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.
Taub lectures House about how he's being an ass to Wilson. House shouts at him about how life is pain and how he's thought about suicide a lot. Lots of people hear him. House leaves and Taub looks sad.
Park is waiting for House when he comes out of the elevator. She tells him they had to delay the surgery because Derek drank ammonia from the janitor's cart. He didn't want to live without his brother's voice. House limps off angrily. He enters the patient's room and loops something around Derek's neck. Derek fights for life while Park and his mother try to fight House off. House shouts about how this proves that Derek wants to live, but he keeps strangling. Park whops House over the head with his cane, which stops him. She says that he's spent his life looking for the truth. And this time, the truth sucks.
Wilson and Foreman. Wilson tells Foreman that he'll be leaving "quite a bit earlier than we had talked about." In the next day or two, in fact. Foreman gently asks if it's something to do with him and House. Wilson says he can't be responsible for House's happiness. Foreman says he is, though. He's kept one best friend for twenty years amid three wives. Foreman: "Enduring pain to do some good for someone you care about. Isn't that what life is?" Man, are you kidding me with this? At this point, I think Wilson should kill himself just to show House he won't be pushed around.
House holds a bag of ice to his neck, alone in his apartment. He takes out some Vicodin and looks at it. We see Wilson alone at home. House plays the piano. Wilson gets some wine and sees a bag of Oreos in his cabinet. Derek's mother watches him sleep/ Derek wakes up and asks if she took his picture of Christopher. She did. Did she throw it out? Nope. Will she bring it back if he agrees to the surgery? She takes his hand. Surgery. Something is removed from Derek's ear. House continues to play piano. Wilson knocks on his door.