Grey's Anatomy (2005–…): Season 13, Episode 8 - The Room Where It Happens - full transcript

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There's this family in Italy

who never slept.

They suffered
from a genetic disease

that kept them awake
for months,

until their bodies
just shut down.

Even after all these years,

scientists still
don't really know why we sleep.

We just know we have to sleep.

Because without it,
we make poor decisions,

we say things we shouldn't.

And sometimes we see things
that aren't there.



What do we got?

MVC with abdominal trauma,

severely hypotensive
since he arrived.

FAST exam show a fluid
in the upper right quadrant,

lots of it.

It's gonna be
a long night.

Don't say that.
I haven't slept in 48 hours.

Thought I saw you
go home earlier.

You did.
I got off an 18-hour shift

to go home to find Zola,
who is boycotting sleep,

and Ellis,
who had an earache.

By the time
I got the last one down,

I got the call.
Where were you?

Uh, four-hour lysis
of adhesions.
Ugh.



Then a triple-A ruptured
in the ICU.

Pierce and I had to do
a balloon catheter bedside

before we rush him
to the O.R.

Oh, that sounds --
Then a GSW
to the abdomen

that Edwards caught --
a duodenal repair.

Wa-- How long
have you been here?

What day is it?

Scalpel.

How do you know when you're
too tired to operate?

Right about when
you make your first mistake.

I hate that answer.

You don't.
You just keep going.

Don't love that one,
either.

Okay, um, Edwards,
grab a hemostat to lift.

Dividing the fascia.

Okay, Edwards,
get lap pads in here.

Get in there.

We got
massive bleeding here.

Okay, we're gonna need
a bookwalter now.

Edwards,
I can't see a thing.

I'm trying. Ohh!

-Ho!
-Whoo!

Wipe.

-Got it, got it.
-Thank you.

Okay, let's get
more lap pads in there.

Let's bring in
another suction,

and we're gonna need
the cell saver.

Good evening, surgeons.

I heard
we've got a good one.

I'm here to give you
another set of hands.

Yeah, we could use it
if you're available.

Available? I'm primed.

I napped all afternoon,

ate a balanced supper,

and just had a cup of coffee.

-Well, that's nice.
-Did you?

All right, someone
tell me what we've got
on our table tonight.

A mess, sir.

Uh, Grade IV liver lac,

portal triad looks intact.

We've just packed
all four quadrants.

Wow! That liver's --

Destroyed.
Like I said, a mess.

Okay, hematoma's tracking
into Zone 2.

Edwards, let's right medial
visceral rotation.

Got it.
Medium clip, please.

How many units
has he had?

We've gone through
at least a dozen.

He's bleeding out
everything we pour into him.

-Clamp.
-Okay, keep suctioning.

-Other lap.
-Retractor.

Suction right there.

I need two more clamps.

You know,
back in the day,

I would always come
into the hospital overnight,

even if I wasn't on call.

That's when the most
interesting surgeries came in.

Best learning opportunities,
am I right?

Yeah. Yes, sir.
Bovie up.

I'll never forget this case

back when I was
a second-year resident.

It was about
3:00 in the morning,

and I'd been on my feet
for about 42 hours.

Right angle.

This fella came into the E.R.
with terrible abdominal pains --

claimed that an alien baby
was inside,

eating its way out.

That's funny.

Uh, Dr. Grey,
do you see this?

This kidney's
cracked in half.

Exactly.
It was his kidney.

Well, a kidney stone.

It was the size of a coconut.

It was six hours in the O.R.

Uh, this seems like
a Grade 4 injury to me.

Any way
we can salvage it?

No. Yes.

If someone could clarify...

Okay, it was the size
of a dinosaur egg.

It almost glowed.

Actually, sir,
I was talking about this.

This liver is shredded.

We don't have the time
or the blood volume

to spend an hour
fixing a kidney.

We could better control
the extra blood loss

if we fix the kidney.

Well, there will be
no blood loss

if we just
take the kidney out.

I'm very happy to keep
discussing it,

but really I think
a final decision would be good.

Take the kidney out.

You know what, Grey?

Le-- Let's hold on
for a minute, okay?

The patient
doesn't have a minute.

Should I clamp
the hilum?

No, we're gonna do
a partial nephrectomy.

