This has been an uncharacteristically uneven season of House. there were episodes of pure brilliance like last weeks, and still other’s that felt stale and repetitive. The formula that has driven the show has become so expected that sometimes it isn’t really important to know much about the illnesses at all. Its Dr House himself (and to a lesser extent the crew) who make the show worth watching. This season-ending episode was proof positive of that. Last week, House kicked his drug habit, stopped hallucinating and finally slept with Cuddy. It was a pretty big week. This week, we’re left to deal with the aftermath.

The patient this week is a man whose left a right brain functions are deviating. So much so that his left arm (operated by the left brain) slaps his girlfriend around while the other hand caresses her. Though it is pretty funny seeing the patient dealing with a sort of tourette’s syndrome for the hand, in reality its a bad metaphor for the conflict that House lives every day.

In typical fashion, he starts by pranking Cuddy and she responds in kind. As their back and forth marches on with eye rolling predictability, the patient and his separated brain illness gets worse. The high point of their pranks is the addition of an elderly patient who the two use as a pawn. The elderly patient is played by TV legend Carl Reiner. There’s no need to go into Mr Reiner’s biography here, but for those who don’t know who he is should check his IMDB profile.

Another left over from last week is the conflict between Chase, Cameron and Cameron’s dead husband’s sperm. Cameron wants to keep it “in case” things don’t work out with Chase. Chase eventually decides that regardless of how strange it may be for his wife to keep her sperm-cicle, its something he can live with. This whole plot just makes no sense to me. Maybe I just don’t get the symbolism of the frozen man mayo, but it feels like a completely unneeded addition.

House and Wilson talk and inexplicably, Wilson suggests that House ramp up the crazy.  Taking his advice to heart, House stands on the balcony of the hospital and makes the grand announcement that he and Cuddy have slept together. Obviously furious, Cuddy fires him while House suggests they move in together. Then seemingly at random, House is approached by the elderly patient. Talking to the patient about his problem somehow triggers his epiphany.

It isn’t pretty.  All the good feelings, all of House’s memories about kicking his drug habit and sleeping with Cuddy where hallucinations. She was never there. He never quit popping pills. It was all in his head. Now, as House realizes how crazy he really is, CTB and Kutner reappear. Now rudderless and terrified, House admits that he needs help. We’re supposed to believe that House spent all day thinking that his bottle of pills was Cuddy’s discarded lipstick. Its a bit more far fetched than usual, but it is a show stopper.

As the season ends, happy scenes of Chase and Cameron being married are intercut with grim shots of Wilson driving House to a dark and creepy psychiatric hospital. There aren’t any answers delivered here, only a cut to black. The patient is simply left without a proper resolution. Sure there is a quick few lines from Taub about their misdiagnosis, but generally this proves my earlier point. The illnesses and the diagnosis of those illnesses is just window dressing.

All season I clamored for change in a show that I love, but found stagnant. In the last several episodes, Kutner has died and House has gone crazy. In taking these risks, House has cracked open a whole new book on how these characters can interact with each other. Who knows how evil a jerk a completely sober Gregory House could be?