Grey's Anatomy (2005–…): Season 8, Episode 22 - Let the Bad Times Roll - full transcript
Six hours after their oral boards, the fifth years relive their answers and worry about their chances. Back at the hospital, Bailey has to woo potential candidates for the hospital and Mark...
Extract Subtitles From Media
Drop file here
Supports Video and Audio formats
Up to 60 mins and 2 GB
Are you wondering how healthy the food you are eating is? Check it - foodval.com
---
Taxi!
Carpe diem.
That was hell.
Actual physical hell.
I think I went a tad overboard.
How annoying is carpe diem?
A lot overboard.
They took something from me.
Yeah, that wasn't an exam.
That was an interrogation.
Like, way... way overboard.
- The mind games.
- Trick questions.
It felt like Al Qaeda in there.
How are you supposed to plan a life,
a career, a family,
if you're always carpe-ing the diem?
Next test is june.
June's not bad.
2013.
Oh.
What's done is done.
Let's just not even talk about it anymore.
If we all seized every
moment of every day,
there wouldn't be doctors.
Who would sit through med school?
Anyone know how Alex did?
Anyone know if Alex made it?
Made it?
What do you mean, made it?
We'd all be too busy...
living in the now.
Whatever that means.
Hey.
You okay?
I'm...
I'm not sure.
I-I hope you're not
worried about last night.
I'm not worried about last night.
I'm worried because I checked
with some of my friends
on the committee and
one of your Seattle Grace doctors
didn't pass.
Any idea who?
They weren't sure.
But if it's Jackson,
he'll blame me forever.
Welcome to the American
Medical Board of Surgery
Certifying Examination.
We'll give you four separate scenarios
in 3 30-minute sessions,
10-minute breaks in between.
To pass the test,
you must pass two
of the three sessions.
- Now you can fail a session and still pass.
- Still pass.
But examiners
are not permitted to indicate
whether you passed or failed
each session.
You'll be rated on your ability
to diagnose, manage treatment,
handle the unexpected...
Basically, the strength
of your constitution in crisis.
And when we move on
to the, uh, next scenario,
th-there's no doubling back,
meaning,
once a question is asked...
You can't go back.
Understood, sir.
Are you in a hurry,
Dr... Yang?
No, sir. Just...
ready when you are.
Mm-hmm.
So then,
a 65-year-old woman
is being seen by
her primary care physician
for a workup
of osteoporosis
when she is found to have
elevated calcium.
Her P.T.H. level
was well above normal.
Her doctor sends her
to you.
Elevated calcium and P.T.H.
would indicate primary hyperparathyroidism.
I would offer the patient
a para...
thyroidectomy.
And first I would explore
the right side.
If that gland is large...
I would biopsy it.
Um, after doing the biopsy,
I would...
Hang-hang on.
What-what did
the pathologist report say?
Path comes back
with parathyroid hyperplasia.
Uh... Um, and how large
was the gland?
How much longer are we
gonna give this Dr. Karev?
15?
Next, I would resect it and
explore the other glands.
Aggressive choice.
Well, I suppose I could
wait for the I.P.M.
before taking further actions.
Mm-hmm.
Are you sure you're okay with that?
Yes, I'm okay with that.
Mm-hmm.
If the I.P.M...
showed P.T.H. levels
in the normal range...
Dr. Grey?
I would feel comfortable
concluding the procedure.
Dude, there's no other way?
Helicopter. Magic carpet.
That lane is open.
That's the bus lane.
I don't see any buses.
I'll get a ticket.
Come on, man. I'll give
you double any ticket.
What about my insurance?
Come on, man. Just take the bus lane.
- Nah.
- How far are we?
20 blocks, give or take.
Catch the game last night?
Come on. Move.
I heard it went 11 innings.
Move! Move. Look out.
Move. Come on. Come on.
Okay, who wants more pancakes?
You haven't had any. Sit down.
I can't sit still.
He's taking his test right now.
It's cute, you being nervous for Jackson.
You want some more juice?
It's paternal. You're a natural father.
Are you sure you don't want anything?
I could make some bacon...
We should have a baby.
Don't freak out.
I-I mean, I like... this.
I like you,
I like your kid,
and I like your kid's moms.
And I...
You-you know,
you-you don't have
to say anything right now.
Just g-go back to worrying about Jackson,
and we-we can talk about this later.
Um, I would say no rush, but, you know,
actually, my F.S.H.
levels would suggest that
rushing a little might not be
the worst thing in the world.
Julia wants to have a baby with Mark.
Oh, I can't even deal with that right now.
Wow.
I should've picked him up myself.
I mean, I... what's wrong with me?
Okay, I thought he was
your brother's best friend, not yours.
We were all super close,
and he was my rock when Tim died.
I just... oh, god. I let my rock take a cab.
Oh, so you let him take a cab.
Well, I mean, listen,
he just flew in from Tibet
and he has cancer.
I mean, the least I could do
is pick him up at the baggage claim.
Hey, hey, hey, hey, hey, okay,
you need to chill out.
- Wh...
- Look, I know that you're worried,
but as far as cancers go,
I mean, his is very slow growing.
He told you he found out,
what, six months ago?
I mean... he could be fine.
- Yeah.
- Yeah.
Well, with you in the O.R.,
I'm not worried.
You're gonna love him,
and he's gonna love you.
Well, I'm taking his tumor out.
It's the least he could do.
Phoenix.
Nick!
Hey.
Oh, it's good to see you.
Ohh. Wait. What's with the cane?
Tumor, man. It hurts to walk.
Already? But you were only
diagnosed six months ago.
Did I say months? I meant years.
So... you must be the wife.
Yeah.
Good to meet you.
Good to meet you, too.
Julia went all F.S.H. on me this morning.
Is that a sexual term?
You know what? Never...
You know what? I don't want to know.
She wants a baby. She wants my baby.
What did you say?
Nothing. It's crazy.
Until you think about it and
realize it's kind of genius.
I love Julia.
I want Sofia to have some
siblings to grow up with.
Why wouldn't I do it?
Are you asking me
if you should have a baby?
Well, you think I shouldn't?
Have a baby or ask me
if you should have a baby?
So you think I should do it?
Well, do you want Julia to
be in your life forever?
You think I shouldn't?
Uh, do you have to answer that right now?
Hey. Answer what?
We were just talking about the,
uh, cranioplasty.
Oh. It's exciting, right?
Yeah.
Charlie Konner, 37.
Uh, he fell off the roof six months ago.
He presents for repair
of a skull bone defect
that occurred secondary
to surgical removal
of part of his skull.
Um, we waited several
months for the swelling
to s-subside before...
Wh... uh, what-what were
you doing, um, anyway?
Being an idiot.
B... you gonna fix it next time?
No, I want the roofers to fix it next time
like they had to do it this time
because humpty-dumpty
almost killed himself.
Wh... you want to pay for it?
Okay, we have mirrored
the healthy skull...
and created a custom titanium plate
that we will secure to the bone.
Titanium. Like the terminator.
And I'll take fat from
the belly and fill in the gaps,
pull your face into shape.
So, doc, what are you using
to fasten the new skull into place,
- hexagonal screws?
- Yes.
You know your stuff.
Yeah, we could do this in my garage,
save me a few grand.
You got a 2-millimeter bit?
Do I have a 2-millimeter bit?
Please don't encourage him.
What?
No.
I am counting on you to
treat these candidates
extremely well.
Show them whatever they want to see.
- Really woo them.
- Woo?
Yeah, woo. You know, uh...
What about me says "Woo"?
After the boards, we might be losing
some very good doctors to other programs.
Now if that happens, we need to be sure
that we have some fresh talent
ready and willing to take their place,
so I am asking you,
as chief, please woo their socks off.
For you, just this once,
I will woo.
Uh, their socks off?
D-don't push it.
Hi.
Hey.
Hey, um,
so, uh... do you have any word
on what Cristina's plans
are for next year?
No. No, not yet.
Oh. Oh, okay.
Um... will you keep me posted?
I will.
Good. Thanks.
The first session was so easy.
