“This is the only ‘me’ you get.” A simple declaration by the resigned House (Hugh Laurie in a raw and surprisingly emotional performance) at the end of the newest House, M.D. episode “The Softer Side." Acceptance by one’s family and friends frames this episode’s narrative, a theme explored for both patient and doctor. Set against the diagnostic backdrop of an adolescent boy with “genetic mosaicism” (he has both XX and XY chromosomes, making him equally male and female), the episode touches on several key themes that so often make House compelling TV.
Jackson’s genetic condition makes him "different." Born equally male and female, Jackson's parents had to choose years earlier whether their newborn baby was to be a boy or girl. Surgery and a lifetime of testosterone treatments will help Jackson grow into a “normal” young man. His parents (his mother, really) have decided to keep information from him, saying that “he’s not ready for it.” On the other hand, his mother in particular, seems to be forcing him into the “boy” box, making him choose “basketball or hockey” when he would prefer dance. She cannot accept Jackson for who he is, and therefore tries to make him into who he “should” be.
Collapsing while playing in a school basketball game, Jackson's parents, along with House's team are convinced that young man's illness must be related to his sexuality. Trying to diagnose the inquisitive young man without revealing the parents' secret proves difficult, and eventually 13 lets the cat out of the bag, forcing the parents to deal with Jackson's ambiguous sexuality and their own issues related to it.
And like Jackson, House seeks acceptance for who he is, not to be folded, spindled and mutilated into someone else’s version of who he should be. House’s advice to the parents at the end of “The Softer Side” ring wise and true—and–coming from a lifetime’s experience. “You gave birth to a freak of nature. Doesn’t mean it’s a good idea to treat him like one,” he admonishes the parents after finally diagnosing the boy with simple dehydration.
It’s good advice, and advice that perhaps Blythe and John House would have been wise to follow with their young, socially isolated genius son. In some ways, the scene contains echoes of House’s season-three conversation with the dwarf-mom in “Merry Little Christmas.”
At its core, House M.D. is the story of Dr. Gregory House’s struggle with both his physical and emotional wounds. From time to time, House has made (sometimes elaborate) attempts to diminish his physical pain. When he has succeeded ("Meaning") we are privy to a completely different side of House, more easy going and far less impatient. But we've also seen indications over the years that House somehow connects his isolated, miserable existence with his razor-sharp edge concerned about sacrificing that as the cost for living pain-free.
House’s pain is very closely enmeshed with his drug use. He insists that the Vicodinis strictly for the pain in his leg. But nearly everyone in his circle has at one time or another accused him of taking using drugs to dull his emotional pain, even going so far as to suggest that some or all of his physical pain is a manifestation of his emotional turmoil ("Skin Deep," season two).
Wilson and Cuddy have, over the seasons, raised this to an art form. From manipulating bets and watching him go through the hell of cold-turkey withdrawal to refusing to give him medicine he clearly needs to function, Cuddy and Wilson have acted the tough-love parents, in often misguided attempts to get House off drugs or otherwise change his behavior. Much of early season three focuses on Wilson's attempts to force House to change.
But House’s pain is real, and he suffers—most often in private. As recently as “Painless,” we’ve seen the degree to which House suffers, living with pain that is “on good days merely intolerable” and on bad ones “suck the soul right out of you. (“Words and Deeds,” season three).
When he has attempted new methods of pain control (“Insensitive,” “Half Wit,” season three), he has most often done it secretly, unwilling to put himself through the expected lectures about his self-destructivenss. In “Half-Wit,” even Cameron immediately jumped to the conclusion that House had entered a Massachusetts clinical trial “to get high,” rather than understanding what might really motivate someone in such constant severe pain to try something radical and experimental.
In “The Softer Side,” House has once again decided to try an alternative to the Vicodin. Of course, he does it privately, telling no one on his staff, and keeping it secret from Cuddy and Wilson. But observing House’s unusually good mood, even with a moronic (but hysterically funny) clinic patient, Kutner, Wilson and Cuddy and then Foreman all suspect something is up.
After House stops breathing in his Eames chair while napping, Wilson leaps to the idea that House has upped his narcotic ante to heroin. And to test his theory, he offers House a bourbon at a local bar, knowing that if House is on heroin, he’ll refuse to drink it, given that one drink could easily kill him.
But House is immediately on his guard, guessing Wilson suspicions, and realizing that the drink is Wilson’s make-shift tox screen. But House tips back the drink anyway, disappointed, hurt and frustrated that Wilson “can never figure anything but the most screwed up scenario” when it comes to him. As House stalks out of the tavern, Wilson follows closely and has his suspicions apparently confirmed as House vomits the alcohol. But he's not on heroin; he’s on methadone:“heroin without the high.” The news does nothing to allay Wilson's concern.
“It’s twice the risk,” Wilson argues. Assuming that House is taking methadone to detox from Vicodin, he reminds House that there are better ways to withdraw from narcotics, still not considering that House may have completely legitimate reasons for using methadone that have nothing to do with addiction. Like pain, for instance. “I’m not detoxing,” House insists, frustrated.
“Fine for pain, then, whatever,” Wilson says dismissively changing only the semantics, not the sentiment that House is behaving inappropriately and recklessly. Granted, House has been reckless, risked death (and has nearly died) too many times to count and Wilson’s panic about House’s latest death-defying behavior might be justified.
