"But here's the thing. Humiliation comes in all kinds of packages. People finding out that your son's a perv, that's... that's pretty high up there. People finding out that you'd rather let your son die than sign a piece of paper... where does that rank? And trust me, if I have to paste up a sign in every nail salon and dumpling shop in Pennsylvania, I'll make sure they know."

―Love Hurts

Love Hurts is a 1st season episode of House which first aired on May 10, 2005. When House snaps at a patient in the clinic, the patient appears to suffer a stroke as a result of the confrontation. To avoid legal trouble, he agrees to take the patient's case. However, when none of the easy answers are right and the patient gets worse, House has to push past the patient's lies to find the right diagnosis.

The title perfectly sums up the primary theme of the episode - that love and relationships usually come with either physical or emotional pain. In this episode, it appears everyone in a relationship can only avoid one type by turning to another.

Primarily, the unusual relationship between Harvey, the patient, and Annette is brought into focus. Although hints as to the nature of the relationship are dropped throughout, and Annette tries to make the relationship seem as mercenary as possible, it's clear that she cares about Harvey and, when the basis for their relationship seems to have to change at the end of the episode, neither one of them is sure how they can have a relationship without the physical pain involved.

Similarly, the affection between Ramona and Myron is so great that they endure physical pain rather than risk the emotional pain they fear will come from confronting each other about their true feelings.

Then, there is Cameron and House as the Hameron relationship seems to come to its logical and unfortunate conclusion. Despite being warned that a relationship with House will be all about pain, Cameron moves forward nevertheless. Now, we know that House has always found Cameron to be attractive, but when confronted about his feelings about her, he is simultaneously kind but devastating. As Cuddy points out in future episodes, despite his rude nature, House actually holds back. He's capable of cutting anyone to the quick, but like a playful cat, he prefers to bat people around with his paws rather than going straight for their neck. Cameron isn't so lucky - House lets her know that how he feels about her is largely based on his completely correct assessment of why she gets into doomed relationships.

By the end, we find that Wilson was right - it's not Cameron who's at risk in this relationship, but House himself. He's off real relationships because he couldn't stand the pain of ruining his last one. Unfortunately, despite his best efforts, we see that House efforts to avoid a doomed relationship are similarly fruitless.

House is in a clinic exam room with Wilson and a "patient" who does not appear to be ill, watching a baseball game. Wilson is trying to learn the condition set by Cameron for her return to work. House has agreed to her request for a date. After he walks out of the exam room, telling Wilson and the patient who are singing the kissing song to grow up and learn to harmonize, he lashes out at Korean patient Harvey Park (John Cho) who he mistakenly believes has spilled urine on him, but it is actually only apple juice. When he goes back to apologize to avoid the inevitable suspension, he realizes the patient is having a stroke.

Chase and Foreman are surprised, but glad, to see Cameron back. The team is unable to perform an MRI because Harvey has a steel plate in his jaw. As Foreman attempts to take his medical history, he is continuously interrupted by Harvey's accompanying female friend. Foreman requests that Harvey provide his own answers. When he describes his teeth grinding, Harvey exhibits a condition called nominal aphasia (in which relatively simple words, i.e. nouns, cannot be recalled to mind easily). Harvey has been to a number of alternative medical practitioners. Annette says that Harvey first saw an acupuncturist, who sent him to a Shen balancer, who referred him to a homeopathic doctor, who sent him to a chiropractor, who sent him to a naturopath, who sent him back to the acupuncturist.

Foreman asks Chase if everything's ready for the angiogram. Chase says that Cameron's doing the EMG first. Chase asks who the woman with Harvey is. Foreman says she's his guru, but Chase scoffs, "That's what she called herself?", but Foreman says that's just from how she acted.

Before Cameron begins the EMG, she explains to Harvey that it may be painful having needles inserted into his arm and having him flex his muscles. The machine will measure the electrical impulse exerted my his nerves. If it is too painful, she can pull back. He tells her no, that he can handle the pain. As she inserts the needle, Harvey smiles slightly, seeming to enjoy the sensation.

Cameron briefs the team on the clean EMG. House says his symptoms could be the result of treatment from one of the alternative medical practitioners. Foreman says the only abnormal result was a mitral valve prolapse in the echo report. A clot could have formed on the faulty valve and gone to his brain, causing a stroke. Chase says it could be an aneurysm due to trauma, but Foreman dismisses it. House picks up a magic 8 ball and shakes it while sarcastically wondering out loud if he should go with Foreman's theory, which is marginally supported by medical tests, or Chase's theory, which is completely unsupported by medical evidence. Unsurprisingly, House goes with Foreman and prescribes blood thinners and antibiotics.

