The team had returned to the conference room, having taken multiple samples from Castleton and his brother (though not permitted yet from his mother) and set those tests in motion at the lab. House stood at the whiteboard, and he underlined again congenital vs. acute beside jerk. He then turned around. "So, medically speaking, what can make someone act like a jerk?"

Foreman rolled his eyes. Taub considered the question, and Kutner considered House. Earlier this morning, House hadn't really wanted the interplay and had pushed the ending of the differential, hurrying to his office. Now, he was in classic Socratic mode, clearly with something in mind but wanting the team to arrive at his conclusion for themselves. What had happened between?

"Hormone imbalance," Taub suggested.

House nodded. Good answer but not the one he was thinking of. "Wouldn't hurt to test." He doubted it, though.

"There is an element of congenital jerkness here," Foreman pointed out. "That is, unless the entire family including alleged half siblings has the same hormone imbalance. Some people are just born that way, after all; there doesn't have to be a medical explanation."

House gave him a nod, acknowledging the unspoken thought. "Flattery will get you nowhere. But it is a point. Some are born to jerkhood, some achieve jerkhood, and some have jerkhood thrust upon them. Or option D, multiple of the above."

"Going by what his girlfriend said," Taub put in, "he's been more irritable lately and hasn't paid as much attention to her input." That was, after all, the line that had given House an idea earlier.

"Exactly." House sounded pleased. "Even conceding that he was born a jerk, he's been worse lately. Why would he be more irritable and less responsive to what others say?"

"Stress," Foreman suggested.

"What else?"

Kutner tilted his head suddenly, considering the girlfriend's comment. House looked at him, expectant, waiting. "You do mean something medical, not just psychosomatic?"

"I might," House replied. "Or I could mean both."

"What if -" Kutner was drawing it out, thinking as he went. "Maybe he's slowly developing problems with his hearing. It could be that he isn't ignoring her but just isn't hearing things quite straight unless he's focused on the speaker at the time. That could also lead to irritability, especially if he was in a setting where multiple people were speaking, like socially or even at the company at meetings if they really got a discussion going. He might not even be consciously aware of it yet, might just think they're mumbling, which would make him annoyed and snappy."

"BINGO." House gave him a genuine smile, then turned to write Hearing? on the whiteboard. "Think about it. Foreman said himself he had trouble getting his attention away from the laptop occasionally. Hearing is what I went down there to get a reading on, although their inconvenient status fit and denial got in the way of a full test. But every time, Castleton was slightly behind in reactions to auditory stimuli that took place to the side rather than in front of him. When I walked in, he was the last to look up. When he and his brother were going at it, his brother looked to a new speaker first, and Castleton drew the cue from him and then turned a half second later. When I made a comment to the mother while turned mostly away from him, he was still trying to sort out that question a few seconds later and didn't reply to Cuddy until she'd repeated the point to him. It's nowhere close to deafness, not yet, but I think he is having trouble registering sounds clearly unless he's focused straight on the speaker and working to pay attention. Good call, Kutner."

"He's pretty young for hearing problems," Taub pointed out.

"He's pretty young for renal problems, too," House countered. "Put them together, and you get what? What can cause renal problems and associated hearing problems with initial presentation in the late teens to early 20s?"

All of them saw it together, though it was Foreman who filled in the blank. "Alport syndrome."

"X-linked is by far the most common type, making the mother the carrier," Kutner said. "She could be asymptomatic, 50% chance to her children. If the sons got the bad gene from her, both of them would have the disease, with no extra X chromosome to buffer the abnormal one. No question of maternity, apparently. Autosomal recessive is about 10-15%, and autosomal dominant is rarest of all, just a percent or two. He might be slightly late developing symptoms, but it's well within the variation range."

"Making the question of the parents even more relevant," Taub said. Autosomal recessive syndromes were passed along when each parent has a defective gene, and both contribute it, with the combination of the two bad genes forming the disease. Autosomal dominant syndromes can be passed by only one parent with the defective gene.

"Precisely," House said. "Maybe that idiot mother will see the point now. It would be ironic if she was the carrier for X-linked and gave it to him herself. Of course, if it's autosomal recessive or autosomal dominant with the father the carrier, she had supremely bad luck picking a cheating partner, so it's still her fault."

"We need to check the eyes," Kutner said. "Not as common as kidney and hearing problems, but it can show up. To confirm Alport, genetic testing takes a little while, but we could do a kidney biopsy faster. Electron microscopy would show up the changes in the walls of the blood vessels of the kidney."

"Skin biopsy is much less invasive," Foreman pointed out. "Type IV collagen alpha 5 chain also occurs in the skin."

"Also less diagnostic," House countered. "Yes, it would tell us if it's X-linked, but it won't diagnose autosomal dominant or recessive varieties."

"X-linked is 80-85% of all cases," Foreman insisted. "Makes sense to run the simpler test first."

"80-85% isn't 100%," Kutner protested.

House nodded in approval. "Plus there's the family. If it isn't X-linked, do you want to be the one to go back to them and get consent for a kidney biopsy, telling them that it was the more conclusive test and we just wasted time with a lesser test first?"

