Grey's Anatomy (2005–…): Season 8, Episode 11 - This Magic Moment - full transcript
The doctors form two teams to operate on conjoined twins.
She's a love bug.
Have you ever had the
starring role in a play...
A solo in a recital?
Okay, she's gonna take her
first steps any minute.
I can feel it.
All eyes on you...
Okay, so I am gonna give you the giraffe,
and maybe she'll walk to you.
Well, she's not gonna do it on cue.
She's gonna surprise us, right?
You gonna surprise us? Here you go.
Waiting for you to do...
what they came to see...
- Oh! Hi. Yeah, daddy.
- She's gonna take her first steps
while she's in day care,
- and then I'm gonna kill myself.
- No, she won't.
You're not gonna do that,
right, Zo? Zo, come to daddy.
Come to daddy.
Come on. Come get the giraffe.
You're just the cutest
kid on the entire planet.
Why is that?
She's perfect.
Okay.
Feeling the incredible
pressure to perform.
There was a time when
they used to call operating rooms
an operating theater.
It still feels like one.
Scores of people get ready for the show.
The sets are arranged.
There are costumes...
masks...
props.
Everything has to be rehearsed...
choreographed...
All leading to the moment
when the curtain goes up.
You know what they say
about Carnegie Hall?
There's only one way to get there.
Practice, practice, practice
until it is perfect, people.
This is a long, complex procedure
with many parts.
Therefore many opportunities for error.
So we're gonna go over this again.
Team leaders, let's get in place.
All right, green team over here, please.
Let's go, red.
We've offered this family
every pro bono dollar,
every surgical hand,
every resource this hospital has.
So I'm asking you for every
resource that you have.
Be sharp, be present, be focused.
Dr. Robbins has been
caring for these children
since the day they were born.
They will each get a new life today.
Our actions will decide what
kind of lives they will be.
Let's begin.
I thought I had Dr. Knox.
You know what I love about you?
Your warmth.
You were doing the conjoined twins.
- Well, now Knox is doing the conjoined twins.
- Uh-huh.
Uh, we're not talking about it.
Oh, of course we're talking about it.
It is a crazy idea
that I am not talking about
- because it's crazy.
- It's not crazy.
We'd sleep in one bed,
we would have breakfast at the same table,
we'd have one electric
bill instead of two.
Oh, that's why you want
me to move in with you,
so we could save on the electricity?
Yeah, it's the responsible thing to do...
for the planet.
I am not moving in with you.
It w-what, look, we've been together,
what, two weeks?
Two weeks and nine months,
before the pause.
And I want to hit play again,
right where we left off.
I don't want to start at the beginning.
Because it's good for the planet?
And I have a better TV.
Look, come on now. Admit it.
You-you want to live with me.
You love me.
I want...
Knox back.
Mm.
Flaps are inset and viable.
We are looking at at least 18 hours,
so come and go if you need to,
hydrate, eat,
but be here at least 30 minutes
before your procedures.
All right. Next up, general surgery.
First we need to establish
each baby's blood supply
to the shared colon.
Then we separate the colon,
making the first incision...
I will make the first incision.
We'll separate the colon.
Okay, and now I'm checking
the displaced kidneys...
To make sure they're
intact and functioning.
Uh, that's implied.
I don't care. Say it.
Checking the kidneys to make sure
they're intact and functioning.
Man, she's wound up tight.
Thought you were off work today.
I won't see another one
of these in my lifetime.
- Okay, you need to tie that off better, though.
- You're doing the flip, right,
- Karev, with Robbins?
- Uh-uh.
The flip's a critical part. You ready?
- Yes, sir.
- You forgot to cauterize.
- You want this baby to bleed out?
- Do I...
- No, I...
- Yeah, I should think not.
Look, I know this procedure is her baby,
but she keeps nitpicking everybody,
she'll destroy their confidence.
- Don't let her do that to you.
- Oh, no, sir.
Good, because if this flip goes wrong,
she's gonna blame you.
It'll go on your record,
and-and boards coming up...
it's not gonna look good.
- Did you check the pelvis?
- I-I...
Glad it's not me.
Okay, it's time to flip them.
Karev, you're up.
Ready?
Yeah.
And why is the flip so important?
It just gets very tricky.
They have open incisions,
so they have to stay sterile,
and we have to make sure
that they stay intubated
- and monitored.
- Okay.
And we also have to keep
all their I.V.s and wires
from getting tangled and
intertwined in the process.
You know, I...
Imagine, um,
changing the battery of your car
while speeding down the freeway.
Except it's not a car or a battery.
I mean, they're your babies.
So... it's a bad analogy. I'm sorry.
No, that's the first thing you've said
that I've totally understood.
But if the flip goes wrong, then...
everything after that is...
is hosed.
Well, the doctors have planned
and rehearsed this for weeks.
I mean, they've got it down.
Karev, you rushed it.
You're like two steps ahead of me.
No, you over me.
Yours over mine, everything's fine.
Mine over yours, babies in the morgue.
That's how it works.
That's your pneumonic device?
Great. Now Brandi's wounds are exposed,
and little Andi's gone without
oxygen for a whole minute.
Okay, I... can we start over?
No, there's no time.
Let's just finish this practice
and try the flip again. Next.
- Neuro.
- Ortho.
Okay, we will access and separate
the conjoined spinal canal.
Separate the bony elements of the spine.
Well, that was a train wreck.
You nearly killed both dolls.
Look, I have it. I know it.
If only freakin' Robbins
would trust me to do it.
Doll killer.
Meredith Grey. Okay, come with me.
O.R. two. Right away.
Okay, I am gonna tell you
something about my personal life.
Really?
Okay, um, my personal life
is none of your business.
The fact that I know things
about your personal life
is one of the great
sadnesses of my existence.
Sorry about that.
And the fact that you're
going to know about mine
is exponentially worse,
but I don't see how we get around it.
Okay.
We're about to operate with Dr. Warren.
He and I are... involved.
Everybody knows that.
Can you not pretend?
Oh, oh. You and Dr. Warren? Wow.
Uh, he is going to try and
discuss personal matters
in the O.R. today,
- and I don't want that to happen.
- Okay.
Okay, so I'm going to teach you a lot.
And you are gonna ask questions... a lot.
And if he gets a personal
word in edgewise,
I want you to forget which is
the business end of a scalpel
real quick
and ask for help.
Okay, but let me get this straight.
You pulled me out of
a once-in-a-lifetime surgery
to be a buffer between
you and your boyfriend?
Oh, don't use that kind
of language with me.
Spinal separation complete.
I have to go. Teddy.
It's been two weeks now.
You need a break, and she does, too.
I gotta go.
Okay, I am now prepared
to separate them completely.
Wait. Hold on. What about complications?
I mean, what if there's
a double hemivertebra
or a tethered cord?
We will cross that bridge
when we come to it.
- We're done here.
- I-I'm sorry.
What if we're standing
on that bridge right now?
Dr. Robbins, I said...
No, no, no, no.
We haven't even separated them yet.
We haven't gone through
the post-separation surgeries.
- Dr. Robbins, stop.
- There's so much m...
We're done practicing.
We have practiced our parts
not only here in this O.R.,
but in the shower, on your drive to work.
We are ready.
We know what to do.
Now we just have to do it.
Ladies and gentlemen, present to you
Andi and Brandi Edwards.
Let's give them new lives,
shall we?
It's showtime.
Raising the skin flap. Avery, you there?
- One step ahead of you.
- You want to race?
No, no, no. No racing.
That was fun last night.
Did you and Mer have a good time?
- I know Julia had a good time.
- Yeah, we did.
You got enough length there for coverage?
Yeah, I'm dissecting from
the base to the midline.
Did Mer say anything about Julia?
- She liked her.
- Jackson, slow down.
And Zola like Julia, too?
Yes, she did. Everybody liked Julia.
Anybody else here meet Julia?
Did you like her?
Show of hands if you liked her.
Ah, you did? You did?
I think I'll update the parents.
Hunt, they're clearly racing.
- No racing.
- We're not racing.
We have been rehearsing this for months,
and now they're gonna
jeopardize the patient because...
Robbins, you take care of your team.
I'll look at the big picture.
- Done.
- I win.
