House barges in on Cuddy as she is seeing a clinic patient, who is a 15-year old dwarf named Abigail. The mother of the girl, Maddy, is equally diminutive. House demands his pills from Cuddy and offers to take the case in exchange. He rudely assumes that it is relatively simple because the girl has a popped lung. Maddy notes that both she and her daughter have Cartilage-Hair Hypoplasia. House grabs the case file, again asks for his pills and retreats to the office to find his team.
The team would rather talk about Wilson's deal with Tritter, and they think House should take it. House moves on to the unexplained lung collapse and anemia. Realizing that many dwarves have compromised immune systems, rendering most tests inapplicable, House schedules a gallium scan.
Cameron explains to Abigail that gallium is a radioactive isotope that will travel through her veins. Any bright spots that show up could indicate infection. While Cameron is setting up the test, House and the mother continually fire jabs at each other. Maddy gives just as good as she's getting. House is quite amused and intrigued by this little firebrand.
Cuddy upbraids Wilson for making a deal with Tritter without consulting her first. He knows that House will never take any deal. Wilson suggests they stop House's Vicodin supply. When the pain becomes unbearable, offer him pills in exchange for taking the deal. Cuddy worries about the effect House's detoxing with have on his patient.
The gallium scan on Abigail shows nothing. Although House thinks the liver scans out, every part of the girl's body is glowing brightly in the scan except for the liver. Why? Cuddy rips into the office and announces that House is off the case. Furthermore, his treatment privileges have been revoked until he accepts Tritter's deal. She's also cutting off his Vicodin and taking over Abigail's case herself. Her first order of business is an MRI of Abigail's lungs. The team exits and House warns Cuddy that she's going to come to him begging with help on the case long before he comes to her begging for pills.
The MRI is clean, but Abigail begins vomiting blood during the test. House was right about the girl's liver failing. The team will perform a liver biopsy in search of cirrhosis, hepatoma or other causes. Foreman sneaks word to House that his thoughts on the liver were accurate in the hopes that House will point him in the right direction. House offers him one theory in exchange for Foreman jimmying open one drawer for him. If that drawer just happens to be where Cuddy is hiding Vicodin, so be it. As Foreman works to pick the lock, House explains that the problem Abigail has is global. It started in the liver but will spread in short order. He should focus on the pancreas. House eagerly opens the drawer, but there's no Vicodin inside.
Cuddy returns with the results on the test that Foreman ordered. It was negative. Cuddy and Wilson are quite aware that Foreman was led in this direction by House. The liver biopsy indicated severe duct inflammation, so it's time to turn their attention back to the liver.
House sits in an examination room at a 24-hour clinic. He claims he had a fall and Princeton-Plainsboro discharged him with directions to a clinic. The clinic doctor offers some pain medication and House invents various reasons that different prescriptions won't work to steer the doctor toward Vicodin. However, the clinic isn't allowed to prescribe opiates to new patients. Enraged, House rails that gabapentin -- the doctor's original drug recommendation -- is for nerve damage. Realizing that House is a medical professional, the clinic doctor calls security. House shuffles out.
Foreman and Wilson prepare Abigail for her next liver test, but she falls unconscious. Checking her airway, Foreman notes that her breath smells fruity. Wilson recognizes diabetic ketoacidosis. Abigail's pancreas is failing, as House had predicted. Grasping for answers, Cuddy orders an LP for lymphoma as well as an antibody test for lupus.
Cameron sneaks off to House's apartment to talk about Abigail. When he opens the door, Cameron is shocked that he's in such bad shape. Noticing a cut on his arm, she forces her way in. She cleans the cuts and sees that each is straight. House cut himself on purpose because it releases endorphins and endorphins relieve pain. House asks if Abigail has been sick lately, then suggests Still's disease.
When Cameron returns to the hospital, Cuddy asks what House said. She is the one who sent Cameron to him. Her report of Still's disease is disappointing because it is virtually unable to be confirmed. Cuddy asks how he is doing. When Cameron pointedly says they can trust his judgment, Cuddy orders the treatment.
House ambles into the hospital and asks Wilson for a prescription to help stop the vomiting from detox. Wilson advises him to go into rehab, where he can get the drug. House checks the case file that Wilson left behind, then barges into a room where Wilson is consoling an elderly widow whose husband just died. House makes a racket about being strung out and still able to come up with a better diagnosis than Wilson. The widow begs him to leave and he heads out. Wilson realizes that House could've made this scene anyway. He searches House's pocket and finds a bottle of oxycodone that House stole from the dead man's bedside. Wilson asks House if he's sure that he doesn't have a drug problem. In shame for once, House limps out.
Cuddy tells Wilson that Abigail is responding to treatment and that House's diagnosis was correct. Wilson is despondent that he never even considered Still's disease. Later, Wilson sees Tritter. He argues that drug addicts hurt people, but House saves lives and makes right decisions that nobody else could ever make. Wilson won't testify against him. Tritter threatens that, based on previous statements, Wilson will be sent to jail. His refusal to testify won't protect House, either.
Cameron is called to Abigail's room when the girl starts bleeding from her mouth and ears. House heads to the hospital pharmacy to pick up a prescription. The pharmacist points out that it's for Dr. Wilson. House claims he's picking it up as a favor, badgering the pharmacist into handing over the pills. Drugs in hand, House retreats to a lonely stairwell and immediately pops some pills.
Abigail is on the verge of a multi-system failure and the doctors have no idea why. Cuddy tracks down House in the hospital cafeteria and tells him that the diagnosis was not Still's disease. They are desperate for answers, so she offers him pills in exchange for a look at the case. Yet he is acting loopy enough to alert Cameron to the fact that he found some pills already. Ignoring Cuddy and talking to a young girl in the cafeteria, House has an epiphany. They need to x-ray Abigail's leg.
The leg is more than fine. It has normal growth plates, which should be impossible in a dwarf. Wilson is still trying to figure out how House got his hands on more pills. Barreling ahead, House explains that they all assumed Abigail was a dwarf because her mother is one. Because Abigail doesn't have the skeletal structure of a dwarf, she clearly has a growth problem caused by a pituitary issue. The only thing that connects pituitary problems with the lungs, liver and pancreas is Langerhans cell histiocytosis, which is a group of idiopathic disorders. The doctors' hunches about cancer or autoimmune issues were both somewhat correct.
Popping a few more pills, House explains the issue to Abigail and her mother. With some chemotherapy, the removal of Abigail's granuloma and a round of growth hormone pills, Abigail will begin to grow to a normal size.
That night is Christmas Eve. House sits at home, staring at a pill bottle. He picks up the phone and leaves a message to his parents, wishing them a Merry Christmas. Then he hangs up and downs more pills before chugging a glass of whiskey. On Christmas morning, Wilson comes by and finds House face down on the floor in a puddle of vomit. Next to him is the prescription bottle that House stole from the pharmacy. Wilson recognizes the name of his dead patient on the label of the empty bottle.
Later that afternoon, having scraped himself off the floor, House swings by Tritter's office to take him up on his offer. Yet the deal is now off the table. Tritter has found some new evidence and no longer needs Wilson to bring down House. Tritter saw the pharmacy log and noticed that Wilson's dead patient picked up his oxycodone. House realizes that he is in serious trouble.