02x18 - Sleeping Dogs Lie

[bunniefuu]

[Episode opens with sound of dripping tap. Camera pans in on the exceedingly vexed face of the Patient of the Week, Hannah. Camera pans up to reveal culprit dripping tap into sink. Camera whooshes out of kitchen, pans up the stairs of the house, moving all the way back into the teenager's bedroom. Sound of dripping tap magnifies.]

[Dramatic flash as the camera zooms back in on the vexed face of the teenager, and then there is a rapid transition of time on the clock beside the bed to signify the passing of many hours. Hannah is awake this entire time, and the camera focuses on her at short intervals, continuing to show her frustration at being awake.]

[Hannah sits up in bed, and all the noises in the house and the nearby area outside seem to magnify, intensifying her frustration. The dripping tap noise becomes faster, as does the hissing noise of the radiator, the ticking clock downstairs, and the noise of a passing car is heard outside, magnified greatly.]

Max: Hannah, you OK?

Hannah: [quietly panting]

Max: Still can't sleep?

Hannah: [very slightly shakes her head] I'm fine.

Max: [sighs] Can I do anything to help you?

Hannah: Just go back to sleep, I'm going to go get a glass of wine.

Max: I can keep you company.

Hannah: You have work in the morning.

Max: Are you sure? You don't want me to?

Hannah: I'll be right back. Just sleep.

[Hannah stands, exits the bedroom. The camera flicks in a mild psychotic fashion.]

[Camera focuses on the alarm clock, now showing that it is 8:00AM. Max wakens from sleep, discovers that Hannah is not beside her in bed. Max sits up and then walks down the stairs to investigate.]

Max: Hannah? [Pauses, reaches the bottom of the stairs, sees Hannah on the floor in the room adjacent to the one she moves into] Hannah?

[Max moves over to Hannah. Camera pans in on Hannah to reveal that she is slowly and repeatedly thumping her head against the wall. Max rushes over to her, crouches down in front of her. Max raises Hannah's chin up to inspect her. Notices empty pill bottle on the floor nearby, which camera quickly pans in to reveal the empty pill's label, "Sleeping Capsules". Max quickly picks up the bottle.]

Max: [desperate tone] What did you do?

Hannah: I just wanted to sleep.

Max: I'm calling an ambulance...

Hannah: [slowly tilts her face towards the camera, revealing blood on the wall, and a trickle of blood which is running down her left cheek.]

[Black out.]

[Cue to House MD Opening Sequence with Theme Song "Teardrop" by Massive Attack]

[Camera pans up in an aerial shot on House, to reveal that he is lying on an examination table in exam room one, a medical journal covering his face. He is fast asleep and snoring. Sound of the door opening. Then a 'click' as the light switch is turned on.]

Cuddy: [stands in the doorway for a brief moment, then loudly shuts the door.]

House: [jumps, startled from sleep, takes the Medical Journal off his face.]

Cuddy: You've seen one patient in the last two hours.

House: Complicated case. I'm a night owl - Wilson's an early bird. We're different species.

Cuddy: Move him into his own cage.

House: Who'll clean the droppings from mine? [Rolls over, turning his back to her]

Cuddy: [walks to the other side of the examination bed, hands him the file] Twenty-five year old female with sleep issues.

House: I'm guessing she's... what's the medical term? Upset. These 25-year-old females are usually completely rational. They're rocks. Really. [glances at the file momentarily] Eh... my theory seems to be supported by the fact that she swallowed a bottle of sleeping pills. Get her a shrink. And I need some shut-eye.

Cuddy: She's a little bit more than upset. She hasn't slept in ten days.

House: She's lying. Without REM sleep, your neurons stop regenerating - the brains shut down lobe by lobe. She'd be insane after five days - dead by ten.

Cuddy: Give me a little credit, I know what gets you off. She took the pills to sleep, not to k*ll herself.

House: Clever alibi.

Cuddy: They didn't work. She stayed awake, even though she downed the whole bottle.

House: [seems intrigued, takes the file from Cuddy]

Cuddy: And the longest anyone has ever survived without sleep is eleven days. Which gives you about 22 hours. [exits]

House: [sits up properly and reads the file]

[Cue to House's office area.]

Cameron: [slaps a medical journal down on the table] You stole my article.

Foreman: I wouldn't do that.

Chase: [gives Foreman a wary glance]

Cameron: I wrote up the case where we induced hypothermic cardiac arrest in the terminal cancer girl.

Foreman: I wrote my own, I didn't steal yours.

Cameron: You knew I was writing one, you gave me notes!

House: Got a case. It can wait, you two finish. [To Chase] Five bucks says someone loses an eye.

Cameron: [snatches the file from House and begins reading through it]

House: Fine. You're only putting off the inevitable. Twenty five year old female, hasn't slept for ten days.

Cameron: I assume the ER tried giving her some sedatives, we should up the dosage.

Foreman: Sedation isn't the same as sleep.

Cameron: Thanks for your insight. For someone who hasn't slept in ten days, sedation is a great start.

Foreman: Sleep is an active process. Reboots the system, restores the brain, sedatives don't---

Cameron: [interrupts him] The brain is being stressed, we need to relieve that. [To House] You've had my article on your desk for the last four months!

House: I'm a very slow reader. No fever, no white count, means no infection.

