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House must diagnose a patient at gunpoint during a hostage crisis in this week's episode.

TV Review: House, MD – “Last Resort”

Confined-space scenarios (or as they are sometimes called, “bottle” episodes) in film and television (and in theater) generally are intended to produce heightened tension as the room seems to become smaller and options become more and more desperate. The ninth episode in House, MD’s season five, “Last Resort,” was such a “bottle” episode — and a wonderful showcase for the acting talents of Hugh Laurie and guest star Zeljko Ivanek.

Dr. Gregory House is a medical court of “last resort.” People come to him for diagnoses from all over the world because they have tried everything else and everyone else. They don’t care if he bends (or breaks) established protocols or ethical standards. They usually don’t care if he is arrogantly blunt or verbally abusive. They simply want to know. They simply want to get better. But seldom do they seek his unique skills at gunpoint. (Although, House was, of course, nearly fatally shot by an angry family member at the end of season two.) And despite the fact that the gun-wielding patient threatened House, 13, and a roomful of other people, House deeply empathized and related to this week's very disturbed patient.

Jason (played with a wonderful neurotic intensity by Emmy-winning character actor Ivanek) has seen 16 doctors over a two-year period. He has racked up tens of thousands of dollars in medical bills; he simply wants an answer. Now! He is sick and tired of being sick and tired. And so he comes to Princeton Plainsboro Hospital to see dean of medicine Lisa Cuddy. To see her best doctor. (I wonder if he had come to PPTH specifically seeking House’s services.) Unfortunately for a handful of clinic patients and medical staff, this time he has come packing a handgun.

The high-strung Jason surprises House as he rummages through (or rather, dismantles) Cuddy’s desk drawer… (STOP! Hold on a moment. Rummaging through Cuddy’s desk drawer? Okay, so just what was House doing in her office in the first place? Was he dismembering her drawer as one of his playful pranks? In Housian terms, that would be full-on courtship, as Wilson would likely say — and as he say — did in “Joy.” )

As I started to say… Jason surprises House, who chases him away, but only momentarily. After all, Jason’s looking for Cuddy, not House. But he returns shortly thereafter, bringing with him several clinic patients, a nurse, and 13, taking everyone, including House, hostage, while Cuddy and her security team empty the main hospital foyer until the Princeton SWAT team can arrive.

I loved how House tried to take early control of the situation by ordering up the sedative with which to dose the gunman. Unfortunately it didn’t quite work, and it resulted in a rapid escalation of the standoff. With one person shot, and 13 chosen as Jason’s guinea pig, House calls in his teams old and new to help speed things along diagnostically. However, Chase is unwilling to participate in what he thinks is House’s game of cat and mouse towards a diagnosis.

To House, who is, of course, a huge risk-taker, the challenge of diagnosing Jason would have been irresistible under normal circumstances. And even under these tense conditions, House follows his normal process, using Cuddy’s wall as a “white board,” finding the challenge of being right when 16 other doctors were wrong impossible to ignore.

But as Jason gets sicker, suddenly showing heart symptoms, the diagnosis and treatment path becomes more complex. The drugs used to confirm House’s theories are dangerous and a potentially lethal combination, especially given to 13, whose central nervous system is already compromised by Huntington’s disease. House is clearly uneasy with the position she’s in (and his responsibility for her) as the drugs take their toll on 13, and she gets sicker and sicker — and he gets no closer to a final diagnosis.

The theories eventually begin to point towards cancer; but a CT scan is required to confirm. Trading two additional hostages for a free pass to radiology, Jason is down to his last three hostages plus House and 13. Four have been freed and the remaining hostages are bound and moved at gunpoint to radiology.

But the test is no good with Jason wielding the gun, thereby distorting the CT image. House knows this, and realizes that this is his chance to get the gun from the patient. He tells Jason either to give him the weapon and get the CT or shoot him now, since they’ve come to a diagnostic stalemate.

Jason gives up the weapon and two more hostages flee. House re-does the CT scan only to learn that it’s not cancer. The diagnosis is wrong. House then makes a decision that is both dangerous and completely in character for him. House can end things here. He holds all the cards; he’s completely in control of the situation.

But there’s a hitch. Yes, House can end the standoff. But Jason will not have his diagnosis and House will not have his answer. House’s obsessiveness gets the best of him, and in an impulsive lapse, House relinquishes control back to Jason, returning his weapon to him. I also think that by this point, House has developed an empathy for Jason's situation. He deeply relates to Jason's frustration, his predicament, and wants to help him. House wrongly thinks that he can still control the situation, that Jason will play fair, since House has trusted him.

House has gravely misjudged Jason, who doesn’t play by the same rules of logic and fair play. Despite his promise to House, Jason still insists on testing all drugs on 13. House even offers himself, refusing to allow 13 to sacrifice herself. But the self-destructive 13 plays into Jason’s agenda, perfectly willing (at least at first) to be his lab rat.

