The fifth season of House, M.D concludes with Dr. Gregory House (the always extraordinary Hugh Laurie in a heartbreaking performance) watching his world come crashing down around him — his sense of reality shattered, unable to distinguish fantasy from reality. It was a somber way to end the season, the camera pulling back to reveal the lone figure of Wilson, watching sadly from afar as House enters the doors of Mayfield Psychiatric Hospital.
House co-executive producer and the finale’s writer Doris Egan explained the significance of the final sequence during a one-on-one interview the day after the finale aired. We also discussed the episode’s themes and the series’ relationships.
Egan has written for House for several seasons, penning some of the best and most beloved episodes of the entire series, including season three’s “Son of Coma Guy,” her Writer’s Guild-nominated “Don’t Ever Change” (co-written with Leonard Dick) from season four, and season two’s “House vs. God,” for which she received a Humanitas Award nomination.
The final scene of “Both Sides Now” intercuts joy and sadness: the sunny spring setting and smiles of delight as Chase and Cameron exchange vows and wedding rings set against House’s shell-shocked expression, gray chill day and desolate walk up the steps of Mayfield. The montage, set flawlessly to the Rolling Stones’ classic "As Tears Go By" was choreographed by the series’ Emmy Award-winning director Greg Yaitanes (he won for last season’s penultimate episode “House’s Head”). “Yaitanes pretty much laid out the choreography of the entire final sequence, except for House handing his belongings to Wilson, which was scripted,” Egan explained.
The difference in atmosphere, she said, was intended for visual contrast. “In my original version,” noted Egan, “we went inside the place and saw House hand himself over to strangers there, recite his symptoms flatly to a doctor as his personal possessions were taken and Wilson added unhappy amplifications — all without sound, under music, as you saw it — and then Wilson watched as House went through a locked door.”
Moving the final scene outside, she said powerfully demarcates the different worlds that House and Wilson now occupy. Obviously, if you go that way, you still want to see House divest himself of his ordinary possessions and all they imply; so as House hands Wilson his wallet, pager and cell phone and watch, Wilson became the Keeper Of House Past.”
Egan told me that there were a couple of main challenges to writing the script, which had to be written so the big reveal of House’s delusion wasn’t given away too early. During the entire episode, she said, House and Cuddy were on different pages: “House was going to be thinking one thing and Cuddy something else.”
Neither the characters nor the audience were supposed to put it together until the last few minutes of the episode. “Of course we couldn’t keep them totally separate throughout the episode. They were going to have to have conversations that worked on two different levels and make sense to each character as well as the audience.” We knew what House believed: Cuddy was having second thoughts about starting a relationship with him.
But it wasn’t actually until the end that we understood their ongoing argument from Cuddy’s point of view as well. Egan pointed out that it’s also a challenge for the actors because the dialogue is written on two different levels. “They have to be true to what their character is thinking and can’t give too much away.”
The other challenge in writing the episode is that from the audience’s perspective, House and Cuddy slept together in the previous episode (“Under My Skin”). “Ordinarily when that happens,” said Egan “the next thing you want to give the audience is the morning-after fun and games, and perhaps some morning-after more serious things. You want to get to the romantic comedy of it.”
She suggested that as a viewer, she would expect some sort of banter between them the morning after. “It would be great to see how they deal with it. But we couldn’t do a full-blown episode like that — because the lovemaking never happened. I could imagine an entire episode full of this House-Cuddy banter.” But not this particular episode. She liked the idea of House shouting form the balcony and Egan said she would have liked that idea even if they had actually gotten together. “'Cause man, it had been so long!”
Although the nature of the story precluded any sort of post-coital romantic comedy, it is clear as House limps around his apartment the next morning searching for Cuddy he has fond recollections of their passionate lovemaking, especially after he finds her lipstick on the sink (and smeared on his face). The scene is dialogue-free but, said Egan, “the script directions describe it as a ‘sort of Christmas morning happiness.’” That is exactly the sense you get from House’s quiet delight, played impeccably by Laurie: a faint smile, a gleam in his eye — afterglow. “That is one great thing about these shows,” noted Egan. “You put something like that into a script and Hugh or someone else… it’s so perfect. It’s wonderful to watch. It’s like being God (seeing your creation come alive).”
