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It’s quite the shock to realize that the jerk of this episode’s title is not House, at least not exclusively or even primarily. Nick Lane as rage-prone teenager Nate is possibly too effective as the mini-jerk. From the unmodulated bullhorn voice to the constant, not-particularly-funny smart remarks, the fictional kid is not someone I’d want to spend even an hour with. Not even an hour between 9 and 10 p.m. on a Tuesday evening. I realize this confession reveals my own jerkdom, but it was the first ever House episode where I was rooting for the patient to die. I’m not completely heartless – I would have settled for a prolonged coma. Even a persistent vegetative state.

There’s a lot of brats in this episode, from House to Nate to the clinic patient’s son to the writers – I can’t believe they opened with a head exploding threat. How am I supposed to block the head exploding scene of “Resignation” out of my head with reminders like that?

House is back to his usual level of jerkiness, apparently off his antidepressants and ruining my chance to pontificate on what he learned from Wilson’s coffee-doping trick in the previous episode. Here’s my updated pontification: nothing. He’s learned nothing.

Nate, who has absolutely no redeeming qualities — unless you count being unconscious for a few minutes out of the episode — serves to highlight how finely balanced the character of House is. The kid even demonstrates some drug-seeking behaviour to hammer home the similarities to our hero, but the juxtaposition reminds me how remarkable it is that Hugh Laurie takes this bastard who careens between wildly inappropriate nastiness and appropriate misery, always laced with that acerbic wit he’s so proud of, and rarely-to-never crosses over into unbearable. If only House had smothered Nate with a pillow during their chess match, I would have extolled his virtues even more.

Nate’s long-suffering mother is not unreasonably happy that the initial (and therefore inaccurate) diagnosis of cluster headaches means her son’s personality is likely to change with treatment. “I thought I was a bad mother and I hated myself because I hated him,” she confesses to Chase.

Mom Enid’s journey from that confession to being upset with Foreman for sedating Nate just to shut him up to relief that her kid is going to live, albeit with his current personality, is given a lot less room in the episode than I would have liked. Both the initial confession and the end relief seem natural enough, I suppose, but they’re too pat, with no expectation-bending or emotionally impactful scene to make me care that she’s facing her son’s long, miserable life with more joy than she might have anticipated at the beginning.

Foreman is a bit of a jerk this episode, but he’s got reason to be. Someone called to cancel the interview he had lined up with a hospital in New York, starting a chain of suspicion and denial throughout the episode that starts and ends with House. Foreman accuses House of interfering, too childish to ask Foreman to stay instead of playing games with him. House denies it. “Yeah, it was one of the other petty socially repressed assholes I work for,” Foreman scoffs.

House accuses Cuddy of being the saboteur in her efforts to keep Foreman:”You are one evil, cunning woman. That’s a massive turn on.” She denies it, then Lisa Edelstein performs this wonderful chain of expressions from puzzlement to dawning realization. She accuses Wilson, since she thinks it has to be someone who likes House: “It’s either you or the weird night janitor who wears his pants backwards.”

Wilson denies any involvement, saying he wants Foreman to leave to teach House that he needs someone who will stand up to him: “House is a six year old who thinks he’s better off without parents.” She doesn’t believe him – about the not sabotaging Foreman, not his assessment of House — since that kind of lesson-teaching doesn’t fit the role of Wilson as enabler. I diagnose amnesia: the poor woman has forgotten Wilson’s previous attempts to teach House a lesson role in “Detox” and with the Tritter deal.

We get Robert Sean Leonard doing the face of dawning realization, then continuing the chain by accusing Cameron, using the same rationale Cuddy used on him. He also tries to manipulate her into a confession by saying Cuddy thinks it’s him and is going to fire him, but she’s not fooled for a second. “You so would have fallen for that three years ago,” he sighs.

She denies being the one to ruin Foreman’s interview, with a bonus denial of not being in love with House, and then Jennifer Morrison gets to do the face of dawning realization. She accuses Chase of cancelling Foreman’s interview solely to be a jerk, and he bristles, implying she’s a jerk for thinking so, but still managing to spit out his weekly reminder that he likes her and wants to go out with her. It’s about as unromantic as you can get without being House, and yet it still made me say “awww.”