I want to punch your face.
Hey.
Hi. I am, uh,
so, so sorry to interrupt.
I'm, uh, I'm Dr. Karev.
I was stuck in Seattle
with a patient, and, uh,
well, I don't want to bore you
with a bunch of travel crap...
Your time was set for 9:00 this morning.
We were here. We called your name.
Yeah, I was with a patient. You get that.
We all have patients, Dr. Karev,
yet, here we were.
So what, I-I-I just fail?
The first of three sessions, yes,
which means you need perfect
scores in the next two sessions.
How are you everywhere?
How'd it go for you in there?
Look, baby, I know you were shocked.
Shocked?
Shocked at the sight
of my mother half naked
with a senior attending at my hospital?
No, far from it.
Okay? I mean, it's kind of par
for the course for you,
right, mom?
But every door that I open,
every-every corner that I turn,
there you are.
I know I'm your mother,
but I'm also a woman.
- I have needs.
- Mm.
If you don't want to talk
about this like an adult,
don't bring it up.
Wait a second. Did I bring it up?
Did I bring it up?
Don't play games. Just talk to me.
Just leave me alone!
I'm in the middle of my freakin' boards.
Are you following me, mom?
I'm the examiner in
the room right next to yours.
Of course you are.
After that, I might
mobilize the small intestine
to create a roux limb,
and open up the pancreatic duct
longitudinally from the tail to the neck?
The patient has died.
Moving on to the next scenario.
Um, can we... can we go back
- just-just for a second?
- We're moving on, Dr. Kepner.
- A 38-year-old male with a history...
- Yeah,
but-but if we could just go back,
just for one second so that I can clarify.
You have a 40-year-old man
who complains of rectal pain
and burning with defecation
and occasionally some blood
in the bowel movement.
I would do a rigid sigmoidoscopy
to make sure there were
no lesions in the rectum.
Squeamish, Dr. Grey?
No, not at all.
Good, then let's pick up
the answers, shall we?
Of course.
If there were lesions in the rectum,
I would do an incisional biopsy...
and begin to fulgurate...
I would cover the bowel with omentum
and close the fascia primarily.
The sutures tear right through the fascia.
In that case, I would use
1-0 nylon retention sutures
through the full thickness
of the abdominal wall.
Moving on.
Because I would make sure the area
- was adequately drained and closed...
- Dr. Kepner...
Because if it leaked,
and if the leak was early,
I would re-explore
the patient and repair the leak,
making sure that if... that if...
Once a question is finished,
it's finished.
Finished. Yes, I know. I'm sorry.
I just really need you to understand
that if the leak was late,
I would obtain an abdominal C.T.
just to make sure,
and also, if it wasn't...
if it wasn't drained... god.
Um, can you hang on just for a second?
It's just so incredibly hot in here.
Ohh! Oh, god.
Oh, god.
Can we move on, Dr. Kepner?
Would you allow us that courtesy?
Yes.
Yes.
Great. Thank you.
Now a 38-year-old male with
a history of diabetes...
I'm sorry. I'm sorry.
I'm sorry. Just-just-just...
Just-just one last thing
going back to the beginning,
'cause you... you heard what I said
about finding the pancreatic duct, right?
Because I just... I really
want to make sure you know
that I would drain the anastomosis, r...
Well, I-I... that patient should be stable!
They just...
Why won't you tell me?
Just... just-just tell me!
How am I supposed to answer this question
without the full information?
Please t...
Um...
Look, I'm-I'm, um,
I'm-I'm a really good doctor. I am.
I just-I need...
I need all the information.
I'm...
I'm a really good doctor.
Um, no free air.
The spleen...
the spleen looks fine.
There is some perihepatic fluid...
I'm sorry. Are you guys
hearing this noise next door?
It's very distracting.
If we could just ask them to...
keep it down.
If you get distracted this easily,
I think it calls to question
your ability to function
in a high-volume O.R.
Certainly calls it into question.
It is not that at all.
Okay? It's just my...
Um...
Never mind.
Let's wait for traffic to die down.
We wouldn't want to throw you
off your game, Dr. Avery.
I'm fine. Let's just...
I would stop the patient's
continuous bleeding
with a portacaval shunt.
Your patient is now in a coma.
That's highly unlikely,
but, uh, in that case,
I would suspect a hepatic encephalopathy
and check an ammonia level to confirm.
I'll save you the trouble.
It's confirmed.
I would check the patient's medication...
Medication...
Okay, then I'd start
on lactulose and neomycin.
- The patient...
- Still not getting better?
Then I would do a shunt
revision with a stent graft.
Stent graft?
Yes, a stent graft.
Mm.
Well...
Risky move, Dr. Yang.
Well...
moving on.
Did you have something to add, Dr. Yang?
Nope. All good.
Mm-hmm.
Does that hurt?
Nope.
- What about...
- Ow.
Yeah. That's what happens
when you wait six years to get treated.
Ohh.
So she's not shy.
Yeah, I know. I never went for shy.
Yeah.
I've been working with a naturopath.
I figured I'd try
the nontraditional route.
- It helped.
- Oh.
It did.
But the pain started to kick up,
so I saw a real doctor.
And he was gonna send me
to an orthopedic surgeon,
but then I was like, "Hold up."
"Yuma Robbins just married one of those."
Not that it was a real wedding.
Excuse me?
Oh, um, she thinks you're serious.
Oh, I am serious.
Tucson's already married.
Mm-hmm. To him.
She loves me.
We were 10, it was in my tree house,
and we had rings made of crabgrass.
You're probably
the last guy I ever kissed.
It was a beautiful ceremony.
Tim officiated, her brother.
He made me swear to stop pulling
the streamers off of her bike.
Mm.
It was an issue for a while.
Yeah, I'm a little concerned
about how much pain you're in.
So I am going to order some new scans.
These are how old?
9, you know, maybe 12 months.
I had to finish up a project
on the guys who carry all
the tourists' crap up K-2.
With a cane?
I stayed at base camp.
Play through the pain, right?
- No.
- Anybody?
Is she always like that or am I dying?
No, you are going to be fine,
because she is a genius with a scalpel.
She'll be in and out,
and you won't even know it.
- And they're not even gonna use drugs.
- Oh.
Nope, nope, just, um, chamomile tea.
You are so damn cute.
How does she get through
a work day with you around?
I don't know.
I forgot how much I missed you.
Me, too.
And our surgical rotations often allow
flexibility to set aside consecutive days
for research projects and
field work if necessary.
Any questions?
Would I have to share an office?
We don't h...
I'll have to check on that.
Are parking spaces
assigned for attendings,
or do we have to, like, find our own?
I'll have to check on that.
All right, we just need to screw this down
and then adjust it to fit.
Well...
Mark said that I get to graft the fat.
How cool is that?
Yeah, that's cool.
I'm gonna be your big
brother for 30 seconds.
Okay.
Uh, Julia wants to have a baby with Mark.
She what? What did she say?
Well, I don't know.
What do you mean, you don't know?
Wh-what did he say? How did it go down?
My 30 seconds of brotherly advice is over.
I gotta go check on a patient.
No, I... oh, does he want to do it?
I mean, did it seem like
he was excited about it?
Or does he seem like,
"That's an insane idea"?
Because it is. Yeah, you know what? I...
D... I hope you told him that
it's an insane... idea.
Are all your questions gross?
Gross? What do you mean, gross?
Uh, they keep asking me about bowels
and bloody stools?
It's general surgery. What do you expect?
You're not helping, at all.
My guy is a freakin' fossil.
The last time he was in the O.R.,
it was lit by candles.
Maybe I'll just live in here,
in this stall,
in my filth...
till I die.
Sick woman in here. Go away.
Uh, I-I really need to get in there.
Uh, sorry. Closed for maintenance.
- Please let me in.
- Come back later!
Hey, the applicants keep
asking to see the gym.
Should I show it to 'em?
'Cause I don't want the, you know, cobwebs
and sweaty menthol stench to scare them...
When did I become the advice columnist?
- Touchy, touchy.
