House rules

I’ve been watching a lot of detective shows lately, and nothing comes close to House.  In the future I will try to specify why this show, while containing all the formula, devices and cliches of every detective show and every medical drama manages to be more than the sum of its parts.  But for now I’d like to analyze a single episode to parse the dense, intricate twists and turns that make it electrifying television.

I could have chosen any episode at random but I was taken by the extra-twisty structure of an episode from Season 2, “Sex Kills.”

PRE-TITLE SEQUENCE: A young woman, Amy, plays bridge with her father and a group of her father’s friends.  She is clearly out of place and uncomfortable in this company, in this activity.  Many glances and innuendoes flutter through the air.

Amy suddenly feels ill, says she’s nauseous.  Is she pregnant?  Is she pregnant by one of the elderly men at the bridge game?  Is she pregnant by her elderly father, played by the only “name star” in the episode, WKRP‘s Howard Hesseman?  Amy gets up to use the bathroom.  Her father stops her.  He’s concerned.  He knows something.  He grabs her arm.

Then, out of nowhere, he freezes and the camera goes into his eye and we see something go blooey inside his brain.  He’s having a stroke or a seizure or something.  Ha!  The show’s not even two minutes old and already we have TWIST #1.  The patient of the week isn’t young Amy, it’s her elderly father!

Now then — the show just teased us with the possibility of a young woman pregnant by her own father, then pulled the rug out from under us.  That means that whatever is wrong with the father is more shocking, more disturbing, more interesting than him impregnating his daughter.


1. The father is admitted to the hospital.  He has had an “absence seizure” and has also complained about having acid reflux for years.
2. The weekly “differential diagnosis” scene: Foreman says the father has all the symptoms of testicular cancer.  House says that that can’t be right because everyone is wearing the wrong shoes and goes on to clarify: if Foreman thinks the father has testicular cancer merely because he has all the symptoms of testicular cancer, then there’s no reason to be having this meeting and the team would all be out bowling.  Rather, House believes that the father has a micro-abcess in his brain.  “When guys have brain/crotch problems, it’s usually the result of using one too much and the other too little.”  The shift from testicular cancer to micro-abcess would be an act-break twist in another show, here it goes by in a heartbeat and is never mentioned again.
3. The “personal” story of the week: House believes that his friend Wilson is having an affair with someone on the hospital staff.  He’s been acting strangely (at least strangely to House’s Holmesian-level deductive mind), not spending enough time at home, buying foreign chocolates. (“Norwegian chocolates!  Frankly, if you buy that stuff the terrorists win,” grouses House.)
4. The B-story: a teenage boy in the clinic wants House to prescribe to him a high dose of Depo-Provera, which, we learn, will chemically castrate the boy.  Why does the boy want this?  He cannot stop himself from having sex with cows.  House believes that the young man has been put up to this by his frat buddies and writes a fake prescription for him to show his friends.
5. Foreman tells the father that they think he has a sexually transmitted disease.  The father says he hasn’t been sexually active, he broke up with his wife (who is Amy’s mother) months ago.  I’m not sure how we got from “micro-abcess” to “STD” but then I’m not sure what a “micro-abcess” is in the first place.
6. Foreman reports to House with the father’s answer and House scoffs at him.  The father’s lying, everyone has sex.  He shouts across a crowded lobby to Wilson:

HOUSE: Wilson!  How long can you go without sex?
WILSON: How long can you go without annoying people?

7. With Amy out of the room, House confronts the father:

HOUSE: I hear you’d rather die than admit you had sex.
FATHER: I’m sorry, I couldn’t tell my daughter.
HOUSE: Right, because she’s, what, 22?
FATHER: I, I slept with her mom.
HOUSE: She probably knows that happened already.

The father explains the breakup he had with his wife and how they got back together for a one-night stand following a cheese festival.

FATHER: I assume you’ve been in love.
HOUSE: Is that the one that makes your pants feel funny?

Now then: the cheese becomes important later; note how skillfully the writer hid his clue amid two sure-fire comic exchanges so we wouldn’t notice it.  I’m going to count “Father gets STD from ex-wife, who he isn’t supposed to be seeing” as TWIST #2.