Chase: Schizophrenia?

House: No delusions.

Cameron: You read his!

House: I signed it, I didn't read it. [pauses] Aside from the sleeping pills, tox-screen was clean. No cocaine, meth, amphetamines, or diet pills.

Chase: Any medications she'd had recently are steroids for poison ivy, and ibuprofen for a knee she hurt skiing.

Cameron: Nothing that would cause sleep disturbances. When did you get his article?

House: Ahh.. about three weeks ago. Let's go back to the beginning.

Chase: How far back?

House: Genesis. God said, let there be light.

Foreman: Sleep is initially controlled by external light cues.

Chase: And if her brain can't interpret those cues..

Cameron: Optic-nerve disease.

House: I'm sensing another article.

Cameron: I'll go run the tests.

[Cue to examination area. Patient is seated on one side of the eye examination equipment, Cameron on the other.]

Cameron: I'm injecting a dye which will allow us to look at your retina and your optic nerve.

Hannah: Everything's kinda blurry.

Cameron: Normal because of the dye. It's going to be that way the next few hours.

[Foreman opens the door, enters]

Foreman: Need a hand?

Cameron: No.

Foreman: [amused sigh] We're never going to work together again?

Cameron: I just don't see the need to make you feel better by forgiving you.

Foreman: [sighs] I wasn't asking for forgiveness, I was asking if you needed help.

Cameron: It's unprofessional to be talking about this in front of a patient. Maybe that doesn't matter to you, but...

Foreman: It doesn't matter. She's not listening.

Cameron: [glances at Hannah] She's asleep.

Foreman: Normal stage one brain waves.

Cameron: You mean she's... better?

Hannah: [opens her eyes again] It's still blurry.

Foreman: You.. fell asleep.

Hannah: No I didn't.

[Both Cameron and Foreman look rather stunned]

[Cue to hospital cafeteria area.]

House: [takes some vicodin out the pill bottle he had in his pocket and places it inside of a folded napkin]

Foreman: Negative for optic nerve disease.

House: But she sleeps.

Foreman: For like 10 seconds. Maximum, one minute. We also checked the ocular pressure. It's normal.

House: [begins loudly crushing the vicodin folded inside of the napkin with the back handle of his cane] And she doesn't know she sleeps.

Foreman: The brain is often unaware of stage one sleep. CT showed no tumors, no clots, no seizure disorders.

House: [unfolds the napkin and sprinkles the crushed vicodin over his food] So.. she sleeps, she just can't stay asleep.

Foreman: You... going somewhere with this?

House: You know what keeps me awake at night? Monsters in the closet.

Foreman: [laughs] There's no monster in the closet, we looked.

House: Well, it's certainly not showing up on the scans. [pauses] Where's Cameron?

Foreman: She felt I could deliver the news on my own.

House: Oh, this is going to work out great.

Foreman: [silently smirks]

House: [wipes his hands off on the napkin] Come on.

[House and Foreman exit the cafeteria area]

[Cut to Princeton Plainsboro Hospital hallways]

House: If you two guys can't play nice together, I'm taking away your toys. I don't care whose fault this is.

Cameron: If YOU hadn't---

House: [interrupts her] I especially don't care if it's my fault. [pauses] Whatever this woman has, it's not showing up on our tests, which means she's sick... just not sick enough for us to see it.

Chase: [amused] You want us to make her sicker?

House: Yes. I want to stress her body. Specifically her brain. Keep her awake.

Cameron: But probably even with the few minutes of sleep she does have, its t*rture.

House: So is cutting people with knives. But you can totally get away with that if you have a doctor coat on.

Foreman: House, those few seconds of sleep are maybe the only reason she's still alive.

House: The more symptoms we can force out of her, the more tests we can do, the more tests we do, the more information we get, the quicker we make a diagnosis. [pauses] See how much more fun it is when you guys get along? [points to Cameron and Foreman] You two, take the first four hours.

[House exits into his office. Cameron, Chase, and Foreman walk in the opposite direction down the hall]

[Cut to Hannah's patient room]

Hannah: [is lying in her bed, her head leaning forward]

Foreman: Hannah?

[silence]

Foreman: [louder] Hannah.

Hannah: [jolts awake]

Foreman: You fell asleep.

Hannah: No I didn't.

Cameron: Your brain doesn't remember, it was just a few seconds.

Max: Is this really necessary?

Foreman: The sooner we find out what's wrong, the sooner she can get a real night's rest.

Cameron: Hannah? [pauses, lightly shakes her] Hannah? Hannah.

Foreman: [rolls his eyes, sighs, moves over, pokes Hannah's thumb with a needle]

Hannah: [jolts awake once more, wincing in pain] Ow... what did you do that for?

Foreman: You fell asleep again.

Hannah: No I didn't.

Cameron: We're sorry.

Foreman: We have to do this.

Cameron: [moves him away from the patient, then speaks in a lower voice] You don't have to be cruel.

Foreman: [amused sigh] You know what happens when you're nice. Nothing.

Cameron: That's how you define nice? Not stealing?

Max: [desperately] Doctors?

Hannah: [has her head relaxed and forward once again]

Foreman: She fall asleep again?

