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House 517 - The Social Contract

House Episode 5-17 - "The Social Contract"

Airdate: Monday March 9, 2009

The Hook:

A nervous author sits in a luncheon talking to his publisher about his fear of public speaking - a fear she says he will have to overcome before his upcoming book tour. His publisher introduces him to the other diners in their group and urges him to say a few words. He appeals to his editor, Nick, for support. Nick begins to provide some, but can't stop himself from inserting some disparaging remarks about the author and his work, as well. The disparagement could be classed as brutal, nay "Housian" honesty. The publisher tries to call him off. His wife tries to call him off. But nothing works until his own body provides a nose bleed and a collapse.


Act 1

Kutner characterizes their new case as a "Phineas Cage", referring to a famous case of a Vermont railroad worker whose brain was pierced by a railroad spike in an accident, and who suffered severe anti-social personality changes. The condition is called frontal lobe disinhibition and House wonders what Nick's "railroad spike" is, since actual spikes are in short supply at book luncheons. Since the brain scans by the E.R. have ruled out the usual suspects, they're looking for a tumor in an unusual place. Hadley suggests a nasal cavity, and House sends the team out to probe for one.

Nick plays cards with his daughter Marika. He's telling her what cards he has and she says he can't win if he keeps doing that. Nick asks "How about if I tickle you while I tell you?" and Marika shrieks and laughs. Taub and Kutner come in to do the tests with an overly cheerful greeting on Kutner's part and Nick wonders out loud if Kutner isn't just a little too happy, maybe being more interested in the problem than the patient. Taub assures him that they are going to shove this humongous probe up his nose without any undue enjoyment.

Taub asks Marika to excuse them, but she doesn't get the hint, and mom Audrey begins an explanation about Marika having this little 'auditory processing difficulty' when Nick just asks her directly to hop off the bed and she does with no sign of impairment. Audrey begins to leave the room to do some phone calling for the upcoming 'Walk for Breast Cancer' she's managing, but as Nick begins insulting the size of Taub' schnozz, she decides she'd better stay. Nick moves on to insulting 'walks for charity' which is an attitude I can identify with. "Pay me to do something I want to do anyway because the money's for a good cause" seems like a dumb charity business model. Why not do something useful? Building houses, as Nick suggests, or picking up trash on the side of the road - I could get behind that one.

Nick employs the same brutal honesty on his wife as he did on his author - belittling her charity job, and ascribing his past participation in same to a desire to get laid. Audrey thinks better of her decision to stay in the room - look out Taub and Kutner. Even as he does it, the patient realizes how he's alienating everyone around him and begs the doctors to "make this go away."

House catches Wilson in the hall, and invites him to a monster truck rally. Wilson says he hates monster trucks and only went to placate House in the past. Is this disease catching? House can't take brutal honesty when turned on himself, and suspects ulterior motives, while Wilson protests his motives are right there on his sleeve.

Kutner comes up to report there's no nasal tumors and shortly will be mo marriage either if "our patient keeps saying everything that pops into his head without regard to the consequences." Wilson wonders if House has a twin brother, but Kutner says they hope this is only a temporary condition in Nick. House says even if the impulses are controlled, they're still there - so the guy's basic personality will be unchanged.

Things get existential as Wilson argues that a constructed persona of a nice guy is just as valid a personality as the raw id underneath. House thinks Wilson is describing himself. Kutner come up with another cute Kutnerism from the sf/fantasy world, saying the patient is "Harry Potter" who chose the nicer Griffindore over the Slithering house that the sorting hat wanted to put him into. House says go find the brain damage wherever it lies.

Foreman and Hadley examine Nick. They will scan his brain while they ask him questions to see where there might be damage, which they hope they can then cut out. Nick alternates lascivious remarks toward Hadley with apologies for the same. Then Cuddy comes in and it's lasciviousness squared. The women are half complimented, half insulted, as Foreman is quietly amused. Cuddy asks where House is, she's sure he paged her just to see Nick's effect and wouldn't miss the fun. Sure enough, House comes out of a darkened observation room and exits, Cuddy following him as the patient is placed in the scanner.

House tells Cuddy she should be complimented that a guy who can only tell the truth said he preferred her to Hadley. I'm wondering if this follows - wouldn't disinhibition also remove the inhibition against lying? Cuddy says she is not amused, but smiles as the elevator door closes on her.

Hadley tell Foreman she's not jealous the patient preferred Cuddy to her. As the test begins, of asks Hadley if she's offended that the man found her attractive, hospital says there's a difference between attraction and sexual desire. Foreman: not so much, it's just what women want to believe.

