My mother used to say this about residency:
It takes a year to learn how to cut.
It takes a lifetime to learn not to.
I'm up. I'm here. What's going on?
Jackson's BP, it's a little down from yesterday. No big deal.
But if we make a few calls, get pushy,
we could get him bumped a few spots up on the transplant list.
Dr. Bailey, you paged me 911. At 2:30 in the morning. To chat?
- You like to chat. You're chatty. - Not at 2:30 in the morning!
Look, he's young, he's near the top of the list.
UNOS will find him organs when they find him organs, and God knows,
staying up all night chatting about it is not gonna help.
Now, I'm going to get some sleep. I suggest you do the same.
He's running out of time.
They always are. Welcome to Peds.
Of all of the tools on a surgical tray,
sound judgment is the trickiest one to master.
And without it,
we're all just toddlers running around with ten blades.
Ohhh. I asked them not to wake you. "Whatever it is can wait till morning.
- Dr. Shepherd needs his sleep." - Your latest head CT shows
the brain contusions expanding. We need to get you into OR right away.
This... this brain thing, it could kill me?
If we don't treat it, yes.
- You find that funny. - I'm sorry, it's just they're gonna
execute me in five days.
Five days.
Might as well take my chances with this brain thing, right?
- Mr. Dunn... - You've got to admit,
it's a nice way to go,
plenty of attractive females.
All the Jell-o I could want. Have you tried the strawberry?
- It'll change your life. - You're refusing surgery?
Either way, I'm going to die, Dr. Shepherd.
Might as well do it on your watch.
Why do you have to live in Meredith's attic?
How am I supposed to sneak out with that frat party going?
- Don't you kids ever sleep? - They're cleaning the house
for Dr. Shepherd's mother.
Mrs. Shepherd's coming?
- To Seattle? - So?
That woman practically raised me, taught me right from wrong.
If she found out that I was...
with you, that we were...
You're Meredith Grey's little sister, forbidden fruit.
You are 25. You're a fetus.
Twenty-four. I skipped third grade.
I feel dirty.
Ten bucks says she tanks in the first five minutes.
I have faith in Death.
She's holding that bottle of tequila like it's a life vest.
- Don't listen to them. She'll love you. - No. Mothers don't love me.
Mothers like bright and bubbly and happy and...
- Izzie. Mothers love Izzie. - They do.
- Mothers do love Izzie. - My mother would've loved you.
Uh, I stashed all the tequila, took the condoms out of the cookie jar.
I replaced all your trashy magazines with issues of Annals of Surgery.
- OK? - OK.
Does it smell musty in here?
My mom's house smells like peppermint. It's homey.
- My house isn't homey? - I feel at home.
- This place is a palace. - Why isn't my house homey?
- It's just a feeling! - Izzie can't fix a feeling!
She's freaking out. Tell her something I can fix.
Rebecca peed on that couch cushion.
I've been sleeping there for weeks.
Thanks, Alex. You're a good friend.
You're welcome. Keep drinking.
- Mark? - Hey, there you are.
- Wanna drink? - It's 4:00 am.
You're right. I should've called first.
Hey, I hear your mom's coming into town. Good times.
You'll be fine.
Just keep the talking to a minimum. Short nuggets of Meredith.
That's all anyone really needs. If you get stuck, just smile.
You have a really great smile.
That's just scary.
Mer? Are you sure you want to wear your hair like that?
You're wearing an alarmingly high ponytail.
Your mother is coming.
Mr. Dunn, the swelling in your brain is increasing rapidly.
- The longer we wait, the worse it gets. - Excellent.
- Go, team. - I suggest you reconsider surgery.
Have you seen the inside of a maximum-security prison?
Believe me, if you have to die, this is the place to do it.
In good company.
You two vigilantly monitor Mr. Dunn's elevating ICP's,
you will do hourly exams. When he goes unconscious, which he will,
- we'll rush him to surgery. - You can't do that. Can he do that?
When you're unconscious and can no longer make decisions,
a two-doctor consent is needed to treat you.
