doc_on_duty (doc_on_duty) wrote in clinic_duty,

House MD – 5.02 Not Cancer

Originally Aired: September 23, 2008

Written by: David Shore & Lawrence Kaplow
Directed by: David Straiton

Transcribed by: Jane (poeia)


[Open on two women playing tennis. During a long, hard volley, the brunette drops her racquet and falls to the court, holding her chest. By the time the blonde reaches the net, the brunette is dead.]

[Cut to a construction site. A crane operator is moving a huge container truck. A man on the ground giving him instructions via radio.]

Man: Bring it up about six more feet. Okay, you can go ahead and start dropping it.

[The crane operator’s hand on the controls opens. The crane starts dropping very fast.]

Man: Whoa. Whoa!

[He and another worker barely get out of the way before the container drops. They go to the crane and open the cab door. The crane operator falls out, dead.]

[Cut to a kick-boxing match. The crowd is shouting. The fighter with the shaved head and goatee is clearly winning until, mid-punch, he falls over backward. Blood is coming from his ear. By the time the referee reaches him he is apparently dead.]

[Cut to a music classroom. Tibalt is playing the tuba while a younger man watches, his tuba in his lap. Tibalt coughs convulsively, spraying blood over the sheet music, before he collapses and dies.]

[Cut to a college lecture hall. Apple is writing a formula on the blackboard. Thirteen enters, accompanied by an EMT.]

Thirteen: Class is over.

Apple: What's going on? Who are you?

Thirteen: I'm a doctor. Did you have a corneal transplant five years ago?

Apple: Yes.

Thirteen: Every other patient who had a transplanted organ from that donor is either dead or dying. You got a purse?

Apple: [gets her purse] I feel fine.

Thirteen: I don't mean to scare you, but so did the others.

[Opening Credits]

[Cut to patient room. Apple paces. Frank is in a bed with an oxygen mask. His wife sits next to him, holding him.]

[Cut to morgue. The Diagnostics team is scattered around the room, which is dominated by four bodies on stretchers. House sits at a table.]

Foreman: One living, one almost dead. Four fully dead. Nothing in common except their donor. Carl got a new heart and lung — liver kills him. Tibalt got a new liver, lung killed him. Holly got a new kidney, her heart blows up. And Frank, the old guy gasping for breath upstairs, he got an intestinal graft, his pancreas is failing. All within eight months of each other. And in each case, serious complications came on suddenly and without warning.

Kutner: Which means arrhythmia, massive pulmonary embolus, or cerebral bleed.

House: What did Wilson do for me?

Taub: [ignoring him] If the donor had an infection that somehow slipped by a screening, it could lay dormant —

Kutner: Five organ systems hit. Would need five infections for it to somehow slip by screening.

House: Oh, sure, he made me laugh on a rainy day, made me see the colors I never knew —

Thirteen: None of the donated organs were hit. It means whatever they got came from the donor's blood.

Kutner: That wouldn't help us narrow down what —

Thirteen: It narrows down who. Corneal transplants are bloodless. It means Apple's gonna be fine.

Foreman: You secure enough in that theory to send her home?

Thirteen: I guess we could wait till we figure out what's wrong with Frank.

House: On the other hand, Gilbert Gottfried makes me laugh. And how many colors are there really? Once you got red, blue, and green —

Kutner: He paid for your lunch, liked Monster Trucks, and was your conscience. Autoimmune disease.

Taub: ANA at autopsy of all four victims were normal.

Foreman: Wouldn't cover vasculitis. Henoch-Schonlein purpura —

Taub: Antiphospholipid antibodies, normal.

Thirteen: Then that leaves cancer.

Foreman: Cancers have names. They have a progression. They affect specific organs. Bone cancer can't turn into liver cancer. Forget cancer.

House: [getting up to leave] It's cancer.

[Cut to the hallway. The team follows House, Foreman arguing the whole way.]

Foreman: It's not cancer.

House: You're right, of course. What was I thinking?

Foreman: No single type of cancer blew up three organs in the chest while also herniating in the fighter's brain stem.

House: The fighter's irrelevant.

Taub: You don't like coincidences.

House: It would be a coincidence if six transplant recipients had nothing else wrong with them — like being an idiot, which leads to getting your head knocked off. The others had cancer.

Foreman: Four autopsies and about 1,000 lab tests say it's not cancer.

House: Redo the thousand tests and the four autopsies. Taub and Kutner, check out the donor. Find out which cancer —

Kutner: He didn't die of cancer. His head got chopped off in an industrial accident.

House: Find out which cancer would have killed him. Check the home and office for carcinogens, toxins —

Taub: He's been dead for four years. I assume his home's been rented to someone else by now.

