It's depressingly easy for a TV series to fall into a rut, particularly when the amount of continuity is limited. Oh I don't mean that they recycle the same story week after week but they follow the same basic guidelines. House sometimes feels like that. The basic plot line runs something like this: a case arrives at the hospital that somehow piques House's jaded interest; he gathers his crew around him to discuss what the disease could be; they offer suggestions he shoots them down; A course of treatment is agreed upon but it doesn't work and probably makes the patient worse rather than better; they come with more ideas that don't work and then House has a sudden breakthrough of inspiration which makes things right. At some point during the evening you can usually count on Cameron getting soft and sentimental about someone's chances of living, Chase sucking up and Foreman being sarcastic. Add in copious amounts of Cuddy being exasperated and Wilson being his somewhat frustrated best friend, a soupcon of humour as House does clinic time and simmer in a stock of house being alternately callous and sarcastic and you have the recipe for a typical episode of the show. I'm not saying that the results are uninteresting but they do tend to follow a pattern and what raises the show above mediocrity is the cast, primarily Hugh Laurie, whose performance is inevitably the best thing on a given episode, and lifts the show above the pedestrian. But when the writers step outside the formula, that's when House becomes one of the best shows around. That was what happened with the first season's penultimate episode Three Stories and it is what happened in this year's season finale, No Reason.
The episode opens normally enough. House's interest is piqued by a patient in the clinic whose tongue has swollen to such a size that it won't fit into his mouth. As he begins the differential diagnosis with his team though a man walks into his conference room and very calmly shoots him twice, once in the abdomen and once in the neck. When House wakes up in recovery he finds that something is missing - his pain. It seems that Cuddy, who we know at least partially blames herself for the way that the misdiagnosis of the infarction that caused his constant physical pain, used an experimental treatment to put him into a temporary coma during the surgery to repair his wounds. The idea was to essentially reboot his brain so that he wouldn't feel the pain, although potential side effects included hallucinations. He has an hallucination - a beautiful woman claiming to be the wife of the patient with the enlarged tongue except that he was unmarried - but doesn't tell Cuddy about it and only mentions it to Wilson. The situation, both for House and his patient. The patient loses an eye and has his scrotum literally blow up and no one knows what is wrong with him as each test comes back negative. As for House he seems to have increasing numbers of hallucinations which are increasingly difficult for him to differentiate from reality. There are little clues, some of which - like a sudden shift in scene from the conference room to a stairwell - would seem to be simple convention in TV terms except that House might not remember how he got there, or he catches himself doing something that he'd never do. Eventually we - and House - discover that everything he's experienced since being shot is an hallucination, an illusion.
Throughout it all House is heckled (about the most appropriate word I can think of) by the other patient in his hospital room - the man who shot him. The cast listing at IMDB and other places calls the character "Moriarty", although he is never named at any point in the episode and certainly not before he shot House. Professor Moriarty, of course, was the most infamous adversary of Sherlock Holmes, the man who "killed" Holmes in The Final Problem, the man who Holmes refers to as "The Napoleon of Crime." (In his book The Seven Percent Solution - the title refers to Holmes's drug addiction to a 7% solution of cocaine in water - Nicholas Meyer suggests that Moriarty is simply Holmes's former mathematics tutor who has been blown up to titanic proportions of villainy in Holmes's mind by his cocaine addiction.) House's Moriarty, played by Canadian actor Elias Koteas, is like the Moriarty in the stories only so far as he's the opposite of House. While the Holmes's Moriarty was a villain whose reach extended into every criminal enterprise in London, House's Moriarty - the illusory one - embodies much of what House himself is trying to repress with his misanthropy, sarcasm and belief in the worst in people. Moriarty's heckling of House, calling him out on his beliefs while House himself is forced to confront the notion of whether the pain and his attitude make him a better doctor or just a massive pain in the ass.
There is one extremely memorable scene in the episode, one of tremendous erotic beauty which is also representative of House's greatest personal problem. In it he caresses Cameron's cheek, lifts her blouse slightly and gently blows in to her navel, and opens the top of her blouse by one button to ever so slightly expose the lacy top of her bra. Except that he doesn't do it himself. He arouses her, but he's using a surgical robot to do it, as a demonstration for the patient with the enlarged tongue. A small gripper moves down the side of Cameron's cheek, a probe with a blower blows into her navel, and an arm with a scalpel slices the button off of Cameron's blouse and another one opens it up. House is remote, detached, unfeeling, even clinical as he performs this incredibly intimate act, in much the same way that he's normally remote, unfeeling detached and clinical as he's dealing with human beings that he's treating. The scene is symbolic of his life.
Television too often falls into the trap of repeating what works, becoming formulaic. No series is entirely innocent of this, but it is different when a superior series - such as House - falls into the trap. It can be sad, if the show can't escape the trap and falls into mediocrity, or exhilarating when the show manages to escape the bonds of mediocrity and even for an episode or two in a season manages to escape the rut. The House season finale was one of those times. By pulling away from the formula for a while to examine the character of Dr. Gregory House through the medium of hallucination where what he chooses to repress confronts what he chooses to expose to the world, the writers the producers, and of course Hugh Laurie, have managed to give us an outstanding hour of television.