That would be useless.

-And why is that?
-What?

Well, I wasn't asking
for myself.

I was asking for Edwards.
Why is that?

What does Edwards
have to do with this?

Well,
she's our resident here.

This is
an excellent teaching case,

and she'd benefit
if you'd elaborate.

It's fine, really.

Richard, please --

Now, look,
you and Dr. Hunt

are Chiefs of General
and Trauma Surgery.

Yeah, and if we
don't make a decision,

we're gonna be here
all night.

I'm going to repair the kidney.
Suture.

Hunt!
All right,
now, look, you two

should want this resident
to learn from this patient.

Owen, if you do this,

Edwards is gonna learn
from this patient

when he's a cadaver
in my lab.

Dr. Webber, I'm sorry.

You're tired.

No, it's not --
It's just...

Fine.
Let's do the partial.

Good.

Retractor.

Edwards.

Yes, sir?

Tell me about
the patient.

Uh, okay.

He came into the E.R.
unconscious.

No, no.
Tell me his name.

Well, he didn't have any I.D.,
so as of now he's John Doe.

A car sped up the freeway,
ramped the wrong way,

smashed into another car.

One guys's in O.R. 5,

and the other one's
right here.

So, do we have
the reckless driver,

or do we have
the innocent victim?

We don't know.

So, we don't know
if this man had a family,

we don't know if he was
running away from something,

and we don't know if he was
the good guy or the bad guy.

We know nothing.

What do we need to know
in order to do our jobs

and not simply be
mechanics?

How are we --
We're not being mechanics!

You're treating
this patient

like a sack of organs
on a table!

Now, here's
what we're gonna do.

We're gonna play a game.

And how is this
the best use of our energy?

Now,
here's how we start.

This patient
is no longer John Doe.

Who is he, then?

Basin.

We make him someone.

Anyone we want.

What is he doing?

He likes to teach.

When he's pissed,
he really likes to teach.

Surgicel, please.

All right,
first things first.

We need a name.
Who's got one?

Brandon.

-All right, Brandon.
-Mm-hmm.

Now, who is he?

Uh, I think he's the guy in I.T.
who parks next to me.

Okay, is he a good guy,
someone we like?

I don't know.
We've never spoken.

Okay, well,
then pick someone else

and make them someone good,

and they don't
have to be a male.

All right.

How about Joanie?

Now, why Joanie?

'Cause you
didn't like Brandon.

How about Gail?

Gail's nice.

Let's go with Gail.

She's 45 -- No.

She's 46.

What is it
we like about Gail?

And be specific.

I mean, do not stop

until you picture this woman
on the table,

until you can truly see her.

Do not stop
until we can hear her voice

and what she has to say.

Well, this
is going to be fun.

So, who is Gail?

Why do we like her?

And why would we go to such
lengths to save her life?

I'm sorry,
shouldn't we want to save her

even if
we don't like her?

Yes, but let's make it
easier on ourselves.

I mean,
we need to fill Gail in.

I mean,
really give her something

that we can
sink our teeth into.

Does she have hobbies,
or...?

Or is she known
for something?

Right lobe
is still bleeding.

-Over here, too.
-Okay. Large clip.

Well, what if Gail
plays the cello?

Edwards?

Uh, sure.

My mother forced me to learn.

Something about
learning an instrument

would helped instill discipline.

Remove the top blades.

-What are you doing?
-Remove them. Scissors.

The pringle didn't make a dent
in the bleeding,

so I'm gonna try and create
more exposure

with a subcostal --
10 blade.

Because that's
what this guy needs

is more incisions
to bleed from.

Okay, suction is blocked.
Fix it now.

Okay, uh, what else?

Okay, we need
to make Gail more real.

Okay, she plays the cello.

Someone answer him.
I'm too exhausted.

-Well, you started it.
-You're the one who was --

Oh, my God.

Dr. Webber,
I have a question about Gail.

Okay, well, go ahead,
Edwards, and don't be shy.

Uh, does Gail...

have a dog?

Excellent question, but no.

Gail doesn't have time
for a dog.

She's got two --
no, three young kids,

so her house
is already mayhem.

Three boys?

No, no.

Two boys and a girl.

That's nice, right?

Hey, stop terrorizing
your sister!

