In continuing with the search for a new staff, House (Hugh Laurie
) decides to split up the remaining people into two teams in order to diagnose a man who's already suffering from a severe ascending muscle weakness. In the meantime, a patient from the clinic makes House wonder if there's life after death. Cameron (Jennifer Morrison
), Chase (Jesse Spencer
) and Foreman (Omar Epps
) also appear in their new working environment.
The main patient is Stark (Brian Klugman
), a 37 y/o man with Spinal Muscular Atrophy, an incurable and progressive neurological disease that weakens muscles. He is wheelchair bound and assisted by his dog Hoover. While crossing the street, Stark faints without warning and is nearly hit by a car. He is admitted to the hospital to find out why he had the fainting spell.
House divides the ten remaining applicants into two teams of five each: boys versus girls. The team that diagnoses Stark correctly wins and gets to remain. The losing team is fired. Everybodys favorite alpha-female Amber (Anne Dudek
) wants to join the mens team but they rebuff her.
Both teams initially consider that Stark may have picked up a bacterial infection from his dog Hoover, but discard the idea. The womens team now decides he must have become infected with Strongyloides (threadworm) on his recent trip to Thailand. They treat him with Ivermectin, an antihelminthic drug (i.e. an anti-worm drug). The men have no working diagnosis and want to run a full battery of tests on Starks hair, blood, and stool. During this conversation, it is revealed Stark is also incredibly constipated. Amber manages to finagle her way onto the mens team by convincing them to try xenodiagnosis basically, have a bug bite the patient, and test the bug for any parasites that the patient may have. In the middle of the test, Stark starts choking and coughing.
The next morning, House reveals the patient has suffered an aspiration, but is improving on oxygen and chest PT. House seems intrigued by the womens diagnosis of Strongyloides and dismayed that the men have only managed to run test after test. He places the mens team in the penalty box making them sit in his office and not talk about the case while the women go about proving theirs. Their plan is to perform a tilt table test on Stark and try to induce a fainting spell. If the test is negative and there is no fainting, then their diagnosis and treatment must be right (but not necessarily, the tilt table test only reproduces certain types of syncope and not the type the patient has and/or he might be getting better for other reasons beside their treatment).
Amber and the guys have not given up. They want to know whether Starks choking is dysphagia (difficulty swallowing) or achalasia (an esophageal motility disorder). The old guy suggests paraganglioma a tumor in the neck that presses against the vagal nerve, thus causing fainting, whenever the patient eats. The tilt table test is negative, seeming to confirm the womens diagnosis and treatment, but Amber runs a CT on Stark anyway. No tumor is revealed, but she believes the results are consistent with scleroderma, a type of connective tissue disease commonly affecting the skin and esophagus. House disagrees and fires the men and Amber. Shes not done though, she talks Chase into running labs on the patient for her. She wants to run an anti-centromere antibody test, a blood test sensitive for scleroderma. When she draws the patients blood, it turns out to be green.
With this finding, House rehires the mens team and Amber because the diagnosis he thought was right clearly is not. The plastic surgeon deduces the blood is green because the contrast for the CT the patient had the day before has not been filtered out by the kidneys meaning Stark has kidney failure.
The differential is now a gram negative bacterial infection from his indwelling catheter versus scleroderma. House orders Stark to be started on Ampicillin and Gentamicin, two potent antibiotics, for the possible infection; he also orders skin and lymph node biopsies to look for scleroderma. Shortly, the team reveal the antibiotics are having no effect and the biopsies are negative. Or are they? House notices some black specks in the cervical lymph node biopsy and suspects Stark has melanoma of the eye which has spread throughout the body. He wants to remove the eye and manages to talk Cuddy (Lisa Edelstein
) into agreeing with the surgery. Before surgery, the applicants are performing a thoracentesis (draining the fluid from around Starks lungs) to make his breathing easier when they notice the fluid is clear. This is not consistent with fluid from a cancer, which tends to be cloudy and bloody. Stepping in after House's injury (discussed below), Wilson (Robert Sean Leonard
) and the team decide Stark has Eosinophilic Pneumonia, and he is started on corticosteroids and cyclophosphamide (a potent immune suppressant and chemotherapy drug, used for certain types Eosinophilc Pneumonia). The medication doesn't help and Stark dies quickly and quietly, his faithful dog by his side. When the dog is revealed to be dead a few minutes later, House realizes Hoover took the patient's Invermectin (fatal to the breed) instead of the patient. Thus, the women were right and the patient had Strongyloides all along, and died of an overwhelming threadworm infection.
While the team is treating Stark, House sees a patient in clinic who pulls out a knife and sticks it in the wall socket right in front of him. House manages to revive him and the patient admits he was in a car accident a few days previous and experienced a near death experience. He reports it was the happiest that hes ever been and wants to replicate the experience.
Later, when Wilson accuses House of not knowing for sure whether there is an afterlife or not, House decides to find out for himself, and sticks the patient's knife in a wall socket (but not before paging Amber). She performs CPR and manages to revive him, though he suffered a burned hand and an extended loss of consciousness. Because of this, Wilson had to take over Stark's case in the end.
Meanwhile, at a hospital across town, Foreman is running his own diagnostic team, only he is trying to make it friendlier and more supportive than Houses. They have a patient with fever, boggy lungs, and blurry vision who the antibiotics arent helping. The team diagnoses Apergillosis and starts the patient on Amphotericin B. It doesn't help, and the patient now develops yellow gums, a sign of jaundice. Foreman believes the patient has anaplastic large cell lymphoma, a rare and aggressive cancer. He wants to start treatment right away. His boss disagrees and feels a severe infection is most likely.She has Foreman start a potent antibiotic. Foreman's gut feeling gets the best of him and he stops the antibiotic and starts the cancer therapy. He is correct and saves the patient's life, but his boss fires him for not following the guidelines and putting his gut feelings ahead of medicine.
(Ed. Note - Factual errors should be pointed out in the "Goofs" section, not the synopsis.)