Quality TV makes a 'House' call

A service industry I recently worked in had a saying. "Cheap. Fast. Reliable. Choose any two." Expect to compromise.

I am so accustomed to compromises in the deadline-and-budget driven medium of television, that I have had to redefine good drama as either good acting and directing, or a good script idea that is muddled through as best as possible. In that sausage factory of television production, survival of a show is determined by (a) consistent production within budget, and (b) achievement of respectable, and preferably growing, ratings. Quality is often an added bonus (and sometimes, it seems, an accidental by-product).

A show that has both a great script and great acting is so rare, even (perhaps especially) in productions with Hollywood-size budgets, that when it does occur I am sufficiently gob-smacked to want to give it some credit. Such is my feeling about Fox's House, MD, a rare example in American television.

The show is a recreation of Arthur Conan Doyle's mythical detective Sherlock Holmes. Doyle was a doctor himself, and reputedly based the character of Holmes on a diagnostician. House, the exasperating diagnostician, brings the creation full circle. House brings the trademark detective work, precocious intelligence, and dogmatic logic of his famous predecessor Holmes. Even Holmes' drug habits (House is addicted to Vicodin, although this seems to cause him more trouble than Holmes' mild cocaine habit ever did), his ethics (it is fine to lie to police and housebreak to solve the case) and his coldness towards people, but passion for solving a case, are all inspired by Mr Holmes. There its similarity ends. House, ahem, is not a gentleman.

It would take an exceptional actor to be worthy of such pedigree. Exceptional is one word for James Hugh Calum Laurie. Laurie was born to play Dr House. His audition for the role was so flawless that on seeing Laurie's audition tape, Bryan Singer (one of the producers and directors, more on him later) declared how relieved he was to finally find an American perfect for the role - but Laurie is very English. In fact, it is hard to imagine an American playing this role. I can't imagine anyone but an Englishman bringing that unique blend of overbearing arrogance, superiority and self-loathing required to enable House's rapid-fire insults and antics, to be delivered with both ease and intelligence.

We can speculate why Laurie is such a good fit. Maybe Laurie brings an empathy born of his own medical history - his father was a doctor, and he himself has suffered debilitating mononucleosis and clinical depression. Maybe it is his theatrical pedigree, or his imposing physicality (he was a champion rower at Cambridge), or maybe his other precocious talents, notably music and writing, which in many cases mimic House's own. Speculate all we like, the bottom line is Laurie is brilliant. He is so good that one wonders why he has never hit his stride outside the UK before. His previous roles included various upper-class British fops and a few Hollywood movies, such as an unfortunate casting as an emasculated father to an anthropomorphised mouse. I suspect these roles hardly did Laurie justice.

Even more impressive is the amount of work involved, which for Laurie must be considerable. He carries the hour each week.  "Grinding" is an adjective often heard during on-set interviews with more candid actors. That Laurie delivers a physically disabled, drug-addled, cranky, sociopath genius - in (for Laurie) a foreign accent - with near perfect comedic timing - is an achievement.

In an interview before the third season, Laurie expressed his willingness to trust his role to the script, wherever it leads.  House is really a one man show. That Laurie would put the largest role of his career in the hands of the show’s writers is, in this case, understandable  - the script is excellent, and is the second element of the show's success. The five other regular characters, although often endearing and usually entertaining, are simply foils for House. These characters also serve to create a (sometimes improbable) environment where House gets away with behaving as he does. I suspect a real doctor would be fired, committed, arrested, or possibly all three.

The most interesting of the five supporting characters is his only friend and professional equal, Wilson (Robert Sean Leonard). Wilson loves House dearly, which, luckily for House, assures his tenure, as Wilson is also on the board of the hospital. Wilson is the vehicle to deliver trenchant "truthiness" (thanks Stephen Colbert) to House about his various personality disorders. House's direct boss, Cuddy (Lisa Edelstein) is hinted to be House's ex-lover or at least a previous sex partner. This history allows House some easy familiarity, and sometimes blatant disdain, for the hospital hierarchy. The regular cast is rounded off with House's team of three "cottages" (little Houses). These characters act as sounding boards for the medico-babble, the same role Dr Watson serves in the Holmes stories. Only one of the “cottages”, Foreman (impressively played by Omar Epps, previously of ER) has the technical nous and confidence to challenge him. His troubled past, as well as his race, is mercilessly manipulated by House, causing Foreman to hold House in some professional disdain. All supporting characters, to various degrees, are aware of the fame by association with the unconventional House, and the opportunities that working in his team brings to their careers, which makes their tolerance of House's antics (barely) believable. However, the major factor that lets House get away with what he does is that he saves lives where others can't.

All five foils are, with the possible exception of Foreman, obsequious, milquetoast characters, who buckle to the abrasive power of House. To ensure House has a really meaty rival, a nemesis must be brought in from outside the regular cast, in the form of guest stars in multi-episode arcs (or, in some cases, an especially difficult patient).  For example, in the first series we see Vogler (the physically imposing Chi McBride), a wealthy pharmaceutical executive who basically buys the hospital and House with it.,  and season three has Tritter (David Morse), a detective on a mission to get House as a drug addict.  Both serve as straight-men authority figures to House's clown. House dispenses with Vogler with political aplomb while Tritter is somewhat more of a pain in the backside for House.

