A Conversation with House, MD Writers Doris Egan and Dr. David Foster

The fifth season of House, MD is off to an intense and exciting start, finding House and his best friend Wilson on the outs in the aftermath of Amber’s death at the end of last season. After a slightly uneven fourth season, House seems to have kicked back into high gear this year. The first three episodes have been packed with drama, keeping the lighter moments as grace notes of comic relief.

Hugh Laurie continues to be the best actor on television, setting a high benchmark for serious television performance. And Tuesday's episode “Birthmarks,” written by veteran House scribes Doris Egan and Dr. David Foster will likely be counted among the series’ most important episodes, exploring both House’s difficult relationship with his parents and his complex relationship with Wilson.

Egan and Foster kindly sat down with me earlier this week to talk about “Birthmarks” and the series. David Foster has been writing for House since season one, and has written some of the most compelling explorations of House in the series, including “DNR,” “All In,” and “Informed Consent.” He also serves as a medical consultant producer on the series, being a full-on medical doctor. (I’ve hear that he owns his own stethoscope and everything!)

Doris Egan is known (and revered by many fans) for her detailed examination of House’s relationships, particularly with Wilson, although she also penned the beautifully realized “Failure to Communicate” in season two. That episode set hearts aflutter (mine, anyway) as House and Stacy shared a tender kiss in the midst of a Baltimore snowstorm. In addition to writing for the show, Egan does double-duty as a co-executive producer.

Over the years, both writers have beautifully mined House’s complex personality, focusing not only on his drive, bluntness, and brilliance, but managing to uncover what lies beneath House’s defenses: those rare and beautiful gems of House’s humanity. Commenting on House’s outwardly abrasive personality, Egan noted that “on one level you want to say that under that hard shell of a man there’s a hard shell of a heart. But he’s clearly a guy with a lot of problems. And a lot of deep feeling that he’s not going to tell anyone about.”

In Foster’s season one episode “DNR,” House tries to explain how his medical philosophy differs from that of Foreman’s old mentor. “He thinks you try your best and what will be, will be. I think what you and I do is important! He sleeps better at night. He shouldn’t.” To me, that line always presented a crucial key to understanding House, his medical point of view and his own sense of self. And it seems to contradict the conventional wisdom about House — that he is an arrogant and egotistical prima donna. Egan explained that House has a keen objectivity, which he applies even to his own theories. He’s no less harsh on himself than he is with his fellows — or his colleagues.

Pointing out that such objectivity is incredibly rare, Egan noted that in everything from politics to medicine, people view information through the subjective lens of their own biases. “That’s why (in medical research) we have double blind studies,” suggested Egan. “I think House, surprisingly — for someone who has a big ego in some ways — never lets that ego get caught up in his theories and ideas. In a way, he’s sort of selfless in that sense. He’ll look at what the truth is and if what he’s thinking is incongruent, he will throw off what he believes. It doesn’t really matter to him.”

I suggested to Egan and Foster, that this is perhaps one of the most compelling aspects of this incredibly compelling character. I also offered that fundamentally this is what he’s trying to teach his fellows. The writers agreed.

Tuesday's episode, “Birthmarks,” was an intense and emotional roller coaster ride. House’s father, Marine Colonel John House, dies and, not so surprisingly, House refuses to attend the funeral. We’ve known since season two in “Daddy’s Boy” that House’s relationship with his father is strained; and House’s revelation in “One Day One Room” in season three that his father abused him expanded our understanding of House’s feelings. But the question posed in “Birthmarks” is “what would happen if House’s father, Marine Colonel John House died?” How would House deal with it… if at all?

“I found it really interesting,” related Foster, who came up with the story idea for this episode, “how House would react to his father’s death. We know from our earlier episodes that House has had a troubled relationship with his father. That being forced to deal with that troubled relationships and what that means or doesn’t mean to House personally — I thought was interesting thing to think about.”

Like other story ideas tossed about by the show’s many writers, said Foster, “the death of House’s father was in the hopper for quite a while.” But the death of House’s father presented the ideal opportunity to pursue House and Wilson’s reconciliation, so the time seemed right. “With House and Wilson being on the outs last season because of Amber’s death,” continued Foster, “we tried to figure out how to get House and Wilson to reconcile. And this seemed like a big enough event to bring Wilson back into House’s life — at least for this moment.” Their reconciliation is happy (or as happy as any ending can be on House.), and as Foster called it, “a typical bittersweet ending.”

