Merry Little Christmas
|"Merry Little Christmas"|
|Episode no.||Season 3
|Directed by||Tony To|
|Written by||Liz Friedman|
|Original air date||December 12, 2006|
|Season 3 episodes|
|List of episodes|
"Merry Little Christmas" is the tenth episode of the third season of House and the fifty-sixth episode overall.
The ongoing legal issues between House and Detective Tritter come to a head as Dr. Wilson attempts to make a deal between the two by admitting to Tritter that he did not write all those Vicodin prescriptions. House stubbornly refuses, in large part because the deal involves House spending up to two months in rehabilitation, and demands that Detective Tritter and Wilson leave his office. Wilson follows House while he makes his way to Cuddy where Wilson says that House will be supplied with low-strength pain medication such as Tramadol and Gabapentin in rehab and that they will work once weaned off Vicodin. Wilson points out to House how he almost "cut a little girl in half" and punched-out a coworker and that those are the reasons that he decided to broker a deal with Tritter. House angrily points out that he was in pain and that Wilson only made the deal for selfish reasons. Eventually, Cuddy sides with Wilson and refuses House any Vicodin unless he takes the deal, forcing him to detox, and removes him from his team's case: a 15-year-old girl suffering from a collapsed lung and anemia. In a bit of foreshadowing, House mentions to Cuddy that she will come begging him to save this girl long before he comes begging her for pills.
The patient, Abigail, and her mother, are both considered to be suffering from cartilage-hair hypoplasia, a type of dwarfism. Abigail also presents with a collapsed lung with no apparent cause.
While getting an MRI of Abigail's lungs, Cameron, Chase, and Foreman discuss the situation between Tritter, House, Wilson, and now Cuddy. Cameron thinks cutting off House's Vicodin is wrong, while Foreman thinks that it's exactly the type of thing that House would do. Chase sides with Foreman saying that he'd rather have House take the deal so they can all keep their jobs. Abigail suddenly starts coughing up blood just as the MRI is finishing up.
It appears that House was correct, Abigail's liver is failing. An endoscopy, along with Abigail's blood work, supports House's theory about her failing liver. House's team meets with Cuddy and Wilson in Cuddy's office and have a mini-DDX about Abigail. Thinking that Abigail could have liver cancer, they end up agreeing to do a liver biopsy and check her home for drugs and alcohol in the event that it's not cancer. When Foreman returns with the biopsy results, he finds House in Cuddy's office alone and apparently trying to break into her desk drawer. Foreman starts to catch House up on the case but House ignores him saying that he is not on the case. Foreman presses by saying that House obviously saw something since he predicted the liver failure. He continues to press House by revealing that the liver biopsy was negative for cirrhosis but showed sclerosing cholangitis and that, even weirder, there was no increase in alkaline phosphatases. House sarcastically remarks "Hmm... medical mystery. Sounds like the kinda thing I'd be good at." Recognizing a chance for a deal, House offers Foreman a theory if Foreman will break into the drawer. Foreman accepts and House starts discussing the case. House says that since the gallium scan was bright, it indicates a global systemic issue, meaning the specific nature of the liver dysfunction is irrelevant. If it is a global issue then it will spread throughout her entire body. Foreman counters by saying that, at the moment, nothing else is wrong with her. House continues by saying that she will have something else wrong, most likely hitting her pancreas next as it will spread through the biliary tree. House ends his "theory" by telling Foreman that they need to get ahead of the game and forget about the liver to focus on the pancreas. Foreman gets the drawer open, however, before he lets House open it he tells him that he understands why House doesn't want to go to rehab but that only an idiot goes to prison for being stubborn. House stubbornly ignores this piece of advice and retorts that "only an idiot stands between Ahab and his whale" meaning don't get in the way of him and his Vicodin. House frantically searches the drawer only to find that there is no Vicodin.
