House wakes up and finds himself in an abandoned warehouse, lying next to a man. As House crawls over, Kutner appears and explains that he’s House’s subconscious and the man is dead. House points out that Kutner is dead from a self-inflicted gunshot wound, and Kutner warns him that the fire burning through the warehouse isn’t dead. He tells House to get moving, but House doesn’t see the point since he’s hallucinating. Kutner asks how he met the dead man.
The man, Oliver, has come into the clinic to see House and complain about his orbital fracture, which he received in a car accident. He admits that he’s been taking pain medicine, and House asks him to take off his shirt so he can check his chest in case it was injured in the crash. However, it’s a ruse to let House see that Oliver has cigarette burns on his collarbone. He explains that Oliver is taking heavy-duty painkillers and drops off while smoking, burning himself. Oliver starts to leave, figuring House will turn him in, but House notices that he has abdominal swelling showing oxygen in his intestines and takes an interest.
When House brings the case to the team, they’re surprised that he’s actually talking to a patient. Taub points out that Wilson is dying and House is due to go back in prison, and wonders why he’s in such a good mood. House avoids answering the question, refusing to discuss his personal life.
House tells Kutner that he didn’t care about the medicine aspect of the case, but Kutner points out that he didn’t answer his staff’s questions. He figures that House had a plan to get out of violating his parole, but figures that House knew from the start that whatever he had planned wouldn’t work.
House meets with Foreman and asks him to tell the parole board that he needs House on staff so that he can save eight patients. Foreman is reluctant to perjure himself and House says that he’ll pay the price eventually. However, he doesn’t want Wilson to suffer for the last five months of his life and asks Foreman to be a friend. Foreman agrees but warns House that he’ll have to take all the cases that he gives him.
Kutner appears in the lobby in the flashback, and says that House asked Foreman to be a friend because he knew he’d need one when his plan inevitably failed. Back in the warehouse, Kutner wonders why House isn’t leaving the burning warehouse and points out that House’s subconscious is manifesting as a suicidal friend.
Wilson is meeting with his replacement, Dr. Frankel, when Foreman comes in and asks if he’s seen House. Wilson doesn’t care until Foreman warns him that no one has seen House in two days, and they figure that he’s doing something stupid... if they’re lucky.
Kutner asks House why he wants to die and House points out that he’s lost his job and his friend and he’s going to jail. Kutner doesn’t believe that’s all there is to House, and figures that House is killing himself because he doesn’t find life interesting anymore and it bores him. Amber appears, replacing Kutner, and asks him about Oliver. He wonders why she cares and “Amber” points out that since she’s only House’s subconscious, the question is why he cares. She asks what happened next with Oliver.
Oliver has a seizure and the staff thinks that he has a clot in his lungs. However, House gives the patient an injection and he immediately seizes, going berserk. As the others try to hold him down, Hose tells them that he gave Oliver naloxone to counter the heroin that has been suppressing his breathing. Oliver screams that he won’t stop taking drugs because he thinks that reality sucks.
Amber appears in the room next to House and tells him that as his subconscious, she knows that Oliver didn’t say that at the time. House then prepares to talk to Oliver, and Amber points out that House must have had a particular reason because he never talks to patients.
Oliver finds House waiting for him to wake up, and the doctor points out that Oliver was a stockbroker with a family. The patient tells him that a friend gave him heroin after he was in a ski accident and pain killers weren’t enough. He’s miserable despite his job and his family, and the reason he’s not miserable now is because he takes heroin to make the pain and unhappiness disappears. House reminds him that he lost everything because of his drugs, but Oliver insists that everything wasn’t enough because his reality sucked.
Amber wonders why House decided to take Oliver as a role model, pointing out that the man is dead. She then asks House why he wanted to hear what Oliver had to say.
As House stays with Oliver, Foreman comes in to warn him that he’s breaking their deal by handing off the cases to other doctors. House doesn’t worry about it, saying that Foreman will do the honest thing for the patients by lying to keep him out of jail. Disgusted, Foreman refuses to life for him and walks away.
House explains that Oliver had found happiness, but Amber points out that the man is dead. She figures that puzzles are everything to House.
When Oliver wakes up, House realizes that he has a twitch in his thenar eminence, indicating the present of Lou Gehrig’s. He tells Oliver that at least it will be quick for him, and is suddenly at the door saying that Oliver is asymmetrical.
Amber wonders why things suddenly shifted and say that House tried to avoid remembering what they talked about between the two scenes. House refuses to discuss it with her.
House determines that the veins on Oliver’s right side are enlarged, meaning that there’s a blockage. Using an ultrasound, he confirms that Oliver swallowed a small branch that fell off a tree while he was nodding off in the park. Because heroin addicts have a suppressed cough reflex, he didn’t choke it out and it eventually caused an auto-immune reaction. Once they removed the branch, Oliver was fine.
House smiles at the thought of solving the puzzle, and Amber points it out to him. he doesn’t think that solving the puzzle matters to much when everyone h’s ever saved will be dead in 70 years anyway. Amber points out that he wants life to be interesting and give him puzzles to solve, and he became a doctor because there’s always illnesses to solve. When House realizes that his subconscious is telling him that as long as he has puzzles he doesn’t need anything else, Amber tells him to go home. However, when he walks to the second-story exit door, he discovers that the fire has cut off his escape.
