October 14, 2008
Episode Number
5.4 Rating
Final Diagnosis
Insertion of large number of pins through skull and into brain shortly after birth
Zebra Factor
Wilson: "Put it back."
House: "Well, he's not going to miss it."
Wilson: "I'm done enabling. You can't even let them put him in the ground without making it serve your agenda?"
— Birthmarks

Birthmarks is the fourth episode of the 5th season of House which first aired on October 14, 2008. House must come to terms with the death of his father, but on the way to the funeral he must also deal with the case of an adopted Chinese woman who collapsed while seeking her birth parents. Wilson drives him to the funeral, but House is soon up to his old behavior.

Birthmarks is one of the most important episodes in the series, providing both major advancement of several Story Arcs and being one of the best reviewed episodes. The patient of the week is a sideshow to the development of the characters of Gregory House and James Wilson, and both provides backstory to Hilson and a reparation of the relationship between the two men.

Like some of the other patients in the series, Nicole represents a part of House himself, in this case, a part of House that isn't revealed until this episode. Although we were aware of House's strained relationship with his father, it is only in this episode we learn that House has suspected for decades that his mother actually slept with another man to conceive him. We also learn that at the tender age of 12, the preternaturally intelligent and mature House challenged his father over the point. The patient is having the same issue, only she has known since she was very young that she was an adoptee and has recently been trying to find her biological parents. Like House, she has turned to drugs for relief. However, both Nicole and House find out that their biological parents aren't what they imagined them to be - Nicole finds out in this episode, and House realizes the truth about his biological father later in the series.

House's belief that John is not his father starts to explain his key credo - everybody lies. In fact, this seems to be revealed as the "big lie" that dominates his view of life and relationships. To him, the rational facts he has embraced in adulthood - that his father isn't his biological father and his mother must have turned to someone else for love, are contradicted every time his parents dodge the issue.

We also learn more about Wilson - the breakup of his first marriage, the start of his inability to break up harmful relationships on his own, and his ability to lose control over his emotions in extreme situations. However, and more importantly, it is finally revealed how House and Wilson met. Ironically, the start of their friendship is only revealed when it seems it may be over.

In the end, everyone gets what they need. Wilson realizes that despite House's faults, House is there for Wilson too and without House, life just isn't fun anymore. However, when House finally proves what he always suspected about his father, he not only finds that the information gives him no solace, but that his father meant more to him that he was ever willing to admit. At some point, it seems although he hated his father's inability to get along with people, that characteristic also defines House himself.

This episode finished 9th in Facebook's poll of the best episodes of the series completed in April, 2012.


A woman visits China to visit her birth parents, but they reject her. As she is making a wish by lifting a Buddha statue, she suddenly collapses with abdominal pain and vomits blood.

House comes into the office and announces that his father has died. He is treating the Chinese woman, and wants to continue the differential. Taub tells him to call his mom, and House realizes that Taub told his wife that he cheated on her. House says he's not upset about his father's death and offers to do the ultrasound himself. Foreman tries to get him to call his mother, but House goes to see the patient instead.

House does the scan on the patient, but finds nothing out of the ordinary. Her adoptive parents, who are Caucasian, come in having done an environmental scan. House finds some licorice root in her belongings, used to treat SARS in China. House figures she has it and starts her on interferon.

Cuddy comes in to give House her sympathy about his father and to give him a shot of immunoglobulin to prevent him contracting SARS. She tells him that his father's funeral is the next day and his mother has asked him to deliver a eulogy. Cuddy tells him either to call his mother to say he can't come or start writing the eulogy.

Kutner goes to the patient to get a list of her contacts, who might also be sick. She wonders if House might have got it from her when she coughed on him.

Suddenly, House collapses in his office.

The patient develops tachycardia and Kutner finds her liver is failing. The SARS diagnosis is obviously wrong.

