Chase enters Vogler's office to ask why Vogler's been talking to the other Cottages. Vogler says that if House fires Chase, Vogler will need another source, because knowing the ins and outs of a department of three freaking doctors is just that important to him. Even the smallest hospitals have a staff of thousands, and more than half of those people have nothing to do with medicine, but with the financial stuff. Is there some parallel storyline we're not seeing here, where Vogler is putting the screws to the leader of the billing department, a renegade who follows his own rules but always gets the job done right in the end? Or the laboratory's Special Chemistry department, who will stop at nothing to get results for their tests, even if they have to lie to do it? Or the ER Admitting nightshift, who will get timely care for all patients, even if they have to fudge some stuff on the records to get people seen? This is ridiculous and contrived, and I'm not going to recap it in any more detail than to say that Vogler tells Chase that he'll keep him around as long as he needs him, and that if he can get one of the other Cottages to turn, he won't need him anymore.
It's been three hours, and Jessica hasn't gotten any better. Foreman and Chase want to start the surgery. House asks whether anything else could have caused Jessica's symptoms besides the warfarin. The Cottages pause, and House tells them just to say the first thing that comes into their heads. "She's fat," says Chase. Well, at least he's being honest about something this episode. Foreman snaps that he's had enough of the fat jokes, and Chase says that he's wondering if the obesity is a symptom of Jessica's problems, not the cause. What causes skin necrosis and obesity? Foreman suggests vasculitis, because it's his turn, and then House notices that Jessica's mom is kind of tall. Chase says that Jessica's dad is tall, too. Where is Jessica's dad, anyway? Did Vogler instill a new one-relative-visitor-only rule just to show whoever's in charge of hospital visiting hours that he's the new boss around here? House says that Jessica is short, indicating stunted growth. Cushing's fits all of Jessica's symptoms, except for the fact that it hasn't shown up on any of her blood tests. House says that the cortisone levels indicative of Cushing's could just be cyclical, and weren't in the bloodstream when the tests were taken by sheer coincidence. So now they're faced with two choices: if they treat Jessica for Cushing's and she doesn't have it, she'll die. But if she does have Cushing's and they don't treat it, she'll lose her breasts unnecessarily and still be sick. House orders an MRI, hoping to see something on it that would cause the hypercortisonism of Cushing's.