And by that, we mean ready
for the colon resection.
- Cafeteria?
- Race you there.
General surgery teams, let's go.
Is that enough lap pads?
A little more is not gonna hurt.
They'll help mobilize it.
How's Zola doing?
Oh, she's great. Thanks.
She's about a minute away from walking.
That's great.
A-and she's in the day care downstairs?
She is, yeah. She really likes it.
Must be nice, having
the whole family in the building.
Yeah.
It's a win-win.
You love Dr. Shepherd, and he loves you,
and you see each other at work,
and then you see each other at home.
Just more of a good thing.
Dr. Bailey, is that
the spleen right there?
That is the spleen.
So are we gonna take out the whole thing?
We will. We will take it right out.
So how many suture ligatures
you think we'll need to do
for the splenic vessels?
Oh, could be two,
could be three.
I'll, uh, see if two does it.
But I may have to throw in a third.
This is good stuff.
I'm glad I skipped the conjoined twins.
There's beauty in the basics.
There's beauty in sharing a bowl of cereal
with a woman that...
I can't remember how to do a stick tie.
No shame in that.
There's no stupid questions.
You sure about that?
Dr. Altman.
Dr. Yang.
You paged me?
Oh, I didn't realize Cristina was...
Do you want me to step aside so she can...
- No.
- But you paged her.
It's no problem, really. I don't mind.
I can go peek in on
the progress of the conjoined twins
- If you'd rather have...
- Stay put, Kepner.
Yang.
From the beginning?
Yes.
Vitals were stable after receiving L.R.
and packed cells.
The bronch was already placed
when I entered the O.R.
so I proceeded with the laser endoscopy
using the c-o-2 laser.
Step by step.
I had good visualization of
the tumor almost immediately.
About 80% of the tumor had been vaporized
when the bleeding began.
He had clots, which
were blocking my scope.
I passed a brush through
the scope to clear the field.
However, Henry's
hemorrhaging was so severe...
Suction, Kepner.
Kepner, suction.
Yang?
Henry's hemorrhaging was so severe
that the brush did not solve the problem.
SATs dropped to 88.
Blood was coming out of the E.T. tube.
At that point, Dr. Webber
exercised his judgment
and stepped in.
We cracked his chest and
tried to get to the source.
Henry became bradycardic
so we pushed atropine.
Then I realized,
the tumor had eroded through
the pulmonary artery.
He flatlined.
We did A.C.L.S.
protocol and got sinus brady.
We pushed high-dose epi.
He flatlined again.
We did more compressions.
We continued in this manner
until Dr. Webber and I both agreed
that since he already lost more
than half his blood volume,
his heart could not restart.
We called time of death... 8:52 P.M.
Again.
When I entered the O.R.
Henry's vitals had been stable.
He had received L.R. and packed cells.
The bronch was already placed
so I proceed with the laser endoscopy.
And then thanks to the unhealthy
level of comfort she felt
working for her husband,
she took some liberties
with the clinical trial
and now neither of
their careers will ever be the same.
You know, I would love to go back
to dividing the gastrocolic ligament,
but I'm not sure I remember how to...
Figure it out. Look, all I'm saying is,
it'd be nice to maintain some boundaries
so a person's life doesn't fall to pieces
like Dr. Grey's here.
For the record, my life
is pretty great right now.
You hush. No one's
interested in your life.
- Dr. Grey.
- Please ask me about a spleen.
Who's the last person you see
before you fall asleep at night?
Or a pancreas. I've got
a very good view of it.
It's tan and lobulated...
Answer the question.
The last person you see
before you fall asleep
at night.
Derek Shepherd.
Must be nice,
all I'm sayin'.
Zero silk.
Thank god.
They're separating the colon right now.
Making sure that they each
have good blood supply.
Have they done the flip thing yet?
That's next.
Um, I gotta get outta here.
Is there a bar around here?
Um... yeah. Across the street.
He's not a total drunk
if that's what you're thinking.
He has a job.
It's a good one, with benefits.
Seriously, Gretchen, I-I-I wasn't...
No, I know what you were thinking.
It's what everybody thinks.
That we accidentally got pregnant
and now we're stuck with
the kids we can't take care of.
You're probably placing bets in the O.R.
of how long we'll stay together
or whose mother is gonna
end up raising the girls.
Well, you can tell everyone in that room
that they're wrong.
We love each other,
and we wanted these babies.
We're staying together,
and we will do whatever we need to do
to make sure that they're okay...
Including accepting
the hospital's charity,
even if I have to sit
around with judgy doctors.
I wasn't judging you.
Really. I-I just...
I was thinking
how lucky you are
to be with somebody that you love.
Looks like Andi has the bulk of
the blood supply to the colon.
So we'll give her all the colon then?
And leave Brandi with an ileosotomy?
I don't think so.
I'll do an ileoproctostomy.
Maybe they should just
share so we don't have to...
No. We'll do it my way.
Check the function of
the blood supply to the kidney.
Flip's coming up,
and I don't want a repeat
of this morning's rehearsal.
That's what I want to talk to you about.
I'm a little nervous about it.
We practiced that flip before,
and it turned out great.
And today...
Robbins doesn't trust anybody today.
Get to your point, Karev.
I just don't want to screw this up.
We gotta be the perfect team.
And you're not comfortable
doing it with her?
She's making everybody uncomfortable.
I get it. You don't need
to say another word.
Who wants to replace Karev on the flip?
No, that's not what I meant.
Uh, I'll do it. Sir.
Mm.
You sure you can do this?
Disconnect and cap subclavian I.V.s,
anesthesiologist holds the E.T. tube,
designated circulators
and the techs hold the monitors.
Yours over mine, babies...
Don't. Don't.
Why aren't you doing the flip?
Webber snaked it from me.
Webber? But he hasn't practiced.
You've been practicing this for two weeks.
Yeah, tell him that.
I told the parents that you've practiced.
I told them that you had
this thing down cold.
Okay, one...
two...
three.
Easy, easy, easy.
I hope he drops her.
How's he gonna like it when
one twin's pushing her sister
in a wheelchair the rest of their lives?
I'm just pissed at Webber.
You're just... a monster.
And we're done.
- Whoo-hoo!
- All right!
Oh, good. Okay.
- Nice work.
- Well done.
All right!
Right?
He flatlined again.
Then Dr. Webber and I decided
that without any blood left to circulate,
his heart would not restart,
so we called time of death at 8:52 P.M.
Tell me about the tumor.
The tumor had eroded through
the pulmonary artery.
Okay.
How do you know?
Know what?
When you say that the tumor
eroded into the pulmonary artery,
how do you know?
There was a hole in the artery.
- Did you actually see the artery?
- I felt it.
You just blindly felt it?
It wasn't a blind feel.
I knew what I was doing.
I traced it with my fingers.
- Uh-huh.
- It was the posterior segmental artery.
I'm sure of it.
How can you be sure?
You never got a visual.
I-I followed the tracheal bifurcation.
It came directly off
the main pulmonary artery.
Okay, Kepner, let's get a few
of these lymph nodes for biopsy
and then get ready to close.
I didn't call it without being sure.
From the top, Yang.
Um, his vitals were stable
after receiving fluids.
He was under anesthesia,
and the bronch was placed
when I entered the O.R.
so I proceeded with the laser endoscopy
using the c-o-2 laser.
Dr. Bailey, op notes done.
Do you mind if I run out for a minute
until the next patient's ready?
He's gonna be here 30 minutes from now.
I know. I can get out and
make it back in that time.
You're going to try and get a sandwich
then I'm going to get the sad
story 40 minutes from now
about how long the line
was in the cafeteria.
He's a nice man. You could do
without me for half an hour.
- Dr. Grey.
- He won't bite.
For god sake.
You can run, but you can't hide.
- Look, what we have is good.
- Mm-hmm.
Now why on Earth do you want to rush it
and-and complicate it
and-and quite possibly destroy it?
Because we're not kids anymore.
B-because my life is happening now,
not ten years from now or five
or a respectable 14 months,
but right now.
And I want to share it,
every day, every morning, every evening,
a-and if that's not what you want,
then I guess we're just
not right for each other.
Now look, we just got back
together two weeks ago.
I-I can't...
Well, I guess I just got my answer.
