"I'm going to ask a series of questions that I want the two of you to answer as honestly and completely as possible," Cyrus began. "And in your answers I would like you to include two things; one, how you personally feel about the situation and two, what need is met or not met that results in said feeling. There's a school of thought that feelings are the direct results of needs being met or going unmet and I think we have quite a bit of that going on between you both. And remember the line from that old favorite song Lean On Me… no one can fill those of your needs that you don't let show. None of us are mind readers. Sometimes you have to be willing to take a risk and clearly state what you need."
"So, one at a time and no interrupting each other, I'll ask you each to answer a question and to include your feelings and the needs behind them. Here's a list of the many different feelings and needs as an example to help you get started," he said, handing each man a sheet of paper which both quickly scanned. "When you've answered, the other one will reflect back what you've said. Not add any interpretation, opinions, or judgements. Just let each other know that you've heard them.
"Alright, first I want you both to think back to the beginning years of your friendship together. What feelings come up when you remember those times? House, you first."
"Umm… happy," House said right off, then consulted the list, knowing that Cyrus wanted more than a single word answer. "Friendly, appreciative, impish alive," he smirked at that on the list, and umm…. Intrigued."
Cyrus smiled and nodded. "And what needs were met by your friendship?
House flipped the page and scanned down the list. Saying his feelings, he'd been somewhat prepared to do but to admit the need behind them was a terrifying prospect. He scanned the columns of words with dread, but if this was what it took to repair his friendship, he'd do it. He'd done harder things that hadn't worked. Like deep brain stimulation.
"Umm… predictability, trust and reliability. Nourishment," he added with self-conscious shrug, "acceptance, affection, generosity, presence, and companionship."
Cyrus turned and nodded to Wilson, who blew out his breath and nodded back.
"Alright, um, in our early friendship you felt happy and friendly, um… impishly alive and intrigued," Wilson answered though he was certain he'd missed something but couldn't remember what it was for the life of him. "And it filled the need you had for predictability, nourishment," he smirked, "and um… acceptance, companionship, trust, and affection."
"Dr. Wilson, same question."
"Oh, umm… well, happy, friendly, trusting, mischievous, fascinated, compassionate," he said, looking down the list of feelings. "And sometimes exasperated and perplexed too."
"And what needs were met by your friendship?"
"Predictability, protection from harm, humor, exuberance, mattering and importance, being seen, friendship, and spontaneity."
Cyrus nodded for House to reflect back what he had heard. He looked very ill at ease but took a breath and nodded.
"In our first years as friends, you felt happy and friendly, trusting, mischievous, fascinated and… compassionate," he added with a frown. "And exasperated and perplexed. Needs met; protection, humor, mattering, being seen, and spontaneity."
Cyrus let them both think about what the other had said for a moment. It wasn't important to remember everything. They'd concentrate too hard on perfect recall and ignore the point, which was to understand feelings and the needs behind them.
"Good," Cyrus nodded, pleased to see both men calmed down from their anxiety and hostility levels, though both were clearly uncomfortable discussing their feelings and needs. That surprised him more with Wilson than with House.
"Next question. What is your favorite hobby? Feelings and needs. House."
"Music," he answered at once and Wilson nodded in full agreement there. "Both piano and guitar, but piano wins in a contest."
"Feelings about music or what I feel while playing it?" he asked.
"While playing it."
"Umm…" he said, again consulting the list, "engrossed, relaxed, composed, sometimes invigorated, or aroused. Needs met, let's see, umm… comfort, rejuvenation, creativity, passion, authenticity."
Wilson was ready with the reflection with no need of prompting. "You feel engrossed and relaxed and sometimes invigorated or aroused when playing music. And it fills your need for comfort, rejuvenation, creativity and passion."
"I uh, I don't really have any hobbies."
"Alright, then something you do a lot when you're not doing work."
"Okay, um… I still don't know what to say. I work late and take work home most nights and -"
"Cooking," House prompted. "You like to cook."
"True, not a hobby really but, yeah, I do like to cook. Could I use that to answer the question?" he asked, looking at Cyrus.
"Okay, then cooking. Cooking lets me feel calm, satisfied, creative, umm… it's more what it helps me out of than what it makes me feel really."
"What does it help you out of then?"
"Um… grouchy, dejected, helpless."
"So what needs are filled for you by cooking?"
"Consistency," he answered, also flipping the page as House had done. "Food, nourishment of course, simplicity, calm, nurturing, and creativity."
House too was ready with reflection. Clearly their hobbies weren't a bone of contention between them. "When you're cooking, you feel calm, satisfied and creative and it helps you not feel grouchy or helpless. It fills your need for simplicity, nurturing, calm and creativity."