Don't make me come over there!

Hey! You're the oldest,
act like it.

Boy, you roll your eyes again,
I'm gonna shut 'em for good.

I imagine Gail's work
keeps her sane.

Does anyone have any idea
what she does for a living?

Um, maybe...
she's an engineer?

Or something
with research, politics.

Maybe she's whatever
Dr. Webber says she is.

Gail dreams of being
Principal Cello

for the Chicago Symphony.

She practices relentlessly
every morning and night.

But in between,

she teaches music
to kids in the neighborhood,

and she helps lead the local
high-school orchestra.

Ugh, if you could just hear
this one student of mine

play Bach's Sonata Number 1
in G Minor,

Fuga Allegro.

She learned it just like that.

Pressure's dropping.

And it's gonna continue
to drop.

He's still bleeding
despite any move we make.

We should just
cut our losses and stop.

Damage control?

Trust me, we should
just pack him up,

and when he's stronger
we can come back in and finish.

No, we're gonna concentrate
on the retrohepatic area.

We're gonna try and repair
the vascular injuries

that are in there first.

I agree with Hunt.

Well, how do you expect
to even see anything

behind this liver
to get a clamp in?

Trust me, we close
and let the body heal.

Somebody call up to ICU
and let them know we're coming.

We should
keep going in here,

try and repair
the damage, okay?

At this point,
this patient wouldn't survive

the elevator ride
to the ICU.

Look at this liver --
At this point,

this patient
is not surviving anything!

So you want to
give up now?

Leave Gail to die
in a bed upstairs?

Is it better if Gail dies
on the table?

It's better
if Gail lives.

What if we call UNOS?

Wh-- Really?

Oh, wait.
Can we really list him

for an emergent
liver transplant?

-No!
-Why not?

You know why not!

He'll be dead before a liver
even gets here.

And if he's not,
he'd be too unstable,

and he'd reject it
immediately.

It would be a waste.

We'd be taking an organ
from a stable,

far better candidate
who could really use it.

Edwards.
Hmm?

Tell me the indications

for an emergent
traumatic liver transplant.

Acute hepatic failure,

portal vein thrombosis,
uncontrollable hemorrhage.

Exactly.

And I don't remember
many case studies

of this procedure
being successful.

Which is why
we're not doing it.

I disagree
with your decision.

Well, I'm sorry,
but --

-But what?
-But he's not your patient!

My hands are in his body.

I would think
that would make him

as much my patient
as yours or Dr. Hunt's.

But it's still my call.

Look, we've got
three attendings here,

and a senior resident.

We need to discuss
the options.

-No, we don't.
-Why not?

Because you also have
the Chief of General Surgery

in here, Dr. Webber,
and I outrank you.

Of course.

And I'm saying no.

We are not listing him
for a transplant,

and we're done talking
about it.

Do you think you can stop
this retrohepatic bleed?

I can try.

Okay, if it doesn't work,

it's up to the ICU.

If you're not on board,
feel free to leave.

Okay, medium clips.
Another one.

Another!

I mean, this isn't working.
The clips aren't even holding.

Sure hope
it was worth it.

What?

Whatever this guy
was doing

that put him on the road
in the middle of the night.

Well, maybe
she didn't have a choice.

"She"?

Oh, Gail.
We're still playing.

Maybe money becomes tight,

she picks up
extra work at night.

Their father left
for the war,

and I couldn't say no
when the boys wanted to go

to a science camp
at the museum.

Or, uh, she takes her shift
in the evening

at a reception desk
at a nearby hotel.

It -- It isn't all night,
but it's late enough.

How much longer?

I need
a little more visualization.

Mobilize the liver
more anteriorly, please.

Yeah, on it.

You know,
this isn't working.

Just give me a minute.

Hold on.

Why don't you take
your turn?
Excuse me?

Try the game. I mean,
turn John Doe into someone.

I-I-I'm not good
at making people up.

I'm sure
you can think of someone.

Richard,
I don't need to.

I operated on hundreds
of John Does

when I was in the army,
and I did just fine.

Malleable.

Load of crap.

I call load of crap --
giant load of crap.

On what?

Whenever we had
a John Doe on the table,

the first thing you would do
is yell at someone

to go find
the patient's tags.

