Up in the operating theater balcony, Stacy stops by to ask Cuddy if she's "okay." Stacy, you might want to go check out all the malpractice going on just below you instead of talking about feelings, eh? But no, Cuddy says she has wanted to be a doctor since she was twelve years old. Stacy says she wanted to be a lawyer since she was six, and this isn't about you, Stacy, so zip it. Cuddy gives us a rundown of her fabulous career, graduating medical school at age twenty-five second in her class and angry that she wasn't first, second-youngest and first female chief of medicine at thirty-two. "If I had been Alfredo's doctor," she starts, and Stacy angrily snaps that Cuddy is Alfredo's doctor, and Cuddy hilariously turns away from her, looking scared at the ourburst. She says that so far, she prescribed two medicines that only made Alfredo worse and didn't even see the pneumonia possibility or look at her own home as an environmental cause (which actually would have meant that one of those dangerous medicines would not have been prescribed and Alfredo would therefore be healthier right now, but anyway). She would have let him die to save his hand. House was right: Cuddy isn't a "real doctor." Chase walks in and says that Alfie's little finger is "dusky." Cuddy's all, duh, that's why we're cutting it off, but no: Chase is talking about the little finger on his left hand: "The one we haven't chopped off yet." Uh oh. Cuddy reacts to this news with the obligatory dramatic music flourishes for about five minutes before we finally cut to commercial.
Alfie's recovering from his amputation, and I have to say, I really didn't think they were actually going to cut off his hand. Damn. Cuddy checks out his other hand, and his two little fingers are both turning black. Pretty soon, he's going to be a no-handyman.
The latest differential-diagnosis session takes place in Cuddy's office, perhaps in the hopes that a new location would yield some new results. Alfredo now needs a ventilator to breathe; Cameron -- sounding just a little pleased with herself that her theory about the fungal medicine being dangerous was correct -- adds that he also requires dialysis for those failing kidneys. House says that they're getting distracted by Alfie's "multi-system organ failure," and should focus on his hands and their tendency to change color. He wonders if the DIC theory is wrong, even though the blood tests indicate it. As the Magic School Bus Cam shows us, House voice-overs that, in endocarditis, the infected heart pumps out bacteria that inevitably works its way through the bloodstream, affecting other parts of the body like Alfie's right hand, kidneys, and left hand. It also explains the fever. And it has the added bonus of being the reason Alfie's kidneys failed, as opposed to those drugs, which makes Cameron wrong again. Cuddy says that totally works, except for the fact that Alfie already tested negative for endocarditis. But wait -- there is such a thing as culture-negative endocarditis that also causes pneumonia. No one knows what House is talking about, so he makes chicken sound effects as a hint. Chase figures out that he's talking about psittacosis, and discounts that immediately, since Alfie doesn't have a pet parrot. House orders doxycycline, the antibiotic used to treat psittacosis. Cuddy jumps up and says no way, since it will make Alfredo's clotting problem even worse. House says it will also save his left hand if administered right now. Cameron says that if House is wrong, Alfie will lose his remaining hand and his feet. House says that Alfie will also die, so no prob. But he does see that some more substantial evidence is needed here. He's off to find out what job lets a twelve-year-old sub for his sick brother.