Surgeons are all messed up. We're butchers.
Messed up, knife-happy butchers.
Sir? Would you like a cot set up for you in her room?
We cut people up. We move on.
Patients die on our watch. We move on,
to the next patient and the next.
No. I'm a doctor here.
We cause trauma. We suffer trauma.
Wait.
And here it comes.
We don't have time to worry about how blood and death makes us feel.
This is how you unwind?
By watching two hours straight of advanced carotid endarterectomy?
Cristina?
Everything OK?
Cristina? Owen!
What...? What?
It's three in the morning, Cristina. This better be...
Callie?
What?
He what?
It's me. Cristina!
What's going on? Owen's out there upset,
- Callie was screaming... - No changes in visual acuity.
No petechiae. I'm fine.
Oh, my God! Your neck! I will kill him!
No, no, no. He had a nightmare.
Cristina, please.
Is she all right? Meredith, I just need...
I just need to know if she's all right.
No, no, no. Cristina, no.
I am so sorry.
I don't know what happened.
- I'm sorry. - Look at me.
I'm fine. See? It's OK. You were asleep.
It's OK. OK? It's OK. It's OK.
- I'm sorry. - It's OK.
I know.
It's OK. You were asleep. It's OK. OK? It's OK.
It's OK. It's OK. It's OK. It's OK.
There's coffee.
No. Not like this.
Today's your first day back at the hospital. Today's about Izzie.
You have to operate on her brain. You have a gift.
And you can do this.
I'm gonna shower before I go in.
You're back!
I'd be lying if I didn't say thank God you are back.
I heard the new monitors are in for repairs.
- They are. - I hate operating on old monitors.
They'll work fine, you'll be fine. You'll feel better back in the OR.
- Did you go home to Meredith? - Yeah.
- Did you propose? - She turned me down.
She turned him down. She turned him down.
Turned him down.
- You're wearing a turtleneck. - Hand me those labs.
I have to get them to Izzie's oncologist.
Turtleneck, under your scrubs. It's ugly.
Not as ugly as the fact that you hugged him.
- You hugged him... - I get it. I hear you. Move on.
Turtlenecks aren't OK. You're not OK. Your boyfriend is not OK.
- Is your boyfriend OK? - What?
To be cutting into brains today. Is he OK to be back?
Yes. Of course. Derek is fine.
I was there for his carnage in the OR, remember? This isn't just any patient.
- This is Izzie. - He knows that, Alex.
Shepherd has successfully performed more metastatic tumour resections
than any other neurosurgeon on this coast.
Trust me, he's the only surgeon we want inside of Izzie's brain.
George, hey. I'm surprised you're not...
Isn't there a presentation happening with Izzie?
- Yes, there is. - Well... how is she?
I don't know.
I didn't know she was sick. Bailey told me after Cristina told her.
Izzie trusted Cristina. I was the very last to know.
- I'm sure Izzie wasn't trying... - I don't want to talk about it.
I want to work. Do you have any room on your service?
- Yeah. Three hip replacements... - Thank you.
You three. I understand why you're here. You want to help.
Don't get the wrong idea. You won't scrub in on Izzie's surgery.
Dr. Bailey, I coordinated Izzie's entire treatment team...
You've done a wonderful job. Today you are not her doctor.
None of you are.
I will be the resident on her case. I will be prepping her for surgery.
If you're going into that hospital room, you will do so as her friends.
Izzie needs her people around her to tell her everything will be fine.
She needs you to hold her hand. She needs you, not more doctors. Understood?
Oh, great. Mer, will you hold this, so I don't lose my stitches?
Great. Let's get started.
As you know, you have stage-four metastatic melanoma.
We have surgeries and procedures lined up for you over the next few weeks.
We've seen mets on your liver, so one of those surgeries,
- Dr. Bailey and I will resect them. - Hopefully improves my immune function
to a level that controls the progression of residual mets.
Exactly.
We also lined up Dr. Parker from OB
to harvest as many healthy eggs as she can before you undergo any radiation.
- Right. Babies. - Leaving the option open for you,
- if you want it. - But our priority
is to address mets in your brain. I'm surprised we didn't catch it.
It causes headaches, seizures, hallucinations.
Hopefully the lesion has clear margins and I can remove it.
Are you people done?
