Previously on Grey's Anatomy:
Surgical training protocol is officially changing, people.
Thought you'd defend your boyfriend to me and I'd take it?
He's not my boyfriend.
- Hi. - Hi.
You and Derek will not work.
Why do you care what I think?
If I'm gonna do this with him, I need you to cheer me on.
As surgeons, we are trained to fix what's broken.
I'm in a hurry. I can't stay.
Chief's having a big meeting,
but I wanted to tell you that I'm finished with therapy.
The breaking point is our starting line at work.
Meredith, you are not finished.
You have worked incredibly hard. Look how far you've come.
- You're scratching the surface. - Derek's moved in
and we've taken it to the next level.
It's not about Derek.
- I'm happy. - You're not done.
I am happy. Isn't that the point?
- No. - But in our lives,
the breaking point is a sign of weakness.
- I need you to stay. I know. - The meeting, the Chief.
Thank you, Dr. Wyatt.
Thanks for everything.
And we'll do everything we can to avoid it.
Whoa!
- Sorry. - What are you doing in here?
Thinking about making this my office when you move out.
When I move out? When am I moving out?
Oh. Soon?
You know Meredith was planning on making us move out?
- I'm busy here. - Join us if you want.
No!
When were you planning on telling us we had to move?
When did you plan to tell them they had to move?
- Why do they have to move? - I made this for you.
It's a zoo, a frathouse. Alex and his parade of women.
- His parade of skanks. - Am I apartment hunting?
I don't know. I have to think about it.
Just eat the muffin, Mer. Taste the muffin.
Remember the muffin.
- I like my roommates. - I like them too.
That was your life. This is our life,
and I'm excited about building our life together.
Come on. It's gonna be great.
So Derek wants Alex and Izzie to move out.
Since when does he say "jump" and you jump?
- Well, I'm happy. - They'll be pissed off.
But do whatever you want.
Hey, you hear anything about what the new rules are?
Last I heard you were at hand-holding, foot rubs,
and lots of late-night gab sessions.
- Excuse me? - Listen up, everyone.
You're talking about the Chief's new rules.
- Thought it was you and Torres. - Listen up!
I've been wrong before.
We're busy people, I'm gonna try and be brief.
I am implementing a new teaching protocol here at Seattle Grace.
Some of these rules are new,
and some are old and are going to be newly enforced.
Jack O'Brien, 47.
Scheduled for an abdominal aortic aneurysm repair.
Last CT showed calcification. So I ordered a CT angio
to determine if it had worsened or remained stable.
Nice catch, Yang. You can take him down after rounds.
Dr. Karev will take over. Dr. Yang, you're done here. Thank you.
First, second and third-year residents
will no longer be allowed to de facto specialize.
The practice interferes with the development
of a fully-rounded surgical education. No more.
Barry Patmore, 63.
Has been experiencing chronic headaches for the past seven years.
Has been treated with narcotics, anti-seizure medications,
antidepressants, and anti-psychotic medications with no success.
How severe is the pain, Mr. Patmore,
- scale of one to ten? - Eight. It's always an eight.
Which is why Mr. Patmore's last consult suggested a bilateral cingulotomy.
A frontal lobotomy for a headache?
Too loud. Please.
And could you do something about the buzzing?
Do we need all these machines?
Mr. Patmore has been experiencing pain every day
- for seven years. - A cingulotomy could cause
seizures, cognitive defects or behavioral changes.
Which is why we are going to explore every possible option
before resorting to such a radical surgery.
- More tests? - Yes.
Dr. Yang, you'll be assisting Dr. Shepherd today.
Personal relationships, personal loyalties
and personal favorites will no longer be a factor
in our training program.
Attendings, you will spread your wealth of knowledge equally
among all of the residents.
In addition, we'll refocus our attention
on patient communication and bedside manner. For some of us,
this means learning the lost art of humanity and compassion.
For others, this means learning how to treat patients
without becoming emotionally involved with them.
Shelley Boden, 30, stage four colon cancer with liver mets.
Shelley has been through extensive chemo and radiation.
According to the CT, a liver resection could be curative.
Will be curative. Will.
Do you have any other questions for us?
What happens if you find more cancer than you expect?