With House’s relationship with his parents set in the series canon over the seasons, particularly in season two’s “Daddy’s Boy,” and season three’s “Son of Coma Guy” (written by Doris Egan), “Merry Little Christmas,” and “One Day, One Room,” I wondered how much those earlier episodes affected the writers’ approach to “Birthmarks.”

According to Foster, “those episodes are certainly the foundation… the starting point to approaching House’s relationship with his father.” Egan and Foster consulted with House writer/executive producer Thomas Moran, who wrote “Daddy’s Boy,” in which House’s parents, Blythe and John, are introduced. Moran “did a lot of work conceiving the characters of House’s parents. He had a very strong vision of who his parents are and what their relationship was.” Series creator David Shore, too, has his own conception of House’s family dynamics. Fundamentally, said Egan and Foster, it is clear that House and his father had not gotten along since House was a young boy. “His father was a very strong personality,” according to Foster, “and had high expectations for the young Greg House. And,” he added, “dealt with him in a heavy-handed way.”

Egan essentially agreed. “I might refer to his father as abusive. But I can also argue his father’s point of view, which was about discipline and helping his son reach his highest potential.” Recalling House’s admission in “One Day One Room” that his father made him sleep outside in the yard, she suggested that House’s father would likely rationalize his position by pointing out that soldiers have been sleeping outside for a thousand years — and that some of those soldiers were as young as 12 years old. ‘You’re telling me I’m abusive,’ he might object, ‘because I made my son sleep outdoors for one night?’ He would have had an argument for everything,” she noted, “but the end result was not so good for his son.”

They made a conscious effort not to paint John House as some sort of caricature-ish monster. Noted Foster, “David Shore likes us to write the characters realistically and have a real perspective. We didn’t want to paint him as some horrible, abusive man. Even as a kid,” added Foster, “Greg House was probably not the easiest to be around, either.”

Egan commented that they had been considering the types of things House’s father might have done to young Greg. They wanted them to be “things that weren’t overtly abusive… nothing physical or anything like that.” One of those became the summer when House’s dad refused to speak him. “John put notes under the door whenever he had something to say to the young Greg. It’s actually a true story,” she noted.

“We set it up so that we hear about that story early in the episode from House’s point of view.” Later, of course, we learn that House had insisted to him that he wasn’t John’s biological son, something upsetting and incredibly hurtful. “House flung this information at his dad, saying in essence that ‘I hate you so much, I’d rather believe I have this fantasy father than you as my dad.’” Of course House’s father grossly overreacted, Egan quickly added. “The onus is on the parent to act maturely even when your child is not.” But, even if not justifiable, John’s behavior didn’t materialize from thin air.

Foster added, “Diane Baker, who plays House’s mom, says to him at one point: ‘The war is over.’ And even though the responsibility is on the parent (and House’s father bears the responsibility), it was a sort of war where both sides were taking part. It takes two individuals to have this sort of a relationship meltdown.”

In another Egan episode, the wonderful and emotional season three episode “Son of Coma Guy,” the father of House’s patient asks him what he would like to hear his own father say to him before he dies. House, who’s in a particularly reflective mood in this episode, wants to be honest with this man who is prepared to take his own life to save his son. House tells him: “I would like him to say ‘I was right; I did the right thing.’” Now House’s own father has passed away with House never having heard those (certainly healing, and much needed, for House) words.

Egan commented that “the tragedy of this episode and many people’s relationships with their parents is that the parent dies before there ever was any closure if closure was ever possible.” And perhaps, for House, that sort of reconciliation and closure may never have been possible. “But I think,” she continued, “certainly that one of the reasons that Wilson wants House to go to the funeral, in addition to doing it for his mom, is that he believes that House will regret it for the rest of his life — if he doesn’t at least get some sort of symbolic closure by going to the funeral and talking about his father.” Egan added that she had hoped in “Son of Coma Guy,” to “explore a little bit more specifically of what House actually meant by his words. On the other hand,” she continued, “I kind of like leaving something so central to House — being right is everything to him — as something his father never said to him.”