Hey, come o... it's been two weeks.
Excuse me. Excuse me. Excuse me.
Okay. Look at this face.
Seriously, look at this face.
Yeah, yeah, yeah, super cute.
They're in the spinal cord now.
Bailey spent the last two hours
telling me how crappy my life is,
but look at this face.
Oh, Zola, look. There's your daddy.
He's about to repair a myelomeningocele.
Can you say myelomeningocele?
- What an ass.
- Hey, language.
Baby here.
He pretends he's all gentle and sad
with the Alzie wife at home,
dispensing zen wisdom
from his half century of being a surgeon.
Well, guess what.
Yoda down there...
biggest shark of 'em all.
The guy is dangerous and mean.
I think what Teddy's doing is mean.
It's fine.
No, it's horrible.
It's-it's horrible and...
You know what else is horrible?
Having a dead husband.
No, you know what? You don't know, okay?
It's not right.
Teddy's O.R., it's like...
it's like a morgue.
Well, Altman's husband
died on Yang's table.
Payback's a bitch.
Oh, will you just shut up? It's fine.
I can handle it.
Well, it has been two weeks of this.
It must be getting to you.
No more than it did yesterday
or the day before that
or the day before that.
It's fine. I'm... I can handle it.
Damn it. Spinal dermoid cyst.
It's all tangled up in the spinal root.
Yeah, there's a lot of scarring in there.
I don't see a clean approach.
Well, no, well, you have to take it out
because the cyst could become malignant.
Yes, we're aware. Thank you.
Maybe if I can come in
from an angle... like this,
but then we risk
the contents spilling out...
Which could cause a chemical meningitis.
Dr. Robbins, we've got this.
Okay, what if we stretch
the nerve root here?
Well, that might paralyze Brandi.
Yes, Brandi might end up paralyzed.
Yeah, no one understands
that better than we do,
which is why we will be
making this decision, okay?
Us. Not you.
Us. You all right with that?
Just make sure... you.
I...
Yes, I'm okay with that.
No more talking from anyone in this O.R.
We need complete silence from now on.
Hey.
I was in the shop downstairs,
and I figured, you know,
now there's gonna be two of 'em,
- they're gonna need their own clothes.
- Ohh.
So I figured Brandi
could be the punk first
and then we could make 'em switch
and see which one wears 'em better.
I love you.
I love you, too.
Oh!
Uh, they're, uh,
about to separate the girls,
which is so...
cool.
It...
Okay, we're ready for the final cut.
All right. Separation complete.
No, no, no, no, no.
Not yet, not yet.
We still need to check
on the motor function.
Let's do...
2 milliamps of stimulation
on Andi first, please.
All right.
All right. Let's try Brandi now.
2 milliamps of stimulation.
Let's go up to 3 milliamps, please.
Come on, Brandi. Just give
us some kind of movement.
Anything.
All right. Let's go to 4
milliamps of stimulation.
Hey, there you go.
All right. Good.
Great work, everyone. One step at a time,
by the numbers, like we practiced.
Let's move.
- Okay, count of three. One, two three.
- Two, three.
Gently, gently.
Nicely done.
We've still got a hell
of a long way to go.
I'll be checking in on you both.
How's it going in here, Sloan?
The flap is well-vascularized,
has good cap refill,
and is covering the defect perfectly.
I nailed it.
Did Avery nail his?
What's going on, Avery?
You should've finished your flap by now.
Yet I haven't even started.
Why don't you give me
a call when you're ready?
Her kidney's completely necrotic.
V-tach.
Okay, push 30 milligrams of calcium.
She's already showing
signs of renal failure.
Her kidney was fine earlier.
Maybe something caused an
arterial spasm while we
were checking the function
of the blood supply.
I don't know, but at this point,
I don't think it's salvageable.
She hasn't had any urine output
since she's been in this O.R.
How did it happen?
Sometimes complications can arise.
I didn't even want this.
I mean, you people,
you doctors talked us into this.
You promised us that you could do this.
So what are you saying, Dr. Grey?
She's saying
that our perfectly healthy daughter
started the day sharing three kidneys
and now she only has one
which isn't even working...
which basically means, she has none.
That's what she's telling you.
Can they fix it?
Is she... is Brandi gonna be okay?
We don't know yet.
We're just gonna have to wait and see.
17-year-old male with
multiple G.S.W. to the chest.
We're bringing him straight from the E.R.
so we don't have a lot of time, people.
Let's get him on the table.
Dr. Yang, are you scrubbing in this time?
No.
All right. On my count. One, two...
three.
Let's move, Kepner.
Yang.
Vitals were stable...
after receiving L.R. and packed cells.
The bronch was already placed
when I entered into the O.R.
so I proceeded with the laser endoscopy.
How was your lunch, Dr. Grey?
Oh, it was fine. Actually, no line at all.
I was able to get my sandwich,
find my daughter, see my husband,
go watch the groundbreaking surgery.
That's going on right next door.
And still get back in time to do my work.
Sounds like you have it all, Dr. Grey.
I do, actually. I have it all.
I've heard enough about the lunch.
I don't see any more perforations.
I'm gonna start closing.
Oh, I'd say we should grab
a drink and celebrate,
but I know you don't have
room in your life for joy.
Is it a crime
that I like to focus
when I'm in the workplace?
If so, my apologies.
I focus.
I focus like a laser.
That's why I don't make mistakes.
That's why my patients survive surgery.
That's why I'm not sloppy or careless...
We're missing a sponge.
Or inconsistent like many
of my colleagues are.
Frankly, like most of my students are.
When you and chatty Cathy over here
we're discussing the magic of lunch,
I was focused enough for both of us.
- Dr. Bailey.
- What?
We're missing a sponge.
Well, count again.
We did. Three times.
We've looked everywhere except...
Except where?
Inside the patient.
Did you clear out the clots?
- Yeah.
- Were there any adhesions?
No, the vessels are clear,
and yet the kidney is-is dead.
What if we tried a bypass graft?
A kidney transplant.
We've got the perfectly
matched donor right next door.
They used to share all
three of those kidneys.
Th-there's be no need
for immunosuppressants
because they're identical twins.
They'd be saving each other.
Okay, Karev. It's your idea.
Make it happen.
The parents wanted to see her
before she went up to PICU.
She looks so weird.
Where's her sister?
I cannot look at her without her sister.
Honey, Brandi's gonna be fine.
She'll be here, too.
They're both gonna be fine.
We need Andi back in the O.R.
What's wrong?
We're gonna do a kidney transplant.
Brandi's kidney failed.
It's straining her other organs,
including her heart.
- No, you can't.
- It's okay. Let them take her.
I can't lose them both.
Please. No. You can't.
How much longer? You need me to scrub in?
Almost there.
Well, can you be almost
there a little faster?
There. Got it.
Thank you.
Open the friggin' door.
Kidney looks healthy. Are you ready?
Yeah. Go ahead and scrub in.
Vitals were stable
after receiving L.R. and packed cells.
The bronchoscope was already in place
when I entered the O.R.
so I started with the laser endoscopy.
I had good visualization of
the tumor almost immediately.
Tell me about the tumor.
It was highly vascularized
and had eroded through
the pulmonary artery.
- How do you know?
- I felt it.
- What did you feel?
- A hole in the pulmonary artery.
- Are you sure that it was the pulmonary artery?
- Yes.
Or did you just blindly feel it?
I knew what I was doing and what I felt.
- You had your hand on it?
- I had my hand on it
- and traced the anatomy.
- Are you 100% sure?
She said she's sure!
Enough! It's enough!
This is enough. You can't keep doing this.
You c... you can't...
He's gone.
Dr. Altman, I-I'm sorry, but he's gone,
and this is not gonna bring him back
so please just stop.
Please.
Are you all right, Dr. Kepner,
or do you need time to gather yourself?
No, I...
No.
Okay, then.
I am 100% sure.
All right.
Henry flatlined.
We did compressions, pushed epi,
got a sinus brady, pushed high-dose epi.
He flatlined again.
We did more compressions.
We continued in this manner
until both Dr. Webber and I
decided that his heart would not start.
We called time of death at 8:52 P.M.
You have every reason to
be pissed with me, Karev.
I played you.
