- Nate: "Hey Dr. X. I know you busted your butt trying to save me."
- Foreman: "It's all right."
- Nate: "I wasn't going to thank you. I was going to tell you you really suck at this."
- — The Jerk
The Jerk is a third season episode of House that first aired on May 15, 2007. The team deals with a teenage boy whose personality is even more obnoxious than House's is. Meanwhile, Foreman's exit plan runs into a snag when someone sabotages his job interview. Cuddy works hard to keep Foreman at the hospital.
During the examination, the patient takes the opportunity to insult Chase. The patient used to be a vegetarian, but has recently started eating meat. His mother says his personality has been this obnoxious since he became a teenager. He has also been in a lot of fights lately because of his behavior.
Chase outlines the symptoms for the team—rage and head pain. House also believes the patient is suffering from a personality disorder, which leads him to believe it is cluster headaches. House orders blood thinners and magnetic cranial stimulation.
Foreman agrees to do the cranial stimulation so he will have time later for a job interview. During the magnetic treatment, the patient complains of other pain caused by the beatings he has been receiving. The patient then takes the opportunity to insult Foreman.
Chase informs the mother that the underlying disease may be causing his personality problems. The mother is relieved when she hears it, and admits that she is at her wit's end trying to deal with her son.
The treatment doesn't help the pain, so the team starts coming up with alternative diagnoses. House still thinks it is cluster headaches and suggests doing something out of the ordinary.
Foreman then confronts House—someone has called his potential employer to cancel his job interview. House denies cancelling the interview. Foreman doesn't believe him, but House maintains his innocence.
House accuses Cuddy of cancelling Foreman's interview. Cuddy denies doing it, although she admits she wants to keep Foreman. He then asks Cuddy if he can give the patient psilocybin mushrooms to treat the cluster headache rather than doing exploratory surgery. Cuddy agrees if the mother consents.
Chase explains the risks to the mother. The patient is all for the treatment and insists the mother consent as his pain is getting worse.
They administer the mushrooms and the pain starts to go away. The patient then (perversely) flashes Cameron, as an attempt to make her come on to him. While very vulgar at first, Cameron notices something strange, and immediately pulls up his robe to look closely at his genitals. She discovers that his testicles are undersized.
They discuss what might be causing the undersized testicles. House orders a biopsy of the pituitary. The patient is opposed to it, but the mother consents. Before they start, the patient becomes disoriented. He turns out to be jaundiced—a symptom of liver damage.
The liver damage is life threatening, and adds another symptom. However, the liver couldn't have been causing the symptoms the patient had the day before. The patient doesn't have any history of drug use that could result in liver damage. They focus on his recent abandonment of vegetarianism. House orders that he be fed hamburger meat, to see if he has a disorder that keeps him from properly metabolizing meat protein.
Cuddy pages Foreman. She offers him double his salary and his own diagnostic team. Foreman refuses the offer because he doesn't want to have to turn to House if he cannot make a diagnosis, and because someone at the hospital tanked his job interview.
The patient doesn't want to eat the hamburger meat. An enraged Chase, fed up with the patient's endless threats and jibes convinces him to do so by threatening restraint and force feeding.
Cuddy accuses Wilson of tanking Foreman's job interview on the basis that whoever did it likes House and they know having Foreman remain on the team would make House happier. Wilson tells Cuddy he wants Foreman to leave, and he wants someone new who will confront House like Foreman used to.
The patient is properly metabolizing the hamburger meat, so House orders him starved to see if his blood sugar spikes. During the procedure, they try to get a urine sample, and the patient becomes enraged. He urinates in the middle of the floor, but starts urinating blood with the urine.
The blood in the urine shows that the patient's kidney are failing. They put him on dialysis and return again to the diagnosis differential. Foreman gives the patient a sedative in order to take a blood sample without a hassle.
Wilson accuses Cameron of sabotaging Foreman's job interview. Cameron denies it too. Cameron in turn accuses Chase, on the basis that he doesn't like Foreman. Chase denies it as well. It being Tuesday, Chase reminds Cameron again that he likes her. He then finds a positive result for an enzyme deficiency.
However, the deficiency doesn't explain all the symptoms. House decides to place the patient under stress to see if he can speed up the process. He challenges the patient to a game of speed chess after he shoots him up with adrenaline. They trade insults during the game. The patient details a move sequence in which he will ultimately beat House. Finally, the patient starts having a seizure. House calls the nurse, orders treatment, and then resigns the chess game.
House studies the chess game while the team adds the seizure as another symptom. Foreman suggests amyloidosis. House finally decides to try to eliminate the patient's personality as a symptom—all the other symptoms would be explained by amyloidosis. If it is that, the patient will require a bone marrow transplant. He tells Foreman to treat him with immunosuppressants and test for it.