The team returns to the room, finding Harvey's "guru" choking the patient. Foreman and Cameron pull her off of him, but then Chase stops them, telling them that she is a dominatrix. Harvey apparently enjoys being strangled, and Chase apparently knows the dominatrix, calling her by her name.

House, Cuddy, and the hospital's lawyer go to Cuddy's office with Annette. She insists that Harvey was in no real danger and the asphyxiation was to reduce his anxiety. House insists she be barred from the hospital.

Chase reveals to Foreman and Cameron that he has some familiarity with BDSM relationships, admitting he was involved with a girl who enjoyed being burned. House tells Chase, "I wouldn't have tortured you if I knew you liked it" and admonishes him for not telling them about the patient's sex life, which could have supported Chase's trauma theory. Still, even though House thinks Chase is probably right about the aneurysm (and Foreman agrees), House still goes with antibiotics and blood thinners as the first and safer course of treatment; if it doesn't work, they'll surgically repair the aneurysm.

Cuddy finds out about Cameron's interest in House, and surprisingly expresses approval. She tells him he should wear his sky-blue shirt for his date with "the only female that can tolerate (him)".

Harvey starts to develop weakness on his right side, indicating mini-strokes, and the blood thinners are discontinued. The team then plan surgery to repair what is most likely damage to his arteries from the strangulations.

Cameron asks House what would be appropriate clothing for their date. After teasing her about paintball, he tells her he has booked a table at a nice restaurant. However, he still asks if she has any spandex.

When the patient expresses refusal to go through with the surgery, Chase tries to dominate him to consent, but fails. House summons the dominatrix to make Harvey submit to the operation, but he uncharacteristically defies her and violently pushes her away before having another stroke and lapsing into a coma.

The lawyer says House will need a court order for the surgery since the patient refused to consent. The patient had said his parents were dead, so they need proof of this to get a court order. The team discusses where to look for an obituary for the parents. House realizes they must still be alive, since they're accountants but Harvey lives in a slum. House sends them to the patient's apartment to look for leads.

Foreman tries to talk House out of getting involved with Cameron. He tells House to be himself (a jerk) because if he lets her down easy, she'll just fall for him more.

Chase and Cameron are examining Harvey's apartment. They are shocked at the S & M gear they find, but see nothing that would explain the symptoms. Chase finds a drawer full of Tic-Tacs and pockets a few packs for himself. Cameron finds a high school yearbook.

Back at the hospital, Cameron, Chase, and Foreman are calling people who might be their patient's parents. When Chase finds them, they hang up when they hear their son's name. House calls them back and lies to the parents by telling that that Harvey is dead and they need to identify the body.

When Mr. Park and Mrs. Park arrive, they are angry about being deceived and are intensely embarrassed about Harvey's fetishes. They have been estranged from their son for some time. Only when House threatens to expose their callousness to their entire community do they finally give their consent to Harvey's necessary treatment.

Wilson is worried about House getting hurt, and goes to speak to Cameron. He advises her to go easy on him, explaining that if he opens up and gets hurt again, there won't be a next time.

As House is preparing for his date with Cameron, Wilson tells House to compliment her earrings and shoes and then ask about her dreams, hopes and aspirations. House takes a corsage out of the refrigerator, commenting on how lame it is. Wilson says that Cameron likes "lame". Cameron loves the corsage but when she realizes House is attempting to be different, she tells him he has one chance and wants him to tell her honestly what he thinks of her. The date appears to go downhill from there as House tells Cameron he believes she is only dating him because she likes men who need to be fixed and what he is what she needs: he's "damaged".

The surgery goes well, but Dr. May finds no aneurysm or other cause for the strokes. Meanwhile, Cameron tells Chase and Foreman about the date; she says they had a nice, candid conversation and that she doesn't know if there will be another date. House tells Wilson how the date went: nothing too intense, mostly small talk. He says he doesn't think there will be another date.

They still don't know what is causing the strokes. However, when he sees another patient using a breath freshener, he remembers that Chase is eating new mints. Chase says he got them from the patient's apartment, where he has a whole drawer full. House realizes that the patient is using large amounts of mints to cover up bad breath. House has Chase smell Harvey's breath, which he says smells like "old vomit". House says that the patient has fulminating osteomyelitis, an infection of the jaw, likely resulting from the original break not healing properly. Pieces of infected tissue kept breaking off, impeding blood flow to the brain. House inserts a syringe into Harvey's jaw, extracting fluid, proclaiming that "We have pus."

The pus and infection in the jaw are causing the strokes. House has the jaw surgically removed.