Amy comes into the room as House isgiving the father a shot and asks what’s going on.  The father admits to his daughter that he’s got an STD but he lies about where he got it from and House covers for him.  The tension is somewhat released by this transmission of information, but then the father suddenly starts coughing blood as we go to commercial.  (Diseases on House must contain at least three shocking, sudden, unpredictable, life-threatening symptoms, one for the end of every act break.)


1. So, it’s not an STD after all.  TWIST #2 has barely settled and already we’re onto TWIST #3 as the mystery starts all over again.  The gang hold a second differential diagnosis, and we get a healthy chunk of the rapid-fire, Apollo 13-level of jargon: “It’s a flash pulmonary edema,  we’ve taken a liter of fluid off but the problem wasn’t with his lungs, it was with his heart — there are vegetations obstructing his mitral valve.”  I nod sagely as though I have any idea what Dr. Cameron just said because, well, because Dr. Cameron said it and I like looking at her face and keep hoping she’ll say more.  “A disease that attacks the brain, heart and testicles,” muses House, “I think Byron wrote about that.”
2. House confronts the father again.  This time he’s asking about the cheese from the cheese festival.  He feeds the father some cheese laced with bacteria and the father says he recognizes the taste from the cheese he ate the night he slept with his ex-wife.  House explains that the bacteria is around all the time but mostly our stomachs combat it.  Because the father was taking antacids for his acid reflux (aha! and you thought the acid reflux was a red herring!) the stomach acids could not neutralize this cheese’s bacteria and the father has come down with a sheep-cheese disease, brucellosis, TWIST #4.
3. As the father gets treated that night, House hangs out with Wilson, accusing him again of having an affair.
4. The treatment on the father does not go as expected.  His heart stops beating and they must use the defibrillator on him — and it’s only Scene 4!
5. Meanwhile, House and Wilson continue their conversation about Wilson’s supposed infidelity.  Wilson is growing tired of this hectoring and we in our homes wonder how long Wilson has been friends with this pushy, thorny pest that he puts up with this kind of interrogation.
6. The gang confer and explain the heart attack.  It was brucellosis, but they got to it too late.  A piece of vegetation broke off in the father’s main artery and caused an infarction (again, I’m going to pretend I know what that is).  The father now needs a heart transplant — once he’s got that, he’ll be a healthy man and be ready to go home.  Ordinarily, the gang on House makes two wrong diagnoses before they hit on the right one, which would ordinarily count as a twist in and of itself, but wait.
7. House goes to the heart-transplant committee and argues for his patient’s case.  The committee says the man is too old, and House responds with sarcasm and character assassination, which doesn’t help his case any, and the committee turns him down.
8. Foreman breaks the bad news to Amy and her father.
9. House comes up with a scheme: get the files on everyone who’s died in the hospital recently — maybe someone whose heart is deemed “not viable” will die and they’ll be able to use the heart for Amy’s father.
10.  Return to B-story: the “Boy Who Loved Cows” has returned, saying that he tried to have sex with a cow and was kicked in the ankle by his beloved.  House, in no mood to listen to this kid, believes him even less this time and threatens him with a series of painful, humiliating tests.  The kid takes the dare, toHouse’s surprise.
11. House and Cameron discuss everyone who’s died in the hospital today.  One of the deceased is a baby, prompting House to gripe “Babies are useless, they’ve got hearts the size of ping-pong balls.”  There is one hope: an overweight woman in a car accident is currently in the ICU and doesn’t look good.  House crosses his fingers and hopes she dies.
12. And the act isn’t over yet!  House goes to the ICU as the woman in the car accident lies dying on the operating table.  The woman’s husband is understandably distraught as House gently but insistently probes him about her medical condition, which included a slight fever and stomach pains, none of which seems very important now that she’s dying from a crushed skull.  The fever and stomach pains turn out to be important later, and this time the writer skillfully places the clues inside an incredibly high-stakes scene, where the woman is dying, the husband is distraught, he thinks House is his wife’s doctor, House does not dissuade him, and in the middle of it, a woman comes up to the husband to assure him that his wife’s organs are going to be treated with the utmost respect.  The husband becomes apoplectic; this is the first he’s heard that his wife has died.  This is a bad situation indeed.