Foreman silently conceded that point after a moment. Kutner grinned. "Okay," House said. "We're going back down there. I will do the talking, and I will specifically be testing his hearing subtly, so don't be making silent comments on manners like you were this morning, Foreman. Medicine trumps manners. Assuming that he continues to show that there might be hearing problems, we'll present the possibility of Alport and get permission for hearing testing and a kidney biopsy. By tomorrow, DNA will be back, and we can tackle the question of identifying and testing parents - the real parents, I mean - and definitely the other brother for Alport, too. For their own health, they need to know."

"You're assuming the real father is alive," Foreman said. "The real father, if he's still around, hasn't been involved or acknowledged his kid in any way in 23 years. Maybe he's dead. Or maybe he's in denial, too; he did know of the possibility if he has any contact with the family unless he sucks at math. If he's not dead, he's apparently just ignored his son all his life." House flinched.

"We don't know that, because the mother is lying to us," Kutner replied, shuffling papers to make the others look back at him and give House a moment. "Maybe he's pretending to be a family friend and watching from a short distance. Or maybe he really didn't realize or follow up with her and was absent for that reason."

"On the other hand, maybe he just didn't care or was practicing self preservation," Foreman continued. "Would you want to join that loving family circle if you had a choice?"

House grinned faintly there, recovering himself, and put down the marker. "Speaking of that loving family circle, let's go. And remember, we're at least getting paid to enter this arena of combined congenital and acute jerkhood."

(H/C)

Late that afternoon, House sat in his office, lost in thought. The Castletons didn't improve upon further acquaintance, but the patient had at least consented to formal hearing testing, simply to prove House wrong, because there was nothing wrong with his hearing, and he hadn't been unusually irritable lately. He would get an add-on appointment in Audiology last slot this evening. The kidney biopsy was scheduled for tomorrow. The team was off checking on all of the tests in progress right now, but at the moment, there was nothing more for House to do. He was confident in his diagnosis, even if it would take on into tomorrow to prove it to this stubborn family.

That left him alone to think, and with the patient diagnosed and the medical mystery over, his thoughts returned annoyingly like a homing beacon to Thornton. The world was conspiring against him. Even the differentials seemed determined to keep his thoughts and feelings about his biological father on the front burner.

Foreman and Kutner had summed up the possibilities very accurately. Either the father truly did not know (and he was an idiot if he didn't have some suspicions if he was close enough to the Castleton circle to have seen the pregnancy), or he was watching from a distance as a family friend, probably choosing to leave his son in that supposedly better environment, defined purely in dollars, or he was chickening out, or he just didn't care, or he was dead.

Growing up, House had had no doubt at all which of those categories Thornton fell into. The man had laughed at him, after all, and told him he belonged there. How could anybody think that John's household was a secure, safe one? Thornton, being neither dead, stupid, nor (completely) absent, clearly just hadn't cared.

Only apparently he had been involved behind the scenes, something House had never suspected. He had provided the music. He had apparently cared at least somewhat. But he still didn't have the excuse of being dead. Was he in fact just stupid?

House unlocked his desk drawer, removing the picture of his grandfather, and studied it again. A fun-loving father who played alongside his child, who gave him birthday parties, who brought a horse into the kitchen while the mother agreed that the occasion was more important than floors. That was the example of parents Thornton had had. And coming from there, he had thought that John - and even Blythe - were better as a situation for his son? House still couldn't comprehend it.

He wished he had known his grandfather. Maybe his grandfather would have seen the truth sooner. Then he wouldn't have been trapped back in the family that he grew up in.

His mind ran back into the past, following the parallel tracks of what might have been and the cold steel of what his childhood actually was.

(H/C)

Wilson had had a horrible day. Not only one patient but two crashing now, and probably both wouldn't last out another 24 hours. He had juggled them in turn this afternoon, calling for family, waiting as they came. One set of long distance relatives was here finally, the other coming. Sandra had just stopped by the room with the patient still waiting for relatives and insisted that Wilson take a break and go eat in the cafeteria. She had to leave herself and relieve the nanny, but an aide promised to stay with Mrs. Williamson while Wilson took a 30-minute break. He parted from Sandra in the elevator, going back to his office for something, but did promise to eat and to call her later with an update.

Now, as he headed for his office, he paused as he looked automatically toward House's. The lights were on, and he could clearly see House sitting still at his desk. The man was rarely completely still physically unless he was in an epiphany, usually at least had the ball tossing or the fingers dribbling, but right now, he was motionless, and his expression wasn't that of intense differential. He looked lost in thought, regretful, and almost wistful, a very odd combination. He was holding something, looking at it, though obviously looking on through it, too. It was the catalyst of his thoughts, not the total of them. Unable to resist investigating, Wilson walked over to the office. He tapped once very lightly just to say honestly that he had. House, as predicted, never looked up. He was totally in his own world at the moment, and that world wasn't a medical one.