House: Find out which cancer killed them. [Foreman stands with his arms folded while the others leave.] Did I forget you? You can check out the patient's eye.

[Cut to the cafeteria. He looks around, quickly grabs a tray and a slice of cake in a container. He comes up behind a doctor by the cash register.]

House: Put this on Dr. O'Shea. [He reaches over Dr. O’Shea.] And some chips.

O’Shea: Forget your wallet, House?

House: No.

O’Shea: [handing money to cashier] I'll take care of it.

House: [quietly, as he follows O’Shea toward the tables] Check.

O’Shea: Are you following me? [He sits at a table.]

House: Word is you're into monster trucks.

O’Shea: My kids like it.

House: But not you?

O’Shea: Predator's okay, but I think the California crusher is overrated. [House sits] Are you checking me out?

House: You're astute. [He takes some pills.] No.

O’Shea: How many pills did you just take?

House: Vicodin, opioids, some B12. Need a little kick in the afternoon. You got a problem with that? [O’Shea ignores him and picks up some food from his tray.] I think I'm falling in love.

Foreman: [approaches] Her right eye's failing.

House: No, it's not. Everyone else's transplanted organs were fine. It means her eye is fine.

Foreman: We need to remove the eye.

House: It's her only working eye.


House: [to O’Shea] Do you have some ethical problem with what I'm doing that you could express in a unique way which might actually make me think that I'm wrong even though I'll never admit it?

O’Shea: Yes.

House: You are funny. [to Foreman] The problem's not in her eye. It's in her head. [to O’Shea] You wanna come over and watch Prescription Passion at my place tonight?

O’Shea: You know I'm not gay, right?

House: Neither am I. If you don't want to have sex, that's cool with me.

O’Shea: I'm not coming over to your home.

House: I'll grow on you.

[He takes his chips and leaves.]

[Cut to the patient room. Frank’s wife is feeding him. House is testing Apple’s vision while Foreman looks on, disapproving.]

Apple: L... P... E... Do I have to be in the same room as him?

House: Whatever he's got, you've got. Fifth line.

Apple: Are you sure?

House: Pretty sure. Fifth line.

Apple: Am I gonna die?

House: Can we talk about something besides you for a moment? Like maybe the fifth line?

Apple: F... E... O... S... P. [The line is actually PECFD]

House: Damn.

Foreman: I'm sorry. We need to remove your eye.

Apple: My eye?

House: A moment ago, you thought you were dying. Blind's actually good news. Unfortunately, he's wrong.

Foreman: You just did the test.

House: She didn't squint. Which means the eye thinks it's fine.

Foreman: It was wrong.

House: I know. The eye doesn't think. The brain thinks, which means if the thinking's wrong, the brain's wrong. Which means it's spread to the brain, which means it's too late for us to remove the eye. Which means we're gonna have to remove your whole head. Don't worry. [He holds up a huge meat cleaver.] It doesn't hurt.

[House swings the cleaver at Apple who holds her hands against her neck and screams loud and long.]

House: Hallucination. That's a brain thing, right?

[Cut to lounge. House, Foreman, Taub and Thirteen are there.]

Foreman: 500 different things can cause hallucination. Doesn't mean it's neurological.

House: It does if one of the other organ recipients also had a brain issue. Did he just drop his hands? [They’re watching film of the kick boxing fight.]

Thirteen: No, none of them had brain issues.

House: If his pupils dilated, if his pupils were fixed, if there was a twitch...

Foreman: He got hit in the head, he died, no mystery. That was your point.

House: Yesterday. You live, you learn. Who shot this?

Taub: Guy who runs the gym has a camera. Uploads the nasty stuff online.

House: Can't see the dead guy's face. I can't see his face. Can't see the twitch, can't see the pupils —

Thirteen: We know the tennis player had a heart problem. We can maybe tie that to the tuba player's lungs, and then somehow tie both those things, to the construction worker's liver, and then possibly meander over to Frank's pancreatic failure, but nothing causes simultaneous brain and heart problems.

Taub: Cancer made no sense. The head and heart make less than no sense.

Lucas: [The coffee machine repairman joins in.] That makes no sense.

Taub: I know. I was making a point.

Lucas: Oh, good. I thought you were an idiot.

Taub: Why are you talking?

Lucas: Oh, the guy doing manual labor can't have an opinion? I might be a genius who just happens to have a passion for fixing coffee machines. No, I'm obviously not, but that's rude to make assumptions about people.

Kutner: [entering] Donor's history came up clean.

Lucas: Ha. Ha.

Kutner: Did he just laugh?

Lucas: No, no, I sneezed.

Taub: He's a genius coffee repairman.