No, Jen. A, that's not gonna happen.
B, Izzie's already answered all of your questions three times.
- Izzie's not the main surgeon. - Izzie's awesome. We love Izzie.
This is Dr. Grey. She'll prep you for surgery
and answer any questions you have.
- Izzie's not staying? - This is a surgical program.
Psychiatry is on the fifth floor.
Let's not confuse the two.
In addition, residents,
your interns reflect on you.
If they fail, you fail.
If they succeed, you succeed.
Attendings, that goes for residents as well.
Teach with enthusiasm.
Learn with enthusiasm.
We are surgeons.
We cut out malignancies.
Let's start at home.
O'Malley? This is Dr. Bennett Epstein.
He'll be your proctor for the exam today.
- You're about ready, O'Malley? - Yes, sir.
You have three hours from the moment you open the test.
Once you break this seal, you may not leave the room
until you have completed the entire exam.
- Good luck, O'Malley. - Thank you, sir.
I can do this.
I'm not married and cheating on my wife with my best friend.
Everything's just as it should be.
Oh!
Damn chair. Hang on.
Looks like the wheel's broken.
That's how things work around me.
My toaster broke last month.
Then my cat ran away and my back porch collapsed.
Also, my TV only shows the color green.
I'll get another chair.
Don't bother. I'll walk. Probably safer.
No. Mr. O'Brien, you need to stay in the chair.
- It's hospital policy. - I had three car accidents...
Mr. O'Brien.
Somebody get me a gurney over here!
- Sir, I am very sorry. - I hit my head.
I am very, very sorry.
Get him a CT. I want hourly updates on his condition.
- Yes, sir. - You're gonna be OK.
Mike, my ceiling's raining here.
Looks like a pipe burst. Gotta turn off the water...
No. This is a surgical floor.
Water's required to scrub and clean equipment
to keep people alive.
- Fix this with the water on. - I can try.
Keep me posted.
Chief, there is some kind of leak in the conference room.
- You don't say. - I was wondering
if there was anywhere else I could take the exam.
I will find a different room on my own.
Thank you, sir.
We have a problem.
Mark Sloan has found us out.
Mark's known from the beginning. I told him.
He's Mark Sloan.
You don't have a person you talk to about things?
You are the person I talk to about things.
I like to keep my private life private
from everyone, but most definitely from Mark...
Sloan.
- How long'll the operation be? - At least a couple of hours.
Think it could be longer?
If there are complications or the mets are more extensive.
They won't be, Jen.
Please, stop. Call Mom and Dad, tell them two hours.
Since I got cancer, my sister's only capable of talking about cancer,
which is so much worse than the cancer.
So I know I don't know you, but spill.
- Spill what? - Anything.
I'm begging you, before she comes back
and asks you to describe my liver cell by cell.
Please.
OK. Um... Do you want to hear about my
stupid boss or stupid boyfriend?
Oh! Boyfriend! Definitely the boyfriend.
Mr. Patmore, I'm gonna give you a variety of different stimuli
so we can take a look at the wave patterns generated.
I need you to remove your hand from your eyes now.
OK. Are we still at an eight?
- It's still at eight. - OK.
Starting visual stimuli.
If you were me you'd want them out.
The roommates.
- I'm not being unreasonable. - Pulse is coming down.
But you have to admit, you'd want them out.
If you were me, you would want them out.
If we have to operate,
I'll let you drill the burr holes by yourself.
Fine. I'd want them out. Whatever.
I knew it. OK, Mr. Patmore.
OK, we're gonna change your position.
- I think I have an idea... - No, don't think. Know.
Run to the lab for his test results.
But Izzie bakes and Alex fixes things.
OK, when I am no longer Cancer Girl
and I can go out and meet a hot doctor who rocks my world
and wants to move in with me,
I might forego the baked goods and repair work.
Ooh. Heads up. Twelve o'clock.
Just so you know, Cristina thinks you should move them out. Talk to her.
Dude, you failed to mention the hair.
Yeah, yeah, the hair.
It's one of the many things that makes me happy.
Dr. Sloan, I'm working with Shepherd today on a pain patient,
and I read this article while I helping George study...
Pathetic.
Yes. I know, I'm pathetic.