1. The gang need to get the overweight woman’s file.  If her heart is deemed “not viable,” they need to know why.  House hacks into her file to find out what she was sick with — Foreman says she had Hepatitis C.  And slowly the reality sinks in, this is TWIST #5: the show isn’t even about Amy’s father any more.  Like Die Another Day, “Sex Kills” is going to change villains halfway through, just as they changed protagonists halfway through the pre-title sequence.  The show is no longer “what is wrong with Amy’s father,” that was just a warm-up, the show is “what was wrong with the overweight woman when she crashed her car?”  The fact that Howard Hesseman, the nominal “guest star,” vanishes half-way through the episode almost qualifies as a twist all by itself.
2. In the ICU, the tearful husband prepares to pull the plug on his clinically-dead wife.  House strides in and turns the machines back on.  The husband is furious.
3. House and the husband go to Cuddy.  House argues for using the wife’s “not-viable” heart for Amy’s father, the husband has had enough of House and his shenanigans and says that he’s going to take his wife off life support.
4. The husband runs into Amy in the hallway.  Amy, knowing nothing of what’s just happened, thanks the husband for giving her father his wife’s heart.  The husband, put on the spot, tells Amy that he’s not giving her the heart.  House comes along and says:

HOUSE: Hey listen, you take your wife off life-support and I’ll have forgotten about this in two weeks.  Gail here on the other hand —
AMY: Amy.
HOUSE: Whatever.

He tells the angry, churning husband not to be angry with Amy but to take it out on him instead.  The husband takes House at his word and  swiftly knees him in the chest, knocking him to the ground, then tells Amy he’ll let her have the heart.
5. Someone (Chase?) tells Amy’s father that if the dead woman’s heart is not viable, he has perhaps three days to live (one of the best features of House is the relentless use of ticking clocks, sometimes more than one in a single episode).
6. So, now that that’s settled, how do you diagnose a dead woman?  What did she die of?  Chase suggests a gall-bladder infection.
7. The team performs an MRI on the dead woman as the husband begins to soften on House: “He must be brilliant; if you’re that big of a jerk you’re either unemployed or brilliant” he muses.
8. The dead woman does not have a gall-bladder infection — she has a mass.  I’m going to go ahead and call this TWIST #6, although the decision for the husband to give his wife’s heart to Amy’s father is probably TWIST #6.  So to be safe we should call this TWIST #7.
9. And the Boy Who Loved Cows is back for his third and final scene.  House still doesn’t believe his story about the cows and the boy finally reveals the truth.  He has a step-mother who is barely older than himself and who parades around the house in a bikini — or less, as TWIST #8 comes home to roost.  The boy is horrified by his sexual attraction to his step-mother and the viewer is satisfied by the inversion of the situation hinted at in the pre-title sequence.  House doesn’t see the crisis in being attracted to one’s step-mother, it hardly seems to count, it’s not the boy’s real mother after all, but he’s essentially a pragmatist at heart, not a moralist, and he gives the young man the drug he needs.
10. House needles Wilson about his personal life again and Wilson blows up at him, questioning House’s friendship.  House does not take kindly to Wilson’s attack and turns it back at him.
11. The treatment on the dead woman (for a gall-bladder infection) is not working and her condition worsens.  House gives up, but now the husband is the one who won’t let her die.  In TWIST #9, the gang stare slack-jawed as the husbands demands that they find out what was wrong with her and give her heart to Amy’s father — it’s the only way her death will mean anything.


