08x03 - Take the Lead
Posted: 10/02/11 11:40
You work, you study, you prepare ... Months and years leading to one day ... the day when you step up.
Okay, let's get started.
Yeah, let's do it.
Got a lot of standing around to do today.
He's right, people.
Starting today, fifth-year residents rotate in as lead surgeons.
We've alerted the morgue.
On that day, you have to be ready for anything.
Attendings, you will observe and stay silent.
Offer help only when you absolutely have to.
Yeah, before you help them swim, let 'em sink a little.
But there's one thing you can never quite prepare for ... The next order of business ... effective 9:00 A. M. this morning, I have resigned as chief of surgery of Seattle Grace Mercy West hospital.
I will stay on the surgical staff.
I will turn this meeting over to the new chief of surgery, Dr. Owen Hunt.
The day when you step down.
Thanks, Dr. Webber.
I know this comes as a surprise to all of you, too.
And I appreciate, over the next couple of days, your help and your patience.
Um, so now I have your call schedules, but I can have them dist ... Wait. What happened?
Why did it happen?
Is this the board? Are they forcing you to step down?
Hmm?
Hunt.
You're the new chief of surgery.
Nice.
Hey. What's going on? Anything new on Zola?
Oh, no. We were supposed to hear yesterday, and then yesterday, they said today, so is it up yet?
Oh, don't know. You okay?
I have no choice. I'm clipping my first aneurysm today.
Well, I've got a valve replacement.
My valve replacement.
Altman just has to shut up and watch.
I hope I get a good O.R.
Is it up yet?
Not yet.
Hey, you heard about Zola?
I haven't heard anything.
And she's clipping her first aneurysm.
Are you sure you don't want to start with something simpler?
Yeah, like juggling chain saws?
Oh, thanks. That's helping.
Hey, is it up yet?
Is it up yet?
It's going up now.
Hey, you heard anything?
Haven't heard anything.
How are you even here?
Well, there's nothing I can do, and I have to do something, so I might as well do this.
It's up.
O.R. 3. Yes!
Mm. I love O.R. 3.
Wait. Bowel resection? I thought you had a peds case.
I switched last minute.
You can't just switch.
Oh, plastics. I thought you were the gunther.
Wasting all your capital on boob jobs, huh?
It's a cleft lip.
I'm changing a kid's life today.
Look at Kepner, she's fixing a bum knee.
Ooh. Way to sh**t for the stars, kid.
Okay, guys.
Uh, you also start teaching skills labs today.
I made up a schedule for the month.
It's up on the board in my office.
In your what?
When did we get this?
Uh, we didn't.
It's for the chief resident, actually.
This is good. I can sleep on this.
Yeah, I got that on Craigslist. It's-it's mine.
We got a fridge?
Okay, guys.
Uh, why is my name on this?
These are this month's intern skills labs.
Each of you has been given one skills lab to teach.
No, I can't teach today. I'm on a mitral valve.
Okay, well, then just switch with one of these guys.
Aneurysm.
Bowel resection.
I got a baby's face.
Guys, come on. I-I-I-I divided these up fairly.
You come on. Every surgery we do this year could end up on the oral boards.
And they love picking the crappy outcomes.
This could affect which fellowship I get.
I mean, it's not just life or death, April.
Now it's our careers.
Okay, how's this?
Whoever has the worst outcome today teaches all the skills labs for the whole month.
That's good.
I'm in.
That's terrible.
You guys get this e-mail?
You know, that's disgusting.
No, no, no. There will be no wagering on patient outcomes.
That-that-that's an order.
So you're out, then?
You know, okay, just ... everyone out of my office.
Whoa. Webber resigned.
He's no longer chief of surgery.
Dr. Owen Hunt is now chief of surgery.
What?
That the Alzheimer's trial?
Heard from the FDA?
I'm sending it to Phoenix.
Carl Baumann is taking over. I'm blacklisted.