Chase, not usually the cleverest of the bunch, is the only one to figure out what’s going on. Of course he had the advantage of being the last in the chain of accusations, assuming the night janitor who wears his pants backwards was never seriously in the running. He accuses House of not only sabotaging the interview, but manipulating the team into “chasing ghosts” and Foreman into rejoining the land of doctors with contributions to make.

“Sometimes I forget why I hired you,” House smiles. He does not, however, take Chase’s advice to tell Foreman he wants him to stay, or feel any remorse at costing him that job: “I cost him a crappy opportunity.”

“It would make him feel like maybe you aren’t evil,” Chase insists. “He needs that.” I need us not to go down the same road as in “DNR,” with the whole “I want some clue that he knows it’s a big deal, that it scares him, that it matters.” I need to know Foreman’s learned something, even if House hasn’t. On the other hand, I need to win my bet that he’s not leaving for good, so I guess I do need us to go down the “DNR” road again.

Cuddy gives Foreman another option besides capitulation, offering to double his salary and put him in charge of a competing diagnostic department. He’s tempted for a minute, but rejects the offer, since he knows he’ll still have to turn to House for the cases he can’t solve, and he doesn’t want to work for a place that would sabotage his other job interviews. That would be an intriguing, show-changing solution, but my gut tells me they’re not ready for show-changing yet. My gut isn’t known for being highly accurate, though, so I’ll be curious to see how they resolve this Foreman situation.

Later, House cannily preys on Foreman’s reasonable doubt that there will be cases he can’t solve. Instead of going Chase’s route of making nice, House decides to go with his strengths and be a jerk. When Foreman balks at treating the kid for amyloidosis, which he’s tested negative for, House points out that he has two choices: argue with him until doing what he asks, or just doing what he asks. When Foreman stalks off, House calls out: “You’re not ready,” pointing out that the third choice was to stand up to him. “You still trust my judgement more than your own.”

It doesn’t help that the jerk patient has pointed out that while he understands Foreman’s done his best to treat him, his best really sucks. It’s almost enough to make me feel sorry for Foreman. He really would have won me over if he’d put something deadly in that sedative he stuck Nate with.

At one point during the differential diagnosis, House says “symptoms don’t lie.” Really? My world has turned upside down. What about infections that don’t act like infections and symptoms that mask other symptoms? I kind of thought the whole show was based on the fact that the symptoms lie and it’s up to House to make them tell the truth. Or something. But then House also rejects the idea that Nate might have two disorders, since “it’s always one.” Really? I also thought many of season two’s patients have had some tricky combination of diseases. Maybe I’m suffering from amnesia too.

I wondered for most of the episode why House, in all his unpleasant splendour, held on to Nate’s unpleasant personality as a symptom. His rationale was that the kid hadn’t said anything appropriate, which is plausible, of course. But this time my gut wasn’t wrong.

House only turns on the kid when he faces him down over a chess board, attempting to stress him and therefore prove one of the team’s obscure diagnoses. It doesn’t work, causing a seizure rather than the expected rage attack. House seems to be more upset about losing the game after the kid goads him into giving up, spending future scenes trying to plot out how he might have won.

He also comes up with the brainwave that maybe the kid is just a jerk, and wipes “personality” off the whiteboard. Foreman disagrees: “You crossed it off because you want to hate the kid, and you can’t hate him if he’s just a victim.”

“You want him to be a victim because you want to believe that people are good, and if they’re not, it’s got to be a chemical problem,” House counters. I don’t think Foreman would argue that House is good, but fortunately he’s got the drugs and maybe even depression to blame it on.

Once the personality issues are out of consideration, the diagnosis is clear: amyloidosis. Except of course it isn’t. After the biopsy is negative, Foreman keeps testing and treating him anyway, and Chase challenges House on his game playing with Foreman, House realizes that the kid’s other aches weren’t from getting beaten up in the playground but from hemochromatosis, having too much iron in his blood. He lets the grateful mother know that her son will have a long and annoying life, and tells the annoying son how he would have beat him at chess. “I know. I was bluffing. And that’s why you lost.”

That gives House another move with Foreman. He bluffs again, letting Foreman continue to test for amyloidosis and not revealing that the case has been solved. It’s not quite as dramatic or funny a moment as I’d hope to end on, but sure, why ask Foreman to stay when you can just crush his spirit. Maybe House is evil. At the very least, he’s quite the jerk.