1. The gang confer over the dead woman.  What to do?  Should we operate?  House grimaces: “She’s a fridge with the power out — we start poking around inside the vegetable goes bad.” Then, noticing the husband standing nearby, “No offense.”
2. House and the husband go to the husband’s house and poke around (a standard scene on episodes of House, usually done without the patient’s permission).  House asks the husband if his wife kept anything from him and the husband insists that she had no secrets.  When House turns up diet pills and hair coloring, neither of which the husband knew about, the husband sadly shakes his head and muses that “you never really know anyone.” This becomes an important moment later but there’s no way to predict why.
3. Amy’s father is dying as the tension rises.
4. House and the husband come back to the hospital.  Cameron comes from the dead woman’s workplace, where she’s found Polaroid photos of naked teenage boys.  House isn’t interested — “teenage boys aren’t toxic” he says (as my wife snorts “They aren’t?”).
5. House guesses that perhaps the dead woman had gonorhrea, that she got perhaps from sex with teenage boys?  (conceptually linking the boy from the B story to the dead woman from the A story.)  The gonorhrea caused her fever and stomach pains, which made her crash her car, which killed her, which made her heart available for Amy’s father.
6. Cameron tests the dead woman for gonorhrea, does not tell the husband she’s doing so (mirroring the Act 1 scene of House discussing the STD with Amy’s father while Amy is out of the room).
7. The dead woman tests positive for gonorhrea as Amy’s father goes into a coma.  House orders two ORs for the heart transplant; Cameron objects, saying that the dead woman’s still has gonorhrea in her system.  “And tomorrow, it’s going to be in his system,” House says of Amy’s father, noting that it’s better to be alive with gonorhrea than dead without it.  Which is as pragmatic and moral a lesson as this episode has to offer humanity.
8. The dead woman’s body is rushed to the OR and House, in a minor TWIST #10, lies to the husband about what was wrong with his dead wife.
9. Another staple of House, a grisly, realistic operating-room scene, involving none of the main characters, just like in a real hospital.
10. Cameron watches the operation with the dead woman’s husband.  As soon as it becomes apparent that Amy’s father will live, Cameron starts to tell the husband that his wife had gonorhrea.  The husband cuts her off, telling her, in TWIST #12, that he gave her gonorhrea, that he was the one who strayed in their marriage (the Polaroids of the naked teenage boys were a red herring!  Curse you, Polaroids of  Naked Teenage Boys!), who lied, who gave her the disease that ultimately killed her, without her ever knowing she had it.
11. Amy’s father is all better.  And who comes to visit him?  His ex-wife, who wants to get back together with him.  And we remember that this all started because we thought Amy’s father had gotten an STD from this woman, but no, it wasn’t the sex or the cheating that caused Amy’s father’s problem, it was the brucellosis in the cheese.  In minor TWIST #13, Amy tells her father that he must wear a condom if he has sex with her mother, since he now has the dead woman’s gonorhrea.
12. That night, House, alone in his house (no hookers tonight, ironically), listens to a recording of what sounds like an ancient bluesman singing “Honky Tonk Women” (another staple of House — recordings I cannot identify but want desperately to own).  The doorbell rings — it’s Wilson.  House was right — he is having marriage problems.  But, as per the theme of the episode, in the FINAL TWIST, we learn that Wilson is not the one fooling around — his wife is.  He has walked out on her and come to House’s, um, house, to sleep on the couch.  House, often mistaken, never wrong, shrugs and asks “Want a beer?”

Next, I will try to examine the tumult, hue and cry of this show and determine why it works when other shows of equal quality do not.

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19 Responses to “House rules”
  1. mcbrennan says:

    There aren’t that many clever twists in all the stories I’ve ever written combined. How do they produce that on a weekly basis? And so fearless. So unafraid to go to dark, twisted places and to not emerge with Uplifting Life Lessons. I don’t know how they do it. To incorporate that level of medical knowledge (at least sufficient to achieve bare plausibility) and then to have the skill to regularly subvert (or invert) the almost mandatory dramatic conventions of TV mysteries/medical shows.

    Excellent breakdown. I’m especially looking forward to your analysis of why it works. I’ve been a big fan of Hugh Laurie for a long time and I don’t think the character would work without him, but the writing…humbling to the point of being depressing. I suppose it’s not too late for me to take up knitting.

    • Todd says:

      There aren’t that many clever twists in all the stories I’ve ever written combined. How do they produce that on a weekly basis?

      I sure don’t know. And I would say that this is an average episode.

