Revisiting The ‘House’ Bus Crash That Shocked Viewers

The penultimate episode of House’s fourth season sees the death wish-chasing doctor unravel the shocking mystery of his own head injury.
House Bus Crash Episode

This essay is part of our series Episodes, a monthly column in which TV Critic Valerie Ettenhofer digs into the singular chapters of television that make the medium great. This time she’s looking at the unforgettable bus crash in the House, M.D. episode “House’s Head.”

When it comes to medical procedurals, nothing on network television delivers fast-paced thrills quite like House, M.D. This isn’t to say that House was always better than the other medical shows that dominated network television in the aughts. Rather, it was simply more intense than most of its contemporaries by design. The eight-season Fox series started with a basic question: what if a Sherlock Holmes type solved medical mysteries rather than crimes? From there, it snowballed into a quick, clever, and often surprisingly edgy series that saw misanthropic, Vicodin-fueled Dr. House (Hugh Laurie) frequently bringing patients to the brink of death and back again in order to figure out what ailed them.

By season three, House had hit its stride, and instead of leaning into what it was already doing well, the series’ writers decided to tinker with its formula. The fourth season shook up the show’s supporting cast, introducing a number of potential hirees including doctors Thirteen (Olivia Wilde), Kutner (Kal Penn), Taub (Peter Jacobson), and Amber (Anne Dudek). Then it capped off the experimental season with a shocking spectacle of a finale, a two-parter that left one of its newbies dead and audiences blindsided. Talk to most fans of House about the show’s high point, and you’ll likely get the same answer: the bus crash episode.

“House’s Head” begins with Dr. House drunk in a strip club. This is normal enough, except that he doesn’t know how he got there. “Say five words,” he demands of the woman giving him a lap dance, and when she does, he can’t remember them. The clues pile up quickly: he has no keys, but he gave the woman money. He’s bleeding from the head, too. It’s only after the dazed doctor stumbles outside that he sees what’s happened: an overturned bus sits in a heap on the road, billowing smoke and surrounded by emergency vehicles. Thus begins the coolest, most creatively explored mystery of the series.

Back at Princeton Plainsboro Teaching Hospital, House is convinced he has a life to save. Despite his obvious head injury, he remembers that he saw someone exhibit a dangerous symptom before the crash. He sends his underlings to figure out where he went, but this is the same guy who’s constantly giving people treatments that could kill them based on a hunch: he’s not patient enough to wait around for someone else to recover his memories. So House does hypnotherapy.

After falsely diagnosing the bus crash victims with meningitis to ensure they’d stick around the hospital for questioning, House sits down with Dr. Chase (Jesse Spencer) to access his prefrontal cortex through medical hypnosis. The series has always had an unrealistic streak, but in “House’s Head,” it leans into its more over-the-top elements than the show ever had before, with marvelous results.

In this case, Chase transports House into his murky memories from the night before. First, he’s in an empty bus with a strange, ghostly light pattern constantly shifting overhead. Then, he’s in a bar, but his brain fills in the gaps he can’t remember: he’s drinking Beer brand beer, and the people playing pool have eerie featureless faces.

Episode director Greg Yaitanes won an Emmy for this hour, and it’s easy to see why: even with over a decade of retrospect, there’s a boundariless yet structured visual imagination to House’s memory retrieval scenes that’s extremely entertaining. House picks up a few wrong answers from the bar scene and also tries to ignore that his best friend Wilson’s (Robert Sean Leonard) girlfriend Amber appears like an intrusive thought. But when hypnosis doesn’t give House the answer he’s looking for, he’s onto the next option: shoving his face into a pile of passengers’ clothes in an attempt to activate a smell-triggered memory.

The series typically operates at a pretty brisk clip, but as House pops an inadvisable amount of pills and grows increasingly desperate to get to the bottom of his missing memory, the episode begins to truck along at a breakneck pace. In his mind, the bus driver tells House he could have a brain bleed, while in reality, Wilson accuses him of having feelings for Amber. Fast forward to 2 am: House’s ear is bleeding, and he’s been diagnosed with a skull fracture, yet he’s forcing Thirteen to put him into a sensory deprivation tank to wring out some more memories from the steel trap of his broken brain. It’s madness or genius, but either way, it’s wildly fun to watch.