- Well, I'm sorry.
It's just, no one can seem to
make up their own mind today.
Oh, people do make up their own minds,
they just need a little
help getting there.
What do you mean?
Okay, if someone comes
to me with a problem...
- Yeah.
- I give them a metaphor.
A metaphor?
A figure of speech which...
Yes, I know what a metaphor is.
- Fantastic.
- Thank you.
Now the next time someone
comes to you with a problem,
you just give them a metaphor.
Any kind of metaphor?
See? That's the beauty of it.
They'll draw some meaning from it,
and it'll help them make the decision
they were gonna make in the first place.
I'll stick with being honest. Thank you.
Suit yourself,
but when they take your advice
and it doesn't work out,
honesty can bite you in the ass.
Ooh.
If you don't mind, it is a men's room.
What? What? You're supposed to be doctors.
I've seen your things. You've seen mine.
It's all just flesh and cartilage.
Get over it!
Ugh!
April, wh...
Oh, hey, Jackson. How's it going?
Not so good. You?
I am dying in there.
I am actually failing.
You, too? 'cause mine is a total fiasco.
They think I'm insane!
Oh, they're toying with me.
I am self-destructing
into a puddle of sweat.
I don't know what's wrong with me.
Oh, I know exactly what is wrong with me
and I still can't reel it in.
I broke my promise to Jesus
and now I can't even talk
to him a-and I need him.
He's the only one who can calm me down!
Why the hell did you do it?
- Why'd you let me?
- I don't know!
- You said it was okay.
- I know!
I knew you'd regret it!
Stop yelling! Why are you yelling at me?!
Because I'm all messed up now, too.
I mean, what am I?
I'm-I'm now the guy that made
you break your promise to Jesus?
I am not that guy! All right?
That guy is gross. Okay?
It's all very unbecoming,
especially for an Avery.
What?
Are you... are you honestly comparing
breaking my promise to Jesus
with putting a tiny dent
in your family crest?
You're right.
You're right, and I'm sorry.
My mom
is the examiner in
the room right next to mine.
It's throwing me.
Oh, god.
I know.
It's-it's... I'm worried about my mom
and what she's gonna think if I fail.
It's pathetic.
- Right?
- No. God, no, Jackson.
It's not pathetic.
That's the most important
relationship in your life.
The problem isn't...
that I broke my promise.
That's not the problem.
The problem is...
The problem is...
That it felt good.
It felt good.
I shouldn't have taken advantage.
Taken advantage?
What?
Oh, we should... we should go.
Taken advantage?
I kissed you, remember?
Yeah, but I kissed you back.
Yeah, but then I unbuttoned your shirt.
Yeah, and then I...
pulled up that skirt.
Yeah, but then I kissed your neck.
Yeah.
And then I took off your shirt.
And I...
But then I unbuckled your belt.
And then...
I slipped my hand up your back.
And I wrapped my arms around your neck.
And then I...
Then you...
Then I...
Oh, no. He's not gonna...
Oh, yes, he is.
Oh! Oh, no, no.
Oh, my god. I told you.
Disgusting.
Dr. Bailey, where are the candidates?
Oh, over there destroying my appetite.
You know, I never thought
I would've said this,
but we need to keep our people, people.
- Mm-hmm.
- Right?
We haven't put in all this training
and put up with all their nonsense
to go groveling at
the feet of bread sniffers.
Kepner's already gotten job offers
- at four different programs.
- Oh.
Well, Grey's not going anywhere.
Not without Yang anyway.
Cristina has options.
My contact in Boston
may have mentioned that Meredith said
their program's her first choice.
You're building a house.
Harvard has an excellent
neurosurgery department.
W...
And they have plenty
of really nice houses.
Don't be all cryptic and
then just walk away.
Meredith?
Uh, I lied to you.
About what?
I'm not okay.
I might be dying. I think
our daughter tried to kill me
with her flu for being a bad mother.
Why didn't you tell me before?
I'm failing, Derek,
and I... and I-I don't think
I can go back in there.
I just can't... I mean...
Will you still love me if I fail?
You want me to yell at you
or tell you to come home?
I want you to tell me what to do.
The test is a mirror.
What are you talking about?
The test... it's a mirror.
Reflecting my sickly incompetence?
Are you saying I won't like myself
if I give up right now,
that I won't be able to look
myself in the mirror if I quit?
Whatever you decide,
I will still love you.
No, you won't. Nobody loves a quitter.
Good luck, Meredith.
You find out the patient
has advanced metastatic
disease and is terminal.
What do you do?
Honestly?
I'd pray for them.
I know that's not the right answer,
but it's what I'd do first.
Or at least if you asked me yesterday,
that's what I'd do.
Now I'm not so sure if he's listening.
Dr. Kepner, this is highly inappropriate.
Yeah, well, so is having
premarital sex in the men's room
with a really good friend,
but that just happened, so...
You know, I have been
surrounded by scientists
for a decade now,
holding back my feelings about
my relationship with god
'cause I was afraid of being laughed at
or judged or considered less of a doctor.
I was hiding,
ashamed to admit that I love him,
that his is the one
relationship I count on.
And now... now I'm not sure
if I just screwed that up
or freed myself from its limitations. I...
The one thing I know for sure,
though, is...
I think I'm done hiding.
Dr. Kepner, we asked you a question.
Yes, I would do a palliative
endoscopic stenting.
If that failed and the patient
was still alive and having pain,
I would do a biliary-enteric bypass.
After that, I might...
A 30-year-old female comes
in with third-degree burns.
You've checked her airway and
started fluid resuscitation
with D-5 N.S. fluids.
Actually, I would use L.R.
for fluid resuscitation,
not N.S.
uh, saline has too much chloride,
and that could cause
acidosis in my patient.
Okay.
So you've started
your patient on a liter of L.R.
Thanks for assisting, Bailey.
You know, Nick did
a big spread in "National geographic" once
on this school for
orphan girls in Calcutta,
and he-he sent them a bunch of cameras.
I think that it was polaroids
so they wouldn't have to pay for
the film to get processed...
But anyways, you know,
a couple of those girls
actually became photographers.
Like professionals. Isn't that amazing?
We're not going to kill your friend.
What? I know. I'm just... I'm saying...
Hey, does he save puppies, too?
Less sarcasm. A little more focus.
Oh, shoot.
We were supposed to
bring snack today to the day care
- for all the kids.
- Today?
Yeah, that mom from psych asked
if we would switch with her,
and I said we would, and then I forgot.
You need to write this stuff down. I...
- I know. I know. I am so sorry.
- I...
Sorry.
You didn't forget snack today, did you?
No, I'm seeing mets in the vessels.
Look at this.
Damn. And if they're here...
They're gonna be everywhere.
The temporalis muscle is atrophied.
Any idea why, Dr. Grey?
Uh, lack of use?
It had nowhere to attach
since the bone was gone.
That's right. It's too
late for this muscle.
It's missed its chance to attach.
Why are we talking about the temporalis?
Teachable moment, Dr. Sloan.
Stay out of it.
Once you inject the fat
into Charlie's temple,
the muscle will...
Again with the muscle?
Yeah, the once healthy muscle
will slowly wither to nothing
all alone,
surrounded by a thick layer of fat.
Very crafty, Dr. Shepherd.
Message received,
loud and clear.
They had snack.
And now I have 2 pounds of
strawberries for no reason.
Why-why is Teddy here?
Oh, honey.
We did a pet-scan, and, um...
Nick has intradural mets.
They've spread into his lymph nodes.
They've even gone into his heart.
He has a cardiac tumor, which looks like
it might have invaded
into the right ventricle.
At this point,
there's very little that we can do.
I-I would be concerned
about Crohn's disease
but differential diagnosis
could be P.U.D.,
ulcerative colitis, or appendicitis.
Dr. Grey?
I'm sorry. I can't...
I'd locate the fistula endoscopically,
then inject fibrin glue.
What about an abscess?
What about it?
Well, apparently, you have ruled it out.
It just feels a bit...
cavalier, doesn't it?
If you say so.