Max: [points to the area of the bed]

[Foreman and Cameron become intrigued. Camera is cued to the lower bed, where there is a large patch of blood on the sheets. The sheet is raised to reveal more bloodstain on the bed, coming from the underside area of Hannah's lower half]

[Scene change to House's office. Area is completely dark, the lights are all off. House is seated at his desk, leaning back in his chair, his feet up on his table. He is asleep and snoring.]

[Sound of footsteps moving up the hallway. Cameron pushes the glass door open, turns on the lights. House wakes up, wincing at the light.]

Cameron: We've got rectal bleeding.

House: What, all of you? [moves his feet off the table and sits in his chair properly] So the monster is peeking out from under the bed. Which either means she has a clotting disorder, or she has a tumor in her colon.

Chase: We'll do a colonoscopy.

House: Who's keeping her awake now?

Foreman: I figured once we found another symptom, it really didn't matter.

Cameron: [sarcastically] Yeah, he's got all the ideas.

House: [stern] Who is with her?

Chase: Her partner is donating blood, so she's with the nurse.

House: Probably singing her lullabies. [pops open his vicodin bottle] I want her awake.

Chase: You have to sedate a patient to do a colonoscopy.

House: Why? Just because of the pain? [places the pill in his mouth] If you find a tumor in her colon, you can knock her out. If you don't - she stays awake.

[Foreman, Cameron and Chase look rather bothered at this, but exit]

[Cut to examination room, colonoscopy equipment is in the room. Chase is positioned behind Hannah, whom is lying on her side with her back to him, Cameron is beside him. Hannah is flinching and making loud pained noises]

Hannah: [groans] It hurts!

Max: Can't you hurry?

Chase: Trust me, you don't want me to hurry.

Hannah: [groans louder] God, you're k*lling me!

Max: [smiles at her] Hold my hand.

Cameron: Keep breathing nice and steady. [pauses] How am I supposed to work with him?

Chase: Maybe.. we shouldn't be talking about this right now?

Cameron: You think I'm overreacting?

Chase: [sighs] Um.. I need you to relax your anus.

Hannah: [continues her moaning and groaning noises]

Max: We're not here. We're skiing. It's thanksgiving,

Hannah: You really want me to think about k*lling myself on a snowboard?

Max: Come on. You never fell.

Hannah: [buries her head in the blankets and makes a loud moan in torment]

Max: You were awesome.

Cameron: Is that what you told him - I'm hysterical and I need to relax my anus?

Chase: I told him... how many cases do we work up in a year? They're all weird, he could have written up any one of them.

[Cue camera to Hannah's face. A large amount of blood begins coming out of her nose]

Max: She's bleeding.

[Cameron immediately rushes to her side of the bed to help]

Hannah: I can't breathe, I can't breathe.

Chase: Hold on.

[Cameron pinches the bridge of Hannah's nose while Chase continues the colonoscopy.]

[Black out.]

[Cue to House's office area.]

Foreman: We packed her nose to control the bleed, and started transfusing two units of whole blood.

Cameron: Pathology from the rectal bleed showed traces of nasal epithelium.

Foreman: So the butt bleed is just a nosebleed.

Cameron: That much blood is not a 'just a' anything.

House: When two people fight this much - you know what it means.

Foreman: It's gotta be a massive sinus hemorrhage, that was draining down her throat and out the back.

Cameron: The question isn't what, it's why.

House: Oh, get a room.

Foreman: Rat poison mixed with some sort of neurogenic toxin can cause bleeding and sleep disturbances.

Cameron: Do you have a specific type of neurogenic toxin in mind, or should we just start running a thousand different tox-screens?

House: Just pretend I'm not here. I'll be reading.

Foreman: It also could be some kind of coagulopathy.

Cameron: Or it could be us, do you have any idea what it feels like to have a six-foot long hose shoved into your large intestine?

House: No. But I now have a much greater respect for whichever basketball player you dated in college.

Cameron: [sighs] We've basically been torturing this girl for the last eight hours.

Foreman: We've been poking her foot, not punching her face.

Cameron: Extreme stress can cause high blood pressure, which can cause bleeding.

Foreman: Wouldn't keep her awake for ten days.

House: What if the poison ivy wasn't poison ivy. She got the rash that was diagnosed as poison ivy around the same time the insomnia started. Rash plus nosebleed, plus sleep disturbance equals Wegener's Granulomatosis. Start cortical steroid treatment.

Foreman: The poison ivy treatment was steroids.

House: Much lower dosage. Get her back on the juice, triple the dose. Get a cianga, and an upper airway biopsy to confirm the wegener's.

[Cameron and Foreman get up to leave the room. Foreman opens the door and motions for Cameron to go out before him. Cameron gives him a weird glance before exiting, Foreman then turns and shrugs back at House, who raises his eyebrows in response.]

[Cut to Exam room one. House enters.]

Mandarin Woman: [speaks in Mandarin to her daughter, whom is standing beside her.]

Daughter: She has a... menstrual problems. They're really bad, the pain keeps her in bed all day, plus, she's super depressed.

House: [pulls up a chair with his cane] She said 'super depressed'?

Mandarin Woman: [continues to speak in Mandarin]

Daughter: She heard that birth control pills can make her feel better.

House: [sighs] She wants birth control pills for her PMS.

Daughter: I guess.

House: Judging by the redness around your mom's nostrils and the tissue she's got conveniently stashed in her wristband, I'd say her problem is more likely a URI than a PMS.