I may never do another clinical trial ever again.
Yeah, I've been blacklisted, too.
And now you're gonna let them fire you?
I fired myself.
It's one thing, taking the blame for Meredith and losing the trial, but ... Why are you doing this to yourself?
You know, I came to ask if you heard anything about your little girl?
No, I have not.
This isn't right.
Hope you hear soon.
How does he not tell me he's chief of surgery?
Well, is it because you ... Didn't have his baby?
I mean, has he said anything?
No. We haven't talked about it.
At all?
Is that bad? That's bad, right?
Well, I mean, it's just ... Oh, hey.
Oh, hey. Uh, i-is it true?
Uh ... yeah.
Oh, my god. When did ... Well, uh, Webber talked to me last night, but ... I was gonna tell you, but you were already asleep, and then this morning, you had already gone ... Oh, yeah. Um, m-my mitral valve.
Right. Right.
Right, sorry.
Sorry. Good luck.
No! No. Oh, god, you ... You, you're the ... uh, w ... Uh, this is great. We should celebrate.
Uh, I guess so, yeah.
Um ... dinner?
Oh, my surgery.
Mitral valve takes, like, a minimum of seven hours.
Oh. Sometime.
Okay?
I gotta ... Oh, congratulations.
Thanks. Yeah.
Congratu ... Congratulations.
Yeah, that was bad.
Hey. I need an intern to assist on my bowel resection.
Well, everyone's booked, so good luck finding someone.
Isn't that your job?
No, my job is making the schedule that you screwed up.
Ah, Karev.
Uh, I just saw that you turned down my 3 month old's esophageal atresia surgery for Webber's, uh ... I'm-I'm so sorry.
I was trying to say Webber's bowel resection, but then I fell asleep.
I just thought I could use more practice with bowel resections.
No, you're trying to pad your boards with good outcomes, so you went for the easy "A."
You keep that up, and you're gonna lowball yourself out of the fellowship.
Is that what you're doing?
Or is this about winning that stupid bet?
Just find me an intern.
Karev, you ready for your surgery?
Uh, I think so, sir.
Kepner's having a little trouble getting it staffed.
What's the problem? I've been treating Sam Kenton for years.
I don't want to have to postpone him.
Uh, no, sir. No, sir. I will find someone to assist.
I'll get it covered, even if I have to do it myself.
Well, great.
Great.
So if Rob's out of surgery, then I'll pick him up from school, but if not, then I'll text you, and you can drop him at Kathy's.
Yeah, thanks so much. Okay, bye.
Sorry, I just ... Have to make sure we got the kids squared away.
I totally understand.
You have kids?
Uh, let's get back to your surgery.
So I will locate the aneurysm, which is the bulge in the wall of your artery.
And then I will take a steel clip, which is like a tiny clothespin, and I'm gonna place it across the neck of the aneurysm.
And that will stop the blood supply.
That way, we don't have to worry about a rupture.
How do you know if you fixed it?
Well, we do what we call a matador move.
I'll take a needle, and I poke the dome of the aneurysm.
And if we see a tiny amount of blood, then we know it was successful.
And if it wasn't successful, it bursts.
Possibly.
And I die.
Not if I get it clipped.
And what's your success rate?
How many have you done?
This will be my first.
I sort of wish you lied about that.
Yeah, well, after today, her success rate will be 100%.
Dr. Grey is the best we have, and I'll be there the whole time.
Do you have any other questions?
No.
No, thanks.
Try and rest easy.
I'll see you after.
Thank you for that.
Have you heard anything from the social worker?
No. Have you?
No.
I'm worried, if we haven't heard back by now, that it's not gonna go our way.
Well, I'll call again.
No, don't. We've called too much.
Derek.
Yes.
What if we don't get Zola back?
I mean, what happens to us?
What do you want to do? Do you want to stay together?
We have a surgery.
