TV Review: House, MD – “Ugly”

“I want to be normal.”

“The surgery will change your face; it won’t change what your face made you.”

This is what I meant when I said I was still waiting for a House, MD episode that leaves me breathless, counting the seconds until the show comes back from commercial break.

Normal” is a recurrent theme on House, MD. As someone who is “not normal,” “outside the circle,” a self-described “freak,” House has sensitive radar for fellow outsiders. He doesn’t feel one needs to be compelled into the tidy circle of normal. This attitude and the bitterness he wears like a suit of flinty medieval armor have been won through a lifetime of pushing back against “circle queens,” who tirelessly endeavor to bend, break, and reshape non-circle dwellers so they fit neatly within circle. Failing that, there’s always pity (as expressed in last season’s “Lines in the Sand”).

Episode 4×07 has every element that makes a House episode great, and then some — pathos, gravitas, social commentary, and humor. The case in “Ugly” concerns Kenny, a young man with a severe facial deformity. A group of filmmakers have funded Kenny's extensive reconstructive plastic surgery; the film crew are to follow the young man through the process. The surgery abruptly ends as Kenny suffers a heart attack just as the procedure is to about to begin. Enter House and Company to figure out why. The film crew, tape rolling, are now intent on following House and his staff through their process. The novel (well, for this show, anyway) insertion of a documentary crew provided a wonderful lens (as it were) though which to view the main characters (and especially House).

House is duly annoyed at this intrusion into the diagnostic process; it hinders the natural free flow and the give and take of his differential diagnostic process. The film crew, shooting in stark black and white, shed light on all of the characters. At one point, House, much to his horror, watches himself interact with his staff (“I am NOT that guy,” he insists to Wilson), forcing him to look in the mirror at a harsh, but true, image. Yet in the final scene, with the film cut and edited, House watches himself again, even more horrified at the way in which the camera has been used to create a false, if flattering and quite surreal, image of Dr. Gregory House.

Using the camera as a prism through which we view the characters, “Ugly” continues exploring this season’s theme of perception (particularly visual perception). The case of mistaken identity in “Alone;” the astronaut (“The Right Stuff”); patients with visions and hallucinations in episodes three and four; the smoke and mirrors of “Mirror, Mirror,” (episode 5); and the hall of illusions that is the CIA (episode 6) all provide variations on this theme.

The themes of perception and normality are nicely interwoven within and across the shifts from real-time color to the high-contrast black and white of the camera’s lens. Placed in front the camera, where images, words and perceptions are captured in perpetuity, no one behaves as they normally might. Everyone’s putting on a show. Their motivations are clear enough: no one wants to look like an idiot in front of the camera. (And, as Taub points out, in front of potential future employers.) And House hates every second of the attention it casts on him.

Last season House, MD was all about "normal." House’s tantalizingly torturous taste of “normal” in the season premiere was ripped away by episode two. Remnants of that taste still lingering, House’s world crashed and burned during the Tritter arc that followed. “Normal” was something that seemed to be just beyond House’s grasp (after foiled attempts to grow pain-insensitive nerve cells in “Insensitive” and to participate in a pain study in “Half-Wit”). The battered House offered patient after patient a "ticket out of the freak show” and to join “normal” society. (“Merry Little Christmas,” “Insensitive,” “Half-Wit,” etc.)

House believes that being normal has less to do with what you look like, and more to do with how you view the world — and how you are viewed in return. Normal is what you feel inside. Even if House had been successful in his efforts last season, the years of damage would not have fundamentally changed him. He would still be "House" with all of the baggage caused by the betrayals, hurts, and other emotional issues caused by his "differentness." Fixing the outside can't undo the years of damage. Ugly is a state of mind that surgery or (in House's own case) radical treatments and Vicodin can't undo. This is what House suggests to this week’s patient. House not only feels "not normal" on the outside, he isn't normal on the inside either. And Taub finally says it. In front of a lot of people. With the camera rolling. For the first time, and with the same sort of brutal honesty House uses, Taub calls him on it. And everyone is stunned into silence. Including House, who is rendered speechless.

When House visits the father and son, he is anxious to put Kenny on steroids to treat what House believes is juvenile rheumatoid arthritis. The father chooses to not believe House, preferring to risk his son's life by moving ahead with the surgery. The treatment House wishes to try (steroids) will set the surgery back months. House is upset that the father and his son are willing to risk death to be “normal." “Can’t do the treatment because it'll postpone the surgery,” they seem to be saying.

