Grey's Anatomy (2005–…): Season 9, Episode 12 - Walking on a Dream - full transcript

Patients who undergo an amputation

often feel sensation
where the missing limb was...

As if it's still there.

The syndrome is called "Phantom limb."

Hey, what do we got?

Plane crash. Open fracture
of the left femur.

Signs of massive infection.

It's as if the body can't accept

that a terrible trauma has occurred.

The mind is trying to make
the body complete again.

Patients who experience phantom limb...



What? What's wrong?

Nothing.

Is it hurting again?

No, I'm fine. I'm fine. Go back to sleep.

Okay.

Report many different sensations.

But by far, the most common...

is pain.

Uh, an acoustic neuroma?

- Oh, boy.
- A long, difficult surgery

With a stupid-high post-excision
mortality/morbidity?

That's what you want
to start my hand with?

It's my hand.

And thanks for making it sound so fun.



You can't try something with
a little margin for error?

I was supposed to operate
on Jimmy months ago,

but then the plane crashed.
It has to be today.

Well, if you can do this,

I guess my hand can do anything.

Still my hand.

Okay, folks. Let's just start.

As many of you know,

Seattle Grace Mercy West has suffered

a financial setback.

The administration is working hard

to keep the impact of that
setback as small as possible.

To that end,

we're gonna have to initiate
some cost-cutting measures.

The board has hired
a physician advisor to help.

What's a physician advisor?

Well, she consults on
maximizing efficiency,

streamlining processes,

assessing where we can trim our budgets.

Who to fire and when to fire them?

She's here to advise and to help.

I was hoping to introduce her in person,

but she seems to be late.

Oh, on her first day?

Not very efficient.

You can expect to see her in the halls,

in your labs, in the O.R.

So we're gonna have an accountant

following us around the O.R.s?

She's not an accountant.
She is a trained surgeon.

- Frankly, she is here to try to help us.
- Oh, okay. Help us. Right.

Thank you for your cooperation.

Hey. Can I get a minute?

It's urgent.

Yeah.

This was urgent?

Yes. It's the stupid pregnancy hormones.

It makes me want to have
sex all the time, urgently.

Oh, I like the stupid hormones.

- Oh, no.
- What?

- Oh, I have a consult.
- What?

I have a consult.

Are you crying?

No.

Yes.

I cry every time I get mad.

You're not... you're mad?

Yes, I'm mad, because I can't have sex

because I have this stupid consult.

- Dr. Shepherd?
- Ross?

Sorry to bother you, sir,

but I was hoping to
scrub in with you today,

and I'm supposed to be on
Dr. Grey's service.

So I was wondering

- if maybe you could talk to your wife for me.
- I'm gonna kill him.

No, Ross, he cannot talk
to his wife for you,

because you are with me,
and we have a consult

with a pregnant lady with abdominal pain.

So go do the workup,

and I will see you there.

I am liking the stupid hormones.

Here you go, doctor.

Dr. Kepner, um, we're swamped,

and I have a shortness-of-breath lady

who needs a consult,

and you probably have better things to do,

but I need help, please.
I'm drowning here.

What bed?

One, two, three...

What are you... stop it.

Edwards, if you're covering the pit,

it is your job to know
every bed in the pit.

Okay. Put on your big-girl pants.

You're about to learn how
to run the pit. Let's go.

I apologize for the wait, ma'am.

You're experiencing shortness of breath?

Luckily, no. 45 minutes in an E.R. bed

before a doctor pulls out a stethoscope?

I'd likely be experiencing
shortness of life.

I don't understand.

Alana Cahill. I'm a physician advisor.

Could you point me towards chief Hunt?

I'm afraid you've made
me late for a meeting.

My bad.

It's like a knife is stabbing me.

You're sure it isn't early labor?

Because if it is,
I'm gonna need to call my sister

and have her bring me my makeup bag.

I'm determined to look cuter
than the baby in the pictures.

Heidi.

Sorry, honey. I babble when I'm nervous.

Brie hates it. She's the quiet one.

