Remorse

Remorse
Director(s)	Andrew Bernstein
Writer(s)	Peter Blake
Airdate	January 25, 2010
Episode number	6.11
TV.com rating	8.2/10
Guest star(s)	Beau Garrett
Final diagnosis	Wilson's disease, Psychopathy
Zebra Factor	7/10

Season Six Episodes: Broken Epic Fail The Tyrant Instant Karma Brave Heart Known Unknowns Teamwork Ignorance is Bliss Wilson The Down Low Remorse Moving the Chains 5 to 9 Private Lives Black Hole Lockdown Knight Fall Open and Shut The Choice Baggage Help Me Episodes • 1 • 2 • 3 • 4 • 5 • 6 • 7 • 8

Foreman: "I’m sorry... for firing you."

Thirteen: "Don’t do that! That’s not what this is about!"

Foreman: "Then I’ll apologize anyway. I did it for me, not for you. I realized that right after I fired you. I couldn’t admit it. I screwed everything up. I hope that we can still work together"

— Remorse

Remorse is a 6th season episode of House which first aired on January 25, 2010. House treats a sociopath, a woman without a conscience, who starts threatening Thirteen, but is charming to the rest of the team. Meanwhile, House tries to make good with someone he wronged during medical school.

Recap

While getting ready to leave on a plane, a woman seems to hear loud noises and feels intense pain in her ears.

After seeing six other doctors, the patient finally finds House. For some reason, the team is meeting in Wilson's office. Foreman says the patient has been suffering from intense intermittent ear pain. House figures she has probably been to too many rock concerts and goes on to the next case. However, when Foreman tells House the patient is "really hot" and is married to an unattractive social worker, House gets intrigued and takes the case. Chase thinks the patient has a vitamin deficiency, because she recently changed her diet. However, Foreman argues her new diet is actually much more healthy than her old one. Suddenly, House realizes the problem isn't in her ear but her heart – the change in her cholesterol level has blocked the blood vessels causing an arrhythmia.

Valerie already knows who her doctors are and identifies them. She is very charming and complimentary.

Wilson finds House sleeping in his office. House is avoiding an old medical school classmate by staying out of his office. It turns out that, at the behest of Dr. Nolan, as part of his therapy, House wrote the classmate, Lorenzo Wibberly to apologize for a past wrong. It turns out that in order to prove his professor was biased against him, House switched out his paper with Wibberly. However, it turned out that the classmate's paper was better anyway and House wound up with an "A". Wilson asks why House didn't apologize to him or Cuddy.

The team found the arrhythmia, but it wasn't related to her arteries. They could treat the arrhythmia without knowing the underlying condition, but they still needed to examine her further. They find the patient's co-worker in her room, and he accuses her of poisoning him to make him look drunk at the airport so he would lose his job. When he goes to leave, he tries to kiss the patient and her husband stops her. After another set of accusations and veiled threats, he leaves. The husband rushes to comfort the patient and tells her he doesn't believe the co-worker.

House is now calling from a secret location (Cuddy’s office) to avoid both Wilson and Wibberly. Foreman tells him about the incident with the co-worker, and also tells him he doesn't think the co-worker was projecting anger onto the patient – he actually believed what he was saying about her. House thinks that the co-worker might have tried to poison her. House asks if the co-worker had dry skin and thin eyebrows. He does, and House tells him the meds for thyroid problems would cause the patient's symptoms. They go to start her on beta blockers, but suddenly Thirteen objects. She wants to know why they believe the patient and not the co-worker, and why she didn't tell them or her husband the co-worker vomited on her shoes just before her symptoms came on. Foreman says the patient is a successful consultant and has no motive to lie. House thinks Thirteen is just projecting her own anger about Foreman ending their relationship and orders beta blockers. Foreman tells Thirteen to give the patient the beta blockers because she's the only one who thinks they are wrong.