I'm gonna be dead as a doornail in five days! Dr. Grey...
- We're done. - Would you fix a broken television
- before you throw it out? - He's got a point.
Trying to cheat the system. We're not gonna let him do it.
- What's the problem? - I have an infection
- from a little surgery I had done. - In Hong Kong.
My crazy-ass brother got crazy-ass elective surgery in Hong Kong.
- Who does that? - Short people.
Desperate short people!
I had my legs lengthened. I couldn't find a surgeon who would do it here.
Look, it's barbaric. They broke his legs,
and they hooked him up to some medieval torture device.
Yeah, that's to pull the bones apart. That's the lengthening process.
It's controversial. I don't perform it myself.
Can I take a look?
They said it'd give me two whole inches.
- Any word from UNOS? - Not yet.
Dr. Karev is in constant contact with them.
How much longer will we wait? Are livers and intestines hard to find?
Jackson's blood is O positive, shouldn't be difficult to match.
He's had blood transfusions, which means there could be
extra antibodies that are hard to match, so we need patience, Melinda.
In the meantime, I need to run some tests on Jackson to check electrolytes.
We're gonna do everything we can to help your son, Mrs. Prescott.
All of us.
- You. You're squirrelly. - I'm sorry?
I don't trust you. I don't trust you in this hospital,
and I don't trust you with my patient of three years
who is extremely important.
- I... - If you want to stay on this case,
you will stay out of my way, you will do what I tell you,
and if you have something to say to or about my patient,
you will raise your hand and wait to be called on.
You've got to be kidding me.
- Yes? - This is a joke, right?
Do I look like I'm laughing?
- You're upset. - I don't get upset with patients.
You're mad at me for killing those women. I get that.
Would you feel differently if you knew I was beaten as a child?
Every day. It's how I learned to read.
I used to hide under the sink
and sound out the letters on the detergent box.
- Is that true? - Did it make you feel better?
Whatever helps you sleep at night, Dr. Grey.
Cool.
Did you do something bad?
Traffic violation.
What's wrong with you, kid?
I need a new liver and a new intestine.
Yeah? You want mine?
Are you in the north terminal? That's where she's supposed to be.
No. Don't go anywhere, just wait.
I found her. There's a town car waiting at the airport.
I don't need a fancy car, I hopped on the bus. Saved you money.
So this cruise... you happened to have a layover in Seattle?
I've always wanted to check out the Space Needle.
I understand you can see Mt. Rainier from the top.
- Anything else? - Are you gonna take me or not?
I got back-to-back surgeries. Got to give me notice.
Yeah, I gave birth to five doctors. I know the drill.
I can wait, maybe meet your colleagues. Is that Mark Sloan?
- Mark Sloan! - Mrs. Shepherd. You look great.
Oh, damn. We'll catch up later?
Perfect timing.
- Mom, this is Meredith. - Meredith! Finally.
- Hi. - My son's been acting like a dog
with his favorite bone, hiding you. I hope you're free for lunch.
I can't wait to dive right in and find out all about you.
Mer looks weird. Does she look weird to you?
- Like she's gonna pee her pants. - Crap. I made her hydrate.
Meeting the family always blows. I'd never make you do that.
Me, either. One of the many perks of dating a dead guy.
- Who's that lady touching Meredith? - Derek's mom.
- Huh. That's why she looks so weird. - She does not look weird.
I've got it under control. Mer is doing... great.
Looks like she's gonna pee.
Dr. Yang, you mind checking in on some of my post-ops?
ER's swamped with traumas. Also, would you like to go on a date?
- I'm sorry? - A date.
You said not to play hot and cold with you, so...
I'll pick you up around eight.
And make sure Mr. Kenner in room 2212 gets that enema.
He's been holding on to it for days.
OK.
'Cause that wasn't weird.
Another perk to dating a dead guy: no awkward dates.
Two to one. But who's counting.
Why can't I have that nice man's organs? He offered.
You know how in school there are rules you have to follow?
Same goes for here. We have to follow the rules,
or else we get in big trouble.