- Aah!
- Usually.

Okay, well, it's definitely not labor,

because I'm not seeing any contractions.

And the baby's heart rate is good.

Did you hear that, honey? The baby's fine.

Then what is going on?

There's a few possibilities.

The labs should help clarify.

Ross, did you get that chem-18 I ordered?

Um, I thought I checked off that box,

but apparently I checked chem-7.

My mistake, which I'll quickly fix.

In the meantime, I'll leave you
the lab work I didn't forget.

I guess he babbles when he's nervous, too.

- Ah!
- Okay, okay.

Everyone at Namboze was
so worried when we heard

the program might move to U.C.L.A.,

myself included.

You make the kids feel so at home here.

Well, we were never gonna let that happen.

No, I was away, but now I'm back.

And as long as Dr. Karev and I are here,

then the program stays here.

Okay, um, Nyah's
pericarditis is quite severe.

The pericardial sac around
her heart is inflamed

and starting to adhere
to the heart itself.

So I'll perform what's
called pericardial stripping.

So I'll remove the sac,

and her heart will start
beating on its own again.

What shall I tell her?

Oh, tell her we're gonna fix her heart,

and she'll breathe much better.

Nice program.

Shame to see it go.

Thanks. Wait. What?

We're getting a visit
from the efficiency fairy.

You think she's not gonna
make this disappear?

Look, shut up. We just got it back.

She's trimming fat.

You're flying kids across the world

for a pro bono surgery.

That's pretty fatty.

Yeah, they're orphans.

Well, now you're just making my point.

Oh, my god.

Mac 3 and cricoid pressure.

- Is she okay?
- E.T. tube.

Yeah, start her on 10 mics of dopamine,

and where are the damn labs?

Here. She's in liver failure.

Talk to me, Bailey. What's going on?

Yeah, uh, Ross is right.

Brie's liver won't last another week.

I just went to the gift shop.

What happened?

Is this because of the baby?

No, no, no. It appears to be
unrelated to the pregnancy.

Brie's liver stopped filtering out toxins,

so her body's shutting down.

Without a transplant,
her liver may not last 72 hours.

Don't people wait years for a liver?

Not always. In emergency cases like this,

patients get moved to the top of the list.

So we've notified U.N.O.S.,

and as soon as they have a liver...

What-what-what about the baby?

The baby is perfectly fine for now.

So now we just wait, okay?

Okay.

Do not...

say anything.

I am so... so sorry.

Is this you not saying anything?

Go away

and do not come back

without a liver.

Um, can I get you a tissue?

Go!

Hey, there's my guy.

Jimmy. Hey, Carla. How are you?

Please say you're not still married.

Ah, afraid so.

- Ignore my sister. No boundaries.
- Ah.

You think she cares?
Unless she's the wife.

You the wife?

- Oh, no. You're in the clear.
- Headaches still bad?

He can barely get off the couch,
he's so dizzy.

Meanwhile, I have to wait on
him like he's the boy prince.

Warms your heart, doesn't she?

Yeah. Wilson, what are
some of the other symptoms

of an acoustic neuroma?

Hearing loss, increased
intracranial pressure,

tingling in the face...

And being a giant pain in my ass.

I tried to find another surgeon
while your hand healed.

Turns out, no one will go
anywhere near this thing.

Well we're gonna run some scans

and some labs

and see if the tumor has progressed.

You mean, it could be worse?

Well, we'll have a clearer
idea once we see the scans.

See if you can switch with Ross.

Oh. Did I...

No, it's nothing you did wrong.

It's that Ross knows what
I want before I even ask for it.

I won't have time to
teach you on this one.

Shepherd, this is Alana Cahill.

She is our physician advisor.

Derek Shepherd.

Neuro. I saw you're doing
an acoustic neuroma.

- Very exciting.
- First thing tomorrow.

Patient's here today.

Are pre-op overnight stays
typical in all departments?

That is a question for chief Hunt.

If you'll excuse me, I have to prep.