I wanted in on that surgery,
and I looked for the weakest link,
and it was you.
That's all right.
Next time I'll know better.
It's not all right.
That was your moment,
and I took it away from you.
What I did today was... sad.
It was pathetic.
An old man acting out of fear.
You get to a point in your career...
hell, in your life...
when you realize you got more
yesterdays than tomorrows.
And that realization is hard on a man.
But when you get a chance
to get in on something like that...
You fight like a tiger,
all because you think
it'll give you just a little
more time in the game.
I don't think you have
to worry about that.
You kidding?
A year from now,
maybe two if I'm lucky,
they'll stick me in an office
in a part of the hospital
nobody ever goes to.
They'll appoint me
to some do-nothing board
that makes up rules
nobody pays attention to.
They'll let me do a couple of appys a week
so I can still call myself a surgeon.
You reach a certain age,
that's what happens.
It's the order of things.
I can't think of anything
more humiliating.
Can you?
No.
Hey, you want to scrub
in on the transplant?
Robbins just needs one of us.
Go ahead.
Really?
Go on or I'm gonna change my mind.
I-I don't know...
Thanks, Karev.
36.
37.
38.
39. Nope. The X-rays are here.
Oh. Look, keep looking.
Uh, Dr. Bailey, we have to close.
He's been under too long.
You have boards coming up.
Is this really what you
want on your record?
Well, don't just stand
there like a whipped puppy.
Check under the liver again.
It's-it's not under the liver.
Excuse me?
It's not in the patient.
Dr. Grey, I-I thought I
taught you the simple,
reliable rules, like when
you don't find the problem
on your first look, check again.
Double-check, triple-check if you have to.
We don't throw our hands up in my O.R.
when a man's life is at stake.
Dr. Bailey, the sponge is
on the bottom of your shoe.
On the...
Wh...
Focus...
like a laser.
Why aren't we getting any urine?
There's a kink in the vessels.
Papaverine, please.
Hey, why are you doing this and not Karev?
He was the one who
suggested the transplant.
I picked Karev's pocket.
You what?
Twice in one day, Karev?
Honest to god...
it was like taking candy from a baby.
No, that's not right.
It's not fair to the baby.
It was easier than
taking candy from a baby.
At least the baby puts
up a bit of a fight.
Removing clamp.
- Whoo!
- Ahh!
- Yes! Oh, we got it.
- We have urine.
The kidney's working. We did it.
Good job.
Dr. Webber exercised
his judgment and stepped in.
So we cracked his chest
and tried to tamponade the bleeding
and get to the source.
He became bradycardic,
so we pushed atropine.
Um, I then realized
he had lost so much blood
because his...
The tumor had eroded through
the pulmonary artery.
- Right.
- That's when he flatlined.
We did compressions...
Pushed epi, got a sinus brady...
Push high-dose epi...
Which is when he flatlined again.
Yes.
And you and Dr. Webber agreed
that he had lost too much blood...
Yes.
And didn't have enough left to circulate,
so his heart...
would not restart.
Yes.
So you called time of death.
- 8:52 P.M.
- 8:52 P.M.
I'm sorry.
Oh, you don't apologize.
You hear me? You don't blame yourself.
You did every single thing
that I would have done.
You were me in that O.R.
You were good
and you did it right.
He just...
He just...
He just died.
I had a husband and a baby
and I was a surgeon.
I had it all.
And then it all...
turned bad.
So I got divorced.
And then I got back on my feet.
I found you.
And then there was a shooting.
So now I am finally back on my feet
again
and I have you again.
I just don't want it to blow up.
Okay. You-you're scared.
See, all right, now...
I am, too.
Why can't we be scared in the same house?
Well, don't act like it's not complicated.
It's not complicated.
We just take it one step at a time.
Put a toothbrush in my house today.
Tomorrow, maybe a couple pairs of socks.
Then a suitcase on the weekend...
I have a child.
I can't just move in with you.
Wait. You-you have a child?
Whoa. When did... when did that happen?
Oh, stop... you are not a funny man.
I met him. Rick, right?
It was a mistake to even
enter into this conversation.
T. rex versus megalosaurus... who wins?
Well, I have no idea.
You know who does?
I do, and so does Tuck.
Megalosaurus is a tenth of the size.
T. rex eats megalo every time.
But T. rex versus pteranodon, though...
Ben...
Pteranodon can fly. That's an easy win.
Unless you think that's a forfeit.
Yeah, I can do this all day,
and so can Tuck.
You're bored already,
and we've been at it 30 seconds.
I like Tuck.
I like hanging out with Tuck.
I like dinosaurs and transformers
and... I like you.
I... want the whole package.
I know you don't come without Tuck.
I know that.
I know who you are.
So that's it?
Nothing?
My toothbrush is in my locker.
One step at a time.
So that went well today.
Hmm. You were a monster.
No, no, no, no,
I was just... I was amped up.
Okay.
Yeah. I think people found me helpful.
Oh. Mm-hmm. Okay.
Okay. Anyways.
I'm gonna go check on the twins,
then I'm gonna head home.
Hey, could you, um, put
the humidifier on in Sofia's room?
She seemed a little
congested this morning.
- Yeah, I noticed that.
- Yeah, but don't give her anything for it.
- I don't think we're there yet.
- All right.
Oh, and give her the pink blanket
that your friend Terry gave us.
She likes that.
- No, no, she doesn't...
- Uh, yes, she does.
And don't put it on her directly
'cause she'll just fling it off.
Lay it down on top of the sheet,
fuzzy side up.
Uh, excuse me.
This is important. Are you getting this?
Fuzzy side up, not down. Up.
- Not down, up.
- Fine, fine, fine.
- Not down. Up. My way.
- Fine, fine.
- My way.
- Fine, fine, fine.
I was a monster.
Hey, Mike.
Hey.
You mind if I get started?
No, no, no, go ahead, Mike.
We were just leaving.
Hey, I'll come see the babies with you.
Seriously, though,
I'm putting the humidifier on.
If only life was just a dress rehearsal...
and we had time for do-overs.
That's something, isn't it, Karev?
What a surgery.
This is a teaching hospital, okay?
You were the chief for 20 years.
You're supposed to be
teaching your residents,
not stealing surgeries
like some shark fifth year.
It's not cool, okay?
It's not fair.
Oh, I think I taught you something today.
You don't give up a
once-in-a-lifetime surgery,
not for any reason,
not for anyone, not ever.
Watch your back, Karev.
I may decide to teach
you something tomorrow.
We'd be able to practice
and practice every moment
until we got it right.
God, I wish you could've
been in there with me today.
Really?
Me, too.
Oh!
- I'm sorry. I wasn't...
- No, no.
I'm-I'm sorry. I was... hearing things.
It was... long day.
I'm just gonna... okay.
Unfortunately...
every day of our lives
is its own performance.
She's gonna need rehab,
but the fact that her
legs are moving already
is a really good sign.
Is this a private party
or can anybody join in?
Here you go. Brandi...
meet Andi.
She's the one who's been kicking
you in the ass your whole life.
Can we, um...
Is it okay if we touch 'em?
Of course you can.
Charley, look at them.
- They're beautiful.
- Look at them, they're perfect.
It seems like even when we
get the chance to rehearse
and prepare...
and practice...
Sweetie, you have to go to sleep.
You have to.
Just walk her around.
Oh, I am too tired to walk.
Ohh.
- Is that from today?
- Mm-hmm.
She looks bigger.
Hey, are you getting bigger?
Okay, she's gonna take her
first steps any minute.
- I can feel it.
- She is getting bigger.
- She looks bigger.
- Mm-hmm.
Come on. Come get the giraffe.
You're just the cutest
kid on the entire planet.
- Why is that?
- Oh!
- Derek, Derek.
- She's walking.
- Where's the... oh, where's the camera?
- Come to daddy.
- Come to daddy.
- Turn it on.
Hi. Hi, baby.
- I can't open it. I can't open it.
- Hi, baby Zola. Hi, baby.
I can't... I can't... I can't do this.
I can't... oh, gosh.
Turn it on! Turn it on!
- Right now! Right now!
- I can't get it on! I can't get it on!
There. Ah! Walk for me.
We're still never quite ready
for life's grand moments.