House wakes up to find himself in a car with Wilson driving. House realizes the immunoglobulin shot was actually a sedative. He smiles when Wilson says he's not doing this because he cares about him. He also realizes that his mother called Wilson and not Cuddy. He also finds his Vicodin is missing. He realizes Wilson will use them to keep him from trying to get back to the hospital.

The team calls House to tell him about the liver. Wilson is originally reluctant to give House his phone, but the ringtone is for his team. He gets on the line, but his team already has a good hypothesis and, without House saying more than he’s being held hostage, Foreman orders the team to draw blood to test for genetic liver diseases.

Kutner goes to see the patient, but she's missing.

House threatens to pee in Wilson’s car unless he gets a washroom stop. However, Wilson won't give him his cane so he can slip away. House is telling Wilson how his father wouldn’t talk to him for two months and going to the funeral would be a lie. Wilson is insisting that he go to the funeral and be nice. House negotiates for the return of his cane and agrees to go the funeral. He uses his cane to knock the car keys out of Wilson's hand into a sewer.

Kutner finds the patient smoking in the courtyard. He decides to draw her blood there. The patient is telling Kutner about being a Chinese person with Caucasian parents. Kutner tells her he was adopted by Caucasians too. The patient starts bleeding profusely from the spot where blood was drawn and Kutner rushes her inside.

Wilson tries to recover the keys with a flashlight and coat hanger, but when Wilson hands House the flashlight to hold, House drops it into the sewer too. Wilson has another flashlight. He tells House the delay won’t work - Blythe will hold the funeral up until House arrives. House says his mother would never do that because it would disrespect his father’s love of punctuality.

Cameron is trying to decide what flower arrangement she should send on House‘s behalf to make it look like he cared enough to do it. Kutner comes in to tell Foreman about the patient. Foreman orders a CT Scan. Chase figures House is a mess despite his denials about his feelings for his father.

House tells Wilson he doesn't think that John House is his biological father. House says he has a birthmark that matches a family friend, their toe length is reversed (big and second toe) and his father was away when he was supposed to have been conceived. Wilson reminds him that John could have taken a plane to see Blythe and conceived him then, and that House would have performed a paternity test if he suspected that, and since he hasn‘t said he performed one, he obviously didn‘t do one. Suddenly, House sees a cop and presses his cane on the accelerator.

The team is doing the CT. Kutner is telling Taub that the patient was adopted before her adoptive parents had three children on their own. They find a cyst on the pancreas.

Wilson is trying to talk his way out of a ticket without telling the cops that it was House using his cane. House is talking to his team while Wilson gets arrested. The cyst is large. House makes a "steamroller" metaphor, but the officer takes House's phone before he can finish explaining his thought. The officer tells Wilson there is a warrant for his arrest in Louisiana.

The team, being cut off from House, starts a differential about the cyst. Foreman figures they should focus on its size and location. Thirteen wants to concentrate on House's "steamroller" metaphor.

House is trying to get his phone back. He is also trying to convince Wilson he took care of the Louisiana matter. Wilson was charged with vandalism, destruction of property and assault in a bar he visited while in Louisiana for a medical convention. Wilson is trying to explain, but the officer doesn’t want to hear about it. However, the officer finds out House is trying to delay getting to his father's funeral. The officer says House is not allowed to miss the funeral if his mother is still alive and agrees to listen to Wilson’s story.

Chase, Cameron and Foreman are talking about what House meant and both he and Kutner figured out that House thought the patient had gallstones.

Wilson is explaining to the officer what the warrant is about. Wilson got mad at a guy who kept playing the same song over and over again on a jukebox. He threw a bottle into a mirror to get the guy to stop. House and Wilson met when House bailed Wilson out after he was arrested. House was interested in Wilson enough to follow him around the convention. The officer lets them go when he finds out that Louisiana doesn't want to pay to get him back. The officer tells House to go pay his respects to his father.

Chase plans a cholecystectomy. However, he notices her urine has turned brown - it's not gallstones and her kidneys are failing.

