It's a Wonderful Lie
January 29, 2008
Episode Number
4.10 Rating
Final Diagnosis
Atypical presentation of breast cancer
Zebra Factor
Maggie: "You don’t even know what I have."
House: "What you have is one last Christmas with your daughter. One last chance to give her a present. The truth. It‘s inexpensive. Highly valued. You never have to stand in line to return it the day after Christmas."
Maggie: "What are you talking about?"
— It’s a Wonderful Lie

It's a Wonderful Lie is a 4th season episode of House that first aired on January 29, 2008. It is a Christmas episode. House has seemingly met his match when he treats a woman and her young daughter and they insist on being honest with each other. However, when the mother’s case appears hopeless, House pulls off a Christmas miracle. When Kutner suggests a Secret Santa, House decides to both test the cohesion of his team and get a bonus for himself.

Recap Edit

A young girl is climbing a rock wall while her mother Maggie belays her. The girl slips, but her mother has a hold of the rope. However, all of a sudden, the mother can't hold onto the rope anymore and the daughter drops to the floor. They realize the daughter has a broken arm, but the mother is no longer able to move her hands.

Taub is explaining to the rest of the team that the patient has been to several doctors who haven't been able to figure out what is wrong with her hands. House comes in and tears down the Christmas decorations. Kutner denies it was him who put up the decorations, but House figures out it was him by process of elimination. Kutner then asks to hold a Secret Santa. Thirteen tells House that it’s unlikely the patient is lying as her own mother died of breast cancer without telling her about her illness and she was determined not to do that to her own daughter. House tells them to MRI the patient's chest to look for breast cancer despite the patient’s preventative double mastectomy and then goes to speak to the daughter about her mother's drug use. The daughter denies the mother uses anything stronger than marijuana. House cross-examines the daughter about lying when the daughter denies ever doing it. House is surprised by the daughter's candor, however, when she is able to tell him that her mother has sex on her stomach to stop her various lovers from staring at the scars from her mastectomy.

House discusses the necessity of lying with Wilson. Wilson looks at the patient's scans and dismisses the possibility the cancer has recurred. However, the patient has had multiple sexual partners. The team has ruled out an STD, but House thinks it's related. Taub and Foreman go to speak to her sexual contact, who denies doing anything wrong. However, the contact appears to be always thirsty and they diagnose him with the same thing the patient has. He admits to giving the patient Ecstasy and the doctors admit they lied about the diagnosis.

Taub comes back to report about the Ecstasy. House is not impressed that Taub is so straightforward and fearless around him.

They start treatment for Ecstasy overdose. All of a sudden, the patient starts complaining that the lights have gone off. They realize she has gone blind.

The Ecstasy turns out to be pure - no other toxins. Ecstasy wouldn’t explain the onset of blindness days after she took it. Kutner is surprised that House has agreed to a Secret Santa. They choose names and start discussing the case. House orders an environmental scan, including the computer. Foreman thinks it is Kearns-Sayre syndrome, but House dismisses it because of the lack of family history. He allows Taub to test for MS and check for bleeding in her eyes.

They start testing the patient's eyes and discussing why House thought the patient was lying. The patient's eyes look fine, so they aren't the problem.

House tells Wilson the Secret Santa is designed to drive everyone apart. He thinks that buying the wrong gift proves how little they know about one another.

Kutner and Thirteen come back with the patient's computer. Foreman thinks the paralysis and blindness might be a conversion disorder - something psychological. House decides they have to trick her mind. Thirteen opposes it, but they try to convince the patient's daughter to lie to her mother even though the daughter believes her mother won’t lie to her. However, the daughter won't agree because she won’t believe her mother is depressed.

Taub gives the patient a placebo and starts talking about the daughter with the patient while the rest of the team keeps the daughter distracted and talk about the Secret Santa. The daughter mentions that her mother buys the best presents for the teachers with whom she gets along least.

House tells Wilson that his name was the only one in the Secret Santa draw. However, the team has also figured this out, and they get Kutner to agree not to buy House anything.

The patient starts getting worse as her lymph nodes swell so much they cut off her airway.

House figures the swollen lymph nodes rule out a conversion disorder. House goes through the patient’s e-mail until Thirteen stops him. However, House has realized she might have sarcoidosis - she's been cutting back on physical activity. House gets his first present - an iPhone.

The team starts testing the patient, and try to figure out who bought House the iPhone. However, House just stole it from Wilson. Thirteen tells the team to stop speculating who bought it - it was obviously House . However, they realized the patient is now bleeding out of her eyes. They have ruled out sarcoidosis but now fear she will bleed to death. House orders a bone marrow aspiration to determine why she isn't producing platelets. Kutner asks why House got a present when he's his Secret Santa. He then gives House a present anyway.

Chase starts the aspiration by drilling into the patient's bone, but Foreman notes that it is smoking, meaning the bones are harder than the steel drill bit.

They can't find any hot spots in the bone scan that would indicate higher bone density, but Foreman doesn't think Kutner screwed up the test - he believes her entire skeleton has the same high density. Kutner comes up with a diagnosis for this symptom that House rejects until Kutner reminds House that any other cause of the bone hardening would be fatal.