Over the next four weeks, you're slated for three major surgeries,
seven outpatient procedures, just for mets we've found.
In all likelihood, we will find more. We may have to cut into you more.
You might as well get used to the idea.
I'll be administering your radiation, chemotherapy and immunotherapy.
The treatment will be aggressive, it will be harsh. Prepare yourself.
I'll be overseeing procedures, including today's,
which means every surgeon in this room now answers to me.
Welcome to the cancer wing, folks.
See you in the OR.
Thanks.
Don't you guys have rounds?
Seriously, don't just stand there staring at me. It's making me nervous.
- Get out of here. Go save lives. - Yeah, we have rounds.
- Yeah. - OK. See you later.
How's Izzie doing? How'd it go with the doctors?
How do you think?
Me and the interns, we're worried about her. If there's anything we can...
The last thing she needs is idiot interns crawling all over her. Back off.
Hey. So, Shepherd's back.
Are you gonna say anything to him? Seen him?
I have not seen him. I have nothing to say to him.
Are you presenting?
Joyce Wellington, age 93. post-palliative thyroidectomy
for malignant lymphoma of the thyroid.
She coded last week during surgery,
but she was able to be extubated post-op.
Given her advanced age, unlikely she'll rally.
We have to inform the family there's not much time left.
Be a good learning experience for you, Grey.
With everything going on, I understand if you'd rather stay outside.
I'm not bailing. I can handle a dying old lady.
Morning.
Hi, Dr. Sloan. These are Aunt Joyce's nephews, my brothers Tobin and Luke.
They flew in early this morning. Dr. Sloan did the surgery.
I'm sorry. Your aunt is very sick.
Her blood pressure is still extremely low.
We tried multiple medications to get her pressure up,
but none of them seemed to help.
There's not much more we can do for her.
- Probably time to say your goodbyes. - Do you mean say our goodbyes now
or sometime in the next 24 hours?
I mean, what kind of time frame are we talking about?
- Twenty-four hours seems unlikely. - You sure?
Because I have a flight to catch in the morning,
and if I wait past noon, I can't change it.
I need to be on a plane tonight. Board meeting tomorrow.
So do you think she'll die before tomorrow?
Hey, freaky little stalkers. What are you doing?
- Nothing. - That's the problem.
It's just that Dr. Stevens was kind of our mentor.
- And now... - And now she's patient X.
OK, well, I have a dozen post-ops,
two central lines, one possible chest tube.
Divide those up. Come see me when you're done.
You mean you'll let us handle these all on our own?
Izzie was a good teacher, right? So show me what you've learned.
- You turned him down? - Excuse me?
You turned him down? I mean, you like the man, don't you?
You want him to feel confident today, feel good when he steps into the OR.
Don't you know the quickest way to wreck a man's confidence
is to turn him down when he proposes?
Whether or not I say yes
to that ring Derek hit into the woods with a bat
is none of your business, sir.
A simple "yes" would do!
You don't have to mean it.
Kid's only seven years old.
Think there's any way we can avoid surgery?
Hard to say. Hand me the callipers, please.
I could reconstruct that mandible without much difficulty.
Great.
I heard about Izzie Stevens. So sad.
I feel bad. I only worked with her once.
In retrospect, she seemed like she was acting a little strange,
talking to herself.
I feel like I should've recognised it was more than a quirk.
Bummer, though. She seems like a promising resident.
Baumann angle's off. Your kid needs surgery. I'm sorry.
Thanks.
Don't take it personally. Stevens isn't her favourite topic.
She slept with Callie's ex-husband before he was her ex.
Right. I forgot about that.
So Callie's holding a grudge against a dying cancer girl, huh?
That's one way to look at it.
Dr. Swender, I have the labs you asked for.
Think Shepherd's the guy for Stevens' surgery?
- Someone else in mind? - Shepherd wouldn't be my choice,
given his recent history, but it's not my brain he'll be manhandling.
- No. - Damn. She's HLA type B3.
I hoped to put her in a clinical trial for an immunological vaccine.
But she's not eligible.
Have to hit her with the DTIC and high dose IL-2 instead.
Nasty stuff. I was hoping to avoid it, at least for a while.
Think I'll swing by Stevens, go over it with her.
- LL-2? That's pretty toxic. - About as bad as it gets.
- You're gonna tell Izzie this now? - I am her oncologist.
