First, my apologies on getting this review up so late in the week. I wanted to mull it over, given the episode’s dual themes of pain and suicide, two themes that have threaded through four and a half years of House, MD. So forgive me if this reads more like a short essay than an episode review (author’s prerogative, I suppose).
Of course House’s own pain is a major trope of the series: its ebbs and flows affecting (or even being affected by) House’s emotional well-being. Throughout the four-and-a-half years of House, MD, we’ve witnessed House have better days and worse days. And occasionally, really bad days. He seems to have hit another bad patch now, which is not too surprising considering the stresses he’s been under since the end of last season. Emotional stress absolutely seems to make House’s leg pain worse.
Usually House conceals his pain, hiding it beneath a biting sarcasm; deflecting with an insult before anyone (hopefully) notices. He steadfastly refuses to allow himself to be defined by his disability to the point where denial of its power defines him anyway.
But as we see in “Painless,” when he is alone, House suffers much more than he lets on. Sitting in the bathtub (presumably to soak his leg), House appears to be in terrible pain, barely keeping it together. I have to say that Hugh Laurie does such a brilliant job of portraying House’s pain that to watch it, I feel almost a voyeur. His eyes, the hunch of his shoulders, the heaviness with which he leans on his cane or walks without it tells us whether House’s pain is a “10” or merely a “5,” which, for him, might be a “good day.” As he told detective Michael Tritter in “Words and Deeds,” his pain is “merely intolerable” on good days, but “soul-sucking” on bad ones.
Although it’s not quite as pervasive a House theme as “pain,” suicide has been tackled several times during the series run — in different contexts. “I got no problem with people killing themselves,” he tells his patient in “DNR.” And he doesn’t — after the patient has all of the relevant information. After that, it’s the patient’s call. In “Painless,” when Jeff attempts suicide a second time, House seems almost angry that Jeff is determined to kill himself, refusing to allow him the privilege. “Just let me die,” pleads Jeff. “No,” is House’s emphatic response, not while there’s a chance he can be cured. That has been House’s M.O. In "Informed Consent," Wilson advocates that House help Ezra Powell die, reminding him that he's assisted a patient's death in the past. House counters that he's only done that when the patient is terminal, "and we're nowhere near that," he emphatically insists.
House has never seen suicide as being a relevant way to “go onto something better.” He doesn’t believe in that “something better,” only the here and now. With no belief in an afterlife or heaven, House strongly believes that a miserable life is better than no life.
Is he opposed to suicide? No. And he has facilitated it — and understands it. (Gabe in “Son of Coma Guy” and “Informed Consent” — after the “terminal” diagnosis made a painful death inevitable. Even for himself, he surely had to have at least contemplated it in “Merry Little Christmas.”) However, as miserable as he is, when it would have been easier for him to simply give up, the tenacious House has fought himself back from the brink three times since we have known him (“Three Stories,” “No Reason,” “Wilson’s Heart”). Perhaps it’s part of his personality, never allowing himself to let go — to give up — but fundamentally House has consistently believed that a miserable existence (since everyone’s miserable) is better than the nothingness that is at the end of life. And while hope exists, suicide is not something he advocates.
Back in season two, House had a couple of episodes when his pain meds stopped working (“Skin Deep” and “Who’s Your Daddy”). Between those episodes, we witnessed House having more and more difficulty walking and clearly in a greater amount of pain. Despite the placebo effect of the saline injected by Cuddy in "Skin Deep," by the episode’s end, it had worn off, and House continued deteriorating until the end of the season when he was shot. But clearly during that time, his future was weighing heavily on his mind. Resorting to morphine use, and an bleak future, House is shot by a former patient in the season two finale, but as he lay bleeding to death, his survival uncertain, House chooses “life,” when death would have been so more simple an answer for him. Instead of letting go of it all, he fights back to consciousness long enough to request an experimental pain treatment. There is something about House, that despite his depression, his disability, and his pessimistic outlook on humanity that keeps him coming back. Whether it’s courage or a deeply-buried, underlying optimism, he cannot give up on life. It’s like he told Apple in “Not Cancer” when she senses the similarities between them. “Only difference is, I haven’t given up,” he tells her — a patient who has given up on finding any sort of joy in her life.
