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The eight-episode "survivor" arc accomplished more than providing House with a new team. The games gave us new insight into the grumpy doc.

What the House, MD Season Four “Survivor” Arc Tells Us About Dr. Gregory House

The substantive difference between words and deeds is one of House, MD’s most important themes. Wrapped in a medical procedural package, and occasionally bordering on comedy, the series is essentially a detailed character study of one of the most complex characters ever written for television (and certainly network television).

House is played by the ever-amazing Hugh Laurie (please forgive my entirely forgivable use of hyperbole), each week peeling back minute facets of this intricately crafted character, letting us glimpse the wounded, intellectual and deeply sensitive man beneath the sarcasm, cynicism, rudeness, and labyrinthine game-playing of his façade.

Left at the end of season three with no team, House, under pressure from Wilson and Cuddy, set out to hire a new staff. The “hiring arc,” also known as House Survivor lasted for eight episodes (not counting the season premiere). Had this been a “normal” 24 episode season, it would have taken up only a third of the season four narrative. As it played out, however, with the season delivering only 16 episodes, the “survivor” arc spanned half the season, giving it too much weight and not quite enough room for everything else that might have gone into the series' fourth season. A very good (but slightly lopsided) season might have been exceptional had the full slate of 24 episodes aired. (The nine post-“survivor” arc episodes contained some the series’ best, including “Frozen,” and the breathtaking finale episodes “House’s Head” and “Wilson’s Heart.”)

On the other hand, the “survivor” arc serves to give us some insight into the "real" House; what he values and what he does not value in a medical colleague; how he thinks, and even how he feels. And it gives us a rare extended glimpse of House, the teacher.

Finding the "real" House isn't so easy. You have to ignore half of what he says as subterfuge and concentrate more on what he does: his facial expressions, off-hand comments in those rare unguarded moments, his body language, and his ethical boundaries (those lines beyond which he adamantly refuses to color). It’s like Wilson says way, way back in the pilot episode, when House’s patient Rebecca Adler asks him if House cares about him. Wilson immediately replies, “Everybody lies.” Adler retorts that it’s not what you say, it’s what you do (this is one the series’ most important touchstones). Wilson finally admits, “Yeah, he cares about me.” You have to observe, sometimes as keenly as House himself, what he does as much as what he says. And this is especially true of the “survivor” arc, during which House’s game-playing was a way for him both to distance himself from his prospective fellows as well as provide a smokescreen for Cuddy and Wilson, to keep them clueless about how much he actually does care — about his patients and those who work for him.

Wilson chides House in “Alone,” that he will ultimately hire only people he can’t stand. He believes that House wants to thereby prevent himself from getting too close to his fellows, for fear they will eventually move on and abandon him; a situation which “is just too stressful.” Of course, House would vigorously beg to differ with that sentimental assessment, and suggest instead that wants fellows who would make “interesting” (“Ugly”) playthings to study and manipulate for his personal amusement.

But as viewers, we know better. House, the game-playing merry prankster, is, at his core, a very serious man who takes his work seriously. Back in season one, he tells Foreman (referring to Foreman’s old mentor — a famous Hollywood physician), “He believes that you do the best you can and what will be will be; I believe that what we do matters. He sleeps better at night; he shouldn’t.” House, the doctor who spends sleepless nights thinking about his latest patient, his latest case, is not interested in a staff of court jesters and interesting playthings. He wants the best doctors he can find.

House has a keen sense of his own strengths and the limitations of his genius. He admits this outright to the fellow candidates at the end of “Alone.” “I have a gift for observation; for reading people,” he tells them. “But sometimes I am wrong,” he admits. House is often accused of arrogance and smugness, but it takes a particular sort of humility for House to surround himself not with sycophants and fawning groupies, but with fellows who challenge him and stand up to him — making him a better doctor.

Everything he and his fellows do — every test, every treatment (despite what he may tell them) — must serve the interest of the patient before doctor, insurance company, hospital or a piece of paper. This is House’s ethical line in the sand. In “You Don’t Want to Know,” Kutner wants House to treat a magician; House declines. But when Kutner pushes, House lets him perform some tests to see if he's really sick. Kutner is concerned that if he's wrong House will fire him. “Will I get fired if he’s not actually sick?” Kutner asks. “You gonna let your patient die if I say ‘yes?’” House snipes. House is saying that it shouldn’t matter what House thinks or might do; it’s the patient's life that matters, and Kutner’s actions should be based on that alone. It’s a professional philosophy that House has lived by consistently since long before we met him four years ago.

