Grey's Anatomy (2005–…): Season 8, Episode 9 - Dark Was the Night - full transcript

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"I had a terrible day."

We say it all the time.

A fight with the boss,

the stomach flu,

traffic...

Okay, try and breathe for me.

I'm trying.

Okay, okay.

That's what we describe as terrible

when nothing terrible is happening.

Okay, okay.



You're gonna be okay.

Let's get a good line him.

Okay, and where is X-ray?
Get them in here, stat.

He, uh, hasn't been having trouble

with his, uh, V.H.L.

No, uh, tumors since, um...

uh, when, uh, when was your last C.T.?

It was, uh, it was june.

Dr. Webber did a full workup.

Okay, then let's page Dr. Webber, please.

- Right away, doctor.
- His veins are shot.

Let's go ahead and put in a central line.

We're gonna put a line in so
we can give you I.V. fluids.

And once we get the X-ray,
we should have a better idea



of what's going on, all right?

We got him. Okay?

Yeah. Yeah.

All right.

Okay, well, what about the eye?

Good. We'll... we'll be waiting.

Okay.

Oh, hey, Avery.

We got a kid with half
his face torn off by a dog,

so can you get Sloan and
meet me outside?

- Yeah.
- And, hey, see if Shepherd's still here,

- 'cause we may need him.
- Okay.

Dr. Robbins.

You're popular tonight.

Hey, this is Robbins.

Right now?

Well, where?

That was pathetic.

Shut up.

She told you to go screw yourself.

We could hear it all the way over here.

It's not 'cause she wasn't into me.

Oh, does "Go screw yourself"
have some secret meaning

we're not aware of?

I kinda already knew her.
I just didn't remember.

You slept with her before
and forgot about it

and then tried to pick
her up all over again?

You're not even drinking.

I have a history of
Alzheimer's in my family.

What's your excuse?

It's O'Malley's fault.

I mean, talking about dead people,

it throws me off my game, that's all.

Mm.

It's Janet.

- Can you, uh, pay for my, uh, thing?
- Yeah, yeah, yeah.

Thank you. Hey, hey, Janet.

I gotta run.

Would you pay for mine?

No. I'm leaving.
I'm going to the skills lab.

Oh, come on.

She had the social worker on the phone.

You can fish 20 bucks out of your pocket.

I want to see you
for a follow-up next week.

And listen, I know Drew is
a kid whith a lot of energy,

but we just put a bunch
of screws in your back,

so you gotta take it easy for a few weeks.

And I am not kidding
about physical therapy.

You're gonna need all
the support you can get

to keep up with... that little one.

I'm gonna do it. I really am.

You feelin' okay?

I still kinda like the idea of
keeping you here another day.

No, it's been three days.

You know, it's hard on Drew.
He needs his mom.

I just want to get home.

Okay.

Mommy!

- Hey, sweetheart!
- Hey!

- Hi. How are you?
- Hey, careful with mommy, okay?

Ah, no bending.

- Hey.
- Hi, sweetheart.

Oh, I missed you so much.

- Oh.
- You all right?

Yeah, just stitches.

Okay.

Hey, Drew.

I am gonna need you to be
really gentle with mommy

for a few days, okay?

Okay.

All right. Okay.

All right, guys.

Call me if you need anything, okay?

We will.

Thank you so much.

- Anytime.
- Hey, you. Bye.

What did Janet say?

Meredith?

We're not getting her back.

What do you mean? What...
what exactly did she say?

That we're not getting her back.

She said that?

She said that the court...

canceled our hearing date.

And when they do that,
it means either one of two things...

That they looked at our file

and they love us and
they're giving her to us,

in which case they call Janet
and they tell her that,

or that they hate us

and they're giving her to another family.

And she didn't get
the "They love us" call.

Well, maybe they didn't get around to it.

She said we should move on.

That's what she said.

You want to know her exact words...

were "I think it's time that you and Derek"

"start thinking about moving on."

Oh, my god.

Oh, god. How can they do this?

- You can cry.
- I don't want to cry.

I know.

I'm never gonna see her again.

God.

Okay, stop. I don't want to cry.

Okay. I know.

Call up to C.T.
Tell 'em we're on our way up.