House uses and abuses his cheering crowd of five supporters, often at great risk to them, to dig himself out of these holes.  How can a character be so despicable yet so irresistible? The answer, as outlined above: Hugh Laurie's talent.

Such a happy coincidence of acting and script, I suspect, is no accident. Some credit has to go to (creator) David Shore's clarity of (Holmes-inspired) vision. Bryan Singer, a producer and director of the pilot and third episode, has some experience with getting exception performances from fine actors (think Kevin Spacey in The Usual Suspects and the Ian McKellan/Patrick Stewart rivalry in the first two X-Men movies).

So how does one write a House script? A typical episode follows a formula as strictly as a Zen monk's Morning Prayer.

Stage One: The Cold Open. Before our opening credits we need our introduction to the Affliction-of-the-Week. Familiar to most TV viewers, a cold open is used with impunity in cop shows such as Law and Order. Like cross hairs on a gun going from person to person, we can never quite be sure who going to turn into the diseased wreck that allows House to go postal.

Stage Two: The Referral. House is usually at his tantrum-throwing best here. He demands and schemes his way into taking a case he finds interesting, or, Cuddy tricks and bullies him into taking one that he (initially) doesn't.

Stage Three: The Differential Diagnosis.. House grandstands before his whiteboard goading his team into suggesting possible diagnoses ranging from the mundane to the bizarre.  We can never be sure if House secretly knows the answer and likes to test his team as a sort of deranged training exercise, or if he is desperately seeking a solution himself. Either way, he manages to insult each of his doctors with his unique style of divide-and-conquer provocation.

Stage Four: The MRI. Not being a doctor, I can't say whether it's realistic for all patients to invariably be swallowed into this oppressive looking technology. It has considerable horror effect (maybe it's just done to justify an expensive-looking set).

Stage Five: Detective Work. This can be made up of:

1. Sparring between House and nemesis-of-the-week (Cuddy or patient to stand in if in between nemesis arcs).
2. Cuddy self righteously revoking House's patient due to his unconventional methods and shameless behaviour.
3. A touching Wilson-House exchange in which Wilson berates House for being a House (will Wilson ever learn?).
4. An illegal break in of the patient's house or place of work, and the subsequent detective work to find pathogens.
5. A patient has a catastrophic failure, usually while in dramatic mid-sentence, or, even better, while deep in the MRI. This requires sudden violent convulsions, foaming of mouth, beeping of equipment, resuscitation by crash-cart, cries of "Ohmygod, the kidneys are failing", and spontaneous afflictions requiring makeup work that would put Star Trek to shame.
6. Some ridiculous time deadline due to imminent death unless tests can be completed and/or a cause found.
7. A confrontation with a rotten lying liar (namely, the patient, or the patient's parents if patient is unconscious or underage).
8. A (gasp!) misdiagnosis, usually blamed on the lying liar and/or a “cottage” and/or a meddling Cuddy.
9. Much incredulity that House actually wants to interact with a patient and/or shows some unexpected humanity.

Stage Six: Sexual Tension. Choose between Chase-Cameron, House-Cuddy, House-Cameron, House-Patient, Wilson-hospital employee or patient, or any other combination of the above. Foreman doesn't get to play.

Stage Seven: The Resolution. The episode must end with the patient either recovered or dead. Death is no obstacle to achieving the all-important Final Diagnosis.

Optional: some resolution or advancement to some relationship dynamic (required during nemesis arcs).

Add zeitgeist and pop culture references and quasi-familiar medico-babble. Repeat seventy five times (and counting). Result: House.

Perhaps aware of the risk of repetition, the formula is being increasingly varied. This weakening of The Formula has caused existential angst - for me anyway - like there is something fundamentally wrong with the (House) universe. The supporting characters are weaker. Foreman is given a House-like position at another hospital. He becomes a caricature, losing the gravitas he needed to resist House's immature posturing. He tries to treat his team with the respect he was never shown by House (a little prematurely in hindsight), and, ironically, is sacked for being too House.

So, is House going downhill? I suspect (and hope) not. Foreman has been re-hired. Some of the new "cottage" applicants have great potential. Henry 'Bosley' Dobson (played with characteristic gravitas by Carmen Argenziano), a fraud non-Doctor who wins House's respect, is predictably fired due to the risk of upstaging God. Being admired by House is traditionally the kiss of death.  Another character, "Cutthroat Bitch" (her official name, aka Amber, played by Anne Dudek) is similarly feted to leave, according to The Hollywood Reporter. The producers appear to have decided to go with “cottage” clones played by Kal Penn, Olivia Wilde (the bisexual Alex Kelly from the OC) and Peter Jacobson for ongoing roles. I guess nothing beats sticking to formula.