House calls his team, who tells them he never thought it was gallstones. He and Wilson are two hours late for the funeral and House wants to turn around. He tells them the cyst is causing all the patient's symptoms - it’s a multiple cyst spreading into the organs Thirteen suggest injecting bubbles into the cyst to see where they travel and House agrees.

Wilson and House arrive at the funeral home.

Kutner realizes the patient is suffering from the DTs - alcohol withdrawal.

House's mother greets her son warmly. House is astounded that she held up the funeral until he arrived since his father was a very punctual man. She tells him his father is dead and won’t care and to do a eulogy even though he didn't like his father. She reminds him the war is over and tells Wilson to stop worrying.

Kutner is telling the patient and her parents that the patient has to be paralyzed to do a procedure, and that she will be going through withdrawal.

House still doesn't want to do the eulogy. House points out the man who he thinks is his biological father. House reveals he already confronted his father about his paternity, and that’s why his father didn't talk to him all summer, passing him notes underneath his bedroom door if he had something to say to House. Blythe introduces him to give his eulogy. House starts his eulogy and starts ripping into his father about how he treated people he had control over badly. He also noted his father cared about his job more than his relationships. He starts to break down, goes to his father's casket and kisses him on the forehead. However, Wilson realizes he's getting a DNA sample. He orders him to put it back, but House won't.

Out of earshot of the mourners, Wilson confronts House about his behavior, but House confronts Wilson about liking House's behavior and accuses Wilson of being scared to lose him. He demands that Wilson admit it, but instead, Wilson hurls a liquor bottle through a stained glass window.

Wilson and House go out for a meal at a diner. They talk about the convention and how House saw Wilson carrying around his unopened divorce papers all weekend. House calls the team, who tells him the ultrasound scan was grainy but there is a mass in the left atrium of the heart. House thinks the graininess is the result of an iron overload, which would also explain the other symptoms. He orders an MRI. House then calls the translator who was working for the patient in China to try to confirm that the birth parents also have haemochromatosis. However, the translator said they didn’t’ have any of the symptoms of the condition House described. He also doesn't think they were the birth parent's despite the patient's belief that they were - they acted more confused than anything else. House wonders why the mother was frightened and discusses it with Wilson. Wilson suddenly realizes something - the patient is too young to be a girl born in China. She was born after China's one-child law came into effect and girls were routinely killed. He thinks the birth parents freaked because the father was supposed to have killed her and the mother thought she was dead. They start thinking about toxins.

House returns to the hospital. The team hasn't done an MRI yet because she keeps vomitting. He tells them about the poison theory. They start discussing why the symptoms started when she tried to lift the Buddha in the temple. When Kutner mentions it must have gained weight because she was able to lift it the first time, but not the second. House suddenly realizes they will kill her if they give her an MRI. He orders an x-ray of her brain. They find pins in her head that were placed there to try to kill her. When tried to lift the Buddha the second time, it was kept in place by a magnet which shifted a pin and caused her symptoms. They plan surgery to remove the pins. The parents don’t want to tell her, but Kutner explains to the adoptive parents that a pin was in her addiction center, which caused her destructive behavior.

Wilson and House meet and House shows Wilson the results of the DNA test - they show John was not House’s biological father. He realizes his mother didn't like his father much either. Wilson tells House he's coming back to his old job at the hospital. He admits that he has fun with House and that's why he hangs around him. The realization that his dad is dead sinks into House.

Major Events Edit

  • It is revealed that House's father has passed away.
  • Cuddy gives House a sedative under the guise of an injection.
  • When House eventually regains consciousness, he learns that Wilson is bringing him to the funeral.
  • House tells Wilson that he has suspected John House isn't his biological father.
  • House and Wilson are both arrested by a Sheriff after House uses his cane to speed past a patrol car.
  • Wilson's middle name is revealed to be Evan.
  • Wilson reveals how he and House became best friends.
  • At the funeral, House points out to Wilson the man he believes is his biological father.
  • House and Wilson become friends once again.
  • House performs a paternity test on John House's DNA and confirms that John is not his father.