Screw C.T. and go straight
to the bronchoscope.

You need to find out what is down there.

C.T. will clarify what we're dealing with.

It won't delay anything,
and you're not his doctor.

Richard is.

I hear he's good. I mean, I-I don't know.

He's new around here.

She doesn't like it when
I'm in the hospital.

Makes you wonder why she married
a guy with chronic illness.

Masochist. Call me if you need anything.

I'm coming to C.T.

I wouldn't have it any other way.

Good.

Meredith is in the E.R.

Look at this. Scalpels from the 1860s.

I want to get 'em for Meredith.

She needs to talk to you.

Oh, can you distract her?

It's on eBay,

and I got 25 minutes left on the auction.

Derek, Janet called.

The baby was born a couple of hours ago,

and it looks like
a tracheoesophageal fistula.

You know what that is?

Yeah, it's the connection between, uh,

the trachea and esophagus.

Fills the lungs with secretions.

Baby can have a hard time
breathing and feeding.

Exactly Bentley hospital is tiny.
They can't handle it.

So you need to go pick up the baby,
bring her back,

and then hopefully, I'm done with the kid

that's on his way in
by the time you're back.

You need to reconfigure the ambulance

for intensive neonatal transport.

And I think you should
get someone else to go...

Grey, ride with Karev. He's on a baby run.

Well, I have to talk to Derek.

Well, newborn life hanging
in the balance. Make it fast.

10-year-old male, dog bite to the face.

Vital signs stable in the field.

All right, trauma three.

Laura.

Hey, Dr. Avery.

Honey, this is my guy.

You must be Griffin.

Yeah.

And Drew.

Hey, your mom said that you were a kid,

but you are almost as tall as me.

You're not that tall.

So, listen, thanks so much for
taking such good care of her.

My pleasure. How you feelin'?

Oh, just ready to go home.

Okay, but you make sure to give me a page

when you come in for
a follow-up, all right?

Nice to meet you.

Okay.

I, uh, see what you mean about those eyes.

Wow.

If I weren't such a confident guy,

I might have to, like,
challenge him to a duel or something.

Honey.

Can we get some help, please?

Maybe there's an appeal process.

- Did you ask?
- I didn't.

You talk to the lawyer?

I just got off the phone with Janet.

We'll appeal. We'll sue
the agency if we have to.

They don't think we should
be Zola's parents, Derek.

They don't think I'm trustworthy,

and they're not the first
ones to raise that concern.

Meredith.

They don't think
I should be Zola's mother.

She's gone.

It's gonna be okay.

Okay?

We're gonna find a way.

Zola was our baby,

and she's gone,
and I don't want another baby.

She's barely got any pulse.

What was she in for?

A thoracic spinal fusion
to fix her scoliosis.

Dr. Torres just released her,
and she was doing fine.

Okay, heart sounds are muffled.

Let's call Altman.

She's not protecting her airway.
I'm gonna intubate.

- Is she okay?
- Sir, there's a waiting room.

What's happening?

Take your son out of here.

We will let you know when we know.

We're gonna need the ultrasound,

and somebody find Torres.

Right away.

They can put on some music.

Nah, I'll just take a nap.

You're gonna be fine.
You know that, right?

I do.

Good.

I just wish I hadn't spent the day

trying to kill your hopes and dreams.

You know, that's why
I started spitting up blood,

so I'd win.

I'm happy to have you
go to medical school.

You don't have to be happy.

No, I am. I'm not...

I-I love med students.

I'll help you study.

You'll be my study buddy?

I'll make you flash cards.

That's so hot, I'm not
sure I can even handle it.

It'll be fun.

It's your worst nightmare.

- Yeah. Whatever.
- Mm-hmm.

We'll figure it out.

Mm-hmm.

Don't move.

Where's Bailey?

Uh, Henry doesn't need both of us,

and we all agreed that
you'd be less of a hassle

with the former chief of surgery.

Nice. You're nice people.

So are you planning to
get a look with contrast

or just the non-contrast study?

Which would you prefer?

Both.

Um, can you get some contrast ready?

- Got it.
- Thanks.

Are you kidding me?

The E.R.

- Owen wants a consult.
- Well, go ahead.

