Wilson's Heart (House)

"Wilson's Heart" is the sixteenth episode and season finale of the fourth season of House and the eighty-sixth episode overall. It aired on May 19, 2008. It is the second and final part of the two-part fourth season finale, the first part being "House's Head".

Plot

The episode opens up with a distraught Wilson and House at Princeton General Hospital, discussing planned treatment of Amber, who remains in critical care from the bus accident in the previous episode. After House discusses several theories given by Amber's attending physician, he transfers her to Princeton-Plainsboro Teaching Hospital under the false pretense that Wilson is her husband. On the ambulance, Amber undergoes ventricular fibrillation. Before shocking her heart, Wilson suggests that Amber be placed under protective hypothermia and put on bypass, as her heart is already damaged and it would give House the precious time needed to diagnose her.

During the differential diagnosis, Kutner suggests that House take an approach to cause him to remember what happened the night of the accident, similar to the physostigmine that caused him to remember that Amber was on the bus with him. House dismisses this at the moment, stating it is not necessary; he sends Taub to get a toxicity screen on Amber, and Kutner and Thirteen to check her house for anything environmental that could cause her symptoms. At the house, Thirteen states that Wilson is too close to Amber, and House is too close to Wilson to remain objective on the case. Kutner discovers Amber to be hiding diet pills, amphetamines and anti-depression pills (SSRIs) inside a multivitamin container, and the team tests Amber's heart to determine if a valve is calcified, indicating the pills were responsible. House notes Thirteen's negative aspect towards the case, and requests her to "get over whatever it is, and do [her] job." Before the heart can be tested, the team notices that Amber's liver is failing, ruling out the pills.

Meanwhile, House experiences a dream where Amber is serving him sherry. Kutner suggests that the sherry represents Sharrie's Bar. Wilson and House go to the bar and ask the bartender (guest star Fred Durst) who House was with on the night of the accident, and if he remembers any symptoms. After getting information that she was sneezing, House determines this to be a new symptom and they return to Princeton Plainsboro. House determines that Amber is suffering from Hepatitis B, and requests she be put on IV interferon.

Later, in another hallucination, Amber shows House she has a rash on her back, a symptom that doesn't fit with her diagnosis. Taub determines the rash to be caused from influenza, while Wilson suspects Amber may have caught a tick several weeks ago. Wilson reiterates that he does not want the team starting Amber's heart until they are 100% certain of the diagnosis, causing House to stand up for Wilson. After another confrontation with House, Thirteen draws blood from herself in order to test for Huntington's chorea. Meanwhile, House's team reviews Amber's records, and determine that she will not be able to remain on bypass for much longer. Defying House and Wilson, Foreman and Cuddy begin to warm Amber's body temperature. After analyzing Amber's EKG, Wilson and House determine the illness to be spreading to Amber's brain. House believes it to be caused from an autoimmune disease, and orders prednisone. Wilson, however, believes her illness to be caused from an infection, and says that steroids would destroy her immune system and kill her.

Wilson again suggests House undergo deep brain stimulation, effectively risking his life in order to save Amber's. During the procedure, House experiences a memory from what happened prior to the bus accident. It is revealed that, after work, House went to Sharrie's Bar and got drunk. The bartender, noting this, takes House's keys in exchange for a phone call to get a friend to drive him home. He calls Wilson. However, Wilson notes was on-call that night, while Amber was home. Amber finds House, and after one round of drinks, Amber sneezes. House notes that Amber's sputum is yellow-green, possibly indicating influenza. A drunken House gets up and leaves the bar without paying, forcing Amber to do so herself. House leaves to get on a bus at this point, leaving Amber at the bar.

Amber finds House on the bus, and brings him his cane which he forgot at the bar. She sits across from House, and sneezes again. House realizes that she indeed is suffering from influenza, but his attention is drawn to a bottle of prescription pills that she pulls from her purse. House realizes that she was taking amantadine, a drug that suppresses the symptoms caused by influenza. However, Amber was taking such a high dosage of this pill that when the bus accident destroyed her kidneys, it damaged the rest of her organs. Wilson suggests that Amber be put on dialysis, but House notes that amantadine binds with proteins, and that dialysis cannot clear it out of her blood. Realizing that there is nothing that he can do to save Amber, House apologizes to Wilson, realizing that he can partially be put to blame for her death. At this point during House's procedure, House suffers a complex partial seizure, which widens his skull fracture, causing a brain bleed and resulting in a coma.

House's team briefly discusses the possibility of finding a donor heart for Amber, but Foreman notes that her other organs are also damaged, so she would not be a candidate for receiving a transplant. Cuddy keeps Amber on bypass and weans her off of the anesthesia, thereby allowing Wilson and House's team to say their goodbyes. Wilson reminisces with Amber, and reluctantly shuts off bypass.

House experiences another hallucination, this one while comatose. He and Amber are on an empty bus, surrounded by a white void. House seems to know that Amber is dead. The two talk for a moment, and House admits that he does not wish to leave the bus. When Amber asks why, he tells her that he wants to remain in the bus because, there, there is no pain or worry. He also tells her that he does not want Wilson to hate him. Amber tells House that "you can't always get what you want," (an in-joke: House is a Rolling Stones fan, and "You Can't Always Get What You Want" has appeared in several episodes, including the pilot and first-season finale). This persuades House to get off the bus, and he awakens. Cuddy is found to be sitting next to him waiting for his recovery. As the episode closes, Thirteen discovers that she has tested positive for the Huntington's gene. We see Taub returning home to his wife, and Kutner sitting alone in front of a television set. Foreman is sitting at a restaurant, only to be joined by Chase and Cameron. The camera follows Wilson home, where he grasps the place on the bed where Amber should be. He discovers a note written by Amber on the night of the bus accident, reading, "Sorry I'm not here. Went to pick up House. Love, A." A depressed Wilson holds the note up to his heart, crying over Amber's death. The episode closes on a shot of a depressed House on a bed at Princeton Plainsboro.

Cultural references

When House is in the bathroom talking to Thirteen, there is a bumper sticker on the wall for "Change '08". This seems to be a nod to either Barack Obama or Hillary Clinton.

House taps Thirteen's foot with his from a neighboring bathroom stall and says, "Sorry, wide stance," in reference to the Larry Craig airport bathroom incident.

Music

Two songs play towards the end of the episode: Bon Iver's "Re: Stacks" and Iron and Wine's "Passing Afternoon". A cover of Massive Attack's "Teardrop", by Jose Gonzales, the show's theme music, is also heard during the episode. "Light for the Deadvine" by People in Planes is heard when House awakens in the white bus.