Daughter: URI?

House: Upper respiratory infection. A cold.

Daughter: I don't think so...

House: I also think she's got a problem with SAC.

Daughter: SAC?

House: [winks at her] Thanks for playing. Stupid American child. If you want the pill, all you have to do is walk into any health clinic in Jersey alone and ask for it.

Daughter: [sighs]

House: What exactly was your plan? [clicks his pen and begins writing a prescription] You were going to exchange the birth control pills for some over the counter decongestants in the hopes that your mom's cold lasts another six years?

Daughter: No.

House: [pulls off the prescription paper and hands it over]

Daughter: That for a cold?

House: No. That's for your ovaries. I assume you haven't had a stroke, have you ever had a blood clot?

Daughter: No.

House: Super. In three months when you need a refill, take a bus to a free clinic. Don't wait around hoping for mom to get another sniffle. [stands upright once more, then leans closer to the Mandarin mother] Not the sharpest chopstick in the drawer, is she?

Mandarin Woman: [happily thanks him in Mandarin]

[House exits the exam room, Cameron is waiting outside the door for him.]

Cameron: Is this just one of your experiments? You just wanted to see how I'd react to being screwed over by Foreman?

House: [shuts the exam room door] Nice idea, but no. This was just good old-fashioned laziness. I gotta hand it to Foreman though, he knew that you were a suck up and I don't give a crap. He successfully exploited us both.

Cameron: Right. We're both victims. A simple heads up, that's all I needed. You know, between your incredibly witty remarks about a**l sex and Cuddy's breasts, you could have tipped me off.

House: Then I'd have Foreman pissed at me. And as annoying as you can be, at least I know you're not going to pop a cap in my ass. Witty, huh?

Cameron: [sighs, starts to walk away]

House: You on the other hand, continue to be flabbergasted every time someone actually acts like a human being. Foreman did what he did because it worked out best that way for him. That's what everyone does.

Cameron: That is not the definition of being human. That's the definition of being an ass.

[Cut to patient's room.]

Chase: This will numb you up. [sprays an anesthetic spray at the back of Hannah's throat] And this will keep your tongue out of the way. [places a ] Don't worry, you shouldn't feel anything except for a slight pulling.

Foreman: So you think I was out of line?

Chase: That article was going to sit on House's desk for the next six years.

Foreman: I could have told her.

Chase: You could have written it for her too. She knows House as well as any of us. She should have known she was waiting for him to do something he was never going to do.

Hannah: [her eyes begin rapidly moving left to right]

Foreman: [watches her] Chase?

Chase: [also turns his attention to the female] Hannah? Still with us?

Max: What's wrong with her eyes?

Foreman: Looks like REM.

Max: What's that?

Chase: Rapid Eye Movements. It's what your eyes do when you're sleeping.

Max: But she's awake.

Foreman: Hannah. [pause] Hannah can you hear me?

Hannah: [comes out of her daze] Yeah of course.

[Cut to House's office area]

House: Was she sitting up or lying down?

Chase: Sitting up.

House: Then it wasn't REM.

Cameron: But Chase says her eyes are moving the exact way.

House: Did you start her on the steroids?

Chase: Not yet, we were still doing the---

House: Then she wasn't sleeping.

Chase: How do you know?

House: Because we haven't done anything yet. She may be able to sleep with her eyes open, but unless you also discover that she's got two extra teats in the hooves of her feet, there's no way she'd be able to retain enough muscle tensity during REM sleep to sit upright. It's a movement disorder. Which rules out Wegener's. Where's Foreman?

Chase: Keeping her awake.

House: Good.

Chase: Rabies could cause muscle spasms, malaise, anxiety, and wakefulness.

Cameron: I don't think she'd forget being bitten by a crazed animal.

Chase: She could have been exposed to an open wound.

House: Did she have a dog?

Cameron: For less than a week. She had an allergic reaction, so they had to give it away.

Chase: Allergies.

Cameron: Animal allergies seems unlikely, but its possible that---

House: When?

Cameron When what?

House: When did she get rid of the dog?

Cameron: About a month ago. Her girlfriend gave it to her for her birthday.

House: Well then it's not allergies. She's just leaving her girlfriend.

Cameron: You... spoke to the dog?

House: If her birthday was a month ago, she would still be on steroids for the poison ivy. And those meds would have suppressed any reaction she might have had to the dog, which means she lied about being allergic. The dog's a commitment. You pretend to be allergic, because you don't want to tell your girlfriend that you're not planning on being around that long. So I think we can move onto options other than allergies.

Chase: We should still do a scratch test. If she's allergic to one thing--

House: She is not allergic.

Cameron: Okay. Well, we could either base the diagnosis on your admittedly keen understanding of lesbian relationships, or, we could do a scratch test.

House: Do a scratch test.

[Cue to patient's room]

Cameron: You still feeling a lot of blood in your throat?

Hannah: No, it's actually getting a little better.

Cameron: Good. Maybe things are just starting to improve on their own. Just a few more. You want some water to wash out your mouth?

Hannah: No, I'm OK.

Max: Come on, that can't taste good. I'm going to get you a soda. It's OK, isn't it?

Cameron: You and Max have got a very nice relationship.

Hannah: Yeah.

Cameron: She's very supportive.

Hannah: Uh-huh.