It'll take five minutes,
and we don't both need

to stand here watching the C.T. load.

Are you sure?

If you're not back in five,

I'll find you as soon
as the film comes up.

You will?

I said I would, didn't I?

Thank you.

Oh.

Look at that.

What the hell happened?

That's what I was gonna ask you.

She's in shock and...

it looks like her
pericardium's full of blood.

She just had spinal surgery.

- Wh-why would she...
- I was hoping you would answer that.

She's arresting.

Uh...

All right. I'm gonna do a thoracotomy.

Open up a chest tray. Kepner...

prep the chest.

You're gonna crack her chest?
She's not a trauma.

Yes, but she's dying.

It's probably a mistake.

You know, courts...
they screw up all the time.

You call 'em in the morning...

It's over, Alex.

It's been over for a while.
Everyone knew it.

No one wants to say it.

So get-get a surrogate or whatever.

You can't just write off
having a family like that.

Get Yang to carry a kid for you.

She gets knocked up at the drop of a...

If you don't shut up in
the next three seconds,

I'm gonna shove you out
of the back of the rig.

What the hell is happening?

What do we got?

I had to open her up.
Her pericardium is full of blood.

Ton of clots.

Gunshot?

No, she had spinal fusion three days ago.

- What?
- I don't know.

She has no history of heart
disease or risk factors.

This is crazy.

Could it be a retrograde dissection?

No, I don't think so.
She has no history of Marfan's

or aortic widening on X-ray.

Oh, her heart's beating again.

All right, let's get her upstairs now.

Throw a sterile towel on her and move.

All right, people. Let's go.

I don't need you in there. I'm good.

Okay. Well, she's my patient.

Did you cut her heart open
in your spinal fusion?

- Uh, no.
- Then she's my patient.

All right, Henry's in C.T.

somebody tell Webber where I am.

Oh, oh, oh, hold on.

Teddy!

Right there. The bronchus.

Judging by the ossification,
probably a cardinoid tumor.

Because of his tumor condition?

Yeah, he's bleeding in
his lungs and trachea.

Lexie's prepping him.
We're gonna take it out.

You're gonna bronch him and use a laser?

I was planning to open him up.

Take out the lung, resect the tumor,

- put it back in.
- A laser is less invasive

and the recovery time is much faster.

I hear that, but I've never
done one with a laser.

What?

Not for this kind of procedure.

And I don't want my first
one to be on your husband.

Well, I...

Um...

I think we should get another surgeon.

- Cristina.
- No. Come on.

Taylor is on vacation.

Goldman is 45 minutes away.

I did an endobronchial tumor
with Cristina last week

with a laser.

I barely did a thing. She did it all.

We've done three in the last year.

Teddy, it-it's just too much pressure.

Now she's a resident,
it's her mentor's husband.

She's a machine. She doesn't
care if it's my husband.

No, she's not, and we can get Rudzki.

Rudzki's an ass, and he's sloppy.

Gown.

I think we should reconsider
having Webber do this.

I don't have anything to prove.

If I'm not state-of-the-art,
have Yang do it.

There's no question,

Henry's on his feet faster
if we don't open him up.

Cristina doesn't have
to know that it's Henry.

Drape his face, don't show her the chart,

give her a verbal history.

You put a bronchoscope
and a laser in her hand,

she's not gonna ask

for the guy's name and,
uh, a family photo.

She is gonna cut.

You really think this is a good idea?

Look, I'll be there the whole time.

If she has trouble,

I'll go in and open him
up the old-fashioned way.

Lap sponges, please.

Owen? Is he scowling?

Yeah. So am I.

I don't like it either.

Frankly, the only thing
that I'd be comfortable with

is doing it myself.

But since we all know that
that's not gonna happen.

The next closest thing is Yang.

She is the only one who
will do it the way I would.

Fine.

What'd he say?

Uh, he said fine.

Thank you.

Richard, watch her like a hawk.

If she screws this up,

you're gonna have to
take out half his lung.

And the last thing I need is to
have to explain to my husband

why that happened.

I'll watch her.

Cautery. Keep suctioning.

You gotta get some of those clots out.

- Okay.
- Good.

Hey, we're here to pick up a newborn,

take her to Seattle Grace.

You're, uh, you're looking for me.