Zebra Factor 10/10Edit

The pins inserted into Nicole's skull could have been fatal all on their own. It was somewhat of a minor miracle that she survived at all, let alone lived to adulthood to suffer these symptoms.

End Credits Message Edit

Male Announcer: Stay tuned. A new Fringe is next on FOX!

Trivia & Cultural References Edit

  • The freeway that House and Wilson use on the way to Lexington is actually the 10 West Freeway in Southern California. At approximately 10:47 you can see the CLA Building in the background.
  • A birthmark  a type of benign irregularity on the skin that usually develops in utero. It has several meanings in this episode, including the influence parents have on children's lives, and the reason for House's suspicion that John House wasn't his biological father - a birthmark shared by a family friend as such features often run in families.
  • In the temple scene, when Nicole collapses, the translator's Chinese translates to "Is there a doctor in the house?".
  • It takes just over 11 hours to drive from Princeton to Lexington in good traffic. The route is largely over Interstate Highways 76 (to Harrisburg, PA), 83 (to Hagerstown, MD), 68 (to Morgantown, WV), 79 (to Charleston, WV) and 64.
  • House's request for Wilson to join him on the dark side is from The Empire Strikes Back
  • House's ringtone for his team is "MMMBop" by Hanson.
  • House says his ringtone for Wilson is "Dancing Queen" by Abba.
  • Nicole references a popular segment on the kid's show Sesame Street ("Which of these things doesn't belong?") as how people see her and her family.
  • "Vive la Resistance!" or "Long Live The Resistance" was the rallying cry of the French Resistance during World War II.
  • Che refers to Che Guevara, the Argentinian born Marxist guerilla.
  • Okinawa is the largest of the Ryukyu Islands. Historically a part of Japan, they were occupied and administered by the United States from the end of World War II until the 1970s.
  • Mad Libs is a word game where players provide appropriately grammatical words (nouns, verbs, adjectives, etc.) which are left blank in an otherwise written text, which is read back with the additions.
  • Leave a Tender Moment Alone was one of Billy Joel's lesser hits - reaching a high of #27 in 1984. Every other single he release from the album "An Innocent Man" hit at least the top 25.
  • Scenes from an Italian Restaurant is from Joel's album The Stranger. It was never released as a single, most likely because at 7 minutes and 37 seconds, it is Joel's longest studio recording.
  • When Wilson arrives at the funeral, he remarks "Good Heavens we haven't missed it." and notes that the line is from A Christmas Carol.
  • More about Lexington, Kentucky.
  • Wilson makes a reference to James Bond, the fictional spy. Sean Connery was the first actor to play Bond on film in Dr. No.
  • One of the unanswered questions in the episode is whether House was putting on a show of emotion during the eulogy just to get a DNA sample of his dead father, or whether any of the eulogy accurately portrayed House's feelings about his father.
  • China's One-child policy was instituted in 1979. It puts legal, social and economic restrictions on urban couples so that they can only have one child. It applies to about 40% of China's population.
  • The dialect of Chinese in which the Chinese speaking characters spoke was actually Cantonese which implies that the events set in China took place in Guangdong as the only other Cantonese speaking area (Hong Kong) was under british rule when the one child policy was in force.


Reviews of the episode were universally positive, although some critics felt the medical mystery was completely overshadowed by the funeral plot. House's eulogy was considered to be both some of the best and most unexpected dialogue in the show's history, and Hugh Laurie's delivery was praised. However, some felt Robert Sean Leonard had to do a more convincing job expressing anger.

  • The episode scores a 9.0 on IMDB.
  • Polite Dissent gave the non-medical part of the episode a solid A, but only gave a B to B- for the medical parts.
  • The Onion AV Club gave the episode an A.
  • IGN scored the episode a 9.1.
  • TV Rage users scored the episode a 9.1 as well.