Hmm. Well, I'll see you
in the O.R. tomorrow.

Typically, you need to be invited.

If things were running typically,

I wouldn't be here, now would I?

Okay.

Brian Turner, age 55.

Minor head injury. Vital signs stable.

Fell off the damn ladder
cleaning the damn gutter.

I was gonna say all that. Fewer damns.

You'll need to know if he lost
consciousness in the field.

Sir, did you lose
consciousness in the field?

I didn't fall in a damn field.
I fell in my damn yard.

Ask the paramedic, not the patient.

Oh, he was conscious the whole damn time.

Um, could we just start over?

Uh, no time. Get him triaged. Go.

45 minutes in an E.R.
bed before I saw a doctor.

Well, that's not good.

No, it's not.

Alana Cahill?

Uh, Dr. Webber.

Wow. Uh, Alana was a student of mine,

uh, how many years ago now?

Oh, do we really have to say?

She was a great student
and a gifted surgeon.

So what brings you back?

You looking at joining the staff?

Uh, she is the physician
advisor that I told you about.

Um, well, we should get
a cup of coffee, catch up.

I'd love to, but I'm pretty booked.

- In fact, we should get going.
- Mm-hmm.

O-of course. It was, uh, great to see you.

Your hero sent me to
trade services with you.

You're welcome.

Can't. I'm waiting for
U.N.O.S. to call with a liver.

So go wait in the O.R.

While you play teacher's
pet with Shepherd.

I'm not moving from this spot.

Great cell reception. See? Five bars.

You know it's not like
ordering a pizza, right?

It could take days.

My patient doesn't have days.

Okay, fine. I'll wait.

And when U.N.O.S. calls,
I'll run to Medusa. I promise.

Give me my phone.

If I miss the call, Grey is gonna kill me.

If I go back to Shepherd and I'm not you,

he's gonna kill me.

Give me my phone.

Oh, my god.

Give me my phone.

Hello?

The pericardium is free.

You should see an increase in,
uh, cardiac function.

It's weird. Heart's floppy.

Still not the way
a kid's heart should look.

Mm. Could be endocarditis.

I'll do a biopsy.

Uh, biopsy needle, please.

Unless it's...

Oh, my god. It couldn't, could it?

Could this be endomyocardial fibrosis?

I-I've only read about it.
It's rare, subtropical.

- Could this be that?
- Maybe.

Remember we had that kid
with pentalogy of cantrell?

This program...

is a medical freak show goldmine.

They can't cut it.

Nobody's cutting it. Robbins,
tell her to stop saying that.

I'm sorry. What?

- You all right?
- Uh-huh.

Okay, um, take that to path. Stat, please.

Oh, you know what? I'll take it.

- Alex, you take my place.
- The nurse can take it.

No, I'd rather take it myself.

Are there pastries

and bagels in every one of your lounges?

No. Well, maybe. I don't know.

Is that the kind of thing
you're gonna be looking at?

I will be looking at everything, doctor.

Huh. Um, Dr. Robbins.

This is Alana Cahill.

Oh. Uh, are you all right?

Mm-hmm. I'm fine. I'm sorry.

I...

Could you just give us a minute?

Of course.

That was the efficiency lady, right?

Yeah, so I probably look
as crazy as a bag of cats.

So it was nice working with you.

Is it phantom limb pain?

Callie said it only happens at night.

Until now.

I'm going crazy. I...

You're not. You're not crazy.

Phantom limb is a very real thing.

I just left a surgery
because there was pain

in a part of me that no longer exists.

So I... what are you doing?

We're helping you visualize
a leg that doesn't hurt.

Here we go. Now...

just look at that.

I... are you kidding me?

We are rerouting your brain,

reminding it of what happened.

There are many treatments
for phantom limb.

There's heat, there's massage,

there's virtual reality therapy.

I knew a guy in the army who
had to stab his prosthetic

- with a screwdriver as hard... as he could.
- Oh, great.

Well, that's not crazy.

Well, for him, it was the
only thing that worked.

