Open with Gregory House (Hugh Laurie) waking up on the floor near a man. He looks and sees Dr Lawrence Kutner (Kal Penn), who tells him "Don't bother, he's dead." House says "you're dead, too," to which Kutner replies "The fire isn't." House looks over and sees some flames behind a wall. Kutner asks House how he met the deceased man, which leads to a ...
...flashback to House treating a patient looking for pain meds because of an orbital fracture. The man, Oliver (James LeGros), is clearly drug seeking, but House makes him stay when he sees bruising around his abdomen.
House brings this new case to the team, who are shocked he is both in a decent mood and wants to work on a new case.
Kutner asks House why he didn't tell House's team about his plan.
House asked Dr Eric Foreman (Omar Epps) to lie to his parole officer and say he needs to stay to work on a life-or-death case. Foreman agrees on the condition that he actually work on all of the cases he has.
Kutner thinks the reason House is still sitting on the floor of this burning building instead of leaving is because he's suicidal.
Foreman tells Dr James Wilson (Robert Sean Leonard) that House has disappeared.
Kutner asks House why he wants to kill himself. House mentions all of the obvious reasons. Kutner doesn't think death would be interesting for House, but wonders if perhaps life has ceased being interesting.
Kutner leaves and House is now interacting with Amber Volakis (Anne Dudek). She tells him Oliver's case must be relevant to why he's still sitting on the floor. He relays to her that Oliver coded. House ended up talking to Oliver, a former stockbroker who says he was miserable which was why he started doing heroin. Now he isn't miserable. Heroin has taken away the pain and unhappiness from his life. "Reality sucks," he says.
The question becomes why House all of a sudden was interested in talking to a patient about things not relevant to his case.
Foreman is furious that House has passed on all of his cases to other doctors. He wants to know why he's risking destroying himself. House seems confident Foreman will continue to lie for him, but Foreman says "No."
House tells Oliver he has Lou Gehrig's Disease. He then notices that his veins are not symmetrical. As a junkie Oliver inhaled a branch while high, which set off an autoimmune reaction. He is going to live.
House tells Amber that his life doesn't matter and that eventually he'll be dead just like all of his patients She points out that he's shallow and needs to live for the next case. She tells him to go home. House gets up and tries to walk out, finding fire on the other side of the door.
Foreman and Wilson go to House's place and find his bags packed and food rotting. Foreman learns House no-showed on a hooker. They see in House's phone a strange number he dialed four times.
House falls through the floor of the building, which is now almost completely engulfed in flames.
Wilson and Foreman go see Dr. Darryl Nolan (Andre Braugher) who recently spoke to House. One of Dr Nolan's patients (Patrick Quinlan) asks whether he can go on speaking, as that was his time. Dr Nolan is a psychologist, and he mentions that he must keep the doctor-patient confidentiality, but Wilson says "unless he's a danger to himself or others". Since House is potentially a danger to himself, Nolan tells them that House mentioned "reaching oblivion" and Foreman realizes that Oliver was a heroin addict.
Now House is speaking to Stacy Warner (Sela Ward). She asks him whether he believes in anything and brings up love.
We see House asking Wilson to take the fall for him since Foreman is now buckling. Wilson doesn't like the potential of spending his final months jail or tarnishing his reputation. House says "I don't want to lose this time with you" and Wilson agrees. But then Wilson changes his mind since House assumed he would bail him out. Wilson doesn't like rewarding his bad behaviour. He wants to teach House that there is only one person he can count on: "I need to do this," Wilson says. "For you."
Stacy says that Wilson was right. She says he needs to find within himself what he's been getting from Wilson. She helps House to his feet and she hands him a baby. She says that she and Cuddy aren't the only two people capable of loving him. He gets back on the floor, ignoring her telling him he doesn't have to die.
Next Dr Allison Cameron (Jennifer Morrison) shows up in House's subconscious. She says she loves him, but thinks he should die "as a reward." She thinks he's suffered enough and deserves a chance to give up -- like Wilson did.
Wilson and Foreman arrive at the address. It looks bogus, but they smell smoke. The spot a building on fire and we hear sirens in the background.
Cameron tells House to "just let go. Go to sleep."
We see that House told Oliver he is dying. Oliver wants to take the fall for him. Eventually House agrees. On his way out of the room he tries to establish why he's doing this for him. Oliver says he has nothing else to lose. House is struggling with whether or not to tell Oliver the truth. Cameron points out that House was taking the cowardly way out. House agrees with her and says "but I can change."
House stands in the window as Wilson and Foreman arrive. A huge explosion of fire blows out from the place he is standing, knocking Foreman and Wilson, and the just-arrived firefighters to the ground.
The next morning the team waits at the scene. A body bag is pulled from the building.
Foreman tells Wilson the coroner confirmed it was House's body.
We see House's funeral. We hear positive memories from family and friends, like his wife Dominika (Karolina Wydra). Wilson stands at the podium and says that House was a jerk, selfish to the very end. A phone begins to ring and Wilson is surprised to find it is in his pocket. A text says "Shut up you idiot."
Wilson drives to a location and finds House waiting on some steps for him. He tells Wilson he got out of the back of the building. He switched dental records with Oliver.
Wilson points out that House can never be a doctor again. "I'm dead, Wilson. How do you want to spend your last five months?" Wilson laughs and smiles.
We see that Dr Robert Chase (Jesse Spencer) has taken over House's office.
Dr Chris Taub (Peter Jacobson) looks happy being a father.
Cameron smiles looking back at pictures of House and the team. She's married and has a child.
Foreman spots House's key card hidden underneath the leg of a table in his office. He smiles and sits back in his chair.
Wilson tries to talk about the cancer. House says "Cancer's boring" and they climb aboard their respective motorcycles and ride off.