I'm having a hard time understanding
why I would open her up when
I could treat it endoscopically.
Precisely my question, Dr. Yang.
I've treated this condition a dozen times.
And I a thousand times.
If you would rather I open her up
and do tube duodenostomy,
that's... fine, too.
It's more invasive, but fine.
Mm-hmm.
Dr. Grey.
Dr. Grey, we're gonna have to call this.
You can take the exam again next year.
And we won't... we won't
count this as a failure
- so please...
- Okay, you're doctors.
You can't handle a little vomit?
Dr. Grey, it... it's really okay...
I would repair it with
an abdominal approach,
reduce the size of the hernia contents,
excise the sac, close the hiatus,
and perform a floppy nissen
for antireflux and gastropexy.
But ask me something else,
because I've known that answer
since I was, like 12 years old.
My mother practically
invented the floppy nissen.
So keep them coming,
but don't go easy on me.
All right. A 40-year-old man presents
with a suspicious lesion
on his left temporal,
sent in by his in...
Whew. Pigmented lesion?
You seem awfully sure of yourself.
I'm sorry. Is that a question?
Do you feel threatened?
Oh, have we moved on to psychology?
I find your hostility curious.
And I'm curious as to
why you think me hostile.
You know, if you don't
agree with my approach,
I wish you would voice your issues.
I-I don't disagree.
I don't believe you.
Are you calling me a liar, sir?
Fine. You know what?
Earlier when I said I was
okay with that open procedure,
I wasn't.
That might have been okay when, like,
hawkeye and B.J. did it on "M-a-s-h,"
but this being the new century and all,
I would have, as I said earlier,
treated it endoscopically.
Then you lied earlier.
You know what? Oh, god.
I can answer these
questions any way you want
using medical techniques from any era.
So how about we just,
you know, pick a decade
you're comfortable with
and go from there?
Well, then...
It's been a pleasure being
witness to such genius.
I can now finally retire
knowing that such advanced
and creative minds
are at work in the surgical field, hmm?
That's it?
Oh, I think we've had enough
of an education today,
Dr. Yang.
But... there's still 20 minutes.
No need.
Oh...
best of luck.
I'd do a biopsy.
Path shows L.C.I.S.
What's your best mastectomy approach?
I'd make a periareolar incision
to preserve the inframammary fold.
But wait. Did you say L.C.I.S.?
Yes, lobular carcinoma in situ.
You wouldn't do a mastectomy.
You'd observe and repeat mammos.
You already did a skin sparing mastectomy.
That was a trick question.
You had all the facts to answer.
Yeah, but my answer was wrong.
I'm gonna fail because
of a trick question?
The questions are designed
to get your response...
You gotta be kidding me?
You missed your first session.
You're lucky to be even
getting this chance.
Yeah, I missed my first session
for the best freakin' reason.
I was with a patient.
For months with this kid who...
who doesn't have a chance,
not a chance.
And we give them a chance
and we try everything,
and then when there's nothing left to do,
I'm supposed to just walk away
from his mother?
I had to be there. I had to.
And what... what did I miss here,
a few more hypothetical trick questions?
What are you staring at?
You guys are doctors.
You're supposed to decide
if I'm gonna be a doctor,
and you can't understand that?
Thank you, Dr. Karev.
It's Karev.
Can you at least tell me if I passed?
Thank you.
Thank you.
Taxi.
Well, you-you don't
want to miss your flight.
No, I don't want to miss my flight.
I better go.
Richard, I don't regret last night
one bit.
Neither do I.
It's just bad timing.
You know, we live in different cities.
It's-it's too complicated right now.
Yeah, bad timing.
Bye, Richard.
Bye, Catherine. Safe flight.
Oh, uh, call me if you hear
any more about the boards.
Oh, I will, and call me when you get home,
let me know you got there okay.
I will.
Are... you going to
the trauma and critical
care conference in May?
In New Orleans?
I'm speaking at it.
Me, too.
I'm at the Sonait house.
Where are they putting you up?
Um...
Windsor court.
Oh, no. Sonait house is much better.
The breakfast biscuits will
make you jump up and down.
When do you fly in?
Uh, I think it's Thursday.
I fly in Thursday, too.
I can't believe it.
My whole Charlie is back.
You people are miracle workers.
So how long till I'm back on the ladder?
- I-I just got a tile saw...
- Uh-huh.
And I'm gonna mosaic the stucco.
You ca... Dr. Shepherd,
talk some sense into him.
It's really not my place.
But if you want to say
something to your husband,
please, by all means, you should do it.
I know how much you love
to work on the house,
but listen to me, you are clumsy.
And I can't stand the thought
of almost losing you again.
So would you just take a second
and what's left of your brain
and think about how I felt about it,
how scared I was to lose you forever?
You're right.
I'm sorry, babe.
I'll-I'll-I'll find a new hobby.
Right, something... something
we can do together, like, uh, bowling.
Oh, no, um, I... I hate bowling.
But you never even tried it.
Well, you can hate something
without trying it.
Oh.
Hey.
Hey.
Thanks, uh, for today.
For-for letting me, uh...
You did a good job in there.
Thanks.
You okay?
I love you.
Oh, g... oh, my god. That just came...
fly-flying out of my face
like it was s-s-some kind of...
I-I l... I love you.
I just... god.
Did it again.
I... I-I-I-I love you.
I-I do. I just... I-I love you.
And I have been trying not to say it.
I have been trying so
hard to just mash it down
and ignore it and not say it.
And Jackson is a great guy.
He-he is, and he... he's gorgeous,
and-and he's younger than you,
and he doesn't have any grandkids
or-or babies with his lesbian B.F.F.S
and he's an Avery,
and-and he liked me, you know?
He... he really liked me.
But it was never gonna work out
Because I-I love you.
I am so in love with you.
And you're-you're... you're in me.
It's... you're like... it's...
it's like you're a disease.
It's like I am infected by Mark Sloan.
And I just can't...
I can't think about anything or anybody,
and I can't sleep.
I can't breathe.
I can't eat.
And I love you. I just...
I love you all the time,
just every minute of every day.
And I-I-I...
I-I...
love you.
God, that feels good,
just to-to say that...
to j... I am...
I feel so much better.
Just... I love you.
Mark?
Hey, Lexie.
I thought you said the lobby. You ready?
Hey there, sunshine.
You feeling okay?
Yeah. You know, just groggy.
You guys got good drugs in this place.
Good. What the hell were you thinking?
- Dude...
- You're an idiot.
You should have called me.
I mean, wh-why didn't you
call me? I'm a doctor.
What do you think I do all day long?
Instead you go to some quack in Tibet.
I mean, you should've freakin' called me!
Naturopathy works, too, flagstaff.
Whoa. It's not flagstaff!
And it's not Phoenix and it's not Tempe.
It's Arizona Robbins, M.D.
Do you know what that means?
How do you spell it?
It's not funny, Nick.
Nothing is funny. You're dying!
And you know what hell
it was when Tim died
because you were there,
and-and you and I barely
made it through that.
So to do nothing for six years
and then to come when it's too late,
I... I...
Why do you think I didn't
come to you sooner?
As if after Tim died, I could...
You think I don't know how
this must feel for you?
You're an idiot!
I couldn't have helped Tim,
but I could've helped you!
I'll admit, the romans had a point.
You've gotta live life.
Ugh. Gotta pee. Gotta pee.
Gotta pee. Gotta pee. Gotta pee.
What time you got?
12:04.
Oh! It's supposed to
come online at midnight.
I mean, it's four minutes late.
Come on, people. Crazy doctors,
they crashed the system.
I already know I failed,
so I don't know why
I keep hitting the refresh button.
And living means that every
morning when you wake up
you have to choose...
Okay, if anyone failed, was me,
because my guy had a vendetta.
Please. I've got the odds on failure.
Are any of you on call? I've got a trauma.
No!
Wait. Wait. Wait.
I passed. I passed.
I passed! I passed! I passed! Yes!
I passed! I passed!
Oh, my god! Yeah!
