Risky Business

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"Do you really believe in this diagnosis? Because if this is just a pissing contest, you're at a severe anatomical disadvantage."

―Risky Business

Risky Business is an 8th season episode of House, M.D. which first aired on October 31, 2011. It was directed by Sanford Bookstaver and written by Seth Hoffman. A CEO falls mysteriously ill just days before he signs a contract that would relocate his company's entire labor force to China. In a bid to restore funding to his department, House attempts to make an underhanded business transaction with his wealthy patient. However, when the patient's condition worsens, the team must work around the clock to save his life. Meanwhile, Park (Charlyne Yi) prepares for her hearing with the Princeton Plainsboro Disciplinary Committee chaired by Foreman (Omar Epps), but it soon becomes clear to her that House's concerns for her future are based solely on the bet he has placed against her. Adams' (Odette Annable) outlook on her patient's business venture reveals her deeper feelings about loyalty. Meanwhile, House must once again contemplate an important choice - risk going back to prison or letting orthopaedics get away with pranking him.

Recap

A man comes out of his magnificent house only to find his tree has been TP'ed. It's the work of protesters who are opposed to his plan to move jobs out of the country. He starts cleaning up. His daughter asks if he’s going to call the police, but he’s not concerned about it. They discuss his plan to move his plant to China. He believes it’s the only way to save his company without selling out a controlling interest to outside investors, but his daughter wants to go with this plan to keep the jobs in the United States. However, the man starts to have perceptual difficulties (seeing everything as very small) and asks to be taken to a doctor.

House is mimicking the patient’s condition by looking through the wrong end of binoculars at his computer screen while Park suggests the patient’s problems are related to his recent trips to China. However, the patient’s vaccinations are up to date. Park next suggests a mental illness, but his examination was normal. However, House is distracted by an e-mail sent out by Dr. Mark Andrews, Park’s old boss, apologizing for his inappropriate behavior and saying that he‘s undergone sexual harassment training. House tells Park she doesn’t have a chance at the upcoming discipline hearing. Andrews is claiming that he gave Park a celebratory slap after she completed a difficult procedure for the first time. Park bets $100 that she won’t get fired. House takes the bet, then fires her. She protests that she meant that she won’t get fired by the discipline panel, and House agrees to take that bet too. Adams shows up saying she’s been at a job interview. They start a new differential and Park suggests thyrotoxicosis, which House likes.

House goes to give the treatment, but the patient complains that although everything looked too small before, everything now looks too large. House realizes the idea is wrong, but that it’s a migraine causing Alice in Wonderland syndrome, which is treatable. He then asks the patient for a donation. However, the daughter tells him that they are trying to save money to keep their plant in the U.S. House tells the patient it’s a good thing that the symptoms didn’t arise in China, because (switching to Mandarin at this point) they look down on mental illness. The patient also replies in Mandarin. The daughter asks what they're talking about, but House just says its about cultural differences. However, House intimates that if word gets out about his illness, the Chinese will be spooked and will probably back out on the deal. The patient asks him, in Mandarin, how much he wants.

House comes back bragging that he can hire both of them. However, Adams is upset that the patient is moving jobs out of the United States. They get into a discussion about patriotism. House tries to steal Adams’ burger, but she tells him she has hepatitis C. When House tries to steal Park’s burger instead, Park says Adams got it from her.

The patient starts to improve, but the daughter is concerned about whether he can get out of the hospital before the markets open in the morning. Adams asks the daughter about the shutdown of the American operations. The daughter thinks her father’s motivation isn’t greed, but wanting to get away from the memory of her late mother, who recently died of Non-Hodgkin’s lymphoma. All of a sudden, the patient has an alert - he’s coughing up blood.

The bleeding was from one of the lobes of the patient’s lungs. They discuss a new differential while in Eric Foreman’s office. They discuss Park sending out an apology, but House says it’s not going to work - it makes her look pathetic. House also wants to know why Adams is so upset with the patient when she was never judgmental about any of the patients in prison. House also tells her he doesn’t think she was at a job interview because she got in at 9:15 and the nearest hospital with an opening is a 45 minute drive away. Foreman comes back and tosses them out of his office. House tells Foreman that he should have his conference room back because his patient made a big donation. However, Foreman has looked into it and realizes House blackmailed the patient. He tears up the check. On his way out, House grabs Foreman’s ass. Foreman asks what he’s up to, but House tells Park he was expecting Foreman to belt him, showing what the natural response to it would be. Foreman just stares him down and tells him to get his hands off of him.

Park asks why House did it, particularly because Foreman is the chair of the disciplinary committee. She realizes he’s trying to win the bet and begs him to forget about it. He orders them to treat the patient with Human activated protein C. They both object, saying that it could cause bleeding or clotting. House says he knows and once it does one or the other, they will have a diagnosis.

