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After the rule-bending episode last week – no medical mystery, gobs of philosophical dialogue, House in close proximity to the patient throughout – “Needle in a Haystack” is by-the-books House. And it’s a pretty good book.

If last week’s is the kind of episode I’d special order, this week’s is the kind I could describe in my sleep. If I had a very specific kind of sleep disorder that led me to describe TV shows. We meet patient, patient gets sick, patient responds to treatment, oh no he doesn’t, conflict with family, hmm what’s wrong, OK we’ve got the real diagnosis this time, House and Cuddy and Wilson shenanigans, doctor-patient parallels bring out emotional side of the story. That may be the overall template of most episodes, but the depth is in the details.

So is the fun. In wintry weather, House pulls up to his hospital parking spot to see someone else’s name inscribed on it, and his now some distance away. He clomps into the hospital, more peeved about getting his shoes wet than the effort of walking, it seems, but that’s not how he’s going to make his case.

He asks his team who this J. Whitner is. Cameron identifies her as a new researcher.

Chase: Is she hot?

Cameron: She’s in a wheelchair.

Chase: Doesn’t mean she’s not hot.

And she kind of is, though the fact that the actress, Wendy Makkena, played Sister Mary Robert in Sister Act infringes on that image a little. That’s unfair since, after all, Bertie Wooster and Prince George haven’t exactly diminished Hugh Laurie’s claim to the adjective. In any case, sparks fly a little, as they usually do when House meets a woman who can snark right back at him.

Their battle of the snarks results in a hilariously un-PC battle of the handicaps, as each asserts their right to the closer spot. “Cane!” he cries. “Wheelchair!” she responds.

He does have a point, as he usually does – walking causes him pain, and he could easily slip on the ice, so he needs to be close to the door. But he is also incredibly wrong and pig-headed, as he usually is. “Oh, well, since you asked so nicely … wheelchair” she tells him when he asks her to trade spots. Cuddy has no sympathy either, pointing out that his new spot is still within the limits of his application for a handicapped space.

The dilemma does let them get into another of their ridiculous but ridiculously funny bets. Cuddy says he can’t last a week in a wheelchair. He says he’ll do it for the better parking spot. So he proceeds to spend the rest of the episode in a wheelchair.

As much fun as it is to see House do his stupid cane tricks, it’s a nice treat to see his stupid wheelchair tricks this episode. My favourite is how he closes the passenger side door after scrambling in there with the wheelchair, followed by House’s satisfied smile. And here’s some random trivia that hard core fans already know: creator David Shore originally wanted House to be in a wheelchair, but FOX’s Gail Berman vetoed that and suggested the cane – the only time, Shore joked, that he’s appreciated network interference.

All this, and there’s an interesting medical story, too. Written by doctor writer David Foster, “Needle in a Haystack” starts with the usual patient of the week teaser. Even the content of the pre-credits scene is familiar, with teenaged sexual fumblings ending in one of them gasping for breath, in the “I’m going to die” way, not the “was it good for you” way. Sex kills, you know.

Our patient of the week with the long dark hair is 16-year-old Stevie, who went into respiratory arrest and seems to have a plural effusion – which Google tells me is fluid in the lung lining – and a leaky artery. Despite his lack of formal education (which we don’t know about yet), Stevie is a science whiz, asking all the right questions as Foreman performs tests on him, saving Omar Epps from having to take on too much of the boring medical exposition. As Stevie asks, if there’s a leak in his pulmonary veins, then where’s the bleeding on the scan? Strike one on the diagnosis.

Everyone lies, but Stevie does it badly. His lies lead to suspiciously unanswered phone calls to his parents and a wild goose chase at the wrong address when Chase and Cameron try to scout out his home – embarrassingly but entertainingly interrupting an adulterous couple.

Stevie’s blonde girlfriend has an annoying attachment to the truth, and fills the doctors in: Stevie is Romani, a gypsy, whose parents would consider the outsiders, like the doctors, like her, as contaminants.