Between seizing what
life offers in the moment
and forging ahead,
no matter the weather...
- Alex?
- It's not coming up.
Here. Here. Use mine.
Oh, unh!
Yes!
Wait. Wait. Where is April?
Or closing the curtains...
and shutting out the day.
---
Taxi!
Carpe diem.
That was hell.
Actual physical hell.
I think I went a tad overboard.
How annoying is carpe diem?
A lot overboard.
They took something from me.
Yeah, that wasn't an exam.
That was an interrogation.
Like, way... way overboard.
- The mind games.
- Trick questions.
It felt like Al Qaeda in there.
How are you supposed to plan a life,
a career, a family,
if you're always carpe-ing the diem?
Next test is june.
June's not bad.
2013.
Oh.
What's done is done.
Let's just not even talk about it anymore.
If we all seized every
moment of every day,
there wouldn't be doctors.
Who would sit through med school?
Anyone know how Alex did?
Anyone know if Alex made it?
Made it?
What do you mean, made it?
We'd all be too busy...
living in the now.
Whatever that means.
Hey.
You okay?
I'm...
I'm not sure.
I-I hope you're not
worried about last night.
I'm not worried about last night.
I'm worried because I checked
with some of my friends
on the committee and
one of your Seattle Grace doctors
didn't pass.
Any idea who?
They weren't sure.
But if it's Jackson,
he'll blame me forever.
Welcome to the American
Medical Board of Surgery
Certifying Examination.
We'll give you four separate scenarios
in 3 30-minute sessions,
10-minute breaks in between.
To pass the test,
you must pass two
of the three sessions.
- Now you can fail a session and still pass.
- Still pass.
But examiners
are not permitted to indicate
whether you passed or failed
each session.
You'll be rated on your ability
to diagnose, manage treatment,
handle the unexpected...
Basically, the strength
of your constitution in crisis.
And when we move on
to the, uh, next scenario,
th-there's no doubling back,
meaning,
once a question is asked...
You can't go back.
Understood, sir.
Are you in a hurry,
Dr... Yang?
No, sir. Just...
ready when you are.
Mm-hmm.
So then,
a 65-year-old woman
is being seen by
her primary care physician
for a workup
of osteoporosis
when she is found to have
elevated calcium.
Her P.T.H. level
was well above normal.
Her doctor sends her
to you.
Elevated calcium and P.T.H.
would indicate primary hyperparathyroidism.
I would offer the patient
a para...
thyroidectomy.
And first I would explore
the right side.
If that gland is large...
I would biopsy it.
Um, after doing the biopsy,
I would...
Hang-hang on.
What-what did
the pathologist report say?
Path comes back
with parathyroid hyperplasia.
Uh... Um, and how large
was the gland?
How much longer are we
gonna give this Dr. Karev?
15?
Next, I would resect it and
explore the other glands.
Aggressive choice.
Well, I suppose I could
wait for the I.P.M.
before taking further actions.
Mm-hmm.
Are you sure you're okay with that?
Yes, I'm okay with that.
Mm-hmm.
If the I.P.M...
showed P.T.H. levels
in the normal range...
Dr. Grey?
I would feel comfortable
concluding the procedure.
Dude, there's no other way?
Helicopter. Magic carpet.
That lane is open.
That's the bus lane.
I don't see any buses.
I'll get a ticket.
Come on, man. I'll give
you double any ticket.
What about my insurance?
Come on, man. Just take the bus lane.
- Nah.
- How far are we?
20 blocks, give or take.
Catch the game last night?
Come on. Move.
I heard it went 11 innings.
Move! Move. Look out.
Move. Come on. Come on.
Okay, who wants more pancakes?
You haven't had any. Sit down.
I can't sit still.
He's taking his test right now.
It's cute, you being nervous for Jackson.
You want some more juice?
It's paternal. You're a natural father.
Are you sure you don't want anything?
I could make some bacon...
We should have a baby.
Don't freak out.
I-I mean, I like... this.
I like you,
I like your kid,
and I like your kid's moms.
And I...
You-you know,
you-you don't have
to say anything right now.
Just g-go back to worrying about Jackson,
and we-we can talk about this later.
Um, I would say no rush, but, you know,
actually, my F.S.H.
levels would suggest that
rushing a little might not be
the worst thing in the world.
Julia wants to have a baby with Mark.
Oh, I can't even deal with that right now.
Wow.
I should've picked him up myself.
I mean, I... what's wrong with me?
Okay, I thought he was
your brother's best friend, not yours.
We were all super close,
and he was my rock when Tim died.
I just... oh, god. I let my rock take a cab.
Oh, so you let him take a cab.
Well, I mean, listen,
he just flew in from Tibet
and he has cancer.
I mean, the least I could do
is pick him up at the baggage claim.
Hey, hey, hey, hey, hey, okay,
you need to chill out.
- Wh...
- Look, I know that you're worried,
but as far as cancers go,
I mean, his is very slow growing.
He told you he found out,
what, six months ago?
I mean... he could be fine.
- Yeah.
- Yeah.
Well, with you in the O.R.,
I'm not worried.
You're gonna love him,
and he's gonna love you.
Well, I'm taking his tumor out.
It's the least he could do.
Phoenix.
Nick!
Hey.
Oh, it's good to see you.
Ohh. Wait. What's with the cane?
Tumor, man. It hurts to walk.
Already? But you were only
diagnosed six months ago.
Did I say months? I meant years.
So... you must be the wife.
Yeah.
Good to meet you.
Good to meet you, too.
Julia went all F.S.H. on me this morning.
Is that a sexual term?
You know what? Never...
You know what? I don't want to know.
She wants a baby. She wants my baby.
What did you say?
Nothing. It's crazy.
Until you think about it and
realize it's kind of genius.
I love Julia.
I want Sofia to have some
siblings to grow up with.
Why wouldn't I do it?
Are you asking me
if you should have a baby?
Well, you think I shouldn't?
Have a baby or ask me
if you should have a baby?
So you think I should do it?
Well, do you want Julia to
be in your life forever?
You think I shouldn't?
Uh, do you have to answer that right now?
Hey. Answer what?
We were just talking about the,
uh, cranioplasty.
Oh. It's exciting, right?
Yeah.
Charlie Konner, 37.
Uh, he fell off the roof six months ago.
He presents for repair
of a skull bone defect
that occurred secondary
to surgical removal
of part of his skull.
Um, we waited several
months for the swelling
to s-subside before...
Wh... uh, what-what were
you doing, um, anyway?
Being an idiot.
B... you gonna fix it next time?
No, I want the roofers to fix it next time
like they had to do it this time
because humpty-dumpty
almost killed himself.
Wh... you want to pay for it?
Okay, we have mirrored
the healthy skull...
and created a custom titanium plate
that we will secure to the bone.
Titanium. Like the terminator.
And I'll take fat from
the belly and fill in the gaps,
pull your face into shape.
So, doc, what are you using
to fasten the new skull into place,
- hexagonal screws?
- Yes.
You know your stuff.
Yeah, we could do this in my garage,
save me a few grand.
You got a 2-millimeter bit?
Do I have a 2-millimeter bit?
Please don't encourage him.
What?
No.
I am counting on you to
treat these candidates
extremely well.
Show them whatever they want to see.
- Really woo them.
- Woo?
Yeah, woo. You know, uh...
What about me says "Woo"?
After the boards, we might be losing
some very good doctors to other programs.
Now if that happens, we need to be sure
that we have some fresh talent
ready and willing to take their place,
so I am asking you,
as chief, please woo their socks off.
For you, just this once,
I will woo.
Uh, their socks off?
D-don't push it.
Hi.
Hey.
Hey, um,
so, uh... do you have any word
on what Cristina's plans
are for next year?
No. No, not yet.
Oh. Oh, okay.
Um... will you keep me posted?
I will.
Good. Thanks.
The first session was so easy.
I want to punch your face.
Hey.
Hi. I am, uh,
so, so sorry to interrupt.
I'm, uh, I'm Dr. Karev.
I was stuck in Seattle
with a patient, and, uh,
well, I don't want to bore you
with a bunch of travel crap...