Foreman and Wilson go to Foreman’s apartment and discover that he hasn’t been there for two days and his suitcases are still there. Wilson wonders if they should have handled things differently but Foreman insists that they did the right thing. House’s cell phone rings and they discover that it’s his hooker, complaining that he never showed for their session two nights. They check House’s list of outgoing calls and discover that he called one person they know on four separate occasions.
As House looks for another way out, the floor collapses beneath him, dropping him into the first floor where he’s surrounded by flames.
Wilson and Foreman go to see the person House called: his former therapist, Dr. Nolan. They interrupt group therapy and tell him that they need to know what House about, insisting he’s a danger to himself. Nolan is reluctant to breach doctor-patient confidentiality but his silence speaks volumes and they work out that House has turned to heroin, and then head back to the hospital to check Oliver’s records.
Stacy Warner, House’s ex-girlfriend, appears to House and asks why he tried to leave but then stopped. She asks him if he’s sure he doesn’t believe in God, and House insists that he can’t live his life in something he doesn’t believe in. Stacy points out that he’s willing to kill himself for something he doesn’t believe in, and says that she knows from their time together that he believe sin love.
House meets Wilson in the cafeteria and asks him to lie for him, pointing out that no jury will convict a dying cancer patient of perjury. He asks Wilson to claim that House gave him the tickets and for Wilson to claim that he was disgusted at the act of pity and threw them down the toilet. Wilson doesn’t want to ruin his reputation but House begs him, saying that he doesn’t want to lose the time that he has left with Wilson. Wilson starts to agree but then refuses, saying that House is counting on him to bail him out, the same as always. He tells House that he needs to learn how to take responsibility for his own actions when Wilson is gone, and that he can only count on himself.
Stacy agrees with Wilson and tells House that he has to develop a conscience. House doesn’t believe it, but Stacy says that he’ll be better off without Wilson. She stands up and helps House up... and he finds himself in the house that he would have had with Stacy if they had stayed together. Stacy shows House the child they would have had, but House says that it’s a reason for him to die because he can never have that kind of love. Stacy says that if he had it once then he can have it again. Dominika appears, seated with House in his fantasy. He refuses to accept it as too easy, but isn’t any more satisfied with a group of cheerleaders. House dismisses it all as fantasies and ignores Stacy when she says that he can still save himself.
Back in reality, House simply lies on the ground, waiting for the fire to take him. Cameron appears and sits down, saying she doesn’t want to convince him to live. House takes it as a sign of her hatred for him, but Cameron says that she loves him and thinks that he’s suffered enough. Just as House accepted that Wilson wanted to let himself die rather than live with pain, it’s time for House to give himself the same gift.
Foreman and Wilson go to the address Oliver gave to the hospital, but find an empty warehouse lot. However, they smell slot and see the burning paint warehouse a block away.
Cameron tells House to give up, telling him that he could have avoided dying in the fire but he messed it up like so many other chances. She points out that he’s self-destructive and arrogant, and House finally remembers what he talked to Oliver about.
House tells Oliver that he’ll die fast, and then Oliver offers to take the blame for the ticket prank. He tells House that he can say that he was pissed at House, stole his tickets, and stuffed them down the toilets. House thanks him and starts to leave, but then points out that Oliver is doing it because he’s dying... which means the world is a better place because Oliver is dead. He then wonders if he should tell Oliver what’s really wrong with him, because then he’ll live and the world won’t be a better place. Cameron appears in the room and figures that House cared more about the puzzle than himself. She tell him that he’s stalling so he can take the coward’s way out, and that he won’t even admit it to himself.
House admits that Cameron is right and that he’s a coward, but he believes that he can change. He stands up and walks toward the door. Just as he gets to the door, Wilson and Foreman arrive and see him... and the building comes down on top of their friend.
The next morning, the rest of the team arrive and watch as the fireman go through the wreckage. They remove House’s body and take it to the morgue, and Wilson and Foreman wait until the coroner confirms from the dental records that it actually is House.
A few days later, everyone gathers for House’s funeral service. His mother Blythe speaks of her son, Stacy and Dominika speak of how they loved House, and the staff old and new speak of how House did so much for them. Finally Wilson gets up and starts to talk about House the friend and the healer. However, he finally decides to be honest and tells everyone that House was a bitter jerk who insulted everyone. As he gets on a roll, a cell phone rings and Wilson realizes that it’s his own. He checks and discovers that he has a text message: “Shut up you idiot.”
After the funeral, Wilson drives to his apartment and finds House waiting for him. House explains that he got out the back and switched the dental records at the morgue. Wilson points out that he’s destroyed his life and there’s no going back for him now, but House tells him that he’s dead as far as the world is concerned. He then asks Wilson what he wants the two of them to do together for the last five months of his life, and Wilson smiles.
Chase becomes the Chief of Diagnostic Medicine at Princeton-Plainsboro, inheriting House’s old office, and meets with Park and Adams.
Taub becomes a father to both his daughters and meets with his wife Rachel and mistress Ruby.
Cameron works as the head of the emergency ward and then leaves with her husband and baby.
Foreman sits in his office, bored. After a minute he finds House’s ID badge lying on the floor and smiles.
House and Wilson get on motorcycles and prepare to ride across the country. When Wilson starts to talk about what to do if the cancer gets too bad for him, House tells him that cancer is boring and they ride off... together.