After House's medical license is reinstated, he reclaims his role as Head of Diagnostics in time to treat Hank Hardwick (guest star Troy Garity), an adult film star admitted to Princeton Plainsboro for pulsating eye pain. Meanwhile, Cuddy is reminded that Princeton Plainsboro is not conducive to healthy personal relationships. Throughout the episode, House tries to reassemble his old team of Foreman, Cameron, Chase, Thirteen, and Taub. Taub and Thirteen initially ignore House's attempts to get them to come back.
In the episode Dr. Cameron and Chase decide to leave House's team and the hospital because of Dibala's death and to save their relationship. When Foreman convinces Chase to remain on the team for the remainder of the case by telling him "he owes him one", he and Cameron agree to finish the case. The episode progresses to a point where Chase meets House at his front door and tells him he wants to remain on the team. Chase wondered throughout the episode why Cameron forgave him: House deduces, and Cameron confirms, that her anger was directed towards House as the source of the atmosphere leading to Dibala's murder. Towards the end, she confronts House by saying he ruined Chase's life making him "unable to see right or wrong and not to see the sanctity of human life". Cameron admits her former love for Dr. House – which has disappeared as a result of recent events, along with her love for Chase (as he was when she first met him). She puts her hand out to shake House's hand and he does not accept – much like the end of Season 3 – and she kisses him on the cheek, signaling that she is leaving the diagnostic team. Cameron leaves the team but Chase is shown to continue to work with House, along with Foreman, Thirteen, and Taub. In the closing scenes, it shows Cameron walking out on Chase with her bags packed and giving him a tearful hug. It also shows Lucas and Cuddy walking through the lobby of Princeton-Plainsboro with House watching them from above.
After a wild night out, a teenage girl (Anna Attanasio) is brought to Princeton Plainsboro with severely swollen appendages. The team must work to diagnose the young girl, who is less than honest about what happened the night she fell ill. As her condition worsens, she becomes unable to distinguish fact from fiction, leading Cameron to believe that she may have been drugged by roofies and raped by a comic book creator (Marcus Giamatti) she was following. They first give her flumazenil to antagonize the effect, but later intentionally drug her with amobarbital to make her tell the truth about the night.
Meanwhile, Cuddy, Wilson and House spend a weekend away from the hospital to attend a medical conference. Wilson feels remorse after having performed euthanasia on a terminally ill cancer patient by intentionally having told the sequence to the patient's PCA machine to a coworker loud enough for the patient himself to hear, availing him to administer himself a morphine overdose. Wilson plans to give a speech about the incident, although it may sever his career, but House drugs Wilson and takes his speech during the convention in another person's name. Later, Wilson admits that it was irrational to sacrifice his career because of his remorse.
After the convention, House finds that Cuddy is dating the private investigator Lucas (Michael Weston), who takes care for the baby which a babysitter was supposedly taking care of. House is told by Wilson he isn't reliable because he drugged him.
Towards the end of the episode, Chase confesses to Cameron that he killed Dibala. The episode ends as Cameron lies in shock of what she hears.
A police officer named Donny is chasing a man who continuously evades him and his partner eventually leading to a rooftop. He attempts to leap from building to building in pursuit, but misses and falls to the ground.
In hospital, Donny reveals that his great-grandfather, his grandfather, and his father have died of a mysterious heart disease shortly after reaching the age of 40. This leads the team to investigate, despite House's claims that it's merely a coincidence. Chase and Foreman begin performing a battery of tests to look for genetic diseases and examine his ancestors' remains, but find nothing. House eventually fools the patient into believing he has an imaginary disease (Ortolli syndrome) and discharges him after giving him mints as a "treatment" for his illness. However, a few hours later Foreman tells House that Donny had collapsed while doing his laundry and was declared dead.
During the patient's autopsy he bleeds and suddenly awakens, obviously alive, which leads the team to readmit him and to try to find the reason for his illness and "miraculous" resurrection. House eventually solves the case, with the solution being that the patient had an intracranial berry aneurysm in the brain stem which applied pressure on various nerves, leading to the patient's symptoms, including the "stopping" of his heart.
Side stories include House hearing whispering in odd places, which turn out to be Wilson whispering to Amber at night. Chase, who cannot get over the death of Dibala, is unable to enter the ICU. At House's behest, Chase finally seeks a priest for help who tells him that the right thing to do would be to turn himself in. Ignoring the priest's advice, Chase tries to drink his troubles away instead. Cameron is seen phoning the police as Chase walks in late, and goes away on her own when Chase still won't tell her the reason for his odd behavior.