I'm Jordan Wagner.
I am really glad to see you guys.

Yeah, I'm Alex Karev. Meredith Grey.

Okay. Li... uh, listen,
she was born six hours ago,

right away, trouble breathing.

Stomach looked distended,
so we put down an N.G. tube.

But the X-ray showed that
it was just coiling in her chest.

We've done everything
we can to keep her breathing,

but it's been a struggle.

You don't have a neonatal mask?

We're not set up for neonatal or O.B.

She was an emergency delivery,

otherwise, we would've sent her
to the hospital in Leavenworth.

Pulse ox is 79. Respiratory rate is 80.

She's got retractions.

How come she's not intubated?

The smallest tube we had didn't fit.

Please tell me that
you brought a neonatal tube.

We're gonna need X-ray in here
for a post-intubation film.

This I.V.'s no good.

Yeah, you don't even have
a neonatal central line kit.

No.

I.O. needle?

No.

You will not call Dr. Yang into the O.R.

until Henry is intubated and draped.

You will make sure to drape
every inch of his face.

You will give a verbal history,

and you will simply
omit the patient's name.

But Dr. Webber's gonna be in there?

- Yes.
- And he knows?

He knows, you know. Dr. Yang does not.

Can you handle this?

You sure?

Yeah. I-I mean, I'm gonna
be wearing a mask, right?

I mean, as long as I don't
start giggling then we're...

we're fine.

She doesn't want any kids at all?

Zola was her baby.
She doesn't want another baby.

Ah, she'll come around.
She's upset. Give her some time.

I don't know.

Look, if it doesn't work out,
you can always share Sofia.

There's three of us parenting
her already. It kinda works.

No one gets too exhausted,
you're not on very night.

We can work you into the rotation.

She's a baby. She's not
a time-share in Cabo.

You're close-minded. That's your problem.

That's my problem?

Avery.

What's the deal?

Nose is hanging off and
a lot of soft tissue loss.

Probably nerve damage.

I'll let you know when
Dr. Robbins is ready for you.

It's Karev.

How's it going?

The kid's septic. She's got pneumonia.

Was she intubated when you got there?

Yeah, well, they don't have any
neonatal stuff here at all.

We intubated, we started an umbilical line

to hang d10 normal saline and antibiotics.

But her SATs aren't coming up,

and all the oxygen's
going into her stomach.

You're gonna need to put
in an amplatz umbrella.

They don't have a 3-0 E.T. tube.

You think they're gonna have an amplatz?

All right. Elevate her head.

All right. Get her head up.

All right, do they have
a Fogarty catheter?

They use those on grown-ups.

A Fogarty catheter?

- Yeah, what else?
- You're gonna have to

thread the Fogarty down her trachea,
pretty far down,

then blow up the balloon,

and pull up until you get traction.

That'll occlude the fistula

and get the air flowing into the lungs.

You're gonna have to keep the blind
pouch clear on your way back.

And I'm not sure you have

anything in your box that's gonna do that.

Uh, how about an 8
french suction catheter?

Yeah, that'll work.

Got it. All right.

- We're gonna call you when we get to rig.
- Hey, Alex.

You don't have a lot of time.
You know that, right?

Yeah, I know that.

Look at that.

- There's a huge tear in the left ventricle.
- Can you repair it?

No, it's too big.
We're gonna have to go on bypass.

Dr. Altman, I've got your husband.

Oh, good. Henry.

Hey, babe.

I am so sorry.

This woman's heart is
spouting like a fountain

for no apparent reason.

That sounds like fun.

Well, if there was any way
I could get out of here, I would.

Stop worrying about it.

You can hold my hand... in post-op.

You were such a wuss
before my last surgery,

it's probably a good thing anyway.

Yeah, that wasn't my best work.

We're an old married couple now.

You don't have to drive me to the airport.

You don't have to walk me to the O.R.

Well, I still want rides to the airport.

That's 'cause you're high maintenance.

You know it.

Look, I'll, uh, I'll see you after.

Henry, don't ask for extra morphine

just 'cause you like the dreams.

- Get back to work.
- Love you.

Yeah, you, too.

All right. I'm good.

More sponges, please.

Wow. There aren't enough
sponges in the world.