Lorenzo finally finds House with the help of Wilson. They go to the cafeteria for lunch and Lorenzo thanks House for the letter and tells him he doesn't have to feel bad. It turns out Lorenzo never graduated medical school because he was short a credit on the course where House switched the paper – he received an "F". He's currently a grocery baggier.

Thirteen performs an MRI on the patient without anyone's approval on the pretext she's looking for a brain tumor. When Foreman comes in to confront her, she tells him she's been testing the patient by getting her to talk about the things she loves and hates. Although her language centers worked fine, her emotional centers remained inactive. This indicates she knows what emotions are, but doesn't experience them, a sign that she is a psychopath.

House decides he wants to meet the patient. Foreman realizes they have to get the husband to leave, so House just tells him to leave the room. He asks the patient how long she's been a psychopath. She denies it, but House presses her on the symptoms. He also tells her that the heart problem is probably related to her mental state. She finally agrees to talk to them, but she denies she poisoned the co-worker – she just gave him Valium and an emetic. She also tells them she's married to her husband because he has a large trust fund.

House asks for a differential for psychopathy and heart arrhythmia. Thirteen is surprised that House thinks the conditions are related, but he says they are both rare. Foreman points out that late stage syphilis could cause brain damage approximating psychopathy as well as arrhythmia. House orders penicillin as well as tests for Wilson's disease and Hashimoto's disease.

Foreman tells House that Thirteen is flouting both of their authorities and she has to be disciplined. However, House points out she was right. Foreman points out she may not be right the next time. They argue about who has to do it, and House makes it clear to Foreman that it's his responsibility.

Cuddy comes to House and admonishes him for cutting up pictures of her for fun. He's destroyed the only copy of a picture of her on her last trip with her father. However, he's unapologetic.

He goes to find Wilson in the clinic with a Spanish speaking patient, and is soon correcting Wilson's Spanish. He tells him that Wibberly is probably trying to guilt him into getting him a better job, but he's not angry at all. He also says he's not responsible for an unforeseeable consequence of the switch. He also tells the patient not too get stoned at work again and, if he does, not to use so many eye drops.

House goes to see Wibberly again. Wibberly has a nice house, much nicer than House's condo. However, he's moving because he can't keep up with his mortgage payments.

Taub tells the patient's husband they are testing for syphilis. Thirteen assures him that she may have contracted it years ago and it probably isn't contagious. Suddenly, the patient starts coughing and sends her husband for water. When he leaves, the patient threatens Thirteen that if she ever makes one of her snide comments again, or discloses what she told them, she will have her medical license pulled and sue her for any money she loses in the divorce. Suddenly, Thirteen asks to see the patient's arm. She turns it over and the patient screams in pain – Thirteen has broken her right arm.

The patient calls Cuddy to demand Thirteen be removed from the case. However, House refuses. Taub reveals why House refused – the patient's bones were brittle because of kidney failure. House realizes the psychopathy isn't a symptom and concentrates on the kidney and heart. Foreman thinks it is paraneoplastic syndrome from lymphoma. Most of the team wants to start radiation therapy but Thirteen objects. She wants to do an immunoassay of the patient's urine. Foreman points out that with her kidneys shutting down, they can't get a sample. Thirteen points out there is some leftover from previous tests. Foreman says there is not enough, but Thirteen points out incomplete results are better than nothing. House sends Taub and Chase out of the room. He tells Thirteen and Foreman to either have sex, fight, or quit because their behavior towards each other is affecting their work.

They take the patient for radiation, but the husband is worried. He asks Thirteen for alternatives and she suggests an environmental scan. She asks the husband if she has any hobbies and he says she studied landscaping every Thursday. That's the day Thirteen knows she was having an affair with the co-worker. On the pretext that she may have been exposed to toxins, she asks him to find out about the landscaping class and he agrees.