Kutner: Coffee repairman wears argyle socks? [Taub looks]

Lucas: I thought I already talked about not judging.

House: What kind of idiot wears argyle socks with construction boots?

Lucas: Uh, I'm not an idiot. I'm just… I'm not good at disguises.

Foreman: Who is he?

House: He's apparently a very bad private investigator.

Taub: Uh, why is he pretending to fix the coffee machine?

House: Because I wanted to find out what you guys found out before I find out what he found out. So I can find out if I need a private investigator. So, nu?

Kutner: The donor has no history of unusual infections, no international travel in the 12 months —

Lucas: Ha, ha, ha, ha, ha. No, seriously, that's how I sneeze. [They all look at him.] He was in Madrid and the Bahamas.

Kutner: Credit card receipts showed no —

Lucas: Girlfriend paid.

Kutner: There is no girlfriend.

Lucas: She was his high school sweetheart.

Kutner: High school sweetheart is married to his best friend.

Lucas: I know. Shhh. She had a kid four years ago. Timing fits. She's still pretty hot though.

Foreman: You found out anything medical?

Lucas: The kid has a tummy ache. Also, the dead guy was exposed to mercury, mold, and hydrous perchloric acid because their sex pad was next to a garage that was demolished after those toxins were found. Oh, yeah, that will be $2,300. [He pulls a sheet off a mini notepad and hands it to House.]

House: I'll get you a check.

Lucas: No, I don't take checks.

House: You think I'm gonna stop payment?

Lucas: Aren't you?

House: Of course I am, $2,300 is insane.

Lucas: No, actually, that price includes footage of the boxing match from four different angles. 30% of the crowd paid by credit card. I got their names. Four of them had digital cameras, which I composited like NASA did for the pics of Mars. You know, the rovers and all that.

[They’re all staring at him. House folds his arms and smiles.]

[Cut to the team walking down the hall.]

House: Pupils were dilated.

Foreman: But he didn't drop his hands, which means he maintained muscle tensity —

House: Say it.

Foreman: You were right.

House: God, that was petty of me.

Foreman: He maintained muscle tensity, but was momentarily distracted when he got hit. That's a temporal lobe seizure.

Kutner: Does that PI guy mean we don't have to break into people's homes anymore?

House: It's the whole reason you went to medical school. I'm not gonna take that away from you.

Taub: He's better than we are.

House: And costs more. Gonna biopsy the brain.

Foreman: No.

House: Say it.

Foreman: You were right, but no.

House: Temporal lobe controls speech, hearing, memory. She loses those things, she's gonna be a terrific date, but beyond that —

Taub: We cut out a piece of it, good chance she's a vegetable. Nothing to hear, nothing to say, nothing to look back on.

House: You're right. She has so much to live for. [They’re standing outside the patient room. They look at Apple.] Do we have another patient who's almost finished with all their living? [House moves a couple of steps down so they’re looking at Frank.]

Thirteen: So it's okay to stab his brain because he's old?

House: No, it's okay to stab his brain because he's dead if you don't. Get the widow to say yes.

[Cut to Frank’s bedside.]

Frank’s Wife: No.

Taub: The lung inflammation is a complication of the pancreatic failure, which is reversible. This is actually his best chance. If we can find out what's wrong...

Frank’s Wife: How can a test that will probably kill him —

Taub: I didn't say —

Frank’s Wife: You said it was extremely risky. What does extremely mean?

Apple: [who has been listening] Please.

Frank’s Wife: I'm sorry. I can't.

Apple: I have a husband. I have a two-year-old daughter. Her name is Julia. You'd be saving her mother.

Frank’s Wife: I think you're lying. You haven't had one visitor. Not one phone call since you've been here [to Taub] Does she have a child?

Taub: No. But her life is still worth —

Frank’s Wife: More than my husband's?

Apple: I lied to save my life. Wouldn't you?

Frank’s Wife: Not at another human being's expense.

Apple: No, you'd just rob me of my only chance so your husband can struggle to breathe for a few more days.

Frank’s Wife: Just shut up. [The beepers on Frank’s monitors start going off.] I don't want to hear from you.

Taub: Ladies.

Apple: You want to hate me so you won't feel guilty.

Taub: Shut up!

Frank’s Wife: Frank?

Taub: Give me a scalpel.

Frank’s Wife: Frank.

[Frank’s wife gets shoved out of the way as Taub performs a tracheotomy. Blood bubbles out of the tube.]

Taub: He's coding. [The nurse hands him the defibrillator paddles.] Clear. [zap] Clear. [zap] Clear. [zap]

Frank’s Wife: Frank!

Taub: Clear. [zap] Clear. [zap] Clear.

