If you don´t want any spoilers for next House MD episode… leave this blog post right away!

If not… here´s the juiciest recap, via Fox of what´s going to happen in a couple of days, come January 19th, when House MD returns for episode named “Painless”.

Painless

Episode 512 : 2009-01-19

A man named Jeff solemnly writes a letter and signs it with, “I’m sorry.” He removes his wedding ring and takes out shirts from the closet. His wife and son arrive at the house to find the shirts piled in a line across the front of the garage. Jeff is passed out in the car with the motor running. His wife frantically pulls him from the car.

Cuddy gets to work late, stressed over an impending visit from the foster caseworker. She remarks to House that Cameron did his department budgets for him.

Cameron briefs the team on the case, asking House to take it on in repayment for her favor. Jeff’s chronic pain is undiagnosed. Thirteen suggest fribromyalga. House orders Taub to take a pain profile of the patient.

Thirteen and Foreman search through the patient’s home, and they discuss their relationship. Thirteen does not want to pursue anything further with him. She pulls a clear plastic bag of frozen poultry out of the freezer, and thinks it is quail, which could have caused rhabdoymolysis.

House considers this diagnosis and orders muscle biopsies on the patient. Taub protests that Jeff does not have a toxic reaction — it’s a psychosomatic reaction. House figures he can leave work early since Cuddy came in late.

Thirteen and Kutner take deep-tissue samples with a large-bore biopsy needle. Jeff’s wife does her best to comfort him as the son watches, hopeful. Suddenly, Jeff has an excruciating pain in his arm and he loses consciousness. Foreman calls House, who is in bed, ignoring the phone.

Thirteen tells the team that the VQ scan showed a pulmonary embolism. The desk phone rings, and Foreman takes the call from House. He is sitting on the edge of his bed, massaging his thigh with one hand while holding the phone with the other. Thirteen explains that the hypercoagulable state could cause pain and a PE. Kutner suggests a cancer syndrome like Trousseau’s would explain the blood clots, multi-focal pain, and lack of obvious physical signs. House tells them to check Jeff’s chest, abdomen, and pelvis for tumors.

House feels a drop of water fall on the back of his neck. He grabs a t-shirt from the bed, drapes it over the end of his cane, and reaches up to wipe the water off the ceiling. As he gently pushes on the ceiling with his cane it crashes down on him. House watches as a plumber checks the hole in his ceiling. He says the insurance deductible doesn’t cover negligence. The pipe didn’t burst — it was pulled apart from the shower.

Taub views images on a monitor and Kutner mans the controls as Jeff undergoes a full-body CT scan. They discuss the act of suicide.

Foreman tends to Thirteen during her drug trial. She insists they should not date. Kutner and Taub enter with the news that there is no trace of cancer in the patient but they did find edema in his intestine. Air in the intestinal blood vessels would explain the pain. Kutner hands the file to Foreman and Thirteen. Foreman tells them to do an angioplasty on the superior mesenteric and find the other blockages before the patient suffers another cardiac arrest.

House enters his office, still unkempt and aggravated. Foreman lets him know that the CT showed intestinal edema and air in the blood vessels. House is skeptical. “If it was vascular, we should’ve seen uneven pulses and he’d have hemorrhages in his fingers,” he says.

Jeff continues to struggle with the pain, as Thirteen is about to start the angioplasty. Everyone turns to see House and Foreman come in. House disconnects an IV tube from the three-way stopcock that connects Jeff’s forearm to three different IV bags. There are teeth marks from when Jeff blew in his IV tube. Jeff insists he wants to die.

House, Thirteen, Foreman, Taub and Kutner are gathered as Cuddy stands to change Joy’s diaper in her nursery. Cuddy is annoyed that they let this happen. Thirteen suggests the diagnosis of non-motor seizures. The pain started in his abdomen, near his intestine. Foreman offers up a glycogen storage disease, like McArdle’s, would explain the pain. Plus, there’s plenty of muscle cells in the wall of his intestine. House says to run an ischemic forearm test.

As Thirteen enters her drug trial, she sees Janice, who’s shaking a bit but looks much better and happier. Thirteen did not know that their appointments were back-to-back again. Janice says that hers got switched that morning. Thirteen confronts Foreman about switching Janice’s appointment time, which he denies.

Kutner and Taub stick an IV tube into Jeff’s arm, place a blood-pressure cuff extra-tightly on the same arm and hand him a tennis ball. He asks his family to leave him. Suddenly the arm pain jumps to his leg.

House, still unkempt and in pain, types on a laptop as Taub and Kutner brief him. He needs the name of a good lawyer and asks Kutner who represented the hospital when he set that patient on fire. House types the name into the email he’s composing.