Now...

is your pain any better?

Y-ye... it is, a-a-a little.

You see? You just need to
figure out what works for you.

Callie knows all this. What does she say?

I ha... I haven't told her.

She's an orthopedic surgeon.

And I have been her patient for so long.

And I just am starting to
feel like a wife again,

and she needs me to. I cannot have this.

I am finally getting
my life back together,

and-and I will not be screwed over

by something that's not even there!

All right.

We're gonna work together.

We're gonna work together,
and I'm gonna help you,

and we are gonna figure this out.

Okay?

African babies are a godsend.

You don't have to tell me.

Oh, not Zola. Not the cute ones.

The sick ones.

They're exotically diseased,

beautiful little train wrecks.

I just found a case of E.M.F.,

and I get to do an endocardial stripping

of the left ventricle.

Do you know how many other
people have done that?

- No.
- Me neither. It's unheard of.

Where are you going?

I have to see a man about a liver.

Dr. Bailey.

Can I please get another intern?

What's wrong with Ross?

A lot.

The kid made a tiny mistake.

Because he's an idiot.

If I have to work with
him one more second,

I'm probably gonna kill him.

Uh, you think I didn't want to kill you?

You cut L-vad wires,
and yet there you stand.

So... be merciful and suck it up.

Cousin Dora sent him
a stupid giant cookie,

but he can't eat before surgery.

So now I'm starving and I gotta look

at this giant freakin'
cookie that I can't have!

I keep just telling her
to eat the damn thing.

Oh, so you can make fat jokes?

- Then throw it away.
- Jimmy...

Oh, no. What's that look? What's wrong?

The tumor's progressed.

But you could still operate, right?

Yes, we can,

but all those risks we
talked about before...

- Like me going deaf...
- Mm-hmm.

Or half my face being melted
like it was blowtorched,

or me not surviving at all?

Yeah, the chances of those
things happening are much higher.

So... you should take some time

and think about if you still
want to do the surgery.

I've taken time.

I waited for months for you to get better.

Doc, I can't just sit here

and wait for this thing to kill me.

I...

I'm dying, she makes it about her.

Hey.

I'm sorry. I can't let him see me cry.

I'll never hear the end of it.

No, it's okay.

It's a horrible thing to say, I know,

but when I heard you
were in a plane crash,

part of me was relieved.

It's an awful thing that happened to you,

and I'm so sorry.

But it gave me more time with my brother.

These past months have
been the best we've had.

I'm ready.

We both are.

Here's the recheck on
the calcium level you asked for.

Ross is gone, sir. I'm sorry.

He and Dr. Grey went to go get a liver.

I don't want anybody in the gallery.

I don't need an audience.

You up for this?

I want you to know,
the thing with the labs,

it won't ever happen again.

Okay. Just let it go, okay?

Congrats on the baby.

Thank you.

You must be, what, three months in?

Baby's the size of a lemon.

So... second trimester, huh?

The fetus is growing feet...

discharging urine into the amniotic fluid.

And you must be feeling better,

less nausea.

But the second trimester's
also known to bring with it

swollen gums, heartburn, gas...

Do you want me to start crying?!

And on three. One, two, three.

Last B.P. was 110 over 70,

but there was significant
dashboard damage.

Stop. Dr. Edwards, what injuries
are we most concerned with

in this patient?

We always start with the ABCs.

If you'd been listening to the paramedic,

you'd have your answer.
Can you start over?

There was significant
damage to the dashboard...

What's the basic law of motion, Edwards?

The basic...

Energy cannot be created or destroyed,

but can change in form or be absorbed.

Uh, which means
the impact to the dashboard

was absorbed by the patient.

So the injuries
we're most concerned with are?

Are knee injury, possible pelvis, C-spine.

Correct.

Matthew here stabilized
the pelvis in the field.

Uh, it really wasn't that big of a...

So now you can start your exam.

So I'll just... see myself out then.

Okay.

Okay, Ross. There's the knot.

It's a nice one.

Uh, okay.