I did read this article. I do have a photographic memory.
Chief's on his new thing with the interns to be heard...
- Use fewer words, Grey. - I think he needs an ENT.
You're an ENT, right?
How are you doing in there, Mr. O'Brien?
Could be worse. Could have brain leaking from my ears.
That's the spirit. It'll only take a couple more minutes. Hang on.
Guess what I found. An apartment.
A beautiful apartment.
With hardwood floors and an honest-to-God fireplace
that you can build honest-to-God fires in...
and I can't afford it by myself.
So... I thought if you could get over yourself
we could live together.
No, thanks.
I mention the hardwood floors, the honest-to-God fireplace?
I'd rather live in my honest-to-God car.
Right.
How's he doing? Think we're looking at a lawsuit?
No, we don't have a picture yet, but... no.
This guy doesn't seem like the lawsuit type.
Let's hope you're right.
Hello?
I cannot apologize enough.
Treat him like a king. Hear that, Mr. O'Brien?
Dr. Karev is going to take great care of you.
You are our number one priority today.
- Are you OK? - God hates me.
- Mr. O'Brien... - My wife left me.
My accountant stole from me.
The store I worked at burned down.
I was diagnosed with an aneurysm for which I'd require surgery
in a hospital that seems to be crumbling around me.
God hates me.
You can see the remaining tumors easily identified here.
Her liver looks so healthy.
That's the beauty of general surgery.
See badness surrounded by goodness.
Cut out the badness, all's right with the world.
It's just you and your scalpel,
one on one, mano a mano.
OK, this is me teaching with enthusiasm.
Oh...
Oh, no.
- O'Malley. - What?
Um... if you're finished with your test...
Look, the hospital's flooding. The CT's on the fritz,
my post-op and pre-op patients are backed up for days,
I gotta get a handle on this thing
before the patients find out and our ranking drops way past 12.
I found a nice, quiet room in Psych for you to take your exam.
Oh, I see. Um...
No, you go ahead.
Chief!
I am your intern at least for one more day.
I can help.
- Dr. Shepherd, a word. - Excuse me. Yes?
You mind if I run a quick test on your patient?
He's in a lot of pain. I don't think he needs a tummy tuck.
That's funny. No, Dr. Grey came to me with an interesting idea.
Unlike you, I'm taking the Chief's new teaching protocol seriously
so I listened.
I read a thing about swelling
and compression of the ethmoid nerve.
I believe if we were to stick a cottle elevator up his nose...
I'm sorry, up his nose?
If Dr. Grey is on the right track,
the patient'll let us know.
OK.
Mr. Patmore, I'm Dr. Sloan,
head of plastic surgery and an ear, nose and throat specialist.
I'd like to run a test with your permission.
I've seen 16 ENT's. Not one could help me.
Now breathe normally.
I'm gonna angle this into here.
Let me know when you feel any... pain or anything.
That's it. That's the pain!
That's what's causing the pain.
Oh, my God! Oh, my God.
Anterior ethmoid neurovascular complex.
A simple middle turbinectomy will fix it.
Unless you still want to chop out the front of his brain.
Nicely done.
Hi.
How'd it go?
Hi, Shelley.
We found that the mets were much more extensive than the CT detected,
and the main tumor actually extended in and around
the major blood vessel behind the liver.
We're gonna start a new round of chemo, that's all.
I already have a call in to your oncologist.
That's him. I'll be right back.
We can manage your pain.
I'm sorry we don't have better news.
So did you decide what to do about your roommates?
I'm so sorry, Shelley.
Come on.
So how good is the hot boyfriend in bed?
Look, we don't even know what we are yet.
So how does Mark Sloan know?
Why are you talking to him instead of me?
Ladies.
Am I interrupting?
- Your timing is perfect. - Really?
Were you about to feel her up?
- Stop. You have to stop. - I can't.
- Seriously, she hates it. - That's why I can't.
- Don't... You want a spanking? I... - OK?
You told Derek you think I should kick them out?
No. No, I...
I told him I would want them out. Me, not you.
I only said it because he wouldn't stop talking.
You don't think I should? I think I'm going to. It's the adult thing to do.
- What does your shrink say? - I quit my shrink.
- I'm happy. We're happy. - Can I sit here?
