- "There’s a reason we’re locked away from nice, normal people. Your life outside is over. Friends, your girl, everyone you worked with. They’ve moved on."
- ―Twenty Vicodin
Twenty Vicodin is the first episode of Season 8 of House, M.D. that first aired on October 3, 2011. It was the last season premiere of the series. It was directed by Greg Yaitanes and written by Peter Blake. The episode takes place about one year after the episode Moving On.
Season 8 starts out with Gregory House serving out a lengthy prison sentence for his various misdeeds in Moving On, including his trip outside the country in an attempt to escape responsibility. Entirely cut off from his old life, House determines his current problems are the result of his inability to deal with people. Feeling he will never be able to practice medicine again, he plans instead to go back to university to earn a doctorate in physics - a field that will all but assure his isolation from other human beings. As expected, House has great difficulty getting along with his fellow inmates, but does find his "one friend", an elderly prisoner who shares a fondness for chess. After one year, he's unable to bring himself to apologize for his conduct, show respect to the parole board, or cooperate with the prison system. However, due to prison overcrowding conditions, the parole board sees him as a candidate for early release as long as he can stay out of trouble for five days. This faint hope may turn out to be pointless. First, he meets a fellow prisoner with a mysterious medical condition, and convinces a beautiful doctor he has met working in the infirmary that with her help he can figure out what is wrong with the man. Second, one of the prison gangs makes it clear to him that he will not get out in one piece unless he delivers something within his control to them as an "exit fee" before he's released. In the end, House must walk a fragile path to save the patient, avoid trouble, and still walk away with his relationship with the pretty doctor intact.
This is also the first episode in the series not to feature Lisa Edelstein in the opening credits.
Gregory House is sitting before a parole board. He has been in prison eight months and has become eligible for parole for the first time. It’s going disastrously until Warden Delaire admits to House that the prison is overcrowded and if he behaves for five days he will be released. Otherwise, he serves four more months. House gets contrite and assures the board he can behave.
House is going through the prison routine and minding his own business until the time comes to get medication. He helps his cellmate Asofa make sure he takes the proper anti-psychotic. House gets his dose of Vicodin. When one of the long term prisoners, Mendelson comes for his propranolol, House points out the nurse gave him the wrong dose. When she goes to correct it, House takes a Vicodin out of his cheek and slips it to Mendelson. Mendelson shows off his new swastika tattoo, so House tells him he’s Jewish - and a gay black Gypsy too!
House visits the cell of Frankie and makes a chess move without even looking at the board. A prisoner, Nick approaches House and tells him about his symptoms. House chides him for mistaking him for the medical clinic. House gets back to his cell and finds Rollo stealing his food. Rollo knows House is leaving and won’t need it. House confronts him, but he realizes if he does anything about it, he loses his chance at parole. Frankie comes along and tells him to forget it - he will be getting out Friday. He then asks if he’s just been checkmated and House confirms it.
While cleaning up, Stomper tells House he wants his stereo and headphones. To make his point, he urinates on the floor so House has to mop it up.
House finds himself in the clinic. He hears Dr. Adams starting Nick on ceftriaxone. Dr. Sykes compliments her. However, House immediately realizes she thinks the patient has gonorrhea and tells her she’s wrong. The patient thinks so too. Sykes tells Adams that House used to be a doctor. House tells Adams the patient has lupus. She’s sceptical and House tells her off, but realizes he may get written up and asks her not to. She says she usually doesn’t.
Frankie tells House not to mess with Stomper. However, House isn’t taking advice. He hides his stereo in Rollo’s cell. Stomper comes looking for the stereo, and House tells him that he did put it in Stomper’s cell, but Rollo stole it. Stomper is sceptical, but House says that Rollo was making fun of him. Stomper goes to see Rollo and finds the stereo. A fight breaks out. House gets his stereo back, along with some of the tuna Rollo stole. Frankie comes along to tell him he was stupid. House says he will be teaching physics in Fiji by the time the two men get out of solitary. Frankie asks him how many tricks he has left.
The next day, Tuesday, House is sleeping in his bunk when he hears a chirping sound. He finds a cricket. Asofa wakes up too and grabs House when he tries to get rid of the cricket. House reminds Asofa about his history with pets.
House goes to visit Nick to look for the rash that would indicate lupus. Nick starts talking about his girlfriend Nicole, but House couldn’t care less. He goes to Dr. Adams in triumph, telling her there’s a rash on Nick’s left thigh. Adams has done her homework though, and knows all about House’s previous life. She wants to know about his drug use and prescription forging, but House dodges her questions and tells her to start Nick on prednisone. Adams wants to know why he thinks she will do what he asks. House has pegged her as a smart girl from a family with a trust fund who took the job to satisfy her liberal tendencies, and she‘s bored. She wonders why he thinks that and he says he’s notices she wears different expensive shoes every day, but never any leather. She also has an antique locket and only wears a scarf on Fridays, indicating she did her residency at Johns Hopkins Medical School. He also notes the only time she doesn’t look bored is when she’s discussing Nick with him.
