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Previously on Grey's Anatomy:
Divorce papers.
The ball's in your court.
If you sign,
I'll be on the first plane out.
Would you like
to go out with me tonight?
The hospital grants you
four months to retake the exam.
If I don't pass a second time?
You will no longer
be a surgical resident.
- You look great.
- Thanks.
- Are you OK?
- You ready to go?
- I didn't lie.
- You withheld the truth.
- Had I known you were pregnant
- You broke off with me.
- Dr.
Yang!
- Cristina!
It's an extrauterine
pregnancy.
She's bleeding out.
- I'm not supposed to be here.
- No, you're not.
I don't want someone
who doesn't want me,
but if there's the slightest chance
that he does, I'm not leaving Seattle.
Pain comes in all forms.
I had a good time.
Really.
Thank you.
It was the perfect evening.
Best date ever.
- Whatever.
- Izzie.
I especially liked the part where you
treated me like crap the entire night.
- That was fun.
- I had a good time.
- Really?
- Yeah.
The small twinge, a bit of soreness,
the random pain.
The normal pains we live with every day.
I gotta go.
Seriously?
Then there's the kind of pain
we can't ignore.
Seriously?
A level of pain so great
that it blocks out everything else.
- I'm sleeping.
- Oh, shut it.
Shut
Makes the rest of the world fade away.
- I don't want to talk.
- Meredith
You didn't sign the divorce papers.
Fine.
End of discussion.
- Meredith
- What?
Until all we can think about
is how much we hurt.
I usually just say "Meredith"
then you yell at me.
I haven't thought past that point.
I actually didn't have anything planned.
- How we manage our pain is up to us.
- What is that? Hey.
Stop it.
Seriously? Seriously!
Seriously!
This is a very small bed.
He's a brain surgeon.
I look fantastic.
I shaved my legs.
He's a brain surgeon.
How can he be so brainless?
- Hello? Seriously!
- Seriously!
Shh.
Sleep.
Pain.
We anesthetize
ride it out, embrace it, ignore it
And for some of us, the best way to
manage pain is to just push through it.
- You're dripping.
- I'm back.
I just want to make that clear.
I'm ready to work.
- Has anyone seen Dr.
Shepherd?
- His name's on the OR board.
- He should be here somewhere.
- I'm good.
Ready to scrub in.
- I'm 100%% on top of my game.
- You just got discharged.
- Pace yourself.
- I'm paced.
I'm paced.
Rounds, people.
What? You're not talking to me anymore?
OK, what happened last night?
What is going on with you?
I'm fine.
What's your problem?
Fine.
You know what, Alex?
No, I'm not talking to you anymore.
Dr.
Bailey.
Henry Lamott, age 42, is scheduled
with Dr.
Shepherd for a spinal implant
to control the pain
of his herniated disk.
Is allergic to all pain medication
- Is that?
- ***.
***?
- As in ***?
- All right.
- What are we watching?
- Karev.
Go stand in the hall.
Mr.
and Mrs.
Lamott,
I'm sure you are really nice people,
and what you do
in the privacy of your own
Look, we can't have *** in here.
This is a hospital.
It's for my pain.
My doc said
it releases endorphins in the brain
and helps keep my pain
at a manageable level.
- Really?
- George.
Hall.
- What is this?
- Nasty, Naughty Nurses 4.
- That does not look comfortable.
- Trust me.
It's not.
Get in the hall.
O'Malley, Karev,
you're in the Pit.
Stevens, there's a cardiac patient
for you on two.
Yang, keep an eye on the Lamotts.
I don't want any problems.
Go.
Grey, your mother's
being discharged this evening.
- You've made arrangements?
- The nursing home is coming at eight.
Then you're with Shepherd,
Derek Shepherd, today.
Hey, life is short.
Times are hard.
The road is long
with many a winding turn.
He asked for you.
Take it up with him.
OK.
Pete Willoughby, 25-year-old,
GSW to the chest.
- Return of 860 cc's of blood
- Oh, damn, this hurts.
He's put out more than 200 cc's
over the past hour.
Movies never say
how much it hurts to get shot.
Push morphine, two milligrams.
Alex, this is my case.
Morphine, five milligrams.
- You didn't call him.
- I was here first.