Dr. James Wilson: That's how we met: I was in jail.
Sheriff Costello: This guy was a total stranger to you and you bailed him out?
Dr. Gregory House: It was a boring convention. I had to have somebody to drink with.

[after Wilson breaks a stained glass window by throwing a bottle]
Dr. Gregory House: Still not boring.

Dr. Chris Taub: House, call your mom.
Dr. Gregory House: What are you? My mom?

Dr. Lisa Cuddy: If there's anything I can do, just...
Dr. Gregory House: You know, you're right. I don't think I can sleep alone tonight.

Dr. Lisa Cuddy: [preparing a shot] It goes better in a large muscle. Drop your pants.
Dr. Gregory House: You know, I usually pay tens of dollars to hear that.

Dr. Allison Cameron: What do you think House would send, the "Gentle Comfort" arrangement, or the "Warm Thoughts" bouquet? I mean, if he wasn't an ass.
Dr. Robert Chase: Send one of those giant cookies shaped like a coffin. His mom would believe it was from him.

Dr. Gregory House: You "lost track of your speed"? I think that was Hitler's excuse. Lost track of the Jews. No one held him responsible.

Dr. Gregory House: I need that phone call. I'm a doctor, and when someone tries to call you three times, it's code for "Pick up the damn phone before someone dies."
Sheriff Costello: I'm sure there's other smart doctors.
Dr. Gregory House: You'd be surprised.

Thirteen: Bubbles.
Dr. Gregory House: Is that your new stripper name?
Thirteen: Yes. And also we inject bubbles into the cyst and follow where they drift.
Dr. Gregory House: Bubbles is right.

Dr. James Wilson: You know, you could just wait for the MRI to have your curiosity satisfied.
Dr. Gregory House: What person who is nothing like me are you saying that to?

Dr. Gregory House: [giving his father's eulogy] There's a lot of people here today. Including some from the Corps. And I noticed that every one of them, is either my father's rank, or higher. And that doesn't surprise me. Because if the test of a man is how he treats those he has power over... it was a test my father failed. This man you're eager to pay homage to, he was incapable of admitting any point of view but his own. He punished failure, he did not accept anything less than... He loved doing what he did, he saw his work as some kind of sacred calling, more important than any personal relationship. Maybe if he'd been a better father, I'd be a better son. But I am what I am because of him, for better or for worse.

Dr. James Wilson: [after House knocks Wilson's keys down a sewer] Amber gave me that key ring.
Dr. Gregory House: No, she didn't. Unless her pet name for you was "Volvo."

Dr. Gregory House: Come on, forget the keys. Call a locksmith. We'll go inside and play "guess that smell" with the truckers while we're waiting. Join me on the dark side.
Dr. James Wilson: Dark side's done, House. I'm delivering you to your mother and that's it.

Dr. Gregory House: I'm not deflecting because I'm avoiding something deep. I'm deflecting because I'm avoiding something shallow.

[On the phone while Wilson is getting arrested]
Dr. Gregory House: Make it fast; I don't want to miss the anal cavity search.

Dr. Gregory House: Eulogy, derived from the Greek for "good word." Now if she'd asked me to deliver a "bastardogy," I'd be happy to.

Dr. Gregory House: Let her vomit through the MRI, that's what nurses are for.

Dr. Gregory House: Pins. Some people use them to tailor a shirt, others use them to kill a baby.

Bob: Did her drinking cause this?
Dr. Gregory House: No.
Bob: Can you tell her it did?

Dr. Gregory House: Kutner, you're sort of Asian. Go get this Chinese translated.

Dr. Gregory House: He's here.
Dr. James Wilson: Who's here? The one you're pretending is your father? Good pick, he looks like Sean Connery. So back, when you were devising this fantasy, did you tell your father. "Dad, I refuse to recognize your existence because I have chosen James Bond as my dad."
Dr. Gregory House: I used different words.