"Now think about your jobs. Dr. Wilson, you start this time."
"Okay, um… when I'm doing my job, I feel... absorbed, sensitive, compassionate, nurtured/nurturing, touched, inspired, enriched, concerned, helpful. And I also feel frustrated, troubled, weary, overwhelmed, anguished, despondent, disheartened, and irritably edgy. Needs met… I would say kindness, compassion, understanding, gratitude, mourning and celebration. But when patients die, these other feelings appear and then needs for compassion, sensitivity and recognition go unmet."
Cyrus nodded and gave that statement a moment of silence to recognize the depth and gravity of it then looked at House, pleased to see he had been intently listening to Wilson. This had been an issue between them he knew, the different ways that each approached and thought about his job.
"With your job you feel sensitive, compassionate and nurturing. You feel touched and inspired and enriched. Helpful. And you feel frustrated, overwhelmed, anguished and disheartened too," House added quietly, having watched Wilson rage over the injustice and indiscrimination of cancer over the years. "Your job fills your need for compassion, understanding, gratitude, mourning and celebration. But can also leave you in need of compassion and recognition."
"House, your turn," he said after a long, pregnant pause.
"When I'm doing my job," House began, nodding at and purposely mimicking Wilson's phrasing, "I feel… Well, I guess there's two parts to this for me. When I have a diagnostic's case, I feel intense, inquisitive, fascinated, intrigued, excited, confident. I feel alive. Not impishly alive, just… alive. And when things take a turn for the worse, I feel frustrated, perplexed, boggled, and weary. And when I don't have a diagnostics patient, I feel indifferent, bored, reluctant, and grouchy."
"Needs met… challenge, mastery and skill, passion, collaboration, power and respect. Unmet… valuing, recognition, achievement, autonomy."
Wilson had refrained from rolling his eyes at House separating his job into two parts, even if it was true. It just seemed like splitting hairs to him, but then he supposed the two parts to his job were so radically different it might just seem that way to him.
"Okay, in diagnostics you feel inquisitive, fascinated, intrigued, confident and alive," he added with a concerned look. "And when you don't have a case you feel bored, indifferent and grouchy. It meets your need for challenge, mastery, power, collaboration and respect. But it can fail to meet your needs for value, recognition and autonomy."
"Are we allowed to ask each other questions about this?" Wilson asked Cyrus.
"You are but I will stop any question that becomes an attack or is meant to cause harm or shame, from either of you."
Wilson nodded and carefully considered how to word his questions.
"Would you be willing to explain more detail about your feelings and needs?" Wilson asked. If House wasn't willing, there was no point expending energy thinking about wording.
"I'm here aren't I?" House said gruffly.
"That's not an answer and straying close to the line," Cyrus interjected. "It's a fair question. If you're not ready to discuss them today, simply say so. Revealing them is good enough for the first session."
House gave Cyrus the side eye for correcting him but he took a deep breath and looked at Wilson. "Choose one of the questions. Not all of them. If you do that, then yes, I'll explain in more detail."
"Alright. And you can do the same for me with the same agreement," Wilson responded and House nodded.
"You said your unmet needs with your job were value, recognition and autonomy. I'm confused by that. Your department and you yourself are renowned, sought after for treatment, for conferences, for journal articles. And Cuddy gives you more of a free hand than any other department head. So I don't understand."
"The unmet needs mostly come with clinic duty," House answered, relieved that Wilson had chosen this topic. "When I'm compelled by her and my contract to do clinic duty. Certainly not autonomy, because if it was up to me, I'd never work in the clinic again. And as for recognition and value… we're a teaching hospital. We've got plenty of brand new baby doctors who need to cut their teeth on treating patients to work the clinic. It's perfect work for them. It would build their confidence with easy diagnoses and treatments, with an occasionally challenging one to grow by. And by doing that, we would be recognizing their achievement and growing skill and by giving them more challenging cases, showing that we valued them."
"But when Cuddy sends me to the clinic to work, it isn't that at all. It's punishment. KP duty, to prove to me and everyone else that she's in charge. She says it'll make me a better doctor. And in that I don't feel valued or recognized. You don't use a thoroughbred to plow a field if you have a barn full of draft horses."
"Hm. I get it now. That's the first time you've ever really explained it instead of just complaining that it was so boring a monkey could do it."
"Well a monkey with a medical degree," House smirked.
"Why haven't you ever explained it to her like that?"
"She doesn't care."
"She cares about you," Wilson admonished, "or she wouldn't fight the board so hard to keep you here."
