"Don't. Please don't."

―Bombshells

Bombshells is a 7th season episode of House which first aired on March 7, 2011. It is directed by Greg Yaitanes. This episode took a rather different approach through use of dream sequences and choreographed scenes. Among the styles copied were '50s television sitcoms, modern westerns, and zombie movies.

House treats a teenager who coughs up blood during a basketball game, but he's distracted when Cuddy has symptoms of her own and has to go through her own diagnosis. The character's hopes, fears, and aspirations start playing out as fantasies and dreams. When Cuddy's prognosis gets worse, House can't bring himself to face her until he turns to an "old friend".

The ultimate conclusion was hinted at in earlier episode as the initial high feelings of the couple settle into routine. Remarkably, the professional, even tempered Cuddy turns out to be the short-tempered one in the relationship, while the high strung unpredictable House turns out to be the one with the patience and humor. In addition, as House gets closer to Cuddy, he also becomes closer to Rachel and Arlene as well. Despite his faults, he shows he's perfectly capable of endearing himself to people when he makes an effort.

However, as Arlene puts it later in the series, perhaps the outcome of the relationship between the "two idiots with impossible standards" was a foregone conclusion. House expects his relationship with Cuddy to be like his relationship with Wilson - a constant stream of forgiveness because House, after all, is an intelligent and engaging companion with those he knows best. However, Cuddy expects her relationship with House to be like her relationship with her staff - a group of people to take the burden off of her shoulders even as she demands the best from them. In the end, both of them are disappointed.

Cuddy wakes up to an empty bed and goes to look for House. Suddenly, she feels someone grab for her leg, but it's just House, who has gotten up early and hid under the bed just to scare her. She's amused and they start making out, but she has to go and pee. House grabs a book. Cuddy calls for him - she tells him there is blood in her urine.

House accompanies Cuddy to the urologist for her exam, but brings his team along because they have a patient who spit up blood at a basketball game. The team starts a differential and Cuddy sends them out of the room. House calls at them to use a pill camera and check for angiodysplasia.

Taub explains the pill camera to the patient. The patient has lost weight over the year, and his father said it started after he quit the swim team. The patient says he quit because he had to get up too early. Taub sends the parents out of the room to talk to the patient about sexual activity, but when they leave, he asks the patient how long he has been self-cutting. The patient says the scars on his abdomen are from a fall from a skateboard, but Taub gets him to admit to sleep disturbances, loss of appetite and quitting something he used to enjoy. He asks the patient how long he has been depressed.

Taub reports the patient admits to depression and marijuana use. Taub thinks the marijuana was laced with toxins. House pays off a technician for test results and orders tests for lead poisoning and intravenous fluids.

House comes to Cuddy and starts reading from what appears to be her lab results. Cuddy wants to know where he got them, but he shows her a blank piece of paper - he realized from her behavior that all the tests were normal. Cuddy is afraid the blood is coming from her kidneys, but House accuses her of worrying too much, just like her mom. Cuddy agrees and House offers to buy her lunch in the cafeteria. However, after he leaves, Cuddy schedules an ultrasound.

Taub admits to the patient he lied to his parents and said they had no idea how he was exposed to toxins. The patient wants to know how Taub figured out he was depressed when he's been hiding it from everyone for months. Taub tells him that's his job. Taub suggests he talk to his parents about it, but the patient says they would blame themselves. Taub tells him that in med school, he felt he was the only one who couldn't deal with the pressure. He says he hurt himself as a result. However, Taub soon notices red spots in the patient's sclera that weren't there before.

Wilson does the ultrasound on Cuddy. She sees Wilson get worried and asks him what he sees. He says there is a mass on her kidney.

The patient's symptoms point to a cloting problem. However, Chase thinks it's an infection. House agrees and starts the patient on antibiotics.

House finds Cuddy with her lawyer drafting her will. House tells her she's freaking out about nothing. He tells her that she should get a biopsy, but she says it's scheduled the next day. House knows she can get someone to get her a biopsy right now. She says she can't knock other patients off their schedule. House says she's more important, but she counters that he said she isn't sick. He agrees to drop it.

A teenager is in the patient's room and he's angry about something. Taub asks him about it and it turns out that the patient sold some medication to the teenager. The teenager paid, but the patient got sick before delivery. Taub gives him the $80 to give back to the teenager.

