A band hangs out in a recording studio. They're all waiting for their guest horn player to arrive, one "John Henry," who Special Guest Star Brandy claims is the best trumpet player alive and is sure to make their recording great. Her bandmates are dubious that he's coming.
Cut to the inside of a limo, where the man who must be John Henry makes a gravelly-voiced request to be taken to the studio. His female companion, who may or may not be his manager, says she thought John Henry wasn't doing any sessions for a while. "Let's find out," he says cryptically.
Back at the studio, Brandy's only bandmate with speaking lines sings a little tune about how John Henry is not coming to their session. Brandy overacts her anger at this so much that you'd think the song was about the morality of Hitler's policies. And then John Henry is wheeled into the room. "Am I late?" he asks. He's two hours late, actually, which is kind of a dick move, but I guess fictional trumpet legends in wheelchairs can make their own schedules. John Henry starts to play along with the recording, but doesn't get very far before he's gasping for air and dropping his trumpet on the ground. Oh no! Now Brandy's music career will NEVER get back on track! Things have just gone from bad to worse ever since Beyoncé went solo.
Cuddy -- and, one would assume, the entire viewing audience -- are shocked when House actually requests to be put on a case. His interest has nothing to do with John Henry's musical talents (and I will be referring to him by his last name, "Giles," so as not to get confused with the steel-driving folk hero) and everything to do with the mysterious leg paralysis Giles has had for the past two years. Cuddy tells House to hold his infectious-disease-investigating horses: Giles is being treated for pneumonia, and only for pneumonia. His doctor back in Los Angeles is treating the paralysis. So there's nothing for House to do here. House points out that Giles's doctor, Marty Hamilton, has done just about everything to Giles except fix his legs. Cuddy takes great delight in informing House that Hamilton already called to ask for House's team's help. "By 'team,' I don't mean you," she says gleefully. It turns out that Foreman did his residency under Hamilton, and Hamilton would like someone he can trust taking care of his patient. House limps away to figure out how he can hijack this away from Foreman and start killing Giles to make him better.
One of the benefits to his new lead position is that Foreman gets to stand up and write on the Transparent Pane of Symptoms while everyone else has to sit down and tell him things. House reacts to his demotion to Cottage status like a stubborn little boy, all putting his legs up on the table, tipping his chair back, and saying he has nothing to report from the microbiology lab. Foreman tells him to go wash Foreman's car. "Oh, this is fun!" says House, who will not be washing anyone's car. Foreman orders the Cottages to do some stuff. Chase and Cameron get up to leave, but they are stopped by House's outstretched legs, an impenetrable force field for timid little kiss-asses. House says he wants to talk about Giles's paralysis, and Chase and Cameron obediently sit right back down. Foreman says it's been already diagnosed as ALS (a.k.a. Lou Gehrig's Disease, a.k.a. Not Good At All). House calls this a "disease of exclusion," since there are no tests for it. The diagnosis is made once everything else has been ruled out, and House has not ruled everything out. He wants to do an MRI. Foreman says that the diagnosis has been made and the case is closed. House gets to his feet and limps over to the Transparent Pane. A power struggle over who gets to hold the marker commences, and House seems to have the edge until Foreman reminds everyone that this is his case and that he is going to follow Hamilton's instructions. So there.