House was describing Vince's case to his team. Vince had a fever of 103F and House had been so amused by his attempts to talk he asked him irrelevant questions. Foreman was sure it was an infection, toxin or allergy. He had assumed that House had given him epinephrine and that ruled out allergies, so that meant giving him antibiotics and keeping him overnight just to make sure he got better if was a toxin.
At that moment, Jack Moriarty, who claimed to be a former patient, shot House twice.
After the shooting, House thought he was awake but he was actually unconscious and hallucinating. "Cameron" told him he had been out for two days. He asked about Vince and was told they had done a biopsy of his tongue and House realized that the biopsy and blood tests were negative - they had ruled everything out or why else would they do a biopsy? He also realized Vince had increased intracranial pressure. Cameron figured out the reason House knew that - a lumbar puncture would have been a definitive test and the only reason they couldn't do one was increased pressure. He told Cameron to "take out the trash" and Cameron realized he was referring to the lymphatic system. He ordered a biopsy of the lymph node beneath the jaw.
The "team" reported back the biopsy was negative and they had to a tracheotomy to let Vince breathe. They had started broad spectrum antibiotics with no effect. House ordered the lumbar puncture despite the risks. "Foreman" objected but "Chase" pointed out that given the patient's current condition, it was worth the risk. House said he couldn't have said it any better.
House met the patient's "wife" who was observing the lumbar puncture. He told her it was most likely an STD. She realized that House wanted her to admit to an affair, but she denied having one. House watched as the LP was successful and uneventful, but the patient's eye buldged out of his socked due to the pressure of blood in the socket. Suddenly, the eye popped out and sprayed blood.
They eye popping out made House think it was a bleeding disorder, like a weakness in the occular veins. Cameron suggested a bleeding granuloma in his sinuses due to Wegener's disease. However, Chase pointed out they would have noticed it during the operation to repair the eyeball. House thought that since the nose wasn't affected, the eye and tongue were being affected by a common source - the brain. He told them to check the brain's trash system. Chase pointed out the lymphatic system doesn't reach the brain, but Foreman realized he meant the blood-brain barrier. House ordered the biopsy, but Cameron wanted to be more careful and eliminate other possibilities. House agreed to albendazole in the event it was parasites and Foreman suggested levofloxacin, another antibiotic. Chase wanted to use erythromycin for possible STDs. However, House thought the STD medication was a waste of time because he didn't think the patient was cheating on his wife. However, Cameron pointed out Vince wasn't married - he's a widower.
House realized he had hallucinated the wife. He was afraid his perceptions and judgment were compromised, perhaps permanently from the surgery. "Wilson" tried to reassure him. House went to confront "Cuddy" about her use of ketamine during the surgery and she asked him if he had any neurological symptoms like hallucinations. However, he denied it.
The blood-brain barrier biopsy was also negative, although there was blood on the wrong side of the barrier. House realized that blood on the wrong side would be treated like a foreign object by the immune system and cause the fever. Foreman realzied that meant cancer. House ordered them to find it. He started making another metaphor about your trash cans being full and dumping your trash in the neighbor's garbage, but it's daylight so you have to go around the back way. Chase realized he was talking about the lymphatic system in the chest. House was impressed he got it so fast, but Chase pointed out it was obvious - the saliva glands in the tongue are connected to the lymphatic system in the lungs. He went to get a biopsy of a lymph node in the lungs. Moriarty suggested that perhaps Chase got it so fast because the question wasn't that tricking and House was getting dumber.
When Cameron and Foreman came back, House realized the biopsy was negative. However, Chase soon reported that Vince's scrotum had swollen up with blood and burst when he tried to urinate after surgery. The surgeons repaired the damage, but found no sign of a burst artery. Chase thought it might be trauma, but that wouldn't explain the tongue and eye. House thought the blood may have come from the kidneys, but Cameron pointed out that was impossible - there is no connection between the two. Foreman realized it could be testicular cancer. House wondered why he didn't think of it and how he got basic anatomy wrong. He was afraid the ketamine had affected his brain and he soon realized he was hallucinating.
However, the team reported the tests for testicular cancer were all negative as well. However, a cystoscopy was negative as well. Foreman suggested bacterial prostatitis,He ordered them to find out if he trouble urinating or was the offspring of an incestuous relationship and do a prostate biopsy. When Cameron pointed out cutting though his stomach to do the biopsy would cause more bleeding, Foreman pointed out that they had no clear diagnosis. Then House realized he couldn't remember how they all got in the stairwell.
He went to Cuddy to remove himself from the case. He admitted to having blackouts. However, he asked Cuddy why she jumped up and she said it was because he was violent the last time he was there. However, House realized Cuddy was talking about his previous hallucination which meant this was a hallucination as well. He found himself back in intensive care and then outside with Moriarty. He wondered how he could tell the difference between his hallucinations and reality. Moriarty suggested he only come up with ideas and not take any actions. He realized he had to trust his team.
The patient's tests were negative again for blood in the prostate and structural abnormalities. House asked them what their assumptions were. Cameron said they assume the tests are right. House asked whether they could even trust the biopsy. He likened taking a representative sample to dipping a cup of water into the ocean and saying the ocean had no fish when it came back without them. He thought they needed to delve in deeper - exploratory surgery. However, if he had a bleeding disorder, surgery would kill him. House suggested using the robot to do the surgery because it would cause less bleeding. They managed to convince the patient by demonstrating its capabilities on Cameron withough actually cutting anything other than a button off her blouse.
However, during the procedure, House walked into the operating room even though he wasn't sterile. He asked the team why they hadn't tried to have him removed from the case. He wondered why they were always on board with what he wanted to try, and why they seemed to have identical knowledge. He thought that the entire episode was a hallucination. He tried to grab the robotic controls and Chase stopped him. House asked him why and Chase said it was because he was going to try to kill Vince. House said the only way Chase could know that was if he knew what he was actually thinking. He realized that as long as the delusion made sense, it would continue. He grabed the surgical controls and ripped into Vince's body, killing him. The vital signs monitor flatlined. House was shocked at what he had done, and thought he had made a mistake, but suddenly Vince dropped a bullet out of his hand. House went over to see it and suddenly he came back to consciousness on a gurney being rushed into surgery. He asked for ketamine.