Finally realizing that they had been missing a crucial piece of the diagnostic puzzle (that Jason had been to Florida), House comes up with the correct theory. But Jason doesn’t trust that the prescribed drugs will cure him. He still insists on giving them to 13 first, who by now is in kidney failure. Exchanging House’s freedom for the needed drugs, House at first refuses to go, not wanting Jason to dose 13 with what could very well be a fatal injection. But given no choice at this point, House leaves, staying close to the lab, deep in thought (and pretty shaken up) for the end game as he waits for the SWAT team to do its thing.

I’m wondering if he’s processing his potentially fatal decision that may cost 13 her life. Although House calls her a coward for being terrified of death, continually edging herself closer to it by her self-destructive behavior, 13 also calls House on his own fatal flaw: refusing to allow himself ever to be wrong, to ever be “ordinary” — just a plain “human being.”

Ultimately, confronted with her own probable death, 13 chooses life, refusing to inject herself, even as Jason threatens her at gunpoint. But unable to pull the trigger, or force 13 to self-inject — and knowing that the SWAT team are very near to breaking in — Jason wrests the syringe from her, injecting himself.

With the standoff over, a shell-shocked House returns to the radiology lab. He’s not sure what he’ll find — whether 13 is even still alive. It’s an incredible acting moment for Laurie as re-enters the room, horrified, terrified — and then finding 13 thankfully alive.

Now in handcuffs, Jason observes House, who is still badly shaken by everything that’s happened, looking almost as lost as he did in the aftermath of the bus crash. House gestures quietly, his hand to his abdomen, perhaps a small, silent gesture of thanks (at first I didn’t even catch it) for sparing 13’s life. (I’m not entirely sure what the gesture meant, but perhaps House was assuring Jason that 13 had survived the final moments of the standoff. Perhaps House was even checking that Jason's breathing properly after the right treatment.) Whatever else it is, it is a stunning moment between the two men in the denouement of their intense confrontation. As Jason is removed, the camera lingers on House’s very emotional expression, with much to think about.

For her part, 13 has turned a new page and is ready to submit to some sort of treatment for her Huntington’s. House is also ready to turn a page — with Cuddy. His prank with the desk drawer was clearly intended as an attention-getting move, and their furtive glances at each other during the entire ordeal spoke of something very definitely going on between them. In the end, Cuddy finally asks House point-blank whether he wants a relationship with her. And while his words said “no,” his eyes, with that fabulous deer-caught-in-the headlights expression said “I am in such trouble!” But even the SWAT team guy picked up on Cuddy’s concern about House, so one only has to wonder where that will all lead — and who’s in control.

This episode was all about control: control over the way one lives; control over the way one dies. House, who controls so little of his physical life, and whose life has been pretty brutally out of his own control for months, tries to control an impossible situation. And he does it with mixed results, succumbing to his own weakness, despite the positive eventual outcome.

Jason, too feels a need to control — something. Anything. He is fed up with the unfairness of the medical establishment. He realizes that he won’t come out of this a free man – he’ll either die or be arrested – and he doesn’t care. This is something to which House can deeply relate —  needing to know so badly that nothing else matters; he needs to control something in his life.

13, too, needs something over which she has power. And as her life careens out of control, she believes that the one thing she can control is the manner in which she will die. House also can relate to this, and having been there, part of him understands, and part of him is appalled and unwilling to watch while she self-destructs in such an overt manner.

Ivanek and Laurie are perfectly matched in the episode. Laurie’s slow burn intensity as House was a great counterpoint to Ivanek’s crazed gunman. Both men obsessed with finding a truth that may or may not exist; both willing to risk themselves (and possibly others).

Katie Jacobs has a wonderful director’s eye. I’ve loved her other two outings: “Half-Wit” in season three and “Wilson’s Heart,” the heart-stopping and heartbreaking finale to season four. Her intimate camera work ratcheted up the tension by millimeters at a time, while eliciting nuanced and sensitive performances from all of the episode’s central characters, especially Laurie, Ivanek, and Olivia Wilde.

Next week looks like a fun and lighter episode. As much as I have adored this season’s gravitas and angst, a lighthearted episode to send us into the winter holiday season will be much enjoyed.

At this season of Thanksgiving, I wish to thank my readers for a wonderful first (plus) year, and for making this column such a success. A joyous and peaceful end of the year to all.

About Barbara Barnett

Barbara Barnett is Publisher/Executive Editor of Blogcritics, (blogcritics.org). Her Bram Stoker Award-nominated novel, called "Anne Rice meets Michael Crichton," The Apothecary's Curse The Apothecary's Curse is now out from Pyr, an imprint of Prometheus Books. Her book on the TV series House, M.D., Chasing Zebras is a quintessential guide to the themes, characters and episodes of the hit show. Barnett is an accomplished speaker, an annual favorite at MENSA's HalloWEEM convention, where she has spoken to standing room crowds on subjects as diverse as "The Byronic Hero in Pop Culture," "The Many Faces of Sherlock Holmes," "The Hidden History of Science Fiction," and "Our Passion for Disaster (Movies)."

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