How can you not love a House episode that features the main cast attired in tuxedos and evening gowns? But even without all of the window dressing and eye candy, “All In” is one of season two’s best episodes. An examination of House’s medical obsessiveness, Hugh Laurie’s textured performance slowly peels back new layers of House’s inner life, as he grapples with the case of Ian, a young boy whose symptoms match those of a previous patient, the elderly Esther Doyle.
In a sense, death can be viewed as House’s archenemy, something with which he does battle relentlessly; and sometimes to a point beyond which other doctors would turn in their scalpel and wave their white coat in surrender. It’s part of what makes House heroic, especially because he often does it with little regard for his own comfort or career (or life); but House’s medical relentlessness also is part of what makes him a medical outsider.
But House doesn’t always win; death is a powerful adversary, and despite House’s sometimes heroic efforts, it defeats him and patients die. One of House’s more macabre traits (as seen by his colleagues, anyway) is that he will continue to pursue the illness beyond death. He needs to know the cause; what went wrong and why. It’s not (just) morbid curiosity with him. Figuring out the “why” even after death has won allows House to add one more case, one more bit of knowledge, one more weapon, should that disease ever come round again. It’s not something that his colleagues always (or even most of the time) understand. It’s why he continued in “Occam’s Razor” (season one) to search for the mistaken colchicine pills long after the patient was cured, why he needed to know the source of the girl’s infection in season three’s “House Training” even after it was too late to save her. And why, even 12 years later, House still can’t let go of Esther, succumbing to a rampantly aggressive disease — one that killed within hours. A disease that House could not defeat in time to save the patient; a cause of death he could never confirm.
Of course you might say that House’s obsession with Esther’s case is part of (as Wilson termed it in season one’s “Detox”) his “Rubik’s complex.” “Some doctors have a Messiah complex; you have a Rubik’s complex — you have to solve the puzzle.” Is it a simple case of an unsolved puzzle? Like a word in a “super-challenge” crossword puzzle you’ve never been able to figure out, still bugging you years later? It’s certainly a less romantic explanation, and one that House’s colleagues (who don’t know him as well as we viewers do!) might suggest. But House’s intensity, his growing anxiety and anguish and ultimate deliverance at having arrived at the answer suggests that this isn’t really about puzzles and curiosity. There is something much deeper going on within him.
The episode begins on a very light note (after the teaser, that is) as House, Cuddy, Wilson, and the whole team participate in a formal benefit poker tournament. Dressed in a gorgeous tuxedo and sporting a silver, snake-handled cane last seen in season one’s “Sports Medicine,” House actually seems to be enjoying himself, teasing Wilson and Cuddy while raking in the bucks. (How can House be anything but a fabulous poker player, with his mind and observational skills?) Cuddy is stunning in a sapphire velvet gown, Cameron in a close-fitting red cocktail dress. Holding two aces, House listens as a doctor briefs Cuddy on a patient of hers, just admitted to the ER. His interest is immediately piqued as he listens to the symptoms. Cuddy brushes off the symptoms as gastroenteritis, asking the doctor to treat Ian and reassure his parents until she can absent herself from the benefit. Wilson is suspicious when House suddenly folds, holding two aces, excusing himself “for air.”
House has seen this presentation of symptoms before, and, to him, there’s no way it’s simple gastroenteritis. Visiting the young patient, House becomes convinced that Ian has what Esther died of 12 years earlier, but could never confirm: Erdheim-Chester. Gathering the team, House begins to white-board the parallel differential diagnoses of Esther and young Ian. Chase dismisses House’s interest as obsession. He’s seen this before with other patients in the months before Cameron and Chase joined the team. But when House correctly predicts kidney failure as the next symptom, they realize that he may be onto something.
But as it becomes clear that it’s not Erdheim-Chester, House’s anxiety mounts as does his desperation. Each wayward turn brings House closer to the edge, frustration and uncertainty growing, as they get no closer to a diagnosis. At one point, Cameron suggests lymphoma, something he had not considered with Esther. Could he have missed it then? Had he thought of it then, might he have saved Esther’s life? But when Chase confirms that it’s not lymphoma, House is back to square one.
Meanwhile, House keeps Cuddy (after all, Ian’s her patient!) engaged at the poker table with Wilson. But Wilson senses that something’s wrong, despite House’s trademark deflection and subterfuge (and hilarious manipulation of the game). Eventually called into the case when the diagnosis veers towards leukemia, Wilson lectures House about obsession and white whales. He knows about Esther, as does Cuddy, who pulls House off the case after he attempts a nearly-fatal biopsy. Of course when has that stopped Ahab…er…House, especially when he possesses said biopsy tissue in hand (or, rather, in refrigerator)?
As the team grows concerned for House’s emotional well-being, they watch him become increasingly agitated, slowly falling apart before their eyes as time runs out. Even Foreman wonders what will happen if they fail to diagnose Ian. “He’ll die,” acknowledges Cameron, answering the simpler question. “I mean what about the next 12 years?” presses Foreman, making clear what they all feel for House.
Twice, House needs to excuse himself from the differential, distressed and dispirited — out of answers and time. He knocks over his beloved white board in frustration, and breaks the lock of a nearby coffee bar, wildly grasping for anything that might explain Ian’s (and Esther’s) condition and save the boy’s life. “Treat for everything!” he demands, clearly at the end of his rope. But nothing works, and finally, discouraged and needing to be alone with his thoughts, House quietly asks the team to give him a minute. Sitting on Ian’s bed, his cane stretched out across the sleeping boy’s body (almost as if it's some sort of protective shield) House seems to be seeking answers or, at least, inspiration.
With no more answers to be had, a dejected House retreats to his balcony, and when Wilson seeks him out, excited about winning the poker tournament, House gets his epiphany. Telling House about his “pocket aces,” House thinks that maybe Erdheim-Chester is simply hiding, having tested for it too early in the disease’s progress.
With no other explanations forthcoming, and a renewed air of self-confidence, House insists that his team use the final slice of biopsied tissue to retest for the rare disease. Skeptical, the team reluctantly agrees to do it. As they perform the test, House hides his emotions but becomes visibly emotional, nearly losing his composure, when the test comes up positive. Collapsing with relief onto a nearby lab bench, House knows that not only has he saved Ian’s life, but has achieved closure.
So it is fitting, case solved at last, that House finds solace (and emotional expression) in Oscar Peterson’s “Hymn to Freedom,” which he plays on a piano as maintenance cleans up the mess left over from the poker benefit. And, in a great final scene, House and Wilson pick up where they left off the night before — playing poker.
House returns with new episodes September 16 (two months and counting!); the season four DVD set hits the streets on August 19. And let’s keep our collective fingers and toes crossed for Hugh Laurie and the series as this year’s Emmy nominations are announced on Thursday!