So what does get you fired in House’s elaborate game? And what wins you one of House’s coveted fellowship positions? After firing a whole lot of candidates in “The Right Stuff,” we move on to “97 Seconds.” House divides the 12 remaining candidates into two teams to diagnose and treat the patient, who suffers from Spinal Muscular Atrophy (SMA). The patient dies because of 13's failure to watch him take pills to treat a parasitic infection. She takes responsibility for the mistake, but House only fires her teammates. It's possible that he kept her because, despite the mistake, she got the diagnosis right, but I think he fired the others, because they failed to take any responsibility for the mistake — why weren't they also watching? This was supposed to be a team effort, after all.

The mistake itself, while tragic, would not necessarily cause House to fire her. House does not have a history of firing people because of mistakes, even fatal mistakes (for example, Chase in “The Mistake”). As angry as House became (“You forced us to act on a faulty assumption … Everything we built from that step on. Every test. Every theory. Every treatment…”) he did not view what she did as a deal breaker, believing in her ability to overcome and learn from the experience. “Stop lecturing me and fire me already,” she begs House. “If I was going to fire you, you wouldn’t be getting the lecture.” House has decided that she is worth his effort.

In "Guardian Angels," House finally fires Henry,the “ridiculously old fraud,” of whom House has grown somewhat fond. Keeping him on after discovering that Henry is not really a doctor, House appreciates Henry’s encyclopedic book (if not practical) knowledge. But ultimately, House has to draw a professional line, and can’t really hire him as a medical fellow. And although House could theoretically hire him as a research assistant, Henry’s way of processing information is too like House’s. Like Henry himself says, House “doesn’t need someone around who thinks exactly like him.” On the other hand, House opts to keep Cole, the African-American Mormon, although Cole slugs his boss in the jaw after he insults Joseph Smith, the Church's founder. (And passing House's test as to whether Cole would have the spine to stand up to him if provoked.)

In “Whatever it Takes,” Dr. Grumpy, mistakenly believing that House would approve of his enterprising attitude, exploits a sick patient as a pretext to advance his own research ambitions. “Isn’t that why you hired us? To do whatever it takes?” he asks House in the end, completely misunderstanding one of House’s most important ethical principles. House has been known to do anything, say anything — even risk his career (and his life) to test a new theory — but with very, very few exceptions, it is ALWAYS to serve the patient — never his own selfish needs. (And, yes, I remember Coma Guy and the migraine from season two's "Distractions.") House neither wants nor needs some self-serving, glory-seeking (albeit very creative) doctor on his staff, and Dr. Grumpy is quickly disappeared (and reported to the authorities!).

In “Ugly,” it is Taub who defies House, undercutting his authority with the patient in a way that would get him fired by many supervising physicians. Taub’s clear disdain for both House and his medical practice lead the doc to investigate further. Discovering that Taub has left a lucrative plastic surgery practice, resigning and signing a non-compete agreement with his partners to buy their silence on his extra-marital affair with a nurse, House confronts him about it, but House possesses a romantic streak (most evident in season two’s “Need to Know”) and seems to admire people who sacrifice for love. Perhaps more importantly, House also respects Taub for risking his job to “do the right thing” for the patient — standing up to the "boss" despite the risk to his job and thereby serving the patient’s interest and not his own.

Next on the chopping block is Cole, who is fired after conspiring with Cuddy to win the “You Don’t Want to Know” round of House Survivor. The goal of that game was to steal a pair of Cuddy’s coveted (by House) panties. “Bring me the thong of Lisa Cuddy,” House challenges his team. The point of the game is to do something risky without getting caught, but it also affords House the opportunity to observe the fellow candidates working together and against each other to win the challenge. I have to wonder if the real way to have won this particular game was to defy House altogether and refuse to play along. You told us to do whatever it takes to win, Cole explains to House, defending his actions, but misunderstanding the actual challenge. “Break the rules.” “Her rules, not mine,” he retorts. “You gave her powers she didn’t already have.”