Suction.

Must be hard for her to be in the O.R.

and not here with you.

Can I tell you something
kind of embarrassing?

Yeah.

I want to go to med school.

That's not embarrassing.

I wouldn't exactly be
the youngest kid in my class.

Yeah, but you'll be mature.

You'll have perspective.

None of us had that in our class.

Teddy's not crazy about the idea.

We kinda had a...

a big fight about it right
before all this happened.

Well, she might need some
time to get used to the idea.

None of this is very
easy on relationships.

You seem to do okay.

Jackson, right? He's-he's great.

Yeah. Though we're not together anymore.

Oh. Um... Mark Sloan?

We're not together either.

So who's-who's gonna be operating on me...

Dr. Webber?

I don't know.

Hey. Teddy's got a patient with
an endobronchial carcinoid.

She wants you to take care of it.

- Now?
- Yes.

Why can't she do it herself?

Well, she's working on a woman
who almost bled out in the E.R.

so, uh, she can't do it.

Well, how about Goldman?

She's giving you a chance to
fly solo on a major procedure.

I know, but we just did a similar one.

I basically handled the whole thing myself

while she planned
the menu for what sounded like

a really boring brunch.

And I'm supposed to do my first
bentall procedure tomorrow.

It's from my bucket list.

I'm practicing the steps. You want to see?

Okay, drop the damn suture
and go scrub. All right?

Okay. Relax.

This better be fast.
I want to be fresh tomorrow.

Cristina, this is emergent.

Yeah, I'm going.

I'm just saying, I'm glad she likes me,

but if she's gonna call
me every time she has

a procedure she doesn't feel like doing...

I mean, I'm not her valet.

Maybe it's not the end.

You'll call the lawyers in the morning.

And m-maybe there's something
else you guys can do.

Meredith didn't want kids.

I pushed her. She opened herself up.

Now I feel like I...

I did this to her.

She wanted it, too,

or it wouldn't have happened.

She'll blame me...

like I've been blaming her.

We lost Zola, and now
if I lose Meredith...

She always comes back.

She might need a minute
to back away, but...

she comes back.

Try this patch on the tear.

We're gonna have to cut it to size.

Ah, hang on.

Sorry. I... my glove is stuck on something.

I'm taking my hand out.

What happened?

There's a hole in my glove.

You're kidding.

Can we get Dr. Kepner a new glove, please?

Did it break the skin?

No. I think I'm fine.

- Here you go.
- Thanks.

My god.

What the hell is that?

Dr. Yang.

We just started the bronchoscopy.

Looking forward to seeing your work.

Hopefully I'll learn a thing or two.

It's an honor, sir.

Uh, 35-year-old male,

endobronchial carcinoid tumor,

presented with active hemoptysis.

He's been given two liters L.R.
and a unit of packed cells.

Okay.

So we'll resect with the c-o-2 laser.

Is it ready to go?

Yes.

You know, I think I'm gonna time myself.

Last time I did this, it took me like

two and a half hours, skin to skin.

That's too long.

I think I get hypnotized, um,

when I watch that laser or something.

We should be able to get it down to,
like, two hours.

Let's start the timer for Dr. Yang.

Okay, laser, please.

Is that them?

Wait. I'm coming with you.

Dana?

Why is she out here?

She said if I didn't take her, she'd walk.

I was afraid she'd try it.

Please let me come with her.

Dana... you just had surgery,

and you've lost a lot of blood.

I'll be fine. Please.

I need you to take care of yourself.

These guys, they're the best.

She is in great hands.

Please.

She's my baby.

We're supposed to be together.

I can't leave her. She's so little.

Please.

I have to be with her.

Please let me go with her.

I'm Dr. Grey. And that's Dr. Karev.

And we're gonna take your daughter

to the best baby surgeon there is.

She doesn't even have a name yet.

Well, you're gonna give her
one when you come to Seattle

and hold her in your arms.

And until that time,
I'm gonna take care of her.

You hear me?

I have her.

Okay?

What happened?

Show her the tray.

That's the screw

That I just pulled out of your patient.

It was stabbing her heart,
slicing into cardiac muscle

every time the heart tried to beat.

This thing looks like hamburger
meat right about now.

Oh, my god.