Wilson entered the office and walked softly across the room. It was a picture, apparently, that House was holding, odd in itself since he disliked looking at pictures, always calling them posed fakes. Was that writing on the back? House's fingers partially obscured it, but it looked almost like figures to Wilson's long-distance squint. Surely he wouldn't have a picture with the phone number of his partner in infidelity from this weekend? Still, Wilson had never seen quite this expression on House before, and he had decades of experience with his friend to draw from. He crept closer stealthily, pushing guilt down with the thought that he wasn't sneaking up behind House, after all. He was sneaking up on a front diagonal, and House could have seen him easily if he'd just looked up. Within a few feet, Wilson made an abrupt grab for the picture and the chance to obtain some data for himself.

House jumped a country mile before the hand ever reached him, nearly falling off his chair, though he did not drop the picture. Rather, he tightened up on it possessively, clutching it to him, giving Wilson no chance to see the subject and blocking even more of the digits on the back than previously. House stared at him, seeming totally disoriented for a moment.

"House?" There was real concern in Wilson's voice now, and the picture retreated from his thoughts. House was breathing quickly. Wilson truly had scared him for a moment. "It's okay. It's just me."

House closed his eyes, then immediately reopened them, taking a deep breath, focusing now. "Easy," Wilson said. "I apologize; I didn't mean to startle you like that." He reached out - gently this time - toward his friend's wrist, trying to check his pulse, and House pulled away.

"Quit it. I'm fine." He took another few deep breaths, and then the anger hit. "Damn it, Wilson! Why the hell were you sneaking up on me like that?"

"I knocked," Wilson protested feebly. "You didn't hear me." He looked at the picture, still turned with the face to House's chest. "You were looking at that. Is that a picture?"

House quickly went into action, unlocking his desk drawer and returning the picture to it, carefully keeping the face away from Wilson. He relocked the desk and pocketed the keys. "It's obviously a picture," Wilson protested.

There was an accusing glint to the blue eyes now. "You tried to grab it away from me. You reached out suddenly. At least . . ." He drifted off, trying to replay his abrupt emergence from thoughts of childhood. That sudden hand had been real, hadn't it? Ripped from memories, he had thought at first it was John, but he was sure the grab had been real.

"I didn't . . . okay, I did reach out for it. I was just curious, that's all. Was that a phone number written on the back?"

"No." House's left fingers were dribbling on the edge of the desk now, his right massaging his leg gently. "Wilson, it seems a little obvious to have to mention this at this point, but if I'm ever totally lost thinking about something and don't know you're there, it's not the greatest idea to make a sudden grab at me."

Wilson looked down at his shoes guiltily. "Sorry. I mean. . ."

"Oh, forget about it. How's your patient from earlier?"

"Dying, probably. Two of them now. I doubt I'll get out of here tonight, not for several hours, anyway."

"Be sure to call Sandra and let her know that's where you are," House suggested.

Wilson immediately got defensive. "Of course I'll call Sandra. You don't have to remind me of that. In fact, she knows what's going on with the patients already. She stopped by on her way home and insisted I go to the cafeteria for a quick break. You want to come? I was just on the way there."

House considered and looked at his watch. "Probably no time tonight; I promised the girls a piano session, so I don't need to be late. We ought to set up a night out sometime, though. Haven't had one in a week and a half. How's everything doing with the kid?"

"He's fine. Growing steadily now." Wilson was puzzled at the shielded urgency behind House asking about Daniel, but he took advantage of the suggestion. "A night out is a great idea. Tomorrow's liable to get tied up with patients, too; hope I don't have to cancel Jensen. What about Thursday?"

"That works. We need to talk."

Now this was more like it. "Yes, we do. Great, Thursday night it is."

Cuddy entered the office at that moment, her stride brisk and business like. House looked up. "Yes, mistress? Your wish is my command."

"Drop the smile, Greg. I'm still annoyed at you." Her tone was harsh, and Wilson flinched. "You can earn some brownie points to work off your deficit, though. I have to make a quick stop on the way home. Since the patient is just testing right now, can you go on and relieve Marina? I hate to ask her to stay late. You can even go ahead and start dinner, but not like you did last night. A real dinner."

"Sure. How many brownie points will apply for that?"

Cuddy kept her face strict. He was not going to make her laugh right now, damn it, because she really was still annoyed at him. "I'll have to decide later. Depends on how you do with dinner." She turned around and stalked out, and both House and Wilson watched her rear end twitch through the door.

"Well," House said, rubbing his leg more firmly preparatory to getting up. "That answers the question about tonight, anyway. You'd better head to the cafeteria to fortify yourself for another death watch, and I'd better get home."

This obviously wasn't the right time to delve into more extensive subjects with both of them on deadlines. "Right. Remember, we're going out for a guy's night on Thursday. Think Cuddy will let you?"

"Oh, sure, I'll be out of the dog house by then. I earn brownie points well when I want to."

Wilson swallowed. "That's . . . good. Well, I'd better go eat. Sandra will ask later to make sure I did, and there's an aide who's patient sitting at the moment." He left the office, his mind still whirling. House would be out of the dog house by Thursday? Cuddy was still mad at him, but things like starting dinner would apply to working off his deficit?

The oncologist was still concerned about his friend, but part of him deep down couldn't help feeling resentment. It just wasn't fair.