And what that man offered you is definitely against the rules.
She's fighting with the insurance people again.
You're not supposed to worry about stuff like that.
Tell her something good today.
Even if nothing good happens. She needs good news.
I've got a body full of high-quality parts here.
Three-day liquidation sale.
Everything must go.
Even if we could do it, you have to be a match for him.
Which means we have to cross match your blood with his.
Good thing we're both in a hospital then.
Let... let me save a life before I go.
It's the least I can do.
So you really expect me to believe you want to do this for a kid?
Whatever helps you sleep at night, Dr. Grey.
The infection's made its way deep into the bone.
We're gonna take the rods out.
Clean out the infected skin and bone.
I won't get my two inches? All that pain, for nothing?
Mr. Ruben, at this point, you're lucky to keep your legs at all.
That's easy for you to say. What are you, 5'10, 5'11?
- Leave the doctors alone. - Shut up, Gary.
You are over six feet tall!
Do you have any idea what it's like
to have everybody you know literally look down on you?
Or how humiliating it is to have to ask for help from a teenager
at the grocery store because you can't reach the top shelf?
I've gone on two dates in the last six months
with women I met over the Internet. No one wants to see me again.
- No one wants to date the short guy. - Chuck...
I wanted those two inches, Gary. I wanted them so bad.
It's two inches. What's the difference between 5'3 " and 5'5"?
5'5" you can say out loud.
OK. I made a list of the best pediatric GI's in the country.
We can get one of these guys to come do a TIPS procedure on him.
On a kid who needs a new liver?
Like putting a Band-Aid on a bullet wound.
- You have a better idea? - I do.
Wait for UNOS. Trusting the process. Why can't you do that?
Because I'm tired of waiting while this kid gets worse.
Jackson's tired, his mother is. The only one who's happy to sit
and twiddle her thumbs is you!
I've been patient with you, I've been nice,
but I am really over you constantly telling me how to do my job.
- Somebody's got to... - I have 20 other kids...
Shut up!
Respectfully. Respectfully, shut up.
Because we got organs.
I wish you could get organs delivered instead of having to go pick them up.
I hate flying. I always feel much closer to death on a plane than in the OR.
- Don't you? - I do now.
I met Izzie the other day.
She's very pretty.
So do you think she's the one?
I... I don't know.
Well, we're at that age, right?
Marriage, babies.
- That the plan? - I don't know!
I'm sorry, I don't make plans, OK?
If there's a future, great. If not, I'll get over it. I always do. OK?
OK.
I think it's nice. Your date.
You and the pig murderer make a good couple.
- OK. - What are you gonna do?
- What are you gonna talk about? - You care?
Yeah, why do you care?
You only get to do a first date once. It should be fun
and sexy and...
Ask really good questions.
Ask him why he first decided he wanted to save lives.
- Ask him what his best surgery was. - I know how to go on a date.
Why is Meredith eating pot roast?
It's a show lunch for the mommy.
She's freaking out. That ponytail is gonna blow.
Derek tells me you grew up here in Seattle.
- Are your parents...? - Dead.
Meredith's mother died last year.
Oh.
I'm so sorry. And your father?
Oh. You know,
I should go check on the patient.
Who's the serial killer...
who's here.
Not killing people.
So that's good.
- I should go. - Yeah.
OK.
Family isn't her favorite topic, OK?
- She's had a rough time of it. - I didn't say a word.
I know what you're thinking.
I was thinking... it must be awful for you.
Treating a murderer.
Dad died a long time ago. I'm fine.
- What are you doing? - Sleep with me, you lunch with me.
- New rule. - You let interns sit with you?
- That's so cool. - Wanna go halfsies on that cookie?
What are you gonna trade me for it?
You guys, they have Tater Tots!
I have to go.
- Mark? - Mrs. Shepherd.
- You've been avoiding me. - What? No.
You have the same look on your face as you did when you were ten
and put Derek's favorite frog in the microwave.
- I never pressed start. - What's going on?