Studies show giving patients bad news before surgery
can drastically increase their chances of complications.
Today or tomorrow, the news is the same. Right now, I have time.
You coming?
I believe Izzie is down in radiology now.
Fine. We can wait an hour.
Karev, I just reviewed Izzie's most recent MRI.
Doesn't look like the tumour has grown since her last scans.
Yeah, I saw those.
Do you have concerns you'd like to discuss with me before we brief Izzie?
Just try keeping her frontal lobe inside her skull this time.
Good morning, Izzie.
- You coming? - No. I'm on this old lady, so...
- This'll only take a minute. - I gotta go, really.
Is she doing OK?
Yeah. Well, she says she is.
- Do you believe her? - No. Not really.
Heads up.
- Chief, you paged me? - Karev. Yes, I did.
I didn't want to bring this up earlier,
in a room full of people. It's a little personal.
As you know, we're gonna be harvesting eggs.
From Stevens.
Who, I believe, is someone you're having relations with.
- Chief. - Frozen eggs have a better
survival rate when they're... fertilised.
- Fertilised. - I know this is a lot to digest.
So take some time, think about it.
If you decide this is something you might consider...
- Give me the cup. - Karev. Speak to Stevens.
Just give me the cup!
- What do you hear? - Motorcycle lost control. No helmet,
massive head trauma, lost vital signs en route.
- Good to have you back, Shepherd. - Thanks.
Get back inside. He's DOA.
Hunt? Did you hear me?
Owen.
Swender, she sees one bad lab result...
There's got to be other options.
- Swender has no vision. - We need to talk about the turtleneck.
- No, we don't. - Wrapped his hands around your throat,
- you're pretending nothing happened. - It's not like I have cancer.
Let's focus on Izzie.
Hunt literally tried to kill you. He's barely back from Iraq.
It's obvious he has issues, things that he needs help with.
That doesn't mean you have to stand by...
If he had a heart attack or a stroke or lost a leg, would you walk away?
How is it acceptable I walk away from this? He's wounded.
He has war wounds, Meredith.
OK, I... I can see how I...
I can see why you're worried, but trust me. It's not cut and dried.
And it's not as bad as you think it is.
Clear.
- This might be it. - From your lips to God's ears.
Charge to 360. Clear.
- Oh, for the love of God. - Hey.
Know how many people are in here waiting,
hoping loved one might live? They're a bunch of vultures.
- But we're not. - Aunt Joyce was given a month to live
three years ago. And we were crushed.
And we held her hand at her bedside for weeks,
and we said our tearful goodbyes. And then...
she stabilised.
She's been in and out of the hospital once a month.
Each time we jump on a plane, sit by her bed, say our goodbyes all over again.
And each time, she winds up getting better.
We want to be here when she goes. We really do.
But... it's a lot of flying around the country.
She's ready. We're all ready. It's time.
And I've got a board meeting tomorrow.
Big one.
- There you are. - Sorry. I needed to clear my head.
Yeah.
They're doing tests that show altered brain anatomy in patients with PTSD.
Close to understanding the physical side of psychological trauma.
- Amazing what you can see with an MRI. - What did Meredith tell you?
Post-traumatic stress is a real injury, Owen.
It can be healed. There are resources, vet centres, therapy.
You shouldn't try and handle this on your own.
I came back in one piece, both arms, both legs.
Lots of guys came back with real injuries.
The worst I have is nightmares or freezing for a moment...
Is that what happened last night? You had a freezing moment?
Meredith didn't tell me what happened, but from what you're saying...
- It's not... - You don't have to tell me.
If you want, I can help.
Oh, yeah?
I'm not the one who needs help. I'm not the one who cut out half a brain
and ran off to hide. I'm not the one half the hospital is talking about.
You should spend less time worrying about me and take a look in the mirror.
Karev? Just checking in. To see how you're com...
- See how you're doing. - I'd be doing better
if you weren't on the other side of the door listening.
Right, right. Sorry.
- How's it going? - Pretty sure it's not.
I said go away.
- Alex, it's Meredith. Are you decent? - Yes.
You left the door unlocked. That's bold.
- The chief send you in here? - No. I offered to come in
- in case you need to talk. - You think talking will help?
A Dixie cup full of my swimmers will make everything OK? It's crap.
This is crap!
