TV Review: House, M.D. – “Family Practice” in Depth

Lies are at the heart of so many of Dr. Gregory House’s (Hugh Laurie) cases: lies patients tell doctors, tell family members, and tell themselves. In “Family Practice,” this week’s latest House, M.D., episode the lies are compounded because family and medical treatment are wrapped up together along with the emotional relationship between of the patient’s daughter, Lisa Cuddy and her doctor (House, of course).

Arlene Cuddy (Candice Bergen) is out clothes shopping with her two daughters Julia and Lisa. It is apparent even from this moment that Arlene’s relationship with Lisa’s sister Julia (guest star Paula Marshall) is much closer and more cordial. But when Arlene begins to feel “funny” in her heart, Cuddy (Lisa Edelstein) puts on her M.D. and gets Mom to Princeton Plainsboro, suspecting it’s more than simple palpitations.

Knowing that Cuddy wants him to treat Arlene, House hides in the morgue with the rest of the team. “You don’t want me to treat her,” he argues. “You don’t want you to treat her.” House recites to her the ethics of why it’s a bad idea to treat someone with whom you have an emotional connection. And he’s right. But he allows himself to be talked onto the case to appease her.

Cuddy wants the best for her mother, and a staff cardiologist just won’t do. House is willing to go along (barely), sending the team to check out Arlene’s house, where they find the possible culprit—along with some very revealing photos of Cuddy’s mom. She’s been having a hot affair for years with a married man—something about which she’s never told Cuddy (but Julia knows all about it).

House’s initial diagnosis is lead poisoning, writing off the rest of Arlene’s symptoms to hypochondria. And sooner rather than later, House manages to piss off Arlene enough to insist he be fired from the case.

This is just fine with House, who doesn’t believe they should be treating her anyway—only doing so as a bit of self-preservation. But when it’s clear that there is something wrong with Arlene, Cuddy insists House continue working on the case behind the scenes and behind the back of the new attending physician, Dr. Kaufman.

Cuddy’s request and House’s willingness to go along with it set off a series of events nearly ending in disaster, and feed the episode’s central question about family conflict and confrontation. Arlene controls Cuddy by blunt truths designed to sting and keep her just this side of parental disapproval.  

“We just don’t have that sort of relationship,” explains Arlene to the hurt Cuddy when she learns of Mom’s affair. That’s why she confides in Julia, leaving her other daughter out in the cold. “Does it really surprise you?” she asks. And later in the episode, Arlene zings Cuddy with one of the most devastating things a parent can say: “I love you both, but I like her better.” Ouch. Bullseye.

Not wanting to further court her mother’s disapproval, she backs away from confrontation. So, instead of insisting to her mother that no matter what she might think of him, House is her best bet for survival, Cuddy backs off. Not only does this force House into a terrible ethical dilemma, it also keeps House and Arlene apart, which delays the final diagnosis.

There is an enormous amount going on in “Family Practice,” Some of which I talked about in last week’s preview. So I won’t retread that territory here.

The simplest part of the episode’s narrative is the question: what would happen if House had to treat someone close to Cuddy? We know what happens when he treats someone near to him: Foreman’s illness put him so far off his objectivity, Cameron had to real him back to his rational self. But this is different because although Arlene is not someone close to House, she is Cuddy’s mother. And the how he approaches the case—and its outcome can have a lasting effect on their relationship.

House has spent a lot of time this season really trying to make things work with Cuddy. And in “Family Practice,” House is put in a position he should not be in. Although he argues with Cuddy that he should not be treating Arlene, he isn’t willing to really confront her about it, and goes along, getting deeper and deeper into an ethical conflict that might end in killing Arlene—and destroying his relationship with Cuddy anyway. It is only when, in the end, House finally confronts Cuddy about her own issues with Arlene, that House can come face to face with his patient—and come up with the amusing and perfectly Housian epiphany. Arlene can’t recognize sarcasm! And that leads House to a diagnosis of Cobalt poisoning from her artificial hip.

I am a non-confrontational person. To be honest, confrontation scares the hell out me—whether at work or home. It’s probably because I grew up in a home where conflict was the normal state. I totally understand where Cuddy is coming from. But confrontation is healthy in the right place and tempered with love and understanding. Without it, relationships grow toxic and perhaps even deadly. And that’s really what this very emotional episode of House is all about. 

