House Watch: Return to the Dark Side

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Like any show in its latter days, House M.D. has struggled during its seventh season to do two things: seem relevant to young audiences and also stay true to the procedural rhythms that have made it a reliable slot in the Fox lineup for so long. Tonight, the show went back to its roots.

Before you see any of those roots, a spoiler alert: if you haven’t seen last night’s episode, look into Chase’s beautiful Australian eyes and watch before reading on.

It its cinematography, this episode returned to the dark palettes of the pilot, which was directed by Bryan Singer, a filmmaker whose wonderfully muddled heroes in The Usual Suspects and Apt Pupil shouldn’t be discounted by the lesser characters he offered in films like Superman Returns. In the House M.D. pilot in 2004, Singer presented a drug-addled but brilliant physician-hero, and in doing so he finally moved the medical procedural beyond the simple homilies of E.R. Tonight, we finally got Singer’s House back.

The early setup of tonight’s episode gave away none of these game-changing elements. In fact the entire medical mystery tonight was almost intentionally ridiculous if you consider the show’s New Jersey setting. The patient was a rodeo cowboy. And House — after his breakup with Cuddy last week — was ensconced in a sunny resort hotel that I bet you wouldn’t find anywhere in the Garden State in any month, especially March.

In the opening scene, the cowboy rides his steer with obvious skill. The shots of him doing so — directed by someone called Sanford Bookstaver (could that possibly be a real name?) — are filmed with a dexterity not seen in House M.D. since, well, the pilot. So get it? All the show’s producers — I counted 22 of them in the credits, including Singer — want this show to prove it can still work.

Our patient is an very hot and very young man — a signature of Singer’s casting — who goes catatonic at his rodeo and is trampled by his steer.

Meantime, we are reminded that last week, Cuddy dumped House, who is back on Vicodin. Not that I’m in favor of drug abuse, but I was so happy to see House popping pills like in the old days that I wanted to call my own drug dealer.

Wilson visits House at the hotel only to find his friend surrounded by a bowl of cash, a bunch of pills and a rotating group of hookers. Again: Thank you. This is the role Hugh Laurie signed up for; it’s what he does best; and it’s what we want from House M.D.

Cut to Cuddy, who is apparently taking 200 mg pills of zolpidem, better known as Ambien, which would be enough to put down a mastodon. (A typical dose of zolpidem is 10-12 mg, but the writers don’t always get the medicine right.)

Foreman starts the DDX by noting that the “patient has a ruptured diaphram, cracked sternum, broken nose and partial hearing loss — which can be explained by a bull jumping on him.” But the patient also has “a neurological disorder [remember the catatonia], low-grade fever, nausea, and peripheral muscle weakness that can’t.”

Masters offers the idea that the cowboy has some kind of inner-ear infection that would cause his disorientation. Later, as Foreman reports the results of an EEG exam, House says over his cell phone that his staff are all morons. A nice touch: House is licking a hooker’s toes as he says this.

The cute cowboy then displays another symptom: his spit is brown and bloody. It also turns out his eyes are jaundiced. But House is still fooling around. He even has one of his hookers play a hurdy-gurdy — an actual hurdy-gurdy — as he gives diagnostic advice.

House eventually orders a typically risky test — a ventricular puncture, which would involve sticking a needle into Cute Cowboy’s brain. Masters, who likes Cute Cowboy, objects to this test, but House — who is under the sheets with yet another hooker — says “Pick a spot. Stick a needle in it.”

The risky test turns up nothing, but Cute Cowboy now has a new symptom: incredibly smelly feet. (I sometimes wonder if every writer on House M.D. is a 13-year-old boy.) House says the odor could point to diabetes, athlete’s foot or gangrene, but Taub sharply retorts, “None. None of those cause bloody sputum.”

Meanwhile, Cuddy and House are having trouble — and let me just take this moment to reiterate that I despise the shipper business between them. It’s ridiculous, and I’m happy the show it moving away from it.

Anyway, House figures out that Cute Cowboy doesn’t have partial hearing loss. “He’s missing moments,” House says. “He reported having something like a complex partial seizure during the bull ride, as if it hadn’t happened since. Well, what if he’s wrong? What if the infection of the brain is causing it to happen all the time?”

It turns out there’s no infection in Cute Cowboy’s brain, which leads House to believe the infection must be in the organ most important to blood flow to the brain: the heart. House wants to open the man’s chest and stress his heart so severely that any little breach caused by the infection would bleed openly — so that it could be sutured.

Predictably, Cuddy objects to the risky procedure. But House cuts her with one of his most searing comments in years: “My damaged, depressed, drug-addled judgment is still better than yours or any other doctor’s in this hospital … You can either have security arrest me and my team, or you can get the hell out of my way.” Cuddy doesn’t respond, and just to twist the knife, House adds: “Aaaaand, she caves.”

House turns out to be right, of course. The final diagnosis is an infection called bartonellosis.

In the closing scenes, we see that House doesn’t care that he was right, just as in the episode two weeks ago, he didn’t care that he was wrong. He takes to drinking Scotch doubles and then jumps from his hotel suite into the pool. As he emerges from the water, we are left to wonder whether he is washed clean or truly nuts.

A few questions for your next DDX:

1. How long will the writers let House be addicted to Vicodin again?

2. Will the writers wimp out and restore the absurd Cuddy-House relationship, or will they find a woman who can truly tame House?

3. How much has House paid to Steven Alan, whose shirts he has faithfully worn for so many years?

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Follow my health columns on Twitter @JohnAshleyCloud

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