House

Sarah is leading a Special Ed class and one of the students, Johnny, notices that they have a new assistant. Sarah tells him that the old assistant got married and he wonders why Sarah isn't married yet. He wonders if they can get married and she puts him off. Johnny spills glitter on a neighboring girl's painting. However, the girl starts to cry, and Sarah tries to comfort her. However, Sarah starts coughing up blood and then collapses to the ground, unconscious.



Cameron brings the case file to House in the cafeteria as he steals some food, and tells him that she's been put in charge while Cuddy's gone. House figures they'll all learn a valuable lesson and then things will be back to normal. He takes the case to the team and notices Foreman is smirking at the fact Cameron is in charge. House assures them he's going to do his job, and leave Cameron crushed in his wake. Foreman suggests blood ailments and Thirteen disagrees, and House calls them on it, noting it's a smoke screen and wonders if they have differing opinions. He tells them to run a bleeding-time test. Hadley and Thirteen administer the test and Sarah gushes about her students and is incredibly happy. There's no sign of clotting, suggesting something is wrong. She assures them she's not worried.



At home, Wilson visits Cuddy and talks about Rachel. He notices something is wrong and Cuddy says that she doesn't feel anything for the child. She dismisses her concerns and insists she's doing everything she's supposed to do, and Rachel will be fine.



Thirteen and Foreman explain that Sarah's platelets are damaged and House wonders why they're agreeing. House orders irradiation for possible ITP, which will cause cancer and kill her digestive track. Kutner believes it's irresponsible. House offers to go to Cameron to get her permission. She immediately agrees with him, to his surprise, and tells him if he comes to her with a request he thinks is necessary, she'll approve it. Surprised, House goes to his team and asks them for a reason to not do the irradiation. They decide to fake the procedure but not actually flip the switch. House okays it while ordering increased drug treatment.



Foreman talks to Chase about the fact he accidentally learned that Thirteen is receiving the placebo in the Huntington's drug trials. Chase advises her not tell her to avoid compromising the trial. He wants to put her on the real drug and Chase notes that it's crazy.



Thirteen and Taub administer the fake test to Sarah, who asks for a timeout so she can go to the bathroom. They agree but she collapses as soon as she gets off the table. Her heart stops and they're forced to resuscitate, and the heart condition indicates it's not ITP.



Back in differential, the team concludes there are no heart problems. House wonders why someone would have to pee in the middle of a nuclear procedure. Thirteen suggests Sarah has cold agglutinins caused by low temperatures in the oom and the radiation chamber. Foreman agrees and House tells them to stop. House then tells them to give Sarah a cold bath: if she has cold agglutinins her heart will start racing.



Cuddy is visiting Cameron, wanting to know why she approved the radiation procedure. Cameron explains that she said yes because House wanted her to say no. Cuddy warns her not to play House's game but Cameron insists on doing it her way. House arrives and waits for Cuddy to leave, noting Rachel is outside. He concludes that Cuddy brought Rachel to work to dump her because she hates the baby and thinks she's making a mistake. He admits Wilson told him and says it's not a big deal. He explains Cuddy doesn't have any obligations yet and emotionally she'll feel guilty, but Rachel will never know her. Cuddy sarcastically thanks him and leaves, and he tells Cameron what he wants. She approves the procedure but tells House to draw blood and freeze it first to see it if clumps. The team wonders what Cameron is up to and Foreman figures Cameron is playing House.



Kutner goes to draw the blood and finds Johnny and his mother visiting Sarah. Johnny's mother explains that Johnny has improved since studying under Sarah, and he started to lose ground when Sarah became ill. Kutner draws the blinds so the nurses don't know and leaves with the blood samples.



Foreman and Thirteen are testing the blood and she drops something. She admits she's feeling better because of the medicine and Foreman warns her not to get too hopeful. Thirteen insists she's feeling better. The tests show that Sarah's blood is clumping, indicating the possibility of cold agglutinins.



Foreman goes to see Cameron, who tells him not to bother.