Your time was set for 9:00 this morning.
We were here. We called your name.
Yeah, I was with a patient. You get that.
We all have patients, Dr. Karev,
yet, here we were.
So what, I-I-I just fail?
The first of three sessions, yes,
which means you need perfect
scores in the next two sessions.
How are you everywhere?
How'd it go for you in there?
Look, baby, I know you were shocked.
Shocked?
Shocked at the sight
of my mother half naked
with a senior attending at my hospital?
No, far from it.
Okay? I mean, it's kind of par
for the course for you,
right, mom?
But every door that I open,
every-every corner that I turn,
there you are.
I know I'm your mother,
but I'm also a woman.
- I have needs.
- Mm.
If you don't want to talk
about this like an adult,
don't bring it up.
Wait a second. Did I bring it up?
Did I bring it up?
Don't play games. Just talk to me.
Just leave me alone!
I'm in the middle of my freakin' boards.
Are you following me, mom?
I'm the examiner in
the room right next to yours.
Of course you are.
After that, I might
mobilize the small intestine
to create a roux limb,
and open up the pancreatic duct
longitudinally from the tail to the neck?
The patient has died.
Moving on to the next scenario.
Um, can we... can we go back
- just-just for a second?
- We're moving on, Dr. Kepner.
- A 38-year-old male with a history...
- Yeah,
but-but if we could just go back,
just for one second so that I can clarify.
You have a 40-year-old man
who complains of rectal pain
and burning with defecation
and occasionally some blood
in the bowel movement.
I would do a rigid sigmoidoscopy
to make sure there were
no lesions in the rectum.
Squeamish, Dr. Grey?
No, not at all.
Good, then let's pick up
the answers, shall we?
Of course.
If there were lesions in the rectum,
I would do an incisional biopsy...
and begin to fulgurate...
I would cover the bowel with omentum
and close the fascia primarily.
The sutures tear right through the fascia.
In that case, I would use
1-0 nylon retention sutures
through the full thickness
of the abdominal wall.
Moving on.
Because I would make sure the area
- was adequately drained and closed...
- Dr. Kepner...
Because if it leaked,
and if the leak was early,
I would re-explore
the patient and repair the leak,
making sure that if... that if...
Once a question is finished,
it's finished.
Finished. Yes, I know. I'm sorry.
I just really need you to understand
that if the leak was late,
I would obtain an abdominal C.T.
just to make sure,
and also, if it wasn't...
if it wasn't drained... god.
Um, can you hang on just for a second?
It's just so incredibly hot in here.
Ohh! Oh, god.
Oh, god.
Can we move on, Dr. Kepner?
Would you allow us that courtesy?
Yes.
Yes.
Great. Thank you.
Now a 38-year-old male with
a history of diabetes...
I'm sorry. I'm sorry.
I'm sorry. Just-just-just...
Just-just one last thing
going back to the beginning,
'cause you... you heard what I said
about finding the pancreatic duct, right?
Because I just... I really
want to make sure you know
that I would drain the anastomosis, r...
Well, I-I... that patient should be stable!
They just...
Why won't you tell me?
Just... just-just tell me!
How am I supposed to answer this question
without the full information?
Please t...
Um...
Look, I'm-I'm, um,
I'm-I'm a really good doctor. I am.
I just-I need...
I need all the information.
I'm...
I'm a really good doctor.
Um, no free air.
The spleen...
the spleen looks fine.
There is some perihepatic fluid...
I'm sorry. Are you guys
hearing this noise next door?
It's very distracting.
If we could just ask them to...
keep it down.
If you get distracted this easily,
I think it calls to question
your ability to function
in a high-volume O.R.
Certainly calls it into question.
It is not that at all.
Okay? It's just my...
Um...
Never mind.
Let's wait for traffic to die down.
We wouldn't want to throw you
off your game, Dr. Avery.
I'm fine. Let's just...
I would stop the patient's
continuous bleeding
with a portacaval shunt.
Your patient is now in a coma.
That's highly unlikely,
but, uh, in that case,
I would suspect a hepatic encephalopathy
and check an ammonia level to confirm.
I'll save you the trouble.
It's confirmed.
I would check the patient's medication...
Medication...
Okay, then I'd start
on lactulose and neomycin.
- The patient...
- Still not getting better?
Then I would do a shunt
revision with a stent graft.
Stent graft?
Yes, a stent graft.
Mm.
Well...
Risky move, Dr. Yang.
Well...
moving on.
Did you have something to add, Dr. Yang?
Nope. All good.
Mm-hmm.
Does that hurt?
Nope.
- What about...
- Ow.
Yeah. That's what happens
when you wait six years to get treated.
Ohh.
So she's not shy.
Yeah, I know. I never went for shy.
Yeah.
I've been working with a naturopath.
I figured I'd try
the nontraditional route.
- It helped.
- Oh.
It did.
But the pain started to kick up,
so I saw a real doctor.
And he was gonna send me
to an orthopedic surgeon,
but then I was like, "Hold up."
"Yuma Robbins just married one of those."
Not that it was a real wedding.
Excuse me?
Oh, um, she thinks you're serious.
Oh, I am serious.
Tucson's already married.
Mm-hmm. To him.
She loves me.
We were 10, it was in my tree house,
and we had rings made of crabgrass.
You're probably
the last guy I ever kissed.
It was a beautiful ceremony.
Tim officiated, her brother.
He made me swear to stop pulling
the streamers off of her bike.
Mm.
It was an issue for a while.
Yeah, I'm a little concerned
about how much pain you're in.
So I am going to order some new scans.
These are how old?
9, you know, maybe 12 months.
I had to finish up a project
on the guys who carry all
the tourists' crap up K-2.
With a cane?
I stayed at base camp.
Play through the pain, right?
- No.
- Anybody?
Is she always like that or am I dying?
No, you are going to be fine,
because she is a genius with a scalpel.
She'll be in and out,
and you won't even know it.
- And they're not even gonna use drugs.
- Oh.
Nope, nope, just, um, chamomile tea.
You are so damn cute.
How does she get through
a work day with you around?
I don't know.
I forgot how much I missed you.
Me, too.
And our surgical rotations often allow
flexibility to set aside consecutive days
for research projects and
field work if necessary.
Any questions?
Would I have to share an office?
We don't h...
I'll have to check on that.
Are parking spaces
assigned for attendings,
or do we have to, like, find our own?
I'll have to check on that.
All right, we just need to screw this down
and then adjust it to fit.
Well...
Mark said that I get to graft the fat.
How cool is that?
Yeah, that's cool.
I'm gonna be your big
brother for 30 seconds.
Okay.
Uh, Julia wants to have a baby with Mark.
She what? What did she say?
Well, I don't know.
What do you mean, you don't know?
Wh-what did he say? How did it go down?
My 30 seconds of brotherly advice is over.
I gotta go check on a patient.
No, I... oh, does he want to do it?
I mean, did it seem like
he was excited about it?
Or does he seem like,
"That's an insane idea"?
Because it is. Yeah, you know what? I...
D... I hope you told him that
it's an insane... idea.
Are all your questions gross?
Gross? What do you mean, gross?
Uh, they keep asking me about bowels
and bloody stools?
It's general surgery. What do you expect?
You're not helping, at all.
My guy is a freakin' fossil.
The last time he was in the O.R.,
it was lit by candles.
Maybe I'll just live in here,
in this stall,
in my filth...
till I die.
Sick woman in here. Go away.
Uh, I-I really need to get in there.
Uh, sorry. Closed for maintenance.
- Please let me in.
- Come back later!
Hey, the applicants keep
asking to see the gym.
Should I show it to 'em?
'Cause I don't want the, you know, cobwebs
and sweaty menthol stench to scare them...
When did I become the advice columnist?
- Touchy, touchy.
- Well, I'm sorry.
It's just, no one can seem to
make up their own mind today.
Oh, people do make up their own minds,
they just need a little
help getting there.
What do you mean?
Okay, if someone comes
to me with a problem...
- Yeah.
