Wilson stands and this speech gets its own paragraph: "I don't owe you anything. Our entire relationship has been about you. My dying is about me."
Wilson cries in his car as House walks up. House tells him he doesn't want to die, which Wilson agrees with. But he fought it. Once. He says, "I have five months to live, and you're making me go through this ALONE?" He needs House to be there for him as a friend. He needs House to tell him that his life was worthwhile and he needs House to tell him that he loves him. House says, "No. I'm not gonna tell you that unless you fight." House gets out of the car and walks away.
Derek goes into the tube. The blood vessels are non-reactive, so it's not a migraine. He says he feels weird. When he's slid out, he calls Park "Dr. Adams." And then! Suddenly! The ceiling collapses because some jerk's been screwing with the plumbing! You thought it was going to be something to do with Derek, didn't you? Or at least Wilson? Nope! Apparently we need a prank subplot.
Ambulance! Firemen! The hospital is full of wreckage! House looks around, somewhat dazed and ducks below some police tape so he can participate in this week's case. Adams is pretty mad at him for injuring her, destroying the MRI machine and endangering the patient. House swears he had an alibi. Taub says House is only here because something happened with Wilson. House claims to be done with Adams, which nobody believes. Park says they got enough from the MRI machine to know it's not a migraine. Also, the patient mistook her for Adams. House looks thoughtful. Then he grabs something from a medical drawer and leads everyone to Derek's room.
He pokes a hypodermic needle into Derek's eardrum. And when he pulls out the plunger, it's not full of air, but blood. It's "persistent stapedial artery." It's supposed to disappear in the embryonic stage, but it didn't. So it's been pushing against his frontal lobe all this time. House leaves and Taub follows. Derek asks if his brother's voice will go away.