When he goes to check on Harvey post-op, there is a woman in scrubs there – it's the dominatrix. House says hello to her, asking her to stay because he wanted to speak to both of them. He tells them that the strangulations must stop or the patient will die. Annette explains that it isn't about pain, it's about being vulnerable. She says that when you can be that open, that trusting of another person, it changes you. Harvey asks about his parents, but House doesn't answer.

Later, House is in his office, wistfully gazing at a photograph with worn edges as Some Devil by the Dave Matthews Band plays in the background.

A senior woman (June Squibb) comes to the clinic complaining of vaginal pain that is exacerbated by urination. House finds some vaginal tearing. She complains that her lover Myron, who is now trying Viagra, has been a little overeager with her. House prescribes a hormone replacement to increase vaginal lubrication. However, when Myron (Peter Graves) comes back for a refill, House finds out that he is feeling the pressure to perform. House prescribes blue pills that aren't Viagra instead. They both return later to complain the new pills weren't working. House admits that he prescribed acetaminophen. House makes them admit the fact that they both want less sex. House then realizes from their different wedding bands that they are married to other people and are having an affair. They settle their differences and House tells them they can go drug-free for a while.

Cases of acute osteomyelitis like this one are very rare, occurring about 8 times in every 100, 000 people per year.

• TiVo is a subscription based digital video recording system.
• Wilson and the clinic patient sing "The K-i-s-s-i-n-g Song", a song used by children in many English speaking countries to taunt people about their crushes and potential romantic relationships.
• Chase is telling Foreman the punchline to the Bear and Rabbit Joke
• "The happiest place on earth" is the tagline of Disneyland
• "Eye of newt" is a reference to a famous line in Macbeth
• A Magic 8-Ball is a novelty item which contains an icosahedran (20 sided figure) with vague answers (essentially yes, no or maybe) written on them. The figure floats on dark liquid sealed inside the eight ball, which has a clear panel on its bottom. When the eight ball is turned upside down, one side of the figure appears in the window with the "answer" to the question posed to it.
• A Dominatrix is a woman (the male noun is "Dominant") who takes on a dominant role in BDSM activities with her partner.
• "Mistress Ilsa" is most likely drawn from Ilsa, She Wolf of the SS, a 1970s exploitation film. Dyanne Thorne played the title character.
• Spandex is a synthetic cloth known for its extreme elasticity. It is generally used in the making of brassieres and swimwear.
• Malt liquor is a term used for any beer based beverage with an alcohol content over 5%, usually sold in bottles that are the size of regular liquor bottles. The alcohol content is raised by using other sources of sugar or starch during fermentation.
• Marvin Gaye was an American rhythm & blues singer
• During the environmental scan, Cameron teasingly refers to Chase as Sherlock,
• House is perpetuating stereotypes about Korean-Americans by threatening to post notices in nail salons and dumpling shops (fields that are dominated by Koreans in the United States), as he did earlier by noting that Asian-American accountants were unlikely to leave their son destitute in death.
• Jack the Ripper is, of course, the infamous serial killer in London during the year 1888.
• Lou Costello was a famous American comedian, known primarily for his work with straight man Bud Abbott. His memorial statue in Patterson, New Jersey does, indeed, show him with a tie that is far too long with the short end not hidden behind it.
• A decoder ring was a popular promotional toy that allowed its user to encode or decode a simple substitution cipher.
• Disco was a form of dance music characterized by a strong four-to-the-bar beat, high-hat cymbals eight or sixteen times to the bar, a syncopated bass guitar line and a full instrumental background, often featuring string instruments.
• Sigmund Freud is the father of modern psychiatry and psychoanalysis
• Ravioli is an Italian dumpling, made by placing a filling between thin square sheets of pasta. Spaghetti alla puttanesca or "in the style of a prostitute", is spaghetti in a sauce of tomatoes, olive oil, anchovies, olives, capers and garlic
• Oy vey (roughly "woe is me" or "oh, woe") is a Yiddish phrase used to express exasperation or dismay.
• The sequoia is the world's largest tree, both in height and volume, often reaching heights well in excess of 200 feet.
• John Cho, Matt Malloy, and Elizabeth Sung have all starred on Charmed. Coincidentally, John and Elizabeth played a mother and son on Charmed as-well, making this the second time that John has played Elizabeth's son. This is also makes John, Matt, and Elizabeth the third, fourth, and fifth actor/actress to appear on House who has also appeared on Charmed, the first two being Lori Rom and Dakin Matthews who both starred together in the episode, Damned If You Do. Charmed also had an episode entitled Love Hurts.
• John Cho's co-star in the Harold and Kumar films, Kal Penn, would later become a regular actor in this series, playing the role of Lawrence Kutner.
• At the very beginning of the episode, an announcement can be heard paging "Dr. Lee." This may be a reference to John Cho's character "Harold Lee" in Harold and Kumar Go To White Castle, which was released a few months earlier.
• Jeopardy! is a long running American quiz program.
• At the end of the episode, House finds himself looking at a photograph. Although she doesn't come up in this episode, it's most likely a picture of Stacy Warner. Given Cuddy's conversation with House about being out of a relationship for five years, it is likely that they broke up 5 years before the series started.
• House jokingly suggests that he and Cameron should enter a paintball tournament on their date. Incidentally, House met Stacy playing paintball.