Let's just focus on that.
You.
Ruth Bennet, 50, mitral valve replacement patient, complained overnight of stomach pains.
These stomach pains, what did you do?
You.
We tested her cardiac enzymes, ran an echo.
Both were normal.
Did anyone touch her stomach?
No one touched the patient?
Are you guys the slow class?
Palpating the patient's abdomen is first, before tests or labs.
Basics, people. Fundamentals.
I'm all about not skipping steps.
Ow.
Oh, sorry.
Does it hurt more or less when I take my hand away?
M-more.
See? Basics.
You should be doing this in your sleep.
Take, uh, Mrs. Bennet for a triple-contrast C.T.
Try not to get lost.
He just seems so little.
I mean, I thought it could wait.
I understand, but I assure you that now is the right time.
By fixing those muscles early, his maxilla, his whole upper jaw, will have a real shot at forming properly.
But he'll have a scar?
Well, I'm gonna do what's called a straight-line repair.
So that'll leave a little scar, which I'll hide right in the contour of his lip right here.
And then over time, it'll fade altogether.
Shouldn't even be noticeable.
Then he'll look even more handsome than he does right now, if that's possible.
He is a pretty handsome guy, isn't he?
He certainly is. Yes, you are.
You want to wait here with your mama while I go get you all set up?
Yeah?
I'll come back this afternoon, all right, buddy?
Thank you, Dr. Avery.
My pleasure.
He'll do great.
Excellent.
You couldn't have been clearer, you answered her questions, you eased her fears.
Thanks. That's, um ... Mark Sloan's gonna do the surgery, though.
How's that?
It's not you. You're great. You're the gunther.
But you're planning a straight-line repair, and I'd rather the kid get a millard rotation so that we don't risk the lip shortening over time.
But I was actually ... For the kid's sake, I-I gotta have Sloan do it.
He's-he's an artist.
Dr. Robbins, uh, it's my procedure.
I'm sorry, Avery.
Just not this time.
Uh, this is Sam Kenton, 55.
He's here for a bowel resection due to chronic mesenteric ischemia.
This is Sam's third surgery with us.
Third time's the charm.
And this is Sam's son Jason.
Jason should be in school instead of here, playing nursemaid.
It's one semester. Think how much money I'm saving you.
Well, I'm worried, you're not getting any smarter.
Kid's not very smart.
Wonder where I get that from.
Did he just call me stupid?
I think he did.
Sam's been Dr. Webber's patient since ... Kepner, just give me the b*llet, okay?
Sam Kenton, 55, presents with chronic mesenteric ischemia.
Um, nonresponsive to revascularization.
Scheduled for an exploratory laparotomy and possible bowel resection.
Oh, it's so sad.
I mean, how many years was he chief for?
11.
I mean, are we supposed to all pretend we don't know what really happened?
Oh, why did he cover for her?
I mean, what's his deal with her?
D-d ... Hey. Hi.
Good morning, ladies.
Uh, uh, so what's the system here?
Does everybody have a spot or ... Oh, anywhere is fine.
Oh, all right, then.
Right ... here.
And I will see you this afternoon.
You all have an excellent day.
You, too.
Already am.
I mean, he's trying so hard.
He talked to his sandwich.
Well, what are ... Uh, doctor ... uh, sorry. Chief.
Um, Larry Jennings sent you this bottle of scotch to say congratulations.
Oh. Thanks. Just, uh, put it somewhere.
Okay. Uh, and, Dr. Torres, I need to push my meniscus repair to tomorrow.
I have to teach a skills lab.
A skills lab over a surgery?
Yeah, and then I have to assist Karev ... uh ... on a bowel resection.
You should be delegating that stuff.
I tried, but no one would cover it.
Don't try, Kepner. Just order them.
Leadership isn't about making friends.
Oh, well, then I'm doing it right. Mm.
That was nice. Very chief-y.
Dr. Hunt.