Adams goes to see the patient, who knows she objects to his plan to move to China. He wonders why she’s okay working for a boss who tried to blackmail him if she questions his business ethics. They start talking child labor, and Park is actually in favor of it because it beats the alternatives. The patient starts itching.

The itching soon disappears. They tell House, who is bothering orthopedics by flashing a light through the glass partition. Dr. Morgan comes to confront him, but House’s light makes him nauseous and he has to go and vomit. Dr. Morgan threatens to go to Foreman, but House reminds him he has no proof. They get back to the differential and Adams comes up with the idea that the late wife’s lymphoma was the result of a contagious virus. House orders radiation therapy.

Park comes to report to House in the clinic, and he tricks her into saying that it’s satisfying to punch someone who deserves it into a recording device, although he takes the remark out of context.

Adams talks to the patient about the death of his wife and whether its affecting his judgment. He says that visiting his wife’s grave is the only thing keeping him in the United States. Adams realizes it’s just about the money he needs. He tells her about a Japanese company that went bankrupt five years ago after being in business for over 1400 years. He doesn’t want to be the last CEO of his family’s company. He then complains he has to move. Adams stops the radiation and asks if he has tightness in his chest. When he says he does and she notes his heart rate is up, she thinks he is having a heart attack.

Park goes to see Wilson. She tells him about the bet and that House appears to be trying to get her fired. Wilson says that’s probably right, but it’s not about the money - House would feel dishonored if he lost or he cancelled the bet. She asks for advice, and he tells her to give House something he values more than honor, and to update her resume.

The EKG on the patient was inconclusive, so House orders Adams to do an echocardiogram. House asks Adams for $200,000 so that he can buy the patient’s company’s stock and make a profit when he gets better, but Adams turns him down flat. House negotiates, and Adams agrees to front $5,000 if House agrees to double his clinic duty to try to improve his bedside manner. Instead, House tries once again to determine where Adams was the morning she was late.

House arrives in his office to find everything covered in plaster bandages. He confronts Dr. Morgan, who dares him to start escalating their pranks and risk going back to prison.

The echocardiogram is normal, so Park suggests an EP study. House and Park get back to her chances at the disciplinary hearing. It comes out that Dr. Andrews was also drinking the night of the incident. House wonders why Foreman didn’t make a deal about that, but then changes the subject.

Park confronts Foreman, who admits he knew Andrews was drinking. However, Andrews was the only person available to treat a dying patient. Andrews admitted he was drinking, but recommended Park to do the procedure while he supervised. Park threatens to make it public, but Foreman already has told the Board of Directors about it and has been penalized two weeks pay. Foreman realizes Park has been working for House too long.

Park tells Adams she’s dead and House has set her up. All of a sudden, the patient’s oxygen stats plummet even though his heart and lungs appear to be working normally.

House tells Adams he has lost her money and another $15,000. He asks for the $200,000 again. House again starts speculating why Adams was late. Adams is about to tell him, but House cuts her off. House then tells them he thinks it’s a brain problem. However, they find themselves outside Dr. Andrews’ office. Park realizes House is up to something. He leads them into Andrew’s office, and House feigns surprise that Andrews knows Park. House starts making sexually suggestive comments about Park. Andrews gets around to a differential, but he and Park start arguing. However, House sides with Andrews.

After they leave to give the test Andrews suggested, Park plans to do a stress test on a tilt table to confirm her own diagnosis. She thinks House is testing her. After discussing it with Adams, Adams agrees to do the test while Park prepares for her hearing.

During the test, Foreman comes in to look for a skin resurfacing laser. Adams wonders why Foreman is asking her, and he says its because she works for House. When Adams asks how much it’s worth, she realizes House stole it to get the $200,000 he wanted for his stock market bet. Foreman leaves to go to Park’s hearing, and warns Adams to decide what line she won’t cross before House asks her to cross it. When Adams checks back with the patient, she realizes he’s in a coma, just as Andrews predicted would happen if they did the tilt table test.

Foreman starts Park’s hearing. As Park starts to speak, House bursts in and asks the committee to fire Park for insubordination because the patient is in a coma. Security comes in and removes House. Foreman apologizes for House’s behavior and assures Park that House’s actions will not affect their decision.

As Adams confronts House about his behavior, he admits he wanted them to do a tilt table test all along. He just backed Andrews to get Park to defy him so he would win his bet. However, despite the coma, House still doesn’t think Andrews was right and starts a new differential. House goes for a liver problem despite normal liver enzymes and orders a biopsy.

Back at the hearing, Park admits it was unacceptable to hit Andrews, but prevaricates and stops making sense when she talks. The subject of the bet comes up and she begs them not to fire her.

Adams does the biopsy and asks the daughter how she’s doing. She admits she’s decided to go ahead with his father’s plans because it’s still his company. Adams tells her she doesn’t have to sign it.