Sure enough, when toothpick-chewing dad (clue alert!) and soup-bearing mom arrive at the hospital, they view Foreman and his fancy MRI with high skepticism. But the MRI helps narrow the diagnosis to Wegener’s granulomatosis (a form of vasculitis, if you’ve been playing spot that disease), whose pokey granuloma things are punching holes in the kid’s vital organs.

Though the treatment for Wegener’s is making the kid worse, House insists it’s the treatment that’s wrong, not the diagnosis. He sends Foreman to sell the modern-medicine-skeptic parents on an experimental, non-FDA approved treatment. Shockingly, the parents refuse.

The confrontation does allow Foreman and Mr. Lipa to compare the racist oppression of their peoples – their very own version of “my handicap trumps your handicap.”

There’s got to be a little mini theme about the consequences of not playing nice here. Foreman didn’t bother to win over the parents or make any accommodations to their beliefs, partly leading to the mom’s distrust. Not that I think she’d have agreed to the experimental treatment anyway. But it fits nicely with House not playing nice with his parking space rival, partly leading to her refusal to trade with him. Not that I think she’d have agreed anyway. OK, that’s not even a themelette, really. But it’s a nice moral: play nice. Unless you’re House, in which case you’ll get your way anyway.

Foreman not only likes the kid, he identifies with him, bringing up his own underprivileged upbringing in a less than stellar school, facing prejudice, using his brains to pull himself up. He also wants him to live, so he finds an excuse to clear the room and talk one on one with his patient.

The episode’s established that Stevie’s mature and bright enough to understand what’s happening to him, so Foreman asks him to make the decision to take the experimental treatment, and hide it from his parents. Foreman points out that he’s putting his medical license at risk by ignoring the parents’ wishes in a bid to win Stevie’s trust.

Before Stevie can even make the decision, however, his spleen explodes. Surgery to remove it can, as a bonus, confirm the diagnosis. Except it unconfirms it. House, watching from his wheelchair in the observation deck above the operating room, refuses to believe there are no granulomas. So he races down before the cranky surgeon can close the patient up. Even though time is crucial, House can’t let go of the bet. He first waits for the elevator, then bounces the chair down the stairs. See – stupid wheelchair tricks are fun.

House does forget about the bet and stands when, to prevent the surgeon from closing before House can prove the existence of granulomas, he desperately inserts his hand into the incision, then removes the poor kid’s guts and squeezes them inch by inch to find those elusive lumps. Which don’t exist. Because it’s not Wegener’s, no matter how much hoping would make it so. And also, yuck.

House has – well, you could call it an epiphany, but it seems more like a hail Mary. Anyway, he decides they need to do a colonoscopy, and Foreman is for once eager to take the leap with his boss and help, racing to the ICU before the parents’ limited visiting privileges kick in. “I like that kid. He’s got spunk,” House says, and he’s not talking about Stevie.

While House distracts the dad with slurs about gypsies, and Wilson distracts House with the news that even if he wins the bet, Cuddy has no intention or legal basis for honouring it, Foreman finds a toothpick in Stevie’s gut. Remove the needle in the haystack, and the haystack … oops, that metaphor doesn’t quite go there. Stevie’s fine.

The episode doesn’t really pit science versus traditional therapies, but it does pit modern life versus traditional. When Foreman offers to recommend Stevie for an intern position and encourages him to explore a life beyond his family’s boundaries, Stevie proves again that he is mature enough and bright enough to know exactly what he’s choosing. And “I’m choosing them,” he tells Foreman.

“I see you with Doctors Chase and Cameron. You’ve all got empty ring fingers. You’re alone,” Stevie points out. Good thing the kid never met House – he’d have sworn off modern life forever.

To further emphasize the message, we see Stevie and his family in their joyous escape from the hospital contrasted with Foreman reading a medical paper while eating dinner alone, and the sad triumph that is House’s battle of the parking spot.

Cuddy might have thought she had power over House post-Tritter (Tritter who?), but he still knows how to manipulate her with her guilt and pity. He unfairly appeals to her sense of fairness in making a bet she had no intention of honouring, and she caves. He’s not a proud man, but he’s a man who gets his own way. And he’s a man who has the prime parking space again.

The next episode of House airs next Tuesday, Feb. 13, at 9 p.m. on FOX.