Cuddy is meeting with her sister Julia, who is agreeing to act as Rachel's guardian if Cuddy dies. Julia wonders why Cuddy didn't ask House and she reminds her that they've only been dating a few months. Julia reminds Cuddy that she's been talking to her about House for ten years, if only to tell her how much she wanted to smash his mouth in sometimes. Cuddy tells her that people change.

The scene shifts to a parody of Two and a Half Men, with Wilson playing the role of Alan and House as Charlie. An eight-year-old Rachel shows up at the door with a police officer. Wilson scolds her for being late, but she blames the cop for not running red lights. The cop wonders where Rachel got her bad language, and House walks in. He denies doing anything wrong. Rachel had been shoplifting. House tells the cop Rachel's mom is dead and Rachel is his "favourite tax write-off". He assures the cop it won't happen again because Rachel won't get caught. He high-fives Rachel. They all hug.

Cuddy wakes up from her nightmare.

Masters is pleased Taub believed the patient. The patient comes out of the bathroom telling the doctors there is blood in his urine.

The blood rules out an infection and points to a kidney problem, probably a mass. However, Chase points out a kidney mass wouldn't explain the coughing blood or blood in his eyes. Chase finally figures House is talking about Cuddy, who does have a kidney mass. Foreman reassures House that Cuddy's biopsy will be back soon. Taub suggests heroin use by the patient, but there are no withdrawal symptoms. House goes with Chase's idea of antiphospholipid syndrome. He orders plasmapheresis. He also lets Taub do an environmental scan.

House wonders why Wilson isn't with Cuddy, keeping her company before her biopsy. Wilson thinks he's worried, but House feels he would just make Cuddy feel worse because he's bad at companionship. Wilson tells him to practice. House says he will be there for her once there is something to worry about, but Wilson tells him he should be there merely because Cuddy is worried, even if there is nothing to worry about. House agrees, but sends Chase to keep Cuddy company. Chase offers to read from 1st Corinthians, but Cuddy points out that's from the New Testament and she's Jewish. Chase tells her she doesn't know what she's missing. Chase assures Cuddy that House will show up. Cuddy tells Chase he can't possibly believe that, but she hopes House will show up too. She finds it ironic that House usually couldn't go 15 minutes without bothering her and now he's afraid to come into the same room. Chase quotes from the Bible anyway "Love hopes all things."

Foreman and Taub do the environmental scan and Foreman asks why Taub is interested in the patient. Foreman feels that Taub thinks helping the patient will improve his own life. Foreman gets a call that the patient has lost all feeling in his right arm. He starts to head out, but Taub finds a yearbook filled with violent imagery.

The scene shifts to what appears to be a hospital in ruins, with House looking for Chase to see how Cuddy is. He finds Chase, who has turned into a zombie and attacks him. House manages to fight him off with his cane, which he then turns into an axe to decapitate him. He hears Cuddy crying for help. The cane turns into a shotgun, which is used to dispatch zombie Taub and zombie Masters. However, he finally turns to face zombie Foreman, who is dispatched with three shots to the chest. The cane next turns into a high powered flashlight which House uses to look for Cuddy in the ruins. He sees Cuddy being eaten by zombies, but then wakes up from his nightmare. Masters and Chase ask him if he's okay. He says he was sleeping.

The arm paralysis while on steroids rules out an autoimmune disease. House is figuring out how Cuddy hid her biopsy results from him. Foreman suggests an angiogram to look for clotting. They finally get House's attention and he agrees to the angiogram. He tells Masters to look through all the recent biopsy slides to find Cuddy's.

Taub is worried about the violent imagery, but Chase says fantasizing about killing people is normal teenage behavior. Even Masters says she fantasized about torturing her classmates - and House. Taub agrees it might not be a big deal, but Chase starts to think - he remembers someone actually shot House once.

Wilson finds House hiding and tells him he has to be with Cuddy. House says Chase did a fine job and Cuddy is fine. Masters bursts in. As Wilson goes to leave, he tells House not to screw it up. Masters tells him she figured out which biopsy was Cuddy's, but it was inconclusive because the mass was at the center of her kidney and they couldn't get a proper sample. House realizes they will have to remove it surgically. Masters tells House they are doing imaging now.

Foreman comes home to find House in his apartment playing video games. He tells House they found a clot in one of the patient's cranial arteries and he's been started on blood thinners. Foreman tells House the same thing as Wilson - even if House thinks he won't be a good companion for Cuddy, it will be even worse if he's not there. He then sits down and starts playing video games with him.