Searching for a revealing but 'safe' line of questioning, they ask Nick about his voting habits, which turn out to be nil - he doesn't vote, considering it a waste of time. They find a suspect area, but it's too close to the brain stem to biopsy. Foreman suggests to could be neuro-sarcoidosis, which they can diagnose by treating with steroids and seeing if it gets better. Foreman checks out Hadley's ass as she walks from the room, but when called on it says he finds her "strong attachment to a working democracy" extremely attract. Foreman=sly boots.

In the cafeteria, Taub obsesses on the size of his nose, Kutner on the deficiencies in his bedside matter. They reassure each other.

House joins Wilson at a table. House says Wilson's compulsive niceness is nothing to be ashamed of. Wilson protests he's not always nice - to House at least. House says that's because Wilson knows House is bored by nice, therefore not being nice to him is...(wait for it)...nice.

House proposes Wilson reflects whatever the person he's with needs - the interesting question, he says, is why? House asks him why he lied about monster trucks. Wilson says he didn't. House says he checked Wilson's appointment book for Tuesday night - he's booked, but it doesn't say for what, meaning Wilson is hiding something from any nosy-Parker who snoops through his appointment book. Gee, wonder who.

Wilson says he's playing racket ball with Taub that night, and hiding it from House so as not to rub House's nose in the fact that (a) he's with someone other than the possessive House, and (b) doing something House can no longer do.

Foreman rushes into Nick's room in response to a call. The steroids aren't working, in fact Nick's kidneys are failing and he needs to go on dialysis, stat!

Act 2

The team discusses the latest events as Taub examines the reflection of his nose in a spoon. Taub tells "Cyrano de Berkowitz" to let it go and get back to diagnosis. House asks him how long he's been playing racket ball with Wilson. "Four or five times", Taub says.

As the rest of the team debate diagnoses, House presses on. He slurs Taub's Jewish ethnicity as "unathletic". House questions him about racket ball shots. Taub deflect the questions.

Despite not seeming to have paid attention to the diagnostic talk, House tells the team to test for peripheral nerve damage (Kutner) - the daughter, not the patient, and for diabetes (Taub). He also tell Taub to do all the blood draws himself - not have a nurse do it. House denies he's punishing Taub for spending time with House's best friend - rather he's punishing him of lying about it - he says.

Kutner is placing bands on Marika's feet and hands. He tells her 'the better she does the better they can help her daddy', and to tell him as soon as they get uncomfortably hot or cold. He retires to a booth and talks with Audrey as the tests begin with heat. Kutner asks Marika if she's doing OK, but she doesn't answer.

Audrey tells Kutner she's having trouble with Nick's new truthfulness - that these are feelings he's had all along but kept hidden. A shriek from Marika brings them running into the room. Marika has endured the heat too long, thinking the longer she could bear it, the more it would help her daddy, and her hand is burned.

Taub begins the blood draws. Nick discusses Hadley with him, and says he doesn't want to be defined by his thoughts but his actions. He, for instance, has never cheated on Audrey. He instantly deduces from the look in Taub's face that Taub has cheated, and can't stop from blurting it out, as well as how little Taub's colleagues must think of him - unless of course they're idiots. Taub rushes from the room to stammered apologies.

House summonses Taub to the tile-walled morgue. He hands Taub a ball and a racket and tells Taub to play against the tile wall as he reports. Taub reports no sign of diabetes but suspects it could still be an endocrine problem - thyroid instead of pancreas.

As he talks he hits the ball around the corpse in the middle of the room, until one wild hit bangs into some equipment and he gives up in frustration and admits he's never played racket ball with Wilson, and only cooperated with Wilson's plan because he thought a department head owing him a favor might be useful. House congratulates him on his excellent preparation, marred only by his failure to recognize the squash racket he was given. House says to tell Kutner to do a thyroid reuptake test.

Kutner explains the test to Nick, but Nick wants to know why Marika has a bandage on her hand. Kutner explains, saying since Marika 'has a neurological disability like you'... Nick says she has none. When Audrey tries to remind him of her 'problem with auditory processing" Nick says she hasn't got one - she's just a little slow - below average, like half the kids in the world (except in Lake Wobegone.)

He's saying all this with Marika in the room, while Audrey tries to shush him. Nick tries to apologize to Marika, but the apology just makes it worse. Marika runs from the room, as Nick collapses, coughing, and Kutner says his lungs are filling up with fluid and calls for help.

