TV Review: House, M.D. — “The Tyrant”

An ailing old man: a  head of state, comes to an American hospital. A dictator, he is responsible for the deaths of thousands. And if he survives, he will likely kill a hundred thousand more. Does he have a right to medical treatment? Does he have a right to live?

Or is it better to eliminate him, knowing that to cure him will mean certain mass murder and genocide in a small African nation? This is the question pondered in “The Tyrant,” this week’s House episode. Guest star James Earl Jones, the epitome of menace and evil as the voice of Darth Vader the legendary Star Wars saga, plays a President Dibala, an African dictator who begins to vomit blood after being served with papers accusing him of crimes against humanity.

It’s a compelling ethical question. One that touches on a core House theme: the tension between “ethics” and “doing what is right.” Is the right thing to pre-empt genocide and let the tyrant die? Perhaps even take an active role in hastening his death? Or is the right thing to treat him because he has the right to proper medical treatment, leaving judgment and punishment to the international legal and political systems?

Usually on House, we are treated to House’s unique take on ethics and morality; this week, as he continues to await the reinstatement of his medical license, House is relegated to a marginal role in the main case. Chase and Cameron are enlisted to work diagnostics for the department's new director, Foreman, after Taub’s resignation and 13’s firing last week. House has returned to Princeton Plainsboro only to observe and offer opinions, but not to treat—or have any patient contact.

The team is tasked with diagnosing and treating President Dibala. They are under siege from Dibala’s protectors, who are suspicious of every procedure; and his opposition: an oppressed people, who implore the team to “do the right thing” and let the man die.

In a way it’s like old home week with the original team intact, yet something seems askew. House is not there, guiding and filtering the debate, leading the team driving the diagnosis—and the ethical debate.

Cameron’s insane moral compass tells her to have no part in saving Dibala, which would make her an accomplice to genocide. She and Chase argue over the moral imperative they have to end this threat to humanity versus their ethical medical duty to treat him. In a case like this what is the meaning of the Hippocratic Oath’s directive to “do no harm?” In the end, Cameron can’t do it; but surprisingly, Chase can—and apparently does.

Swiping a  blood sample from a dead patient in the morgue, Chase fakes Dibala’s test results to make it appear he has scleroderma, a diagnosis House confirms and Foreman eventually acknowledges. They treat Dibala accordingly; but he bleeds to death internally.

Chase confesses to Foreman he did it because he had no moral choice: he could not let Dibala return to his country and commit genocide. But I wonder.

Chase knows Cameron very well; he knows her history and her tendency to be judgmental in the extreme—that “insane moral compass” of hers. He also knows her position on Dibala: they argue about it at least once, and probably continue the debate at home and between the lines.

I can easily see Chase either deciding to kill Dibala thus pre-empting Cameron in order to protect her career and life while risking his own. I can equally see Chase protecting Cameron if she is actually the one to have taken Dibala’s life by faking his own signature to replace Cameron’s on the incriminating morgue log. It fits Chase’s impetuously romantic nature and his natural inclination to protect his wife. When Foreman discovers Chase’s act, he rails about what Chase has done, but in the end, he covers for Chase, burning the incriminating evidence.

Jesse Spencer is wonderful in his scenes, conveying Chase’s anguish, knowing what the future may bring, whether or not Foreman rats him out. I have sorely missed him. Omar Epps, too, expresses Foreman’s moral dilemma nicely as he first argues with Chase, and then becomes his knowing accomplice.

It's interesting to observe Foreman in this episode, on his own, running the differential. This is his case and he loses control of it. As House admonishes, pointing out Foreman's fatal flaw: Foreman either stubbornly held onto a bad opinion (making him too late to treat), or lacked the courage of his convictions. This is the sort of decision House makes every week, knowing the feel of that fine line. 

House is absent for much of the hospital action, and instead becomes involved in a squabble with Wilson’s neighbor Murphy. Now residing with Wilson, House’s innocently tapping his cane on the floor annoys the man who lives just below. Murphy, who lost his arm years ago, is bitter, in pain, and easily aggravated. Unsurprisingly, he takes an immediate dislike to House. Wilson, focused on petitioning his condo to install a fountain garden, doesn’t want to rock the boat with his neighbor, lest he lose his chance at the fountain.

When he first meets Murphy, House is stunned that a disabled man would begrudge a fellow “cripple” the use of his rubber-tipped cane. House tries to make nice, even promising to try to do better, an appeasing, if slightly insincere, olive branch certainly designed to help Wilson’s efforts with the condo association. But the neighbor doesn’t care.

I love the battle we can see waging inside House: his normally sarcastic inclination fighting for dominance with his better angels. And he really, really tries. But it seems nothing he can do will appease such a stubbornly bitter man.

It’s actually Wilson who’s the real jerk here with his imperative is to get that fountain, even if it means jettisoning House from his condo to appease the neighbor. This is such a fragile, critical time for House, and Wilson continues to treat him like a barely-reformed juvenile delinquent on probation.

But when Wilson tells House he has to move, instead of pushing back and calling Wilson out on it, House goes back to the neighbor trying to make amends. House has realized (granted, by snooping around his apartment) that the man suffers from phantom pain: terrible, chronic pain sometimes suffered by amputees from limbs no longer there. Trying a low-tech, yet effective, technique with mirrors, House cures the “phantom pain,” helping Murphy—and Wilson.

The look of delighted satisfaction on House’s face after curing the neighbor, finally pain free after so many years is a subtle, but classic, House moment. For House, this is what it means to be a doctor.

What a fantastic thing House has done for this man—and for his friend! (And subtly played by Hugh Laurie). Wilson then magnanimously allows House to stay. How big of him. Sorry, I thought Wilson’s treatment of House in the episode was unjustified, judgmental, and harsh. And, at this critical juncture for House, potentially destructive.

As much as I liked this B-story for its commentary about House’s internal struggle and his relationship with Wilson, I really missed him at the heart of the moral debate in this episode. On the other hand, keeping House out of the fray will leave him innocent of any fallout, putting him in an interesting position as the ramifications of Chase’s action become known next week. House’s unique view of morality and ethics underlies so much of what makes House compelling, I hope his take on the case frames his return as department head in the weeks to come.

It’s always an amusing parlor game to mine the episode title for its overt and more subtle meanings. Obviously, the main “tyrant” in “The Tyrant” is Dibala, but there are others: Foreman style can be called dictatorial as he tries to run House’s department; Wilson’s neighbor is certainly a tyrant, and even Wilson is a bit of a tyrant towards House. I suppose tyranny depends on your point of view. Tyrants never think of themselves in that way, and tyranny takes on many forms.

House airs Monday nights at 8:00 p.m. ET on Fox.