Cameron: When Max got you the dog, did you lie about having an allergic reaction?

Hannah: No. Why?

Cameron: If you have pre-existing conditions, it's important we know. But, if you don't, it's just as important. If I'm wasting my time doing---

Hannah: [speaks over the top of her] You're not going to tell her, are you?

Cameron: It's none of my business.

Hannah: She's a good person. We've just been together so long, I... [pauses] I'm tired of her. Sounds terrible, doesn't it?

Cameron: I guess it happens sometimes.

Hannah: My back hurts.

Cameron: Hannah, can you turn over?

Max: What's wrong?

Cameron: I'm not sure.

[Cameron pulls up Hannah's shirt to reveal a dark red patch of skin)

Hannah: Oh my god.

[Cut to House's office.)

Cameron: She has massive internal bleeding.

Chase: Did she have access to aspirin?

Cameron: She'd have to take a hell of a lot.

Chase: Why not? Considering her current mental state.

House: What about her mental state?

Cameron: [sighs] You... were right about her wanting to break up.

House: It just means I was right, doesn't mean she's suicidal.

Chase: A bottle of pills is what landed her here in the first place.

House: Sleeping pills. God knows why she'd want them. What else can cause sleep disorder, and internal bleeding?

Cameron: dr*gs or alcohol can mess with the sleeping, and compromise the liver.

House: What are you doing here? Who's keeping her awake?

Foreman: It doesn't matter. Liver function tests are through the sky. The liver's not compromised, it's dead. She doesn't need a diagnosis, she needs a new liver.

House: She's not getting a new liver unless we can figure out what's wrong with her.

Foreman: Test for cirrhosis, twelve hours. Test for hepatitis, eight, she's not going to last another six.

House: So your advice is we just give up?

Foreman: My advice is that we narrow our focus to conditions that we can diagnose, treat and cure in less than six hours. And there's nothing on that list.

House: The girlfriend donated blood, right?

Chase: Yeah. So?

House: That means they're the same type.

Cameron: You can't ask the person she's about to dump to donate half her liver!

House: Does seem tacky, doesn't it.

[Cue to patient's room]

House: I'm Doctor House. I'm in charge of your case.

Max: What's going on? How come no one is keeping her awake any more?

House: You're in acute liver failure. We can continue the transfusions and the lactulose. But it's only a stopgap. There's really nothing we can do to stop the toxins from building up in your bloodstream. Which means that in a few hours you will lapse into a coma. And you won't wake up. I'm sorry.

Max: That's it? You're giving up? You're... not going to try to figure out what's doing this to her?

House: Well even with the right diagnosis, any treatment is going to take longer than the time she has left.

Max: If it's her liver, can't she get a transplant?

House: Wouldn't work without a diagnosis. Whatever k*lled the first liver will do the same to the second.

Max: But it... but it would give you move time to make the diagnosis, to get her better.

House: Well, it may give us an extra day or two, but, no procurement agency is going to let a liver go to a patient with an undiagnosed pre-existing---

Max: Hannah and I have the same blood type. Couldn't I be the donor?

House: It is medically possible for us to take a part of your---

Max: Please, I don't care about the risks!

House: [To Hannah] You're very lucky to have such a devoted partner.

[Cue to House's office area)

House: I just bought us 36 hours. Differential diagnosis - which monster eats your liver, screws up your sleep, and causes bleeding?

Cameron: Does Max know Hannah plans to leave her?

House: Didn't come up, so I guess, no.

Cameron: If she knew, there's no way she'd go through with this.

House: And if you didn't have a pathological need to create a close personal relationship with every dying person you meet, we would be blissfully ignorant of any ethical dilemmas and might actually be able to concentrate on the differential.

Chase: Scratch test was negative.

Foreman: It's rare, but any of the hepatitis viruses can cause sleep disturbances, and liver failure.

Chase: Nope, PCRs were normal.

Cameron: We have an ethical dilemma.

House: No we don't. Continue.

Chase: What about splenic cancer, or non-hodgkins lymphoma? She's the right age.

House: It could explain the bleeding. Maybe the liver failure.

Cameron: We're withholding information relevant to her decision to risk her life. How is that not an ethical dilemma?

House: It's not medical information.

Cameron: Who cares?

House: The AMA.

Foreman: Wilson's disease could explain the liver, and neurological symptoms. It also causes bleeding disorders.

Chase: No kaiser-fleischer rings in her eyes.

House: The rings don't have to be there if there's neurological symptoms.

Cameron: This is immoral.

House: Look, let's say you're right. We tell, she changes her mind, our patient dies. How is that moral? [pauses] What else?

Foreman: Poison mushrooms can cause liver failure, sleep disturbances, and internal bleeding.

Chase: She's not shrooming, she's a sports nut.

House: Right. Skiers never party.

Cameron: She's doing this out of love, and Max doesn't know---

House: It's only moral to save a person if they love you? That's kind of a selfish way of looking at life. I like Wilson's disease, like cancer, love mushrooms.

Foreman: Yeah, but we don't have the time to test for any of these. Before she can get the transplant, we need to do about 80 procedures.

House: So do those tests, and my tests at the same time. Use the pantalope to look for cancer, and Wilson's while you endoscope her bile ducts and scrape her stomach for mushroom spores. One of you CT her liver, While the other two check protein CA125, and CA19.5. Oh yeah, if anyone says anything to Max, they're fired.