The densely packed season finale timed out overtime, causing the show to run an extra minute. But there was even more that never made it the screen, including a story thread in which House insists to Wilson that the nature of the friendship had changed. “House would go into Wilson and say ‘Clearly I don’t need you to get my life together because I have just become incredibly efficient at that, and I’m about to have intimacy with another human being! And you’ll just have to acknowledge that and be alright with it!’ I was going to have a whole thread of that, and actually did in one version, but there was no room!”
(I can just picture the smug look on House’s face, turning the tables on Wilson, who had changed the parameters of their friendship late last season when Amber came into his life, and again after her death.)
Another short scene also had to be cut in which the patient, Scott, tries to take Wilson’s advice and communicate with his other half. “I thought it was a great scene and it was short, but we couldn’t even fit that in. Stuffed to the gills.”
A real hallmark of the series is its rich, multi-layered scripts, which weave several threads around the episode’s themes and ideas. Hugh Laurie once likened the series’ scripts to Faberge eggs because of their intricacy. Egan discussed a couple of the themes that threaded through “Both Sides Now,” and how they threaded through the episode’s several storylines.
“One theme obviously was romance or what people want in finding their significant others.” For the patient, his girlfriend’s love saved him eventually, willing even to do battle with his very assertive right brain (and left hand). Carl Reiner’s Eugene Schwartz sought out medical attention to appease his wife’s annoyance with his “squawking.”
Cameron and Chase worked out the “glitch” in their marriage plans, as Chase refused to accept Cameron’s need to keep her dead husband’s sperm “as insurance” against their marriage not working out. Cameron needed Chase to understand, and eventually he did.
House, too, in the morning after (albeit delusional) glow of his new affair with Cuddy. In House’s mind, Cuddy helped him, healed him, and loved him, even in the aftermath of detox. “One thing that kind of is cool about that … is that it’s a sort of romantic trope,” explained Egan. “That someone can be saved through the love of a good woman. Usually the idea that her strength and her mothering and her understanding, which is like unto no one else’s, will pull a man back from the edge and he will become a better person. It’s a romantic idea, and in real life, most of us would say you can’t really change people that way.”
Egan feels the fact that it is House thinking that way is almost subversive, because this is usually a female romantic notion. “But this is actually House’s fantasy. That he really wanted that so much. I love that it was the man thinking this way.” Of course, noted Egan, “in his right mind House would mock anyone” even suggesting such a thing.
“Both Sides Now” also deeply explores in the patient and in House (and to some extent Chase) “how we are each our own storyteller.” Egan explained that this idea was “something that really struck me when I was doing my original research into split brain issues. I’d always been interested in it and had done a paper on it in college.” She had always hoped to one day write an episode about it — and the opportunity finally arose.
Scott has had a corpus callosotomy for a seizure disorder, which severed the communication bridge between his right and left brains. But the procedure has left him with split brain phenomenon and alien hand syndrome, which brings him to House’s attention.
Egan told me about two split-brain researchers, Michael Gazzaniga and Roger Sperry (who won a Nobel prize for his work). Like their subjects, Scott’s right brain can perceive things the left cannot. That’s why he was able to draw a candle when his left brain couldn’t see the word on the screen; and why when he reacted to seeing the words “stand up” even though he could not see them. His right brain made up a story to fill in the gaps. “Gazzaniga believed the left brain is the narrator of our lives,” Egan explained. “The part that makes it all make sense. The storyteller. I loved that. We basically take the weirdness of the universe an make it make sense to us. There’s always a story you tell when you hear about something to make your own life make sense of it.”
“I loved the idea that House’s left brain was making up a story — a story he would most want,” she said, shifting the focus from the episode’s medical story to its more personal story of House’s issues. Egan sees House’s split from reality, his left brain confabulating the fantasy as “a way of not having to give up Vicodin as it started happening right after House realized that he would have to enter rehab. He knew he had to give up the Vicodin somehow.”