You want to tell me how this happened?

You know, why not try adoption again?

Social services just took our kid away.

What do you think,
if we wait a week, they'll forget

and give us another try with a new kid?

All right. So get a surrogate.

Alex.

Why not?

Because I don't want a surrogate.

Okay? Just drop it.

No. You just don't give up like that.

It's nice that you care,

but it really isn't any of your business.

It is. It's my fault.

I can't handle being responsible
for you not having kids.

It's too much.

I... it's not your fault.

Yeah, it is.

No, it's my fault.

I got the ball rolling.
I messed with the trial.

What you did was turdy,
but what I did was illegal.

Who cares? You just don't give up.

It's lame. You're not a quitter.

That's not who you are.

Dude, what's the problem?

I'm kind of in the middle of a surgery.

No, here's what you're in the middle of.

The surgery on Laura Lewis,

where I supervised you
inserting pedicle screws

and a plate to stabilize t-6 to t-8?

Yeah?

One of them's stabbing her in the heart.

She's half dead,

and we're about to go tell her husband.

So using a laser's not much different

than a normal bronchoscopic resection?

Uh, yes.

You just have to be extra careful

with hidden vascular structures

when using this high a level of energy.

But you're forming an eschar as you go,

so the blood's coagulating along the way.

Pretty much.

That is pretty handy.

Oh, okay. What happened?

Ugh. I must have nicked a vessel.

Pressure's dropping.

Okay, so I'm giving it more irrigation.

Ah, the whole field's obscured.

What happened to the engine?

I don't know what the crap it is.

I called for another unit,

but we're in the middle of nowhere.

It's gonna take forever.

I'm putting these out
and I'm gonna run back.

It looked like there was
a store or something

about half a mile back.

Maybe they got a truck.
You gotta get out of the rig.

It's pouring rain and freezing.

We can't go out there with the baby.

There's no shoulder.

It's not like we can just
take the incubator out.

I mean, there's not
even anywhere to stand.

This thing is full of oxygen tanks.

We get hit, it'll go
up anylike a roman candle.

You gotta get out.

- And leave the baby?
- She'll die.

You want to all die?
I'm putting these out.

You better hope people can see 'em.

You're on a hill and you're on a curve.

I'm telling you, get out the damn rig.

Hey, you need some help?

Why?

Well, his pressure dropped out.

Oh, there was a nick in an artery.

I cauterized, and
his pressure came back up.

Okay, but what
if it was a carcinoid crisis?

Uh, I doubt it.

But if his pressure drops out again,

I'll think about a dose of octreotide.

Cristina...

I'm on a clock,
and you're wasting my time.

What is your problem?

Cristina, there's a patient on the table.

Let go off the clock and
focus on what you're doing.

I am focused.

I'd focus a whole lot better

if you weren't standing here
with your pants on fire.

We've got it, Dr. Hunt.

Apparently, one of the screws

we placed in her spine came loose.

Uh, it could be that
the bone isn't strong enough

to hold the screw.

But at this point, we don't know.

Okay, and so what, it just, um,

and so the screw, it...

it cut into her heart?

Dr. Altman's repairing
her heart right now,

and she's an incredible surgeon.

But, uh, we won't know for a while

exactly what the situation is.

Situation? I... but I... I don't understand.

Where's my mama?

Oh, buddy.

Buddy. Come here.

Look at that.

Very nice.

Right?

If I do say so myself.

Oh, hang on. We've got some bleeding.

Okay, you have some clots
blocking your scope.

Why don't you take out your laser

and pass a brush through it?

Okay. Okay.

SATs are down to 88.

Okay, uh, I'm gonna have to open him up.

Just let me just try this first.

Yang, Yang, you have blood
coming in through the E.T. tube.

Get outta there.

I can clear the field...

Get his chest ready, Grey. We're going in.

Okay, okay, I'm pulling out.

10-blade.

10-blade.

Find all the films... pre-op, post-op.

You go over every inch of every image

and assuming she survives, you get a C.T.

to check the hardware

and run a bone density test...

so we can get a clue as to
what the hell went wrong.

Oh. I, uh...

I'm so sorry. I-I have to go, Dr. Torres.

I'm sorry.

What?