Cameron: We have to.

House: We have to not. Because she's not our patient.

Cameron: She's getting surgery, she's someone's patient.

[Cue to hospital hallways.]

House: Need a little help.

Cuddy: Inexplicable rash on a patient's scrotum you need me to look at?

House: 27 year old female wants to donate half her liver to her dying girlfriend.

Cuddy: That's very generous. This the sleepless girl? What's she got?

House: Liver failure.

Cuddy: I suppose I should have figured that out when you said she needed a new liver.

Cuddy: You don't have a diagnosis.

House: The transplant buys me time.

Cuddy: Let's just skip the part where I say this is insane.

House: It was her idea.

Cuddy: If she wants to be an idiot, it's her call. You don't need me. Have one of your team walk her through the process.

House: The donor and the donee sort of have opposing interests, right? Can't really advise them both.

Cuddy: You're concerned about the ethics of this? What's going on? What do you know?

House: Nothing medically relevant.

Cuddy: But you know something. And it is relevant.

House: If I can't tell her, I can't really tell you, can I? And if you're advising her.

Cuddy: I assume this information is in the medical file.

House: My patient's confidential file.

Cuddy: This hospital's file.

House: You can either satisfy your curiousity, or remain ignorant, do nothing ethically wrong and my patient doesn't die in three hours.

[Cue to examination area with Cuddy and Max]

Cuddy: These tests and the counseling normally happen over weeks, sometimes months.

Max: It's okay.

Cuddy: The most important part we're skipping is time. Time for you to change your mind.

Max: I don't want to change my mind.

Cuddy: Not now, but with time and perspective, maybe we learn things---

Max: If we had the time then we'd take the time, but we don't. So can you get this over with?

Cuddy: Either I sign off on this, or it doesn't happen. So I need you to listen to me. Because there's a chance that you will die on that table.

Max: I just want me and Hannah to be able to lie in bed together. As old ladies. Compare scars.

Cuddy: I need you to lie on your side. And hold your knees.

[Cue to examination area with Cameron and Hannah)

Cameron: I'm going to check for vascular abnormalities that can prevent us from doing the transplant. At the same time, I'm also checking for mushroom spores to see if that's the underlying---

Hannah: I don't do mushrooms.

Cameron: If you lie about your love life, maybe you lie about dr*gs. Open.

[Cameron inserts the endoscopy equipment into Hannah's throat)

Cameron: Aren't you at all concerned about what Max is going through right now? Shoving a tube up her rectum. Then they're going to swab her stomach just like I'm doing. It's going to hurt just like this hurts, which is nothing at all like the risk she's taking on the table.

[Cameron removes the endoscopy equipment from Hannah's throat once again)

Cameron: And you don't love her, do you.

Hannah: I'm not leaving her because I don't----

Cameron: I'm not talking about the leaving, I'm talking about this. If you care for her at all, you won't let her do this blind.

Hannah: You'd really tell?

Cameron: Yeah.

Hannah: You'd die?

[Cue to House's office area. The lights in the room are off. Wilson enters, and drops a medical journal onto the floor, next to House, whom is sleeping on the floor)

Wilson: I take it you've seen that?

House: Seen it, digested it, watched it blow up my entire department.

Wilson: You read Cameron's version?

House: I didn't read either.

Wilson: It was good.

House: Better than Foreman's?

Wilson: Maybe. He was more analytical about the diagnostic procedures. She concentrated more on the ethical dilemmas of informed consent. How any patient can really be informed without a medical degree.

House: The same old party lines.

Wilson: Foreman should have told her.

House: Ah, shoulda, woulda, coulda.

Wilson: If you allow this sort of thing in your department, you're basically saying it's OK.

House: No, I'm saying that I don't care what they do as long as my life isn't interrupted by pointless conversations like this one.

Wilson: They won't trust each other, and they won't trust you.

House: They shouldn't.

Wilson: Deception like this is just one step removed from actively sabotaging one other. Then what would you do?

House: I could be the kindest gentlest boss in the world, and Foreman still would have done what he did because that's who he is. We can only hope that Cameron has learned something.

Wilson: Right. Because you're all about the teaching.

House: Our children are the future.

[Cue to Hospital hallway]

Foreman: Hey! Cuddy cleared Max for surgery. She's OK to go.

House: How's our patient?

Foreman: She's also cleared.

House: I don't care about the prep, what about the diagnostic tests?

Foreman: It looks negative for Wilson's disease, we'll know for sure in an hour.

Chase: Blood proteins are normal, it's not---

House: Where's Cameron?

Chase: Taking a sample of the bile duct.

House: Surgery is supposed to start in about 15 minutes.

Chase: She had a chance to get one last---

House: Hannah and Max will be in the same room.

Foreman: You wanted us to do as much as we can before---

House: Both awake. With Cameron.

[Cue to Operating Theater area]

Cameron: Maybe we should give these two a minute together before the surgery.

Max: You ready, honey?

Hannah: Max.

Max: It's okay. I'm right here.

Hannah: I need you to know something.

Max: I know. I love you too.

[House shoves the door open with a dramatic bang)

Hannah: I don't know how to say this...

House: Good lord.

Max: You can tell me anything.

