Wilson's Heart (House)

"Wilson's Heart" is the sixteenth episode and season finale of the fourth season of House and the eighty-sixth episode overall. It aired on May 19, 2008. It is the second and final part of the two-part fourth season finale, the first part being "House's Head".

Plot

A distraught Wilson and House find a comatose Amber at Princeton General Hospital and transfer her to Princeton-Plainsboro Teaching Hospital. In the ambulance, Amber goes into ventricular fibrillation. Instead of shocking her heart, Wilson suggests she be placed under protective hypothermia and put on bypass, giving House the time he needs to diagnose her.

During the differential diagnosis, Taub runs a toxicity screen on Amber--after suggesting to House that he and Amber might have been out having an affair and could have done drugs--and Kutner and Thirteen check her home for anything environmental that could cause her symptoms. They discover Amber is hiding amphetamines inside a multivitamin container, and the team tests Amber's heart to determine if a valve is calcified as a result. Before the heart can be tested, however, the team notices Amber's liver is failing, ruling out the pills.

Later, House dreams Amber is serving him sherry and flirting explicitly with him. She whispers "electricity", and House wakes up with an idea--deep brain stimulation, a dangerous, potentially fatal procedure. He suggests this to Wilson and Cuddy, but they say no--it's too dangerous and he should get some rest. Then House gets a page from his team. Upon returning to his office with Wilson in tow, they resume the differential. House contemplates the meaning of the sherry in his dream. Kutner interprets it to reference "Sharrie's Bar", so House and Wilson go to the place and ask the bartender (guest star Fred Durst), who served House on the night of the accident, if he remembers any symptoms. After recollecting that she sneezed, House determines Amber is suffering from Hepatitis B, and requests she be put on IV interferon. Yet in another hallucination, Amber shows House she has a rash on her back, a symptom that does not fit with the diagnosis. Taub determines it is caused by influenza, but House replies that this wouldn't have caused her other symptoms. Foreman suggests Rocky Mountain Spotted Fever, and Wilson says she may have caught a tick several weeks ago when he and her were walking with their neighbors and dogs. Wilson reiterates he does not want the team starting Amber's heart until they are 100% certain of the diagnosis, causing House to stand up for Wilson. House confronts Thirteen about her objectivity in the case, determining Amber's situation--a young woman dying--scares her. Thirteen shoots back that he's screwing the case up worse than she is. Later, she's seen drawing her own blood to test for Huntington's chorea.

Meanwhile, Foreman reviews Amber's records, and determines she will not be able to remain on bypass for much longer. Defying Wilson, he and Cuddy begin to warm Amber's body temperature. After analyzing Amber's EEG, Wilson finds the illness is spreading to her brain. House believes it to be caused by an autoimmune disease, and orders prednisone. Wilson, however, believes her illness to be caused by an infection, and says that steroids would destroy her immune system and kill her. As a last ditch effort to unlock House's memories, Wilson hesitantly brings up the aforementioned deep brain stimulation. House complies and recalls that, after work, he went to Sharrie's Bar and got drunk. The bartender took his keys in exchange for a phone call to get a friend to drive him home. He calls Wilson, but since he was on-call that night, Amber was home and took the call. House asks her to find Wilson, but she's not willing to bother him at work, so she goes on his behalf. She finds House and after a Cosmo House ordered for her, she sneezes. House notes her sputum -- it seems like just a cold. He leaves to get on a bus rather than taking a ride from Amber. Amber finds House on the bus to return his cane, which he left in the bar.

On the bus, Amber sneezes again, mentions a flu, and House's attention is drawn to a bottle of prescription pills she pulls from her purse. The pills are amantadine, Parkinson's and antiviral medication that can shorten and ease the symptoms of the flu. However, when the bus accident damaged her kidneys, her body could no longer filter the drug. Wilson suggests that Amber be put on dialysis, but House notes that amantadine binds with proteins, and that dialysis cannot filter it from her blood. Realizing that there is nothing that he can do to save Amber, House apologizes to Wilson, feeling partially responsible. At this point of the procedure, House suffers a complex partial seizure and slips into a coma. The team discuss the possibility of finding a donor heart for Amber, but Foreman states that her organs are too badly damaged, ruling her out as a candidate for transplant. Cuddy convinces Wilson to see her one last time and keeps Amber on bypass, weaning her off of the anesthesia. This allows Wilson and the team to say their goodbyes. In her last moments, Wilson and Amber say tearful goodbyes and Amber comforts him. Finally, Wilson turns and shuts off the bypass machine.

In his comatose state, House dreams he and Amber are on the empty bus, surrounded by a white void. He deduces that she has passed on and admits to her that he does not wish to leave the bus; he tells her that there is no pain and misery on the bus, and above all, he does not want Wilson to hate him. Amber tells him, "you can't always get what you want"--a recurring House theme--persuading House to exit the bus. He wakes to find Cuddy sitting next to him. As the episode closes, Thirteen discovers that she tested positive for the Huntington's gene, Taub returns home to his wife, Kutner sits alone in front of a television set, and Foreman is joined by Chase and Cameron in a restaurant. Wilson visits House in the ICU, where House lies, troubled by the possibility of Wilson hating him. Without a word exchanged, Wilson tearfully turns, leaving where their relationship stands and the blame falls ambiguous. Wilson returns to the empty apartment he had shared with Amber and collapses into bed, an arm across her side of the bed. He sees a piece of paper under her pillow and pulls it out; it's a letter, saying, "Sorry I'm not here. Went to pick up House. Love, A." Back in the hospital, House silently contemplates, with a sleeping Cuddy holding his hand.

Critical reception

Mara Greengrass of Firefox News praised the drama and acting of this episode, including the performances by Hugh Laurie and Robert Sean Leonard. She thought certain other aspects were not as well conceived, such as the sub-plot involving Thirteen's discovery she has the Huntington's gene (Greengrass thought it seemed to be an effort to parallel Amber's illness, but didn't quite fit). She also thought the revelation of Kutner's back story -- that he was orphaned as a boy in India -- felt "shoehorned" into the program. A medical review at Polite Dissent similarly praised the drama as being powerful, "if a little overwrought," but said the medicine was sloppy: the protective hypothermia suggested by Wilson would not really have been workable for such a long period, and the deep brain stimulation used on House could not have so easily targeted specific memories (among some other criticisms).

Cultural references

When House is in the bathroom talking to Thirteen, there is a bumper sticker on the wall for "Change '08". This is a nod to Barack Obama's 2008 presidential campaign. Olivia Wilde, the actress who portrays Thirteen, and Kal Penn, the actor who portrays Kutner, have campaigned for Obama.

House taps Thirteen's foot with his from a neighboring bathroom stall and says, "Sorry, wide stance," in reference to the Larry Craig airport bathroom incident.

In House's posthumous conversation with Amber, he says he doesn't want Wilson to hate him, and she responds "You can't always get what you want." House quoted this line from the Rolling Stones song to Cuddy in "Pilot". This line was also included in "Honeymoon". Early in fourth season, House quoted "the philosopher Jagger" with this line in front of the interviewees.

Music

Two songs play towards the end of the episode: Bon Iver's "Re: Stacks" and Iron and Wine's "Passing Afternoon". A cover by José González of Massive Attack's "Teardrop", the show's theme music, is also heard during the episode. "Light for the Deadvine" by People in Planes is heard when House awakens in the white bus.