You got her first because I let you.
Where's the chest films?
I got it.
You always get the surgery.
Today, I'm getting a surgery.
Guys.
Knock it off.
He's one of Seattle's finest.
You've got an entire police force
watching you.
Page Dr.
Burke.
- Let him know I'm bringing up a GSW.
- "We" are bringing up a GSW.
Looks like you'll be able
to go home today, Ellis.
- But I still have patients to see.
- No.
No more patients.
I'll be back to check on you later, OK?
You should know
I'm thinking of leaving Thatcher.
I should never have married him.
I'll leave him.
You leave Adele.
Then when our residency's over we can
both get jobs at the same hospital.
Why don't you get her meds ready
for discharge, nurse? Thank you.
Ellis, that was a long time ago,
remember?
We had this discussion 21 years ago.
Think about it.
We should make the break now.
If we wait till residency's over, you'll
be at one hospital, I'll be in another.
We could end up at opposite ends
of the country.
It'll be too late.
- Meredith.
- Your wife is looking for you.
Oh, my God,
this is hard for me, Meredith.
Let me make it easy.
I'm not going to be that woman.
The one who breaks up a marriage
or begs you to want me.
You can sign the papers or you can not.
The choice is yours.
Either way, when it comes
to this relationship, I'm out.
Now, where's this patient
I'm supposed to be helping you with?
Down there.
You shouldn't have walked
the dog in the rain.
Oh, Lou, it wasn't the rain.
I just passed out.
- Actually, Mrs.
Bradley
- Verna.
Verna.
You presented with lateral ST elevations
and reciprocal inferior changes
consistent with an MI.
- A heart attack.
- Oh, my God.
Lou, don't worry.
I've had little chest pains before
and it turned out to be nothing.
This is nothing.
Lou, not in front of the doctor.
I've had a twinge in my back
for a while.
I thought it would go away,
but then last night, my legs went numb.
This morning, my back
The pain is just too much.
Miss Chue, we'll put you on a PCA pump,
give you morphine to control the pain.
- Thank you.
- OK.
But there's a greater problem.
- I've just looked at your MRI
- Anna!
- Why didn't you call us before coming?
- I'm sorry.
These are my parents.
- Hi.
- What's going on?
Anna's MRI has shown that
she has a myxopapillary ependymoma.
It's a tumor in her spinal canal.
But the good news
is that we can operate.
You have a 95%% chance
of fully recovering
if we get you to surgery
as soon as possible.
We can't wait.
With a tumor this aggressive
even waiting another day puts you
at risk for permanent paralysis.
Father?
No.
No surgery.
Mr.
Chue, without surgery, Anna will
be paralyzed within the next 24 hours.
No surgery today.
We're taking her home.
- Anna needs surgery.
- She can have it another time.
- Mr.
Chue
- We are taking our daughter home.
Anna, you're over 18.
You don't need your father's consent.
I'm Hmong, and my father is the elder.
If he says I go home, I go home.
Hmong? Let's find out what that means.
Contact Social Services, see if we
can get somebody to talk to them.
- Do I process her discharge?
- Yeah.
It's insane, but we have to.
It reminds me of a case I had
in New York where a woman
Look, do you need me
for anything else work-related?
Look.
I was married for 11 years.
Addison is my family.
That is 11 Thanksgivings,
In one day, I'm supposed to sign
a piece of paper and end my family?
A person doesn't do that.
Not without hesitation.
I'm entitled to a little uncertainty.
A moment to understand the magnitude
of what it means
to cut somebody out of my life.
I'm entitled to at least one moment
of painful doubt.
And a little understanding from you
would be nice.
- Dr.
Shepherd.
Still here, I see.
- I couldn't leave you.
- Have you seen the other Dr.
Shepherd?
- I'll tell him you're looking for him.
- So, thanks for, you know, being there.
- No thanks needed.
- OK.
- So where are we?
The north-east corner of a hospital.
- Oh, I'm getting back on my feet.
- Fine.
- That doesn't mean that
- Cristina
- It's my first day back, I've got
- I'm not waiting forever.
Karev and O'Malley are bringing
a GSW.
Want to scrub in?
No can do.
I'm trying to get out of here
at a decent hour tonight.
- What, you got a date?
