This episode moves back towards the traditional format of focusing on the medical mystery to a degree that we haven’t seen this season. It’s a bit of an exhale for the season, as “Instant Karma” concentrates on traditional “House” issues: namely, rationality versus superstition.

Spoilers after the jump.

Plot Summary:

Mr. Randall, a big-shot billionaire owner of an oil company, brings his ailing son to House’s Foreman’s team after a doctor tells him all possible diagnoses have been exhausted. And it is Foreman’s team, but Randall demands that House make the calls. Foreman grudgingly goes along with the charade, perhaps because he and Chase have been called to do a morbidity and mortality conference on Dibala’s death and what went wrong. Soon, Foreman discovers that the blood sample Chase stole has a different cholesterol level than Dibala’s sample, which would reveal the “mistake” to all the doctors at the conference.

House tells the team to start from the beginning in the diagnosis, so Cameron performs a physical and finds that there is a fecal mass on the left side of his body. The team starts treating for Hirschprung’s Disease, but when Jack has a seizure, they move on. After going through more options, like brain cancer, House finally concludes that it’s the incurable Degos disease. He tells the father, who has a typical reaction—bankrupting his company to balance out his karma so that his son can live. His board protests, and House says he’s being irrational but “is not insane,” so the directors have no way to stop him.

While all this is happening, Thirteen decides to leave the country for Thailand but finds on her way to the airport that someone has canceled her ticket reservation. The blame game goes around, much like it did a few seasons ago when someone canceled Foreman’s job interview with a hospital, and the same person is the culprit: House. But at least one good result comes of it. As Wilson tries to tell House that he’s not the jerk he thinks he is, he says that he was born with a heart three sizes too small. He has one of those moments, and he realizes that the kid has Primary Phospholipid Syndrome. House also figures out what Chase and Foreman have been hiding, and he helps them by finding that Dibala was taking medication that raised his cholesterol, giving Chase and Foreman and alibi. The episode ends with Thirteen leaving on a plane for Thailand.

Character Development:

Chase: Begins to be haunted by his decisions when treating Dibala—specifically, murder. Every time he passes Dibala’s old room, he’s reminded of the man’s last moments, blood gushing from his mouth, knowing he’s the only one responsible for the dictator’s death. Chase doesn’t open up to Cameron, so their relationship hits a bit of a snag.

Thirteen: Leaves for Thailand. Foreman realizes he made a mistake in firing his girlfriend, but she spurns his attempts at reconciliation. Despite House’s attempts to keep her in the states, she’s set on leaving (the show?). Hypothesis: Thirteen comes back to the show and either A) she brings back a case, or B) she is the case.

House: Back to the old House we all know and love. He berates the billionaire for believing in karma, saying that “the medicine worked”—as opposed to the dad’s implication that what worked was giving away billions of dollars.

Medical Mystery:

Very standard like previous episodes. Two diagnoses that fit are present, but it isn’t until House jokes his (own) heart is three sizes too small that he realizes it’s primary antiphospholipid syndrome.