TV Review: House, M.D. – “Under My Skin”

” I’ve been popping pills for years, what changed?” House  asks Wilson (Robert Sean Leonard) as he tries in this week’s episode of House, M.D. to deal with his intensifying visions of Amber. So much in House’s life has changed over the course of this season, and with Kutner’s death, lack of sleep and medicating himself even further with Vicodin just to try keep the demons at bay, he seems to have only unleashed them — or rather her.

Here we are boys and girls, down to the last two episodes of the season. Hugh Laurie and Anne Dudek turn in Emmy Award-caliber performances once again “Under My Skin.” Wow! What a ride. House and his team try to treat a prima ballerina who collapses during a performance in New York. As her skin sloughs off due to an extremely rare antibiotic reaction, and she is in danger of losing her career and her life, House, too has his own thicker veneer stripped away, exposing him. The ballerina, at the prime of her career nearly loses everything: her love, her feet and hands, career, her very life to an STD — something she indirectly caused. Something for which only her lifestyle choices can be blamed: gonorrhea, a sexually transmitted disease, which she contracted from someone other than her boyfriend. (And then passed on to him.) And by the end of the episode, we wonder too whether House’s descent into madness has been at his own hands after years of Vicodin use (and refusing to seriously consider alternatives—except for radical treatments).

House, like the ballerina, is at a “turning point.” No longer functional as the prima diagnostician he has been, House is staying home, taking a personal leave day, away from where he can do damage to patients and colleagues. The entire episode, driven by Hugh Laurie’s tour de force performance is a breathless journey into House’s mind, his heart, and his soul.

What is it that we fear? The monsters that live in the closet, going bump in the night? What happens when those demons, who live in the dark recesses of our troubled pasts assert themselves, inserting them into our conscious thought. They are our fears, our terrors.

We think of our skin as being a tough outer layer, protecting us from things that would harm us from the outside. But in reality, skin is paper thin, nearly transparent: a fragile covering without which we would be exposed, raw and bleeding. So it is with our ballerina — and so it is with House.

House has taken a personal day, unwilling to insert himself into a new case, filled with self-doubt and remorse at Chase going into anaphalactyic shock at his bachelor party in “House Divided.” House is certain that he should have realized that the stripper he hadn’t seen for years used a strawberry body butter and that Chase is allergic to strawberries. (That in itself is being unreasonably hard on himself.) With Amber at his shoulder, goading, taunting and outshouting everyone else in the room, House doesn’t trust himself to do much of anything but sit in front of the television.

When Foreman comes to tell him they have a new case, he declines despite Cuddy’s threat to fire him if he doesn’t show up to work on the high-profile case. Not believing that Cuddy would fire him for taking one personal day, Amber, hovering at his shoulder asks him how many days he’s willing to hide in his apartment until she simply goes away.  Filled with self-doubt, distracted and exhausted, House returns to the office.

With Amber always there, a constant and intrusive presence in the foreground of his mind, House tries to ignore her, refusing to listen to her diagnostic ideas, sane or not. But when Amber suggests that dehydration might be hiding an infection, House knows that’s true, despite his self-doubt, and takes the seemingly safe course of treating the ballerina with antibiotics.

But unable to decide when he should listen to his “Amber voice,” House finally confides to Wilson that he’s hallucinating. House can’t tell him it’s Amber that he’s seeing and hearing. “It’s Kutner,” he lies, when pressed. That spooks Wilson enough to take House very seriously. But House resists being admitted for testing and asks Wilson. Saying that he can’t practice medicine so impaired, condition, he tells House he needs to be admitted.  House confesses that he cannot trust his own instincts and  asks Wilson to sit in on his differentials and essentially supervise his work. “I need you to double check everything I do.” House believes that he may have sleep apnea, and why, despite a good night’s sleep he’s still seeing visions.

A skeptical Wilson sets up the sleep test, but suggests that any number of other things might be causing the visions. But despite even the goading from his own mind that it’s not sleep apnea (which would be simple to treat), House clings to the idea, because everything else is very scary and much more complex to deal with.

Eliminating sleep apnea, House comes up with several alternate explanations: infection, trauma, schizophrenia… or pills. House has written these competing diagnoses on the back of an envelope, having omitted “pills” from his written list. I wonder if the possibility that finally it may be his Vicodin use that has pushed him over the edge of reality is simply too scary a notion for him to write it down. Even scarier than MS or schizophrenia.

Drug use/overuse is the simplest explanation, and may in fact be much higher on his internal list, but it’s the last thing he wants to know. “An infection is treatable. Means you still got a job; you still have a life. It’s a nicer diagnosis — doesn’t make it a better one,” taunts Amber as House tries not to listen to her voice.