Back in the cell block, Sullivan tells House that Mendelson is looking for him. Mendelson is upset House didn’t tell him he was being paroled. Mendelson tells House he wants all of his remaining Vicodin doses, plus the ones he should have given him for Monday - twenty in all. House says there’s no way - he only gets four a day - 11 before he gets out. Mendelson tells him he’s smart and will find the answer. House threatens to ask for protective custody, but Mendelson tells him if he does, he will have his friends on the outside find him.
House finds Porter, the prison’s scrounger, and asks if can supply the Vicodin. Porter tells him if he gets $200 from an outside friend sent to a friend of his in Trenton, it’s no problem. However, House says he has no friends on the outside. Porter agrees to do it for all of House’s remaining goods inside the prison.
House finds Nick in pain. He says its just from being jostled a little. Nick’s left arm is hypersensitive to touch - it’s broken and House tells him he doesn’t have lupus.
House wakes up the next morning, Wednesday, with a sore leg. He looks at his one remaining Vicodin. Asofa looks worried, but House says he’s just going through withdrawal. However, Asofa isn‘t worried about House - his pet cricket is sick. He tells House to fix him.
House goes to see Adams to tell her it‘s not lupus, but she figures Nick just broke his arm in a fight. He starts a differential, but Adams won’t show him the patient file. They come up with lung cancer because Nick smokes, but she can’t run an x-ray until Friday. House thinks he will be dead by then and tells her to start him on blood thinners. She says treating without tests or proof must have been an interesting way to run a practice. House tells her he’s going to get proof.
House does another examination of Nick. He then asks Frankie to see if he can find another cricket for Asofa. Freddie reminds him about the pesticides they’ve been using, and House thinks of something. He then runs into Porter, who tells him Mendelson and his gang have bought out all the Vicodin and he can’t help.
Adams and House examine Nick. She finds an acoustical shadow that House also found. It could indicate a tumor. She’s astounded House found it without a stethoscope. She won’t start blood thinners, but realizes they can do a clotting test. House realizes it’s a good idea. They go to her office and she asks if he’s really leaving medicine. He tells her that before he decided to go to med school, he considered getting a Ph.D. in physics. He tells her about dark matter, the greatest mystery ever. She tells him it divorces him from humanity. He tells her he and humanity got together too young. She reminds him he is great at medicine, reading people, and understanding people. When they check back on Nick, he’s bleeding profusely from the cut Adams made - a totally surprising symptom.
It’s Thursday. House is trying to treat Asofa’s cricket for pesticide poisoning with sodium bicarbonate. House looks at the four Vicodin he has managed to collect.
House sees Dr. Adams. She managed to get Nick x-rayed and it wasn’t a tumor, just a lipoma. She sees House rubbing his leg and asks if he’s alright. He says he’s fine and ibuprofen won‘t help. She gives him Nick’s file. They start thinking about toxins, but something that only Nick has been exposed to. Dr. Sykes comes in and catches House with the file.
House goes to get Nick to do an environmental scan. He notices Nick is getting weaker too. Nick just wants to try to phone his girlfriend. House yells at him that the girl isn’t going to wait and there’s a reason why people like them are in prison. Nick throws him out.
House goes to get Adams to help with the environmental scan, but she’s not co-operating either. She wants to know why he lied about being in for drug use and not assaulting his ex-girlfriend. She realizes that if that were the only issue, a man without a criminal record who didn’t actually hurt anyone would have got probation or a fine, not twelve months in prison. When House says he had a bad lawyer, Adams tells him he can’t work on the case anymore.
Mendelson confronts House, realizing he can’t get all the pills in time. House promises to make good once he’s out, but Mendelson says if he shows any weakness with House, every punk in the prison will try to kill him. He walks out with House’s cane.
House limps back to Frankie’s cell and asks for gum and the pen Frankie keeps to protect himself. House uses the foil from the gum to create a short-circuit in a wall outlet and starts a fire. He then goes to the clinic. When the fire distracts Adams, he grabs some Vicodin.
Nick comes back, but House has lost interest. However, when he looks back at Nick, he notices his lips are swelling. House asks about what’s he’s eaten, but it’s only meatloaf, potatoes and coffee. Nick goes into anaphylactic shock and House calls for help. With no immediate help, House uses Frankie’s pen to do an emergency tracheotomy. C.O. Alvarez finally shows up and allows House to finish so Nick can breathe again.