The scene shifts to a '50s sitcom. House has cooked dinner and cured all his patients early so he could spend time with Rachel. Rachel boasts she got 100% on her spelling test, and she aced her law school admission test. House tells Cuddy he's been studying with Rachel and it was supposed to be a surprise. Wilson shows up with Cuddy's 29th birthday cake. She realizes something is wrong and wakes up. She hears someone knocking at her door - it's Wilson with her imaging. She calls House. Foreman asks what the problem is. House tells him what the scans show and Foreman realizes that it indicates metastasized kidney cancer. House realizes she's terminal.

The patient is shown in a video complaining how seat belts keep idiots alive, slowing the progress of evolution. He then sets off a small pipe bomb. Taub wants to tell the police about the video, but Foreman and Chase remind him that he stole the video from the patient's flash drive in his house. Masters comes in to tell them the patient isn't responding well to the blood thinners and the damage will soon be irreversible. They realize they may have to remove the clot surgically. Foreman figures House is with Cuddy, but Masters had just spoken to Cuddy and she doesn't know where House is.

Foreman goes to Wilson's office looking for House. Wilson says he is worried about House, but Cuddy is his patient and if he goes after House, it will be all about him instead of Cuddy. He tells Foreman that Cuddy thinks that House is still going to show up.

They explain the procedure to remove the clot to the parents. He also tells them about the pipe bombs and threats. The mother says the patient will never hurt anyone, and the father is worried about him being expelled if it comes out. He tells Taub to focus on keeping the patient alive.

Taub and Masters discuss Taub's dilemma. Masters assures him that teenagers rarely follow through on threats. She then tells him that if his own view of that part of his life is skewed, he's likely to be overprotective. When Taub tells her she sucks at giving advice, she tells him to blame the statistics, not the statistician.

Foreman and Chase find the clot. However, when they go to remove it, it disintegrates immediately.

House and Cuddy are facing the entire Bolivian Army in the last scene from Butch Cassidy and the Sundance Kid. They talk about going to an Australian karaoke bar. Cuddy realizes she's in a dream. She was hoping House would figure out how to handle it, but he can't because he's still a child. He says he can change, but it might be too late. Cuddy runs out guns blazing, but realizes House isn't with her as she wakes up.

However, when she does wake up, she sees House waiting outside the room. He apologizes for not being there. She says she knew he'd come.

The team is wondering what it was that appeared to be a clot. The patient's liver is now failing and the prognosis is that he won't last more than a day. Masters suggests they page House, but Chase says he's busy. House is with Cuddy. Masters says that House can't help Cuddy, but the others ignore her.

House tells Cuddy if she doesn't survive surgery, he won't sleep with anyone else for a month. She tells him to make it two months. He calls her a bitch and she smiles as they take her away for surgery.

The team keeps up the differential. The surgical team prepare Cuddy for surgery. She sees House in the observation room just before they anesthetize her.

Doctor House - Get Happy

As Cuddy goes under, a variant of House or Ringmaster House appears, sitting on the steps of a staircase, dressed in an outfit that appears to be a combination of a ringmaster and cabaret magician with House also wearing ripped white gloves as well as eyeliner and as he starts singing, various dancers behind him also begin dancing.

As the number progresses, Cuddy joins in too but she soon finds herself alone on a gurney. She regains consciousness to find House by her side. He tells her neither of them have cancer - the tumor was benign. The masses in her lungs were merely an allergic reaction to the antibiotics she was given when they thought she had a urinary tract infection. House makes her a present of her tumor. Cuddy starts to open up to House. She's afraid of so many things she manages to keep hidden, but when this happened, all her fears came out. However, she looks at House and realizes he's figured out what was wrong with his patient. She tells him to go.

House tells his team to take the patient off all the medication. The patient has a simple staphylococcus infection. The parents protest that they treated him for it and he didn't get better. House tells them that the antibiotics only killed the bacteria in the open, and let out a whole bunch of other bacteria that were hiding. Masters realizes House is talking about an abscess. They just have to find it. Taub realizes that if the scars on his stomach are from little pieces of the bombs he's blowing up, the plastic he was using wouldn't show up on scans, but would be a perfect breeding ground for bacteria. When they treated him with antibiotics, pieces of the abscess would break off, lodging in the kidney, liver and brain and look like clots. He just needed exploratory surgery to remove the plastic pieces.

Julia is nursing Cuddy at home. Julia promises not to tell their mother about her surgery to keep her from coming over. She also tells Cuddy she moved the sleeping pills back to the medicine cabinet because Rachel mistakes them for "candy". Cuddy then realizes the relevance of House eating candy in both of her dreams, which she had earlier mentioned. She realizes that her subconscious was trying to tell her that House took Vicodin while she was in the hospital.