Several story threads—House and Cuddy, Cuddy and Arlene, Masters and House—and Taub and his brother in law—feed into this theme. Sometimes avoiding conflict is good; it prevents you from getting your nose busted. Sometimes it’s poison, getting in the way of important truths that can heal. But conflict—confrontation—is too big an emotional risk, and it’s easier to be the coward than take the chance. And both Cuddy and House play the coward: Cuddy is unwilling to be assertive with her mother—and House is unwilling to push Cuddy (and possibly break their relationship).

But in the end, House does confront Cuddy, insisting that she finally face Arlene and take control of her medical situation. House is right—while being protective of both her and his relationship with her. If something goes wrong, he knows that it will ultimately end in disaster for him: he will lose Cuddy. It’s completely selfish, what he’s protecting here—completely House—protecting himself. 

His disclosure that if Arlene dies, that at some point, Cuddy will blame him as the man responsible for her mother’s death, is something he can’t live with. And if Cuddy can’t confront her mother and insist that House be put back on the case, Arlene will die; House will be (at least subconsciously) blamed, and so will end their relationship. It’s one of the best scenes between them in the entire series and beautifully played by both actors.

The other great conflict arising from Arlene’s case is between House and medical student Martha Masters (Amber Tamblyn). Although House attempts to treat Arlene without Masters’ involvement and interference, she realizes eventually what’s going on. Willing to put her job—and her career—on the line for her ethical stance, she rats out House first to Cuddy and then to Arlene knowing that House has threatened to destroy her career if she does so.

Her courage to confront House in the face of his threat (which scares the hell out of her) is rewarded in the end when House realizes her value on the team and to him. At this point, House is all about protecting his relationship with Cuddy. He understands, as he articulates to Masters, that the board won’t long put up with her protecting his practice—and him, now that they’re a couple.

There will be a tipping point, and as long as Cuddy and he are involved, that will always be a risk. Masters serves as another brake on House—one that is unaffected by their unequal power relationship. He understands the value in her and her importance in House’s long-term goal of maintaining his relationship with Cuddy.

In the middle of the episode, when Cuddy realizes that House is right about treating family members, House is momentarily struck by a notion. And I think it is here that House realizes that Cuddy cannot “treat” him: she cannot effectively put the brakes on his tendency to recklessness.

I have a theory about the dynamic between House and Masters in “Family Practice.” I think House knows exactly how Masters will react when he threatens to destroy her career should she choose to rat him out to Cuddy’s mother. When I watched the scene where he threatens her, I wondered how House could seem so out of character to me; his words were stunning enough to Masters that they made her sick with fear. I think It’s entirely possible that the threat intended to test the bounds of her ethical chops. Will she rat him out even knowing the consequences? And in the end, she passes his test—but not without being subjected to House’s incredibly brutal challenge. Am I certain of House’s intentions? No, of course not. 

Unlike House and Cuddy, Masters is unafraid (or completely clueless) of the consequences awaiting her. And somewhere, deep in House’s subconscious, Masters may be part of the calculus needed to keep his relationship with Cuddy strong. “I need you to protect me from doing something Cuddy will regret,” he tells her. And self-protective, self-aware House is right.

And as if to parallel Masters’ bravery, Taub is also set up to illustrate a sort of raw courage of convictions. His actions, misguided as they were, were intended to do good, risking his new job (and he already-shaky relationship with his ex-wife’s brother in law) to do the right thing.

Which brings us back to the beginning of this commentary. Did Masters do the right thing by ratting out House and Cuddy’s lie to Arlene? Was it any of her business and did she, in the end do more harm than good?

“Happy now?” House asks her after she essentially destroys what’s left of Cuddy’s relationship with her mother at that point. Masters’ actions precipitated a moment of truth between House and Cuddy, which led to Cuddy finally confronting her mother—and allowing House to come to his final diagnosis.

But it’s not a medical consequence, but  a personal one. Medically—is it the right thing? Going over Cuddy’s head to Arlene is not only going over the dean’s head—but also the head of the patient’s immediate family. To me, that’s a tough call. I have to think, however, that House would have much valued such a medical student hanging around when Stacy made that decision about his leg all those years ago!

So, what do you think? Is Masters right? And did House set her up to see if she would rat him out? Or was the threat genuine?

And…what was your favorite scene? Let me know in the comments below!