It's quite the shock to realize that the jerk of this episode's title is not House, at least not exclusively or even primarily. Nick Lane as rage-prone teenager Nate is possibly too effective as the mini-jerk. From the unmodulated bullhorn voice to the constant, not-particularly-funny smart remarks, the fictional kid is not someone I'd want to spend even an hour with. Not even an hour between 9 and 10 p.m. on a Tuesday evening. I realize this confession reveals my own jerkdom, but it was the first ever House episode where I was rooting for the patient to die. I'm not completely heartless – I would have settled for a prolonged coma. Even a persistent vegetative state.

There's a lot of brats in this episode, from House to Nate to the clinic patient's son to the writers – I can't believe they opened with a head exploding threat. How am I supposed to block the head exploding scene of "Resignation" out of my head with reminders like that?

House is back to his usual level of jerkiness, apparently off his antidepressants and ruining my chance to pontificate on what he learned from Wilson's coffee-doping trick in the previous episode. Here's my updated pontification: nothing. He's learned nothing.

Nate, who has absolutely no redeeming qualities — unless you count being unconscious for a few minutes out of the episode — serves to highlight how finely balanced the character of House is. The kid even demonstrates some drug-seeking behaviour to hammer home the similarities to our hero, but the juxtaposition reminds me how remarkable it is that Hugh Laurie takes this bastard who careens between wildly inappropriate nastiness and appropriate misery, always laced with that acerbic wit he's so proud of, and rarely-to-never crosses over into unbearable. If only House had smothered Nate with a pillow during their chess match, I would have extolled his virtues even more.

Nate's long-suffering mother is not unreasonably happy that the initial (and therefore inaccurate) diagnosis of cluster headaches means her son's personality is likely to change with treatment. "I thought I was a bad mother and I hated myself because I hated him," she confesses to Chase.

Mom Enid's journey from that confession to being upset with Foreman for sedating Nate just to shut him up to relief that her kid is going to live, albeit with his current personality, is given a lot less room in the episode than I would have liked. Both the initial confession and the end relief seem natural enough, I suppose, but they're too pat, with no expectation-bending or emotionally impactful scene to make me care that she's facing her son's long, miserable life with more joy than she might have anticipated at the beginning.