Act 3

Nick's temperature is climbing and the team's now thinking he has an 'infection on steroids', due (a) an infection and (b) well...steroids. House sends Kutner to get a more detailed history, but tell Taub he has something else to keep him busy.

Taub confesses to Wilson that "I've been made" and House is sending him back as a double agent.

Kutner starts with a quick exam, finding only that Nick's "eyes are a little red." Nick asks his wife to leave during the history taking because he's afraid he might say something else to hurt her. She leaves saying "this is pathetic". He agrees.

Kutner finds House twirling his cane in the hall and reports that Nick "leads a boring life." No bad habits, no exotic pets, no nearby standing water. But, he reveals, Audrey rescues dogs, and they currently have a big Rottweiler who marks his territory all over the living room and may have slobbered in Nick's drink. On hearing that the patient's eyes are red, they're both thinking Weill's - a bacterial infection. House says to start him on the antibiotic doxycycline.

Taub emerges from Wilson's office and reports that he told Wilson about his double agent status and got Wilson's approval to print out his emails, which doesn't impress House, but that while he was doing that he also, unbeknownst to Wilson, printed out Wilson's deleted emails - the top on, he says, is the one House wants.

It's from a J. Gonzales at NY Mercy hospital, confirming a 7PM Tuesday appointment. A little Googling tells House that Dr. J. Gonzales is an oncology expert who's written papers on suicidal patients. Taub is worried Wilson might be depressed. House discounts this possibility.

Act 4

Foreman and Kutner tells Nick that the drugs have cured his infection but that the damage it has done is permanent and inoperable due to being too close to the brain stem - the slightest mistake could kill him or cause severe handicap. They try to tell him patients have learned to live with similar conditions. He orders them out of his room.

House intercepts Wilson as he returns from a coatless walk in the severe cold outside. He reveals he knows about Gonzales. Wilson walks off to the cafeteria to get some hot coffee. House pursues. He analyzes that Wilson chose to be uncomfortable for some reason - self-punishment, perhaps? Wilson blows up and says he'd appreciate a little un-analyzed privacy for once.

Nick intercepts House outside his office. He says he's pissed - he can't go home in this condition - driving away anyone who cares about it - he wants an operation. House says he could die, Nick says he's prepared to take that chance. He says he's always been kind of impatient guy, but he's learned and disciplined himself to keep his mouth shut to make his wife and his little girl happy. He wants that back or his life's not worth living. House does some reflecting on this - condemned to live House's life? No one should be forced to do that. (No, he doesn't take the next logical step.)

House goes to Chase - looking for a surgeon. Chase says too risky and he's not a neurosurgeon. Chase's boss is, House says, and an egomaniac, to boot. Sounds interesting - why don't we meet this guy? Chase won't help unless House tell him why he cares. Chase is not impressed until House describes the life Nick is condemned to if he doesn't get help. As soon as Chase realizes House is describing his own life, Chase agrees to help.

Act 5

The operation proceeds, with House and Wilson in the gallery. Wilson apologizes for his blow-up. House has done a little more intel work and has discovered that there is also a nurse J. Gonzales in the NY Mercy psych ward, and that there is one Daniel Wilson there as a patient. Wilson's brother was taken there after being picked up by the cops sleeping in the lobby of an office building. He's about ready to receive visitors after a few days on his psych meds, and that's where Wilson's going.

So why not tell House? Because House doesn't buy into the social contract, couldn't be expected to say soothing things to calm Wilson' nerves which House immediately demonstrates. But there is some sort of contract there, as House also demonstrates by offering to go along.

Nick is in the recovery room - the operation was a success, the affected area has been removed. "Oh, thank God" Audrey says. Taub quizzes Nick on his orientation. "Nick Greenwald, former SOB," he says. But as he continues to speak, it becomes evident that the damaged brain matter may be gone, but the disinhibitions are not. Nick and Audrey nearly have a melt-down right there. She runs from the room crying as Nick arrests and Foreman calls for the paddles.

Act 6

The team, less House, consider the matter as Nick's temperature fluctuates. House is uncontactable. Foreman orders a full body scan, as the other team members echo House's sentiments that full body scans are a waste of time - revealing minor irregularities that send doctors chasing false leads. Foreman points out House isn't there and the scan proceeds.

Nick and Wilson sit waiting in the lobby at NY Mercy. Wilson's brother has lived on the streets, for years, avoiding his family. House ignores pages from his team.