House goes to see the patient again. She's curious because she knows House avoids patients. They start talking about her psychopathy and House admits the conversation is in his self-interest, but that in most people it's tempered by a conscience. She says that a conscience can be ignored or rationalized away and that's why he's talking to her.

The husband comes back and tells the patient he knows that she lied about the landscaping class. The patient realizes that Thirteen told him about it. The patient denies having an affair and says she was working late at the office and that she was afraid he would get mad because he got angry one time because she was overworking. She tells him he can call the office to confirm. The husband believes her and goes to hug her. The patient stares directly at Thirteen.

The patient talks to Cuddy about Thirteen and asks her to fire her. However, Cuddy points out Thirteen didn't actually reveal any confidences and had a valid reason to ask about the landscaping. She knows that the patient won't sue because she would have to testify to deceiving her husband. However, she agrees to remove Thirteen from the case.

Thirteen gets a call from the medical board about an allegation of sexual harassment and goes to confront the patient. However, Chase and Foreman are there and Foreman orders her to leave the room. He tells her that the case will probably go away unless she does something stupid like shouting at the patient again. Thirteen tells Foreman he would be angry too, unless he's just like the patient and doesn't feel emotion. Suddenly, Foreman apologizes for firing her and tells her he did it for him and not for her.

Suddenly, the patient has liver problems. Blood flow is backed up and spilling into her esophagus. There is probably too much bleeding to use banding so Foreman plans to use a TIPS shunt to bypass blood flow around the liver until they can figure out what is wrong. The husband is indecisive, but tells Foreman to do what he thinks is right.

Chase tells the team that given the liver shunt, the prognosis is no better than two days before she dies. Thirteen suggests amyloidosis, but there were no speckles on the MRI. Chase suggests alpha 1-antitrypsin deficiency, but that would not account for that much kidney failure. Taub suggests primary hepatic fibrosis, and House agrees it is the best idea. He orders steroids, but the patient will still need a liver transplant, and with no confirmed diagnosis, she's unlikely to get one. The husband is not a candidate for the transplant, but he's still sticking around even though he suspects infidelity.

Wilson finds House writing Wibberly a check for his mortgage payment. He wonders why House is going the extra mile for him, but won't even apologize to Cuddy about her photo. He realizes House has real feelings for Cuddy, which makes apologizing harder. House says he will apologize about the photo, but Wilson tells House that Cuddy loved him and he only abused her – that's what he should apologize for.

Thirteen intercepts the patient's sister Sarah, who visited the patient. She's surprised she would visit, and Sarah agrees – even her own family wondered why. Sarah was even tested as a donor, but was the wrong blood type. Thirteen tells her that she above all people should realize how bad her sister is, but Sarah tells her that the patient protected her from their abusive father even though the patient was younger than her. She says that the patient's personality changed after years of the abuse.

Thirteen realizes the psychopathy is a symptom. She tells House that the patient had a normal personality until she hit puberty. House starts thinking again – how could the disease be dormant so long. He suddenly remembers her change in diet – she's eating far more nuts, which are rich in copper – it is Wilson's disease. However, Thirteen points out she doesn't have the obvious symptom, Kaiser-Fleisher rings in her iris. However, House realizes there is one other symptom. He grabs some fingernail polish remover and removes the patient's fingernail polish. Her cuticle is blue. He orders chelation therapy.

Thirteen calls the patient's husband out of the room. She tells him that the treatment won't really fix her psychopathy – she will probably just fake being better. However, the husband doesn't care as long as they can go back to being happy.

House presents the check to Wibberly. However, he says he can't accept it. He reveals that the paper House prepared actually got him an A+, a better grade than the A he otherwise would have received. House was apparently right about the professor's bias. He finally admits he did graduate medical school and became an orthopaedic surgeon, but also had a gambling problem. He over billed patients and lost his license. He only lied to House because he figured that House was still a miserable man like he was in medical school. However, they fight over whether he will take the check. House finally screams at him to take it, but he won't.