- Hi, baby! Go back.
- Oh, my goodness. Oh, I missed it!
Good girl!
Have you ever had the
starring role in a play...
A solo in a recital?
Okay, she's gonna take her
first steps any minute.
I can feel it.
All eyes on you...
Okay, so I am gonna give you the giraffe,
and maybe she'll walk to you.
Well, she's not gonna do it on cue.
She's gonna surprise us, right?
You gonna surprise us? Here you go.
Waiting for you to do...
what they came to see...
- Oh! Hi. Yeah, daddy.
- She's gonna take her first steps
while she's in day care,
- and then I'm gonna kill myself.
- No, she won't.
You're not gonna do that,
right, Zo? Zo, come to daddy.
Come to daddy.
Come on. Come get the giraffe.
You're just the cutest
kid on the entire planet.
Why is that?
She's perfect.
Okay.
Feeling the incredible
pressure to perform.
There was a time when
they used to call operating rooms
an operating theater.
It still feels like one.
Scores of people get ready for the show.
The sets are arranged.
There are costumes...
masks...
props.
Everything has to be rehearsed...
choreographed...
All leading to the moment
when the curtain goes up.
You know what they say
about Carnegie Hall?
There's only one way to get there.
Practice, practice, practice
until it is perfect, people.
This is a long, complex procedure
with many parts.
Therefore many opportunities for error.
So we're gonna go over this again.
Team leaders, let's get in place.
All right, green team over here, please.
Let's go, red.
We've offered this family
every pro bono dollar,
every surgical hand,
every resource this hospital has.
So I'm asking you for every
resource that you have.
Be sharp, be present, be focused.
Dr. Robbins has been
caring for these children
since the day they were born.
They will each get a new life today.
Our actions will decide what
kind of lives they will be.
Let's begin.
I thought I had Dr. Knox.
You know what I love about you?
Your warmth.
You were doing the conjoined twins.
- Well, now Knox is doing the conjoined twins.
- Uh-huh.
Uh, we're not talking about it.
Oh, of course we're talking about it.
It is a crazy idea
that I am not talking about
- because it's crazy.
- It's not crazy.
We'd sleep in one bed,
we would have breakfast at the same table,
we'd have one electric
bill instead of two.
Oh, that's why you want
me to move in with you,
so we could save on the electricity?
Yeah, it's the responsible thing to do...
for the planet.
I am not moving in with you.
It w-what, look, we've been together,
what, two weeks?
Two weeks and nine months,
before the pause.
And I want to hit play again,
right where we left off.
I don't want to start at the beginning.
Because it's good for the planet?
And I have a better TV.
Look, come on now. Admit it.
You-you want to live with me.
You love me.
I want...
Knox back.
Mm.
Flaps are inset and viable.
We are looking at at least 18 hours,
so come and go if you need to,
hydrate, eat,
but be here at least 30 minutes
before your procedures.
All right. Next up, general surgery.
First we need to establish
each baby's blood supply
to the shared colon.
Then we separate the colon,
making the first incision...
I will make the first incision.
We'll separate the colon.
Okay, and now I'm checking
the displaced kidneys...
To make sure they're
intact and functioning.
Uh, that's implied.
I don't care. Say it.
Checking the kidneys to make sure
they're intact and functioning.
Man, she's wound up tight.
Thought you were off work today.
I won't see another one
of these in my lifetime.
- Okay, you need to tie that off better, though.
- You're doing the flip, right,
- Karev, with Robbins?
- Uh-uh.
The flip's a critical part. You ready?
- Yes, sir.
- You forgot to cauterize.
- You want this baby to bleed out?
- Do I...
- No, I...
- Yeah, I should think not.
Look, I know this procedure is her baby,
but she keeps nitpicking everybody,
she'll destroy their confidence.
- Don't let her do that to you.
- Oh, no, sir.
Good, because if this flip goes wrong,
she's gonna blame you.
It'll go on your record,
and-and boards coming up...
it's not gonna look good.
- Did you check the pelvis?
- I-I...
Glad it's not me.
Okay, it's time to flip them.
Karev, you're up.
Ready?
Yeah.
And why is the flip so important?
It just gets very tricky.
They have open incisions,
so they have to stay sterile,
and we have to make sure
that they stay intubated
- and monitored.
- Okay.
And we also have to keep
all their I.V.s and wires
from getting tangled and
intertwined in the process.
You know, I...
Imagine, um,
changing the battery of your car
while speeding down the freeway.
Except it's not a car or a battery.
I mean, they're your babies.
So... it's a bad analogy. I'm sorry.
No, that's the first thing you've said
that I've totally understood.
But if the flip goes wrong, then...
everything after that is...
is hosed.
Well, the doctors have planned
and rehearsed this for weeks.
I mean, they've got it down.
Karev, you rushed it.
You're like two steps ahead of me.
No, you over me.
Yours over mine, everything's fine.
Mine over yours, babies in the morgue.
That's how it works.
That's your pneumonic device?
Great. Now Brandi's wounds are exposed,
and little Andi's gone without
oxygen for a whole minute.
Okay, I... can we start over?
No, there's no time.
Let's just finish this practice
and try the flip again. Next.
- Neuro.
- Ortho.
Okay, we will access and separate
the conjoined spinal canal.
Separate the bony elements of the spine.
Well, that was a train wreck.
You nearly killed both dolls.
Look, I have it. I know it.
If only freakin' Robbins
would trust me to do it.
Doll killer.
Meredith Grey. Okay, come with me.
O.R. two. Right away.
Okay, I am gonna tell you
something about my personal life.
Really?
Okay, um, my personal life
is none of your business.
The fact that I know things
about your personal life
is one of the great
sadnesses of my existence.
Sorry about that.
And the fact that you're
going to know about mine
is exponentially worse,
but I don't see how we get around it.
Okay.
We're about to operate with Dr. Warren.
He and I are... involved.
Everybody knows that.
Can you not pretend?
Oh, oh. You and Dr. Warren? Wow.
Uh, he is going to try and
discuss personal matters
in the O.R. today,
- and I don't want that to happen.
- Okay.
Okay, so I'm going to teach you a lot.
And you are gonna ask questions... a lot.
And if he gets a personal
word in edgewise,
I want you to forget which is
the business end of a scalpel
real quick
and ask for help.
Okay, but let me get this straight.
You pulled me out of
a once-in-a-lifetime surgery
to be a buffer between
you and your boyfriend?
Oh, don't use that kind
of language with me.
Spinal separation complete.
I have to go. Teddy.
It's been two weeks now.
You need a break, and she does, too.
I gotta go.
Okay, I am now prepared
to separate them completely.
Wait. Hold on. What about complications?
I mean, what if there's
a double hemivertebra
or a tethered cord?
We will cross that bridge
when we come to it.
- We're done here.
- I-I'm sorry.
What if we're standing
on that bridge right now?
Dr. Robbins, I said...
No, no, no, no.
We haven't even separated them yet.
We haven't gone through
the post-separation surgeries.
- Dr. Robbins, stop.
- There's so much m...
We're done practicing.
We have practiced our parts
not only here in this O.R.,
but in the shower, on your drive to work.
We are ready.
We know what to do.
Now we just have to do it.
Ladies and gentlemen, present to you
Andi and Brandi Edwards.
Let's give them new lives,
shall we?
It's showtime.
Raising the skin flap. Avery, you there?
- One step ahead of you.
- You want to race?
No, no, no. No racing.
That was fun last night.
Did you and Mer have a good time?
- I know Julia had a good time.
- Yeah, we did.
You got enough length there for coverage?
Yeah, I'm dissecting from
the base to the midline.
Did Mer say anything about Julia?
- She liked her.
- Jackson, slow down.
And Zola like Julia, too?
Yes, she did. Everybody liked Julia.
Anybody else here meet Julia?
Did you like her?
Show of hands if you liked her.
Ah, you did? You did?
I think I'll update the parents.
Hunt, they're clearly racing.
- No racing.
- We're not racing.
We have been rehearsing this for months,
and now they're gonna
jeopardize the patient because...
Robbins, you take care of your team.
I'll look at the big picture.
- Done.
- I win.
And by that, we mean ready
for the colon resection.
- Cafeteria?
- Race you there.