Maybe 'cause I didn't want
to have to do all the paperwork.

Uh-huh.

Where the hell
is that rummel?

Maybe ask for it nicely

and someone
will bring it to you.

I already did, and I shouldn't
have to ask twice.

Dad would say that.

Oh, God!
You turned into Dad!

That is a thing
anyone would say.

You've got his nose
and his chin

and his unreasonably
high expectations

of everyone
around you...
You know what?

...that no one
could possibly live up to.

But not his beard --
His beard was good.

Yours is just sad.

My beard is fine.

Actually,
I shaved this morn--

Why am I
even explaining this to you?

Feel free to stop.

I need that
rummel tourniquet now!

Screw it.
I can't reach it.

Okay,
I'm gonna open the chest.

Scissors.
What? Why?

Total hepatic vascular
isolation.

We're gonna completely stop
the blood supply to the liver,

find the source of the bleeding,
and then we'll repair it.

All right,
that's smart.

That'll give you
infrapericardial control.

Cutting him from stem
to stern right now

is completely reckless.

Just get control of the IVC
from above and below the liver

from the incision
we've already made!

Yeah, that is what the textbooks
would tell you to do,

but any trauma surgeon
will tell you

it will not work
without a sternotomy.

Edwards, it's all you.

Saw.

Doesn't have to be pretty,
just fast.

We're racing
against the clock here.

I'd love to know
what is so hilarious

when my patient is fighting
for his life!

"Trauma surgery is fast
and a race against time."

If it's a race,
you're losing,

because you suture
like a dumb tortoise.

I like my sutures
to hold.

Oh, and your beefy, fat hands
slow you down?

Do they have to special-order
those gloves for you?

I am trying to teach.

You've never
supervised trainees,

so you don't get it.

Oh, I get it.

Enough to know that you
don't know what to do next

with your patient.

Am I right?

Why are you stopping?
I don't know
if this is gonna work.

He's still bleeding.

I wanted to close,

and you said
you could isolate the liver.

I know, but...

Then do it.

What's wrong?
Nothing.

Stop.

I'm not doing anything.

You're giving me that look,
and I don't like it.

Mom does it, too.

Well, you should
call Mom more.

Will you just go away?

You're the one
that brought me here,

and you usually
only bring me around

when you feel guilty.

Why are you guilty,
Eeyore?

I am working.

Is it Nathan?

You feel bad
about being nice to him lately.

Nope.

It's fine.

Well, I mean...
it's not fine.

He cheated
on your little sister, but --

I don't feel guilty
about anything!

Oh, well, that's a first.

Well, something wrong.

What is it, then?

New wife
isn't working out?

I'm done talking to you.

You're not gonna
choke anybody again, are you?

Will you shut up?!

Shut up for God's sakes.

Hunt!

Uh, uh...

Suction's full.
Change it, please.

Obviously.

She's what's wrong
with you!

No!

What happened?

An affair?

No, we're -- we're
just friends.

Mm, well...

I like her.

Yeah, well,
good for you.

Hmm.

You should have
married her.

Then you'd have kids.

I didn't want
to marry her, okay?

I just --
I wanted it --

I'm trying to save
this guy's life here.

Who the hell
is this guy anyway?

What does that matter?

Uh, because I can see his
liver...or what's left of it.

You've really been throwing out
some bold moves.

You're monopolizing
the O.R.,

you're wasting hospital
resources and personnel.

It's not a waste
if we save the patient.

Owen,
why won't you call it?

I mean, you know
where this is headed.

Because
you don't stop, okay?

You don't stop until
you've got the final answer.

You don't stop until
you've saved them, or y--

you find out
that they're...

that they're dead.

Owen.

This guy isn't me.

Pressure's dropping.
I know.

Surgicel, EVARREST.

Let's give him
10 units of cryo.

I see bruising
on his neck and face.

Okay, let's pack him,
get ready to bring him upstairs.

I miss you.
No.

Cut it out.

You have to focus.

You know
what you have to do.

DeBakey clamp.
What are you doing?

Edwards, call the UNOS.

Send them everything
we have on this patient.

-I'm sorry?
-What?

Go now!

Owen.
Webber's right.

Transplant's the only way
to save this patient.

I'm removing his liver.
It's only making him worse.

Scissors.