  2. eronanke says:

    Produced by Brian Singer, acted by Hugh Laurie.

  3. ghostgecko says:

    House is pretty damn awesome. What I think sets it apart from something like Chicago Hope or ER is that it focuses on the illness and not the characters. ER was a sophisticated soap opera punctuated by hospital scenes which, although more technically accurate than something like General Hospital, were still B storyline.

    It’s when House strays from medical mysteries into the regular characters’ personal lives that it stumbles. CSI has the same weakness. To me at least, the intricacies of medicine are FAR more interesting than the same old quotidian romantic triangles you see on other shows.

  4. gretchdragon says:

    I started watching House in January of this year because I heard the ratings were so awesome. Hugh Laurie really brought Greg House to life; I can’t imagine anyone doing a better job with the character.

    Unfortunately for me we have several friends who are doctors, and my husband studied biochemistry and is pretty hip with a lot of medical knowledge, so the medical portion of the show is strained at best for me. Our doctor friends feel the same way; Hugh Laurie is great, but the medical portion of the show sucks. It requires great suspension of disbelief; while watching the series you’ll be simply AMAZED at how many times they end up taking brain samples or go into the brain, and it seems that everyone on the staff is fully capable of performing a brain biopsy (something that would never happen in RL). CSI did a much better job of researching their topics; the episodes on combat robots and furries were both well researched and factually presented (if anything, the one with the furries was sanitized for the public!).

    Despite that, I love House. Then again I loved Sherlock Holmes as a child, and House is essentially Holmes with a complete absence of a social filter and a really crappy attitude. People are House’s playthings; his favorite hobby is watching what makes people tick, what makes them react, where their buttons are. Why do they believe what they do? Of the shows we watch (Lost, Battlestar Galactica, SG-1, Bullshit, House, 24, Heroes) this one makes me consistently put down my knitting and actually watch the show so I can solve the clues while at the same time enjoying the beautifully shot scenes….it’s no secret that this particular show makes great use of colors and unusual shots.

    • greyaenigma says:

      Not to mention that some huge percentage of the doctors’ interaction with the patients would actually be done by nurses.

      But that’s a perennial dramatic problem — any expert in anything dealt with in entertainment seems destined to be disappointed, if not outraged by the inaccuracies.

    • laminator_x says:

      If only the furries themselves had been sanitized.

  5. greyaenigma says:

    I can never understand why Wilson is such good friends with House. Is it just because they’re peers? Is it just that Wilson is so chronically nice that he feels like being a friend to a jackass who nonetheless is a good doctor? I’m chronically nice and I wouldn’t put up with a friend like that.

    i do like that the show will toss out these wild medical terms, although it simultaneously frustrated because I want to know, but that’s my limitation.

    Twists — shows that have twists all the time have something of a dilemma because we then expect the twist (even if we don’t necessarily know what it is. And there’s something less than entirely satisfying in expecting a twist. I expect it helps when your get half a dozen or so twists per show.

    • Todd says:

      i do like that the show will toss out these wild medical terms, although it simultaneously frustrated because I want to know, but that’s my limitation.

      I am a medical troglodyte, but I described the show to two regular people who had not seen it and they had no problem following terms like “pulmonary edema” and “cardial infarction.” It seems there is a large swath of American TV-watchers who keep up on medical stuff the same way there are people who keep up on political stuff or history stuff or real-estate stuff or cooking stuff.

      shows that have twists all the time have something of a dilemma because we then expect the twist (even if we don’t necessarily know what it is.

      That’s where the esoteric medicine of House comes in handy. Who could possibly see a twist coming that involves vegetation breaking off in a man’s mitral valve?

      • greyaenigma says:

        It seems there is a large swath of American TV-watchers who keep up on medical stuff the same way there are people who keep up on political stuff or history stuff or real-estate stuff or cooking stuff.

        By pretending knowledge? I’m sure there are people out there who know what “pulmonary edema” and “cardial infarction” mean, but I don’t, and my siblings are medical experts and I tend to know things. (Well, slightly above the norm, at least.)

