Oil company CEO Roy Randall is sitting outside his luxurious manor, contemplating his dog. His assistant calls him in for a sales meeting and he tells his people to close the deal and then says he has a pressing appointment. He goes to his son's room and talks to the doctor, who admits that the prescribed treatment isn't helping and they need to get Jack to a hospital. Jack tells Roy that he doesn't want to go, but Roy says that they'll have to. He assures Jack that he's not going to die and promises that he's always right.
Roy meets with Cuddy and demands that she put House on Jack's case. Cuddy tries to explain that House isn't available but Roy refuses to accept "no" as an answer. She tells him that Jack will be in good hands with Foreman but Roy says that he's already been in good hands and he's dying. Now he wants the best, and that's House.
Cuddy tells House and the team and explains that House will be making the decisions but Foreman will call the shots. Foreman objects and asks when House will get his license back, but House is enjoying himself as it is. Cuddy then tells Foreman to prepare a presentation of Dibala's case for the morbidity and mortality conference. Chase and Foreman both objects but Cuddy insists that they do it. Cameron returns to the case and notes Jack's increasing abdominal pain. House says that everything has been previously ruled out so they'll have to retest everything.
Cameron starts testing Jack and Roy wants to know where House is. She tells him he's in his office and then notices a solid mass in Jack's abdomen.
Chase tells Foreman to keep things clean and simpler, but Foreman warns that the "routine" lab test was done using a dead woman's blood. Chase insists the body is dead and there's nothing that can be proven, but Foreman worries that all the doctors will be looking for something to pin on House's famous team. When Foreman asks if Chase has everything covered, House overhears them and asks what they have covered. Cameron comes in to tell them that Jack's colon is fully impacted since the last x-rays. They believe it's Hirschsprung's, a congenital failure of nerves in the colon. Roy wonders who came up with the diagnosis and Foreman admits that House did. Cameron prepares to give Jack an enema and a new biopsy.
House goes to a coffee shop to find Thirteen, who is making travel plans on her laptop computer. She insists she isn't coming back and House agrees. He figures that if Thirteen came back, Foreman would quit to try to rebuild their relationship and House doesn't want the pressure of leadership. As he goes, Thirteen tells him she's going to Thailand.
The next day, Jack starts to recover but then his abdomen starts to swell and he has a seizure. Foreman believes he has intracranial hypertension. He gets Jack to the operating room and gets Roy's consent to drill burr holes and relieve the pressure. They manage to stabilize him but they have no idea what happened.
The team reviews the new tests as they insert shunts to remove the excess fluid in the abdomen. Foreman notices a discrepancy in the dura layer within the blade and House suspects it was loosened before the fluid buildup, indicating brain cancer. He congratulates Foreman on spotting it and orders more tests.
Thirteen is taking a taxi to the airport and mentions to driver that someone is watching her house. He takes offense at that, thinking she's accusing him of being a thief. She discovers that someone has cancelled her seat on the plane.
Cameron and Chase tell Roy about the possibility of brain cancer. He gets a page and signs off on treatment, and Chase goes to help Foreman. When Cameron offers to help, Chase says she doesn't need to and that he'll see her at home later.
Thirteen goes to see House and tells him to stay out of her life. House denies canceling her reservation, insisting that Foreman is a better diagnostician without her being around. When House tells her to have fun in the Bahamas, she points out she told him Thailand. He points out he figured she was lying because it would have bee idiotic to tell him the truth.
Foreman tells Chase that Cameron ran an anticentromere antibodies test on Dibala's blood. The lab ran a full test, including a cholesterol test, and his is off 20% from the dead woman that Chase took the blood from. He stays the night there to work out with Foreman what to do, while Cameron wakes up alone. Chase insists that no one will compare the cholesterol levels but Foreman warns that Cameron calibrated the equipment. Foreman refuses to continue lying and tells Chase to figure out a way to explain it. Cameron comes in and gives them the biopsy results on Jack. They confirm that he doesn't have brain cancer.
Back in differential, House believes a carcinoma in the stomach would cause the symptoms and wouldn't show up on the CTs. He notices that Chase is distracted, and Foreman orders a new set of biopsies. House then accuses Foreman of canceling Thirteen's reservation. Foreman realizes he's talking about Thirteen and denies stopping her. He admits he's done all he could and now he's moving on. House believes him and admits Foreman's more rational than he thought.
Cameron demands to know what's wrong with Chase and says that he can't hide things. He admits that the HDL levels don't match what was on an earlier panel. Cameron admits that it's weird but Chase says that Foreman is worried about appearing weak. She agrees not to tell House.