Yes, thank you. Scissors.

Careful now.

We're just gonna cut the suture

as close to the knot as possible

without...

Oh, no.

Are you serious?!

Oh, no, no, no, no, no.

You cut the hepatic artery in the hilum.

You cut the hilum before
I had a chance to say,

"Don't cut the hilum!"

You see what he did?

Don't ever do that.

Clamp.

I don't know. Um, Dr. Robbins.

Hey.

Everything, uh, work out all right?

Yeah, I'm sorry that you had to see that.

It was a-a personal...

- You were having a moment.
- Yeah.

We all have 'em.

Just sucks when they
happen at work, right?

I was, uh, just telling Dr. Cahill

how well Nyah's surgery went.

Yeah.

And that you let me finish
the surgery on my own.

- Yeah.
- Thanks again.

That's impressive for a fellow.

Oh, well, he's... he's more than qualified.

Well, I will be observing
Nyah's second surgery tomorrow.

So will that be you or Dr. Karev?

Oh, no, me, of course.

Yeah. Uh, with our cardio fellow Dr. Yang.

All right. I will see you there.

Okay.

What's going on?

Nothing. I'm fine.

I'm sorry about this morning.
Are we all set for tomorrow?

Uh... 8:30, O.R. 2.

Great.

Uh, look, if you want to sit it out,

Yang and I can handle it.

Maybe, you know,
you should just take it easy.

It's just that Yang keeps squawking about

how they're gonna cut the program,

and I just don't want anything to...

Yeah. Um, are you finished?

I just want everything to go well.

Then I'll see you tomorrow morning.

10-blade, please.

Did...

did you see that?

God! Ah!

Morning.

Oh. You all right in there?

Um, yeah.

No, I'm fine. I'm fine. I was just...

I'm about to take a shower.

Oh, want some company?

Um, yeah, of course I do.

It's just, I'm, um, I'm running late.

So how about tonight?

Yeah. How about a movie night?

Yeah. You read my mind.

Okay. All right.

Unfortunately there was
a surgical complication

with the donor liver,
and it is no longer viable.

Oh, god.

Okay. So what happens now?

Well, Brie is back on the transplant list.

We'll continue supportive care

so her body's ready

if another liver becomes available

or if we have to deliver the baby.

A C-section?

Can-can she handle that?

Any surgery is risky,

and her condition is causing
her blood to stop clotting.

So we need to continue
with the blood transfusions

and buy her some time until
a liver becomes available.

If a new liver becomes available.

Yes.

Oh, god.

The last thing I said to her is,
"You're gonna be fine."

You have to fix her, please.

Yeah. Here.

You can see that she's
still on the respirator.

Her vitals actually...

I hope you won't mention

my colossal incompetence to your husband.

He... still thinks I'm the golden boy.

No, stop that. You don't get to do that.

You don't get to feel sorry for yourself

or make little self-deprecating remarks.

You destroyed a perfectly
good liver today.

When I look at you, that is all I see.

A perfectly...

- good liver.
- Hold on a sec.

- I'm not done. Put your phone away.
- I'm-I'm sorry.

Don't be sorry. Be better.

I think it's U.N.O.S.

Hello.

Hmm. Can I help you find something?

No. I'm just observing surgeries today,

and I'm trying to maximize my time.

Shepherd's acoustic neuroma is at 8:00,

and that's gonna be a long one.

Just trying to be everywhere at once.

Actually, Shepherd's surgery
got pushed till later.

Oh, I totally misread that.

That is going to work
so much better for me.

Thank you, doctor.

Well, maybe that, uh,
gives us time for coffee.

I'm afraid not.

Just time for me to see more surgeries.

Well, I always did expect
to see you in the O.R.

One way or another, right?

Right.

Okay, now breathe.

Try to calm the waves.

Try to slow them down.

What... what's the point here?

Well, the idea is,

if you can teach
your mind to calm the waves,

you can teach it to... calm the pain.

But I...

I-I can't do it. I can't do it.

It's... this is dumb.