House: She hasn't slept in eleven days. Are you trying to t*rture her?

[House feeds anesthetic into Hannah's IV line which promptly makes her drift off to sleep)

House: Ding ding, let's go.

House: I told you---

Cameron: I didn't say a word to Max.

House: This is exactly why you got screwed with Foreman. You're looking for people to do the right thing.

Cameron: She hasn't slept, her judgment's compromised due to inactivity in her pre-frontal cortex.

House: Oh, she could have the best pre-frontal cortex in the history of mankind, but given the choice of life versus death, those bad bad people are going to choose life.

Cameron: Then why did you sedate her? If she wasn't going to tell, if she was never going to do the right thing, why bother knocking her out? [pause] This isn't about them, if she talks, if she does the decent thing, then you don't get to solve your puzzle, your game's over, you lose.

House: Yeah. I want to save her. I'm morally bankrupt.

[Camera pans over both tables in the operating theater. The surgery is in progress. Camera pans up to observation room above the operating theater, where Cameron and Cuddy are watching.]

Cuddy: How's it going?

Cameron: They're about to remove Hannah's liver.

[Camera pans back down to the op-theater)

Surgeon#1: All right. I'm good to go. We can start removing Max's liver.

Cuddy: You want to let me in on the big secret is between these two?

Cameron: Did you read Foreman's article?

Cuddy: It was good.

Cameron: He basically stole it from me.

Cuddy: So?

Cameron: You're on his side?

Cuddy: Sides? No, this isn't dodge ball.

Cameron: What am I supposed to do? Just sit back and take it?

Cuddy: No, write another article. Kick ass until you're sitting behind some big expensive desk and someone from John Hopkins's calls and says 'We're thinking about hiring Eric Foreman as our head of Neurology'. And you can say whatever you want.

Cameron: [scoffs] Lovely. Revenge as motive for success.

Cuddy: Ah, it doesn't have to be a motive. But it sure tastes good.

Surgeon#1: She's in VF, I've got no pulse.

Surgeon#2: She's arresting.

Surgeon#2: Paddles.

House: Oh! I am so relieved you two are here. Without you looking at me, they're playing foosball down there.

Cameron: Max's heart stopped.

House: Your patient is on the other side. Now get yourself upstairs and figure out what Hannah has or Max has risked her life for nothing.

Surgeon: Charging... clear. We're okay.

[Cue to House's office area.]

Chase: Max's cardiac arrest was caused by hypoxia from hypoventilation. They restarted her heart and the right lobe of her liver was successfully transplanted into Hannah.

House: Now, where were we before we were so rudely interrupted by the liver transplant?

Foreman: Dopar dicarboxy was processed normally and the serola plasma and copper levels were normal so no Wilson's disease.

Cameron: Gastric content was negative for spores, so no mushroom toxicity.

House: And the initial tests were negative for cancer.

Wilson: Which cancer were you looking for?

House: Any of them.

Cameron: We ran blood tests for ovarian, lung, and lymphomas.

Wilson: Not going to tell you much. Her blood was thick after she was given immuno-suppressants. They fight rejection, they also mess up our ability to get any clear readings.

House: Great battles kick up a lot of dirt. Obscure the battlefields so the generals can't see what's going on.

Wilson: So what are your orders, General House?

House: Sound the retreat.

[Cue to Post-op patient room area.]

Foreman: How are you feeling?

Hannah: [sighs] Is Max OK?

Foreman: She's still unconscious, but her vitals look good. [sighs] We need to stop all the immuno-suppressant dr*gs which are protecting your new liver.

Hannah: [shakes her head] But if you stop the dr*gs, I'll die.

Foreman: You're dead anyway if we don't figure out what caused all of this. By removing any outside influences, it will help us see what's really going on with your body.

Hannah: So you did this to buy me a couple of days, and now you're taking them back? [pause] Will it hurt?

Foreman: As your body begins to go into acute organ rejection, your liver will begin to swell. And that'll put pressure on-- [pauses] Yeah, it'll hurt. But we can knock you out.

Hannah: Mmm. No. If Max wakes up, I want to talk to her.

Foreman: [silently nods his head.]

[Cue to Exam room one. The Mandarin mother and the daughter have returned.)

House: [Opens the door and moves inside.)

Mandarin woman: [Speaks in Mandarin, using a flustered tone as House enters)

Daughter: She's been taking the decongestants, but she's not getting better, She.. also says...

House: What?

Mandarin woman: [grabs House's hand and places it on her chest.)

Daughter: Her boobs are bigger.

House: [Promptly yanks his hand away. Looks intrigued, then places it back where it was.] Wh... how could you get them mixed up? They come in a little wheel, they don't look anything like decongestants.

Daughter: Oh god, the cashier put them both in the same bag, I thought I gave her the right ones.

Mandarin woman: [Asks a question in Mandarin)

Daughter: [Slowly responds to her.)

House: No, you gave her the wrong pills.

Daughter: You speak Mandarin?

House: I can count to ten and ask to go to the bathroom and [pauses, speaks to the mother in Mandarin)

Mandarin woman: [Looks appalled)

Daughter: I'm not pregnant! We haven't even done it yet!

Mandarin woman: [begins speaking to her daughter in a flustered tone)

Daughter: [quickly argues back to her mother in Mandarin)

House: Okay, I'm going to leave you two alone now. I'm sure you've got a lot to talk about.

