Over in distant Baltimore, Medicaid Guy has a problem with House's prescription of Viagra for someone with a heart condition, especially since said patient is a woman who I'm guessing is not having a problem with erectile dysfunction. House explains that Patient Dolores couldn't take nitroglycerin, so he prescribed the Viagra for its vasodilating properties, which he's sure Medicaid Guy is more than familiar with, since House thinks it's smart to insult the manhood of the guy who could do some bad things to House's ability to practice medicine. House says he'd be willing to pay for the pills himself if Medicaid won't cover off-label drug usage, and now he's in trouble for trying to bribe the guy. Stacy tries a different tack, appealing to Medicaid Guy's upcoming retirement and to his own personal feelings about the faults of the Medicaid system. House is both shocked and confused as to how and why someone would try to catch flies with honey rather than cane varnish, but goes along with it.
Outside the office, Stacy and House congratulate themselves on a successful and reasonably fast trip to the Medicaid office. House tries to invite Stacy out for dinner, but she somehow managed to find out when his flight was leaving, and knows that it's too soon for them to have dinner together. She also made sure to book a separate flight from him. House thinks that this is about their relationship, but maybe Stacy just prefers sitting in a bulkhead seat and knows that House, being handicapped and therefore unable to assist passengers in the event of an emergency, wouldn't be able to sit next to her anyway and she didn't want him to feel bad.
The Cottages give Fletch various brain tests until he starts gagging and choking, because his lung has collapsed. Well, that didn't take long. Foreman says they'll need to intubate, and all three Cottages go for the cart at the same time, like when a bunch of people try to enter an elevator at once and get stuck in the doorway, except that this time, some poor guy is behind them dying and suffering due to their inability to function as a team when their boss is away.