- Yes.
Yes, I do.
A handsome man is whisking me away
to a love nest for the weekend.
You got shot in the line of duty?
First month on the job.
Can you believe my luck?
Guy pulls a gun and I freeze up.
The rookie who let himself get shot.
- I'm never gonna live this down.
- Sure, you will.
You think?
Absolutely.
Hey, I got Verna Bradley's tests back.
I don't think she had a heart attack.
Look at the changes in her EKG.
She had something.
Her serial enzymes and
dobutamine stress echo were negative.
- I actually think she's fine.
- Get a cardiac cath.
Be thorough.
I am thorough.
- What's the deal with Izzie?
- She shaved her legs for you.
- And?
- You didn't even kiss her good night.
- You didn't follow through?
- Hey, I always follow through.
- You didn't last night.
- Mind your own business.
Mind
She had expectations.
Women have
expectations.
And you didn't meet them.
I live with these women.
When you guys don't meet
their expectations, I hear about it.
I didn't get any sleep last night.
So, you know, it is my business.
- Dude, we're not moving.
- Really! You think?
Dr.
Cole, 2621.
Dr.
Cole, 2621.
You know how long
the surgical scar takes to heal.
You must be in pain.
You should take something.
- Drugs are for babies.
- I hate Alex.
- And the non sequitur award goes to
- I'm sorry.
I hate Alex.
- I broke up with Derek.
- Burke wants to have a relationship.
Boys are stupid.
Yep.
"If elevator should stop,
do not become alarmed.
"
"Press the button marked 'alarm'
for assistance.
"
If they don't want us to be alarmed,
- why call the button "alarm"?
- That didn't work the last five times.
We've lost power.
We're stuck.
You OK?
His pressure is falling.
Alex, there's a lot more of his blood
in the Pleurovac.
- We need to get him to the OR.
- OK.
Don't whisper.
I don't want to complain,
but I got a bullet in my chest
and whispering isn't a sign
that I'm going to be A-OK, you know?
- Damn it.
It's out.
- It's bad.
It's bad, right?
Someone is going to get us out of here.
Don't worry.
- How we doing?
- Can you move me to another room?
- The lights and TV went out.
- Power outage in the east wing.
They'll have it back on soon.
- You're not critical.
You'll be fine.
- Oh, God! What am I gonna do?
- You mean
- Without my ***.
Read a book.
Talk to your wife.
School closed early
because of the storm.
She had to pick up the kids.
She won't be back until after dinner.
Well, I'm sure you can find
some normal way of amusing yourself.
- I need my ***!
- Yeah.
Lightning hit a substation.
We're running on backup generators.
One of them is down.
Richard, breathe.
The only means of transporting patients
from the ER to the OR isn't working.
Don't tell me to breathe.
I'll breathe if I want to breathe.
- Caught between floors.
- How bad is it?
- Two interns and a GSW to the chest.
- Good air in, bad air out.
Come on, people, get those doors open.
- It's jammed.
It won't open.
- Move.
- This is as wide as it goes.
- What What did you two do?
Nothing.
- How's the patient?
- He's not looking so good.
- Why do the lights keep flickering?
- Something about a backup generator.
This pump will provide you with a
morphine drip and should stop your pain.
I told you, I don't need it.
I'm going home.
You'll have to sign a form stating that
you're leaving against medical advice.
Fine.
I know this is new and confusing.
I called a social worker
and she's willing to talk to you
Spare me the white-girl,
cultural-divide love.
I grew up down the street.
I play in a band.
I went to U-Dub.
I get it.
But my father doesn't.
He says no, it's no.
We're talking about
your ability to ever walk again.
That's what you're talking about.
I'm talking about my family.
Have you even heard of
the Hmong people?
Our religion has got rules
that are way old
and way set in stone and way spiritual
and you don't mess with them.
You don't anger the ancestors.
Even if you pierce your tongue
and play in a band.
What are the rules, exactly?
ICU patients are going
to the south wing.
Telemetry and stepdown patients,
north wing.
- You paged me.
- *** as pain management?
You met Henry.
There are lots
of theories on how to treat pain.
*** as pain management?
It's possible ***
can stimulate the brain
to produce endorphins
that minimize pain.
- *** as pain management.