[Cut to House’s office. Taub enters.]

House: Did you get the consent?

Taub: No.

House: Tell Foreman to get it. Old people are scared of black people.

Taub: It won't matter. Patient's dead.

House: Save the brain. Don't need consent for an autopsy.

[Cut to patient’s room. Apple sits, alone, in her bed.]

[Cut to autopsy. The brain and other organs are in bowls of clear fluid. House enters.]

House: Well, at best, we're gonna bat one for six on this one.

Taub: Thin slices through the parietal and temporal lobes were clean. Occipital and frontotemporal regions were also —

House: Brain's clean. Moving on.

Thirteen: To where? We've gone from making no sense, to making less sense, and then taken a step backwards.

Taub: Each of these people were killed by one thing that attacked one organ. But never the same organ.

Kutner: Could the donor have had two things wrong?

Taub: Or six things wrong?

House: Metabolic diseases specialize. Everything else specializes, but cancer plays the field.

Foreman: You're back to cancer?

House: Metastasis is just a fancy word for screws around.

Taub: Any type of cancer?

House: I don't know.

Foreman: There would be evidence of cancer.

House: There is. We just haven't found it yet.

Foreman: You need it to be cancer so you have an excuse to talk to Wilson.

House: Give me something else that explains this constellation of patients, then you can call me an ass.

Foreman: I didn't call you an ass.

Kutner: Perforated intestine. If this thing started as normal bacteria living in the intestines but got into a blood vessel through a vascular anomaly in the bowel wall, then they would affect every organ through the blood stream. It screws up everything. For everyone.

House: Okay. It's a long shot. It is possible that I'm an ass. Ironically, we need to do a colonoscopy to confirm.

Taub: We checked Apple inside and out when she came in, she's clean.

Kutner: The anomaly would have to be intermittent or they all would have died within a day.

House: She starts getting abdominal pain, shove a tube up her rear before it can get away. And test anyone else with stomach pain.

Thirteen: Everyone else is dead.

House: Not everyone. The one thing the donor gave to each of these people is his DNA. Anyone else have his DNA?

Taub: You want to do a colonoscopy on a healthy four-year-old?

House: She has a tummy ache. If Kutner's right, it's not a tummy ache, it's a fatal brain or heart or lung or liver or pancreas ache.

Thirteen: I'm not gonna scare the hell out of the poor kid's mom because of a long shot corollary to a long shot theory.

House: Fine. Tell her the truth. Then ask if daddy knows who the real daddy is.

[Cut to Kutner performing the colonoscopy. The little girl is silent but kicking her legs.]]

Mom: Does she have to be awake?

Thirteen: We need her to tell us when it hurts. She'll get over it. Your husband might not have...

[Cut to an ice cream truck on a suburban street. House and Lucas are inside. They’re both eating ice cream cones.]

House: What if a kid wants ice cream?

Lucas: The sign outside says 'closed'. Dr. O'Shea's not right for you.

House: What'd you find out?

Lucas: Why are you investigating him?

House: 'Cause I need to know if he lends money interest-free. What did you find out?

[Banging on side of truck.]

Child’s Voice: I want some ice cream.

Lucas: [shouting back] Not until you learn to read. [to House] You're supposed to trust friends.

House: I don't know the guy. I got no logical reason —

Lucas: To be his friend? Have you never seen an after-school special? That is part of the pleasure of friendship: trusting without absolute evidence and then being rewarded for that trust.

House: You're taking pictures of a guy who's having an affair with his own sister. And you're lecturing me about the rewards of trust.

Lucas: There are two types of people that hire me. No, actually, there are three types of people that hire me, but the third type's irrelevant to the point I want to make.

House: Do you have a special rate plan for being a pain in the ass?

Lucas: One type wants to find out that they're right. One type wants to find out that they're wrong.

House: Which type am I?

Lucas: You're the third type.

House: You lead with the irrelevant types?

Lucas: You're the type that doesn't care if you're right or wrong because they've hired me to investigate the wrong person.

House: That's an actual type?

Lucas: You want me to check out Wilson. You want to find out if he's —

House: How do you know about Wilson?

Lucas: What do I do for a living?

House: You checking me out? Have I been paying for that?

Lucas: So far, you haven't paid for anything. You want to find out he's pining. You want to find out if there's something about him that will tell you he's gonna come back or something you can use to make him come back.

House: [House thinks, then looks away as he asks] Is there?

Lucas: No, no, there's nothing. Sorry. [long pause] That will be $900.

[House’s beeper goes off. He checks the message.]

House: I gotta go. I'll get you a check.

[As he opens the door, ice cream truck music begins to play.]