You can't go messing with people's heads like that.
Even if she freezes the embryos, you think we'll get a chance to use them?
You think she'll still be here?
You think she'll survive all this? You think...
I think... She told me... She told me she was seeing a ghost, OK?
And I'm so used to all the crazy chicks in my life that I didn't even...
I'm a doctor. A doctor!
And I didn't even think to...
And now she's... This is...
This is wrong. This isn't how it's supposed to happen.
- I know. - It's crap!
- I know. - I hate this.
I know.
This isn't...
This isn't how we were... This isn't how I wanted to do this.
This isn't how Izzie and I were supposed to make a baby.
I haven't seen you all day.
- How's your...? - Fine.
What if I hadn't woken up?
What if you couldn't fight me off? What would've happened...?
I can't even remember what happened. I have no memory, no way to...
I would never hurt you, ever.
But I did. My hands just...
How could my own two hands be capable...?
- I can't do this, Cristina. - But you did wake up.
- Stop blaming yourself. - We have to stop seeing each other.
- Cristina, I almost... - Almost what?
I told you, I know my limits.
Let me decide what I can handle.
Good. Stand right there. Let me see.
- I never know how long to make these. - Like the colour. Who's it for, Karev?
- Haven't seen much of him today. - He's working. They're all working.
I told them to go work. Their patients shouldn't suffer
because I have things growing on my organs.
I have got a colectomy this afternoon.
If you were the resident assisting me,
and I were to say to you, "Divide the cecum," what would you use?
I'm not assisting you. You're not gonna ask me to divide the cecum.
Yeah, but you're not going to get rusty on me either.
You're not going to make all my hard work go down the drain
just 'cause you're sick here a couple of months.
In a year, you need to do this stuff.
You need to teach residents.
- Think I'm gonna be here in a year? - Yes, I do.
So I have exposed the right lower quadrant,
and you are dividing the cecum with...
Forceps.
Lift free from the arachnoid.
Tacking sutures.
Patties.
Suction.
Starting over.
Here's your cup, all filled up.
- I'm eating here, Karev. - It's fine, I washed my hands.
Did you talk to Izzie about this yet? Considering you two are basically
conceiving a child together, think you should talk with her?
Look, you said she needed my... contribution.
Here's my contribution. Whatever.
Dr. Swender, I went through your notes and Izzie's results.
You're right. Cases like hers don't usually respond well to vaccines.
But there are these guys at NCI having lots of luck with fludarabine
followed by cellular adoptive immunotherapy.
And... and I'm familiar with the patient.
Izzie is young. She is physically and emotionally resilient, she's strong.
- I know these studies. - You don't know how she'll respond.
I think it's worth a try. It might not be as bad as you think.
Collins and Travis at NCI didn't have brain met patients in their study. Why?
They won't accept a case that advanced. If Izzie Stevens wants treatment at all,
she needs to get chemo, radiation and IL-2.
I know the side effects are severe.
She will lose her hair, she may get hypotension, arrhythmias,
fluid on her lungs. She will feel like she is going to die.
But that's the cost if she wants a chance to live.
Maybe things would be different if she'd come to me sooner,
but... those are the facts.
If you'd rather wait until tomorrow to go over them with her, fine,
but the facts won't change.
It absolutely is as bad as I think.
- Hi. How's Izzie? - I don't know.
- How's Izzie? - Why?
- Have you been to see her? - No, I've been working all day.
- What? - Have you been to see Izzie?
No. Haven't you?
We should take our lunches to her room.
She needs her rest.
- She really does. - I'm basically done.
- Hey, guys, can I sit here? - No.
OK.
- You finished that thing in one day? - Had some free time.
- Had a lot of free time. - Nobody came up to visit?
It's OK. If I were them, I wouldn't want to step foot in this room either.
- You don't have to keep checking on me. - I do have to.
I have to start you on this before your surgery.
Right. Surgery.
And I wanted to tell you how my surgery went this afternoon.
- Colon guy? - The colectomy went great,
but I was in there, and I see a mass.
- You're kidding. Was it a big mass? - Big enough. The size of a fist.
This is going to burn a little at first, but just for a few seconds.
So we had to mobilise the SMA
before we could resect the thing and reconnect the bowel.
Hey. I saw you come in here.
I didn't know anybody came in here.