Chase and Cameron tell Ray about the carcinoma and Roy blames himself. When Cameron notes he couldn't have possibly caused it, Roy says that he's been incredibly successful throughout his life. He believes that Jack's illness and the death of his wife is karmic payback. Jack has another seizure and Cameron realizes it's not caused by intracranial pressure.
The seizures stop but they can't find any carcinomas. House notes that every time they try and find the source, Jack has a seizure. House eliminates cancer and Chase suggests a drug-resistant infection. Cameron wonders if abdominal epilepsy is the cause and it only recently manifested as seizures. His fever could have been caused by malnutrition since he wasn't eating due to the stomach pains. House admits it's the best they got and they start treating Jack.
Chase tells Foreman that he's going to testify he gave Dibala statins, which will account for the cholesterol discrepancy. Foreman points out that he won't be able to account for getting the unprescribed drugs and decides to tell the truth. He goes to Cuddy and says he doesn't want to report to the conference and he's busy dealing with Jack and House undermining his authority. Cuddy demands to know what's going on but when Foreman doesn't give her an answer, she tells him to do it anyway.
Cuddy goes to House's office and tells him that Thirteen called and said that someone hacked into her e-mail account. Cuddy says that she thinks it's Foreman and House admits that he'd rather have Foreman in charge. He doesn't want the power if it sets off his mental problems. House tells Cuddy that he believes that Foreman didn't do it. They're interrupted when Cameron pages House to show him spots that are appearing on Jack's chest.
The team goes back into differential with the new symptom. Cameron suggests lupus but it would have showed up on the dural biopsy. Chase suggests polyarteritis nodosa, insisting there was some inflammation and elevated pressure. House notes it's not his decision but suggests they treat and check his groin where serious inflammation would occur. Foreman says he and Cameron will run the test even though it was Chase's suggestion. When Cameron objects, Foreman lets her think he needs Chase to prep for the M&M conference. As they start to go, House wonders if the spots were on Jack's penis and proposes that Jack has Degos Disease. He goes to tell Roy the news, and explains that there's no treatment. Jack only has a day at best before he dies. Roy doesn't believe him but House explains they rechecked the biopsies.
Chase finally goes to Cuddy to tell her the truth about how he rigged the test. However, Cuddy is called to Jack's bedside by Roy's lawyers. As she goes, she tells Chase to come clean if he screwed something up. In Jack's room, Roy is borrowing based on liquidating everything he has, in the hopes that he can balance his karma by getting rid of his money. House notes that Roy is irrational but not insane. The lawyers threaten to sue the hospital if Roy is shown to be inane. Cuddy tries to talk him out of it but Roy insists that Jack doesn't have any time. As Roy signs the papers, Jack flatlines.
Thirteen comes to see Wilson and accuse him of canceling her flight reservation. He denies it but Thirteen says that Cuddy traced the IP and Wilson did it. She wonders if he did it for House or Foreman, and Wilson says that House needs her because she keeps him grounded. He figures House will ask her to stay eventually but Thirteen leaves. As she goes, Wilson warns her that it's a great job and tells her not to throw it away because of a bad breakup.
Wilson then goes to House and tells him that he falsely confessed to Thirteen. He figures House canceled the reservation to get Foreman and Thirteen back together. House denies it, saying he's a jerk and just sold stocks based on Rou's actions. House finally admits that he cancelled the reservation, but won't admit he really values her. When he talks of having a heart three sizes too small, he gets an idea and goes to Jack's room. He tells Foreman to treat for obstructed blood vessels because Jack's heart attack was in the larger blood vessels, which means he doesn't have Degos. House believes he has primary antiphospholipid syndrome. As Foreman leaves, House notes that Thirteen went to everyone except Foreman, and believes she isn't over him. Foreman disagrees.
Chase goes back to his office and finds an envelope. He shows it to Foreman and asks him where he found chromium supplements that were on top of the file. Foreman says he doesn't know about it, and Chase explains that one of Dibala's doctors proscribed the chromium to boost his HDL levels. They can use it to explain the variation in HDL numbers. Foreman says he didn't request the info, which means that House did it.
House wakes up the next morning and reads a newspaper about Roy's company going into the tank. He goes to the hospital and finds Roy with his recovering son. Roy insists it worked.
Chase is in House's office when House comes in. House figured Dibala was taking something for his cholesterol levels. House isn't interested in firing him, pointing out that Foreman is in charge. He's also fine with murder, as long as it wasn't a misdiagnosis and as long as they don't treat any more genocidal dictators. Chase notes that House is running things whether he wants to or not, and always will be, and walks out.
Cameron wakes up alone.
Foreman gives his presentation to the conference while Chase and Cuddy watch.
Thirteen gets on her plane to Thailand.
The bank takes over Roy's house, but Roy and Jack are happy together at the hospital, sharing a pizza.
House considers his desk and his ball, and thinks about what Chase said.