial, but when he asks House's permission to do the trial, House says no just to be an ass. So Foreman gets really angry and heads off to the clinic, because it's the only thing he can think of that will annoy his boss. Cuddy catches him and hands him a separate case to work on along with House's case, in order to prove that he can work on two cases at once (Side note: don't Doctors practice that kind of thing in med school anyway? I sure hope so).
This is how Foreman gets to treat the cutest little guy ever, who also goes by the name of Jonah. Jonah has dark circles underneath his eyes and is vomiting blood. His older brother, who is probably about 8 years old, thinks that maybe he just has to poop. Good thinking, somebody get this kid a lab coat.
Foreman gets Jonah to swallow this gigantic 'pill' with a camera on the end; it's the size of a baby carrot. While he is watching the camera's progress, Jonah starts laughing uncontrollably at nothing. Clearly, Foreman does not know what to do. He never makes people laugh.
So Foreman goes to Chase and Cameron for advice, because everyone knows Chase and Cameron are the comedy experts of PPTH. And finally we are treated to some original team diagnosis! I'm getting nostalgic, are you? Chase thinks Jonah could have meningitis or stomach cancer. Cameron thinks Foreman is just trying to prove a point to House and he's playing a dangerous game with the Cutest-Little-Guy-Ever's life. Foreman thinks Cameron and Chase should test for stomach cancer and meningitis.
They do the tests and they both come back negative, and Chase suggests that Foreman take the case to House. Foreman insists that he doesn't need House's help but is interrupted as little Jonah goes into cardiac arrest. So, Foreman swallows his pride and takes the case to House for a consult. But House won't help because he's got a point to prove.
So Chase, Foreman and Cameron have another brainstorming session in the hospital cafeteria. Aaah, I miss the good old days of this every episode. Chase points out that maybe Jonah's mom or brother have poisoned him or done something to him. Foreman disagrees, but he races off mid-sentence so something Chase said must have given him an idea.
It turns out Jonah is the victim of an iron overdose. His mom has been giving him one children's vitamin every day, but his big brother has been giving him lots more to make him stronger. Big brother explains that he was trying to help, not make Jonah sick!! Aw. I just died of cute.
By working on Jonah's case at the same time as Sophia's, Foreman proves to himself that he can be a part of the clinical trials and work on House's team. In the end he tells House that he is going to do the clinical trials and House says ok. You see the second time Foreman didn't ask permission, so House can't say no if he's not being asked.
Foreman: "I need a differential for uncontrollable giggling."
Chase: (Looks at chart) "He's four, they laugh."
Foreman: "Yeah, nothing like diarrhea and bloody vomit to put you in the mood to goof around."
Wilson: "You made a decision. I can't tell you what's right for you."
House: "Seriously!? Because last week you could, last year you could, in fact, it seems to come pretty easy to you."
Wilson: "Do you want me to tell you what to do?"
House: "I want you to stop thinking that acting inscrutable makes you anything other than annoying."
House: "Tell her the thing about emotional reactions is they're by definition, irrational. Or stupid... You might want to phrase that in your own words."