No Reason

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Moriarty: "How did he know that?"

House: "I wouldn’t have hired him if he wasn’t smart."

Moriarty: "Right. Because you have nothing but respect for him. Maybe he knew the answer because the question wasn‘t nearly as tricky as you thought. Maybe he‘s not getting smarter; you‘re getting dumber"

— No Reason

No Reason is the 2nd season finale of House which first aired on May 23, 2006. After a former patient shoots House, House awakens to find the shooter in the next bed. He also finds that he’s been given an experimental treatment that has eliminated his leg pain, but may have also affected his mind. Meanwhile, the team tries to treat a patient whose test results keep coming up negative even as his bizarre array of symptoms continue to get worse. As the shooter continues to confront him about his seemingly diminishing mental skills and lack of humility, House figures that something is seriously wrong and that must solve the puzzle posed by the other patient in order to get things back to normal.

Recap

While doing a differential on a patient with a badly swollen tongue, a man claiming to be a former patient of House comes in and shoots him twice.

House wakes up in intensive care and finds Cameron next to him. Cameron lies that she hasn't been there the whole time. She tells House about the bullet wounds. He asks about the patient with the swollen tongue. She tells him that they haven't diagnosed him yet. They wheel in the shooter, who has been shot by security.

House decides to walk out of the room, his leg pain killed by the morphine he‘s on for the trauma. He tells Cameron to biopsy the swollen tongue patient's lymph nodes.

Cuddy tells House that having the shooter in the same room is unavoidable. Cuddy tells House not to up his morphine, but instead he is lowering it. He can't understand why his leg doesn't hurt when everything else does. Cuddy tells him to go back to intensive care.

House goes back and lowers the shooter's morphine. He asks why the shooter tried to kill him. The shooter says he didn't mean to kill him, only make him suffer. House shuts off the shooter’s morphine.

The team does the lymph node biopsy on the tongue patient, but it's negative. The patient starts suffocating and they have to do an emergency tracheotomy. House gets a copy of his own operative records. The team thinks the tongue patient has an infection, and House orders a lumbar puncture despite the risks. Chase stands up for the decision because when they decided not to do one earlier, they at least had other choices. Foreman performs the lumbar puncture.

The patient starts talking about his wife, who was a former patient of House. She survived, but the shooter had to admit he had cheated on her. However, that confession had nothing to do with her condition, and House told her anyway. She killed herself over the affair.

House goes to see the swollen tongue patient, and meets his wife. He is surprised that she is so much better looking than the patient is, but tells her that he might have an STD and asks her to confess to any affairs. She denies having any.

After the lumbar puncture, the patient starts bleeding into his eye, which starts to pop out. House notices at the time his own stitches have torn out, and he collapses on the floor.

House and the shooter are back in intensive care having breakfast. House is restrained to his bed by handcuffs. They discuss his (the shooter's) wife's suicide and why the shooter is blaming House. The shooter admits it’s his own fault his wife is dead, but House refuses to take any blame.

House decides the swollen tongue is not an infection, it must be a bleeding disorder. Since his team won't discuss the case with him, he starts impersonating their reactions. He orders a biopsy of the blood-brain barrier. They start talking about STDs, and House says he doesn't think the wife is cheating. The team tells him that the patient doesn't have a wife - he‘s a widower.

House goes to Wilson about seeing a wife where none existed. Wilson tells House he may have imagined it and advises he rest, but House thinks he was hallucinating and that perhaps he can‘t trust his own judgment. House wonders why he got ketamine during his surgery.

House goes to see Cuddy about the ketamine. The ketamine would have put him in a coma. Cuddy admits that they did it on the chance that his chronic pain could have been treated by putting him in a coma. House is still afraid the ketamine might have affected his brain. He denies having any neurological symptoms, like hallucinations.

House goes back to talk about the swollen tongue patient with his team. Chase understands that House believes that the patient may have cancer spreading through the lymphatic system. The shooter wonders how Chase anticipated House, and that maybe House isn't as smart as he used to be. He points out that House is a rebel, but he runs with his own rule - that you have to be blunt and honest or else you're a coward. The shooter counters that being polite and having humility is not a bad thing.

The team comes in to see House. The test on the lymph nodes was negative. Chase is walking the patient to the washroom, where the patient's scrotum starts swelling with blood and bursts.

They can't figure out where the swollen tongue patient's scrotum blood came from. When House suggests the kidneys, Cameron points out that it's impossible - the kidney isn't connected to the scrotum. Foreman suggests testicular cancer.

House talks to Wilson about why he didn't think of testicular cancer and why he screwed up a basic anatomy problem. House thinks his brain is screwed up. Wilson suggests that House doesn't want a healthy leg, because then he would be happy. Wilson points out that persons incorrectly diagnosed with a terminal disease often get depressed when they are told they aren't sick.

House wonders why Wilson isn't more upset about the ketamine. He goes to Cuddy to confront her about the problems with his thought processes and starts trashing her office.

When Wilson tries to stop, House punches him.

Leaning against the door, his nose beginning to bloody, Wilson looks at House and tells House that he's unbelievable before stating that even when House is out of his mind with anger and fear, he still couches it in logical terms before asking House if he's hallucinating.