Do not make that cut!

Basin.

Clips, please.
Boki.

We decided
not to list him.

No, you did.

And we were never supposed
to take out the whole liver.

How the hell
is the patient

supposed to survive
without a liver?

Okay, his liver already wasn't
working in his body, Grey.

Removing it while we wait
for a match

won't make much
of a difference.

Well, how do we know a match
is even gonna come through?

We don't,

but we're gonna do
a portacaval shunt

to bypass
the blood supply.

That should give us
an hour or so.

I imagine Gail
is pretty tough, right?

Gail is tough as nails --
on her feet 16 hours a day.

She wouldn't let up
even when the pain in her back

started keeping her up
at night.

You know,
I thought it was my mattress.

The thing must have been
at least 15 years old,

so I replaced it,
but that didn't help much.

She's one of those people
whose bag rattles all the time

because she carries around
a bottle of aspirin

everywhere she goes.

When you said an hour, did
you mean a minute and a half?

Hang two more units.

UNOS has everything.

Okay,
did they agree to list him?

He's listed as 1A,
and he's a fairly easy match,

so fingers crossed.

There's blood in his ET tube
and nares.

Check his coags
and a D-dimer!

Also, the lab tech mentioned
his platelets

were clumping,
so I was thinking --

Edwards,
you were right.

Looks like he's in DIC.
Let's jump back in.

No, actually,
that's not what I --

The azygos
is bleeding.

It can't be.
I clamped it.

Well,
it's bleeding again.

It must be coming
from his renal vein.

Let me see if
I can feel it from where I am --

got a better angle.

Something else
might be going on.

There is blood
in his urine now, too.

And the neck bruises.

They can't hear you.

If you want them to listen,
like, really listen,

you got to be louder.

Found it.

It is small, but it's definitely
a venous bleed.

Really?
Is it the azygos?

It is.

I got it.
Give me a tie.
I got it.

You don't trust me?
Not really.

I did what was best
for the patient.

No, you lost
your damn mind.

This tissue's
falling apart in my hands.

We'll clamp this,

and then I'm gonna secure it
with a tie.

Move your hands,
please.

Dr. Hunt.

Just a second, Edwards!

Just tell him!
You know what it is.

I don't think the patient's
decompensating because of DIC.

We spent months
reading about it.

You know it.
It's -- It's...

It's his platelets.

We'll just --
We'll give him more.

No, the patient
has a platelet disorder.

There's this cool lab test

that helps prove
the platelets don't clump.

The lab already saw
abnormal findings,

and they can confirm it
with the blood sample.

Okay, fine, fine.

Just -- For now, just get
in there with some suction,

so I can see
what I'm doing.

Damn it.

It's too friable.

We need to take him
up to ICU

until we find
a more permanent solution.

That won't work!

According to chapter 21 of
"Hemostasis and Thrombosis"...

"Hemostasis
and Thrombosis."

Dr. Grey,
if we close him,

he's gonna get worse.

Okay, push bicarb.

You know
what Nurse Paula would say.

Owen,
he can't handle any more.

She'd yell, "If you got
something to say"...

I-I think he can.
I think --

..."speak up!"

I think I'm gonna watch you
kill this patient.

Okay, stop, all of you!
Listen to me!

Something
you needed to say?

Repairing the azygos
won't stop his bleeding at all.

And you can take him to the ICU,
but he's still deteriorating.

This patient
has an autoimmune disease,

specifically idiopathic
thrombocytopenic purpura.

I.T.P.
is extremely rare.

According to a study
in Ko...

Kuwait.

...Kuwait,

there's an incidence
of 125 cases

per 1 million people
per year.

It's more common
than we think.

Edwards, the body is shutting
down because of the trauma.

Talk fast.
That is because

the trauma
is the only thing you see,

because trauma is all
that you are used to seeing.

I see a body that's attacking
itself from the inside,

and every time
we give him blood,

his body chews up the platelets
one by one.

It's like we're filling
a giant tank

with a hole in it,

and the only thing
we need to do to stop it

is to give him steroids,
a lot of them

as soon as possible.

He doesn't have a liver.
Thanks to you.

If we administer steroids,

then without being able
to metabolize,

it could become toxic.

And before you argue

about how risky it is,

let me just say
we have very little time,

and you should listen to me,

because I know
all about this stuff.