The patient improves on chelation, but she will still need a transplant, although now they can get her on the transplant list. The husband proposes they go on vacation when she's better, but instead she tells him he's pathetic. The husband thinks she's still sick, but she denies it and says she can't spend any more time with him. He leaves. Thirteen realizes the patient is no longer psychopathic. The patient says she doesn't know what she's feeling, but it hurts. She then begins to cry.

Thirteen goes to see Foreman, who congratulates her. He's having trouble reading Taub's writing for the discharge summary, and Thirteen helps him out by dictating what Taub wrote.

As House goes to leave, he sees Cuddy and Lucas Douglas in her office. He returns to Wibberly's house and drops off the check through a mail slot in the front door.

Zebra Factor 7/10

House knew what to look for since the symptoms mimicked what Lucy Palmeiro had in Socratic Method and he called Wilson's Disease and he and Thirteen hit it right on the nose. Wilson’s disease is a rare disorder, occurring in about 4 out of every 100,000 people in the United States.

Major Events

• Foreman apologizes to Thirteen for firing her.
• House makes amends with a former classmate from medical school.

Clinic Patient

A Spanish-speaking patient is being tended to by Wilson when House enters the room. House starts out by telling the patient Dr. Wilson called for a consult. The patient tells House his finger hurts a lot. House responds that that it was his fault for hitting it, but not to worry because Dr. Wilson is a great doctor whose empathy towards patients comes from his own battle with impotence. House reveals that the patient injured himself due to being stoned while on the job and hammering his thumb instead of a nail. House then tells the patient that it was a good idea to use eye drops to cover up being stoned on the job, but advises the patient to next time use less, because the amount he used was causing his eyes to tear up uncontrollably.

Title

The title refers to what House likely felt for ruining his former classmate's life. Although, House probably didn't feel remorse after Wibberly reveals that House's test switching did not cause him to fail med school and consequently lead to his current life situation, but rather it was the fault of Wibberly's own actions. Furthermore, the remorse motif is displayed in the behavior of House towards Cuddy as far as the photo cutting and their past are concerned. This was pointed out by Wilson, talking about House taking an easier way by apologizing to his classmate with a check instead of asking Cuddy for forgiveness. The patient herself, not able to feel remorse (until the end), has an intense dialog with House about the natural instinct of conscientiousness. In the end one can assume that the treatment does affect the patient's brain and triggered real emotions. Assuming this, remorse was her first unfaked feeling.

Trivia & Cultural References

• Ted Bundy is an infamous serial killer who was executed in 1989.
• Charles Darwin was one of two people who independently proposed the theory of evolution by natural selection in the 19th century.
• This is the second time a woman with Wilson's disease ended up as a patient of House and his team. The first was Lucy in The Socratic Method.

Cast

• Hugh Laurie as Gregory House
• Lisa Edelstein as Lisa Cuddy
• Omar Epps as Eric Foreman
• Robert Sean Leonard as James Wilson
• Jennifer Morrison as Allison Cameron
• Jesse Spencer as Robert Chase
• Peter Jacobson as Chris Taub
• Olivia Wilde as Remy Hadley
• Michael Weston as Lucas Douglas
• Beau Garrett as Valerie
• Shane Edelman as Bill
• Ray Abruzzo as Lorenzo Wibberly
• Joseph Culp as Russ Smith
• James McCauley as Norris
• Jaime Alvarez as Jose
• Kathleen Macdonald as Sarah
• Bobbin Bergstrom as Nurse
• Mohammad Kaivanpour as Orderly

Links

• Episode article at IMDB
• Episode review at Blogcritics
• Episode page at House MD Guide
• Episode transcript at Clinic Duty
• Episode page at TV.com
• Episode promo at The House of Fan
• Episode article at Wikipedia
• A review of the medicine at Polite Dissent
• Episode summary at Spiritual Journeys

Previous episode: The Down Low

Remorse

Next episode: Moving the Chains