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This article is about an episode of the medical drama House. For other uses, see Joy to the World (disambiguation).

House episode
"Joy to the World"
Episode no. HOU-511
Airdate December 9, 2008
Writer(s) Peter Blake
Director(s) David Straiton
Final diagnosis Post-partum Eclampsia (patient is dying)
Episode chronology
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"Let Them Eat Cake" "Painless"

"Joy to the World" is the eleventh episode of the fifth season of House and the ninety-seventh episode overall. It aired on December 9, 2008.



A troubled sixteen-year-old, Natalie, is singing at her school's Christmas program when she suddenly becomes disoriented and vomits. She is brought to Princeton-Plainsboro Teaching Hospital, where the team discovers her liver is failing for an unknown reason. In House's office, they are exchanging Christmas gifts when House receives a mysterious gift wrapped in green wrapping paper. Kutner reads the note aloud, as it says "Greg- made me think of you." The present turns out to be Dr. Joseph Bell's Manual of The Operations of Surgery. House, annoyed, throws it in the trash. Afterwards, House conducts a differential diagnosis, with the team entertaining ideas such as alcohol abuse and pill-popping. None of the symptoms fit with the entire picture. When Chase and Kutner question Natalie's classmates, it turns out that they gave her magic mushrooms, prompting the doctors to think that this whole episode was induced by others. Meanwhile, Foreman and Thirteen are still involved in the Huntington's drug trial. A woman whose disease is quite advanced drops out of the trial, saying that Foreman told her to "get over it" when her medication made her nauseous. Thirteen, annoyed, accuses Foreman of being like House.

The gift House received turned out to be last year's gift from Wilson, which House never opened. Wilson accuses House of needing to create the false illusion of a gift because he just can't be nice to anyone. They end up betting that he can't get thanked by a patient. Later, after Natalie's tox-screen was clean, Taub and Kutner find painkillers in her school locker, which makes them think she tried to kill herself. They later suspect tuberculosis, thinking she may have picked up something from the soup kitchen she normally attends.

To win the bet he made with Wilson, House puts on his lab coat (only the fourth time House is seen doing so, with the other occasions being the episodes "Mob Rules", "Sex Kills" and "Games") and acts very kind and caring toward his patients. A slightly dim woman, Whitney, who comes to the clinic with a terrible headache, compliments House on his hospitality, to which he responds, "If you can't be nice, why be a doctor?" He later deduces she is pregnant, much to her surprise. He then sarcastically insults her for not recognizing the common symptoms of early pregnancy, such as missing her period and putting on weight. She insists that she and her fiance are virgins, and asks for House to run a paternity test after he suggests that she has had an affair. He does run the test, but after sharing the results with them, he looks surprised, and leaves. He comes back later with the same set of results, and with a look of disbelief, states that Whitney is pregnant as a result of Human Parthenogenesis, a never-seen-before scientific phenomenon. Her baby only has maternal genes due to a spontaneous gene mutation which fertilized her egg, without ever needing male sperm. Her baby will be a virgin birth. Later, however, it is revealed that House faked those lab tests and just told them that story to cover up Whitney's blatant infidelity (as shown by the real results of the test), thereby saving their marriage.

Things make a turn for the worse for Natalie, as she has a seizure, ruling out TB but bringing her brain into the differential, along with liver and lungs. Kutner suggests a mold allergy, to which the team goes to test her. Natalie admits to buying alcohol from her friend Simon, whom Kutner and Taub question. Taub suggests alcohol poisoning, but it turns out that she hardly even drank any of the alcohol she bought from Simon, as it was only a way to "look cool" and stay friends with him. She goes into cardiac arrest, ruling out the alcohol theory. But her high blood alcohol level nonetheless suggests leukemia, and Wilson is brought in to help. While Cuddy desperately tries to rule leukemia out, Wilson discusses the likelihood of it and says that she will die, even if they kill all the cancer, due to her failing lungs and liver. A double transplant wouldn't even save her. Cuddy then has an epiphany and gravely realizes the only other disease that explains everything: post-partum Eclampsia, which means that Natalie must have gotten pregnant and had a child. This turns out to be correct, and her friend Simon is the unknowing father. Cuddy finds the baby girl being cared for by a pair of homeless squatters, and brings the baby back to the hospital. Unfortunately, due to the extent of Natalie's failing organs, she will die (although this is not shown in the episode). The baby, while born premature, seems to be healthy.

In the end, the whole team is full of Christmas spirit. Kutner finds a former classmate he used to bully and apologizes to him. Cuddy plans to become a foster parent and adopt the baby, as neither grandparent wants to care for her as she will recall memories too painful for them to handle, with House wishing her "Merry Christmas, Cuddy." (Despite Cuddy actually being Jewish.) Thirteen tells Foreman that he is not like House, after he welcomed back the woman who dropped out of the trial and is taking better care of her. Foreman and Thirteen passionately kiss, ending the episode with a cliffhanger as the season's broadcasting schedule begins its winter break.


The song at the end is "Whisper" by A Fine Frenzy.

Cultural references

Show creator David Shore has stated that the character of Gregory House is based on Sherlock Holmes and several episodes have contained references to him. In this episode Wilson tells a fictitious story regarding the origin of House's mysterious Christmas gift stating it came from a woman named Irene Adler who was a patient that House treated. In fact, Irene Adler was the name of a character from the Sherlock Holmes story "A Scandal in Bohemia" and is known for being one of the few characters to outsmart Holmes. The name Adler was also used as the surname of House's first patient in the series. The character of Sherlock Holmes is, in turn based on Dr. Joseph Bell, the author of the book Manual of The Operations of Surgery, which House received as a gift at the beginning of the episode.

When House confronts Wilson about ratting him out on his deception, he asks "Why don't you spend your time outside video stores, telling everyone (who's) Keyser Söze? By the way, that ending made no sense at all!" This is a reference to The Usual Suspects, a film directed by Bryan Singer, who is also an executive producer on the show.

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