Avery put pedicle screws

in a woman's spine this week,

and one of them turned out to be

tearing holes in her left ventricle.

Whoa.

I can't... I c... I can't...
I can't even breathe right now.

Yeah, well, come on.
It's part of the deal.

We have to let students operate.

They don't always get it right.

I was reading a magazine.

Hey, come on.

Now don't beat yourself up. We all do it.

I know what J. Lo wore to the coffeehouse.

That's what I was doing.

Shh.

Vascular clamp.

He is losing way too
much blood way too fast.

Okay, put the blood on a rapid infuser

and get me another two units up here.

Right away. He's really bradycardic.

Okay, let's push one atropine. Now.

Uh, hold on. Wait. Wait. Wait.

This tumor has eroded

right through the pulmonary artery.

Damn it.

Let me see.

Sir...

Okay. Let's clamp the hilum.

Uh, he's already lost
half his blood volume.

This lung is like a sieve.

- I...
- Give me bovie.

We're maxed out on dopamine.
Maxed out on norepi.

Sir, I'm not sure what we do next.

V-fib.

Okay, push one of epi. Now.

I'm gonna start compressions.

Ah... let's get this outta here.

Come on, people.

Okay, here we go.

Come on.

Look at that.

His nose is gonna be perfect.

This is gonna be beautiful.

If you do say so yourself.

I offered to time-share Sofia
with Derek and Meredith

if they don't end up
with kids of their own.

He said no.

Why?

Because your child is not a rental car.

We're not gonna take her
out one week a month.

Have you seen her? 'Cause she's
heart-stoppingly adorable.

You're missing the point.

He's missing the point.

No, she's delicious. She's addictive.

- Why wouldn't you want to parent her?
- I just find...

Ambulance broke down, like,
in the middle of the road.

- They can't move. They can't get out.
- Did they send a backup?

It's-it's coming, but it's slow.

Put her on speakerphone.

Yeah.

Alex?

We can't move.
We're a friggin' sitting duck.

We... the... ba...

All right, hold on.
I can't hear you. Say that again.

We gotta take the baby out of here,

but the two of us can't
move the damned incubator

and all this crap on a highway.

Did you set up the flares?

Okay, leave the phone.

See if you can get a helicopter up there.

Yeah. Take this?

Sir, it's been 20 minutes.

There's no way that heart's coming back.

Sir, there's no blood left to circulate.

I'm not sure what you're...

Um... time of death...

8:52 P.M.

There was no way to take
it out without killing him.

And there's no way
he could've lived with it

in him for much longer...

Well, I'll write the op note, um...

But if you can add a few lines,

um, that make it clear

that I didn't come up
with the treatment plan.

It's a bad outcome, and, um, I don't want

To take the heat for it
in my fifth-year boards.

It was Dr. Altman's idea.

Oh, hey.

Um... the tumor

eroded right through the pulmonary artery.

The guy bled right out.

Uh, we were done before we started.

Is there, um,

uh, a family or... something

we need to, uh, talk to?

Secure the umbilical line with extra tape.

You need the D10.

Put the oxygen tank in the holster,

- and take the paramedic kit.
- Get out of the rig.

Swaddle her so that she stays warm.

We can't regulate...

What?

We can't regulate her temp
without the incubator.

They may have to leave the kid.

We are not leaving the baby.

At least one of you
should get out of the rig.

What are they gonna do, flip a coin?

They're sitting in a powder keg.

- Get out.
- Alex...

Go. There's no reason for
both of us to get killed.

Well, I'm not safer in
the middle of the damn road.

I'm telling you to get
out of the damn rig.

Alex, if you want to go, you go.

We're not gonna fix your
guilt by me letting you

die in an ambulance so that I c...

Is it possible the bone was intact

when they closed, and then...

And what, it just fell apart
in the last couple of days?

I don't know how you don't check

if a vertebra is compromised
before you drop a screw in it.

Hey.

How's it going with Henry?

Uh, they're done.

Oh. You almost finished here?

Oh, it's gonna be a while.

Torres missed a loose screw
in this woman's spine.

It tore apart her whole left ventricle.

I've never seen anything like it.

I put in a patch.

I've, uh, still gotta reinforce it

with a muscle flap.