- I give them a metaphor.
A metaphor?
A figure of speech which...
Yes, I know what a metaphor is.
- Fantastic.
- Thank you.
Now the next time someone
comes to you with a problem,
you just give them a metaphor.
Any kind of metaphor?
See? That's the beauty of it.
They'll draw some meaning from it,
and it'll help them make the decision
they were gonna make in the first place.
I'll stick with being honest. Thank you.
Suit yourself,
but when they take your advice
and it doesn't work out,
honesty can bite you in the ass.
Ooh.
If you don't mind, it is a men's room.
What? What? You're supposed to be doctors.
I've seen your things. You've seen mine.
It's all just flesh and cartilage.
Get over it!
Ugh!
April, wh...
Oh, hey, Jackson. How's it going?
Not so good. You?
I am dying in there.
I am actually failing.
You, too? 'cause mine is a total fiasco.
They think I'm insane!
Oh, they're toying with me.
I am self-destructing
into a puddle of sweat.
I don't know what's wrong with me.
Oh, I know exactly what is wrong with me
and I still can't reel it in.
I broke my promise to Jesus
and now I can't even talk
to him a-and I need him.
He's the only one who can calm me down!
Why the hell did you do it?
- Why'd you let me?
- I don't know!
- You said it was okay.
- I know!
I knew you'd regret it!
Stop yelling! Why are you yelling at me?!
Because I'm all messed up now, too.
I mean, what am I?
I'm-I'm now the guy that made
you break your promise to Jesus?
I am not that guy! All right?
That guy is gross. Okay?
It's all very unbecoming,
especially for an Avery.
What?
Are you... are you honestly comparing
breaking my promise to Jesus
with putting a tiny dent
in your family crest?
You're right.
You're right, and I'm sorry.
My mom
is the examiner in
the room right next to mine.
It's throwing me.
Oh, god.
I know.
It's-it's... I'm worried about my mom
and what she's gonna think if I fail.
It's pathetic.
- Right?
- No. God, no, Jackson.
It's not pathetic.
That's the most important
relationship in your life.
The problem isn't...
that I broke my promise.
That's not the problem.
The problem is...
The problem is...
That it felt good.
It felt good.
I shouldn't have taken advantage.
Taken advantage?
What?
Oh, we should... we should go.
Taken advantage?
I kissed you, remember?
Yeah, but I kissed you back.
Yeah, but then I unbuttoned your shirt.
Yeah, and then I...
pulled up that skirt.
Yeah, but then I kissed your neck.
Yeah.
And then I took off your shirt.
And I...
But then I unbuckled your belt.
And then...
I slipped my hand up your back.
And I wrapped my arms around your neck.
And then I...
Then you...
Then I...
Oh, no. He's not gonna...
Oh, yes, he is.
Oh! Oh, no, no.
Oh, my god. I told you.
Disgusting.
Dr. Bailey, where are the candidates?
Oh, over there destroying my appetite.
You know, I never thought
I would've said this,
but we need to keep our people, people.
- Mm-hmm.
- Right?
We haven't put in all this training
and put up with all their nonsense
to go groveling at
the feet of bread sniffers.
Kepner's already gotten job offers
- at four different programs.
- Oh.
Well, Grey's not going anywhere.
Not without Yang anyway.
Cristina has options.
My contact in Boston
may have mentioned that Meredith said
their program's her first choice.
You're building a house.
Harvard has an excellent
neurosurgery department.
W...
And they have plenty
of really nice houses.
Don't be all cryptic and
then just walk away.
Meredith?
Uh, I lied to you.
About what?
I'm not okay.
I might be dying. I think
our daughter tried to kill me
with her flu for being a bad mother.
Why didn't you tell me before?
I'm failing, Derek,
and I... and I-I don't think
I can go back in there.
I just can't... I mean...
Will you still love me if I fail?
You want me to yell at you
or tell you to come home?
I want you to tell me what to do.
The test is a mirror.
What are you talking about?
The test... it's a mirror.
Reflecting my sickly incompetence?
Are you saying I won't like myself
if I give up right now,
that I won't be able to look
myself in the mirror if I quit?
Whatever you decide,
I will still love you.
No, you won't. Nobody loves a quitter.
Good luck, Meredith.
You find out the patient
has advanced metastatic
disease and is terminal.
What do you do?
Honestly?
I'd pray for them.
I know that's not the right answer,
but it's what I'd do first.
Or at least if you asked me yesterday,
that's what I'd do.
Now I'm not so sure if he's listening.
Dr. Kepner, this is highly inappropriate.
Yeah, well, so is having
premarital sex in the men's room
with a really good friend,
but that just happened, so...
You know, I have been
surrounded by scientists
for a decade now,
holding back my feelings about
my relationship with god
'cause I was afraid of being laughed at
or judged or considered less of a doctor.
I was hiding,
ashamed to admit that I love him,
that his is the one
relationship I count on.
And now... now I'm not sure
if I just screwed that up
or freed myself from its limitations. I...
The one thing I know for sure,
though, is...
I think I'm done hiding.
Dr. Kepner, we asked you a question.
Yes, I would do a palliative
endoscopic stenting.
If that failed and the patient
was still alive and having pain,
I would do a biliary-enteric bypass.
After that, I might...
A 30-year-old female comes
in with third-degree burns.
You've checked her airway and
started fluid resuscitation
with D-5 N.S. fluids.
Actually, I would use L.R.
for fluid resuscitation,
not N.S.
uh, saline has too much chloride,
and that could cause
acidosis in my patient.
Okay.
So you've started
your patient on a liter of L.R.
Thanks for assisting, Bailey.
You know, Nick did
a big spread in "National geographic" once
on this school for
orphan girls in Calcutta,
and he-he sent them a bunch of cameras.
I think that it was polaroids
so they wouldn't have to pay for
the film to get processed...
But anyways, you know,
a couple of those girls
actually became photographers.
Like professionals. Isn't that amazing?
We're not going to kill your friend.
What? I know. I'm just... I'm saying...
Hey, does he save puppies, too?
Less sarcasm. A little more focus.
Oh, shoot.
We were supposed to
bring snack today to the day care
- for all the kids.
- Today?
Yeah, that mom from psych asked
if we would switch with her,
and I said we would, and then I forgot.
You need to write this stuff down. I...
- I know. I know. I am so sorry.
- I...
Sorry.
You didn't forget snack today, did you?
No, I'm seeing mets in the vessels.
Look at this.
Damn. And if they're here...
They're gonna be everywhere.
The temporalis muscle is atrophied.
Any idea why, Dr. Grey?
Uh, lack of use?
It had nowhere to attach
since the bone was gone.
That's right. It's too
late for this muscle.
It's missed its chance to attach.
Why are we talking about the temporalis?
Teachable moment, Dr. Sloan.
Stay out of it.
Once you inject the fat
into Charlie's temple,
the muscle will...
Again with the muscle?
Yeah, the once healthy muscle
will slowly wither to nothing
all alone,
surrounded by a thick layer of fat.
Very crafty, Dr. Shepherd.
Message received,
loud and clear.
They had snack.
And now I have 2 pounds of
strawberries for no reason.
Why-why is Teddy here?
Oh, honey.
We did a pet-scan, and, um...
Nick has intradural mets.
They've spread into his lymph nodes.
They've even gone into his heart.
He has a cardiac tumor, which looks like
it might have invaded
into the right ventricle.
At this point,
there's very little that we can do.
I-I would be concerned
about Crohn's disease
but differential diagnosis
could be P.U.D.,
ulcerative colitis, or appendicitis.
Dr. Grey?
I'm sorry. I can't...
I'd locate the fistula endoscopically,
then inject fibrin glue.
What about an abscess?
What about it?
Well, apparently, you have ruled it out.
It just feels a bit...
cavalier, doesn't it?
If you say so.
I'm having a hard time understanding
why I would open her up when
I could treat it endoscopically.
Precisely my question, Dr. Yang.
I've treated this condition a dozen times.
And I a thousand times.
If you would rather I open her up
and do tube duodenostomy,
that's... fine, too.