The scan finds a small abdominal aneurism, a cyst on the pleura of the lungs, some suspect density in the liver that could be vascular malformation. The latter seems the most likely, and Foreman says they'll have to do target scans with contrast and embolize each one.

While he won't answer their calls, House does scan the texts they send him. He say Wilson's walk in the cold screams guilt to him, Wilson seeking to put himself in his brother's place and see what wondering homeless in a New jersey winter feels like so House wants to know what happened to make Wilson feel so guilty.

Wilson's sad tale is that Daniel's schizophrenia began in high school, and continued in college, where, despite his meds Daniel was paranoid and in the habit of calling Wilson every day and talking for hours, while Wilson was in med school and not having hours to spend on the phone.

One night with an exam the next day, Wilson just hung up on Danny and fled to the library. That night Danny went off his meds and left college to begin his life on the streets. House figures that that's the source of Wilson's people-pleasing personality, never wanting to again be the cause of somebody else's failure - an overreaction to a single event.

The topic of over-reaction sends House into a epiphany - he grabs the phone and calls the team. Just then the nurse comes out and Wilson goes in to see his brother alone.

House tells the team that the glucose results could have been explained by the vascular malformations in the liver, and that combined with the lung cyst (which now become a fibroma) the whole adds up to Doege-Potter's syndrome. All Nick's symptoms are a reaction - an over-reaction - to that one fibroma. Remove the fibroma and everything else is cured.


Nick, all cured, packs his bag wondering if his wife will come to pick him up. He apologizes nicely to Taub, and when Audrey shows up, responds appropriately to all the social niceties.

House and Wilson meet. House asks if Danny is OK. Wilson says yeah but, he didn't really connect - they were almost like strangers. He invites House back with him next week and House accepts. House and Wilson discuss their non-contract social contract. Wilson appreciates House's honesty - at least most of the time. Then they proceed across the lobby demonstrating just how much of a social contract they do have, and in fact no one, not even House, can live without, as Nick well knew.

Next Week:

A woman gets a fatal diagnosis from her cat. House get obsessed with the cat.

Last Episode: 02/16/09 5-16 The Softer Side
Next Episode: 03/02/09 5-18 Here Kitty

Cast and Crew Ep. 5-17, "The Social Contract" Aired 03/09/2009

Cast and Crew

Director:___ Doris Egan
Writer:____ Andrew Bernstein


Hugh Laurie________Dr_ Gregory House
Lisa Edelstein_______Dr_ Lisa Cuddy
Robert Sean Leonard_Dr_ James Wilson
Omar Epps_________Dr_ Eric Foreman
Jesse Spencer_______Dr_ Robert Chase
Jennifer Morrison____Dr_ Allison Cameron
Olivia Wilde________Dr_ Remy Hadley (Thirteen)
Peter Jacobson______Dr_ Chris Taub
Kal Penn___________Dr_ Lawrence Kutner

Recurring Role:

Bobbin Bergstrom_____Nurse

Guest Stars:

Jay Karnes___________Nick - the patient
Susan Egan__________Audrey - the wife
Darcy Rose Byrnes____Marika - the daughter
Devon Michaels_______Timothy Moore (author)
Jodi Harris___________Elaine (publisher)
Cyrus Deboo_________Dr Kapur (surgeon)
Sheri Foster__________Cashier


The Shining______Badly Drawn Boy

Posted by Cecil on March 9, 2009 7:25 PM
Permalink |

House + Wilson = Twisted, yet beautiful friendship. =]

-- 1. Posted by: ilovebenjaminlinusxx at March 11, 2009 6:28 PM

I liked this episode. It was awesome.

Let's just say that I hold in so much that if I always told the truth I'd be wayyyyy worse than House.

-- 2. Posted by: ilovebenjaminlinusxx at March 11, 2009 6:35 PM

Thanks for the review, Cecil.

I really liked this episode as well, having a guy who cannot lie was a great case, and watching House deal with him towards the end was a great bit of television, the fact that House was able to pity the man and go to bat for him so that he wouldn't end up like House (alone and unable to maintain relationships) was a great twist. And just as we think Gregory House is going to be there for Wilson...the old House is back.

I also really loved the racquetball scene in the morgue!

-- 3. Posted by: FenwayBen at March 13, 2009 7:01 PM

What a video it is! Genuinely awesome and good quality, please upload more video clips having such good quality. Thanks.

-- 4. Posted by: super slim pomegranate at September 23, 2013 6:45 PM

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