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There was no doctor available in the ER to deal with Alice right away, but word spread to Dr. House who was a great fan of her work and he decided to examine her. The nurse advised that the patient was brought in when her maid believed she had suffered a seizure, but Alice insisted the maid had merely overreacted. After a quick examination, he notice a small burn on her right cheek. The patient was impatient to leave and offered to answer one question from Dr. House if she were released right away. He agreed, and asked her why she tried to kill herself - the abrasion was typical of a gunpowder burn. Alice tried to get up and leave, but Dr. House put her on a 72-hour psychiatric hold.
The patient admitted she had not had a physical in some time because she didn’t like doctors. She denied remembering any previous seizures. She complained about the length of the examination, but the doctors pointed out she was being deliberately evasive with her answers and this was slowing it down. She admitted to the suicide attempt, but didn’t want to talk about why she did it. She then demanded a woman physician. The doctors agreed to leave the room and told her they would just observe her from the other room.
The maid agreed not to call the police, and told Dr. House that she called 911 when she found Alice had collapsed, but Alice recovered before the ambulance arrived and told her she would be fired if she told anyone about the suicide attempt. She thought the patient was depressed because she never went out and didn’t have any friends. Dr. House wanted to see the patient’s latest manuscript, but it was in a safe. Dr. Cuddy asked if Alice ever complained about pain or stress, and the maid told her that Alice complained about pain in her back and hands, but Dr. House pointed out that is common in writers. However, he saw the typewriter and realized it used a ribbon. He also found some tuna cans, and the maid said she often ate two or three cans a day.
Dr. House came in while his team was observing the patient and woke the patient to tell her she had wet the bed, but he didn’t know why.
The patient’s unilateral hyperhydrosis and other symptoms could be explained by mercury poisoning from the tuna, but the urine and blood samples showed normal levels. The patient was still refusing to be examined by male doctors. Dr. House ordered chelation therapy in any case and another set of tests for mercury. He went to ask Dr. Cuddy to speak to the patient. Dr. Cuddy admonished Dr. House for not hiring a female replacement for Dr. Hadley. She agreed to talk to the patient if Dr. House would hire the replacement.
Dr. Cuddy told Alice about the diagnosis, but Alice realized from Dr. Cuddy’s perfume that she had been close to both Dr. House and to her maid. The maid admitted she had spoken to the doctors. Alice fired the maid. The patient then dismissed Dr. Cuddy and said she wanted the other doctors back.
Dr. House tried to examine the typewriter ribbon for clues as to the patient’s condition. The doctors saw the patient talking with no one else in the room and confronted her. She said she was just talking to herself and denied she was hallucinating. She then told Dr. Chase he was recently divorced, had slept with a woman last night at her place, and wasn’t returning her calls. Dr. Chase was astounded. She told him she saw the tan line from his wedding ring, and he reeked of cigarette smoke even though his fingers weren’t stained. He also hadn’t showered or changed. She pegged Dr. Taub as a cute man who cheated on his wife. However, at that point, she grabbed her head in pain and her blood pressure and heart rate spiked upwards. Dr. Chase thought it was an allergic reaction to the chelating agent, but Dr. Taub hadn’t administered it yet.
The new blood and urine tests ruled out mercury poisoning. Dr. Chase suggested hemolytic-uremic syndrome, but there weren’t any blood approaching markers in her urine. Dr. Taub thought the talking to herself could indicate delusions, but Dr. Foreman though it was normal for a writer to talk to herself. However, Dr. House realized both the seizure and the blood pressure spike happened when the patient was emotionally upset and they could both be explained by excess adrenaline from a pheochromocytoma. Dr. House ordered an MRI.
The patient agreed to the procedure even though she was claustrophobic. However, as the patient approached the machine, she started screaming in pain and sparks started leaping from her right calf. Dr. Foreman realized she had something metal inside her leg and directed the others to remove her from the room.