Adams tells House the biopsy was normal. She also checked the patient’s intracranial pressure, and it was elevated (unlike what Andrews thought). Park enters the office in triumph and asks for her money - she was only given minor punishment. They start a differential, but are distracted by the sound of the cast saw next door. House goes to punch Dr. Morgan, but is distracted by an x-ray showing a bone implant. He orders plasmapheresis and tells them the patient will be awake in an hour.

The patient soon regains consciousness. He asks for water. The patient had hyperviscosity syndrome that was thickening his blood and clogging his organs. It was set off by the antibodies that caused his arthritis. He then asks the patient to sign a press release before the market opens. The daughter threatens to leave the company if he moves it to China. He decides to go ahead with his plans anyway. The daughter leaves.

House brings back the laser he took. He runs into Wilson, who it is revealed bet him $100 that Park would be fired. House tries to say he sabotaged Park’s hearing, but Wilson realizes that once House walked in on the hearing, Park was a shoo-in to win because she would lose her composure, become emotional, and the panel would see her as a victim. In addition, everyone on the panel hates House and once he tried to fire her, they would go out of their way not to. House then gives Wilson the $5,000 that he earlier stole from him to bet on the stock market.

House returns the machine to Foreman, but Foreman says he needs some discipline and doubles his clinic hours - to twelve. House says double his clinic hours is six, but Foreman knows about his deal with Adams to do six a week. House gives Foreman a check and tells him to call Robert Chase and Chris Taub. Foreman tells House the check is for far more than they need to fund the department, and House says he knows that.

House calls Adams to formally hire her. He then tells her he thinks she was late because she caught her boyfriend cheating on her and had just broken up with him. It explains why she kept suggesting an STD, why her self-esteem has been low, why she keeps talking about loyalty, and why she’s been going out of her way to look pretty. Adams says it was her husband - she was at her lawyer’s signing divorce papers. They have been separated for a year. He hands her a baseball bat so she can beat the crap out of a medical skeleton. She smashes it, along with some of the other orthopedic equipment.

Clinic Patient

The patient comes in dressed as conjoined twins. He got into a fight with someone who referred to them as “Siamese twins”, which he felt was racist, being of Thai ancestry. However, House reminds him that Chang and Eng Bunker were born in Siam.

Zebra Factor 2/10

Hyperviscosity syndrome is not terribly rare, but its cause in this case was. The disease rarely arises from a surplus of antibodies alone and is more likely to arise from high red blood cell or protein levels.

Major Events

Park bets House $100 she won't be fired. He then works ceaselessly to undermine her case.
House tries, and fails, to blackmail a rich patient into funding his department.
House borrows $5,000 from Adams, steals $5,000 from Wilson and borrows $10,000 to buy options in a patient’s company on the hope he will be able to diagnose him and send the stock back up. However, the patient gets sicker and the options soon expire out of the money.
House tries to get $200,000 from Adams to bet on the company’s stock, but when she refuses he steals a skin laser to get the money.
Park has her disciplinary hearing and only receives minor punishment. She wins her bet with House.
To get House to be neutral, Wilson bets $100 that Park will be fired. Wilson loses the bet and realizes House went out of his way to make sure that Park wouldn’t be fired by staging the dramatics during her hearing.
House cures the patient, makes a killing in the market, and uses the money to provide funding for his department. He uses the extra money to buy the orthopedic equipment so Adams can destroy it.
Adams reveals she has just finalized her divorce.

Trivia and Cultural References

TP-ing is a common form of vandalism using toilet paper to drape over trees or other structures where it is nearly impossible to remove.
Morning Has Broken is a hymn that was first published in 1931. However, it only became well known when it was recorded by Cat Stevens in 1972. His version bookends the episode.
“C-note” is a slang term for a United States $100 bill, from the Roman numeral “C” for 100.
“Very, very late for an important date” is a play on the line “I’m late! For a very important date” from the animated version of Alice in Wonderland.
Chang and Eng Bunker were a famous pair of conjoined twins born in Siam of mixed Thai and Chinese/Malay ancestry. Although they were briefly exhibited, they spent most of their lives as farmers in the southern United States.
Kongo Gumi was a Japanese business that could trace it’s history to 578 C.E. It was liquidated in 2006.
Insider trading is the act of buying or selling stock based on non-public information believed to be both reliable and relevant to a stock’s trading price. It is a crime in the United States and several other countries. What House did probably didn’t meet the strict definition as House’s belief in his own abilities may have both non-public and relevant, but not reliable.
Yale Law School’s student run publication is the Yale Law Journal, not the Yale Law Review.
Grammy Addams (more properly Grandmama Addams) and Cousin Itt are characters from The Addams Family
The comment about Andrews being a broken doctor who is “right twice a day” refers to a common metaphor about a broken clock.
The won is the national currency of South Korea and North Korea. The exchange rate quoted by Park is more appropriate to the South Korean version.
“Brought to you by the letter Y” is a reference to Sesame Street, where each episode is “sponsored” by numbers and letters.