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Captain Cooper became disoriented in an aircraft simulator, crashing it. She sought out Dr. House for diagnosis and treatment, offering him $50,000 in cash to diagnose her on a confidential basis. Dr. House wondered why she didn't ask her insurance company to pay. She told him she had applied to be an astronaut and if any negative information about her health was discovered by the Air Force, her career as an astronaut would be over. Dr. House agreed to help her and asked what her symptoms were. She confided in him that she had been hearing things with her eyes
Dr. House brought the case to his fellowship applicants, telling them the patient was suffering from synesthesia. He told them that they were not allowed to keep a chart and any test results had to be destroyed. He use the code name "Osama bin Ladin" for the patient and introduced her. Number 39 asked if the synesthesia was new, and the patient confirmed it was, but she had suffered from no similar symptoms or mental illness. He asked if she was using any illegal drugs or pharmaceuticals, but she denied it. He asked if her answer on the point was trustworthy, and Dr. House assured him that he would not have taken her case if she was merely an addict. Number 24 asked if anyone close to the patient had been sick lately, but she denied it. Number 13 asked if she spent much time above 25,000 feet - immobility could cause a clot in the leg that could have embolyzed into a PFO. Dr. House confirmed the patient flew frequently. He ordered Number 13, Number 32 and Number 39 to do an EEG, MRI and angiogram. He ordered some of the other applicants to test her blood and stool. He ordered others to do a lumbar puncture and blood cultures. He ordered Number 26, Number 2 and Number 10 to do an environmental scan.
Number 39 reported that there was no sign of a clot and the only remarkable result was a high red blood cell count. That could indicate carbon monoxide poisoning. When Number 39 suggested that it could be a number of other things, Dr. House informed him that the environmental scan team found a damaged fireplace flue. He directed Number 24 to put the patient in a hyperbaric chamber.
Number 6 explained to the patient that the pressured oxygen would flush carbon monoxide from her system, but it would have to be done over time to prevent oxygen toxicity. All of a sudden, Captain Cooper's heart rate rose to 204 and she passed out. Number 24 realized it was tachycardic arhythmia and Number 18 called a code blue and started CPR. However, Number 6 grabbed the defibrillation paddles and, despite Number 18's warning about using them in an oxygen rich atmosphere, shocked the patient's heart back into sinus rhythm. However, he also set the patient on fire. They managed to extinguish the fire, but the sprinklers went off.
They started Captain Cooper on nitroglycerine and blood thinners. Her electrolytes and EKG were normal, ruling out the possibility that the oxygen environment caused the heart attack. Dr. House asked for a new differential. Numbers 15A and 15B started arguing whether it was Takayasu's arteritis or Whipple's disease. Dr. House rejected both diagnoses. Number 26 suggested cardiomyopathy, which might throw clots to both the heart and brain. Dr. House ordered Number 26, Number 13 and Number 2 to a trans-esophageal echocardiogram.
Number 26 prepared the patient, but asked Number 2 to do the procedure because he didn't think someone his age would impress Dr. House by doing another echocardiogram. Number 13 agreed to do it. However, the echocardiogram was normal - structurally sound with no clots, no valve defects and no wall motion abnormalities. She did have a short burst of atrial flutter, so Number 13 ran a rhythm strip twice with the same result. She suggested it might be hormone overproduction. However, he did wonder why Number 26 let Number 13 do the procedure. He directed Number 10, Number 24 and Number 39 to run a TRH stimulation test for hyperthyroidism. Number 2 warned him that this could cause another heart attack, but Dr. House said that if it did, it would confirm the diagnosis.
Number 39 explained to the patient that the hormone injection might make her flush or sweat, but these were normal reactions. The patient's heart rate remained constant. Number 39 asked why there were so many restrictions on them because it made diagnosis harder. She complained of being warm, then when they discussed her case, she became agitated, worrying that they were going to tell the Air Force about her. Number 24 realized her pulse and blood pressure were too high. She started exhibiting synesthesia, paranoia and psychosis and locked herself in another room. They paged Dr. House.
Dr. House wondered what he could do when Number 39 reminded him that if they broke down the door, security would come and they would have to start keeping records on her. Dr. House exhorted the applicants to try to bring pressure on her to give herself up. Number 10 threatened to break down the door, but got no response. He then told her she would die, but she just told him to go away. Number 39 realized she didn't care if she died, and then threatened to blab her secret. She said he didn't know anything, but Dr. House said he did. Captain Cooper burst out of the room, and the applicants subdued her and sedated her. Unfortunately, Dr. Cuddy came by and asked who she was.