This is not dumb. It is biofeedback.

Look, I can't-I can't stop
the stupid make-believe waves.

So... what else you got?

Well, I have a minimally
invasive spinal surgery

that can deaden your nerves.

No, no, I have to operate today.

Then I got make-believe waves,

or I got a make-believe waterfall,

or a make-believe campfire.

Or I could just find a screwdriver

and stab it in your foot.

Just stab me in the head.

C.T. results on pelvic fracture.

Thoracentesis if positive effusion.

Um, musculoaponeurotic grafts?

- What are you doing?
- What am I... what are you doing?

I thought you were trying to talk dirty.

I didn't want you to feel
like the only giant nerd.

I was talking out loud?

Yeah.

Though I was weirdly kind of into it.

Um, I have 60 million things to do today,

and I'm sure I'm gonna forget something.

Kepner's running me ragged.

And that's not working for me anymore.

Um...

You know, if you're too busy for this,

we can, um...

I am not too busy for this.

Mm.

I am too busy for this.

All right.

Thank you for understanding.

Okay.

Her last A.S.T. was 23-42.

I.N.R. was 6.

Is it viable?

I think it's a match.

She'd be crying if it wasn't.

She cries when she's angry,
which is whenever she sees me.

Look.

She's looking at me and not crying.

It's gotta be a match.

Thank you so much. Thank you.

We have a match.

You're gonna fly to Portland, Oregon.

I will fly to Portland, Oregon,

to retrieve a liver for a woman

who I've already destroyed one liver?

Is that the wisest use of our resources?

I can't. I can't get on a plane.
You know that.

I know you haven't been on a plane.

Maybe it's time you try again.

Their procurement team is
going to do all of the work.

You know good and well

we prefer to do the recovery ourselves.

All he has to do is carry a cooler.

Meredith.

If he's been to a picnic,
he can handle this.

Shane, have you ever been to a picnic?

I've been to a picnic.

Oh, look at that. He's been to a picnic.

These women deserve more experience

than a fool who's eaten
a potato salad in a park.

She's right. Maybe I'm
not the best person...

You're an intern.

Of course you're gonna make mistakes.

Bad things happen,
but you have to move past it.

Leave it behind you,
the sooner the better,

and stop you from moving forward.

So just get over yourself.

Move past it, and get
your butt on that plane.

So... now I'm confused.

Who's going to Portland?

I can't.

You and I are going to Portland.

Mm. Okay.

So, Wilson, what do you see?

Cerebellum and occipital brain tissue.

Mm-hmm. Healthy, perfect tissue...

Tissue that needs to be wet.

So every ten minutes when
you hear that timer ding,

you need to drench the tissue.

Okay.

Okay, good.
Now when I get close to the tumor,

what I'm gonna do is,
I'm gonna ask you to...

Drench the tissue. Got it.

No. I'm going to stimulate
the facial nerve with a probe.

And then I'm gonna ask you

to tell me when Jimmy's face twitches.

As long as we see a twitch,

his facial function is still intact.

Okay. Drench the tissue.

Well, let's go. What are we waiting for?

I got word to hold a minute.

Okay, you're right. I can do this.

Get off.

All right. Well, call me when
you get eyes on the liver.

Yeah.

It looks good so far, Bailey.

Now remember, once we get it out,

we're only 50 minutes out.

So you can start prepping her.

Dr. Ross. I-I, no.

I can't make the cut this time.

Let's stop while we're ahead.

No, I don't want you to make the cut.

I want you to get the basin

so I can put the liver in the basin.

Can you do that?

Yes. That I can do.

Uh, Dr. Grey...

Is... that a mass?

- No.
- It isn't?

No, I mean, it is.

I... we have to have that biopsied.

And how much does the Africa program cost?

Less than you'd think.

Admin costs comes out of an endowment,

and all the surgical time is donated.

But endowments don't tend to grow

with the popularity of these programs,

where, very soon,
you have every sick kid in Africa

banging down your door.

What happened?

You need me to step in?

No. No.