        But I agree that the inscrutability of the medical jiggery-pokery works to its advantage — the medical MacGuffins drive the plot, with most of the audience just nodding along and eating it up like so much brucellosis-infested cheese.

  6. teamwak says:

    I totally love House, and I think season 3 is a real standout. The ending!!!!!

    However, is it me, or do the producers concentrate on children or teens and sex quite often? Even if the primary concern isnt down there there seems to be symptoms down there.

    Off the top of my head; Michelle Trachtenberg had a tick bite down there, burn teen has wet dream in coma, incest brother & sister, Jerk teen has small gonads, young brother & sister full of testosterone brother fights Chase for Cameron and sister *ahem* shaves herself. Heck, even an old lady become a sex maniac and had orgasms all over the place 🙂

    Just a thought.

    • Todd says:

      Well, sex and its relationship to love (and death) was the theme of the show this episode — I don’t think House dwells on sex too much. Although, as a Jacobean-style misanthrope, House should, in fact, reduce people’s motivations to sex more often than he does, not less. The fact that the character hires hookers instead of pursuing a relationship (Sela Ward notwithstanding) shows what a pragmatist he is. He’s not interested in love, what he loves is his work — sex is just a bodily function of no moral importance. It doesn’t screw him up, it just screws up other people.

      • yetra says:

        Besides, sex is fascinating. And confusing. Just the act of doing it, or finding someone to do it with it, is fascinating on its own, whether in our own lives, our friends lives, or in our media consumption. There is hardly a show on television or a film made that does not have a romance/sexual/relationship element to it, regardless of genre (scifi, drama, comedy, reality, court drama, cop shows, etc…) We love watching shows about people getting it on. Add in the element of all the random things that can go medically wrong due to getting it on, all mixed in with the lies and embarrassment that go along with such things, not to mention the ongoing divide between sex and love and our ideal that they are entwined when the reality is that they usually aren’t, and you’ve got a sure-fire winner, sure to draw in interest. So the fact that House throws in random sex elements every so often is probably one more reason why it rules so much.

  7. mikeyed says:


    I’ve only seen one whole episode that I can remember. It’s from season one and it’s about House giving a lecture and the whole plot is how these stories progress and what-not. I liked it, but i’m waiting for my local library to start carrying it, since I’m a cheap ass.

  8. serizawa3000 says:

    Someone on my lj friends list (I don’t remember who, but I have an idea) said that Gregory House is as close as we’re gonna get to actually having a Warren Ellis character on television… of course, House wasn’t created by Ellis…

  9. yetra says:

    Can I just say, yay? Yay! I just started watching season one on netflix this week, only 8 episodes in, so I am just completely delighted with the timing of your analysis. Could not have been better planned. Getting to devour several seasons of an awesome show for the first time AND get to read your breakdowns and thoughts on it at the same time? Bliss, indeed.

    Definitely interesting to see that the plot thread around House accusing Wilson of having an affair has continued on so long. It just popped up in the last few episodes I watched, so I’m impressed it is going to take them over a season to get to the stage you covered in this episode. Nice that recurring character storylines get to simmer over a long period, rather than resolved in 2-3 episode arcs before they move on to the next one.

  10. Anonymous says:

    You can read reviews of House episodes from someone who actually does know what all those medical terms mean at the blog. See for this particular episode.


  11. Anonymous says:

    the zoom….

    WOW! I bet somebody in the studio got fired over that zooming… that was from the actual show (from the feed line from the camera on Maddow). Yikes. The tell? The lower thirds and bugs don’t move.

  12. Anonymous says:

    A Bluer Version oh Honky Tonk Women

    HI, I don’t subscribe to cable or satellite and the reception is so bad where I live that I only get to watch shows like House on DVD. I am slowly progressing through season II and the bluer version of Honky Tonk Women at the end of this episode sent me to my computer to see if I could identify the artist.
    The staple about House that you stated above, “recordings I cannot identify but want desperately to own” describes me perfectly and is also one of the reasons that I find the show so appealing.
    Was the recording used in this episode recorded specifically for House or is this a version performed by a recorded artist that I could purchase? Please let me know: I will look for a reply.

    Thank you