"I want meaning!" House cries. With that, he slams the robo-scapel down into Harpo's stomach. Monitors beep wildly, and the Cottages try to wrestle House away from the controls. But they are super-weak and can't even overpower a man who's just been shot twice and isn't wearing any pants, so House continues. He slices through Harpo's abdominal cavity and then uses the pincher-arm to grab a piece of Harpo's intestines and yank them out of his body. Oh, it's horrible. Worse than the exploding testicle, but not as bad as the eyeball, in my opinion. Bear in mind that I do not have any testicles of my own. Harpo flatlines. The monitors have question marks where vital signs should be, because even they are like "what the fuck was THAT?!" Blood drips to the floor. The Cottages are horrified.
Evil Nurse Brenda walks in and says that she is not going to be the person stuck cleaning this mess up. So House takes her over to a dark corner of the room and has sex with her. They share a post-coital cigarette and then she leaves the room. House remembers what just happened and steps towards Harpo and surveys his destruction. "Oh, god," he says, starting to think that this is real after all and he just killed a guy. But then Harpo's arm swings comes out from under the sheet. His fist unclenches and a bullet drops to the floor. House picks it up and smiles. He was right after all. "Good-bye," he says.
Cut to House being wheeled into the ER, presumably immediately following his pre-credits shooting. "Hello," he mutters, opening his eyes. The Cottages tell the ER staff that he's been shot twice, in the abdomen and neck, meaning that even the real Shooter McGavin can't hit a guy in the face at pointblank range. Cameron assures House that he'll be okay. Before he passes out, House mumbles to Cameron, "Tell Cuddy...I want ketamine...." His Shooter McGavin alter-ego made House realize that it's better to risk losing his mind than to keep living as its prisoner. I think it's safe to assume that he'll survive the shooting, but I have no idea what to expect out of him next season now. Can't wait to find out!