General surgery teams, let's go.
Is that enough lap pads?
A little more is not gonna hurt.
They'll help mobilize it.
How's Zola doing?
Oh, she's great. Thanks.
She's about a minute away from walking.
That's great.
A-and she's in the day care downstairs?
She is, yeah. She really likes it.
Must be nice, having
the whole family in the building.
Yeah.
It's a win-win.
You love Dr. Shepherd, and he loves you,
and you see each other at work,
and then you see each other at home.
Just more of a good thing.
Dr. Bailey, is that
the spleen right there?
That is the spleen.
So are we gonna take out the whole thing?
We will. We will take it right out.
So how many suture ligatures
you think we'll need to do
for the splenic vessels?
Oh, could be two,
could be three.
I'll, uh, see if two does it.
But I may have to throw in a third.
This is good stuff.
I'm glad I skipped the conjoined twins.
There's beauty in the basics.
There's beauty in sharing a bowl of cereal
with a woman that...
I can't remember how to do a stick tie.
No shame in that.
There's no stupid questions.
You sure about that?
Dr. Altman.
Dr. Yang.
You paged me?
Oh, I didn't realize Cristina was...
Do you want me to step aside so she can...
- No.
- But you paged her.
It's no problem, really. I don't mind.
I can go peek in on
the progress of the conjoined twins
- If you'd rather have...
- Stay put, Kepner.
Yang.
From the beginning?
Yes.
Vitals were stable after receiving L.R.
and packed cells.
The bronch was already placed
when I entered the O.R.
so I proceeded with the laser endoscopy
using the c-o-2 laser.
Step by step.
I had good visualization of
the tumor almost immediately.
About 80% of the tumor had been vaporized
when the bleeding began.
He had clots, which
were blocking my scope.
I passed a brush through
the scope to clear the field.
However, Henry's
hemorrhaging was so severe...
Suction, Kepner.
Kepner, suction.
Yang?
Henry's hemorrhaging was so severe
that the brush did not solve the problem.
SATs dropped to 88.
Blood was coming out of the E.T. tube.
At that point, Dr. Webber
exercised his judgment
and stepped in.
We cracked his chest and
tried to get to the source.
Henry became bradycardic
so we pushed atropine.
Then I realized,
the tumor had eroded through
the pulmonary artery.
He flatlined.
We did A.C.L.S.
protocol and got sinus brady.
We pushed high-dose epi.
He flatlined again.
We did more compressions.
We continued in this manner
until Dr. Webber and I both agreed
that since he already lost more
than half his blood volume,
his heart could not restart.
We called time of death... 8:52 P.M.
Again.
When I entered the O.R.
Henry's vitals had been stable.
He had received L.R. and packed cells.
The bronch was already placed
so I proceed with the laser endoscopy.
And then thanks to the unhealthy
level of comfort she felt
working for her husband,
she took some liberties
with the clinical trial
and now neither of
their careers will ever be the same.
You know, I would love to go back
to dividing the gastrocolic ligament,
but I'm not sure I remember how to...
Figure it out. Look, all I'm saying is,
it'd be nice to maintain some boundaries
so a person's life doesn't fall to pieces
like Dr. Grey's here.
For the record, my life
is pretty great right now.
You hush. No one's
interested in your life.
- Dr. Grey.
- Please ask me about a spleen.
Who's the last person you see
before you fall asleep at night?
Or a pancreas. I've got
a very good view of it.
It's tan and lobulated...
Answer the question.
The last person you see
before you fall asleep
at night.
Derek Shepherd.
Must be nice,
all I'm sayin'.
Zero silk.
Thank god.
They're separating the colon right now.
Making sure that they each
have good blood supply.
Have they done the flip thing yet?
That's next.
Um, I gotta get outta here.
Is there a bar around here?
Um... yeah. Across the street.
He's not a total drunk
if that's what you're thinking.
He has a job.
It's a good one, with benefits.
Seriously, Gretchen, I-I-I wasn't...
No, I know what you were thinking.
It's what everybody thinks.
That we accidentally got pregnant
and now we're stuck with
the kids we can't take care of.
You're probably placing bets in the O.R.
of how long we'll stay together
or whose mother is gonna
end up raising the girls.
Well, you can tell everyone in that room
that they're wrong.
We love each other,
and we wanted these babies.
We're staying together,
and we will do whatever we need to do
to make sure that they're okay...
Including accepting
the hospital's charity,
even if I have to sit
around with judgy doctors.
I wasn't judging you.
Really. I-I just...
I was thinking
how lucky you are
to be with somebody that you love.
Looks like Andi has the bulk of
the blood supply to the colon.
So we'll give her all the colon then?
And leave Brandi with an ileosotomy?
I don't think so.
I'll do an ileoproctostomy.
Maybe they should just
share so we don't have to...
No. We'll do it my way.
Check the function of
the blood supply to the kidney.
Flip's coming up,
and I don't want a repeat
of this morning's rehearsal.
That's what I want to talk to you about.
I'm a little nervous about it.
We practiced that flip before,
and it turned out great.
And today...
Robbins doesn't trust anybody today.
Get to your point, Karev.
I just don't want to screw this up.
We gotta be the perfect team.
And you're not comfortable
doing it with her?
She's making everybody uncomfortable.
I get it. You don't need
to say another word.
Who wants to replace Karev on the flip?
No, that's not what I meant.
Uh, I'll do it. Sir.
Mm.
You sure you can do this?
Disconnect and cap subclavian I.V.s,
anesthesiologist holds the E.T. tube,
designated circulators
and the techs hold the monitors.
Yours over mine, babies...
Don't. Don't.
Why aren't you doing the flip?
Webber snaked it from me.
Webber? But he hasn't practiced.
You've been practicing this for two weeks.
Yeah, tell him that.
I told the parents that you've practiced.
I told them that you had
this thing down cold.
Okay, one...
two...
three.
Easy, easy, easy.
I hope he drops her.
How's he gonna like it when
one twin's pushing her sister
in a wheelchair the rest of their lives?
I'm just pissed at Webber.
You're just... a monster.
And we're done.
- Whoo-hoo!
- All right!
Oh, good. Okay.
- Nice work.
- Well done.
All right!
Right?
He flatlined again.
Then Dr. Webber and I decided
that without any blood left to circulate,
his heart would not restart,
so we called time of death at 8:52 P.M.
Tell me about the tumor.
The tumor had eroded through
the pulmonary artery.
Okay.
How do you know?
Know what?
When you say that the tumor
eroded into the pulmonary artery,
how do you know?
There was a hole in the artery.
- Did you actually see the artery?
- I felt it.
You just blindly felt it?
It wasn't a blind feel.
I knew what I was doing.
I traced it with my fingers.
- Uh-huh.
- It was the posterior segmental artery.
I'm sure of it.
How can you be sure?
You never got a visual.
I-I followed the tracheal bifurcation.
It came directly off
the main pulmonary artery.
Okay, Kepner, let's get a few
of these lymph nodes for biopsy
and then get ready to close.
I didn't call it without being sure.
From the top, Yang.
Um, his vitals were stable
after receiving fluids.
He was under anesthesia,
and the bronch was placed
when I entered the O.R.
so I proceeded with the laser endoscopy
using the c-o-2 laser.
Dr. Bailey, op notes done.
Do you mind if I run out for a minute
until the next patient's ready?
He's gonna be here 30 minutes from now.
I know. I can get out and
make it back in that time.
You're going to try and get a sandwich
then I'm going to get the sad
story 40 minutes from now
about how long the line
was in the cafeteria.
He's a nice man. You could do
without me for half an hour.
- Dr. Grey.
- He won't bite.
For god sake.
You can run, but you can't hide.
- Look, what we have is good.
- Mm-hmm.
Now why on Earth do you want to rush it
and-and complicate it
and-and quite possibly destroy it?
Because we're not kids anymore.
B-because my life is happening now,
not ten years from now or five
or a respectable 14 months,
but right now.
And I want to share it,
every day, every morning, every evening,
a-and if that's not what you want,
then I guess we're just
not right for each other.
Now look, we just got back
together two weeks ago.
I-I can't...
Well, I guess I just got my answer.
Hey, come o... it's been two weeks.
Excuse me. Excuse me. Excuse me.