Dr. Robert Chase: When my father died, I wound up killing a patient and I hated the man. Whatever House says or doesn't say, I'm sure the guy's a mess.

Dr. James Wilson: Well, I hate to break it to you, Che, but simple delay won't work. Your mother will hold the funeral until we get there.
Dr. Gregory House: Father was a punctual man. Beholden to time. Two minutes late for dinner, you didn't eat. My mother would never disrespect him by starting the funeral late.
Dr. James Wilson: [sarcastically] Yeah, yeah. You clearly have *no* issues to work through.

Dr. James Wilson: I'm not gonna sit here wasting time just so that you can avoid your father's funeral.
Dr. Gregory House: He was my father. I have the right to avoid his funeral.
Sheriff Costello: Not if your mother's alive, you don't.

House: My mom didn't call Cuddy! She called you! I knew you couldn't stay away. I knew you loved me too much.
Wilson: I'm doing this for your mom.
House: I'm not doing this at all. Join me on the dark side!

Wilson: I guess no one gets to choose who their parents are. I'm not sure anymore we even choose who our friends are. I spoke with Cuddy, she hasn't filled my position yet.
House: If you're coming back because you're attracted to the shine of my neediness, I'd be okay with that.
Wilson: I'm coming back because you're right. That strange, annoying, trip we just took was the most fun I've had since Amber died.
House: You hungry?

House: Wilson. My dad's dead.
Wilson: Yeah. My sympathies.

House: Those Chinese surgeons make beautiful stitches with those tiny little hands.

House: Forget Louisiana -- the man was driving recklessly through your comatose village. Do they put lead in the jelly donuts here?

House: All the neighbors were doing it. Keeping up with the Chenses.

House: Shockingly, not all religious leaders are honest. But I'm guessing these particular monks are bilking the faithful by sticking a magnet up Buddha's butt.

House: Are you kidding? She's lucky. We're all screwed up by our parents, but she's got documentation.

International Air DatesEdit

Australia: October 15, 2008 on TEN
Portugal: December 1, 2008 on Fox
Latin America: December 4, 2008 on Universal Channel
The Netherlands: January 29, 2009 on SBS 6
Germany: March 24, 2009 on RTL
Denmark: April 18, 2009 on Kanal 4
Poland: September 10, 2009 on TVP2
Czech Republic: September 28, 2009 on TV Nova
Slovakia: September 30, 2009 on STV1
Sweden: October 20, 2009 on TV4


  • In the scene at the restaurant after the funeral, there are several continuity errors over how much of House's sandwich has been eaten.
  • In one scene, if you look in the rear view mirror of the car House and Wilson are driving in, you can see the police slowing traffic behind them to allow the filming.
  • In Ugly during a fake consultation to find out information about Taub, House was apparently lying about his second toe being longer than his big toe, since he now claims the opposite as evidence of his "father" not being his biological father.
  • Tying DIC to cancer is a big zebra. There are several diagnoses that would have to be ruled out before cancer would be considered.
  • DIC doesn't cause clots in large blood vessels like the hepatic vein. It causes clots in small vessels.
  • The diagnosis by the Chinese doctors of SARS doesn't make much sense. SARS presents with lung symptoms far more serious than an occasional cough.
  • The bubble test proposed by Thirteen probably wouldn't work. The microscopic bubbles can be tracked in a small single organ (like the heart), but are almost impossible to track through the whole body.
  • The doctors should have treated delirium tremens more seriously. It is life threatening all on its own. In addition, Nicole should have been given a benzodiazepine, such as chlordiazepoxide or diazepam (valium) for it, not phenobarbitol. That particular error has been committed elsewhere in the series.
  • CT scanners don't really beep when something weird shows up on the scan.
  • The One Child Policy probably didn't apply to Nicole's biological parents, who were poor farmers.


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