George... George, how did it go?
There's a water problem. I'm just trying to help the Chief.
Now the medical facts are falling out of my ear.
Eat this, it's brain food.
My dude with the aneurysm?
Fell in the water, smacked his head, got stuck in the CT.
My patient's dying. I hate it when I like them and they're dying.
Our guy's been in pain at a eight the last seven years
because of an inflamed nerve in his nose.
I wish I had an inflamed nerve.
There is no way that guy's been living at an eight. He's a wimp.
His eight? My three. I can take pain.
You can't talk to my boyfriend for ten minutes.
There's pain and then there's torture. I can take pain. Test me.
- Nothing. - Impressive.
Shut up! You barely touched her.
- Ow! - Ow! No! No!
- Knock it off! Stop it! - How did you diagnose that nerve?
Because I've never heard of that condition.
I remembered an article from the British journal of ENT.
It was issue 47, page 19, from 1964.
- A photographic memory. - Dude. Lexipedia.
- Oh, I hate you. - Don't hate me. I can help you.
Chief, what's going on with the flood?
It's not a flood, Bailey. It's a pipe that...
It's minor, OK? Not to worry.
Aren't you headed to surgery?
Yes, sir.
Chief, a few months ago
little Tuck flushed one of his action figures down the toilet.
I thought it was no big deal. Minor.
But then I came home to a kitchen
filled with several inches of poop water.
- Poop water? - In my kitchen, sir.
Thank you, Dr. Bailey, but I have this under control.
Yes, sir.
Poop water.
Hey. Hey. So apparently there's some kind of leak.
Chief wants me to move the pre-op patients to the clinic.
Who's free to help me...? Ow!
- What the hell? - Not a high pain threshold?
You know what? Throw him out. Not me, just him.
- She likes me more. - I bake for everyone and I clean.
The only thing you bring to the house is filth.
What would you prefer, chocolate cake or an STD?
Water!
- Get out, get out. - Where is this coming from?
- Get the Chief. - Let's keep going.
Post-ops to rooms 2415.
Pre-ops to rooms 2233, 4 and 5.
- Overflow goes into the clinic. - OK.
Chief!
I got everything under control up here.
I need you to oversee Stevens with the pre-ops in the clinic.
Sir, maybe we need to shut down.
Just send the patients to Mercy West, Seattle Pres.
They can repair the pipe. We'll be up and running in no time.
I am sending our patients to dry ground.
I closed all but two ORs.
Maintenance has isolated the broken pipe, so thank you, Dr. Bailey.
When I say I've got it under control that's what I mean.
Sir, they may have isolated it, but a lot of water got out.
- I'm just saying... - Dr. Bailey, clinic now!
Yes, sir. On my way.
Slow down!
OK, what next?
Wait. Are you sure you have time for this?
I want you to get to take your test.
- Thank you. - Grey.
Despite your unfortunate taste in men,
turns out you're not entirely useless.
Mr. Patmore's condition is extremely rare...
and you nailed it.
You can scrub in.
Now? You're doing the surgery now, with the flood?
Flood's contained. Our man's been in pain for seven years.
See you in surgery.
I can't. I'm sorry. Um...
But I'm really busy helping the Chief... the Chief's intern.
I... Thank you, but maybe next time?
No, Lassie, there won't be a next time.
Pathetic.
Mr. Patmore, I'm gonna draw some blood
and place a topical decongestant before I take you to surgery.
Absolutely, of course.
How's your pain level now?
Eight.
It's always at eight.
Oh. It looked like you had some relief.
I've spent seven years.
I've seen 39 doctors.
I've tried every kind of painkiller and nothing helps.
I've had doctors tell me it's my imagination...
that I'm crazy.
Called me a drug addict.
My wife died last year.
After spending years carting me around to doctor after doctor,
test after test, she died.
She was my best friend.
She was my favorite person in the...
And she died.
But I couldn't feel it.
I couldn't feel that pain
because I was so completely occupied with this one.
Now I finally know what's wrong and Dr. Sloan is gonna fix it
so you're right, you're right, that I'm feeling some relief.
OK, let's get your blood drawn.
I'm not gonna do it. I'm not gonna have surgery.
It's just gonna hurt.
