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It’s hard for Chase to not feel like he’s a waste of space, of time, of resources. Everyone else is smart— Cameron and Foreman always have great ideas, they always almost get the answer right before House snatches it out of their hands. But he doesn’t have anything most of the time.
He craves to be of value, to be respected. For House to smile at him and tell him, hey, you did a good job. He knows it’s a stupid fantasy that won’t ever become reality, but the imaginary approval coming from his boss is more important than material reality from time to time.
“Anything worthwhile to add to the DDX, doctor Chase?”
And House rubs it in his face, too. Reminds him of how he shouldn’t be there. House hasn’t shared the details with him, but he can see his father paying him to let him have the fellowship under House. That oh, he won’t get a job elsewhere with those grades of his, you should let him in. He won’t be a bother.
But he is a bother. All he wants is to be of value. He tries to be smart, he tries to outsmart House, but it doesn’t work out. Once, he does get it right— he gets it right before House does. But House knows what he says is never of value, so he punches him, makes him fall to the floor as he clutches his jaw and explains his diagnosis through tears.
House nearly acknowledges it— he nearly says good job, you’re right. There’s that small second where House almost admits his value in the team. But he doesn’t.
The patient gets better, and they all move on with their lives. Maybe Chase gets the diagnosis right, but that doesn’t mean approval with House.