- Like, ever. - Well, I do, sometimes, to be alone.
Is that code for "Rollergirl, go away, I'm praying here"?
OK. Got the message. I'm gone.
I wished Izzie Stevens would die.
I wished her dead. Every day, for I don't know how long.
I woke up every morning wishing Izzie Stevens would die. And now...
What kind of person wishes someone would die? What kind of...?
What kind of doctor wishes...?
Knowing how things happen, what...?
What kind of...?
What kind of doctor wishes...?
Are you in here, right now, praying for Izzie to die?
No. I'm praying for her to live.
Starting again.
Forceps.
Lifting free from the arachnoid.
Tacking sutures.
Patties.
Suction.
- Clear! - You know what?
- Wait outside! - Will you let us know...?
Yeah. I'll let you know.
- Bastards. - Push one of epi.
Charge to 360. Clear!
Come on, Joyce, you old bag, don't give 'em the satisfaction.
- Charge again. - Charged.
Clear!
Hey. I'm Dr. Karev.
You're a fighter, you know that? You worked hard today.
She needs some rest.
Make sure the family doesn't come in. Give her a break from all the love.
No. They're impatient.
It's been a long time.
But they always come.
They're my people.
People keep you going.
People are better than no people.
Stay here and let her people back in.
- What if she codes again? - She will again. Won't last the night.
But you can handle it. I have to go right now.
- He's still scrubbing in. - I know, just... He should wear this.
It's his ferryboat scrub cap. He loves ferryboats.
- Meredith. - What are you doing?
You're gonna have to re-scrub.
- I'm not ready. - Yes, you are.
I can't make another mistake.
I can't make a mistake on Izzie.
You won't.
I need to know that at least I have you.
No matter what happens in there, I need you to say yes.
- I need to know... - I can't say yes.
Not if agreeing to be with you forever will make it OK if Izzie dies.
I can't say yes. I am here, I'm not going anywhere.
I love you, and you can do this. You can do this.
I know you can.
Iz!
See you soon, Dr. Stevens.
- Hope so. - Know so.
- Dr. Bailey, if something goes wrong... - It won't.
The scarf.
I made it for you.
Beautiful night to save lives.
Let's get started.
I get why I haven't been camped out at Izzie's bedside holding her hand...
- Not talking about this. - Why not?
Maybe it's the fact that I asked Izzie a hundred times what was wrong,
and she just ignored me.
Then there's the fact that when she needed help,
she trusted Cristina, of all people!
Then there's the fact that she'd rather surround herself
with people like Karev than anyone who might actually care about her.
And there's the fact that she's your best friend, and she might die on you.
There's also that.
Come on. We are going to go wait for Izzie.
We're going to pray for her and wish her well.
George, you were my husband and you slept with her.
You are the reason I wished her dead. You owe me this.
And she was your best friend.
You loved her enough to ruin our marriage.
So you owe this to yourself too.
You can lie to yourself all you want, but I know you. I loved you once.
And I know you care if she lives or dies.
Surgery started.
- Hey, have they started surgery yet? - Yeah.
Dr. Grey? We finished the post-ops you gave us.
We were wondering, did Dr. Stevens' surgery start or...?
Keep moving. No loitering. That's the rule.
- You guys are... - You heard her.
If they wanna stay, let 'em stay.
People are better than no people.
Clamp.
I am ready to... No.
Yes. OK. I'm ready to buzz the superficial temporal artery.
- Tenting sutures. - There's no rush. Take your time.
- Everyone is on your side. - Sure that's gonna hold,
- with all the friable scar tissue? - Dr. Swender?
Actually, I saw Dr. Shepherd do three different craniotomies last month,
each with easily double the amount of friable tissue.
They held just fine.
Next tenting suture, please.
Clear!
Push another epi. Charge again. Come on, Mrs. Wallington. Clear!
I'm so sorry. She's not responding. We've done everything, so she's gone.
Thank you. You did a wonderful job.
- Are you kidding me? - Oh, God, this is never gonna end!
No... No, she's gone. She's really gone.
It's really gone. It's her pacemaker.
It's still firing. Makes it seem like there's a heartbeat. She's gone.
Just with a heartbeat.
- Are you sure she's dead, young lady? - I'm an intern.
I'm not authorised to call time of death in a situation like this.