House strongly reacts to this attitude. In his opinion, the kid doesn't require the surgery. At least not urgently. Dealing with the crisis takes precedence in House’s mind. I’m not saying that I agree with House; but that is what he is reacting to.

It’s a short scene, but it’s a season four moment for my list of poignant House/patient scenes I wrote about in my article about House's unique bedside manner. House was not suggesting that the kid never get the facial surgery. He was suggesting that it wasn’t as important as actually living — and living with the deformity a month or two longer. House blurts out his comment that undoing the physical damage cannot undo the psychological damage caused by the physical. It’s an honest moment that speaks to a truth about House himself. His facial expression as he glared at the camera is notable for the range of emotions portrayed.

Because the case involves craniofacial plastic surgery, Taub is involved and excited about this case. Considering the circumstances by which Taub came into House’s orbit, his involvement in a potentially famous plastic surgery case must’ve been very appealing to him. “I took one look at this kid, and I saw an average kid,” says Taub. As a plastic surgeon, he sees the possibilities, something that will win him no favors in House’s book, according to Foreman anyway.

He probably never dreamed after signing a non-compete agreement with his former partners that he would ever work on such a case. That he is attacking it as a diagnostics fellow and not a plastic surgeon has to be intriguing for him. No wonder he seems super motivated, and willing to go up against House. And possibly outshine him. His “I can get House thrown off the case,” to the father was somewhat chilling. Taub wins points, very deservedly, through being as blunt as House. In the face of House’s taunting, Taub admits that, yes, he gave up his successful career because his marriage was more important than the lucrative medical practice. “I love my wife.” (I wonder if Taub isn’t sort of the anti-Wilson, who can’t help telling them about his wives — as revealed in “Spin” in season two.)

Further, Taub also risked his position with House by fighting for his own medical opinion. And he did it because he believed he was fighting for the patient above all else (something that wins him a gold star — of David — from House.)

I love the tension between Taub and House, two very experienced doctors. House’s curiosity about Taub led him to the truth, House’s discretion prevented him from harming Taub’s relationship with his wife. And Taub stood his ground, took House’s best shot, and then gave it back. I think that House, the romantic (agree or disagree with me), appreciated Taub’s sacrifice for his marriage. (See “Need to Know” in season two, if you don’t believe me.) I think the tension between these two doctors — nicely portrayed by Peter Jacobsen and Hugh Laurie — is better and more real than any of the tension created between House and Foreman. He is more experienced than Foreman in medical politics and probably more polished at it than the politically and socially inept House. He should watch his back.

The serious tone of the episode is lightened considerably by the side plot of House and his infatuation with Dr. Samira Terzi. But this story, too, ties in with the episode’s theme of normalcy and perception. House had thought himself immune to the charms of pretty much everyone. (Well, maybe except Stacy). His laser beam vision, which is usually so acute that it can cut effortlessly right down to the idiot gene, cannot pick up on Dr. Terzi’s lack of medical chops. His vision is blurred by the blinding light of her beauty and his (as Wilson puts it) crush on her. He has to rely on Foreman, Wilson, and Kutner to help him judge her contributions to the differential, which makes him doubt his confidence in 13. Wilson tells House to simply go with it; to enjoy the fact that some part of him is simply a “normal guy.” But House can’t accept that he’s a normal guy.

The episode is also lightened by all of the “playing to the camera” by everyone from Kutner to Cameron (okay, I’ll admit it — liked to see her squirm in front of the mirror and Chase!) to Wilson. And then the final scene — the veritable icing on the cake.

Mom and dad at the movies. Cuddy is merciless in the sweetest of ways, relentlessly teasing the embarrassed and humiliated House at the way the filmmakers re-cut the footage to make House into his evil twin: kind, caring, and jovial. And the best part of that wonderful scene comes after House leaves her office and Cuddy turns the tape on again, smiling knowingly, as the boy thanks House for the camera. Even if House can’t be happy about it, Cuddy can stand in for him, appreciating him as no one else can. And it’s captured for posterity on film. Lovely face acting by Lisa Edelstein in that scene.

Everything is shaded by perception; nothing is black and white (even when filmed in black and white); normal can’t be defined for everyone in the same way. Perceptions can be altered, as can outward appearance, but it doesn’t change who you are for good or bad.
A wonderful episode beautifully shot, acted, and written. Only five more before we run out of episodes in what looks like a strike-shortened season. And just when it seemed to be really gearing up. If you missed the episode, it will be shown on USA Network a week from Friday (day after Thanksgiving).

Remember: Support David Shore and the rest of the writers on strike — NO downloading from Amazon Unbox!