Grey's Anatomy (2005–…): Season 13, Episode 8 - The Room Where It Happens - full transcript
A surgery brings back memories for Meredith, Richard, Owen and Stephanie.
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.
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.