Already beginning to break with reality, suffering hallucinations, “House’s brain handed him this gorgeous rationalization all glittery and shiny.” She explained that throughout the episode, House’s right brain, “which is associated with insight taking in all the details that the left brain isn’t even paying attention to and making connections that the left brain can’t make” is trying to signal House as he deals with Mr. Schwartz. With House’s brain not working properly, he isn’t able to make the sorts of connections he usually does but, Egan said, “gradually he starts picking up on things.”
It’s is clear during House’s final scene with Mr. Schwartz, House is clearly shaken that he hadn’t picked up the clues correctly, missing entirely the possibility that the 87-year-old man had pancreatic cancer. The clues had been there, but House had wrongly attributed them to Scott’s condition. After that things begin to unravel completely.
“House realizes that what happened with Cuddy probably never happened. And it’s probably to him the biggest shock of his life. That he cannot trust his own intellect,” noted Egan. One of House’s most important gifts is his insight. Although House mocks the value of the right brain, Foreman rightly reminds him that House owes much of his diagnostic gift to his right brain. “And now,” Egan explained, “it’s actively working against him.”
Cameron and Chase’s glitchy wedding plans also weave through this theme. Egan explained, “Cameron's self-deception was pretty obvious. Believing that she wanted to hang onto the sperm as an insurance policy fit her image of herself as a reasonable person; it's reasonable, as she points out, to prepare for the worst, even if you don't expect it. Hanging onto the only thing left of your husband because you simply can't bear to let go is far less reasonable, though perhaps more understandable.”
Egan added, “This is entirely my own take, but I also think Chase's initial feelings about Cameron wanting to keep the sperm were colored by his internal narration. We've seen Chase grow into a confident doctor and a confident person, at ease with himself and his relationships. He graduated from ‘House’ school, he wooed and won the woman of his choice. But internally, he still has some old storytelling about himself that he hasn't entirely shaken off. Chase fears he's Cameron's second choice. He knows she had a thing for House; he knows she was married before; where does he come into this? The guy who's available because the other two aren't? And now she chooses to keep the sperm of a dead guy, over choosing marriage with him? What does that say?” Until Chase could step back and look at the problem from “right-brain insight,” she said, “he took her story at face value, and assumed she lacked confidence in their marriage.”
I noted the fact that House has admitted himself to a psychiatric hospital rather than a rehab facility like the one at Princeton Plainsboro he went to in season three’s “Words and Deeds.” I asked Egan why House the doctor and House the series made this choice, despite the fact that his problems seem to be connected to his Vicodin use. “I think House is definitely worried about mental illness. He’s obviously gone on beyond occasional hallucinations; and now his brain is presenting him a complete alternative delusional reality. One he didn’t know was false,” she ventured. “I absolutely think that’s his fear and that’s why he’s going to a psychiatric hospital. But beyond that, you will learn next season.”
When Kutner committed suicide in “A Simple Explanation,” House agonized over his inability to pick up on the clues in time to save his life. But as 13 put it, there often aren’t clues. No notes, no cues, no clues. I wondered whether the very guarded House, who buries everything beneath that snarky exterior, had himself left any clues for his colleagues before he went down the “rabbit hole.” Should his closest associates, Cuddy and particularly Wilson, have noticed his behavior before he melted down at the finale?
“The clues were more for the audience than for Wilson,” Egan said. “For instance in ‘Under My Skin,’ many in the audience might have noticed that House’s Vicodin withdrawal was sort of fast — certainly faster than we’ve seen on the show.” (Actually that “rapid detox” was a hot topic throughout the House fandom after the episode aired!)
“Also,” continued Egan, “House and Cuddy got romantic pretty quickly after that, which might have been another clue that all is not quite right with this picture. The thing that makes it harder with House is that he does have issues. He does use too many drugs for one thing, and that’s probably his biggest issue.” But it’s not the only thing that might have caused his hallucinations: factor in sleeplessness (at least at first), depression, guilt over Amber, guilt over Kutner; the list goes on.