House asks Cuddy for permission on a procedure to see if the patient’s pain is coming from his brain or his body. Cuddy’s pager goes off. She glances at it, annoyed. She tells House to do whatever he thinks is right.

Jeff is lying on one side, hooked up to monitors and IV’s. Chase readies the lidocaine injection. A still-unshowered House enters to talk with Jeff about tolerating the pain. “Take a look at your future,” Jeff says.

Cuddy is in her messy house when the doorbell rings. The early caseworker quickly looks around, glances into the other rooms, making notations on a clipboard. “Dr. Cuddy, you’ve got sufficient income, a high degree of personal and professional stability, and you care enough to be embarrassed by what a mess this place is,” the man notes. “Believe me, that puts you head and shoulders above most of the foster moms I visit.”

Jeff tells House and Chase that some of the pain is gone, but not all of it. House, Taub, Kutner, Thirteen and Foreman discuss. Thirteen says maybe Taub was right about it being psychosomatic. House’s lawyer enters and drops a bill in House’s lap. The man sneers that the next time House uses his name in a threatening email, it won’t be just a bill, it will be a lawsuit.

The doctors’ pagers go off. Jeff’s son convulses in pain on the hallway floor. Several nurses attend to him as House approaches, followed by the team. House says that the son is faking. He turns and heads into Jeff’s room. House yanks off Jeff’s bed sheets and sees that he has an empty bottle of rubbing alcohol. The son distracted the orderlies so that Jeff could down a bottle of isopropyl. The son yells out to please just let his father die.

As Jeff is hooked up to a dialysis machine, as the team discusses the case. The DDX includes Fabry disease, Amyloidosis and lightning pain from syphilis. They are out of ideas. House suggests they can’t find anything because whatever injury caused the pain healed long ago. The only thing left is the drugs. Jeff has opioid-induced pain. Both pain and the drugs that treat pain work by changing brain chemistry. Sometimes the pain receptors start reading painkillers as pain.

Cuddy tells Wilson that she passed the home inspection but is disappointed that she failed by her own standards. Wilson asks why women always create ridiculous standards that no human could meet. He tells her to be like a man and get some help. “You’re not Superwoman, don’t be a martyr” he says.

Taub and Kutner prepare to remove the painkillers from Jeff’s system with nalaxone. Kutner gives Taub a look. Taub explains to him that a colleague once attempted suicide and it was selfish. Kutner can see that Taub is still not over this.

House calls Foreman out about messing with the drug trial appointment schedule to move the most promising patient right before Thirteen.

House is with a handyman who inspects a large burned and charred wall of his kitchen. House has a copy of his home warranty policy in his hand. He thinks he will have to replace the entire water line to fix the melted pipe. The handyman tells him he is lucky that the fire skipped the pipes entirely. House realizes he screwed up.

At the hospital, Taub and Kutner attend to Jeff who is strapped into the bed. Jeff groans, sweats and cries through the pain. House has just entered his office to find Jeff’s wife waiting for him. She asks House to just stabilize him so that he can die at home.

House tells Taub that he is going home. Foreman, Taub, Thirteen, and Kutner are at a loss. House lies in bed, eyeing the gaping hole that remains in his ceiling. He pays the handyman to bribe him to lie on the claim. House does not care, as long as the people who pocketed his premiums for nine years also pay. He insists that he didn’t break the pipe. House sees the handyman scratch his privates. He grabs his jacket and cane and heads out.

House meets the team in the hospital. Testicles made him think of Epilepsy, which can cause chronic pain if it enlarges to the non-motor part of the brain. House explains that the seizures may be in a place you can’t see on an EEG, such as deep in the brain like the area that controls the muscles supporting the testicles.

Jeff and his son walk down the hallway, hand in hand. Jeff pulls the IV stand with the anti-seizure meds that are making him pain-free for the first time in years. Watching them, Kutner turns to Taub. “It wasn’t your colleague, was it? It was you,” he asks. Taub rejects him.

Foreman enters the drug trial where Thirteen is seated in a treatment chair, hooked up to an IV. She asks Foreman if he is free tonight. He notices her IV is not properly hooked up and asks the nurse about it. She remarks that the medicine smells bad. Thirteen’s bag has no smell. Foreman realizes that Thirteen is on the placebo.

Cuddy is swamped by a mountain of work and the baby. She stops and thinks. Cuddy approaches Cameron in the ER and asks why she offered to do House’s budget. Cameron thought it would help House to see someone worse off than him. Cuddy offers her job to Cameron. Cameron is not sure how to react.

House goes to step into the tub. He puts one leg into the water, and then braces himself by grabbing the shower pipe before lifting his good leg in. He realizes that when he puts his weight on the shower pipe, he pulls on it. He was wrong — he did break the pipe.