On the other hand, House has a well-defined self-destructive streak that drives him passively towards an early death. His drug use and drinking, his not really caring much whether he lives a long life or dies tomorrow, have been explored in episodes during all five seasons. House’s self-destructiveness has nearly done him in on several occasions. Wilson, in particular, has always been alarmed at House’s apparent indifference to whether he lives or dies.
Enter Jeff, the “patient of the week” in “Painless,” a man with a young family, suffering from intractable chronic pain, despite treatment with narcotics (according to Foreman, Jeff “makes House look like a Christian Scientist” based on the patient’s collection of pain meds) for three years. After three years with no diagnosis and bleak future, Jeff “just wants it to be over,” attempting suicide before his wife brings him to the Princeton Plainsboro Emergency Room. Treating him in the ER, Cameron refers Jeff to House.
Is Cameron trying to make a point to House? She claims she has done it to bring to his attention someone who has “even less to look forward to.” Even though, as she admits, House is unlikely to “learn” anything from the experience. Cameron might be hoping that House would somehow connect with someone who she thinks might be a kindred spirit. Or maybe the case might cause House to reflect on how his own life might be in a few short years (maybe a few short months), and to try another path. Although how much more House can do is debatable. Maybe she’s trying to show House that his life is no less self-destructive than Jeff’s and that unless he changes something, he might find himself at the end of the same rope.
In any event, Cameron knows that, despite his outward attitude, House is a deeply reflective man, and maybe she knows that that Jeff’s pain — and where it’s driven him — will cause House to pause. As Katie Jacobs told me in my recent interview with her, “Cameron is worried about him” and what might become of him if he doesn’t take better care of himself. I think Cameron also knows that unless he’s diagnosed (and cured), Jeff will surely try to “check out” again. Who better to assist a medical lost cause than the relentless House.
It’s interesting to compare the two men and how they deal with their pain. Jeff tells House at one point (although how he knows, unless Cameron clued him in I couldn't say) that with no family, House has an easier time dealing with chronic pain. Jeff argues that there is no one for whom House has to put on an act; no reason to conceal the pain he has; no expectations. Life is more difficult for family man Jeff.
Actually, Jeff has gotten it wrong, because House spends a huge amount of energy doing just what Jeff says he need not. House scowls, glares, and insults for the very purpose of keeping people far enough away that they don’t see how much he’s suffering. Jeff, on the other hand, seems to wear his pain on his sleeve. The pills no longer effective, Jeff conceals nothing — not even from his young son — about his upset, including that he wants his life to be over. Jeff is not only trying to destroy himself, he has no qualms about taking his family down with him (emotionally, anyway). If House were to finally decide enough is enough and to end it, I think it would play out much like the final scene of “Merry Little Christmas.” (alone, a quiet “good-bye” to his mother — but no note, no drama). I always believed that in “Merry Little Christmas,” House, desperate and alone, facing the loss of his freedom and his “one thing,” seriously considers killing himself, taking a bottle-full of Oxycodone and a lot of whiskey. At the last minute though he makes himself vomit, saving his own life, determined to face the consequences.
Ultimately, House is forced to answer this question from his patient: “what if it were you? Could you live like that?” It’s a question to which House cannot honestly answer “yes,” and when Jeff’s wife asks House to stabilize her husband and let him do what he needs to do, House quietly answers, “OK,” barely able to look her in the eye. It’s clearly something he continues to consider well into the night and long after he has condemned his patient to a voluntary death. With House’s clear uptick in pain, he surely has to be wondering about the truth of Jeff’s stinging retort to House — about how life will be when the meds stop working; when House’s “merely intolerable” good days cease to exist.
Good luck to the House cast and to Hugh Laurie at Sunday night's Screen Actors Guild awards. Hugh is nominated for the fourth time. (He has won once.) This is the cast's first ensemble nomination. New episode Monday at 8:00 p.m. ET.