House may not hold tons of cultural cachet these days, but in retrospect, it’s obvious that the mad doctor’s methods inspired plenty of stubborn TV intellectuals who have come after him. The beloved BBC series Sherlock co-opted some of this episode’s visual creativity from the start, showing the detective’s mind palace as a physical presence just as House literalized his clues here. Meanwhile, The Knick’s death wish-chasing John Thackery (Clive Owen) is as grandiose and dangerous as House and just as willing to risk killing himself for the sake of solving a medical problem that bugs him.

As “House’s Head” wears on, it’s clear that death is the direction the doctor’s headed in. In the tank, he envisions his boss, Cuddy (Lisa Edelstein), stripping while the pair work through the unsolvable problem again: which passenger could be his unidentified patient, and what’s wrong with them? She eventually quits dancing (“You’d rather be diagnosing”), and when he comes to in the tank, it’s just long enough to spout a confident and incorrect Parkinson’s diagnosis before throwing up and passing out. Classic House! He also can’t stop seeing a mysterious woman (Ivana Miličević) who seems to want to tell him something.

Eventually, the relentless, adrenaline-fueled logic puzzle comes to a shocking halt. After throwing out and quickly disproving several other theories (including one that required Thirteen to stab someone in the heart with a needle), House brings his coworkers onto a bus to reenact the night before in an identical space. There, they realize it’s not actually Vicodin he’d been popping all day, but an Altzheimers drug that, as Wilson puts it, speeds up the brain but also overpowers the heart.

Wilson’s by House’s side when he collapses on the ground, slipping into unconsciousness as he finally sees the truth: it was his friend’s girlfriend, Amber, who was on the bus with him when it crashed. He realizes only after the mysterious woman who’d been appearing in his hallucinations asks him (while holding her amber gemstone), “What’s my necklace made of?” The reveal hits like a jolt. Moreso, it hits like an actual hit, as a brilliantly framed shot shows a changeover from Miličević to Dudek just as a garbage truck slams into the point of the bus directly behind Amber’s seat. The impact sends her hair flying in every direction as headlights frame her in an almost angelic way.

After seeing the night replayed in surreal tidbits throughout the episode, to finally see it unfold in real-time, with blood and broken glass and the grotesque screech of impact and aftermath, is genuinely harrowing. The fun and games are over now: this is what House’s brain was hiding from him all along. The scene goes on and on, and it’s brutal. When the dust settles, Amber’s missing a chunk of her forehead and has a pole through her leg. The pair reach out for one another, like an adrenaline-shaking play on The Creation of Adam, but they’re pulled apart by paramedics before they can touch.

The episode ends on a cliffhanger, with House recovering from what turned out to be a cardiac arrest just in time to tell Wilson that his girlfriend is dying. The show would go on to deliver a beautifully acted, emotional conclusion the next week, with “Wilson’s Heart.” It would also go on to deliver plenty of great episodes – and some bad ones – across its next four seasons. Yet “House’s Head” stands at the precipice of both the show’s own history and TV history as a whole.

According to the LA Times, the episode was originally planned as a post-Super Bowl release, which explains its near-endless intensity and impressive showmanship. It was rescheduled due to the 2008 writers’ strike, which stands as a major dividing line in television history. On one side, linear TV like House dominated the medium, and on the other, the brave new world of streaming – or what WGA negotiating parties called “new media” – loomed. Another sign of the times? Hugh Laurie earned an Emmy nomination for “House’s Head” but lost to an actor delivering a performance on what would come to be known as prestige cable: Breaking Bad star Bryan Cranston. House was, it seems, part of the end of an era of bold, must-see network TV.

“House’s Head” may be event television that already feels a little bit lost to the sands of time, but the creative, relentless, shocking prime-time mystery is a wild ride that’s well worth revisiting.

Valerie Ettenhofer: Valerie Ettenhofer is a Los Angeles-based freelance writer, TV-lover, and mac and cheese enthusiast. As a Senior Contributor at Film School Rejects, she covers television through regular reviews and her recurring column, Episodes. She is also a voting member of the Critics Choice Association's television and documentary branches. Twitter: @aandeandval (She/her)