FOX's House season seven finale cannot be said to end on a boring note. With a framework story of Cuddy (Lisa Edelstein) and Wilson (Robert Sean Leonard) talking to the cops, the story builds to a big finish. House (Hugh Laurie), a patient himself after attempting to do surgery on his own leg, directs his team to treat a performance artist (the great Shohreh Aghdashloo). As the doctors research the artist, they discover she knows she has a terminal illness, and is faking symptoms to make her case more attractive to Dr. House, all the while filming the procedure to make another artistic piece. House is fine with that, but when he diagnoses the artist with something non-fatal, and she decides to do risky brain treatment because of love, House grows angry. He takes her choice personally, feeling all that he has is his work, and he thinks he has a kindred spirit in her. Soon after, House sees Cuddy with another man, and drives his car full speed into her dining room, hence the frame story.
There is much speculation as to if House really did drive his car into Cuddy's home, or if it is another Vicodin-induced hallucination. After all, Wilson comments that House takes almost a month worth of the medicine in just three days, and House has visions because of the drugs before. But there do not seem to be any hints or clues in the episode that point to the stunt as not being real. Hence, for now at least, it appears to happen.
What is most surprising is House's utter lack of concern for people he has previously shown to care about. He does order Wilson out of the car beforehand, but doesn't pay much attention as Wilson hurts his arm getting out of the way. When House last looks through the window, Cuddy and her guests are sitting right where he plows his car. What if they didn't move? He would have killed four people. House is self-destructive, but rarely shows so little regard for life, and especially for Cuddy.
But is it really out of character? This might just be the result of the good doctor finally snapping. Pressure is building, and with feeling betrayal first by Cuddy, then the patient, House may not be able to take anymore. He has done some crazy things in the past, and while this may be a new level for him, he does have pent up feelings and a drug problem. Those two elements might explain why he would act in this manner.