I'm sleeping with her.
- Oh, Mark, not again! How could you? - No... No.
Not Meredith. God, no.
Meredith's little sister.
Which one is she?
The... one with the juice box.
- Are my new organs here yet? - Not yet.
But we're gonna get you all prepped now
so we can put them in as soon as they get here.
When you wake up, you'll be a brand-new boy with brand-new parts.
I can't believe this is it.
The thought of us getting to live our lives outside this hospital...
Don't get me wrong, I love our chats.
But it'll be nice not to see my face.
So freaking nice!
- It's just a kid. - Yep. Let's go get his organs.
Am I hallucinating or is that a really high ponytail?
You're not hallucinating.
But once your brain starts to herniate, I can't promise anything.
So I'm really circling the drain here?
You should just take my organs right now. Help that poor kid.
They found him organs. They're flying them over right now.
He's going to be fine.
Did you know that they let you choose?
Hanging or lethal. You get to pick your poison.
Literally.
Which one would you choose?
Medically speaking, which one's...
better?
Well, with hanging,
your neck breaks, which severs your spinal cord,
which causes blood pressure to drop, and you lose consciousness.
You don't actually die for several minutes.
And with lethal injection,
they inject an anesthetic first which puts you to sleep,
and then a paralytic which stops your diaphragm and lungs.
And then potassium, which stops your heart.
Was... was I a match?
Yes, you were.
Can I help you with something? Were you looking for Dr. Shep...?
- Are you a good girl? - I... What?
A good girl. I don't mean perfect, I mean... relatively speaking.
- Are you? - Yes.
How many sexual partners have you had? I won't judge.
Um, six. No, s-seven.
Kinda six, kinda seven.
- Criminal record? - Speeding ticket.
- How fast? - Twelve miles over.
- That's fast. - It isn't too... Way too fast.
But it was downhill. I was coasting, ma'am.
I don't suppose you can tell me...
where the gift shop is?
First floor, east wing.
- It's like pudding in here. - It's why I don't do this procedure.
You're living with broken legs for months, you're in excruciating pain.
All for a few inches.
Pain and agony for a little bit of pleasure. I get it.
If it's that bad, why don't you just stop sleep...
- doing what you're doing? - It doesn't feel bad when I'm...
doing it. It's good. It's great.
And maybe if you weren't so scared of getting burned you'd feel the same.
I used to walk tall around here.
I used to walk tall.
Then came George.
He took off at least an inch.
And Erica went and left me. That shaved off a few more.
I got shorter.
All that humiliation makes you shorter. So, yeah, I am scared of getting hurt.
One more personal disaster right now would cut me off at the knees.
So Valentine's Day.
Personally, I think you can't go wrong with jewelry.
- I could recommend some places. - What is wrong with you?
- What? - We just took a liver and intestine
from a little kid. A dead little kid.
And you don't even care.
You're talking about rainbows and relationships and crap.
What the hell is wrong with you?
You don't think I know they just pulled the plug on a kid?
You don't think I get that?
You don't think I know about the tiny, tiny coffin they're gonna stick him in?
I know about the tiny coffins.
I see them all the time. In my sleep.
So if you don't mind, I'm gonna keep talking
relationships and rainbows and crap,
and I'm gonna make plans for tomorrow.
Because that's what you do, Karev. You make plans.
You have to. You turn your back on the tiny coffins and face forward.
To the next kid.
- How's our death-row guy? - Pissing me off.
Blossoming brain contusions, refusing surgery.
- Thinks he'll get a stay of execution? - No, he'd like to die here.
He wants to control it. He wants to choose.
I went overboard buying bears for your nieces.
- Mom, this is Major Owen Hunt. - Major?
I was a Navy nurse for 25 years. Where were you stationed?
- In the thick of it. In Iraq. - Welcome home.
- You must have stories. - Not any worth telling, ma'am.
- I finished your post-ops. - Thank you, Dr. Yang.
- What was your best surgery ever? - What?
Nothing. Uh, stupid.
- Finishing the vena cava. - Anastomosis looks good.