"See but that's gotten all mashed together with the donations and grant money diagnostics brings to the hospital, and to her professional reputation. So it's hard to know whether she cares about me or the money and prestige she can get with me here. I think part of her does care just about me. But maybe not a big enough part to make a difference. I don't know. And I don't think I'm ready to find out for sure."
Wilson had to agree with that point. "You know, if you'd agree to doing guest lectures, she'd let you out of clinic duty entirely."
"I don't want to be a teacher, I want to treat patients."
"But you are a teacher, to your team. And I've heard the rare lectures you've done. Students and long graduated doctors are riveted. Wouldn't that fill a need to be valued? Recognized?"
"Not with a big lecture hall of med students. I do like to teach but I like to teach the ones who have the capacity to grasp the bigger picture, the out of the box concepts. Most of those kids in that hall that day won't remember what I tried to teach them."
Even Wilson had to admit that was probably true. There might have been one or two it made a difference for but most of them had been baffled and frustrated even as they had been riveted wanting to hear the ending. But what about those one or two whose lives and careers could have been transformed by studying under House? Something to ponder.
"Okay, what would you like me to explain?" Wilson asked.
House decided to stick to the same topic for now. "You said that when patients die… when your patients die… you feel the need for sensitivity and recognition." He hesitated seeing Wilson tense up at the chosen topic. Maybe he should have just asked about cooking. Still, it was out there now.
"Yes, that's what I need," Wilson answered tightly.
""When my patients die I feel like I've failed them. Like I didn't search in the right place, try hard enough, push hard enough. Like the answer was there staring me in the face and I was too blind to see it. What do you feel when patients die?"
Wilson sat back, shocked by the unsolicited admission. Me, well I, I feel like I've failed them too. Should I have pushed harder for the more aggressive treatment or to get them into a clinical trial. And sometimes I feel guilty for having done that, when they suffered so much and for longer only to wind up dying just the same. I give a lot of myself to my patients. You know that, you've taken me to task for it enough over the years. So when they die, it's like losing a friend. I know doctors are supposed to remain detached, not get emotionally involved. But how do you do that when you see them for years? How do you not learn their favorite color or soda? What they like to watch on TV? How do you not feel it when they lose their battle and wonder if there was anything you might have done to change the outcome?"
"So you need sensitivity and recognition which you don't feel like you get. From just me or from everyone?"
"Not just from you, although it stings more from you," Wilson sighed. "Especially when you quote statistics or make jokes about it."
"What would have to happen for you to feel like that need was met?" House asked, curious to know Wilson's answer and wondering the same thing for his own until now unacknowledged needs.
"Oh, well, um… not making jokes or quoting statistics would be a good place to start. Maybe a moment of silence for a life lost? A toast over a shot of bourbon? Some awareness of the emotional cost to me, in this job, in seeing them through to their last breath, would be great. Doing something to soothe the edges of that pain, even better."
House thought of the chocolate he'd delivered to Parks when she lost her patient. He used to do that for Wilson. When had he stopped? He couldn't remember and that gave him the unsettling feeling that it had happened as his drug addiction grew out of control.
Silence settled over the room, each man lost in thought, and Cyrus let it linger for a few minutes, then cleared his throat to gain their attention.
"I'd like to point out to you both that while you bring entirely different angles to your friendship, your hobbies, and your jobs, you have some feelings and needs in common. You both agree that during your early friendship you felt happy and friendly and that said friendship met the need for predictability for both of you," Cyrus began. "When it came to hobbies, both of you chose one that met your need for creativity. And when it comes to your jobs, you share feelings of frustration and weariness when things go wrong, and you both feel an unmet need for recognition."
"Here's what I'd like for you each to think about for discussion next week. Think about your friendship now as compared to when it started. Pick out at least one feeling and need that it still fills and then any that it does not fill. Feelings first, then needs, just as we did today. And think about what it would take to have that need met. You've gotten a good start on this. Anything you'd like to ask me or each other before time is up?"
Both shook their heads, spent from the effort of being honest about their feelings with the other.
"Alright. Until next week, gentlemen."
They both stood and walked into the hallway where House stopped uncertainly.
"Yes?" he asked as he shrugged into his jacket.
"Um... I just wanted you to know that your pancakes are way better than the chef I hired makes."
"Are they? Is that you angling for me to make you some?" Wilson smirked.
"Would you? Please?" he added.
Wilson shook his head, recognizing the gesture and request as House-speak for offering an olive branch.
"I'll bring some on Monday morning. Good night, House."
"Good night, Wilson," he answered, turning and heading back toward his office as Wilson headed for home. They both had a lot to think about.