When the patient’s skin starts to shed in transparent layers, House blames it on an extremely rare reaction to the antibiotic, something that no doctor could have foreseen. He blames himself for treating without first confirming the infection, which in itself is unreasonable, since it’s common for a doctor who suspects infection to start treatment while confirming. Even Wilson is confused about why House feels so responsible. “You prescribed antibiotics. You just did what any other doctor would do.” House knows it doesn’t make any sense for him to feel so responsible for the ballerina’s condition, something he attributes to possible damage in the limbic area of his brain, which would indicate MS.

But, unsurprisingly, it’s not MS. As Wilson continues to sit in on House’s differentials, Foreman grows more and more suspicious of Wilson’s presence, wondering if Wilson has been assigned to supervise House’s work. Between Wilson’s presence and House’s decreasing ability to ignore Amber, all of the fellows begin to wonder what’s going on with House. “You’re making him oversee your choices. You don’t trust yourself. Why?” asks Foreman finally.

Backed into a corner and unwilling to open himself up to the team, House sends Wilson from the room. But Wilson’s presence in House’s space seemed to have relegated Amber to a safer distance, and when he leaves Amber jumps intrusively back into the forefront of House’s mind.

 Grabbing an Exacto knife from House’s desk, Amber relentlessly taunts him with his future, knife to her wrist: “Severe mental illness and drugs are the only things left,” she mocks. “Mental illness means you can no longer practice medicine. Vicodin means detox, which means pain for the rest of your life, which means you can no longer practice medicine…” These words — his own subconscious laying out in stark relief what lies ahead, hits House hard.

No longer engaged in the differential but caught up in his own bleak thoughts, House watches in horror as Amber takes the knife to her arm, slicing it elbow to wrist, the blood pouring from it. What is she goading here? To end it now? Or face a life worse than death? It’s over for him, no matter what the diagnosis. Is this House’s suicidal inner voice telling him that he’s crossed the line between living in misery and dying in it?

Suddenly snapping out of it, House takes Amber’s act as a signpost to treating the patient. They need to kill her to cure her: stop her heart to take an MRI. (House did something similar back in “Autopsy,” another Lawrence Kaplow script.) Uncertain about the rationality of this dangerous step, House consults Wilson, suggesting that “she” thought of it. A major slip, Wilson now knows that it’s not Kutner House is seeing, but Amber.  

By now realizing that the only things left on the table in House’s self-diagnosis are Vicodin or schizophrenia, House clings to schizophrenia, continuing to ignore the possibility that it’s overuse of opiods causing the hallucinations. Reminding House that he won’t be able to practice medicine on the sort of psych meds used to treat schizophrenia, he would need to receive Electro-Convulsive Therapy (ECT, shock treatments). “You’d prefer ECT to rehab?” Wilson asks incredulously.

“I’d prefer something that works,” retorts House, who is certain that rehab would never work for him. Not a big believer in drug rehab, House has tried it before (“Words and Deeds,” season three); he believes he stands a better chance if he has even severe mental illness. Not like he has a choice, or anything, in the final analysis.

House is nothing if not (at least subconsciously) very self-aware. Schizophrenia would mean treatment, but he could continue to survive and practice medicine (one and the same to him). He realizes that with rehab, he’d backslide too easily from simple pain relief back into overuse. The idea that he has to live with hallucinations while being on the only drug that seems to work for him is much scarier than having ECT.

Wilson understands that House is terrified of living a life in pain, but cannot believe he’s more afraid of that than the risk of seizure, stroke, and all the other side effects of therapeutic shock therapy. But Wilson hits him with the one potential side effect that is worse (for House) than death: “you live but you destroy your rational mind, the only thing you care about.”

 It’s enough for House to reconsider the drug abuse theory. But still insistent that it’s schizophrenia causing his symptoms, House administers himself insulin, a chemical form of shock therapy, only (according to Wilson) only slightly less dangerous than ECT. Finding him on the floor of his office in convulsions, Wilson is upset at House’s recklessness. But the insulin seems to work, and Amber has disappeared.

Feeling more himself, he comes back into the case, diagnosing gonorrhea with an epiphany based on putting together the clues from observing the dancer and her boyfriend. Momentarily elated, House celebrates alone in a restaurant for having rid himself of his demons.

But, in a scene that simply took my breath away for its creepiness, Amber reappears with a vengeance to terrorize and torment House from inside his own mind. The dawning recognition that he hasn’t rid himself of Amber is stunning on House’s face as he turns to see her smirking at him from the pub’s bandstand.

“Enjoy yourself; it’s later than you think,” she croons the 1949 Guy Lombardo hit, evilly smiling at him. “Enjoy yourself, while you’re still in the pink.” She laughs him cruelly, in a subversion of the song’s upbeat message. A terrified and traumatized house, at the very end of his emotional rope calls Wilson, deeply shaken, his voice trembling. I had a flash back to last year’s finale when we learn that House called Wilson back then from a pub, asking him to rescue him. But back then, it was Amber who answered the call, dying for the effort. Is this then, Amber’s revenge? The torment House has felt for a year, eating away at him until this?