All that's left is to release the clamps.
You should do the honors, Miranda. He's your patient.
Thank you, Dr. Robbins.
Call on me.
Call on me!
There's a spot on the duodenum.
What the hell is that?
- I don't feel good. - ICP is critical. We can't wait.
- We have to get him down to the OR. - No. No.
- We have to get you to surgery. - I'm not scared of dying.
I just don't want to do it strapped down on a table like some animal.
Please... Please, Dr. Grey.
Let me go.
OK, start bagging him.
- Intubate, get him into the OR. - Yeah, right here.
I need another doctor's signature, consent to operate.
Meredith, sign.
Sign the form.
Meredith, sign the form!
Yang, you're scrubbing in.
He's clotting and clotting and clotting. Is there a source?
This can't be happening. Not to this little boy.
- This is not happening... - These organs are dead.
They're making him sicker. Keeping them in is doing harm.
- He will die if you leave them in. - He'll die if we take them out!
Pressure's dropping.
Try a portacaval shunt. It'll bypass the liver.
- That's a temporary fix. - Got any better ideas?
I don't see what choice we have.
How much time to find new organs?
Twenty-four hours.
Get some more laps in here too.
We're going to put this piece of skull in Mr. Dunn's abdomen. Why?
To allow the swelling in the brain to resolve.
Circulation of abdomen preserves the bone marrow in the skull piece.
- Very good. - Thanks for letting me scrub in.
I guess we finally see eye to eye on something.
Are we ever gonna find out why it clotted off?
Sometimes the body, the pieces just break.
- I'm like that. - Yeah? You dying for no reason?
My life is in pieces, all of the time.
And they keep breaking, and as soon as I fix one, another one goes down.
I'm not trying to piss you off. I'm just trying to keep it together.
Piece by piece.
That ponytail... looks ridiculous.
- She's a lovely girl. - A lovely girl who's off-limits.
Baloney. She isn't the problem, you are.
You have very low expectations for yourself, Mark Sloan.
Since you were a little boy. And it's time to raise them.
She's 24.
You have the emotional maturity of a horny 15 year old. You need young.
Mm.
We had to shave off a quarter inch of leg bone in order to save the legs.
You mean I'm shorter?
I'm a quarter of an inch shorter?
Quarter inch. It's not a big deal.
Yeah. I'm under 5'3".
I am 5'2" and three quarters.
But maybe I can still just squeeze over the height requirement
- at the amusement park. - Do you know
why I never played varsity basketball?
- You didn't make the team? - No. I didn't try out for the team.
I didn't want to make you feel bad for being too short to play.
Even now, if I have a bad day, I can't talk to my brother
because maybe you had a bad day and you're short!
I couldn't even be depressed about Lori leaving me
because you don't have a girlfriend and you're short!
By the way, the reason you don't have a girlfriend
isn't because you're short. It's because all you do
is talk about being short!
No one knows how short you are except for you, dude.
No one cares.
- I'm an ass, aren't I? - Yeah.
And you're short.
Good night. Nice to meet you.
Major Hunt? How have you been sleeping?
- I'm sorry? - When I can't sleep,
I use Valerian root.
I know you doctors don't think much of herbs, but I find it helps.
Have you been sleeping? Since you came back?
I'm fine, ma'am. I... sleep just fine.
Good night.
- How's your head feel, Mr. Dunn? - Why didn't you just let me go?
- You're not dying here. - What are you so scared of?
- Losing control? - ICP's stable. Continue neuro exams.
Keep an eye on his blood pressure. I don't want it dropping.
Or maybe you know deep down, you're no better than I am.
You decide who lives and dies all the time.
For you, they call it medicine, not a capital offense.
Nobody gets to choose. Not me, not a patient in this hospital
and certainly not the women you slaughtered.
So when I say you're not gonna die in this hospital,
I mean there is no way in hell I will let you die in this hospital.
You don't get off that easy.
I'm nothing like you.
Meredith.
I was just looking for Derek. I thought you'd be with him.