If I were on the table,
I'd want the risky thing.

I'd want to survive.

Yes.

Where did you
get all this again?

When you're stuck in a bed
for your whole childhood,

you kind of get obsessed

with the thing
that put you there.

I read...a lot.

Good catch, Edwards.

Thank you.

Send up
a blood sample

and give him a gram
of prednisone.

This is a reach.

Well, then you and Webber
should be all over it.

And we'll need
some more platelets.

Dr. Grey,
we might have an I.D.

A woman came in, said
her husband was working late,

then he never came home.

She saw the news.

Go ahead.

He's in V-tach.

I mean, this really hurts.

This isn't normal, is it?

And it's not just my back.

I can
barely get a pulse.

Push 300
of amiodarone.

Did we push the steroids?

It won't matter.
It's because of his liver,

or the fact
that he doesn't have one.

Okay, internal paddles
on stand by.

Look,
we still have time.

Go find out
if he belongs to them.

Something's wrong...

really wrong.

He's in V-fib!
Starting heart massage.

Okay,
internal paddles?

Saline! Charge to 20.

Okay, clear.

No change.

Ah, push one of epi.
Let's charge to 30.

Clear!

Ah, damn it!
Push another epi.

It's him!

The wife confirmed the I.D.
from the photo.

What's his name?

Carl.
Carl Henley.

Are we done with Gail?
Is Gail Carl now?

Are there children?

A little boy and a girl.

They're with her
downstairs in the lobby.

Okay, charge to 50!

Clear!

Still no pulse.

The shunt put too much strain
on his heart.

The liver's only been out
for 20 minutes.

The shunt will bypass everything
for at least another hour.

And then what?
We still have no donor.

Not to mention,
Carl probably has I.T.P.

And how was I
supposed to know that?

Edwards didn't have a problem
figuring it out.

Can Edwards
not be involved?

Every step of the way
you and Webber just took over.

Grey,
what is your problem?

My problem?

Ever since I walked
into this O.R.,

you've been negative
at every step,

shooting down
every approach.

What do you think
I'm doing right now,

massaging this heart
for exercise?

Dr. Grey, you've been
doing that for a while.

You want me to take over?

No! Go again at 50.

Okay. Clear!

I've done everything I can
to keep Carl alive.

It's a miracle
he's come this far

considering the shape he was in
when he got here

and all these Hail Marys.

Since when have I taught you to
stand around and play it safe?

You taught me
to do no harm.

Look, as long as Gail
is on this table, you will --

Carl!
His name is Carl.

Where is Mommy?

She's
with the doctors, sweetie.

Is my Daddy with them?

Let's just wait for your mom
to come back, okay?

Someone should go talk
to the family.

We're in the middle
of resuscitating him.

Someone needs to tell them
what's happening

and prepare them
for what's about to happen.

We've got a rhythm!
-Will it last?

It's faint,
but it'll do for now.

Okay, let's close him
and rush him to the ICU.

With no liver.

It's our only option.

It's time to compromise...
for all of us.

Hey, guys.

Hey.

Where's Daddy?
Is he here?

Remember,
Daddy was driving...

in his car?

Yeah,
is he coming home soon?

No, he was
in an accident.

Oh.

Well, is he hurt?

He was.

Are the doctors fixing him?
Is he going to surgery?

He's hyperkalemic.
Push calcium.

And one amp of bicarb!

How are
his M.A.P.s?

Barely
in the 50s.

No, they can't fix him.

Then you should go in there
and fix him.

Zola...

You fix everyone.

Zola, I can't fix him.

Why?

I can't fix him

because...

because no one can fix him...

...because he's dead,
Zola.

Daddy died.

You didn't make Gail up.

You come up
with what you need to.

Whatever helps --

an old patient.

"Someone good."

It's okay, son.

You were only 10 years old.
There was nothing you could do.

My mother --
She hated doctors.

Or at least
that's what she said.

You know, I think she just
didn't want to worry us.

We thought everything
was fine.

Okay.
Wound-vac, please.

She still taught music classes
every day,

yelled at us about our homework,
fixed us dinner.

We grew up listing to that
damn cello all day, every day.

She played it for hours --

Bach...

Vivaldi...