House’s controls a universe of organized chaos, and as insane as it seems — as insane as the way he runs his team seems — it does have an internal logic (most of the time). The “House” rules keep control of that chaos and keep the diagnostic process moving forward as they test and treat, with House filtering and guiding (and manipulating) that process. By Cole’s willingness to co-opt House’s rules and collude with Cuddy, he reveals himself as inherently untrustworthy. House doesn’t mind, and usually respects, his fellows telling him that he’s wrong, arguing with him, or even going over his head when they think he’s crossed a line; but he needs to trust that fellows won’t try undercutting his rules. House needs to trust his team.

With Cole now dismissed, we are down to House’s “final four” in episode nine, “Games.” It has been two months since he’s brought in the fellow wannabes; House has gotten to know them, respect them, and appreciate their individual attributes. He wants to keep them all. But Cuddy has told him to cut two staff members. House is at a loss, asking Cuddy, Cameron, and Chase for their input. As he had when Vogler forced his hand in season one, House has a very difficult time with this. Maybe House views his team holistically, as he demonstrates in “Games,” using input from each one, including their incorrect assumptions and conclusions, to craft his final diagnosis. He sees the value in each one, and their cohesion into a whole. Maybe it has become harder and harder for him to let go as he has become attached after two months to his new staff (as Wilson had said would happen).

House doesn’t even want to cut Amber, whom he has nicknamed “cut throat bitch,” because he sees the core of humanity beneath her antagonism and aggressiveness. But someone has to go, and although Amber “played the game better than anyone,” her motives are not really compatible with House’s medical philosophy. Amber is prepared to win at any cost, because losing sucks. House wants to “win” to serve the patient. He often loses — personally and professionally along that path to “almost always eventually get the answer right” (“No Reason,” season two). “You have to be prepared to lose,” House tells Amber, sadly dismissing her from his service.

Kutner is a creative thinker and is similar enough to House to be a good ally — but he lacks House’s cynicism. He is reckless, but that also means he is unafraid to take risks if it means saving the life of a patient. House needs someone to replace Cameron’s optimism and Chase’s creativity. In Kutner he has a bit of both.

13 is smart and cynical; wary and aloof. But she possess a wounded quality that I think gets to House in a way he can’t quite define. It’s not romantic, but he’s clearly intrigued by her. More than with the other new fellows, he has taken the time to mentor her, first in at the end of “97 Seconds" and more recently in “House’s Head.”

And then there are (of course) the original fellows. Seemingly quite fine after losing the whole team at the end of season three, House really did grieve their loss, missing even Foreman, of whom he had visions in the season premiere “Alone.” Of the three fellows, only Foreman has returned to House’s team, blackballed from other positions, trying to “be” House “nice,” but possessing neither House’s genius, nor his finely-honed manipulative skills.

Crawling back to Cuddy, Foreman has been dumped in House’s lap as her eyes and ears, something both he and House resent, but eventually have come to accept. Chase, who is now a surgeon (!), takes the pressure off of House’s new fellows to do surgical procedures (providing House with someone on the surgical staff that he trusts). But Chase also expands House’s social network (infinitesimally), conspiring with him to rig a hospital hiring pool and going bowling.

In “Ugly,” Cameron describes House’s old team as “doctors who learned to be doctors from House.” She (for all of her faults) has learned the true value of a House fellowship. He doesn’t just train doctors in diagnostics; he teaches them a unique way of practicing medicine, and of looking at the world. Cameron’s words are a fabulous definition of what House does as a teacher and mentor.

House is one of the most hidden main characters to have ever graced a television screen. On the other hand, finding him — finding the “real” House, even from within the labyrinth of an elaborate game — is so very worth the effort.

My season four overview continues next week; the House season four DVD will be released on August 19 and is available for pre-order. If you missed any of season four be sure to catch up as FOX continues airing the season in order throughout the summer on Monday nights.

About Barbara Barnett

A Jewish mother and (young 🙃) grandmother, Barbara Barnett is an author and professional Hazzan (Cantor). A member of the Conservative Movement's Cantors Assembly and the Jewish Renewal movement's clergy association OHALAH, the clergy association of the Jewish Renewal movement. In her other life, she is a critically acclaimed fantasy/science fiction author as well as the author of a non-fiction exploration of the TV series House, M.D. and contributor to the book Spiritual Pregnancy. She Publisher/Executive Editor of Blogcritics, (

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