But House is an adult. He’s taking a calculated risk and asking that Wilson understand that. Finally tossing his cane into a dumpster, he reveals the methadon has completely eliminated his pain. “My leg doesn’t hurt anymore,” concludes a victorious House, leaving Wilson alone in the alley, speechless. House isn’t high, he’s pain free. It explains his good mood and argues against the conventional wisdom that House’s physical pain has more to do with his emotional state than with his leg injury.
Wilson’s first thought is to confer with Cuddy and figure out how to stop House from continuing the methadone treatment. I’m not sure why Wilson feels the need to meddle into House’s life (when House clearly hates the meddling), but his first reaction is that methadone is bad and he and Cuddy need to stop him from ruining (or ending) his life.
Offering him an ultimatum, Cuddy tells House he must choose between the methadone and his job. “I can’t sit by and watch you kill yourself,” she tells him. But neither Cuddy nor Wilson have really heard House's legitimate argument for changing his pain regimen. House views this a chance, maybe his last one to live pain-free. No wonder House hid the methadone from them.
Cuddy sees only an addict searching for a new way to get high. In her mind the prescribing doctor must have been conned into it and had no idea about House’s “addiction issues.” But House finally and emotionally reveals his disappointment and frustration. “He knows I’m in pain!” House must wonder why it's impossible to accept this simple explanation. It's an argument he will never win. And refusing to further justify himself, House resigns.
“You’re choosing methadone over this job?” Cuddy asks disbelievingly.
“I’m choosing lack of pain over this job.” How sad, that after all these years, House still must repeatedly explain himself. No one, neither Cuddy nor Wilson has a right to make such a fundamental quality-of-life decision for him. His resignation is House's personal declaration of self-determination.
Of course Wilson and Cuddy act out of concern for House; they worry about his recklessness and his clearly defined self-destructive streak. What they do, they do out of love. But that love and concern is sometimes misguided.And this time, their actions have pushed House away at a time when he could probably use their support and encouragement.
This scenario loosely parallels Jackson’s situation, now made awawre of his unique sexuality. Jackson is angry with his parents, banishing them from his hospital room. But, as 13 points out to them, their son needs them more than ever, and even as he pushes them away, they should be there to love and support him.
Nowhere to be found at the hospital, House is back home, having shaved and put on a well-tailored suit. When Wilson drops by to check on House’s well being (and probably make sure he’s still breathing), he is stunned to find House sharply attired, alert and determined to get on with his life—without Princeton Plainsboro Teaching Hospital, Wilson or Cuddy.
This slightly strange, but positive, change in House catches Wilson off guard, causing him to reconsider his position. Going to Cuddy, the two of them decide it might be best to support House, accept that it’s his right to choose—and that perhaps the methadone was even the right choice. Not that it’s really any of their business…
When House drops by Cuddy's office to collect a requested recommendation letter, she has not yet drafted it, and instead offer him his old job–along with the medical support he needs to keep the methadone treatment safe.
“We both know this is where you belong,” she says. House is slightly surprised by her change of heart, and seemingly grateful that she finally seems to understand what he wanted: acceptance. House merely responds with a nod and a quiet, sincere “thank you.”
Now back on Jackson’s case, House realizes that the boy’s illness can be traced to dehydration, exacerbated by the MRI performed on him at the request of the parents. Under ordinary circumstances, House would never have performed a test simply at the request of the family. Especially not after he had just declared the test a “waste of time.” He would mock and deride, arrogantly telling them that they should leave the doctor-stuff to him. Instead, he did what the parents wanted.
He attributes his slip to his good mood. It’s a costly slip, and one that might have cost young Jackson his life. House’s “error” raises one of his deepest fears; one that cuts right to the core of what makes House uniquely gifted. Has the methadone, and its effect on his pain level and mood cost him cognitively. Or has the new drug treatment somehow compromised his ability to reason? Has it made him hazy? Too laid-back to be a hyper-vigilant observer? Has his good mood affected his objectivity in any way?
It is here that House’s desire for a normal, pain free life clashes with his greatest fear: that any treatment he may undertake will compromise his ability to think, to observe—to affect his medical gift. And that’s something he’s unwilling to trade. No matter the upside.
House’s intellect, his genius, is his “one thing.” It defines him and is intricately woven into in his self-worth. After he is shot in season two’s “No Reason,” and after much unconscious soul searching, House is willing to make that compromise, as he seeks meaning beyond simple intellect. And in “Softer Side” House once again considers this compromise, and in the end, he’s decides that the risk is too great.
So when Cuddy stops by to give him his first methadone dose, House tells her that he can’t do it and why. That the cost is too great and almost caused him to kill a young patient. Now arguing the other side, Cuddy pleads with House, assuring him that he is not ONLY about his genius. "You'll still be a good doctor." "I don't want to be a 'good' doctor," he insists, refusing to take the dose.
“Don’t do this,” she begs. “It’s done,” he responds, picking up his cane. “This is the only me you get.”
It is this last line, the one with which I started this lengthy commentary, that has stayed with me since the episode aired. It makes me wonder whether House’s decision to try the methadone was (at least in part) fueled by his desire to have a relationship with Cuddy. But ultimately House tells her (or warns her) that he is who he is, and she will have to accept that if she wants explore anything deeper with him. Because the cost of changing, for him, is too great.
The next new episode of House is on March 9, “Social Contract.”