A billionaire insists his son be treated by House after several doctors failed to diagnose his dying son. Cuddy appoints House to make all the final diagnostic decisions, although Foreman is still in charge of the department. The father believes that his son's condition is the result of karma, saying that "everything he touches turns to gold" except for when it comes to his family. His son's health continues to decline and House diagnoses his son with Degos, an incurable disease. House says that his son has one more day to live, at most. The father then signs a deal that is guaranteed to make him bankrupt in hopes of making his son's health improve by balancing out the success in his life. House soon after diagnoses his son with Primary Antiphospholipid Syndrome, a manageable disease. The bankrupt father is later shown with his recovering son happily sharing pizza.
Cuddy also has Foreman conduct a morbidity and mortality conference regarding the Dibala case in The Tyrant. Foreman privately discusses the matter with Chase, telling him to tie up any loose ends that the participants of the M&M might question. Chase almost admits to Cuddy that he tampered with Dibala's test results, but is interrupted. He later finds the documents he needs left on the table in a blank envelope; after asking Foreman, he realises that House has figured out that he killed Dibala and tells him he'll always be in power no matter what.
Thirteen makes plans to travel for an indeterminate amount of time. After her flight plans to Bangkok are cancelled by someone, she tries to find out who. She confronts House, who says that he wanted her gone; House later confronts Foreman, who says that he is over the breakup with Thirteen and didn't cancel her plans. Thirteen eventually visits Wilson, who falsely admits to the hacking. Wilson says that House needs her on the team, even if House doesn't admit it, and that she is the only person who hasn't "been drawn into House's vortex.". Later, he confronts House about it, leading House to admit that he cancelled it. The episode ends with Thirteen boarding a plane.
The team treats a brutal African dictator named Dibala (James Earl Jones) who has fallen ill; The dictator had made threats of ethnic cleansing against an ethnic minority, and the team deal with ethical issues of treating a potential mass murderer. Chase is more curious than others and confronts Dibala, who eventually makes his views plain that he plans on killing off the ethnic minority.
After many trials, House's new team, Cameron, and Chase with Foreman as boss decide on scleroderma. Dibala afterwards dies from severe bleeding into his lungs. Foreman finds that Chase faked the results with the blood of a 70 year old woman, to cause the team to treat incorrectly and kill the politician.[1]
At the end of the episode, Foreman is seen burning the records which showed that Chase had accessed the morgue without a valid reason, incriminating him of faking the blood test.
The subplot involves Wilson, who tries to make amends with a difficult neighbor. House is staying with Wilson and his curiosity and meddling leads him to confront the neighbor and look into his apartment. He finds that the neighbor is a wounded veteran who lost an arm. The neighbor's anger is derived from his pain, and his pain is due to a psychosomatic attachment to a phantom limb. House solves the dispute with Wilson's neighbor by kidnapping him and forcing him to undergo V.S. Ramachandran's Mirror box therapy, curing his phantom pains in his amputated hand.
Players in a video game known as SavageScape battle ferocious creatures. After the game ends, the testers find their boss, Vince Pearson, claiming that his hands are on fire. House walks into Cuddy's office and quits. Foreman wants to run the diagnostic department and Cuddy allows him a chance to do it. Foreman settles in House's office. Foreman discusses Vince's case with Taub and Thirteen. Foreman plans to treat him for complex regional pain syndrome with a spinal stimulation. Vince has other ideas. Having looked up his symptoms on the internet, he thinks he must have mercury poisoning and wants to be tested. Ignoring Foreman's orders, Thirteen and Taub perform the test for mercury and not the spinal stimulation. House has therapy with Dr. Nolan, who instructs him to take up a hobby. He joins Wilson in a cooking class. Foreman gives Vince news that his mercury test came out negative. Vince demands treatment for the mercury but Foreman challenges him. Taub and Thirteen administer the spinal stimulation, which results in Vince's lungs filling with fluid. Taub and Thirteen report back to Foreman that Vince has a thickened left ventricle in his heart causing pulmonary edema. Taub speculates that cocaine might be the culprit. Foreman admits to Thirteen that he has been comparing himself to House. Taub and Thirteen go search Vince's office. Cuddy visits House at Wilson's apartment. He is cooking with a Chinese classmate and they talk about Cuddy in Chinese. Cuddy wants to know if she is the reason that House left the hospital. He says no.
House awakens in the Mayfield Psychiatric Hospital after suffering through the painful effects of Vicodin withdrawal. Feeling better, he wants to leave. Dr. Nolan (Andre Braugher) refuses to sign a recommendation to the board of medicine saying he is able to return to work. House resigns himself to stay at the hospital and get his clearance.
House tells Dr. Beasley that he will do anything to get that recommendation. He even threatens to turn Ward 6 "upside down" if necessary. House meets his new roommate Alvie (Lin-Manuel Miranda), a manic-depressive who is manic while off his medication. House then begrudgingly participates in group therapy with Dr. Beasley. House tries to get kicked out by humiliating everyone during a basketball game in the yard, but the doctors do not tolerate his antics.
