House limps into the elevator, where he finds Cameron, patient referral in hand. Back in the meeting room, Foreman cannot believe they're dealing with a ten-year-old with a heart attack. Heart attacks are old-people problems! Cameron says that the ER did test after test, and Jessica did, indeed, have a heart attack. So if the department of diagnostic medicine's fortune ever reverses and they find themselves with an open position, there's a gym teacher they might want to consider hiring. Chase points out that their patient is "morbidly obese," which, I'm sorry, but unless she left half her body weight in her backpack, she didn't look exactly morbidly obese to me. Heavy, sure, but I've seen morbidly obese children, and she was not one of them. Foreman says it takes a few decades for morbid obesity to kill you, and Chase says that he'd try to kill himself if he were "that fat." Yes, I'd imagine the rate of suicides in "morbidly obese" ten-year-olds is extremely high. Try thinking like a doctor and not a schoolyard bully, Chase. Everyone settles on a diagnosis of Metabolic Syndrome X, which is a really bad-ass name for a disease; it can cause heart attacks in patients with high blood pressure, and morbidly obese people do tend to have high blood pressure. The Cottages get up to start treatment, and House casually mentions that he is going to be firing one of them by the end of the week. Foreman assumes that House is playing some kind of mind game with them, like his very own version of Punk'd; this show really likes Ashton Kutcher, doesn't it? Cameron doesn't think this is a trick, a suggests that they all pull together in this time of trouble. Chase prefers the every-man-for-himself approach. Foreman agrees with Cameron, saying that the last thing he wants to do is get House off by playing into his little Cottage v. Cottage contest.
Cameron explains Metabolic Syndrome X to Jessica's mother, who isn't all that thrilled with the treatment options of diet and exercise, since Jessica apparently eats right and exercises every day, and has seen several nutritionists and done what they instructed. Whatever's wrong with Jessica, she insists, doesn't have to do with her weight. Cameron says that the only way they'll know that for sure is to do the slightly dangerous test on Jessica that will rule out Metabolic Syndrome X.
Down in the Clinic, House has yet another "morbidly obese" patient complaining of heartburn. House makes the mistake of assuming that she's pregnant, thereby earning him a lecture from the woman about how women are supposed to have curves and her husband likes the way she looks, so House can take his magazine-model ideas of what a woman looks like and give her some goddamn Pepcid AC! House insists that the patient is pregnant, despite the fact that she has been pregnant six times already and House has been pregnant never, and despite the fact that her husband has had a vasectomy and they always use condoms. House says he'll get her some heartburn pills and draw some blood for a special heartburn test that is obviously actually a pregnancy test.