On the surface, House, M.D. looks like a procedural. But unlike, say, The Wire, the show eschews the banality of actual every-day process, just as Sherlock Holmes stories are less a realistic narrative about police work than the fantasy of a world that where it wouldn’t be necessary. You already knew the show was not about real hospital procedure, of course; House’s ability to do as he pleases is implausible on so many different levels that it’s the primary disbelief we have to suspend to makes sense of the show. One might even suggest that this implausible fantasy is one of the guilty pleasures which makes the show what it is: the fantasy of freedom from rules (which House so often tropes on, especially with regard to Cuddy as “Mommy”).
This disbelief in process has narrative consequences, however. The teaser in the opening, for example, is always a vignette that leads up to a predetermined conclusion: one of the myriad of new faces will, by the end, “present” with a dire symptom of some sort, which eventually prompt the intervention of the show’s cast, but which will — more immediately — lead into the show’s credits. Since you know this is what is happening, and the show knows you know, they play games with your expectations as they go through the motions. Is it the little boy? Or his teacher? Or perhaps the Fed-Ex employee entering from left field? These characters will be introduced and placed in motion, but the “story” being told is as irrelevant as the national anthem before a football game, a necessary ritual that needs to be dispensed with. Or, rather, it’s the “mystery story” paradigm in miniature: can you guess the ending before it ends? And nothing else matters.
Every commercial break is more or less like this; since the logic of the show cannot allow causation to be obvious, it’s a given that the patient “seizing” or needing to be “intubated” will come out of absolutely nowhere, both immanent to the show’s narrative economy — since it has to happen — and, because unpredictable, completely unintelligible within the terms the show has set up to explain it. Moreover, because this crisis moment is (apparently) causeless, it is just as apparent that nothing can be done about it: like House’s assistants, we can only gape helpless at the awesome power of the human body to die spontaneously. It is therefore the commercial breaks which resolve the crisis of the moment, providing a temporary (but necessary) relief both to the patient and to the viewer. And when the show returns, the patient has always been stabilized in the mean time, transforming a problem of crisis into a problem which can be addressed at leisure.
What has been cut out, then, is process, bureaucratic procedure. In the teaser, after a soon-to-be-patient has collapsed — often in a public space because drama is a function of spectacle — something has had to happen to transport that patient from the crisis-space of the public to the private and controlled environment of Princeton Planesborough hospital. That thing, it is worth noting, is a function of bureaucracy: for an ambulance to arrive on the scene, there have to be rules, procedures, and a standardized system of behavior dictating how EMT people respond to a situation they do not understand in order to stabilize it. In other words, all the things that House hates about bureaucracy, the ways that rules and regulations and procedures cannot think but must simply respond according to a sharply constricted logical order, are precisely the things that an EMT’s job necessitates. After all, it is in the nature of the job that an EMT cannot understand what is wrong with their patient: this is what defines them as such.
On the other hand, not only does House live in a world in which only causation matters, but so does House, MD. House can callously ignore short-term symptoms (while in search of their cause) because, well, he can. Other people are there to pick up his trash, and while he might not do anything to keep the patient alive long enough to be cured, he can be sure that someone else will. Occasionally, he (and the show) recognize this, as in the current Cameron-as-replacement-Cuddy storyline: without the right kind of oppressive mommy figure, the bad boy doctor can’t do his job properly. And without the offstage angels of medical infrastructure — ambulance drivers and such — to make everything possible, House could not exist. But while he silently requires (and could not exist without) both a vast network of technicians and process-followers and an administration to create the conditions for his existence, think about how carefully the show works to hide them from our view. Sweeping the EMT’s under the rug of the first commercial break is only the beginning. How many nurses has the show ever bothered to name? How many other doctors in the hospital have ever been given identities? Not only is House himself uncomfortable with their presence, but the show’s narrative engine effectively works to silence them, creating the illusion of a hospital staffed by one doctor, three assistants, two colleagues, all emerging ex nihilo in a puff of narrative necessity.
The important point, then, is simply this: since narrative necessity requires untraceable chains of causation to be transformed into clear causation (somewhere inside the black-box of House’s mind), the show is terrible at thinking about why irrational rules actually need to exist. We need rote “in case of emergency” rules and procedures as a way of stabilizing crises in order that they can be properly comprehended. It is in the nature of a crisis that it is unstable, untraceable, and incomprehensible. House would be helpless in a real crisis (as he frequently is); in a situation where one’s choices are both unpredictable — when one lacks the necessary information, but still must choose — his master prognostication would be useless. So the show never puts him in that situation.
This is why it always feels like a dodge when the show wants to make the problem of House into a categorical imperative dilemma; what if all doctors were like Gregory House, it likes to ask, flouting the rules at will? But that’s simply not the right question. The actual alternative to House, M.D. is the world we actually live in, a world where there are one set of agencies and procedures for dealing with time-sensitive crises and another for taking the time to assess situations that are stable enough to do so. This is, if I may, why the show’s 24 tendency is its least intelligent one; its “ticking time bomb” scenarios might be much more interesting than Jack Bauer pablum, but it — like 24 — falls (or leaps) into the fallacy of presuming a crisis situation to negate the necessity of procedure. But crisis is precisely when procedure is most necessary; it’s when you don’t have enough information to make a good decision that you have to be prevented from making a bad one. Thus, while 24 simply invents the fiction of efficacious torture (solving the problem of insufficient information by producing information from nowhere), House has a different fictional solution: positing the non-existence of support staff and administrators, we are allowed to overlook House’s reliance on them.