It's more invasive, but fine.
Mm-hmm.
Dr. Grey.
Dr. Grey, we're gonna have to call this.
You can take the exam again next year.
And we won't... we won't
count this as a failure
- so please...
- Okay, you're doctors.
You can't handle a little vomit?
Dr. Grey, it... it's really okay...
I would repair it with
an abdominal approach,
reduce the size of the hernia contents,
excise the sac, close the hiatus,
and perform a floppy nissen
for antireflux and gastropexy.
But ask me something else,
because I've known that answer
since I was, like 12 years old.
My mother practically
invented the floppy nissen.
So keep them coming,
but don't go easy on me.
All right. A 40-year-old man presents
with a suspicious lesion
on his left temporal,
sent in by his in...
Whew. Pigmented lesion?
You seem awfully sure of yourself.
I'm sorry. Is that a question?
Do you feel threatened?
Oh, have we moved on to psychology?
I find your hostility curious.
And I'm curious as to
why you think me hostile.
You know, if you don't
agree with my approach,
I wish you would voice your issues.
I-I don't disagree.
I don't believe you.
Are you calling me a liar, sir?
Fine. You know what?
Earlier when I said I was
okay with that open procedure,
I wasn't.
That might have been okay when, like,
hawkeye and B.J. did it on "M-a-s-h,"
but this being the new century and all,
I would have, as I said earlier,
treated it endoscopically.
Then you lied earlier.
You know what? Oh, god.
I can answer these
questions any way you want
using medical techniques from any era.
So how about we just,
you know, pick a decade
you're comfortable with
and go from there?
Well, then...
It's been a pleasure being
witness to such genius.
I can now finally retire
knowing that such advanced
and creative minds
are at work in the surgical field, hmm?
That's it?
Oh, I think we've had enough
of an education today,
Dr. Yang.
But... there's still 20 minutes.
No need.
Oh...
best of luck.
I'd do a biopsy.
Path shows L.C.I.S.
What's your best mastectomy approach?
I'd make a periareolar incision
to preserve the inframammary fold.
But wait. Did you say L.C.I.S.?
Yes, lobular carcinoma in situ.
You wouldn't do a mastectomy.
You'd observe and repeat mammos.
You already did a skin sparing mastectomy.
That was a trick question.
You had all the facts to answer.
Yeah, but my answer was wrong.
I'm gonna fail because
of a trick question?
The questions are designed
to get your response...
You gotta be kidding me?
You missed your first session.
You're lucky to be even
getting this chance.
Yeah, I missed my first session
for the best freakin' reason.
I was with a patient.
For months with this kid who...
who doesn't have a chance,
not a chance.
And we give them a chance
and we try everything,
and then when there's nothing left to do,
I'm supposed to just walk away
from his mother?
I had to be there. I had to.
And what... what did I miss here,
a few more hypothetical trick questions?
What are you staring at?
You guys are doctors.
You're supposed to decide
if I'm gonna be a doctor,
and you can't understand that?
Thank you, Dr. Karev.
It's Karev.
Can you at least tell me if I passed?
Thank you.
Thank you.
Taxi.
Well, you-you don't
want to miss your flight.
No, I don't want to miss my flight.
I better go.
Richard, I don't regret last night
one bit.
Neither do I.
It's just bad timing.
You know, we live in different cities.
It's-it's too complicated right now.
Yeah, bad timing.
Bye, Richard.
Bye, Catherine. Safe flight.
Oh, uh, call me if you hear
any more about the boards.
Oh, I will, and call me when you get home,
let me know you got there okay.
I will.
Are... you going to
the trauma and critical
care conference in May?
In New Orleans?
I'm speaking at it.
Me, too.
I'm at the Sonait house.
Where are they putting you up?
Um...
Windsor court.
Oh, no. Sonait house is much better.
The breakfast biscuits will
make you jump up and down.
When do you fly in?
Uh, I think it's Thursday.
I fly in Thursday, too.
I can't believe it.
My whole Charlie is back.
You people are miracle workers.
So how long till I'm back on the ladder?
- I-I just got a tile saw...
- Uh-huh.
And I'm gonna mosaic the stucco.
You ca... Dr. Shepherd,
talk some sense into him.
It's really not my place.
But if you want to say
something to your husband,
please, by all means, you should do it.
I know how much you love
to work on the house,
but listen to me, you are clumsy.
And I can't stand the thought
of almost losing you again.
So would you just take a second
and what's left of your brain
and think about how I felt about it,
how scared I was to lose you forever?
You're right.
I'm sorry, babe.
I'll-I'll-I'll find a new hobby.
Right, something... something
we can do together, like, uh, bowling.
Oh, no, um, I... I hate bowling.
But you never even tried it.
Well, you can hate something
without trying it.
Oh.
Hey.
Hey.
Thanks, uh, for today.
For-for letting me, uh...
You did a good job in there.
Thanks.
You okay?
I love you.
Oh, g... oh, my god. That just came...
fly-flying out of my face
like it was s-s-some kind of...
I-I l... I love you.
I just... god.
Did it again.
I... I-I-I-I love you.
I-I do. I just... I-I love you.
And I have been trying not to say it.
I have been trying so
hard to just mash it down
and ignore it and not say it.
And Jackson is a great guy.
He-he is, and he... he's gorgeous,
and-and he's younger than you,
and he doesn't have any grandkids
or-or babies with his lesbian B.F.F.S
and he's an Avery,
and-and he liked me, you know?
He... he really liked me.
But it was never gonna work out
Because I-I love you.
I am so in love with you.
And you're-you're... you're in me.
It's... you're like... it's...
it's like you're a disease.
It's like I am infected by Mark Sloan.
And I just can't...
I can't think about anything or anybody,
and I can't sleep.
I can't breathe.
I can't eat.
And I love you. I just...
I love you all the time,
just every minute of every day.
And I-I-I...
I-I...
love you.
God, that feels good,
just to-to say that...
to j... I am...
I feel so much better.
Just... I love you.
Mark?
Hey, Lexie.
I thought you said the lobby. You ready?
Hey there, sunshine.
You feeling okay?
Yeah. You know, just groggy.
You guys got good drugs in this place.
Good. What the hell were you thinking?
- Dude...
- You're an idiot.
You should have called me.
I mean, wh-why didn't you
call me? I'm a doctor.
What do you think I do all day long?
Instead you go to some quack in Tibet.
I mean, you should've freakin' called me!
Naturopathy works, too, flagstaff.
Whoa. It's not flagstaff!
And it's not Phoenix and it's not Tempe.
It's Arizona Robbins, M.D.
Do you know what that means?
How do you spell it?
It's not funny, Nick.
Nothing is funny. You're dying!
And you know what hell
it was when Tim died
because you were there,
and-and you and I barely
made it through that.
So to do nothing for six years
and then to come when it's too late,
I... I...
Why do you think I didn't
come to you sooner?
As if after Tim died, I could...
You think I don't know how
this must feel for you?
You're an idiot!
I couldn't have helped Tim,
but I could've helped you!
I'll admit, the romans had a point.
You've gotta live life.
Ugh. Gotta pee. Gotta pee.
Gotta pee. Gotta pee. Gotta pee.
What time you got?
12:04.
Oh! It's supposed to
come online at midnight.
I mean, it's four minutes late.
Come on, people. Crazy doctors,
they crashed the system.
I already know I failed,
so I don't know why
I keep hitting the refresh button.
And living means that every
morning when you wake up
you have to choose...
Okay, if anyone failed, was me,
because my guy had a vendetta.
Please. I've got the odds on failure.
Are any of you on call? I've got a trauma.
No!
Wait. Wait. Wait.
I passed. I passed.
I passed! I passed! I passed! Yes!
I passed! I passed!
Oh, my god! Yeah!
Between seizing what
life offers in the moment
and forging ahead,
no matter the weather...
- Alex?
- It's not coming up.
Here. Here. Use mine.
Oh, unh!
Yes!
Wait. Wait. Where is April?
Or closing the curtains...
and shutting out the day.