But in “Birthmarks,” House certainly talks about his father — reluctantly (to say the least) delivering a eulogy at the funeral. It's an incredibly emotional moment as House speaks haltingly and honestly in public about him and their difficult relationship. But, for House, what he’s going to say, or even if he’s going to say anything at all, is a central struggle of the episode. “When he first hears about his father’s death, it wouldn’t even cross his mind that he would go to the funeral and hug his mom,” shared Egan. “That somehow they would find common ground in the face of tragedy… that’s just not House.”

Foster added, “House isn’t going to be nice for the sake of being nice. Nor is he going to say that everything’s fine — just to make his mom feel better. He’s all about being brutally honest and saying what he thinks the truth is. He is not going to tell a white lie to make people feel good.”

But is House’s characteristic brutal honesty appropriate given this situation? Perhaps not. But others might disagree, said Foster, arguing “why should you lie in that situation?” But Egan and Foster left the door open to interpretation as to whether what House eventually does say in his eulogy was actually sincere. “Was he saying it sincerely, or insincerely as a tool?” asked Foster. Egan added that as writers they like to “get the audience fully involved in the scene and then pull the ‘trap door’ to a deeper level. We hope that causes the audience to rethink what they just saw.”

“Hopefully that happens in the eulogy scene,” said Foster.

But “Birthmarks” is as much about House and Wilson as it is about House and his father. In a critical moment and cathartic moment, House and Wilson have a heated argument in the funeral home. Egan explained that “House and Wilson have their pivotal argument through the lens of Amber’s dying and things that happen at the funeral, and when Wilson picks up that bottle, hopefully you don’t know at that moment whether he’s going to hit House — or what’s going to happen. But it’s more of a random act, and Wilson actually hurls the bottle though a stained glass window,” echoing an incident from the first time they met. In the script, Egan calls it “an iconic moment.” That moment, she laughed, “reflects back on their ‘superhero origin story.’”

And of course, expanded Foster, slightly teasingly, there were the specific “VFX” (visual effects) directions about the bottle flying through the air. “I was obsessed with this,” Egan laughed. “Not only did I write that ‘this is an iconic moment’ but also wrote that ‘we follow the bottle as it goes through the air like the arrow in Robin Hood as it spins towards the window.’”

Iconic moments aside, the House/Wilson relationship is certainly central to the show. And even if House has not been overtly grieving for his father in “Birthmarks,” he certainly has spent the first few episodes of season five bereft and grieving the loss of Wilson’s friendship.

The writers see the House/Wilson dynamic, as they see all of the show’s central relationships, through differing lenses. But both Egan and Foster view that as a good thing, and a healthy environment in which to write such complex relationships. “The writers have differing views of all the relationships. We’re always hashing them out between us in rather vociferous, lengthy conversation,” explained Foster. “Doris and I have different views, but I think that makes it better. But part of what makes the writing better is that we push on each other, push to make each other better.”

“I like to think of Wilson and House as being on fairly even ground,” noted Foster. “Obviously the show is called House and Wilson is the sort of classic sidekick role. But he is able to tweak House, to poke House in the ribs, to see House’s weak spots and comment on them. And in that way, he is somewhat of an equal in that relationship.” Egan added: “It’s like Wilson has veto power in the UN Security Council.”

Both writers enjoy the playful aspects of their relationship. Egan remarked that “hopefully that’s what you see at the end of ‘Birthmarks.’ We didn’t want to end it with Wilson just coming back because House needs him, which is their usual pathology.” Not that their usual pathology “is a bad thing. It’s a nice pathology and I love it,” she said. Foster added that “Doris’ line in 'Birthmarks' referring to ‘the shine of House’s neediness," is a wonderful characterization of that aspect of their relationship.

Egan explained: “At the end of ‘Birthmarks’ House says: ‘If you’re only attracted by the shine of my neediness… (House pauses)… that would be alright with me.’ But Wilson says that this weird road trip was the most fun he’s had since Amber died. We wanted to set it up a little bit like one of those romantic comedies like It Happened One Night, where two people are thrown together in a road trip and no matter how inconvenient and annoying it was, they sort of realize that they should be together.”

And so they should. Stay tuned for my episode review of “Birthmarks,” which should appear in this space in the next day or so.