With Jeremy at her bedside, Penelope gets ready for some torture. Foreman explains they're going to cut a hole in her trachea and inject water in there. She'll feel like she's drowning, but it will be over soon enough. I hope they numbed the area first, as Foreman cuts a nice gash into her throat, sticks a tube in there, and fills her up with water. She starts to choke and pitches forward, even though Taub is supposed to be holding her down. He explains that holding Penelope down is currently a bit difficult, as her skin is coming off in his hands. Penelope just sobs, as would any of us.
After the break, things have gotten a lot worse for Penelope, who now needs artificial skin grafts to cover her increasingly skin-less body. Taub does the work, which makes sense considering his plastic surgeon experience, while Foreman, House, and Hadley watch from the OR balcony. CTB gets a front-row seat on the floor, of course, since hallucinations are allowed in the OR without having to scrub in. House thinks they're looking at some form of cancer and since they've ruled out the lungs, he suggests doing an ultrasound of Penelope's liver to look for masses. I guess if you can't find cancer in the lungs, the liver is the next best hiding place. Foreman says a cancer diagnosis ignores Penelope's newest symptom of literally jumping out of her skin. House says that might not be a symptom at all -- "I think we caused it." How? By the antibiotics that Penelope ultimately didn't even need that caused toxic epidermal necrolysis. Foreman says there's a one-in-a-million chance Penelope would have a reaction like that, but since House has probably prescribed unnecessary antibiotics a million times, I'd say he's due. House says they can confirm it by testing some of Penelope's sloughed-off skin. Hadley's reaction is a dubious slow blink.
House heads for Wilson, and finds him in the Clinic. Wilson has no doubt just finished telling his patient in the exam room that she has three months to live when House's cane bangs on the window and he takes off on her. He tells Wilson about Penelope's skin and that he feels guilty for having caused it. And since House feels guilt just about never, he's worried that this could mean that there's something wrong with the limbic area of his brain, which means MS. He's also probably just a little bit hopeful that it is MS, since blood tests have ruled out an infection and in House's mind, MS is better than schizophrenia or having to stop using Vicodin. He'll test the diagnosis by apologizing to Penelope. If he feels better, he'll know that the guilt was a real human emotion and not a symptom. If he doesn't, it means he has MS. This seems far-fetched and silly, but I'm all for House having an awkward interaction with his patient so I'll accept it.
House walks into the clean room where bandaged-up Penelope (whose face skin managed to stay relatively intact) is recovering from her skin grafts with Jeremy at her side. They exposit that the Cottages did indeed find a mass in her liver and think it's treatable cancer. Also, her artificial skin seems to be taking and she's hopeful that she'll be able to dance again. Happily ever after for Penelope, except that we're not even halfway through the episode so there are more horrors to come for her. While CTB questions Penelope's priorities, House apologizes to her for killing off her skin with unnecessary antibiotics. "Very nice," CTB says, patting House on the leg. The look he gives her is priceless. Too bad no one else can see CTB to really appreciate it. "Thank you?" Jeremy says/asks. He's about to become even more confused, as House mutters that he feels nothing and leaves the room. Outside, CTB is practicing her ballet moves and says perhaps House didn't mean his apology. He says he did, then moves onto Foreman, who says they can't confirm the liver cancer with a biopsy because Penelope's skin is so thin that she'd somehow bleed to death. How is the skin all that involved in a liver biopsy? Weird. Foreman also wants to know why House actually talked to a patient. He does not wonder why House just talked to a wall, even though he was right there when it happened. House orders Foreman to do some special kind of biopsy that will prevent Penelope from bleeding to death and also give Chase some more screentime. He looks to Wilson for approval, gets a nod, and Foreman wants to know what that's about before deciding he'd rather just give House a suspicious look on his way off to do his job. As soon as he's gone, House tells Wilson that he must have MS since he didn't feel better after apologizing. Wilson suggests doing an LP to actually confirm the diagnosis. You'd think that after making a patient's skin fall off with unnecessary antibiotics, House would understand the importance of confirmation before treatment. You'd also think that he'd rather do the LP than apologize to Penelope. For House, LPs are probably less painful than sincere human interaction.
Chase and Foreman perform the biopsy, which gives Chase a chance to tell Foreman about Cameron's little sperm collection. Foreman doesn't understand why Cameron isn't happy with the sperm she's about to marry, and neither does anyone else because this is insane, even for Cameron. Chase says Cameron is hedging her bets so that she'll be able to give birth to one of her husband's children if things don't work out with Chase. "Wow," Foreman says. He does not add "your fiancée is crazy ... it might be time to break things off, hmm?" so clearly he isn't a real friend to Chase. He does say "she married a dying guy. She has issues," although that's kind of rich coming from a guy who is currently dating someone with a terminal illness. He says if Chase forces Cameron to get rid of her Poor Dead Husband's sperm, then the pressure will be on him to make sure they always stay together, because if not, then Cameron will always have him to blame for killing off her potential kids, not to mention all those awesome Octomom endorsement deals and talk show appearances. At this point, Penelope decides that this is all very ridiculous and starts having heart problems to shut everyone up.
After the break, Taub exposits that Chase and Foreman managed to get the liver biopsy despite Penelope's heart issues. It was negative for cancer, and now Penelope's heart rhythm is abnormal. Oops. Foreman would rather know why Wilson is in the meeting room. House lies that Wilson was there just in case the biopsy came back positive for cancer, and Taub says that they can't figure out what's going on with Penelope's heart because its abnormal rhythm makes it impossible to scan. Again, Foreman is more concerned about Wilson, asking if he's been appointed in charge of this case by Cuddy. Obviously, his feathers are all ruffled because he's usually the one who gets to be in charge when Cuddy is mad at House. Meanwhile, CTB is playing with a hallucination scalpel in House's office. Foreman decides that House himself must have put Wilson in the room with them because he can't trust himself for some reason. To prove that's not true (even though it is), House tells Wilson to leave. Nice going, Foreman. Now House still doesn't trust himself and he's been forced to get rid of the one person who knows why and how to deal with it. With Wilson gone, a seat has been left empty for CTB. She sits down and lays her forearm on the table and says that House knows he doesn't have MS, which means it's either mental illness or Vicodin. Either way, CTB says, House won't be able to practice medicine anymore. With that, she cuts a nice, deep gash into her arm with the scalpel. It bleeds all over the place, which is going to be such a bummer for the hallucination janitor.
House turns back to the real world, where Taub has left off suggesting that the only way to get a scan of Penelope's heart is to stop it. He said that a good five minutes ago, and then everyone sat around shooting nervous glances at each other while House got lost in his hallucination. House somehow got from CTB's self-mutilation th