- I didn't prescribe it.
It wasn't me.
Take it up with the physician.
If he turns out to be some sex weirdo,
it's on you.
That's all I'm saying.
- Oh, and your wife is looking for you.
- I know.
- Derek.
- Yes?
Talk to Anna's father.
I'd do it myself
but having testicles is a requirement.
- What happened to Social Services?
- According to Anna, they can't help us.
Anna's father believes she's missing
something she needs for surgery.
- Missing something? Missing what?
- One of her souls.
We don't need a social worker.
We need a shaman.
Shaman?
Cardio tells me
your cath went just fine.
- Is that much bruising normal?
- Your wound looks good.
So do the results on your cath.
You have no blockages in your arteries.
- Which means?
- You did not have a heart attack.
- So I can go home?
- Not yet.
Your EKG shows significant changes.
And I'm going to find out why
before you leave the hospital.
- Hey, Pete, what are you doing?
- I have to get home.
- Pete, you're in the hospital.
- Need to get home.
Need to get home.
- What's his blood pressure?
- It's not reading.
He's too agitated.
- How's his pulse?
- Thready, but still there.
- Do you have instruments?
- A code box and gloves.
You didn't bring an open chest tray?
- We thought
- No time for excuses.
- Blood pressure.
- I've taken it three times.
- And?
- I can't hear a systolic over 50.
He's gonna die.
- Intubate him.
I'll be back.
- Where are you going?
To get an instrument tray.
You guys are
going to have to open up his chest.
- Are you sure about that?
- No.
When's Burke coming back?
When is Dr.
Burke coming back?
- Alex
- Oh, would you shut up?
Mr.
Chue.
You want to take Anna home
for a healing ritual?
When sickness comes, it means
that one of our souls is missing.
Anna needs to have her souls intact
before surgery.
- She needs a shaman.
- Well, you could have told me that.
Why? So you could call me a fool?
I respect that you have traditions
that I can't understand.
But you're standing beside me
in a $3,000 suit
so I know you respect
that I'm telling you
Anna needs surgery in the next 24 hours
if she's going to continue to walk.
She can't leave this hospital.
She can't undergo surgery
without her soul.
She'd die.
All right then.
We're just gonna have to get a shaman.
Today.
In the hospital.
Shamans aren't in the Yellow Pages.
Our shaman is 500 miles from here.
You are an arrogant man.
No.
I'm just a guy
with access to a helicopter.
Thank you.
- Finding her soul won't be easy.
- It never is.
This is unconscionable.
Not
enough power to move those elevators?
They're replacing the backup.
Fire department is standing by.
- Critical patients?
- Moved to south wing.
- Incoming trauma?
- Rerouted to Mercy West.
- That backup should have been replaced.
- Yes, sir.
- Why didn't it happen?
- Chief, you'd have to ask maintenance.
- I wouldn't know.
- Dr.
Bailey, you know everything.
Tell me whose butt to kick.
That would be your butt, Chief.
You didn't authorize
the replacement generator,
saving money for the new MRI machine.
Um
I need to get on
back down to the OR.
Hey, this isn't gonna be too sterile,
but we can still try.
Prep and drape the patient.
Can you get me copies of all
Verna Bradley's records and page me?
- I'll be on the OR floor.
- Dr.
Bennett
Hey! Wait
Where are you two going so fast?
Burke is talking George and Alex
through heart surgery in the elevator.
Shepherd's setting up
a shaman healing ritual.
Rock on.
I have *** guy.
Help! Please!
Mr.
Lamott? What's wrong?
Your pressure's elevated.
Pulse is racing.
You're really in pain.
What? Do you think?
Are you telling me the ***
actually sedated you?
You think I'm a pervert,
watching that stuff in front of you?
Well yes.
OK, OK.
You're allergic
to most narcotics and NSAIDs.
I suppose we can try
droperidol and diphenhydramine.
That put me into a coma last year.
Well, I can get an anesthesiologist
down here.
But with your surgery tomorrow,
he won't give you an epidural block.
- What am I gonna do?
- Uh hold on.
We're really gonna do this.
Take these.
Karev, take the scalpel.
Alex! Come on.
Alex!
Ventilate!
I got it.
What do I do?