House meets a woman named Lydia (Franka Potente) who plays piano for her sister-in-law, an unresponsive patient on the ward who was a musician. He is intrigued by Lydia.
After being placed in solitary confinement, House comes up with a new strategy to try to get kicked out. He addresses his fellow patients to apologize for his insults, but really goads them into creating havoc on the ward over table tennis. Dr. Nolan gives in to the simple House-triggered demand of the patients (they wanted table tennis paddles, as they were using their hands to hit the ball before).
From the hospital window, House sees Dr. Nolan get into a car with a woman. House convinces Alvie to break into Nolan's office to get information on him. Alvie is unsuccessful, so House comes up with another solution. He pretends to beat up Alvie in the rec room. House is put on Haldol, but he cheeks the pills and gives them to another patient in return for the man's phone privileges. House calls Wilson and asks him for help blackmailing Nolan. Wilson refuses, saying that Nolan already contacted him to warn that House may try to do something like this.
A therapist named Dr. Medina makes House undergo a drug test to prove he is taking his meds. Since he is pocketing all his pills, House gets a fellow patient to submit his urine instead.
House starts to adjust to life inside the institution. His only respite is Lydia's regular visits. They discuss music, and she agrees to bring the cello that her silent sister-in-law used to play.
A new patient named Steve thinks he is a superhero who goes by the alter-ego "Freedom Master." Medina provokes him to break his delusion about his dead wife, but Steve has an episode and is drugged into a catatonic state. House gets angry at Medina over this and turns to Nolan. Dr. Nolan then admits that he had switched House to a placebo instead of the Haldol because he knew he was pretending to get better.
House confesses to Alvie that he is out of plans. He waits for Lydia to bring the cello, and has Steve help carry it from her car. Lydia willingly gives her car to House for him to kidnap the depressed Steve. House takes him to a carnival where they are lifted in a wind tunnel ride as if they were really flying. Steve is overjoyed, but then really believes he can fly and jumps off the edge of a parking garage.
With Steve badly injured, Dr. Nolan wants House to leave the institution. House earnestly asks for help in getting better. He begins therapy with Nolan and takes his medication, much to the chagrin of Alvie, who feels betrayed.
Nolan brings House a suit and has him mingle at the hospital's fundraising party. His assignment is to make connections with strangers. It is difficult for House at first, but then he has fun toying with people. Lydia becomes his accomplice and as she leaves, she gives House a kiss.
House discusses the kiss with Nolan. Lydia is married. He also feels guilty about what happened to Steve, and Nolan tells him to apologize personally. During group therapy, Dr. Beasley suggests the patients put on a talent show. House has an idea of how to help Steve, who had been trying to "save" the silent girl with a music box hidden in the nurse's station. He called it her "voice". House convinces Beasley to allow them to get the music box, but Dr. Nolan comes in to break up the group and wheels Steve away, as House was "trying to fix, not move on".
House rebuffs Lydia because he knows that, in the end, someone will get hurt. House is given a day pass by Dr. Nolan who requests his presence. He arrives at a hospital to find Nolan at the bedside of his dying father. A tearful Nolan asks House for a consultation. Although House has nothing to add to the diagnosis, he accuses Nolan of having no one else to turn to but his own patient. Dr. Nolan tells House that he doesn't need him to make deductions, and House realizes that what he needs is company, so he stays and sits in silence.
When House returns to Mayfield, he finds Lydia upset over her sister-in-law. He apologizes, dances with her and they make love.
The residents hold a talent show. House doesn't participate at first, but he is coaxed into helping Alvie when he can't continue with his rap on stage.
House apologizes to Steve, and as he wheels him away, Steve breaks from his silence and gives the silent woman the music box he was holding. For the first time, she speaks to say 'thank you'. Lydia arrives and House takes her in to see the group watching her sister-in-law playing the cello.
Dr. Nolan tells House that Lydia is taking her sister-in-law to a rehab facility in Arizona with Lydia's husband. House gets an overnight pass and goes to see Lydia at her home. He is startled when Lydia's young son answers the door. House wants her to stay, and Lydia says she wants to but ends up asking House to leave. Back in the Mayfield parking lot, House talks to Dr. Nolan about his feelings, which, in conjunction with House getting close enough to someone to be hurt in the first place, convinces him that House deserves the recommendation to the medical board.
House is discharged and gets on a bus back to Princeton. The bus sports an advertisement for a skills improvement institute saying "Prepare to Succeed". After the departure of House, Alvie decides he wants to get better and goes back on his medication. The last shot is of House wearing Alvie's shirt, sitting in the back of the bus with the hospital receding in the background and a rare smile comes across House's face.
