House marches in and asks Della when the last time she got a cold or even just cold-like symptoms was. Progessive Flo answers for her that it's been years, but House says what Della actually felt and what she told her parents she felt could be two different things. Indeed, Della weakly answers that she's had aching ears, soreness in her chest, and some congestion, although it wasn't really noticeable until after a skateboarding tournament in Denver last year. Meanwhile, her parents are all "we had no idea! She didn't tell us!" That's not an excuse. My mom can tell by my voice on the phone if I'm hungry, let alone not feeling well or congested. Maybe my mom should be House's new fellow. She can diagnose the extremely obvious that everyone else seems to miss. Della's been feeling like this for a year now and her parents didn't pick up on it at all. Della didn't complain about it to them because her brother has it so much worse. And soon as she starts in with the saintly selflessness, House plops the oxygen mask back on her mouth to shut her up.
He heads outside, and Taub runs after him, still having no idea what House thinks is wrong with Della. House says Della has "a nasty case of sickle cell trait." That's different than the sickle cell anemia we always hear about and usually much more benign (or so Wikipedia tells me) but it can have complications in rare cases. Those set in for Della after the condition was amplified by her trip to a city at a high altitude. This also caused that false positive test for LAM. House says if Della had just told them or her parents about her symptoms sooner, they could have done something. At this point, though, she has no lungs and the Evil Transplant Committee will never agree to give her a new one. So, House concludes, Della's selflessness has gotten her killed.
OR HAS IT? For House has figured out a way to save Della -- by asking her brother to donate part of his lung and some bone marrow. Unfortunately, while House was waiting for the test results to confirm his diagnosis, Cuddy got wind of his plan and refuses to allow him to ask Della's parents to take a lung from Hugo and thus cut his life span down that much more. House points out that Cuddy is basically dooming both kids to die young, then. "We don't compromise one life for another," Cuddy insists. House nods and agrees with her. Cuddy finally realizes that House might only be obeying her orders because of their relationship. House admits that he is. Cuddy says it's influencing her decisions, too, as she would have never given him the go-ahead to foam Della's lung. She says she'll call HR to get someone else to supervise House ASAP.
House has made no real effort to make his argument to the old father and son as to why the father must go to a nursing home seem convincing. Instead, he just wrote "TEST RESULTS" on a yellow sheet of paper. He says he must recommend that the old guy go to a nursing home. Both father and son pretend to be upset about this news while also giving House big obvious winks to continue this charade. When the old son mentions that his father can't feel hot and cold, though, House suddenly asks to see the guy's teeth. Sure enough, the guy has a set of decade-old dentures, which he uses copious amounts of denture cream on -- enough to give himself zinc poisoning. The old guy admits that he uses about a tube a day of the stuff, which he buys online because he's just that cool. House tells him to get better-fitting dentures so he'll be able to cut down on the denture cream. That will take care of his symptoms, which means that, "medically," the old dad doesn't have to go to a nursing home after all. Old dad and old son greet this news with sad faces. House hands the old guy back his hundred dollar bill (he doesn't give the old son back his money as he already spent it on nanny sex time) and recommends that they spend it on "couple's therapy." I think the old son needs to use it on some kind of net nanny protection for his computer so his father won't secretly buy cases of something seemingly harmless but capable of poisoning him.
House finds Della and Hugo's father in his office. He knows the Evil Transplant Committee will never okay a second lung for Della and wants to tell her what the other options are. House refuses to name them, but Della's dad begs him, saying he'd do anything to save his daughter's life. House admits that they could get a lung and bone marrow from Hugo, and that this will cut Hugo's remaining life expectancy in half. And the parents only have one night to make this impossible decision before it'll be too late. Hugo, apparently, doesn't get a say in it at all.
Sad music plays as they spend the night fighting and crying. Taub goes to check on Della, who wants to know why her parents aren't in the room and why she saw them yelling and crying earlier. "They care about you a lot," Taub says. He thinks that'll tide her over, but Della is in the science club, and so she somehow puts it together that if her brother was a bone marrow match, then he could also donate a lung. She asks if that's what her parents are fighting over. Taub lies that it isn't, and then he walks away.
Meanwhile, the parents wonder how they'll be able to live with themselves no matter which choice they make. Suddenly, Chase and a handful of PPTH staffers rush past. Yes, Della disconnected herself from everything and took a walk down the stairs without anyone noticing until she collapsed on the landing. Taub explains that Della figured out what was going on and must have done this to die and spare her parents and her brother any more pain. Well, except the pain of losing their daughter and sister, although I guess Della either didn't think of that or just figured they'd be better off without her and with Hugo for five extra years and no guilt over having to choose between their kids.
Della is hooked up and sort of breathing again, but she's in worse condition than ever. Her parents will have to make their decision now. Meanwhile, Cuddy tells House that HR can't find House another supervisor, as everyone they asked would rather quit PPTH than deal with House. As well they should. Although, isn't Wilson a department head? Why not him? Or that neurosurgeon guy from last week? He seemed cool. House says they'll just have to find a way to work and sleep together. Cuddy says she thinks House should tell Della's parents about Hugo and the lung after all. House is happy for that, as he admits that he did that several hours ago. He says the dad came to his office and begged, so House felt like he had to do it. Cuddy pouts, then says she should be more angry at House than she currently is. And then, the parents walk up and tell House they made their decision not to let Hugo do the transplant. Um, did they even ask Hugo about this, by the way? You'd think he'd want to be consulted. And then he and Della can have a race to see who can kill himself first in order to save the other.
Cuddy steps forward with reassuring words for the parents, but not House, who expresses his displeasure with their decision by accusing them of sucking on a crack pipe. "Our daughter doesn't want it," Flo says. House says their daughter is a "mindless teenybopper," so her opinions don't matter. Unless they are House's opinions, in which I'm sure he would say they were very important. Cuddy spins around and tells House to stop antagonizing the parents and their "impossible choice." House begs to differ, saying they have just a "crappy choice" and they just chose the crappier option, trading decades of Della's life for four or five more years of Hugo's, in which he won't be able to move anyway. Cuddy argues that Hugo is a human being, not part of a mathematical equation. House says they have to make decisions like this all the time in their job, although not so much Cuddy since she's more of a paper-pusher than a doctor. Cuddy starts in with him now, calling him a bully, and then everyone turns around and notices Hugo sitting there. Oops!
The only adult in the room despite being legally a minor, Hugo springs into actio