[Cut to front of the hospital. Kutner is sitting on the back of a bench with his feet on the seat. He’s tossing a ball in the air. Foreman is standing next to the bench. House approaches.]

Kutner: Colonoscopy was clean.

House: Then that just leaves cancer.

Foreman: The fact that the kid's colonoscopy was negative doesn't prove anything.

House: Yes, the fact that it didn't prove anything didn't prove anything. Excellent point.

Foreman: We don't know if the kid inherited anything. Even if she did, Kutner's theory is that the thing's intermittent.

Kutner: The opening would have to be open shortly before death.

House: Unfortunately, we can't know when shortly before death is until shortly after death. And that seems like an obstacle.

Kutner: What if there was a way around that?

House: Then we're kind of all sweating over nothing.

Kutner: Not around death, around death as an obstacle. We need to see his colon at work.

Forman: You do know what death means, right?

Kutner: Without a living system, there's not enough pressure to get fluid all the way up. Life we can't create, yet, but pressure's easy. We use the same high-pressure water jet we use to test cardiac workload. I mean, he's not gonna be awake to tell us where it hurts —

Foreman: It's not gonna —

House: Do it.

[Cut to morgue. Frank is on his side. He has autopsy scars on his skull and chest. Kutner is performing the colonoscopy.]

Kutner: It's kinda stuck.

Foreman: It's more than stuck. The bowel's been dead for six hours. No matter what you shoot up there, it's closed. [Kutner plays with the machine, trying higher pressure.] This is nuts.

Kutner: It's adjustable. [He reinserts the tube.] It's working.

Foreman: Yeah. Wow. But not much. Increase the pressure.

Kutner: The endoscope's bowing. Push on the stomach?

[Foreman does and the chest wounds start to ooze. He removes his hand.]

Kutner: Those are normal bodily fluids.

Foreman: Yeah, normal bodily sewage.

Kutner: Put the pressure back on. [Foreman does.] That's the end. No leaks.

Foreman: [looking at screen] Wait. What's that?

Kutner: That's just dark 'cause I'm at the end.

Foreman: What if you're not at the end? What if it's a core lesion?

Kutner: Maybe a little more pressure? [He starts fidgeting with the machine again.]

Foreman: Not too much. If it's the end and we — [Frank explodes all over Foreman.]

[Cut to Apple’s room. A nurse is listening to her heart with a stethoscope.]

[Cut to Diagnostics Conference Room.]

Thirteen: It's finally accelerating. Apple's heart rate has become irregular. Breathing is labored. Colonoscopy's still showing no leaks.

Taub: What if it is autoimmune?

House: What if we don't have conversations we've already had? Four out of the five didn't linger. They got sick and died. We don't have time to dismiss things we've already dismissed.

Kutner: Nothing fits.

House: See, that's an example of a conversation we've already had. She's sick. Something fits.

Foreman: MS?

House: [exasperated] No! Okay, from now on, no one says anything unless no one's said it before.

[Long pause. Finally, House pushes down his shirt sleeves and stands up.]

Foreman: Where are you going?

House: You guys start immuno-gels on her CSF to look for hidden protein markers. Then start sequencing her genes. I'm gonna start treatment. [He gets his jacket from the coat rack and opens the door.]

Foreman: Treatment for what?

House: Cancer.

Thirteen: It's not cancer. Chemo's toxic.

House: It's something. Which means we should treat her for something.

[Cut to Apple’s room. She’s asleep. Her breathing is labored. House buzzes for a nurse then drops the controller, noisily, on the bed rails. Apple jerks awake. A nurse runs in. Another nurse follows.]

House: She's fine. Where's her chart?

Nurse: You rang emergency to get her chart?

House: I know. That was bad of me. But I'm pretty sure the chart's supposed to be attached to the bed so that gimp doctors don't have to look all over the place while patients die. [She picks up the chart from the table past the curtains and gives it to him.] Thank you so much. And some peppermint tea when you get a chance. [She gives him a “look” and leaves.]

House (continues):[to Apple] I need you to sign something. Consent to chemotherapy.

Apple: You found cancer?

House: No.

Apple: Then you have tests indicating —

House: Nope.

Apple: Then why should I sign it?

House: That's a good question. It deserves a complicated answer. Placebo effect. People have confidence in doctors. They have confidence in diagnoses, confidence in medicine. Sometimes they get a little better just because they think they will. And that can make us think that the wrong answer is the right answer. Which is very bad.

Apple: So you do have proof that it's cancer but you can't tell me because it might affect the way I react to the medicine?

House: If that were true, and it would certainly make sense, do you think I could tell you that it's true? [enormous wink. She signs.]

Apple: I was practically blind before the transplant — 20/200 vision.

