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"Let Them Eat Cake" is the tenth episode of the fifth season of House and the ninety-sixth episode overall. It originally aired on December 2, 2008.
When a fitness guru, Emmy (Samantha Shelton), faints and breaks her ankle, she is sent to Princeton-Plainsboro Teaching Hospital, under the care of House and his diagnostics team. When House's team realizes she had gastric bypass surgery, Taub accuses her of being a hypocrite. Emmy develops numbness in her left leg. Emmy gradually loses muscle and nerve control throughout her body and hallucinates. Eventually, Emmy gets frustrated and asks for chocolate cake to console herself; however, she becomes healthier after eating it. House realizes Emmy lacks an enzyme that requires carbohydrates. She has hereditary coproporphyria. The treatment is a diet rich in carbohydrates and glucose, but because of her gastric bypass and changes in her lifestyle, she has not been getting enough of either. Emmy rejects the treatment, opting for a pill that will manage her symptoms, but not make her healthy.
Foreman begins his clinical trials on Huntington's disease, with Thirteen reluctantly partaking in the drug regimen. She sees a patient called Janice, and has a flashback, seeing her mother thrashing around the same way. Thirteen follows her medication schedule very strictly, but doesn't show up for her appointments. She tells Foreman that she doesn't want to have to see the state she'll be in in a few years. Foreman tells her to get over it and show up for her appointments on time, or not at all. She has another flashback of her mother getting in a car with herself watching from her window. At her appointment, Foreman tells Thirteen to get to know Janice, so Thirteen helps Janice with her jacket. At the end of the episode, Thirteen goes to talk to Foreman. She tells him that Janice in fact didn't scare her about her future, but it reminded her of her past. She admits that she wanted her mother to die, because her mother yelled at her all the time about nothing, even in front of her friends. Her father told her it was the disease, but she hated her mother nonetheless. She starts to cry and Foreman hugs her.
Cuddy uses House's office while hers is renovated. She becomes an intrusive participant in the team's differential diagnosis, much to House's annoyance. They settle on sharing his desk until House disrupts her while she is on the phone with a donor. Cuddy retaliates by pouring a vial of hydrogen sulfide in his office, forcing House to work in a room smelling of rotten eggs--he chooses to leave. The next morning, he heads down to her office, smashes her toilet with a sledgehammer, and convinces the architect he is Cuddy's boss and that he must approve all renovations. House tells Wilson he is having the toilet replaced with a bidet; Wilson notes House appears to be trying to keep Cuddy in his office, the exact opposite of what he claims to want. Cuddy has the furniture removed from House's office. They confront each other, and House accuses her of wanting him, claiming she wears provocative clothing to get his attention. She claims their rivalry is "going somewhere", but when House gropes her instead of kissing her, Cuddy leaves. To reconcile, House arranges with Cuddy's mom to retrieve Cuddy's medical school desk from storage and install it into her renovated office.
Meanwhile, Kutner tells Taub he has started an online diagnostic clinic, but used House's name, not his own. Taub blackmails Kutner for 30% of the profits in exchange for not telling House. Kutner has trouble with a patient who insists her breast implants are causing problems. The patient shows up at Princeton-Plainsboro to complain to House, whom she believes she has been emailing. Kutner and Taub send her to the emergency room so Cameron can deal with her. When the woman starts singing "Coconut" uncontrollably and bleeding from her ears, Chase tells Kutner to ask House to help. Kutner refuses because his scam will be revealed if he involves House. Chase agrees to help for 25% of the profits. When Kutner and Taub check on the woman, they discover she died. House furiously confronts them with the patient's body on the autopsy table. House blasts Kutner for setting up the site and Taub for not stopping Kutner. House does a series of chest compressions and resuscitates the patient, astounding Kutner and Taub. The whole thing was a prank: House knew about Kutner's website and hired the woman to play a patient; similarly, he bribed Chase and Cameron to play along. House allows Kutner to continue the site, provided he pays House 50% of the profits.
Cuddy heads to House's office to thank him for the desk and what she thinks it symbolizes for their relationship. As she approaches House's office, she spots him flirting with the woman who played Kutner's victim. She turns away, walking back to the elevator dismayed.
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