Okay. Look at this face.
Seriously, look at this face.
Yeah, yeah, yeah, super cute.
They're in the spinal cord now.
Bailey spent the last two hours
telling me how crappy my life is,
but look at this face.
Oh, Zola, look. There's your daddy.
He's about to repair a myelomeningocele.
Can you say myelomeningocele?
- What an ass.
- Hey, language.
Baby here.
He pretends he's all gentle and sad
with the Alzie wife at home,
dispensing zen wisdom
from his half century of being a surgeon.
Well, guess what.
Yoda down there...
biggest shark of 'em all.
The guy is dangerous and mean.
I think what Teddy's doing is mean.
It's fine.
No, it's horrible.
It's-it's horrible and...
You know what else is horrible?
Having a dead husband.
No, you know what? You don't know, okay?
It's not right.
Teddy's O.R., it's like...
it's like a morgue.
Well, Altman's husband
died on Yang's table.
Payback's a bitch.
Oh, will you just shut up? It's fine.
I can handle it.
Well, it has been two weeks of this.
It must be getting to you.
No more than it did yesterday
or the day before that
or the day before that.
It's fine. I'm... I can handle it.
Damn it. Spinal dermoid cyst.
It's all tangled up in the spinal root.
Yeah, there's a lot of scarring in there.
I don't see a clean approach.
Well, no, well, you have to take it out
because the cyst could become malignant.
Yes, we're aware. Thank you.
Maybe if I can come in
from an angle... like this,
but then we risk
the contents spilling out...
Which could cause a chemical meningitis.
Dr. Robbins, we've got this.
Okay, what if we stretch
the nerve root here?
Well, that might paralyze Brandi.
Yes, Brandi might end up paralyzed.
Yeah, no one understands
that better than we do,
which is why we will be
making this decision, okay?
Us. Not you.
Us. You all right with that?
Just make sure... you.
I...
Yes, I'm okay with that.
No more talking from anyone in this O.R.
We need complete silence from now on.
Hey.
I was in the shop downstairs,
and I figured, you know,
now there's gonna be two of 'em,
- they're gonna need their own clothes.
- Ohh.
So I figured Brandi
could be the punk first
and then we could make 'em switch
and see which one wears 'em better.
I love you.
I love you, too.
Oh!
Uh, they're, uh,
about to separate the girls,
which is so...
cool.
It...
Okay, we're ready for the final cut.
All right. Separation complete.
No, no, no, no, no.
Not yet, not yet.
We still need to check
on the motor function.
Let's do...
2 milliamps of stimulation
on Andi first, please.
All right.
All right. Let's try Brandi now.
2 milliamps of stimulation.
Let's go up to 3 milliamps, please.
Come on, Brandi. Just give
us some kind of movement.
Anything.
All right. Let's go to 4
milliamps of stimulation.
Hey, there you go.
All right. Good.
Great work, everyone. One step at a time,
by the numbers, like we practiced.
Let's move.
- Okay, count of three. One, two three.
- Two, three.
Gently, gently.
Nicely done.
We've still got a hell
of a long way to go.
I'll be checking in on you both.
How's it going in here, Sloan?
The flap is well-vascularized,
has good cap refill,
and is covering the defect perfectly.
I nailed it.
Did Avery nail his?
What's going on, Avery?
You should've finished your flap by now.
Yet I haven't even started.
Why don't you give me
a call when you're ready?
Her kidney's completely necrotic.
V-tach.
Okay, push 30 milligrams of calcium.
She's already showing
signs of renal failure.
Her kidney was fine earlier.
Maybe something caused an
arterial spasm while we
were checking the function
of the blood supply.
I don't know, but at this point,
I don't think it's salvageable.
She hasn't had any urine output
since she's been in this O.R.
How did it happen?
Sometimes complications can arise.
I didn't even want this.
I mean, you people,
you doctors talked us into this.
You promised us that you could do this.
So what are you saying, Dr. Grey?
She's saying
that our perfectly healthy daughter
started the day sharing three kidneys
and now she only has one
which isn't even working...
which basically means, she has none.
That's what she's telling you.
Can they fix it?
Is she... is Brandi gonna be okay?
We don't know yet.
We're just gonna have to wait and see.
17-year-old male with
multiple G.S.W. to the chest.
We're bringing him straight from the E.R.
so we don't have a lot of time, people.
Let's get him on the table.
Dr. Yang, are you scrubbing in this time?
No.
All right. On my count. One, two...
three.
Let's move, Kepner.
Yang.
Vitals were stable...
after receiving L.R. and packed cells.
The bronch was already placed
when I entered into the O.R.
so I proceeded with the laser endoscopy.
How was your lunch, Dr. Grey?
Oh, it was fine. Actually, no line at all.
I was able to get my sandwich,
find my daughter, see my husband,
go watch the groundbreaking surgery.
That's going on right next door.
And still get back in time to do my work.
Sounds like you have it all, Dr. Grey.
I do, actually. I have it all.
I've heard enough about the lunch.
I don't see any more perforations.
I'm gonna start closing.
Oh, I'd say we should grab
a drink and celebrate,
but I know you don't have
room in your life for joy.
Is it a crime
that I like to focus
when I'm in the workplace?
If so, my apologies.
I focus.
I focus like a laser.
That's why I don't make mistakes.
That's why my patients survive surgery.
That's why I'm not sloppy or careless...
We're missing a sponge.
Or inconsistent like many
of my colleagues are.
Frankly, like most of my students are.
When you and chatty Cathy over here
we're discussing the magic of lunch,
I was focused enough for both of us.
- Dr. Bailey.
- What?
We're missing a sponge.
Well, count again.
We did. Three times.
We've looked everywhere except...
Except where?
Inside the patient.
Did you clear out the clots?
- Yeah.
- Were there any adhesions?
No, the vessels are clear,
and yet the kidney is-is dead.
What if we tried a bypass graft?
A kidney transplant.
We've got the perfectly
matched donor right next door.
They used to share all
three of those kidneys.
Th-there's be no need
for immunosuppressants
because they're identical twins.
They'd be saving each other.
Okay, Karev. It's your idea.
Make it happen.
The parents wanted to see her
before she went up to PICU.
She looks so weird.
Where's her sister?
I cannot look at her without her sister.
Honey, Brandi's gonna be fine.
She'll be here, too.
They're both gonna be fine.
We need Andi back in the O.R.
What's wrong?
We're gonna do a kidney transplant.
Brandi's kidney failed.
It's straining her other organs,
including her heart.
- No, you can't.
- It's okay. Let them take her.
I can't lose them both.
Please. No. You can't.
How much longer? You need me to scrub in?
Almost there.
Well, can you be almost
there a little faster?
There. Got it.
Thank you.
Open the friggin' door.
Kidney looks healthy. Are you ready?
Yeah. Go ahead and scrub in.
Vitals were stable
after receiving L.R. and packed cells.
The bronchoscope was already in place
when I entered the O.R.
so I started with the laser endoscopy.
I had good visualization of
the tumor almost immediately.
Tell me about the tumor.
It was highly vascularized
and had eroded through
the pulmonary artery.
- How do you know?
- I felt it.
- What did you feel?
- A hole in the pulmonary artery.
- Are you sure that it was the pulmonary artery?
- Yes.
Or did you just blindly feel it?
I knew what I was doing and what I felt.
- You had your hand on it?
- I had my hand on it
- and traced the anatomy.
- Are you 100% sure?
She said she's sure!
Enough! It's enough!
This is enough. You can't keep doing this.
You c... you can't...
He's gone.
Dr. Altman, I-I'm sorry, but he's gone,
and this is not gonna bring him back
so please just stop.
Please.
Are you all right, Dr. Kepner,
or do you need time to gather yourself?
No, I...
No.
Okay, then.
I am 100% sure.
All right.
Henry flatlined.
We did compressions, pushed epi,
got a sinus brady, pushed high-dose epi.
He flatlined again.
We did more compressions.
We continued in this manner
until both Dr. Webber and I
decided that his heart would not start.
We called time of death at 8:52 P.M.
You have every reason to
be pissed with me, Karev.
I played you.
I wanted in on that surgery,
and I looked for the weakest link,
and it was you.
That's all right.