House: Didn't you cover all this personal stuff with Dr. Foreman?

Apple: You don't care who I used to be?

House: You're a post-corneal transplant math teacher. I deduced that you were a blind math teacher.

Apple: I was an architect.

House: [interested] You gave up architecture after you could see?

Apple: The world was ugly. You think the world would be any different if your leg was fine?

House: No.

Apple: Think you'd be any different if your leg was fine? I mean, the doctors told me that my life was gonna be so much better once I could see. I would date, I would dance, but, uh, the guys I hated dancing with before I hate dancing with after. My parents were still dead. I was still alone.

House: You're fun.

Apple: You don't seem all that different.

House: I haven't given up. [He leaves.]

[Cut to House and Lucas walking on the sidewalk of a downtown street.]

Lucas: Wilson's got a new job, hasn't started yet, but —

House: So who are we following?

Lucas: See that lady up there?

House: You point at the target?

Lucas: No, I'm following the one halfway in between that point and that point.

House: [House focuses on the target with his cane.] Pretty. Who hired you?

Lucas: No one. I just like her.

House: You're stalking her?

Lucas: No, no, I followed her out of that bookstore back there.

House: You are stalking her, just not for very long. So what else can you tell me that I might care about?

Lucas: He attends this grief counseling thing twice a week where they go around the room and cry about who's dead. Cameron's been to his house several times. They just talk about death and losing loved ones.

[The “target” turns around and walks past them. They look nonchalant but, as soon as she passes, Lucas immediately turns, too.]

House: What…? [He turns to join Lucas.] If she turns her head, she's gonna see that we're walking the wrong direction.

Lucas: No, no, no, she won't. I'm very nondescript.

House: Well, I'm not.

Lucas: Well, then you stay four feet behind me.

House: How do you know what they're talking about?

Lucas: I'm in the same grief counseling group. I recently lost my mother.

House: You'd get laid more often if you told them you lost a kid.

Lucas: I didn't lose a kid.

House: You're a PI who can't lie?

Lucas: I can lie. I'm just not all that good at it. Well, Dr. Cuddy's been over to Wilson's twice and phoned a bunch of times. Foreman called him. And the rest of the time Wilson's been reading meditation books and magazines about restoring barns.

Target: [turns and walks back to them] Are you following me?

House and Lucas: No.

Target: Are you lying?

House: [simultaneously] No.

Lucas: [simulataneously] Yes.

House: Lesson one: Commit.

Target: It's making me uncomfortable.

Lucas: Sorry. [She starts walking away.] You're very pretty.

Target: [over her shoulder as she continues walking] More uncomfortable.

House: She's not your type. Your type is much stupider than her. What did Wilson say about me?

Lucas: Oh, you've never come up.

House: In the grief counseling or in the other —

Lucas: Anywhere, I got three bugs in his home and one in his car. If I didn't know you, I wouldn't even know you existed. [House looks stunned.] Which is good news. Only two things you ignore — things that aren't important and things you wish weren't important. And wishing never works.

[House’s cell phone rings. He looks at it and leaves.]

[Cut to Apple’s room. Foreman is standing next to her as she pukes in a bowl. House enters.]

Foreman: She's better.

House: I could tell at once.

Foreman: Vomiting's a side effect of the chemo. Her heart rate's stabilized, breathing's good. Amylase and triglycerides are both coming down.

Apple: I guess it's working.

Foreman: Can't believe it. It's cancer.

House: It's not cancer.

[Apple looks at him quizzically. House leaves.]

[Cut to Diagnostics Conference Room at night. The staff is at the table. House enters, carrying a paper bag.]

House: Labs show that our patient is healthier. She's gonna get sicker. Then she's gonna die. I brought Thai food.

Foreman: What did you see in her?

House: Nothing. It's not cancer. All the tests say it's not cancer. They've always said it's not cancer.

Foreman: Treatment proves it's cancer.

House: Eh, treatment proves it could be cancer. It's not cancer.

Taub: This was your diagnosis.

House: I never thought it was cancer.

Foreman: You treated for cancer.

House: I thought that what she had acted like cancer. If it acts like cancer, maybe it'll respond like cancer.

Thirteen: It did. 'Cause it's cancer.

House: We have to find something that walks like cancer, talks like cancer, tastes like cancer, [pops some food in his mouth] but isn't cancer.

Kutner: No, we don't. Better is better. Who cares why?

House: I do. And so does Tetrault.

Thirteen: Who?

House: The dead tuba player.

Thirteen: Tibalt.

House: The point is, he died last, but he died. Which means she's gonna die too.

Foreman: Tibalt wasn't receiving cancer medication.