So I'm gonna get my superior.
Excuse me. I'll be right back. Excuse me.
- I am worried about you. - Meredith...
- Choking. - Stop.
- It's unacceptable. - Back off.
- Hands around the neck. - Ring thrown in your face.
I know my limits. I don't want to talk about it anymore.
Sorry, folks.
This'll shut the pacemaker down.
Time of death, 2240.
There you go. She's officially dead. You can catch your plane.
Get to your board meeting. You can leave.
Actually, could we stay a little while longer?
What are you all doing out here?
Waiting for Izzie, sir. We're waiting.
You're scared.
I'm scared too.
Damn it. Some of the Sylvian vessels are wrapped around the tumour capsule.
- Penfield four, please. - Really?
- Instead of the arachnoid knife? - Yes, instead of the arachnoid knife.
Because the Penfield four will let me slide the arteries around the met.
I need to dissect it free so I can de-bulk the tumour,
avoiding unnecessary trauma to my patient. So Penfield four, please.
- Vitals stable the entire time? - Any spikes in intracranial pressure?
- Was there residual tumour? - Shepherd resected all of the tumour.
She'll be in the PACU for an hour. She's fine.
Your friend is just fine. No thanks to any of you.
Tomorrow, do better.
Your surgery went well today.
Shouldn't you and Meredith be out celebrating or something?
She turned me down twice.
Oh, well...
She said she understands, she forgives me for what happened in the woods.
So you showed her your dark side.
Meredith never struck me as a woman who's afraid of the dark.
I don't know.
Do you know it was Meredith's idea to ask Izzie
if she wanted to harvest her eggs?
So Izzie could have a chance at the future she wanted. The future, Derek.
It never occurred to Meredith that Izzie wouldn't have one.
She was confident you'd succeed today.
Meredith believes in you.
I'm here, Iz.
I'm right here.
- She still sleeping? - Yeah, so far.
Alex, may we wait with you for a while?
- Izzie's surgery went well. - Good. That's good.
I wish things were...
They could be...
- That we could be... - Me too.
Could I hold you?
- Wait! No. You can't take that one. - Why not?
I said don't take it.
I will take the elevator I want to take.
Well, go on.
Hey. Come on in.
This is a CT for Katie Bryce.
16-year-old female, subarachnoid aneurysm.
A fall during gymnastics. I remember.
It was the first surgery we ever scrubbed in together on. Our first save.
Right here is a cerebral cyst. Tough save, but we did it.
I kissed you in the stairwell after this surgery.
This is where Dr. Bailey kicked you out of the surgery
because she caught us in your driveway in my car.
And right here, this was a seven-hour craniotomy.
You held a clamp the entire time and never flinched.
That's when I knew you were gonna be an incredible surgeon.
And right here, this is when I supervised you drilling a burr hole
for the very first time.
I was watching you more than I was watching the drilling,
'cause I knew...
I had fallen in love with you.
Beth Monroe, who made our clinical trial a success by surviving.
You talked me into putting her under.
That's when I knew I needed you.
And this is today. Post-op head CT of Izzie Stevens.
See that?
Right there. Tumour-free.
Because of you. You got me into the OR.
If there is a crisis, you don't freeze.
You move forward.
You get the rest of us to move forward because you've seen worse,
and you've survived worse. And you know we'll survive too.
You say you're all dark and twisty.
That's not a flaw.
It's a strength.
It makes you who you are.
I am not gonna get down on one knee.
I am not gonna ask a question.
I love you, Meredith Grey.
And I want to spend the rest of my life... with you.
And I want to spend the rest of my life with you.
I don't think...
I can't handle this after all.
What...? What do you mean?
- Are you saying...? - I'm sorry.
I am so, so sorry.
But I'm lying here in your arms...
and I'm afraid to fall asleep.
Doesn't matter how tough we are.
I want to apologise for earlier.
- What I said was... It was out of line. - It's already forgotten.
Thank you for doing this.
Trauma always leaves a scar.
I'm engaged.
I broke up with Owen.
It follows us home.
It changes our lives.
I snooched into a cup for you today.
Thank you?
Trauma messes everybody up, but maybe that's the point.
All the pain and the fear and the crap...
Maybe going through all of that is what keeps us moving forward.
It's what pushes us.
Maybe we have to get a little messed up
before we can step up.