House tells Wilson his gambit worked, the team attacked Kutner thinking he screwed up the test.

Taub tells the patient if they are right she will need a bone marrow transplant from her daughter. However, the patient objects to the daughter donating or even being tested despite the low risk to the daughter.

Taub finds a 5/6 bone marrow donor, but House wonders why the patient doesn't want the daughter tested - she's likely to be a perfect match. Taub gives House a present too. However, Thirteen comes in to say the transplant won't help - the blood test for what they hoped she had was negative. Her condition has to be terminal. Thirteen gives House a present too. House agrees to tell the patient she's terminal, but tells his team they can‘t go home until they have a diagnosis. However, while they search Kutner points out there are dozens of terminal diseases that could account for the symptoms. Kutner apologizes for breaking down and buying a present, but the rest of the team quickly forgives him - it will make House crazy. The daughter comes in to ask for a marrow test.

The patient rejects the prognosis, but House tells her she knows that her daughter's marrow test will show they aren't related. The mother admits she didn't want to have her own kids because they would have the same genetic problems she had. The daughter's biological mother was a drug addict and the patient promised not to tell. The daughter comes in to confront her mother about the prognosis and the mother says the doctors may be wrong. The daughter tells her she’s dying and it's not going to be okay.

House goes to the hospital Christmas party and describes to Wilson all the expensive gifts he got from his team (a watch from Kutner, a vintage LP from Thirteen and a second edition Arthur Conan Doyle from Taub). He then tells Wilson about seeing the daughter be honest - the pure truth of telling her mother she's going to die. He realizes the daughter did it because she cared about her mother. When they discuss the fact that things don't care about what happens to them, House gets an idea.

House starts singing "God Rest Ye Merry Gentlemen" to his team. He orders risperidone, an antipsychotic, and promises a Christmas miracle.

House tells the patient that breast tissue sometimes gets mixed up in the developing fetus and winds up in the wrong part of the body. They rejected breast cancer as a possible cause of bone hardening because they couldn’t find it in her chest. House injects her with the respiradone, which causes milk-producing tissue in her body to swell. They find milk producing tissue behind her knee. House orders surgery and chemotherapy.

House's new team meets with Chase and Cameron for a party while House heads out alone.

Clinic Patient Edit

A woman comes in complaining of a sore throat and stomach pain. House diagnoses her with strep throat. She worries about it being contagious, and House figures she's a prostitute worrying about passing it off to clients because she's wearing a St. Nicholas medal and, among other things, Nicholas was the patron saint of prostitutes.

However, the patient comes back. She has a rash on her neck. House thinks it is gonorrhea, but she says there is no rash on her labia. Her lips also look like she has lipstick although she's not wearing any. The only disease that would cause it would be from an equine animal, like a donkey. House quizzes her about it, suggesting she contracted it from participating in a donkey show, and she admits to having recent contact with either a donkey or mule. House diagnoses her with contagious ecthyma, a form of streptococcus. House prescribes an antibiotic crème, and the patient invites him to her show.

Later, House goes to see the patient’s show - she's playing the Virgin Mary in a nativity play and appears to be sitting on a real mule.

Major Events Edit

  • The hospital celebrates Christmas.
  • Lawrence Kutner, Chris Taub and Thirteen officially start work as House's new diagnostics team.

Zebra Factor 2/10Edit

Breast cancer is the leading cause of death from disease in women the patient’s age, although the presentation was a strange one.

Cultural References Edit

  • The title is a reference to the 1946 film It's a Wonderful Life.
  • St. Nicholas was a 4th-century bishop who, among other things, served as the inspiration for Sinterklaas (a gift-bringer in the Netherlands, Belgium and parts of Germany), one of the origins of Santa Claus.
  • Red Ryder BB Gun is a reference to the 1983 film A Chrismas Story.
  • More about Satanism and Druids. Wilson’s wish of “Happy Solstice” to House plays to House pretending to be a Druid as the solstices were important dates in pre-Roman Britain.
  • The second edition Conan Doyle House receives is another reference to Sherlock Holmes
  • A Dreidel is a toy top associated with Hanukkah.
  • The song playing during the Nativity play is Who Took The Merry Out of Christmas by The Staple Singers
  • "A love glove for Francis" refers to Francis the Talking Mule, a character featured in several Universal-International film comedies during the 1950s.
  • The sound clip that starts when Thirteen asks "who's going to tell the patient she's dying" is a combination of the song "Sun King" and "The Little Drummer Boy"
  • Upon receiving the final diagnosis Maggie says to her daughter, "I love you." Jane responds "I know." This may be a reference to the famous exchange between Han Solo and Princess Leia in Star Wars Episode 5 the Empire Strikes back.
  • This is one of several episodes where the opening scene suggest the wrong character will be the featured patient.


The doctors confuse osteopetrosis, a genetic disease which does cause greatly increased bone density, with diffuse bone metastasis, which also causes increased bone density.  In a female patient presenting with increased bone density, breast cancer should be part of any competent differential diagnosis, particularly when the patient has no family history of osteopetrosis but does have a family history of breast cancer.



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