It's just... it's... it's a mess.

Hey, will you... will you check on Henry

and see if he's feeling okay?

I... I told him I would be in post-op.

And I wasn't in pre-op.
I'm-I'm a bad wife.

I'll take over here.
You can... you can go out.

All due respect,

but you are out of your depth.

Why does your face look like that?

Oh, there was an ambulance
broke down on route 2,

so we-we lost contact.

Oh, I hope everyone's all right.

Ohh, route 2 at night?

Awful.

Going over those mountains?

So...

Henry...

wants to go to med school.

Can you believe it?

No.

I mean, I-I squashed the idea like a bug,

which I feel awful about,
but I mean, come on.

I mean, a med student at his age?

That's crazy, right? Or...
or am I just a terrible person?

No.

No, I'm not, or it's not crazy?

The patch isn't holding.

Oh, we cannot get a break here.

All right, let's try a pledget.

Check on him,

let me know how he's feeling... would you?

Yeah, of course.

Oh, and, you know, if you get bored,

I mean, you could mention that
med school is a long haul,

and, you know, he may want

to try to get a degree in something else.

Oh, and...

he's a real stoner on dilaudid.

So don't be surprised
if he compliments your eyes.

I just spoke to emergency dispatch.

Another ambulance is coming now.

The cops are a few minutes out,

and the helicopter wouldn't be any faster

since they leave out of skykomish.

Are we still on speaker or what?

Uh, we were talking to them

and there was a loud noise and...

we lost them.

Avery,

Dr. Shepherd's gonna put
down his instruments

and you're gonna step in for him.

Fancy part's over.
We'll walk you through the rest.

Derek.

All right.

It's not right.

Who's gonna take over in
the middle of a bypass?

There's a woman on the table

who dies if Teddy walks out of that O.R.

It's her husband, Richard.

Another hour isn't gonna change anything.

Goldman's on his way. Tell her then.

She's my friend.

You're not her friend right now.

You're the chief of surgery.

If she finds out that I waited,

she will never forgive me.

Her husband just died in our O.R.

She'll never forgive any of us.

Hunt.

Meredith and Alex are
trapped in an ambulance

- in the middle of the highway.
- I know.

We just lost contact.
I think they got hit.

We need to get emergency
dispatch on the phone.

What is it?

What?

All right. The ventricular
laceration is still bleeding.

We need more volume.

- We need some more blood.
- Right away.

She's dropping again.

Come on, Laura.
You gotta pull it together.

Okay, good. Uh, there we go. 90 over 60.

Good. Hello again. How's he doing?

Uh, he's fine. Woozy. Um, vitals are good.

Uh, did they run a post-op C.T.?

Uh, not yet.

But Cristina felt she got clean margins?

Oh, yes.

Did she figure it out,

who she was operating on?

No.

See? I told you.

Sometimes her lack of interest

in the patient as a human being

can come in handy.

Did you mention the med
school thing to Henry?

No.

You're a coward.

You know, if you think you are
off the hook, you are wrong.

I mean, this could ruin the next
five to ten years of my life.

You do understand that, right?

- I mean, can you imagine...
- These are the things we beg for...

- Helping him study for his MCATs...
- A root canal...

- An I.R.S. audit...
- Quizzing him on anatomy?

- I can't go through that again.
- Coffee spilled on our clothes.

When the really terrible things happen...

We start begging a god
we don't believe in...

to bring back the little horrors...

and take away this.

Are you okay?

You're bleeding.

Mer, what are you doing?

Get me a blanket. I'm taking her out.

Mer, put her back in.

She just got thrown around a plastic box.

She needs to be held.
I'm not putting her back in.

Are you okay?

No, I'm not okay.

Mer, listen, we gotta get outta here

before this thing blows.

Well, how are we gonna do that?

She's connected to a million things.

You got the bag and the baby.

I'll get the o-2 tank and the I.V.

And we're gonna disconnect
her from the antibiotics.

Is that gonna be okay?

Yeah. It's gonna have to be.

It seems quaint now, doesn't it...

the flood in the kitchen, the poison oak,

the fight that leaves
you shaking with rage?

Would it have helped

if we could see what else was coming?

Would we have known

that these were the best
moments of our lives?