House watches from the observation gallery as Kutner and Thirteen put Sarah in the cold bath. She talks about Johnny and how she got him to open up. She mentions going to the wrong room because of a mix up in the room numbers. Her heart rate remains normal, disproving the cold agglutinin theory, but House says that she has brain damage



Back in differential, House explains that her confusion over the room numbers and the fact she forgot to pee before the irradiation procedure. The damage is ongoing, but Foreman thinks that House is simply trying to prove she has brain damage to indicate why she's a nice person. Kutner suggests a pancreatic tumor but House believes it's MS and plaques in her brain are interfering with her brain function and will spread to her brain stem, shutting down her lungs. He orders a brain biopsy but Kutner disagrees and suggests an ERCP on the pancreas. They go to Cameron who says they have to assume it's a brain, but orders a MRI to spot the MS plaques. House refuses, saying that Cameron is hedging her bets to stand up to House. She's wasting time and he tells her to choose. She insists they do the MRI first.



Cuddy and Rachel visit Wilson and Cuddy tells him she doesn't want to go home. She's been wondering if House was right, and doesn't know if she wants to make sacrifices for Rachel.



The MRI shows no MS plaques and House okays the ERCP. Foreman talks to House about ethical advice on helping Thirteen. House asks if the drug will cure, and when he learns it probably won't, notes it'll keep Thirteen alive for maybe three extra years. He asks Foreman if that's worth him risking his life in medicine. Foreman thanks him for the advice, but as he leaves House notes it's worth it if he loves Thirteen.



The others run the ERCP but her lungs shut down. They drain the effusions but Kutner insists the MRI proves House was wrong. House suggests a nerve-conduction study on her brain to find the dead spots, but they'll have to cut off her skull. Kutner wants a more sensitive test but House points out that they don't have time. Kutner goes ahead and does it anyway while House gets permission to cut open Sarah's skull. He goes to Cameron, who already knows about the intended procedure thanks to Kutner. House believes that equine encephalitis set off the damage in the left side of Sarah's brain, possibly caused by a mosquito bite. Cameron still wants something to confirm and House sends Thirteen and Foreman to check out the school. Thirteen says that she wants children, but was reluctant before because of her illness. Now she feels like parenting is an option.



Wilson goes to see Cuddy and gives her a present: a framed photo with an age-accelerated image of Rachel. He tries to get her to think of Rachel as a human being with a future. When it doesn't work, Wilson admits the photo came with the frame.



House comes to Cameron with the results from the oom: three dead bugs and a child suffering from a raging viral syndrome. The bugs are fruit flies and the kid has a common cold: Cameron isn't impressed. Kutner hasn't found anything with his second test. She wonders what he wants her to do and he says to say yes, and she does. Kutner confronts House and points out he's skipping steps to test Cameron. Kutner suggests they remove her spleen and House says that's fine if the brain test doesn't work. House and Cameron attach electrodes to her exposed brain and run the tests to determine the dead sections of her brain. Kutner calls Cuddy at home and she gets on the loudspeaker to tell House to stop. Rachel cries in the background, distracting and irritating Sarah. Cuddy begs Rachel to stop calling as Sarah's blood pressure starts dropping but her nerve conduction increases. Cuddy continues to yell at Rachel and Sarah continues to get mad. Cuddy asks the baby what she wants and she stops crying. Cameron stabilizes Sarah and they close her up.



They have to wait two hours for the anesthesia to clear so they can operate on her spleen. House wonders why Sarah got angry and concludes the low blood pressure is somehow responsible. Later, House reviews the white board and Cuddy arrives with Rachel. Cuddy explains that she actually talked to Rachel and connected with her. Cuddy insists it was real, and asks if House wants to hold her. House does, and the baby spits on him. He realizes it's a problem with her stomach sphincter and gets an idea.



Kutner is reassuring Sarah she can live without her spleen when House arrives and says they didn't look at her heart. He checks and discovers her ductus valve didn't close when she was born. She has a patent ductus arteriosis that directs blood throughout her body when she's under stress. The blood is redirected from the left side of her brain, causing her to become less stressed when in a high-stress situation. Surgery can correct the ductus and fix the problem.



Cameron visits Cuddy, who notes that Cameron was right. Cameron tells her that she's quitting: she can't handle House and approved his tests without sufficient evidence. She admits she'll always say yes to House because he knows her too well.



Johnny comes to see Sarah and spills water on her. Sarah continues to be cheery and upbeat. House looks on, interested.



Foreman switches Thirteen's placebo for the real medicine. Thirteen comes by and he smiles at her.



Cuddy leaves for work, leaving Rachel with a babysitter. As Rachel cries, Cuddy hesitates and then keeps going.