Chase returns from Abigail's home with different medicines from the home and he, Foreman, and Cameron start writing possible causes/symptoms from the things that were found. Cuddy and Wilson enter and ask who ordered an alpha 1-antitrypsin deficiency test since this was not discussed. Foreman takes responsibility and mentions to them that he thinks the problem will be moving to the patient's pancreas; he echos House's thoughts from earlier and tells them that they "need to stop retracing their steps and get ahead of this thing." This proves to be a telling sign as Wilson immediately recognizes it as something House would say. They disagree on whether or not they should use House's medical opinion and Cuddy reveals that the test was negative. She states that the biopsy indicated severe duct inflammation so she instructs them to do an ERCP to check the liver for bile duct cancer. Foreman insists that listening to House would still be beneficial and that they should still focus on the pancreas but Wilson says that House would have made up any theory about an organ to get a fix.
Meanwhile, at the nearby St. Sebastian's Hospital, House is being treated by a clinic doctor. House complains of pain on his face near his eye from a car accident he had recently been involved in. The clinic doctor, noticing that there is no bruising and that the bones are aligned properly, indicates that this type of injury is typical of a zygomatic break. House mentions that this "sounds bad" and, when asked what ER he went to after the crash, he provides the doctor with an ER discharge slip from Princeton Plainsboro. The doctor is convinced and says that he'll be prescribing House some acetaminophen with Codeine. House casually mentions that he has tried that before and it makes him feel nauseous. The doctor understands and offers to prescribe House a drug called Gabapentin to which House replies "great, cause I haven't slept in days." The doctor remarks that Gabapentin isn't going to help with any sleep issues. House then asks if there is something else that the doctor can prescribe, indirectly saying he would like something to help him sleep. The doctor thinks for a second and then tells House that with sleep issues, Vicodin would probably be his best bet, however, the hospitals policy is not to prescribe opiates to first-time patients. House questions this rule and the doctor says that it helps them weed out the drug-seekers that come into the hospital. House and the doctor go back and forth with House trying to say that he is not a drug-seeker and that the doctor should prescribe him the Vicodin. Eventually House blows his cover and calls the doctor out for prescribing Gabapentin incorrectly. The doctor calls security and House leaves voluntarily, albeit with nothing.
Back at PPTH, Foreman and Wilson are preparing to perform the ERCP when Abigail loses consciousness before being given the sedative for the procedure. Foreman notices that her breath smells fruity, a sign of diabetic ketoacidosis, which indicates that her pancreas is now failing. It is obvious that they need Houses help at this point.
Cuddy goes over to Houses' apartment and tells him that he was right, Abigail's pancreas is failing. House says that *he* was right, referring to when he said earlier that Cuddy would come begging him for help before he did for pills. Cuddy pleads for House to help Abigail but he refuses unless he is given Vicodin. House asks if losing this patient is worth not giving him his pills, to which Cuddy says she would rather lose this patient now then suffer through the amount of patients they will lose if House goes to prison. House coldly says to have fun explaining that to Abigail's mother and shuts the door.
Back in Cuddy's office, Wilson, Cuddy, and House's team DDX Abigail's case once more. Cuddy states that they are dealing with a global systemic illness affecting lungs, liver, and pancreas, just as House predicted. Chase suggests Langerhans cell histiocytosis but Foreman points out that there are no neurological symptoms. Foreman then suggests cystic fibrosis but Wilson says that her excrement functions are normal. Wilson then suggests Hodgkin's lymphoma, a systemic cancer which her dwarfism predisposes her to. Cameron says that an autoimmune disease is much more likely and suggests Lupus. Cuddy has Wilson perform an LP and has the others run an antibody test for Lupus.
Cameron visits House unexpectedly and notices House's arm bloodied and bandaged when he answers the door. She comes in to look at the wound and re-bandage him up and they talk about the case and about why House is acting the way he is. The cuts on his arm are straight and obviously self-inflicted. House admits to it and says that cutting releases endorphins which help him with the pain of detoxing. After talking about some of the latest ideas from the DDX, House concludes that Abigail has Still's disease. He instructs Cameron to start Abigail on prednisone, methotrexate, and cyclosporin. Cameron returns with this information and informs Cuddy of House's condition; they agree to take House's advice and start the treatment.