House: There's a cancer drug that's used off-label for arthritis.

Kutner: There's no record of arthritis.

House: Did you interview all the tuba students?

Thirteen: If he had joint pain in his hands, he couldn't have played.

House: Then it wasn't in his hands.

Taub: Then why do we care about his students?

House: One of them is Canadian. Brought him methotrexate so he could hide his arthritis. Already couldn't afford his insurance. And that little piece of business cost me $700. I'm gonna pass it on to the patient with a steep mark-up.

Foreman: This makes no sense.

House: I know. She's dead unless we can find what's cancer... but not cancer. [They all think, silently.] Something's missing.

[Cut to loud knock on a door. Wilson answers it. It’s daylight and House has changed his clothes.]

House: I need an epiphany. [Wilson stares at him, tight-lipped.] What are you billing out at, $300 an hour? Here's four.

[He offers the money to Wilson who doesn’t take it.]

Wilson: There are other oncologists.

House: Better oncologists. But I need you. [He balls up the money and throws it past Wilson into the apartment.] Let me describe the symptoms, problems, issues, and you say whatever you feel like saying, until something triggers an idea in my head.

Wilson: That's not the way it works.

House: You have a way of thinking about things. It's sloppy, it's undisciplined, it's not very linear. It complements mine. It drives me down avenues that I wouldn't otherwise —

Wilson: House, please go away.

House: Cancer, but not cancer. Responds to cancer treatment, but there's no — [Wilson tries to close the door but House blocks it.] How are you?

Wilson: Don't do this. Please. Please. Don't do this. I'm trying to move on.

House: By hanging out with Cameron, talking to Cuddy, Foreman, but not me. I… [short, mirthless laugh] I paid a private investigator to spy on you.

Wilson: [sighs] You didn't.

House: You want to move on from me, you got to deal with me, talk to me.

Wilson: You had no right —

House: We're not friends anymore. There's no trust to be breached. I can have you followed, I can call you names, tell your secrets. [They look at each other.] Foreman did a CT. Temporal and frontoparietal regions are normal. Occipital lobe, normal.

Wilson: I have the right to walk away from you, House. There's a world beyond you. You need to realize that, and even if you don't, I'm moving on. The next time you knock, I'm not answering.

House: Nothing yet. Keep talking.

[Wilson closes the door.]

[Cut to street. As House walks past a park bench, Lucas lowers his newspaper, stands and joins him.]

Lucas: I'm sorry.

House: You charge me for listening in on my own conversations?

Lucas: Yeah, why wouldn't I?

House: How many friends do you have?

Lucas: 17.

House: Seriously? You have a list?


House: Well done. I have one. Had one.

Lucas: You know, friends are important. You're gonna miss—

House: Shut up. Friends allow you to not sit in a room by yourself. Are you charging me for this?

Lucas: Are we friends?

House: No.

Lucas: Then yes.

House: Do you wanna be my friend?

Lucas: No. You scare me a little.

House: He thinks if he's not a friend, he can't talk to me. We can talk, we can be two human beings talking —

Lucas: I'm with him. Sorry. Didn't mean to interrupt.

House: Yes, you did. I was in the middle of a sentence.

Lucas: Yes, I did. You're repeating yourself.

House: I'm grateful. Make your point.

Lucas: It's like that "cancer, but not cancer" thing you were talking about before. Friends are friends, customers are customers, and everything else is everything else. If it's not, nothing's nothing.

House: And anything can be anything. [looks at his watch] 10:10. Stop the clock. [He starts walking away.]

Lucas: What?

House: The world is not as ugly as she thinks it is.

[Cut to Cuddy’s office. House walks in.]

House: Cancer, but not cancer. Doesn't make any sense unless... [He pulls an x-ray from a folder.] Brain, but not brain. Occipital lobe's normal. But her eyes suck. That lobe should be compensating. Since it's not, that tells me that something's in there that shouldn't be in there. Brain, but not brain.

Cuddy: Why are you in my office?

House: To find the anomaly, I need to chop off the top of her head. Pretty sure I need your approval for that.

Cuddy: I'm gonna trust your first instinct.

House: I'm not usually confused when you say things like that.

Cuddy: I'm ordering her cancer treatment to be continued. [Holds up a bill.] Why does it cost $2,300 to fix a coffee machine?

House: Cancer stem cells are real. They explain everything. They're like embryonic stem cells. They become whatever they want. Donor had them, the recipients got them. They floated around, they landed on an organ, got bathed in cytomes and partially differentiated. And the key word there is partially. In the tuba player, they became lung, but not lung. In the tennis player, they became heart, but not heart. Stop me if you've figured out the pattern. They looked as if they belonged, but they weren't doing their jobs. And when they were really needed, boom. Chemo worked because cells are basically tumors. Chemo shrunk them. [He looks at her.] You're still gonna say no, aren't you?