Make a large, anterior, lateral,
midaxillary incision
in the fifth intercostal space.
- How How large?
- As long as possible.
You need to get two hands in there.
It needs to be long and deep.
- Use the scissors if you have to.
- OK.
- Don't cut into the lung or heart.
- How can I be sure of that?
You just have to be sure.
We're not in Kansas any more.
Your shaman's late.
My shaman is never late.
Can you see anything? Poor George,
he doesn't have the steadiest hands.
- Izzie.
- Yeah?
He can hear you.
O'Malley? How you doing down there?
The fire department's here.
- They can get the doors open
- No.
Nobody works on the elevator.
I have an open chest and a very
nervous intern in there.
Keep them back.
- OK, guys, we're not going
- O'Malley?
Dr.
Burke,
I didn't cut the heart or the lungs.
Good, good, O'Malley.
Really good.
Now, check for injuries
and do a pericardiotomy.
I'll need some lap pads, forceps,
Metzenbaums and Satinsky clamps?
Yes, you will.
You tell anyone I did this for you,
not only will I kill you,
I will sell your body parts for cash.
OK.
So
There were these women.
Nurses.
Three nurses.
And they were naughty.
They were really, really naughty.
They
were three naughty nurses.
Saucy, even.
They were saucy and bad and naughty.
Three saucy, bad, naughty nurses.
They were taking a shower.
Together.
Soaping each other up.
And then this doctor walks in
and he sees
these three naughty, bad nurses
with these great big
Mrs.
Bradley, do you realize that
you've been admitted to the hospital
on this date for the past seven years?
That can't be.
- I don't remember the date exactly
- I have the medical records.
On this date for the past seven years
you have what looks like a heart attack.
No.
No, I know I've had some scares
but I don't
Every year on this date?
Is there significance
to this date for you?
No.
Nothing.
What were you doing the first time
you had a cardiac episode?
Who can remember back that far?
We were in the yard.
I remember because
our neighbor What was his name?
- Ted.
- That's right.
He died.
Of an aneurysm, I think.
And we watched as the
funeral home people took him away
and you had your first attack.
- And you were close to Ted?
- No.
We barely knew Ted.
That was all very sad, but what does
that have to do with Verna's heart?
I removed a small clot
from the pericardium.
- No obvious cardiac injuries.
- Change in the vitals?
- BP's still too low to register.
- We need to cross-clamp the aorta.
Stick your hand in
and bluntly dissect down
until you feel two tube-like structures.
The esophagus will be
more medial and anterior.
I feel one tube
that's easily collapsible
and the other's more muscular, spongy.
I feel
I can feel the spine just underneath it.
- Yes! You're touching the aorta.
- I'm touching the aorta.
Wrap the index finger
of your left hand around it
and apply the Satinsky clamp
with your right hand.
Got it.
Wait, I
I think I can localize the bleeding.
It's coming from the inferior vena cava.
- Can you find the lesion?
- Yeah.
Yeah, I think I can feel it.
- It's too far in to repair.
- How big is it?
Small, maybe smaller than a dime.
OK, O'Malley.
I want you
to take your finger and plug the hole.
I can feel his heart starting to fill
more.
It's beating a little stronger.
- Excellent.
Keep your finger there.
- OK.
Now what?
- That's it.
- That's it?
I just stand here
with my finger plugging the hole?
Until we can get you
out of that elevator and into the OR.
Bailey, you can tell the firemen
to get my guys out of there.
Will do.
OK.
We're ready.
- O'Malley.
- Yes, sir?
You just flew solo.
Thank you, sir.
OK, Anna, we're going
to shut off the PCA pump now,
which means you'll be in a lot of pain
for the duration of
- The healing ritual.
- Are you OK with that?
Yeah.
They can't find my soul
if I'm medicated.
- No pain, no gain, right?
- It's not just for your father.
You believe it too, right?
I know it sounds like a load of crap
but watch the ritual.
You'll see.
- See what?
- The moment it happens.
I'm ready.
"Oh, yes! I'm so very, very naughty,"
Bianca said
as she dropped her stethoscope.
"Me too!" said Crystal
as she snapped on her surgical glove.
And then there was Marta
- Where was I?
- Marta.
Oh, yes.
Marta was the naughtiest nurse
of all because she knew how
- Oh, thank God.