[House picks up his book and leaves Exam Room one, leaving the mother and the daughter to argue and bicker with each other.]

[Cue to House's office area.]

Cameron: Fever is 106, she's in full rejection mode.

House: Is that supposed to surprise me?

Cameron: Her white count is normal.

House: Normal is not normal. She's been on steroids, transplant team gave her a cocktail of immuno-suppressants, she hasn't slept in over a week. Her white count should be in the t*nk.

Foreman: Looks like the problem is some sort of infection. Probably causing hypotension, shock the liver.

Chase: We should start broad spectrum antibiotics.

House: Yeah, you might want to add some chicken soup. It's just as useless, but it's got chicken. We need to know exactly what kind of infection we're dealing with, what infection causes sleep disturbance, bleeding, movement disorder, organ failure, and abnormally normal white count.

Chase: What about tularemia?

Cameron: Chest was clear. Tularemia doesn't cause movement disorders.

Foreman: It would if she developed meningitis.

Cameron: There is no ulcerations on the skin. [sighs] The bleeding, it looks more like leptospirosis.

House: Without conjunctivitis and elevated creatinine?

Forman: What about typhoid, or some kind of relapsing fever?

Cameron: Makes sense if we were in the Sudan.

House: You sure she hasn't been out of the country?

Cameron: She hasn't even been out of the state in at least a year and neither has Max.

Foreman: Maybe she lied. You talked to her friends? Neighbors?

Cameron: You don't know? Come on, if you don't stay up to date on my notes, where's your next article going to come from?

House: You talked to the dog?

Cameron: We're not as up on foreign languages as you are.

House: [scoffs] Has the dog been traveling?

Cameron: It came from a breeder.

House: Where?

Cameron: I don't know. A place called Blue Barrel Kennels. They only had the thing for like, two days.

House: Blue barrel is a kind of cactus. Do you see many cacti in Jersey?

[Cue to post-op patient's room. House slides the door open and walks inside.]

House: Wanna see a magic trick? [moves his hand in and pinches Hannah's nose, pretending to steal her nose. He then shakes out his hand, feigning surprise as her 'nose' disappears] Oh no, where'd it go, where'd it go? [Raises Hannah's left arm up] Is it here? [searches it momentarily, then places it down again] How about here? [raises her right arm and pulls up her sleeve, revealing a large pustule wound] There it is. Oh, it doesn't look anything like a nose.

Cameron: That wasn't there this morning.

[House pulls up Hannah's sleeve completely and nods to Cameron, who turns away to take a syringe out of a drawer. House then inserts the needle into the pustule and withdraws completely solid-black fluid from it)

House: Give that to the lab, and call the CDC.

Chase: And tell them what?

House: That we have a patient with the plague.

Chase: The... black plague?

House: [nods] Looks that way.

Cameron: The plague is carried by rodents, not dogs.

House: Where there's dogs, there's fleas. If they hail from the southwest, then those fleas can't tell the difference between prairie dogs and puppy dogs. A small percentage of plague cases present with sleep disturbance. Imagine, an idyllic river of bacteria. Okay, it's not idyllic for her, but it serves my purposes. The steroids and the immuno-suppressants acted like a big hunk of dam across the river. Physics 101, put a dam up in front of a raging river, the river rises. By stopping the immuno-suppressants, we blew up the dam, and a hundred foot wall of bacteria flooded her lymph nodes.

Foreman: We better find out where that dog is now.

House: After you restart the immuno-suppressants, then fill her up to the eyeballs with streptomycin, sulfate gentamycin, and tetracycline. Use a garden hose if you've got one. Get yourselves some prophylactic treatments as well.

Hannah: I've got the plague?

House: Don't worry, it's treatable. Being a bitch though, nothing we can do about that.

[Hannah glares at him. House simply exits.]

[Cue to hospital hallway, outside of Hannah's post-op room area.]

Cameron: You weren't in your room.

Max: The surgeon said I'd heal faster if I walk. Got this far, needed a rest.

Cameron: What you did was crazy, but it was pretty amazing too.

Max: Yeah. I'm a hero. [watches Hannah through the glass from her place across the hallway] She's been planning to leave me.

Cameron: Really?

Max: [nods] She told a friend. The friend let it slip.

Cameron: You knew, and - you gave up half your liver anyway?

Max: She can't leave me now.

Cameron: You really want her to stay out of guilt - that's not going to make either of you happy.

Max: You don't know that. I love her. I just want her to stay.

[Cue to House's office area. The lights are dimmed, Foreman is sitting in a chair and reading. Cameron slowly approaches him]

Cameron: I don't own House's cases. You had just as much right as I did to write it up. You should have told me, but, I should have handled it better too.

Foreman: [settles back in his chair]

Cameron: If we want this not to get in the way of our friendship, I think we both have to apologize and put it behind us.

Foreman: I like you. Really. We have a good time working together. But ten years from now, we're not going to be hanging out and having dinners. Maybe we'll exchange Christmas cards, say hi, give a hug if we're at the same convention. [sighs] We're not friends. We're colleagues. And I don't have anything to apologize for.

[Cameron looks rather shocked as the camera pans out of the office area. The camera shifts into the next room and focuses on House, whom is fast asleep in his chair.]