House makes a visit to the hospital and finds Wilson. He says he has come to show how much the drugs do not have a hold on him, yet he clearly looks exhausted, tired, sweaty, and ill. House tries to get Wilson to "give up" or surrender, as if this were just a game, and Wilson says that House will go to jail in the end if it stays like this. As Wilson starts to walk away House pleads with Wilson to give him a script for Metoclopramide because the nausea is bad and because it's something he would be given in rehab. Wilson says that then he should go to rehab. As Wilson leaves to visit his patient, House checks the file that Wilson was looking at and sees the patient's information along with what room they are in. House then follows Wilson to his patient's room and begins make a scene by belittling the dead patient and arguing with Wilson in front of a newly grieving widow. House is asked to leave and as he walks away, the faint sound of pills rattling around in a bottle can be heard. Wilson stops House before he leaves and reaches into his pocket to find that House had stolen the remaining Oxycodone pills from the dead patient. Wilson is disgusted and House appears defeated.
Wilson stops by to talk to Cuddy about check on Abigail; it appears she is responding to the treatment and is getting better. Wilson thinks about how Still's disease had never crossed his mind. He meets Tritter again and informs him that he cannot go through with the deal he made. He says that House saves lives, that he is a positive force in the universe, and because of that fact he cannot testify against him. Tritter says that Wilson will be subpoenaed and charged with interfering with an investigation, after which he will be sent to jail. Wilson says better him then House, to which Tritter replies that both of them will be in jail.
Abigail suddenly starts bleeding from her mouth and ears. Abigail's mother calls Cameron who appears surprised.
House goes to pick up a prescription for Oxycodone from the hospital pharmacy, supposedly for a patient of Wilson's (the patient from earlier). The pharmacist is skeptical at first, but at House's insistence he gives House the pills. However, he makes House sign the pharmacy log to show that he took the pills for Wilson. House then hurries over to the stairwell where he is finally able to get the fix he has been wanting for the entire episode.
Back in Cuddy's office, Wilson, Cuddy, and the team are back to diagnosing Abigail's case again in light of the recent developments. Chase rattles off the latest info for the case and concludes that Abigail is on the verge of multi-system failure. Foreman says that her head CT was clean, meaning that it's not a neurological problem. Wilson says that cancer still fits, specifically Leukemia, and that they need to do a bone marrow biopsy. Cameron says that autoimmune is still more likely as Abigail initially got better with the treatment. Foreman points out that all they are doing is bouncing back and forth between cancer and autoimmune. Cuddy, realizing that they are stuck, advises everyone to "give her half an hour." Cuddy goes to the cafeteria and finds House who, to her surprise, is not detoxing anymore and eating multiple hot dogs with fries. When she tries to inform him that it wasn't Still's disease and waves Vicodin in his face, which she says he can have, he ignores her and continues his conversation with the little girl at his table who has spinal muscular atrophy. When Cuddy asks House if he is on something, he looks at her incredulously and she realizes he got hold of something. While he ignores Cuddy and continues his conversation with the little girl, he has his epiphany.
House gets an x-ray of Abigail's leg and, much to everyone's surprise, her leg looks completely normal. Wilson is distracted by House's apparent lack of detox symptoms to which House writes off as will power. House then swallows a pill and Wilson is flabbergasted. House continues on and explains that Abigail is not really a dwarf. Abigail is found to have a granuloma pressing against her pituitary gland, causing her apparent "dwarfism". The neurological symptom was there all along; Abigail has Langerhans cell histiocytosis, Chase's idea from earlier that was ruled out. These symptoms are addressed and Abigail is offered treatment by House, but she refuses the growth hormone on account of not wanting to "fade into the background." House questions Abigail's mother on whether the uniqueness of being "a freak" is worth the hardship. The mother later convinces the daughter to go through with the full treatment.
It's Christmas Eve and Wilson invites House to spend time with real people, specifically him, but House scoffs at the idea and goes home instead. At home, House leaves a Christmas message for his mother on the phone and then, realizing the position he's gotten himself in, ends up overdosing on Oxycodone and alcohol. Wilson comes to check on him at his house after House doesn't answer his calls and discovers House on the floor next to a puddle of vomit, pills included. Wilson leaves in disgust after finding the pill bottle of the illegally-acquired drugs from his dead cancer patient from earlier.
Later on, after House comes to, he goes to Tritter at the police station to take him up on the deal. However, Tritter turns him down saying that they don't need Wilson's testimony anymore, they have new evidence: House's signature in the pharmacy log, signing for drugs illegally for a patient that was already dead. Tritter smiles and says "Merry Christmas."