"Yeah, I'm hallucinating!", House snaps.

"No, I mean right now", Wilson says before he repeats, "Are you hallucinating?", only this time, it's Jack's voice that's saying the words, not Wilson himself.

In that moment, House realizes he's hallucinating and that he's back in intensive care with the shooter. House realizes he has wet the bed.

The team comes in - the swollen tongue patient doesn't have testicular cancer. They start walking down the stairwell, and House wonders how they all got there.

House goes to Cuddy again to tell her he thinks he is losing his mind and having blackouts. He takes himself off the swollen tongue case. However, he then realizes that Cuddy knows about his last hallucination, and that he must still be having a hallucination. He finds himself back in intensive care again.

House is talking to the shooter about how he can tell what's real. The shooter discusses whether or not it makes a difference, but points out that his team would stop him if he were doing anything dangerous.

House goes back to discussing the swollen tongue patient with the team. They talk about their basic assumptions. House starts discussing exploratory surgery, but Chase is opposed because of the bleeding problem. They discuss robot surgery, which is far more accurate than a human surgeon.

They take the patient to the surgery suite. House uses it on Cameron and stops the knife just before it touches her face and navel, and cuts a button off her shirt. The patient is still not convinced, but House tells him he will die without it.

House goes back to intensive care. The shooter asks him if he cares if he lives or dies, and tells him that House only cares about things he can measure objectively. House finally realizes what the problem is - his team isn't trying to take him off the case or argue with him. They also have the same knowledge he does.

House goes to the surgical suite, where the patient is set up for surgery. Chase goes to stop House, but House was thinking of hurting the patient, and Chase couldn't have known that. House realizes that as long as his delusion makes sense, he will remain in it. He realizes he has to do something that doesn’t make sense. He deliberately kills the patient. The patient lies there without vital signs, bleeding and House thinks he has got it wrong. Suddenly, a bullet drops out of the patient's hand and lands on the floor. House picks it up.

All of a sudden, House finds himself on a gurney listening to the emergency room personnel and Chase telling them where he had been shot while they work to keep him alive. He tells Cameron to tell Cuddy he wants ketamine before he passes out.

Major Events

During a differential diagnosis, House is shot by a former patient.
Cameron reveals that House had bullet wounds in his stomach and neck. She also explains that the man responsible for shooting him in the first place was shot by security while attempting to flee the hospital.
The shooter tells House that he told him that he'd had an affair and House had told his wife who had then killed herself.
House learns that he received ketamine during his surgery.
After confronting both Cuddy and Wilson, House instantly realizes that he's hallucinating.
In the end, the whole scenario is revealed to have nothing more than an hallucination that House's mind created as a result of being shot.
Back in the real world and seconds before passing out, House asks Cameron to tell Cuddy that he wants ketamine.

Zebra Factor 0/10

This is the only House episode where there is no explanation for the central disease. Subsequent symptoms -- intracranial pressure, rupture of the scrotum -- are hallucinations. but the cause of the swollen tongue is never explained. The man with the swollen tongue is not a figment of House's imagination, because he'd begun the story before he was shot by Moriarty. Although many things can cause a swollen tongue, the case is relatively simple by itself.

Trivia & Cultural References

The shooter, Jack Moriarty, is named after Sherlock Holmes’ arch nemesis Professor Moriarty. However, Professor Moriarty only appeared once in Conan Doyle’s stories, in “The Final Problem”.
Instead of using the term “dress” when talking to the person he thinks is the tongue patient’s wife, he instead uses the British “frock”.
Wilson talks about the situation where a misdiagnosed terminal patient is told they are going to live often results in depression. This very situation became a sub-plot in the episode Games.

Quotes

Moriarty [to House]: You pretend to be a rebel; claim to hate rules, but all you do is subsitute your own rules for society's. That's a nice simple rule: tell the blunt, honest truth in the starkest, darkest way; and what will be, will be; what will be, should be; and everyone else is a coward. But you're wrong. It's not cowardly to not call someone an idiot. People aren't tactful and polite just because it's nice. They do it because they got an ounce of humility; because they know that they will make mistakes, and they know that their actions have consequences, and they know that those consequences are their fault. Why do you want so bad not to be human, House?

Moriarty [to House]: You don't care if you live or die?

House: I care because I live. I can't care if I'm dead.

Moriarty [to House]: You think that the only truth that matters is the truth that can be measured. Good intentions don’t count, what's in your heart doesn't count, caring doesn’t count, that a man's life can't be measured by how many tears are shed when he dies. It's because you can't measure them. It’s because you don’t want to measure them. Doesn’t mean it's not real. And even if I'm wrong, you’re still miserable. Did you really think that your life’s purpose was to sacrifice yourself and get nothing in return? No. You believe there is no purpose to anything. Even the lives you save you dismiss. You turn the one decent thing in your life and you taint it, strip it of all meaning. You're miserable for nothing. I don’t know why you'd want to live.

House [to Moriarty]: Here's how life works: you either get to ask for an apology or you get to shoot people. Not both.

Links

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Who's Your Daddy?

No Reason

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Meaning