As Wilson drives House home to pack for rehab, Amber sits in the back of the car smiling at House with an evil sweetness. Defeated, House, a shell of his former self is ready finally ready to go to admit himself to drug rehab.

Packing his clothes, unsure of himself and his future, House tells Wilson he inexplicably doesn’t feel scared. “Why don’t I feel scared?” House asks, confused.

“You don’t know what you’re feeling at this moment,” Wilson explains believing House is too dissociated from reality — or too drugged out — to  know what or how to feel. House is terrified for his future, his mental health, but not of the rehab.

“What do I do if it doesn’t work?” he asks, afraid of failure.

“You don’t give up.”

“It’s either this or electroshock every six hours?” House’s resignation and low expectations are heartbreaking. He realizes that when the going gets rough, he’ll be able to scam his way out of rehab. Even though he doesn’t want to, he will try when it gets too difficult to handle. In House’s state of mind, he believes that only Cuddy knows him well enough and is under his skin enough to help him through this: to say “no” and mean “no.” But someone who he trusts implicitly to see him in his deteriorated condition.

Having hidden from her the fact he’s been hallucinating, Cuddy is not especially keen on listening to him when arrives in her office as she’s about to go home. “I quit,” he says simply. Not looking at his face or into his eyes, Cuddy assumes this is another mind game, and she’s not in the mood.

As hard as it is for him, he finally admits he’s been suffering visions. This stops her in her tracks. Not sure whether its Vicodin or something else, he needs to know — and he is ready to bare his soul to her. This scene is a bookend to season two’s “Skin Deep.” In that episode, House comes to Cuddy in intractable pain, asking her for morphine, revealing the horrific scar on his leg; asking her if that’s not “real.” If his pain isn’t real. And here he stands once again as emotionally naked as he was physically without pants back then, telling her he needs her and this is it for him.

And, as House goes though his dark night, his dancer patient learns the infection has spread and she risks losing her feet and fingers — who she is. Just as House is in Hell, in the throes of withdrawal, and in grave danger of losing himself and his mind.

As contracted as it is (Hey, it’s television!), the withdrawal sequence is breathtaking for its intensity. We’ve seen House detox before, but this scene is so heartbreaking to watch, because he wants it to work, tries to work with Cuddy, and works through both the withdrawal symptoms and horrific pain that must bring back memories of the past. Cuddy’s quiet strength and support relegate Amber to a safe distance as Wilson’s presence had earlier, enabling House to ignore Amber (or at least lessen her influence) through her taunting and goading.

At his lowest point, House tries to make a feeble grab for a lone discarded pill on the floor, as Amber berates him as pathetic. Cuddy beats him to the pill, flushing it down the toilet. House, broken and miserable sitting on the bathroom floor looks at Cuddy with an expression borne of complete desolation as she keeps physical contact with him, her eyes telling him he’s not alone.

With the light of morning, things look better for the dancer and for House. Amber is nowhere to be seen. Having shared the intensity of the night, House’s feelings for Cuddy (and hers for him) finally come out honestly and without the filters, sentries and castle walls normally between them. Admitting she had been into him as far back as her undergrad days (yeah, let the commentary begin over that interesting bit of timeline fodder), something Lisa Edelstein spoke of during her conference call (actually in response to my question!), Cuddy confesses that it’s not only his professional assets that interest her. One thing leads to another and a tentative kiss leads elsewhere.

So? Did it happen or was it yet another hallucination? Has House actually woken from the insulin-induced coma? Is this the end of Amber or will she be back for the finale?

And what does Amber represent in House’s mind? Is she merely a manifestation of long-term Vicodin use? Is she a reflection of House’s feelings of guilt? Is he going to dismiss the hallucination now that he seems to be feeling better? What is the relationship/continuum from Kutner’s death? How has he been dealing with it? Really? So many questions and only one more episode to go!

I've gone on long enough, but I can't end this review without a word about the acting. Hugh Laurie (Yeah, I know I'm always blown away by his acting.) was simply superb, giving an emotionally raw, but never over-the-top performance as the deteriorating House. Heart-breaking and heart-stopping at times, Laurie gave us complete access into his heart and soul. Anne Dudek, too, was mesmerizing as House's tormentor Amber. Just wow. 

Not to change the subject, but what about Chase and Cameron? Cameron keeping her dead husband’s sperm even through marriage to Chase? Should Chase make for the hills or let Cameron keep the “liquid pre-nuptial agreement?” Lots to discuss. And I’m working on a new poll for over the weekend.

The season five finale airs next Monday, May 11. I will be chatting with Doris Egan, finale's writer the day after it airs. So stay tuned! In the meantime, you can follow me on Twitter. Let the discussion commence!