“But clearly there was something wrong and he was trying to diagnose it,” said Egan. “And after all, House is an expert diagnostician.” As House went about trying to figure out why he was suffering hallucinations, Egan thinks “Wilson was hoping House was getting to the root of the matter. Of course, Vicodin was the last thing on House’s list as a possible cause. That’s the one thing House didn’t want it to be.” Wilson assumes that drugs are the problem, and eventually, after eliminating everything from multiple sclerosis to schizophrenia in “Under My Skin,” House had to face real possibility that the drugs were causing his problem.
House tells Wilson at the beginning of “Both Sides Now” that Cuddy helped him detox (and more, of course!). House is looking pretty good for someone going through opioid withdrawal and not in a lot of pain. “House assumes the detox is going better than expected, never questioning his lack of pain. After all, Cuddy had told him that opioid dependency can make you think you’re in more pain than you actually are.”
But, Egan added, Wilson was still “a little worried that House is in denial about his pain level.” House’s actual level of pain could be masked “because House is now focusing on Cuddy and on the little mysteries he’s apparently creating about her second thoughts.” As Wilson puts it, House is being affected by “romantic endorphins” because of his feelings for her.
“But Wilson wonders how long that can last. And, what’s going to happen when the pain comes back?” Of course, noted Egan, “then House goes nuts. The end. I think Wilson does his best, but he never has the complete facts. For that matter, neither does House, with his brain actively working against him.”
Earlier in season five, Wilson reconnects with his schizophrenic brother, many years after he had disappeared. We learned in “The Social Contract” that Wilson feels considerable guilt about his brother, who vanished shortly after Wilson refuses to take his call, back when he was in medical school. I wondered how Wilson’s experience with his brother would inform his interactions with House.
“Personally I can’t think of how he can’t think of the parallel,” Egan said. “And that’s why Wilson had to be the one to take care of House at that point. I don’t think Wilson would allow anyone else to do it, but that’s just my personal take,” she added. But an expert one, as she seems to have a particular feel for the dynamic between the two friends.
Of course, within some parts of the House fandom, Egan is revered as St. Doris, the patron saint of House/Wilson shippers. “I’ve made no secret of the fact that I love writing Wilson as a character. I like the kind of ambiguity Wilson has. The man has levels. He’s a good character that way.”
She said she has now become known as the official House “road trip” writer, having penned several episodes over the year involving House, Wilson, and a car. Going somewhere. “Birthmarks,” “Son of Coma Guy,” and now “Both Sides Now,” all feature House/Wilson road trips. “I do like people going in cars somewhere,“ Egan said. “I don’t know what it is…”
Egan said she likes writing the other House characters as well, beyond House and Wilson. “I think Chase can be fun to write, particularly since he took a turn a couple of seasons back, and grew up and into the person he is now.” She also enjoys writing Cuddy, although she feels she hasn’t had as much opportunity to write her. “I sort of have to find the spots where they come into things. Of course,” she teased, “we write a lot of things here you never hear about.”
Egan confessed to writing a detailed outline for a prequel to House and Cuddy having sex “for real. And man, it was hot. That’s all I’ll say. It was only an outline, but I put a lot of detail into my outlines.” She hoped her House/Wilson shipper fans would not be too upset that she had ventured into a bit of “Huddy.”
With the season starting its sixth year in September, I wondered how long Ms. Egan thinks the show will go on? “I don’t know,” she replied. "I’m a little surprised we’re still fairly an interesting show this far along. And I don’t know how long that can be kept up. It’s like juggling oranges. I’m not sure how long it can be sustained. On the other hand, we really do have great people, which makes all sorts of things possible. That’s all I know.”
Although Egan wouldn’t tell me anything about what’s in store for next season (“Starfleet command has not given me permission to go there,” she quipped), she did say “there would be fallout” from House’s issues. I tried. Honest I did. All I do know is there will be tomes of fanfiction written about it over the long, hot hiatus.