Treatment against patient's wishes:

The situation where Harvey refuses surgery is a lot more complicated than the episode makes it out to be. In real life, it would probably not be necessary for House to either get a court order or find the patient's parents.

While in most cases, a physician should respect the patient's choices about not being treated (as in Pilot). However, this is not a hard and fast rule. Moreover, although a physician may seek out legal advice, the legal advice being given here is probably incorrect. Although there are both professional and legal consequences for going against a patient's express wishes, both the law and the medical profession give a physician a wide latitude when the patient is in imminent danger.

There are usually four factors that have to be considered when making a decision to override the patient's wishes:

1. Does the patient understand the nature of their illness?
2. Is the patient able to state a choice?
3. Does the patient understand the consequences of their choice?
4. Is the patient capable of rationally integrating information?

If the answer to any of these questions is "no", the physician is usually allowed to pursue any reasonable treatment plan.

Given Harvey's initial reaction, and given that Annette wasn't his medical proxy, House would have been justified in obtaining a psych consult to determine Harvey's capacity to consent. In this situation, the psychiatrist most would have opined that the patient wasn't able to understand the consequences of their choice, was uncertain about the nature of their illness (given that he's undiagnosed), and had trouble integrating information (particularly since he lost consciousness shortly thereafter).

The next thing to be considered is the seriousness of the illness against the risks of treatment. In this case, Harvey was in a coma and close to death. Exploratory surgery isn't a bad option here despite the potential for complications.

Had the matter gone to court, the only thing a court really would have been concerned about in the situation was whether Harvey could be made capable of giving consent. Given that he wouldn't regain consciousness without some sort of treatment, the court may have approved despite Harvey's initial refusal.

Dealing with lifestyle issues:

It's not unusual for a patient's lifestyle to result in medical problems. Tobacco and alcohol both account for a huge number of premature deaths. So do recreational drugs and obesity. However, they're not the only lifestyle choices that can affect health.

As it turns out in this case, Harvey's pre-existing injury was being exacerbated by his asphyxiation play. Although his preferences wouldn't be a major problem for a healthy individual, he most likely kept re-injuring his badly injured jaw, resulting in infections.

However, doctors aren't supposed to be moralists, and often taking the approach of moral outrage has the opposite effect. House is clearly required to warn Harvey that engaging in similar activities in the future will probably result in serious injury. Given Annette's reaction (which is often typical of people with lifestyle related health issues), House has every reason to be pessimistic about Harvey's prognosis.

In many cases, physicians can provide both moral and medical support to patients during such a period of time. This, of course, isn't House's strong suit - Harvey needs a physician who is willing to form a professional relationship with him. Although a psychiatric consult would be an excellent idea, Harvey would also most likely require the support of a help group and a general care physician.

Excluding visitors:

As a rule, a hospital should never prevent anyone from visiting a patient, unless the patient expresses a wish otherwise. The hospital may put rational conditions on visitors (such as having them register), but if a patient wants to have visitors, the hospital should allow it.

There are exceptions of course. Visitors who are disruptive may properly be excluded. So can visitors who have even a minor contagious disease. If a patient's visitors disturb other patients, that is also grounds for limiting visitor privileges. The hospital may also properly set visiting hours when visitors can be excluded, or limiting the number of visitors at any one time. Special rules can also be put in place to accommodate immediate family members, particularly for critically ill patients.

As such, excluding Annette here is questionable. Certainly, she can't go around choking Harvey at will, and her choice to do so in the hospital to "calm him down" is certainly bad judgment. However, excluding even a non-family visitor for a single incident where they have expressed a willingness to behave in future seems a little excessive. In this case, excluding Annette appears to be counter-productive - her absence actually increases Harvey's anxiety and, later on, hides clues about Harvey's change of behavior.

• When House is watching the baseball game in the clinic, the sound of the bat hitting the ball is clearly the sound made by a metal bat. Metal bats are not permitted in Major League Baseball.
• In the scene where House picks up his Vicodin, you can see the boom mic in the shot.
• When House gets a candy bar out of the vending machine, the bar falls out of its wrapper when it falls off the shelf.
• The hospital's lawyer tells House to find a death certificate or an obituary for the patient's parents in order to get a medical court order, but that would be his job to do, not the doctors.