Elgar.

She would
shut the bedroom door

and tell us not to knock

unless someone was bleeding
or something's on fire.

I hated it --

that constant drone
of classical music,

until one day it stopped.

The house was silent.

I missed it.

That's when I knew
it meant something was wrong.

What was wrong with her?

You're the doctor,
you tell me.

46-year-old woman --

backache,
sudden weight loss,

fatigue...

Multiple myeloma?

Breast cancer?

Or...were there
any signs of jaundice?

Good question.
Yes, there was.

Was it gallstones?

Did one of them get trapped
in her bile duct?

No.

It wasn't hepatitis,
was it?

It was pancreatic cancer.
Stage III or IV.

She had six months.

Pretty sure we're almost done
here if you need to take --

I'm fine.

We just need
to finish the -- the closure.

The three of us
can handle it.

Wait.

We should stop closing.

Well, you've been pushing
to close him for hours.

I know, and now
I'm pushing to stay open

because I think we can save him
right here, right now.

Meredith,
we've tried everything.

We haven't tried
a liver transplant.

But we don't have
a donor liver.

We have a liver there.
Boki.

The right lobe
is completely destroyed.

We do a partial
liver transplant.

Look, we ditch the right lobe,
we repair the left,

and graft
the remaining vessels.

It'll work.

But we couldn't repair it
inside of his body.

How are we gonna do it
on the outside?

The main damage was behind it
where we couldn't reach it.

Now we have total access.
This'll work.

We've done liver autotransplants
with tumors, but with trauma?

It's risky.
I've never seen it done.

Because people
give up by now.

It's a Hail Mary.

Hail Mary.
Your turn.

Okay, great. Webber, you and I
are gonna go at that back table.

I need a scrub nurse
and irrigation.

And, Edwards, you and Hunt
are gonna go prep

for the anastomoses.

We got to work really fast.

Nice save, Grey.

Should have
thought of it sooner.

All right,
I'll get him up to ICU,

and...then I can
update the family.

I can update the family.

Thank you, Edwards.
Thank you.

All right, let's go.
Thank you.

Sorry for things
that I said.

Ah, it's okay.

No, it's not.

You were right.

I was tired,

but I have to learn
to push past it.

And you did.

Have you always done that
with your mother?

I didn't used to.

Back then...

I was trained
to depersonalize the patient.

Tissue was tissue,
faces were covered,

and blood was a mess
on the floor.

We were to stay focused,

and our hands were inside
just mannequins.

So, what changed?

One afternoon,
I was in the O.R.,

and we lost a patient
on the table,

and I went along
to inform the family,

you know,
tell them the horrible news,

and I was numb.

I watched them sob
and hold each other and --

and it didn't affect me...

at all.

That patient died
from the same thing

my mother died from,

and I was a robot.

After that...

I started
changing the rules,

and it made me
a better surgeon.

We've all hit that point
of exhaustion,

the point where
nothing makes sense anymore.

You've saved her now...

...about 1,000 times.

I suppose.

Good night, Meredith.

Good night.

Your body hurts,
your brain becomes foggy,

and you feel like
you're trapped in a tunnel...

...when all you want
is your bed.

So...how do you keep going?

How do you not just sit down
and give up?

Sometimes it's easy.

Sometimes you play games
in your head.

You make up someone...

someone good.

Hi.

I'm sorry.

I didn't think
anyone was in here.

Whatever you need...

It's all yours.

...to keep you going.

What are you
looking for?

It's right here.

Well, damn.

13 seasons

of fun.

Gimme, gimme, gimme.

13 seasons of drama.

This act

was a felony.

It was nice knowing you.

Shut up.

13 seasons of twisty turns...

It's bad.

You're falling
for me.

I slept with him.

...like only "Grey's"
can deliver.

Damn right.

"Grey's Anatomy."

Thursdays on ABC.

Congratulations.

You've each been chosen for my
very first criminal-law clinic.

In here,
you're not just students

but actual practicing lawyers.

You finally get to be me.

Thursdays on ABC...

At least they chose
a good photo.

...brace yourself for a mystery
so killer...

This could destroy us all.

...not everyone is gonna
make it out alive.

No!

"How To Get Away With Murder."

Thursdays, 10:00, 9:00 Central

on ABC.