Next time I'll know better.
It's not all right.
That was your moment,
and I took it away from you.
What I did today was... sad.
It was pathetic.
An old man acting out of fear.
You get to a point in your career...
hell, in your life...
when you realize you got more
yesterdays than tomorrows.
And that realization is hard on a man.
But when you get a chance
to get in on something like that...
You fight like a tiger,
all because you think
it'll give you just a little
more time in the game.
I don't think you have
to worry about that.
You kidding?
A year from now,
maybe two if I'm lucky,
they'll stick me in an office
in a part of the hospital
nobody ever goes to.
They'll appoint me
to some do-nothing board
that makes up rules
nobody pays attention to.
They'll let me do a couple of appys a week
so I can still call myself a surgeon.
You reach a certain age,
that's what happens.
It's the order of things.
I can't think of anything
more humiliating.
Can you?
No.
Hey, you want to scrub
in on the transplant?
Robbins just needs one of us.
Go ahead.
Really?
Go on or I'm gonna change my mind.
I-I don't know...
Thanks, Karev.
36.
37.
38.
39. Nope. The X-rays are here.
Oh. Look, keep looking.
Uh, Dr. Bailey, we have to close.
He's been under too long.
You have boards coming up.
Is this really what you
want on your record?
Well, don't just stand
there like a whipped puppy.
Check under the liver again.
It's-it's not under the liver.
Excuse me?
It's not in the patient.
Dr. Grey, I-I thought I
taught you the simple,
reliable rules, like when
you don't find the problem
on your first look, check again.
Double-check, triple-check if you have to.
We don't throw our hands up in my O.R.
when a man's life is at stake.
Dr. Bailey, the sponge is
on the bottom of your shoe.
On the...
Wh...
Focus...
like a laser.
Why aren't we getting any urine?
There's a kink in the vessels.
Papaverine, please.
Hey, why are you doing this and not Karev?
He was the one who
suggested the transplant.
I picked Karev's pocket.
You what?
Twice in one day, Karev?
Honest to god...
it was like taking candy from a baby.
No, that's not right.
It's not fair to the baby.
It was easier than
taking candy from a baby.
At least the baby puts
up a bit of a fight.
Removing clamp.
- Whoo!
- Ahh!
- Yes! Oh, we got it.
- We have urine.
The kidney's working. We did it.
Good job.
Dr. Webber exercised
his judgment and stepped in.
So we cracked his chest
and tried to tamponade the bleeding
and get to the source.
He became bradycardic,
so we pushed atropine.
Um, I then realized
he had lost so much blood
because his...
The tumor had eroded through
the pulmonary artery.
- Right.
- That's when he flatlined.
We did compressions...
Pushed epi, got a sinus brady...
Push high-dose epi...
Which is when he flatlined again.
Yes.
And you and Dr. Webber agreed
that he had lost too much blood...
Yes.
And didn't have enough left to circulate,
so his heart...
would not restart.
Yes.
So you called time of death.
- 8:52 P.M.
- 8:52 P.M.
I'm sorry.
Oh, you don't apologize.
You hear me? You don't blame yourself.
You did every single thing
that I would have done.
You were me in that O.R.
You were good
and you did it right.
He just...
He just...
He just died.
I had a husband and a baby
and I was a surgeon.
I had it all.
And then it all...
turned bad.
So I got divorced.
And then I got back on my feet.
I found you.
And then there was a shooting.
So now I am finally back on my feet
again
and I have you again.
I just don't want it to blow up.
Okay. You-you're scared.
See, all right, now...
I am, too.
Why can't we be scared in the same house?
Well, don't act like it's not complicated.
It's not complicated.
We just take it one step at a time.
Put a toothbrush in my house today.
Tomorrow, maybe a couple pairs of socks.
Then a suitcase on the weekend...
I have a child.
I can't just move in with you.
Wait. You-you have a child?
Whoa. When did... when did that happen?
Oh, stop... you are not a funny man.
I met him. Rick, right?
It was a mistake to even
enter into this conversation.
T. rex versus megalosaurus... who wins?
Well, I have no idea.
You know who does?
I do, and so does Tuck.
Megalosaurus is a tenth of the size.
T. rex eats megalo every time.
But T. rex versus pteranodon, though...
Ben...
Pteranodon can fly. That's an easy win.
Unless you think that's a forfeit.
Yeah, I can do this all day,
and so can Tuck.
You're bored already,
and we've been at it 30 seconds.
I like Tuck.
I like hanging out with Tuck.
I like dinosaurs and transformers
and... I like you.
I... want the whole package.
I know you don't come without Tuck.
I know that.
I know who you are.
So that's it?
Nothing?
My toothbrush is in my locker.
One step at a time.
So that went well today.
Hmm. You were a monster.
No, no, no, no,
I was just... I was amped up.
Okay.
Yeah. I think people found me helpful.
Oh. Mm-hmm. Okay.
Okay. Anyways.
I'm gonna go check on the twins,
then I'm gonna head home.
Hey, could you, um, put
the humidifier on in Sofia's room?
She seemed a little
congested this morning.
- Yeah, I noticed that.
- Yeah, but don't give her anything for it.
- I don't think we're there yet.
- All right.
Oh, and give her the pink blanket
that your friend Terry gave us.
She likes that.
- No, no, she doesn't...
- Uh, yes, she does.
And don't put it on her directly
'cause she'll just fling it off.
Lay it down on top of the sheet,
fuzzy side up.
Uh, excuse me.
This is important. Are you getting this?
Fuzzy side up, not down. Up.
- Not down, up.
- Fine, fine, fine.
- Not down. Up. My way.
- Fine, fine.
- My way.
- Fine, fine, fine.
I was a monster.
Hey, Mike.
Hey.
You mind if I get started?
No, no, no, go ahead, Mike.
We were just leaving.
Hey, I'll come see the babies with you.
Seriously, though,
I'm putting the humidifier on.
If only life was just a dress rehearsal...
and we had time for do-overs.
That's something, isn't it, Karev?
What a surgery.
This is a teaching hospital, okay?
You were the chief for 20 years.
You're supposed to be
teaching your residents,
not stealing surgeries
like some shark fifth year.
It's not cool, okay?
It's not fair.
Oh, I think I taught you something today.
You don't give up a
once-in-a-lifetime surgery,
not for any reason,
not for anyone, not ever.
Watch your back, Karev.
I may decide to teach
you something tomorrow.
We'd be able to practice
and practice every moment
until we got it right.
God, I wish you could've
been in there with me today.
Really?
Me, too.
Oh!
- I'm sorry. I wasn't...
- No, no.
I'm-I'm sorry. I was... hearing things.
It was... long day.
I'm just gonna... okay.
Unfortunately...
every day of our lives
is its own performance.
She's gonna need rehab,
but the fact that her
legs are moving already
is a really good sign.
Is this a private party
or can anybody join in?
Here you go. Brandi...
meet Andi.
She's the one who's been kicking
you in the ass your whole life.
Can we, um...
Is it okay if we touch 'em?
Of course you can.
Charley, look at them.
- They're beautiful.
- Look at them, they're perfect.
It seems like even when we
get the chance to rehearse
and prepare...
and practice...
Sweetie, you have to go to sleep.
You have to.
Just walk her around.
Oh, I am too tired to walk.
Ohh.
- Is that from today?
- Mm-hmm.
She looks bigger.
Hey, are you getting bigger?
Okay, she's gonna take her
first steps any minute.
- I can feel it.
- She is getting bigger.
- She looks bigger.
- Mm-hmm.
Come on. Come get the giraffe.
You're just the cutest
kid on the entire planet.
- Why is that?
- Oh!
- Derek, Derek.
- She's walking.
- Where's the... oh, where's the camera?
- Come to daddy.
- Come to daddy.
- Turn it on.
Hi. Hi, baby.
- I can't open it. I can't open it.
- Hi, baby Zola. Hi, baby.
I can't... I can't... I can't do this.
I can't... oh, gosh.
Turn it on! Turn it on!
- Right now! Right now!
- I can't get it on! I can't get it on!
There. Ah! Walk for me.
We're still never quite ready
for life's grand moments.
- Hi, baby! Go back.
- Oh, my goodness. Oh, I missed it!
Good girl!