You seem like a very nice person.
You've been kind and you've given me a chance.
It seems like you want to like me.
So it's only fair you should know...
the pink and the ponytail and the smiling with the teeth?
I'm a fraud. It's fake.
I'm not the kind of girl mothers like. I'm not happy and bubbly.
I'm dark and cloudy,
because I'm the type of crazy person who...
feels bad for serial killers.
It was very nice to meet you, Meredith.
What's wrong?
- I want to meet your mother. - Iz.
I want to go on a date with you. I want to eat dinner in a restaurant
and not look like a crazy person talking to myself.
I want to walk down the street with you and hold your hand.
I want to tell my friends about you and I want...
I want...
- What? - I want you alive.
Are you breaking up with me, Izzie Stevens?
I think I am.
- So you wanna get a drink? - I would, but I have plans.
Right.
- Walk tall. - What?
All you can do is be brave enough to get out there.
You fought. You loved.
You lost.
Walk tall, Torres.
You're late. Really late. They closed the kitchen.
I didn't want you to think I stood you up.
Are you drunk?
I haven't been on a date in five years, since before I entered the military.
- I wanted to take the edge off. - You're late and drunk?
I will make this up to you. I promise. This is not what you deserve.
This is not what you deserve. I will make this up to you. I promise.
Before you say anything else, Dr. Goodtimes, shower.
You smell like a distillery.
No. Not here! I...
Your father always wanted you to have this for the right girl.
Addy wasn't right, clearly.
You spent less than an hour with Meredith.
- You barely even know her. - I know enough.
I know it's easier to have compassion for a good person than a murderer.
I know how angry you still are about Dad.
Of course I'm angry.
Aren't you?
I still can't sleep on his side of the bed,
the mattress is wearing unevenly,
but no.
No, not angry. Not anymore.
Sweetheart...
- You see things in black and white. - Mm.
Meredith doesn't.
You need a spoonful of that.
You need her.
- She's the one. - Yeah.
Yang! Yang!
- I thought of my best surgery. - You're wearing shoes in my shower.
First blast injury in the field. Body was mangled.
Homemade explosive device, wires embedded five inches in the abdomen.
Arms and legs hanging on by threads of skin. Never seen anything like it.
Not in a textbook, not in residency. Incredible. Body full of holes.
Trauma surgeon's dream. I put tourniquets on where I could,
started tying off arteries with my bare hands, but bleeding was everywhere:
stomach, chest...
Best pressure I could think of was my own body.
I laid there for two hours on top of him, not moving,
trying to keep that dam from bursting with my hands, knees, elbows.
Body... full of holes,
and... he never bled out.
I wouldn't let him.
He made it to the hospital, home. A month later, he sent me a letter
thanking me for saving his life. Then he shot himself.
That was my best surgery.
And my worst.
We're human.
We make mistakes.
We misestimate.
We call it wrong.
But when a surgeon makes a bad judgment call,
it's not as simple.
So I checked and we have a few vacation days coming up.
Maybe we could take a road trip, stop in Iowa, see some corn.
- Doesn't your mom live in Iowa? - Yeah.
I think she'd like to meet you.
Or not. Bad idea. Forget it.
There's a bottle of tequila in the laundry room that has our name on it.
Don't move.
Alex...
We gotta talk.
People get hurt.
They bleed.
I'm so sorry, I just heard. What happens now?
Now, we wait for a miracle.
So we struggle over every stitch,
we agonize...
over every suture.
During surgery, Dr. Shepherd removed a piece of your skull.
Which means your brain is only covered by dura mater.
It's virtually exposed. If somehow that area were to be damaged,
it would cause intracranial bleeding, which could cause your brain to swell
worse than it did today, which would result in brain death.
So, as your doctor, I need you to be very careful not to damage it.
Do you understand what I'm saying?
Dr. Grey?
Are you doing this for the kid...
or for me?
Because the snap judgments,
the ones that come to us quickly and easily, without hesitation...
Whatever helps you sleep at night.
They're the ones that haunt us forever.