Cuddy goes to confront House as to whether he took Vicodin before he came to see her in the hospital and whether he was stoned when he showed up. House admits it, but tells her it was only a one time thing and he wouldn’t be taking them again. However, Cuddy thinks he used the Vicodin to avoid feeling the pain, as with everything else he does. She tells him that if you care about people, you can't avoid feeling pain. She says he wasn't really with her and he tells her he wanted to be, but she replies that it's not enough. He says he can do better in the future, but Cuddy doesn't think he can. He begs her not to leave him, but she walks off.

Taub drops a package addressed to the Trenton Police into the mailbox.

Cuddy is then seen commiserating with Julia, while House is in his bathroom with two Vicodin in his hand. He quickly swallows them.

Staphylococcus is a very common bacteria in the environment and is the most common opportunistic infection. It readily infects any untreated open wound. Chase came up with this as a diagnosis at the first instance.

• Ryan's character draws heavily on the shooters at the Columbine High School massacre, such as the use of pipe bombs, videotaping rants, and the use of the phrase "natural selection". Ryan's character is also similar to the shooter at the Jokela High School Massacre, notable for also speaking of "natural selection" and regularly posting YouTube videos of violent attacks and tragic disasters resulting in deaths of people en masse. However, instead of posting videos of pipe bomb blasts, the shooter would publicize videos of shooting apples for target practice.
• This episode won an Emmy Award for Outstanding Sound Mixing for a Comedy or Drama Series (One-Hour).
• The episode had no opening title sequence.
• In Cuddy's first three dreams, House is always seen with some kind of candy, a clue given to her by her subconscious to warn her about House's need for vicodin.
• A Corn dog is a hot dog on a stick, dipped in cornmeal batter and deep fried.
• Emo is a modern style of rock music characterized by a focus on melody and expressive lyrics.
• A bonobo is a great ape closely related to the chimpanzee.
• Mel Gibson is an American-born Australian actor who has been criticized for some of his verbal outbursts. On the other hand, Nelson Mandela was a South African lawyer and politician who is known for bringing South Africa peacefully out of apartheid and into a multi-racial democracy.
• House's outfit in the first dream sequence is based on the clothes worn by Charlie Sheen's character in the sitcom Two and a Half Men.
• The model airplane House is carrying in the '80s sitcom is a Supermarine Spitfire, a World War II British fighter, and likely a reference to Hugh Laurie's nationality as in real life, he is originally from the United Kingdom.
• A ninja is a covert mercenary active in feudal Japan.
• Tom Cruise is the one of the highest-grossing box-office stars of all time.
• 1st Corinthians is one of the most quotable books of the New Testament. Chase's quote (actually paraphrasing) is from 1st Corinthians 13:7, "Love bears all things, believes all things, hopes all things, endures all things."
• Classic Doctor Who generally refers to the run of the program from 1963-1989, covering the first seven Doctors.
• The BBC is the British Broadcasting Corporation - the United Kingdom's national public broadcaster.
• A Zombie is a corpse that has been animated by supernatural means. They have been a fixture of popular culture since the late 19th century. They have been regularly depicted in movies since the 1930s.
• In the Zombie dream sequence, when Zombie Taub is shot, the famous "Wilhelm scream" can be heard.
• Additionally, in this scene, extensive use of the "blown away" trope is used, in that some of the zombies when shot fly back several feet. This is in fact something that violates Newton's third law of motion (for every action there is an equal and opposite reaction). For this to be realistic the shooter would have to fly back as well. This myth was tackled and busted in a 2005 episode ofMythbusters.
• Once again, the video game that was being developed in Epic Fail is being played. Foreman refers to it by the name Savagescape 2: The Revenge this time.
• Little Rachel's score of 170 on the Law School Admission Test would put her in the top 2% of test takers.
• Butch Cassidy and the Sundance Kid was a 1969 Western starring Paul Newman and Robert Redford in their first film together. It was the top grossing film that year.
• Newark is the largest city in New Jersey.
• Karaoke is a form of entertainment where members of the audience sing popular songs to prerecorded background instrumentals.
• More about those terrific Australian acts Midnight Oil, Men at Work, and Olivia Newton-John.
• Physical was a #1 hit for ten weeks. It was Olivia Newton-John's biggest American hit.
• Get Happy was first performed in 1930, but the most popular version is Judy Garland's 1950 version from Summer Stock.
• The dream sequences as well as the performance of Get Happy, had striking similarities to the Bob Fosse musical All That Jazz.
• The last scene deliberately follows the same pattern as the last scene in Help Me with House alone in his bathroom contemplating whether to take Vicodin. Without Cuddy to save him, he gives into temptation.
• The axe cane, like many of the canes on the series, was a collectible token in House M.D. - Critical Cases.

