House is building toward a climax like many other shows this time of year. Its been a surprisingly rocky season for House. I spent much of the season longing for a shake up, but when one finally came (in the form of Kutner’s suicide), I wished it hadn’t. Network executives always say critics are fickle, I suppose they’re right.

Newlyweds Chase and Cameron are discussing the idea of a prenup. Not a normal prenup though. Cameron kept the frozen sperm of her deceased husband. She tells Chase that she wants to keep it just in case things don’t work out with Chase. Odd to be sure, and I don’t really think this was a good time to add another layer to the episode. It just felt tacked on and out of place. The real meat of the episode, was house and his hallucinations.

With the CTB still trapped in his head, House tries to take some time off but is drug in to deal with a new patient. This week’s insane patient is a ballet dancer. As usual, the cause seems unknowable. Unable to trust his own judgement, House turns to Wilson for help overseeing all of his diagnostic work as well as helping him treat his hallucinations. Even so, he can’t bring himself to tell Wilson that its his dead love Amber who is stuck in his head.

This particular patient has perhaps on of the single grossest symptoms ever. Her skin is coming off. Yikes. House thinks the skin disintegration was his fault and feels guilty about it. House takes this as a symptom of his own sickness (which on second thought is hilarious) and worries about possibly having MS. In an attempt to reconcile that emotion he goes to the patient and apologizes. All the while, the CTB is acting as his subconscious mocking him from inside.

While trying to talk out the diagnosis and his hallucination with Wilson, House lets slip who the real identity of his invisible friend is. Wilson takes it surprisingly well but also decides that House has to detox. Regardless of what the cause is, House’s future as a doctor hangs in the balance.

Because of the icky skin situation, House and the crew elect to stop the patient’s heart in order to get an MRI. Its risky and crazy dangerous, but they can’t figure another way. At the same time, House becomes desperate and tells Wilson he’s going to put himself into insulin shock thinking this will exorcise the CTB demon in his head. Its an excellent back and forth scene with the crew trying to save the patient, while House fades into shock. Its very well done and quite gripping.

House wakes up without his hallucination. Sure that he’s cured, he returns to the patient.  Foreman saw a shadow behind her heart during the MRI andbelieves there was something there. House comes to the psychotic epiphany that her boyfriend gave her gonorrhea and that it has somehow made it to her heart. Huh?

With House now celebrating his victory, Foreman calls and throws a monkey wrench into the whole thing. House guessed right, but it was a lucky guess not an informed one. As this dawns on him, the CTB returns. House immediately calls Wilson and sets out to check himself into rehab. At that moment, Foreman calls to tell him that the patient is spiraling down. Thought the diagnosis may be right, they can’t stabilize her enough to operate. House however is off the case now. The crew is on their own. Eventually they do figure a way, but the drug they give her gives her gangrene in her feet and hands. It requires amputation but as a dancer she’d rather die. Spurned on by Taub, they crew tries an long shot treatment that pays off, curing her black extremities.

House goes to Cuddy to quit his job. In doing so he makes an emotional plea for her help. House begins to withdraw from the Vicodine with Cuddy acting as his nurse. He tells Cuddy where his stashes of drugs are, confounding his hallucination. CTB and House go back and forth arguing over Cuddy and his addiction. Clearly his hallucinations are standing in as a symbol for his addiction. The scene is excellent, cathartic and raw.

As the morning comes, House and Cuddy talk about their past. Suddenly, House realizes CTB is gone. As she’s about to leave, Cuddy and House embrace and we get the moment we’ve been waiting for. The two begin to tear each other’s clothes off and the show cuts to black.

The reappearance of the CTB has been fantastic. Acting as House’s subconscious she added a whole other layer of subtext. It remains to be seen if House’s new found cleanliness will last, or if the romance with Cuddy will see the light of day next episode. Regardless, this episode was rock solid television. The fundamentals of House are strong once again.