Robbins?

Try to picture the waves.

I'm trying.

Okay, really, what is... what is happening?

Just calm the waves.

These are tsunami-force waves, Owen.

What is wrong with this woman?

I mean, is she having a panic attack?

Should she even be in the O.R.?

Don't you have another operation

you need to go see?

I mean, Shepherd's doing...

Yeah, an acoustic neuroma,
but that's later.

No, it's now. He started hours ago.

Look, you should go. I'll take over.

All right. No one is moving.

I'm stripping the endocardium
from the papillary muscle.

I screw this up, I'll have
to replace the mitral valve,

so don't move.

I can switch out...

Just shut up. I'm at the beach.

Something's wrong.

They should be back by now.
Something's wrong, isn't it?

Uh, um...

there was a mass on the liver.

We're waiting for pathology to...

Oh, god. A mass means cancer.

It's cancer. You got two
donor livers in two days.

There's no chance
we're getting another one.

If this one has cancer, then...

Okay, okay, Heidi,
just... it's not bad news yet.

Okay? So just come on.

Take deep breaths.

Okay?

Oh.

Grey.

Okay. Yeah.

I'll see you in 50 minutes.

Liver's fine.

Oh, thank god.

Okay. Oh. Thank you.

All right.

Okay, now we have to remove the tumor

from the nerve sheath.

Stimulator.

Uh, I don't see any nerve fibers.

It encased the entire nerve?

Yeah, I'm afraid so.
Okay, facial function.

Still twitching.

Syringe.

I was worried I missed the whole thing.

Where are we at?

Where we're at is, I'm trying to focus.

I mean, how long has
the patient been open?

Counting the minutes I'm wasting

answering your questions?

I'd have fewer questions,
but your intern told me

that the surgery had been moved to 3:00.

Clearly, it wasn't.

So forgive me if I'm
trying to play catch up.

Intern mistake. I apologize.

Dr. Wilson was under orders
not to allow any visitors...

I'm not a visitor, Dr. Shepherd.

Anyone who is not surgically necessary

is not welcome in my O.R.

All right, cottonoid,

Boki, please.

I have to switch, Alex.

No one is switching.

You're holding the mitral valve,
so don't move.

What's wrong? Are you sick?

Alex, take that scalpel...

What? What are you doing?

And stab me in the foot.

What? What?

- My prosthetic. Stab me.
- What is wrong with you?

- Dr. Karev.
- Ohh!

I am the chief of surgery.

This is an order.

Stab Dr. Robbins in the foot right now.

What?

Alex.

Of course.

Arizona? Alex!

That's better.

That's better.

Suction.

What happened? Did I...

You didn't do anything.
It's a bleeder. Cautery.

Cottonoid.

Okay.

Got it. How's the facial function?

I'm sorry. I don't see a twitch.

Come on, Jimmy. Twitch.

Damn it.

What does that mean?

It means we may have cost Jimmy

the ability to move half his face.

We won't know until he wakes up.

Oh, perfect timing, Grey.

Oh, no. Did I step on your foot?

No. I'm not mad this time.

Oh. So you cry when you're happy, too?

Apparently.

Eyes on the liver. Learn something.

Edwards, status report.

Uh, uh...

Your M.V.C. is in bed 1
waiting on an angio.

I paged an ortho consult for bed 2,

and drunk guy in bed 3.

- And what's in bed 4?
- New patient. Patellar dislocation.

And bed 13?

There is no bed 13.

Good job, Edwards. You passed.

And your waiting room is clear.
Nicely done.

Ah, sorry to interrupt.

Do you need something?

Kinda.

I've been watching you for two days.

You don't seem to slow down.

I thought you might need a break.

Maybe grab a cup of coffee?

Probably shouldn't have started

with the whole "Watching you" thing, huh?

Now you think I'm some
sort of creeper. I'm not.

Unless you're inclined to
have coffee with creepers,

in which case, I totally creep,

like, all the time.

Her heart is, uh, pumping like a champ.

Thank you, both of you.