She's gonna slice me in half and probably kill me.
If she doesn't kill me, it'll just hurt like hell.
Probably get infected and hurt worse. I'm not gonna do it.
I get that you're scared, but if you want to live you need the surgery.
If I want to live? Have you been paying any attention?
My girlfriend had a hysterical pregnancy and went nuts,
cut her wrists while I was in the next room, had to be committed.
Now my roommate's planning to make me move.
I have no money for a deposit.
Chances are next week I'm homeless.
You're making stuff up to make me feel better?
You must have something to live for.
Or even just the possibility of something.
This girl at the grocery store.
I keep meaning to say hello.
Instead I... just keep asking her about the produce.
All right. So you get the surgery.
'Cause chances are your luck's gonna turn around.
It's science. It's the law of averages.
It's gonna turn around.
And when it does, you say hello.
I say hello.
Chips?
Chocolate?
Thanks.
- What? - You're not a terrible person.
- OK. - I know we don't see eye to eye, but...
I found this really great apartment.
It's across the street from the hospital, has great light.
I know you can afford it and it's Burke-free.
It must be kind of awful living in his old place.
Think about it.
You can open that retractor up more if you want to get a better look.
Just make sure you keep the small bowel inside.
I want to avoid a post-op ileus.
We better. He thinks there's a dark cloud following him around.
That sounds overly dramatic.
What's that?
- What's...? - What the hell?
Hey, hey. Hey, move! Move!
- Move the patient! - What?
Move the patient!
Oh, my God!
Is everyone OK? How's our patient?
- Vitals holding stable. - Irrigation, please.
- How can I help? - Find Chief, tell him what happened.
God, we need a new OR.
Shut down the other ORs except for this one and Dr. Sloan's.
Karev, go to Sloan. He just got started, maybe he can close.
I need everybody's help. Get ready to move Mr. O'Brien.
- What do I tell Sloan? - Tell him the damn sky is falling!
Nasal speculum and lidocaine.
Larger speculum, another lidocaine.
- You're just watching? - I'm a pain specialist
and I would've missed this thing. So yes, I'm gonna watch.
Don't ever use me again to try and influence her.
You and I are not Team Meredith.
We need the OR.
We need the OR!
On a patient?
- Yes, sir. - Collapsed?
Your staff wasn't hurt, but the patient's abdomen was open.
He's stable, as far as I know.
Dr. Bailey, spread the word.
We are closing the surgical floor
and shipping patients to Mercy West
- and Seattle Presbyterian. - Yes, sir.
And Dr. Bailey...
- Try not to gloat on the way out. - No gloating, sir.
Anybody see any more damage? Any bleeding?
No bleeding. I cleared the lower left quadrant.
Give me the pulse irrigator.
Dr. Hahn, take a look at this right here.
The pancreas. Is that damage from the debris?
No, no.
That's a tumor.
Oh, son of a bitch.
You're the shrink, right?
- Yeah. - Well, you can't let her quit.
Let me guess. Cristina.
She talks? Whatever.
Um, you can't let her quit because I'm no longer
allowed an opinion. I'm being supportive.
So you're my last hope.
It's your job to have an opinion, right?
You're paid to have an opinion?
- That's right. - OK. So, um...
She lives her life on an eight.
Her pain. On any given day, she lives at an eight,
and he doesn't get that.
I mean, he moves in and expects her to move her roommates out?
Which goes to show you how completely he doesn't get her
because she needs them.
So you need to tell her not to move them out.
It's not gonna work out in the long run.
She thinks that she's happy, she's not.
It is your job to tell her.
It must be incredibly painful for you,
the idea of losing Meredith to Derek.
You're a terrible shrink.
- Just talk to the oncologist. - No.
There's a clinical trial using chemo plus Avastin,
- and there's... - You're not a doctor.
Please stop talking like you're a doctor.
Hello?
- Did you have me paged? - Yes, because I'm dying
and you can't let me die without knowing what you decided.
No, they found mets underneath her liver.
You look very serious.
Oh, my God, are you gonna break up with him?
No fair!
I'm dying and you're casting all that hotness in the wind.
No fair.
It's no fair.
I...
I'm alive.