Cuddy: You've no proof.

House: I have the brain scan.

Cuddy: The normal brain scan.

House: This is why I need to take off her head.

Cuddy: To treat or to prove you're right?

House: To treat. Chemo's not killing anything. It's just hiding the real problem. She's gonna crash. If we wait until she does crash, it might be too late.

Cuddy: So the next step is what? I say no, and then you do something to make her crash so that I'll think you've proven your theory?

House: I would never do that.

Cuddy: No, you won't.

[Cut to Apples room. A nurse is inside and two uniformed guards are at the door. House looks at them and leaves.]

[Cut to House sitting on the floor of Wilson’s empty office, playing with a rubber band. The door is open and a seating area can be seen outside. Light comes through the windows.]

[Cut to House sitting on the floor of Wilson’s now dark and empty office. Several hours must have passed. House takes out his phone and dials.]

[Cut to Apple’s room. A male nurse’s hands are adjusting her IV. Her heart rate quickly rises from 90 to 96 to 108.]

Male Nurse: She’s crashing!

[Several other nurses run in and the first nurse leaves. All that can be seen are his shoes and his argyle socks.]

[Cut to the brain surgery. Chase is assisting as the neurosurgeon opens Apple’s skull and puts a slice of something — brain? bone? — in a solution.]

House: [on intercom from observation area] You might want to check her IV. From here, it looks like saline instead of chemo.

Chase: Yeah, they look identical.

House: Still. You should probably check.

Chase: You switched her meds?

House: How could I? I had no access.

Chase: [to the neurosurgeon] Close her back up.

House: Do the surgery.

Chase: There's no reason to —

House: No reason not to. The stupidly dangerous part is already over with.

Surgeon: We're ready with the neural net.

[Chase looks at House who raises his eyebrows. Chase bows a fraction of an inch. House sits down. The surgeon puts a net on Apple’s brain. Lucas enters the observation area.]

Lucas: Is that someone's brain?

House: Except for the part that isn't brain.

Lucas: Hey, that's the patient I — You said she'd be fine.

House: I'm a better liar than you are.

Lucas: I swapped her meds. I mean, she's got a brain problem. I coulda killed her.

House: Yup. The neural net will show us how fast her neurons are firing. If there's something in the way, say... Brain that's not brain, the normal neural impulses will be sucked into a vortex because they're unable to do their job. The computer will then process it and give us a picture of where to cut.

Lucas: Cool.

House: Excuse me?

Lucas: Sorry, I thought that's what you wanted to hear. You think all this is amazingly cool. And you have no one else, so you're paying a guy to listen. Sorry —just trying to save you some cash.

House: I'm on the clock.

Lucas: Yeah, why wouldn't you be? You think this is interesting to me?

Chase: House?

House: [looks at monitors next to him.] I see it. Can you get it?

Surgeon: I think so.

House: Turns out you didn't kill her.

Lucas: Cool. You owe me $5,000.

[Cut to Apple’s room. She’s in bed with her entire head, down to the middle of her nose, swathed in bandages. House stands at the foot of her bed.]

Apple: Why are you just standing there, Dr. House?

House: How'd you know who it is?

Apple: I can smell you.

House: Yeah, like you're a field of roses. [He pushes the emergency buzzer for the nurses. The same two enter.] Peppermint tea.

Nurse: You ever hear of the boy who cried wolf?

House: Never really bought that. I don't care how often a kid cries, he's being eaten by a wolf, mom's gonna come running. [The nurses leave. To Apple.] The world is ugly. People kill. They go hungry. [He buzzes again. Just one nurse comes in.] Just proving a point. [She leaves.] People are asses.

Apple: Why are you telling me this stuff?

House: Because the world is not as ugly as you think it is. Your transplanted cornea's fine, your eye is fine, but your brain wasn't working right. I'm gonna take the gauze off your eyes now. It's gonna be bright.

Apple: I know.

House: The brain cells that weren't brain cells were in the way of processing visual information correctly. After the transplant, you could see, but not see.

Apple: I could see. I could read.

House: Yeah, but it was dull, or foggy, or gray. I don't know. What I do know is that you were not seeing what everyone else was seeing.

Apple: And now? Things are gonna be... beautiful?

House: Things'll be what they are. [He removes the last of the bandages.] How do I look?

Apple: You look sad.

[Cut to House’s office at night. He’s tossing a cricket ball in the air. He picks up the phone and dials.]

House: Hey. Is there any way I could put you on retainer?

[The End]

Tags: season 5

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