An injured House sits on his bathroom floor and stares at a hole in the wall.
Eight hours earlier
House goes to see Cuddy, who tells him a crane collapsed in downtown Trenton. He isn't interested and gives her her great-grandfather's book as a housewarming gift. When he wonders if there's something wrong between her and Lucas, she ignores the question and leaves for the accident site. House goes along and begins helping. He and Cuddy begin triaging and House determines that one victim won't survive.
They find the crane operator, who claims that he passed out while working. When House learns that he was using caffeine pills and drinking coffee, he concludes that the operator has a neurological problem. He prepares to take the man back for diagnosis but Cuddy tells House to let his team deal with it while he tends to the injured. House agrees, and then calls Wilson, in the ER, to share his suspicions that Cuddy and Lucas are having problem. Wilson dismisses his concerns and goes back to work, and House hears someone pounding on metal. He follows the noise and calls the emergency workers over, but they get any response and conclude House was mistaken. Once the leave, House knocks on a nearby metal pipe, considers, and then starts crawling into the wreckage, calling for the person to respond. When he gets no answer, he continues and finds an injured woman, begging for help.
As House tends to the woman, she talks about how she picked up a picture for her husband. She finally identifies herself as Hanna and House checks her for memory impairment. Once he's satisfied, he tries to move her but discovers that her leg is pinned. He has no choice but to go, although Hanna begs him to stay. Once outside, House calls the team in ER and starts the differential of the operator. As they discuss the issue, House wonders where Thirteen is, and Foreman admits he doesn't know. The EMT then reports to House that Hanna is okay but bleeding. When he realizes the EMT doesn't know how to administer an IV through the tibia, House goes down with them.
The emergency workers try to free Hanna but warn that the structural beam pinning her can't be broken. As they go to get other tools, Hanna tries to get closer to House, but he insists that he won't be there long. She insists she has to call her husband but House says he can't and leaves again. Outside, House talks to Cuddy and asks if things are going badly with Lucas. She insists that everything is going fine and explains that she thought it was an engagement present. They got engaged the previous night, but House notes she's not wearing an engagement ring. Cuddy says she left it in her desk because she knew she was coming to the accident site. They're interrupted when an emergency worker comes over.
Taub and Chase run an MRI on the crane operator, Dolce. They don't find anything, but discover that he's bleeding from the eye and nose.
House and Cuddy go back down, and the captain in charge, McCreavey, warns that they can't get her free and will have to amputate. Cuddy warns that the more she's pinned, the better the chances she'll get cramp syndrome, and the poison released will kill her. House insists that she has at least two hours and refuses to agree to her leg amputation, but McCreavey warns that they're risking further collapses. Cuddy reluctantly agrees with House to delay for two hours. Once they're alone, Hanna thanks House and gets him to promise not to cut off the leg.
The team calls House to tell him that Dolce is bleeding, and House insists it proves there was something wrong. Thirteen arrives and claims she was in physical therapy and left her phone in her locker. House snaps angrily at them to check again and leaves, telling Hanna that he's the only one who can help Dolce. Outside, House prepares to leave but Cuddy tells him that Hanna is panicking and wants him. He agrees to stay.
In his bathroom, House considers his Vicodin.
House returns to Hanna, who apologizes for needing him but is happy to have him there. He gives her his phone so she can call her husband Charlie. He already knows what's happening and she apologizes for not being there on his birthday. House notes that she's getting upset and her BP is rising, endangering her leg, and she hangs up. He blames himself for doing something stupid, but Hanna insists it was nice. She asks about his leg and House sarcastically dismisses her comment, and she wonders why he wasn't nicer. Hanna then asks him to pray with her, and House refuses. When she admits she doesn't believe in God, just like him, he agrees. Hanna then wonders how bad things can happen to fundamentally good people, and House admits he knows how she feels.
As Thirteen and Taub test Dolce, Taub notes that she lied to House about the therapy. She refuses to explain but insists that she's fine.
As McCreavey tries to free Hanna, Hanna wonders if she and House can be friends afterward. He dismisses her suggestion and they manage to get the beam up. However, as they pull her out, the basement collapses around them.
When House and McCreavey recover, they discover that one of Hanna's lungs has collapsed and House works to reinflate it. House is bleeding and McCreavey advises him to get up top for medical treatment. Cuddy treats his wound while the team calls to tell him that Dolce's fever is spiking. McCreavey informs House that due to the extra debris from the collapse, they can't use the air bags to lift the beam for at least five or six hours. He tries to come up with a way to prevent the potassium buildup caused by crush syndrome, but Cuddy points out that it's hopeless. When House persists, Cuddy accuses him of taking out his anger on her over the engagement. House denies it and insults her, and she asks him what he has in his life. She and Wilson are moving on, but he's got nothing. Cuddy informs him that she's going down to convince Hanna to consent to the amputation.
Hanna refuses to allow the amputation, insisting that House promised and she can wait. House comes down and tells her that they have to amputate because they've run out of time. He explains what happened to his leg and that he refused to let the doctors amputate. When she points out he saved his leg, House says that he wishes they hadn't and that because of the constant pain, he's a worse person and alone. He tells her that Hanna doesn't want to be like him, and she can still have friends and family. Hanna thinks it over and then agrees. House tells Cuddy that he'll handle the amputation and sends her out.
House describes the procedure to Hanna and then cuts off her leg. The EMTs get her out and her husband is waiting for her. He assures her that he loves her no matter what and leaves with her for the hospital. House gets in the ambulance, looks back briefly at Cuddy, and then leaves with Hanna. En route, the team calls House and tells him that Dolce was being questioned by an officer and went into a coma. House realizes that the stress caused Dolce's BP to spike, as did the caffeine earlier. Dolce has an arachnoid cyst on his lower spine.
Hanna suddenly starts gasping for breath and House realizes that he waited too long. She has a clot in her lungs and he administers a blood thinner. It doesn't work and House realizes that it's a fat embolism from the amputation. He informs Charlie that there's nothing they can do.
The ambulance arrives at the hospital and Foreman arrives just as Hanna flatlines. Later, Foreman tries to comfort House, noting there was nothing he could have done and it would have happened no matter what. House walks away and then yells at Foreman, saying that he knows there's nothing he could have done but it doesn't make him feel any better. As House leaves, Foreman tells him that he shouldn't be alone but House orders him out of the way.
Thirteen leaves an envelope on House's desk. As she goes, Taub comes in and asks what she's doing. She tells him that she's asking for some time off and says that she's not okay.
House goes home and checks his injury, which is still bleeding. He then yanks the mirror of the wall and smashes it, revealing a hidden stash of Vicodin in the wall. He sits on the floor and considers the bottles and pours some pills into his hand. Cuddy comes in and says that it's his choice to go back on drugs. She informs him that she broke off her engagement with Lucas. Cuddy tells House that she can't move on and all she can think about is him. She asks him if she and he can work. House wonders if he can fix himself, and Cuddy admits he doesn't know. He warns her that he's the most screwed-up person in the world, and Cuddy admits that she knows but she loves him anyway. With her help, House gets back up and kisses her. He wonders if he's hallucinating, and Cuddy points out that he didn't take the Vicodin. She figures they're okay, and House agrees, throwing the pills away.