What else do you have over there?

I'm sorry?

Uh... sick...

orphan... children?

Kids with heart problems?

Aah.

She means, she's glad the program

is up and running again.

Both of us are.

Yes.

Look at me. I'm a mess.

I ate a stupid big cookie.

That's what you get when
you keep me worried sick

for 22 hours.

Hey, Jimmy, can you wince like that again?

Answer the man.

Facial expression looks symmetrical.

Mm-hmm.

Did he... can you hear me?

Who could ignore that voice?

All right, welcome. Welcome, everyone.

Thank you so much for coming.

It has been a privilege to watch you work,

and I am so impressed with what I've seen.

Dr. Karev's pediatric
African exchange program...

You cannot cut that program.

I'm sorry, but these children,

these... little orphans...

we are the only hope they have.

Many of them have rare disorders

that most western doctors

rarely have the opportunity to treat.

And if you stop the program,

I will never get that chance again.

They.

They will never get that chance,

the precious children.

I have no intention of cutting it.

Super.

It's a no-brainer from a P.R. standpoint.

That kind of positive visibility is gold.

However, there will have to be some cuts.

And I'm going to suggest one

that is going to seem surprising at first,

but that addresses fiduciary concerns

with nominal impact on the core facility

and the human and physical resources.

Oh, I'm sorry. What?

Uh, yeah. I'm out.

I am proposing that we close your E.R.

What?

We're a level 1 trauma center.

We're a hospital.

In the last three days,

your E.R. went from being in shambles

to peak efficiency.

Well, then why would
you propose cutting it?

This allowed me to see
that in either case,

it's not bringing in the money.

It's bringing in the patients.

Over half of whom are non-emergent,

under-insured,

and belong in a primary
care physician's office.

You have surgical interns
in there doing chest exams.

It's hemorrhaging resources.

Look, I know these cuts
are going to be painful.

But understand that I am trying

to keep your hospital doors open.

This is ridiculous.
You can't close the E.R.

You went to med school.
You have to ask yourself...

Do you have a better idea?

Because the way I see it,

this woman is trying to keep
the hospital from closing,

in-in which case there'd be no patients,

we'd have no jobs,

and some of us don't have
a few million to fall back on.

So unless you have a better idea,

why don't you just sit there

and listen to what she has to say?

All right.

So... the other proposals

include a review of I.C.U.,
step-down closures

with a reorganization of post-op care...

Alana.

Uh, you've been here three days.

I've been here for years.

Maybe you judged us a little harshly.

Maybe we can work together...

Being a harsh judge

is a necessary part of my job, sir.

I can see you're disappointed in me,

but it was your job to judge me
when you were my teacher.

You're not anymore.

No, that's not the case. I'm...

You said something to us
during my intern year

that I have never forgotten.

You said, "Medicine is
constantly changing."

"You need to be part of
that change or get out."

I'll be making some changes.

You should be proud of me.

By the way,

you logged fewer O.R. hours

than any other general
surgeon on staff last month.

Good night.

The body can be stubborn when
it comes to accepting change.

Ugh. This...

this is so stupid.

We're a level 1 trauma center.

This woman's an idiot.

Well, and a little bitchy.

Ugh. This was supposed to be a good day.

Shepherd did a 23-hour surgery.

We're supposed to be popping champagne.

Let's try and go to sleep.

Ugh! I don't think I can. I'm so pissed.

The mind holds out hope

that the body can be whole again.

Do you want to go to the beach with me?

What?

And the mind will always fight for hope,

tooth and nail...

Bailey had no business
calling you out like that.

She's nervous.

Everybody's nervous.

Everybody should be nervous.

It's not our fault.

Is it?

It feels like it is.

Hey, congratulations.

For what?

Your acoustic neuroma.

Mm.

You got your hand back. You're you again.

We can be happy about that.

Until it finds a way of understanding

this new reality...

I flew on a plane today.

You did?

I did.

Congratulations.

And accepts that what is gone...

Is gone forever.

This really kind of works.