Dr. Hahn's gonna come in and talk to you in a couple of minutes.
How'd it go?
- OK? - Actually, not so OK.
The flood weakened the ceiling in the OR.
The ceiling collapsed and several fragments landed inside your incision.
'Cause of the ceiling thing we had to explore your abdomen
more thoroughly than we normally would have.
As a result we found a malignant tumor on your pancreas.
Cancer?
You found cancer?
Whoa, wait. Listen. Listen, man, 'cause here's the thing.
We took it out, sent it to pathology.
- It was only stage one. - Only stage one.
We never find pancreatic tumors so early.
They're almost always a death sentence by the time they're diagnosed.
But not for you.
We took the tumor, the whole thing. We took it out.
You won't even need chemo.
That ceiling collapse, it saved your life.
Your luck has turned, man.
It's turned.
I'm gonna go say hello...
to that girl.
I'm gonna say hello.
Chief.
Chief? I've downloaded all our patients' labs and radiology onto DVDs
and attached them to their charts.
Is there anything else I can do to help?
How'd it go?
I know. I'm pathetic.
And George doesn't know I exist, I missed my surgery.
- Could you tell me how it went? - We didn't get to do the surgery.
Mr. Patmore's been shipped off to another hospital.
And he will be out of pain by this time tomorrow.
Photographic memory, huh?
- Yeah. - Periodic table. Go.
Hydrogen, helium, lithium, beryllium, boron, carbon, nitrogen, oxygen,
fluorine, neon, sodium, magnesium, aluminum, silicon, phosphorus, sulfur...
I can keep going.
- We can burn actual wood? - That's my favorite part.
- You can't find that anymore. - It's gorgeous.
- What do you think? - This is a fantastic apartment.
- We love it. - I love it.
It was really great of you. Thank you.
You're kidding, right?
Cristina, are you kidding me?
I am getting kicked out of my house.
Think I pulled this off the board for you?
I was asking you to live there with me.
I'm sorry. I'm... That's hilarious.
- I'm sorry. - I'm walking to the bar.
You are just...
Give me the flier.
Um... I already put a deposit down. I'm sorry.
You should've been more clear.
Fine. You know what? It's fine.
Keep it, that's totally fine. Enjoy it. That's fine!
Thank you.
I get that you're a private person, but I am not.
I process my stuff out loud.
I gave up too much of myself in my marriage.
I can't give up pieces of myself again.
And Mark is my friend.
I think I just hate him because he's seen you naked.
What was the point?
All those hours and all that money?
What's the point? The world is a horrible place.
Young people die of diseases.
It makes absolutely no sense to try to be happy
in a world that's such a horrible place.
Yes.
- What? - Yes, horrible things do happen.
Happiness, in the face of all of that,
that's not the goal. Feeling the horrible,
and knowing that you're not gonna die from those feelings, that's the point.
And you're not done. You've made progress
because you're feeling and you're telling me about it.
Six months ago it would've been just you and a bottle of tequila.
My door's always open.
Bones break.
Organs burst.
Flesh tears.
Hey. Are you OK?
You know, I'm happy for you.
I am. I'm really happy for you and Derek,
and that you guys are moving forward.
I don't know how it happened that I don't have anyone,
but... I don't have anyone.
That's not true, Iz.
That's not true.
Hello.
We can sew the flesh.
Repair the damage.
Ease the pain.
I found your mom's vintage martini set.
They're my family.
You can't just assume I'm gonna kick my family out,
and you don't get to announce it to them and ambush me.
And you definitely don't get to try to get Cristina on your side.
They're my family, they're who I have. You and them.
OK.
- OK? - I'd like to talk about it again,
when you're ready. But for now, OK.
So you still love me?
But when life breaks down...
- Meredith... - when we break down...
yes.
There's no science,
no hard and fast rules.
We just have to feel our way through.
And, to a surgeon,
there's nothing worse and there's nothing better.
Are you sure about this, sir? You've had a long day.
It's one thing to stand on a stage and give a speech.
But if I want our teaching program to be the best,
and I do, it starts here.
And it starts with me.
I can't do anything about the flood.
But I can give you your shot, O'Malley.
You earned it.
- You ready? - Yes, sir.
OK.
You get three hours.
Go.