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House has finally returned to Fox’s schedule after a month of baseball, and the four-episode-old season is looking consistently fine so far, with another great one showing some creativity within the constraints of the patient-of-the-week platform.

Dr. Sebastian Charles (guest star Ron Livingston, Sex and the City, Office Space) is an expert on tuberculosis who not only works tirelessly in Africa treating the stricken, but campaigns at home for more funding and supplies. When he collapses at a presentation to a pharmaceutical company, he self-diagnosis TB, then refuses treatment in order to bring attention to his cause. Dr. House (Hugh Laurie) takes an instant, vicious, and hilarious dislike to the man, who takes control of the differential diagnosis meeting, dismisses House’s belief that TB is not, in fact, the question, and calls a press conference in his hospital room while demanding to be treated like a third-world TB patient.

David Foster, the doctor on the House writing staff, wrote this tale of two equally arrogant doctors, and again uses the nice touch he used in last season’s “DNR” of referring to House’s foil by his first name in a show where the doctors rarely are. It’s one little sign that Dr. Sebastian Charles is more accessible, more likable, and also that he’s more concerned with appearing more accessible and likable than the guy whose best friend calls him House.

The episode explores the concept of whether appearance is reality: is what appears to be TB really just TB, is a man who appears to be a hero really a hero, is one who appears to be an ass really an ass?

The two men are not polar opposites. Sebastian isn’t a saint, nor is he simply House with a social veneer and a global cause. Their vices illuminate the other’s virtues, and vice versa (yes, bad pun intended – I’m inspired by the title of the episode). Sebastian’s brand of altruism is leveraged into corporate sponsorships and press conferences while he saves thousands but sees millions more suffer. House’s altruism is in not caring if anyone is looking while he saves a life a week. Both could be said to have selfish motivations – personal glory, in Sebastian’s case, and the satisfaction of solving the puzzle, in House’s.

House hogs most of the zingers in an episode filled with them – I can’t believe I laughed out loud at a joke about drowning a cat. Neither can my cat. But Foreman (Omar Epps) and Cameron (Jennifer Morrison) in particular get some of the spotlight, too. Foreman’s evolution into a highly reluctant mini-House continues, with a humorous subplot where he substitutes for House in the clinic and discovers that reputation can be a harsh reality. He and Wilson share a priceless scene – and some popcorn – when they watch House on television destroying Sebastian’s press conference, and saving his life. “Now that’s compelling television,” Wilson remarks. Yes, yes it is.

Cameron finally has some fun with an inappropriate flirtation, this time with a patient instead of a boss. Her scenes with Sebastian, who asks her to work with him in Africa, are light in contrast to her charged scenes with House, who appears a little jealous, and not only because of her professional adulation of his rival.

No simple explanation is given for House despising Sebastian so thoroughly, but several rationales combine into one complex characterization of a man whose conflicting public images as ass and cripple neither cancel each other out nor represent him fairly, who has difficulty with the concept of hope, and who is gleefully nasty but profoundly joyless.

And about the question of whether the appearance of being an ass is reality? A definite yes. But he’s an entertaining, affecting ass.

(Cross posted to Blogcritics)