The tests are unable to confirm amyloidosis. When Foreman starts to argue the diagnosis but agrees to House's course of treatment, House accuses him of not being ready to trust his own judgment.
Chase accuses House of sabotaging Foreman's interview on the basis that only House would put everyone at each other's throats. House admits it, but says it's because the job wouldn't have challenged Foreman. Chase tells House to talk to Foreman if he wants him to stay.
At that point, House realizes he missed a symptom - the patient was unable to bend his thumb when he played chess. The patient has too much iron in his blood—hemochromatosis. It explains all the symptoms and his body aches. The only thing it didn't explain was his personality, which turned out not to be relevant to the diagnosis—he really is just an obnoxious jerk. He will need regular procedures to thin his blood and dialysis, but he will live a normal lifespan. House then says he would not have lost the game, and details his own set of moves. The patient admits he knew that, but bluffed House into thinking he was in a hopeless position.
House finds Foreman still testing for amyloidosis. He tells him to run the test again rather than telling him the patient's real diagnosis.
Cameron guessed that the patient had hemochromatosis during the first differential, but the suggestion was rejected as House believed that the patient's personality was a symptom. In addition, when Foreman was treating the patient, he complained of aches which he attributed to the constant beatings he received. However, the aches were a symptom of the underlying illness and had nothing to do with the beatings.
A patient comes in with sunburn with mysterious white marks. House figures out how much change is in his son's pocket. He then matches up the coins with the father's white spots - his son placed them on him while he was asleep.
Zebra Factor 2/10
Hemochromatosis is one of the most common genetic diseases, occurring in about 1 out of every 500 people of European descent.
- House and the team meet a teenaged chess player who quickly starts insulting them.
- Everyone begins to wonder who screwed up Foreman's job interview at New York Mercy.
- In an attempt to get Foreman to stay on staff, Cuddy offers him the chance to run his own department, but Foreman refuses.
- Chase finally figures out that it was House who was responsible for ruining Foreman's interview.
Trivia & Cultural References
- The title has several references. In addition to describing House and the patient (House uses it at the end of the episode to describe Nate), Chase uses it when accused of breaking up Foreman's interview to describe the motive Cameron must have attributed to him - that he's just a jerk.
- Speed Chess is a variant of Chess where both players are given just five minutes to make all of their moves.
- The song Nate sings when he makes his final move in the Chess game at the beginning is Na Na Hey Hey Kiss Him Goodbye. It reached #1 in 1969.
- During the opening, Nate's opponent lays down his king to resign the game, but it is not checkmate at that point. It is indeed check, but he could have moved his king to h8. On the next move, however, it appears Nate could have moved his bishop to f8, causing checkmate via the rook at h5. In short, it is not checkmate, but the game appears to have been decided.
- During House's game, House correctly claims that Nate played the Bird. However, it is far from a passive opening. Nate comments that House played the Sicilian. However, Sicilian is the response c5 to e4, not to f4.
- Homie was originally a contraction of the Mexican/Latino slang word "homeboy" for a close friend or fellow gang member in the 1960s. By the 1980s, it had worked its way into Black Vernacular English and is generally indicative of hip hop culture.
- Another reference to Ashton Kutcher, this time to his reality prank show Punk'd. Ashton was also mentioned in Poison.
- "Party On, Garth" as referenced by House to Cuddy is an allusion to Wayne's World.
- Skippy the Bush Kangaroo was an Australian children’s program in the 1960s.
- Doogie Howser M.D. was a television show about a 16 year old physician that ran from 1989 to 1993. It started the career of Neil Patrick Harris.
- Dr. X is a reference to Malcolm X, an African-American Islamic minister and human rights activist who was murdered in 1965.
- Nate's personality and "jerk" behavior may be a reference to a famous 20th century chess player Bobby Fischer.
- The medical plot was reused in Prima TV (Czech Republic) series Modrý kód (Code Blue) ep. 39 Všechno jinak (2017).
- "The symptoms never lie."
- ―Allison Cameron
- "I hate this kid."
- ―Gregory House
- 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
- Nick Lane as Nate
- Colleen Flynn as Enid
- David Bowe as Doug
- Ben Bledsoe as Opponent
- Jack Maxwell as Male Proctor
- Kyra Da Costa as Female Proctor
- Cindy Lu as Nurse Diane
- Dustin Joiner as Mark
- Katie Boggs as Screaming Girl
- Bobbin Bergstrom as Nurse
Bobbin Bergstrom sighting
After the chess game, she appears to be the nurse in pink who runs into the room. She also seems to appear in the last scene with the patient when House starts bleeding him.
In Other Languages
- El Cretino - Spanish "The Cretin"