- We're back up.
How long do you think it takes
to retrieve a lost soul?
I don't know.
- Way to go, George.
- I have my finger in a heart.
Very cool.
- You have stress cardiomyopathy.
- Cardiomyopathy?
- What Can you tell me what that is?
- It's Ted.
Ted?
Ted.
Not just the neighbor
you barely knew, was he?
I don't know what you're talking about.
Every year, on the day he died, you get
a rush of adrenaline caused by stress.
Your pressure rises, you have chest
pains and you end up here.
I loved the man next door,
and he loved me.
I know how this is gonna sound but
Ted was my soul mate.
And then he just died.
It's grief.
Your heart stops
because you're grieving for Ted.
So what do I do next?
I mean, how do you treat it?
I wish I knew.
I told Thatch I'm leaving him.
You left Thatcher, Ellis, but
I couldn't bring myself to leave Adele.
Do you remember?
Painted horses.
Yes.
We were on the carousel
in the park.
It was raining.
- I have an offer from Boston General.
- You took it to get away.
We swore we'd never talk again
about what we had together.
It was gonna always be our secret.
Richard?
Yes, Ellis?
Carousels give me the creeps.
How do you put up with it?
I mean, Nasty, Naughty Nurses 4
and, I'm assuming, 1, 2 and 3.
- He's my Henry.
- I know.
But don't you find it misogynistic
and degrading and kind of
I mean, 24 hours a day of ***?
Seriously? That's your life?
I'm grateful for it.
It takes away his pain.
See, the thing is, Henry
Henry takes away my pain.
I lied.
I'm not out
of this relationship, I'm in.
I'm so in, it's humiliating,
because here I am begging.
- Meredith
- Shut up.
You say Meredith and I yell, remember?
- Yeah.
- OK.
Here it is.
Your choice? It's simple.
Her or me.
And I'm sure she's really great
but, Derek, I love you.
In a really, really big,
"pretend to like your taste in music,
let you eat
the last piece of cheesecake,
hold a radio over my head
outside your window,"
unfortunate way
that makes me hate you, love you.
So pick me.
Choose me.
Love me.
I'll be at Joe's tonight.
So, if you do decide to sign the papers,
meet me there.
Goodbye, Ellis.
I am gonna come see you tomorrow, OK?
He doesn't love her.
He can't.
But he'll stay with her anyway.
She's his wife.
Mom?
- Mommy.
- Meredith.
- You grew up.
- I did.
It's a shame.
It's awful being a grownup.
But the carousel never stops turning.
You can't get off.
OK.
You think he'll show?
He'll show.
Hey.
How's your patient?
- The one that got her soul back?
- She's going to be fine.
- Gotta go.
- Look at you.
You look like a girl.
- Is that your date?
- That's my husband.
- You're married?
- Ten years today.
- I didn't know you were married.
- You never asked.
You haven't signed
those divorce papers yet, have you?
Bailey.
Tell me what to do.
- God, why does this have to be so hard?
- It's not hard.
It's painful but it's not hard.
Come on, you know what to do already.
If you didn't,
you wouldn't be in so much pain.
Pain.
You just have to ride it out.
Hope it goes away on its own.
Hope the wound that caused it heals.
So here's where we are.
I work too much,
I'm competitive, I'm always right.
- And I snore.
- What?
I'm trying here.
Oh Oh.
Oh!
- Yeah.
- So?
OK, we're a couple.
Whatever.
Don't make a big deal about it.
There are no solutions.
No easy answers.
You just breathe deep
and wait for it to subside.
Oh, man.
I just
He's not coming.
- You don't think he's coming.
- He might come.
- Yeah.
You never know.
- He's definitely coming.
Ow!
Want her doing tequila shots all night?
I'll be the one cleaning up the vomit.
Besides, I touched a heart today, Porny.
Most of the time,
pain can be managed.
Pour me another one.
But sometimes, the pain gets you
when you least expect it.
I'm telling you.
Any second.
Hits way below the belt
and doesn't let up.
I have been looking
everywhere for you.
Well
- You found me.
- So
you going to sign
those divorce papers or not?
Pain.
You just have to fight through.
Because the truth is
you can't outrun it.
And life always makes more.