Gregory House is injured in a motorcycle accident in Middletown, NY and finds himself in bed next to a patient (Mos Def) suffering from locked-in syndrome after a bicycling accident. His attending doctor diagnoses brain death, and suggests transplanting his heart into another patient. House notices the patient following the doctors with his eyes, and is immediately interested in taking up his case. Thirteen suggests a well-placed tumor, so the team does an MRI. House sees a lesion on the scan. However, the patient's attending thinks the patient has an infection and has him on antibiotics. House tells the patient if he has cancer, the antibiotics could kill him. However, they could almost kill him, in which case it would confirm that the patient doesn't have an infection. Just then, the patient seizes. Communicating through blinking, the patient requests transfer to Princeton Plainsboro.
The team plans to do a brain biopsy on the new patient, but he loses his eyelid movement in the operation, and with that, his only way to communicate with the doctors. Dr. Taub suggests they should use a brain–computer interface for communication with the patient. It takes the patient a while, but he finally manages to shift the arrow up, showing he's still mentally present. Communicating via yes or no (up for yes and down for no) on the computer, the team takes the patient's history. He claims he did not visit St. Louis, contradicting his wife. Unable to explain himself, his wife concludes he has had an affair. Further investigation reveals that the patient has stayed at a friend's home, in order to maintain the facade of a successful business. Unbeknownst to his wife, he was moonlighting as a janitor, where he was exposed to cadmium, leading the team to believe that he has heavy metal poisoning.
Thirteen notices that he has a tear in his epithelial cells in the eye, and a Fluorescein Stain reveals ulcerative keratitis. Cameron suggests the team does a lumbar puncture, noting that polys (polymorphonuclear leukocytes) would mean it's varicella, and lymphs, Behçet's. During the lumbar puncture however, the patient crashes. They bring him back, but his foot starts to itch, which he manages to communicate to the team after several questions. This indicates liver failure. Thirteen suggests that the dying liver released toxins which lead to locked in syndrome. Foreman suggests that the liver, kidney and eye points towards sclerosing cholangitis. House orders a biopsy to confirm.
As the team gets ready to perform the biopsy, Kutner notices a rash on Thirteen's wrist, where some of the patient's urine had spilled. He deduces that it is a rash due to Leptospirosis, which was transferred from rats, living in the basement where the patient had stayed. Sure enough, the patient has a paper cut on his index finger. The treatment is started, and Kutner manages to get the patient to lift a finger. The patient gradually regains control of his body, and thanks House, who has gone to the patient's room to retrieve a recorder which he's been using to listen in on his team from under the patient's pillow.
Meanwhile, Wilson gets curious as to why House was in Middletown. At the end of the episode, Wilson finds out that House was in Middleton to see a psychiatrist, and confronts him on the issue. House reluctantly acknowledges Wilson's accusation, but says he is not going to continue any further sessions. The episode ends with Wilson predicting House will end up alone, and showing that House's vision blurs in a similar fashion to the "locked in" patient as he looks towards Wilson.
Foreman also tells the patient that he bought his first girlfriend a silver necklace and she never wore it, so he never bought his girlfriends jewelry again, until he met Thirteen. He bought her a bracelet, but again, she doesn't appear to be wearing it. Later during the liver biopsy, Kutner asks Thirteen why she's not wearing her bracelet. Foreman says he didn't realize she was wearing it at all, and Thirteen questions why Kutner noticed but not Foreman. Kutner then notices Thirteen's rash, which he attributes to the patient's urine which could have entered through a scratch from the bracelet.
Read more about this topic: Locked In (House)
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