• The team starts Ryan on sodium benzoate on the suspicion his ammonia levels are high. Ammonia levels can be tested quickly and easily so they should have tested before starting treatment.
• If Ryan is bleeding and clotting at the same time, that narrows down the differential diagnosis to a few conditions. Disseminated intravascular coagulation is the most obvious choice.
• Streptokinase is a really bad choice for a stroke patient. It's a very old drug and its efficacy in stroke cases is questionable at best - it's not even FDA approved for the condition. Foreman, a neurologist, would be aware of this. In addition, it's contraindicated if the patient has had recent bleeding disorders. Finally, if a patient doesn't improve on the recommended dose of streptokinase, the right procedure is to try another anticoagulant, not to increase the dose.
• Taub is right that PVC pipe will not show up on an X-ray. However, it does show up on an ultrasound, and abscesses do show up on X-rays.
• In most cases, if intravenous antibiotics can't reach an abscess (which are often located behind a blood-proof barrier) they also won't break off pieces that will float through the bloodstream.
• Cuddy's sleeping medication, Zolpidem (more commonly known as the brand named Ambien), comes in 5 mg and 10 mg pills. Her pill bottle shows the dose of each pill to be 200 mg.
• Antiphospholipid syndrome causes clotting, but not bleeding. In any case, plasmapheresis isn't the appropriate initial treatment.
• The team never considers a blood culture, which would clearly show staph.
• This one is on the art department - in the Yearbook, the word "Achievements" is misspelled as "Acheivments."

The episode focuses heavily on patient confidentiality. In modern medical ethics, the relationship between the doctor and patient is of utmost importance and the right of the patient to privacy is very broad. For example, as a rule, doctors can't be compelled to testify about what their clients said to them and a breach of patient confidentiality that's even as minor as revealing their address is often met with loss of a job and sanctions from the medical licensing board.

However, there are several major exceptions to this general rule:

• If a patient has a communicable disease (particularly an STD) the physician is required to report it to the appropriate health authorities, largely to inform others of the risk of infection.
• In psychiatry, if a patient threatens immediate harm to others, or to themselves, there is again a requirement to report the threat to the appropriate authority.
• If a physician suspects a minor has been sexually abused, they are required to report it to child protection authorities (see Skin Deep).

There are other duties that are not absolute, such as reporting intoxication or drug dependency if the patient is a healthcare professional. In such cases, the decision to breach confidentiality is generally up to the physician's judgment.

In this episode, confidentiality is explored both with House's concerns about Cuddy's test results (which are entirely a matter of personal curiosity) and Taub's concerns about Ryan's behavior. There's no question that House's tactics in using his authority to check hospital records to find out about Cuddy's tests results is unethical, but Cuddy is unlikely to report him. Instead, she goes through more and more elaborate schemes to hide her test results from him. House uses similar tactics to throw his team off the scent in Blowing the Whistle and Half-Wit.

House's environmental scans have always been legally and ethically questionable, but here the seemingly non-medical information (which turns out to be medically relevant) puts Taub in particular into another difficult position. Taub identified with Ryan because he sees his high school bouts with depression mirrored in the patient. When it appears Ryan might turn violent, Taub seems to turn to his own (suspected) suicide attempt to determine the likely outcome. However, the rest of the team is right - Chase is right to remind Taub that nothing they've found raises any medical ethics issues whatsoever. Foreman is right that Taub's own ethical breach is likely to come to light if he presses the matter. Masters is right when she reminds Taub that only a small fraction of teenagers who harbor such beliefs actually act on them.

Taub is even walking on ethically questionable grounds by discussing the matter with Ryan's parents. A minor patient does not lose the duty of confidentiality merely because the doctor feels the parents have a right to know. House knew this better than anyone in Kids when he refuses to disclose his 12-year-old patient's pregnancy.

As such, Taub's decision to disclose the whole kit and caboodle to the police anonymously may be right from an overall ethics standpoint, but is almost certainly wrong from a medical ethics standpoint. Had Taub learned of a specific threat, he would have been forgiven for the disclosure. However, such general threats do not rise to the same level which is why he probably realized he couldn't come forward publicly.