I'm generally indifferent to cold opens—the routine is so set at this point that there's no real excitement to them—but tonight's seemed especially generic. Pretty ballerina gets dropped on stage, has breathing problems. Woo-hoo. The dialogue was annoyingly clunky, and the whole thing happened at a rehearsal, not an actual performance, which seems like a wasted opportunity. (Although I guess having somebody collapse during a live show would be kind of a cliche.) Plus, the ballerina, Penelope, wasn't even played by Summer Glau. What the hell, people?

Still, the rest of "Under My Skin" was pretty good. It wasn't without its problems; in some ways, it succumbed to the kind of uninteresting sensationalism that every other medical show trades in (I'm thinking of Cameron and her dead husband's sperm here), and House's transition from hallucination sufferer to dried out Vicodin addict seemed to happen a little fast. And yeah, there are my usual issues with the whole Chuddy thing, which we'll get to. But the sense of urgency the series has been lacking for months was back tonight, with House fully engaged in a problem and the stakes seemingly very high indeed. While Penelope's woes got all the good gore, you could say that there were two PotW this time around—and the second one was by far the more compelling.

Despite House's best efforts, Amber is hanging around, playing a ukelele (badly) and taunting him with all the ways he's messed up his life. House hasn't been sleeping, and apparently he's been avoiding work; Foreman shows up and tells him it's time to come in, or else Cuddy will fire him, so I guess it's been more than a day or two since last week's episode. But House has very good reasons for wanting to stay out of the hospital. As previously shown, Amber's influence on him puts him in the uncomfortable position of being unable to trust his own judgment on, well, anything. That's bad enough when he's hanging out in the apartment trying to pretend the woman who isn't there isn't there, but when it comes to having a person's life in his hands, it's just too big a risk.

Or it would be for any normal person. House isn't normal; and one of things in "Skin" that works is that his problems with Amber aren't just philosophical or medical. This is a very real, very desperate personal crisis—as a man who defines himself on being rational, as seeing things exactly as they are and making deductions based on that, knowing that he can't trust himself completely is a terrifying thing. It could cost him his ability to practice medicine (much in the same way Penelope's gradually worsening condition puts her own career at risk; can't be much of a dancer if your skin is sloughing off, or if you don't have hands and feet), and without that, there's nothing left for him. Most of us have lives outside our jobs. House does not, so as entertaining as she is, Amber has got to go.

House is so desperate that he even tells Wilson what's happening. Some of it, anyway; when he asks Wilson to sit in with the team to make sure he isn't making any insane choices (another nice acknowledgement here; because even sane-House's ideas are often seemingly crazy, he needs someone he can trust to judge the line between "regular me radical" and "off the charts), he lies about who he's hallucinating. Amber's right, Kutner does make for a good cover, although Wilson eventually finds out the truth anyway. It's a little disappointing that Amber's identity isn't made more of here. Wilson's reaction is fine, but the fact is, House is hallucinating her, not anyone else. Obviously he's doing it because of her death last season, but it seems a shame to let what she represents get so quickly shunted aside.

It was pretty cool seeing her screw with House, though. He and Wilson go down the list of possible causes—at one point, he feels guilt over something that happens to a patient (a million to one shot that, apparently, turns out to be just that—did I miss something? Was the skin coming off ever anything more than a bad reaction to antibiotics?), and has to apologize to see if that relieves the guilt, because it might be a symptom. Amber continues to mock him at every turn, and, in one of the coolest moments we've had this whole season, pops up in a restaurant to mock him just when he think he's finally gotten rid of her. (By inducing insulin shock, no less.) Very creepy, very nicely done; just the look of absolute horror on House's face when he realizes what's happening was brilliant.

It all comes back to the Vicodin. Of course. And House realizes that rehab isn't the answer, as he'll just find a way to cheat out of it; Wilson's no good either; so he's left with only one person who can force him to see through withdrawal to the end: Cuddy. That in and of itself makes decent sense. At her best, Cuddy has always been able to stand up to House (we're talking semi-idealized best, so let's just ignore all those times the writers forgot to give her a spine), and he's always struggled with his sense of responsibility towards her. Plus there's the whole semi-maternal thing going on—Cuddy's always been the mom of the hospital. Once she realizes what's going on, Cuddy immediately agrees to come over and help House come down off his pills. 'Cause that's what sort of but not really moms you kinda want to bone do, right?

During all this, things haven't improved for poor Penelope. House managed to figure out the problem—gonorhhea, creating an abcess in her heart—but because of her condition, it's too dangerous to operate. Obviously House is in no position to help (points to the ep here for not caving on this part; House has his epiphany around forty minutes into the hour, and then he's done), so Foreman, 13, and Taub have to solve the problem on their own. They give Penelope Dopamine to keep her heart from imploding during the operation, but while the abcess is successfully removed, the dopamine stops the circulation in her hands and feet, so it looks like they'll have to be removed. Our tiny dancer won't have any of that, and thankfully, Taub isn't willing to back down—he finds a solution that will most likely amuse the hell out of anyone who knows anything at all about medicine, and the day is saved.

House manages to get through the crisis as well, with more than a little help from his friend. (His come-down seems awful fast here. I know nothing of Vicodin addiction; would one night off the stuff be enough to put you on the solid road to recovery?) The two bond, she reveals she was into him twenty years ago, and then they make out. It's funny, I was digging it until riiiight about the moment where House says, "I always want to kiss you." I can't decide if it's my own innate cynicism—not really a romantic guy, and as House is a character I strongly identify with, maybe I'm just pissy that he's got a girl now—or the fact that the writing on this show just turns to shit whenever it tries to make House into a lover. I had similar problems with Stacey; their banter was terrific, but once they actually hooked up again, that shit got painful, fast.

Maybe I'm just sad Amber's gone. The mystery's resolved, it's the same thing it's always been, and we're back again to the the plotline that's been dogging us since the fall. Has House changed for good? Are he and Cuddy going to keep on saying stupid things to each other? And what of Cameron's dead husband's sperm?

Tune in next week. It's the season finale and, apparently, we are all going to be shocked. (Well, they probably won't kill Kutner again.)

Grade: B+

Stray Observations:

  • Yeah, about that "Cameron and her dead husband's sperm" thing… Don't care. (Although apparently she has a short memory: "I didn't plan on my husband dying." Um, yes, you did. You married him after he was diagnosed with a terminal illness. It's not like he got hit by a bus.)
  • Loved how quickly Foreman realized something was up with Wilson in the room.
  • Hugh Laurie is awesome. I may have missed mentioning that this week, so just in case.