House takes advantage of the new second-floor balcony to throw grapes at a janitor. This seems mean of him until you realize that this is probably the same janitor who couldn't clean his bloodstain off the carpet. I mean, come on! It's called OxiClean, guys. It's available in finder retails stores nationwide. But with a new balcony comes a new balcony mate, and so Wilson comes up to get all pissy at House for his attempt to barter with Cuddy, as if House has never done something outrageous like this before. Shut up, Wilson. House says that he ran some more tests and they came back negative, so he'll get his spinal surgery after all, because it is the only option left for Karen. And then House "accidentally" hits the janitor on the head with a grape and immediately runs away, leaving Wilson there to get the full blast of the janitor's glare. Ha! Enjoy having your office floored cleaning with a mixture of water, cleaning product, and urine for the next six months, Wilson.
Wilson won't leave House alone, though, and follows him all over the hospital telling him about why he thinks House took the case and what his feelings are. Ugh. House continues to ignore Wilson in the operating room balcony, where he notices something on Karen's toenail (apparently, ketamine makes one's eyesight amazing!) as she's being prepped for the unnecessary spine surgery. He runs downstairs (because he can) to stop the surgery, pointing out to the annoyed surgeon that Karen's big toenail is all brown and gross.
Cut to Karen being forcefed OJ by Foreman, who tells her that she has scurvy, just like a proper English sailor. Scurvy ruins hair and toenails, makes it hard to move, and causes blood to build up around the heart. "But I'm on this great diet," Karen protests. What the hell? Unless that diet came out of the eighteenth century Royal Navy handbook, I don't think so. These days, one has to actively TRY to get scurvy. There are people who eat McDonald's for every meal who don't get scurvy! And I'm pretty sure that before one's heart starts to hemorrhage, indicating the onset of death, there are many other symptoms that would force one to seek medical attention. Like all your teeth falling out and your gums bleeding. Little things like that. Idiot.
House isn't sticking around the pretty girls with bleeding gums, though, as he's got a Stephen Hawking to make feel better. Arlene finishes packing him up to leave and thanks House for making her husband's pain go away, even if he couldn't do anything to make Richard any better. House suggests that Arlene lock Richard away in a "facility," preferably one without a pool, as the rent at those places is probably cheaper and there's less of a chance for suicide attempts. Arlene says she won't do that to her husband and the father of her child. She'll stick with Richard, she says, for the same reason that House helped them. "Because some guy shot you and you hallucinated?" House asks. "I have a responsibility," Arlene says, completely ignoring what House just said. I mean, I would have had some kind of reaction to that. At least asked a follow-up question or two. Not Arlene, though. House demands to know why Arlene is wasting her life and her energy on her lump of a husband. "What's the meaning you take from this?" he asks. So many mentions of the word "meaning" and so little of House actually being mean. Sigh. I know I've said that I don't like it when House is an asshole, but House in self-discovery nice mode is just boring. And his cases suck! Brain cancer that was diagnosed and treated eight years ago and a throwback to 1752. House and Arlene figure out that while taking care of Richard doesn't make her happy, not taking care of him would make her miserable. House struggles to understand this thing called a "conscience," while Richard just lies there probably wishing there was a way for him to tell everyone that he can hear everything they're saying and he'd prefer it if they talked about him outside. That's just rude.