Dr. Cuddy came to the lecture hall and demanded to know who she was. Number 10 told Dr. Cuddy her name was Greta Cooper and she was an astronaut trying to hide her condition from NASA. He found out her name when he did the environmental scan. She went to Dr. House to demand that he start keeping charts and that she be copied on all tests and requisitions. He went back and fired Number 10.
Dr. House started a new diagnosis Number 37 suggested high blood sugar from thyroid problems. However, her thyrotropin was only 1.3. Number 24 suggested a liver disease because her ALT levels were at the edge of the normal range - it could be cancer and paraneoplastic syndrome. She wanted to do an MRI. However, Dr. House informed them they couldn't perform any procedure that had to be charted because the patient wouldn't consent.
Dr. House went to get a consult from Dr. Wilson as to how to test the patient's liver without scan. Dr. House suggested palpitating the area around the liver, but Dr. Wilson pointed out that wouldn't work unless the tumor was huge. He realized that he could test the patient's liver by stressing it.
He went back to the applicants to ask how he could stress the patient's liver. Number 13 suggested giving her Vitamin D and putting her in a tanning booth. She would go into a coma if it were a metabolic problem. Dr. House was impressed, but noted it wouldn't be definitive as the kidneys also metabolize Vitamin D. Number 6, who had recently been fired, came up with the idea of giving her alcohol until she passed out. If it were too fast, it would indicate a liver problem. Dr. House re-hired him.
Dr. House convinced Number 18, a Mormon, to be a control subject for the test as he was the only non-drinker. Dr. House, a heavy drinker, and Number 13, a moderate drinker, also participated as controls. All of a sudden, Captain Cooper had trouble breathing. Number 18 wanted to intubate, but the patient refused to cooperate. Instead, Number 13 took her to a treadmill and gave her oxygen, charting it as a stress test.
Dr. Cuddy confronted Dr. House about performing a tooth density scan and several tox screens. He said the former was to test for hypocalcemia and the latter was to ensure she wasn't using amphetamines.
Dr. House found Number 13, Number 18 and the patient in the treadmill room. He put on his stethoscope and started percussing her chest. It is possible to work out structural detail and small deep masses in this way. He finished and told the patient she had either lung cancer or tuberous sclerosis. They had to do an invasive surgical biopsy of her lungs. However, she refused consent because it would leave a scar and NASA's doctors would see it. Dr. House tried to get her to consent, but she refused, saying she preferred to die. She told him to find another way.
Dr. House asked his applicants for suggestions on how to trick the patient into agreeing to surgery. Number 18 said the problem wasn't the surgery, but the scar. He asked Number 39, a plastic surgeon, if they could be hidden. However he did suggest giving her a breast enlargement - the incision was in the same place and would give them access to the lungs. The patient initially resisted, but consented.
Dr. Cuddy wondered why they were performing a breast enhancement and threatened to stop the surgery unless she was told why. However, she backed off once Dr. House told her the reason would make sense.
Number 39 made the incision and they took a look inside. They counted at least three cysts on her lungs. Number 13 thought it was alveolar hydatid disease, but this would have caused seizures. Number 39 thought it might be pulmonary Langerhan's, but this would not explain the high red blood cell count. Suddenly, Dr. Chase appeared in the observation room and suggested Von Hippel-Lindau Syndrome. If she had a pheochromocytoma, it could also explain the neurologic episodes and heart attack. When Dr. House realized that it really was Dr. Chase, he asked why he was in an off-limits area. Dr. Chase pointed out it wasn't off limits to PPTH surgical staff, and he had just joined. Dr. House realized he was right, but assured the rest of the applicants he wasn't going to hire him. He ordered Number 39 to remove the cysts and get a histology report to confirm.
Number 6 explained to Captain Cooper that although she could be treated, there was no cure. The cysts would keep coming back. They told her that she had to tell NASA. Dr. House arrived to tell her he had already informed NASA, but they didn't understand the condition and wouldn't be revoking her astronaut status.
However, Dr. House later told Dr. Cameron that he really didn't call NASA on the patient. She admitted she was the one who gave Captain Cooper his pager number. Dr. House felt her knowledge of her condition made her safer than someone with an undiagnosed condition, but she thought that Dr. House just didn't want to destroy her dreams.