That night, House’s leg hurts, but the cricket is better. House looks at his Vicodin, then at the bottom of Asofa’s bunk, which he’s using as a whiteboard. He finally takes three Vicodin, leaving him with only seventeen.
It’s finally Friday. House is still scheduled to be released. He looks at his remaining Vicodin and takes two more. He then decides to flush the rest down the toilet to prevent either himself or Asofa from contraband charges. House then asks for protective custody. However, when he sees a steaming cup of coffee, he thinks of something and denies he needs protective custody anymore. He goes to Adams and tells her that it was heat, like from coffee, that set off Nick’s anaphylaxis - he has mastocytosis. Dr. Sykes wants to run blood tests, but House realizes they won’t be able to confirm it that way. He suggests giving Nick five aspirin, which should induce anaphylaxis. Sykes realizes how dangerous it is, but Nick agrees to try it. However, Sykes refuses. House calls him a moron and coward because if Nick has another attack, he will likely die. Adams finds herself agreeing with House. When House goes to do the test himself, Sykes threatens to write him up if he comes back to the clinic.
Adams follows him out of the clinic and tells him she realizes he stole the Vicodin to pay an exit tax. She asks if he’s okay. He asks for twenty and she gives them to him. She promises to take care of Nick and tells him to take care of himself.
House takes the Vicodin to Mendelson. When Mendelson tells him he’s done the right thing, House says he realizes that. However, House then throws the Vicodin into the air. A fight breaks out. Mendelson hits House, who thanks Mendelson for giving him an excuse to go back to the clinic. However, Mendelson then orders Sullivan to take him out. Sullivan hesitates because he too is afraid his sentence will be lengthened, but Mendelson threatens him. Sullivan goes to get a hidden shiv. Alvarez tries to help, but he’s overwhelmed too. However, as Sullivan goes to stab House, Asofa comes out of nowhere to hit Sullivan from behind with a garbage can. He then takes out Mendelson’s other men with the garbage can, carefully avoiding hitting House in the process, and starts pummelling Mendelson until the riot cops drag him off. House manages to retrieve his cane during the melee.
Adams is treating House’s injuries. He asks for the aspirin to test Nick. Adams realizes he got beat up on purpose. House quickly locks out the guards and Sykes. Adams confronts House - she found out House had no lawyer and took the first deal he was offered because he wanted to punish himself. She wants to know if he thinks saving Nick will wipe his slate clean. House says he’s doing it because he has a gift. However, before they give the cup with the aspirin mixture to Nick, it’s intercepted and House is dragged away. However, Adams grabs the cup and gives it to Nick. Sykes tells her she will never work again, but she tells him to shut up to see if he has an anaphylaxis attack. However, nothing happens. House is dragged off.
It’s Saturday, and House is in solitary. His food arrives with a note - “You were right!”.
- We find out House has been sent to jail for crashing his car into Cuddy’s house.
- House is offered parole if he can stay out of trouble for five days.
- House comes under the control of a white supremacist gang, who demand twenty capsules of Vicodin as an “Exit Tax”.
- House meets a fellow prisoner with a mysterious illness, and becomes obsessed with trying to diagnose him.
- House meets Jessica Adams.
- Hours away from release, House starts a riot and blows his parole to prove his diagnosis on the prisoner.
- House is sentenced to more jail time, but finds out that he was right.
Zebra Factor 8/10
Mastocytosis is quite rare, although it often tends to be misdiagnosed.
Trivia & Cultural References
- The opening is not shown in this episode, and the same case would apply to the following episodes until "The Confession".
- This is the first episode that Lisa Edelstein is not credited.
- Like "Broken" (Part 1), the only main character to appear is House.
- Along with Jews, Nazi Germany also targeted Gays and Gypsies for extermination.
- The Osler scarf (with a corresponding Osler tie for men) is named after Sir William Osler, one of the founders of Johns Hopkins Medical School. It carries his family’s crest. Residents at Johns Hopkins are given their tie or scarf when they start their residency and, by tradition, wear it every Friday for the rest of their lives.
- Another reference to Vertigo, this time, the plot point where Jimmy Stewart’s character meets a woman who exactly resembles the woman who committed suicide in front of him.
- More about Dark matter here.
- The ACLU is the American Civil Liberties Union, a human rights organization which, in addition to its other activities, does protect the right of prisoners subjected to improper treatment.
- Asofa coming to House's rescue during the riot is an allusion to One Flew Over the Cuckoo's Nest, when Chief helps McMurphy.