An X-ray showed three screws in her right leg from a skiing accident she didn’t tell the doctors about. She suffered third-degree burns and ruptures from heat pressure above the site of each screw. Dr. Taub tried to explain to Dr. House that it wasn’t their fault as the patient signed the consent forms and didn’t tell them about the screws. He reminded them all that everybody lies and that the patient was suicidal and nothing she said could be trusted. In addition, they had to replace the screws and treat her injuries, which wasted most of the day. Dr. Chase said that without the MRI, it could take a week to find the pheochromocytoma, but they only had 39 hours left on the psychiatric hold. Dr. House realized they needed the patient’s cooperation, and hit on the idea of offering the patient assisted suicide if she agreed to be treated. He went to her and filled a syringe, then offered her a choice of cooperating with treatment or injecting herself. He told her that once her pain was gone, she would most likely feel like living. She agreed to the treatment and Dr. House gave her the syringe in the event they failed, and told her it was a good idea to hide it. However, she took the syringe and injected herself in the right thigh.
However, she woke up the next morning. She said she still wasn’t going to cooperate, and expected to be released that day. However, Dr. House said because of her suicide attempt, her hold had been extended another 24 hours. The patient then told Dr. House that the main character of her book series dies at the end.
The review of the PET scans showed no sign of a tumor. They sampled blood from six different areas, but none showed any above normal levels of adrenaline. Dr. Taub noted that without the patient telling them where her symptoms first appeared and where she felt pain, they didn’t know where to look. Dr. Foreman realized the patient would just lie anyway. Dr. House realized again that the new manuscript may contain clues - there is a character, “Aunt Helen”, who appears to be based on Alice. He ordered an ultrasound to look for the tumor.
Dr. House sought out Dr. Carr, who was also a fan of Jack Cannon, and she agreed to use the MRI to see if it could find a pattern in the ribbons. She succeeded and they were able to read the text.
Dr. Chase found something on the ultrasound encased around Alice’s heart, but it wasn’t a tumor - it was a pericardial effusion. However, it didn’t appear on the PET scan done the previous evening. Given there was no sign of a pheochromocytoma, Dr. Foreman thought it had to be a virus. However, Dr. House found a clue in the manuscript. “Aunt Helen” was suffering from joint pain, fatigue, sensitivity to light and depression. “Aunt Helen” kills herself in the book so she won’t be a burden to Jack Cannon. Dr. Taub thinks these symptoms point to Lupus, but Dr. House doesn’t think that’s right, because it isn’t curable. Since Alice will still be in pain, Dr. House is sure she’s going to try suicide again. However, Dr. House orders the patient re-tested to confirm Lupus.
However, after going go-karting with friends, Dr. House realized that Alice had probably broken her leg in a car crash, not a skiing accident. That may have damaged her thyroid gland at the same time. He went to Alice who admitted it was a car crash. He told her she didn’t have Lupus, but what she had was curable - hypothyroidism. However, when she got angry with him for reading her book, she suddenly collapsed and was unable to move.
Hypothyroidism wouldn’t explain the paralysis, even though it fit the car crash. However, Dr. Taub thought of something else that fit a car crash - post traumatic syringomyelia. It would continue to grow over the years and press against her spinal column, causing pain, fluctuating blood pressure and seizures, eventually leading to paralysis and death. However, they should be able to find it and remove it. Dr. Chase pointed out that if they got her medical records from the accident, it would most likely pinpoint the location. When the team complained of being burned out, Dr. House directed Dr. Chase to hire someone new.
However, they team couldn’t find the old medical records, and the patient was also refusing surgery. Dr. House wondered why she didn’t lie about the accident. Dr. House went to Dr. Cuddy, who had already researched doing surgery without her consent, unsuccessfully. Dr. House figured Alice was trying to punish herself - that’s why she didn’t tell them about the pins in her leg. He also told Dr. Cuddy he couldn’t find her old medical records. Dr. Cuddy realized that “Alice Tanner” may not be her real name, and that the records might be under another name. She went to search the database for patients with the type of screw used in Alice’s leg, cross referenced by her age and blood type. Dr. House suggested Alice’s real first name might be “Helen”.
Dr. House went to the patient to tell her he found out that Jack Cannon was based on her son, who died in the car crash. Her real name did turn out to be Helen. She blamed herself for the accident for letting him drive in the rain. Dr. House revealed that her son died of a brain aneurysm, and that’s what caused the accident. Alice agreed to the surgery.
However, Dr. Cuddy realized Dr. House had lied to Alice about the aneurysm, and Dr. House admitted it. Alice soon recovered and was pain free. She also hired back maid.She told Dr. House she still wasn’t going to write any more Jack Cannon books. Although Dr. House was upset that she ended the series on a cliffhanger, she didn’t reveal the truth about her son.