May I have my call schedule, please?
Sorry? My call schedule, which I usually get at the staff meeting, but I didn't, because you said you would distribute them, but you haven't, so I had to come find you, and you're not very easy to find, not unlike my call schedule.
So may I have my call schedule, please?
J ... of course.
I ... just as soon as ... Thank you.
That was way less chief-y there.
Okay. What did I do?
Oh, nothing. Nothing.
She was Webber's right-hand man.
She'd hate anyone in your position.
Yeah, I know it's not about making friends, but you really want Bailey as your enemy?
I was right.
Ruth Bennet's scans show appendicitis.
The morons missed it.
I'm turfing her to general surgery for an appendectomy.
Why don't you do the appy?
Where do I start?
Because it's general surgery, and I'm on cardio.
Because it's first-year surgery, and I'm a fifth year.
Because ... You know what? This is great.
I mean, Ruth has a heart condition, and we have to monitor her anyway.
and because of her C. O. P. D. , she has to have an open appy, and we don't want some moron doing it.
And you get a procedure.
Thank you.
It's a very basic procedure.
But you love the basics.
And you're all about the fundamentals.
Can I ask you something, um, just about his recovery, specifically the, like, bathroom part?
Will I need to be in there with him?
'cause my mom was here for his other surgeries, and ... Right.
I'll do it. I'll totally do whatever he needs.
I just want to be prepared, you know, 'cause ... He'll be embarrassed and I'll ... Well, neither of us is gonna like it.
Yeah, there, um, there are a couple of possible outcomes.
And it all just sort of depends on what Dr. Karev finds during surgery.
So I'll just ... I'll have him come and-and talk you through them, okay?
Is that guy cool?
He seems a little ... douchey.
He's good, very good.
He can be a little douchey ... but he's a good guy, and a very good surgeon.
Thanks.
Meredith, uh ... Oh, I'm sorry.
I'm sorry. I never meant for any of this to ... I know what you wanted to do for me.
But ... I do.
I saw you were clipping your first aneurysm, wanted to say good luck.
I am trying to figure out what clip to use.
Well, you can't, not until you see it.
Every aneurysm is different, a different approach.
You'll know what to do once you get in there.
It's a big deal ... a resident's first aneurysm clip.
Derek's leads the whole O.R. in a round of applause.
I ... don't know that he'll do that today, but ... You two all right?
I, uh, I only ask because if you can't communicate with your attending, you have no business being in that O.R. , no matter how prepared you are.
We're okay.
We're fine.
All right.
I need your pig.
I have to remember how to do an open appendectomy.
No. Does a pig even have an appendix?
Uh, let's find out.
Who wants an aneurysm?
I'm about to have one. I have to do an appy.
On a pig? Does a pig even have one?
On a person.
I haven't thought about one in ... three years.
Oh, well, come on. Who wants to trade?
I'll do anything.
Unh-unh. Clipping those things is like defusing a b*mb.
One wrong move, and it explodes.
Well, I'm worried about Derek exploding.
Can I have your pig?
No.
How about just the head, huh?
Want to clip an aneurysm?
Good luck, MacGyver.
Oh, there you are. Alex ... Does a pig have an appendix?
I don't know.
I thought you were teaching my skills lab.
I am. I just left them to practice whipstitches. Alex ... Stop. Turn out the lights. Close the door.
Check this out.
Injected fluorescein dye ... it makes any viable part of the bowel glow.
Nice.
Yeah, in high school, I had a metallica poster just like this.
You might win the bet.
Yeah, with a color-coded colon.
No kidding.
I have a b*mb to defuse.
This is crazy.
I gotta find a book or a skills l ... Oh, skills lab.
I gotta get some instruments.
I'm just gonna use the head, all right?
Will you talk to Jason Kenton? He has some questions ... I'm busy.
Turning a pig into a lava lamp?
My patient ... It's not my job. You talk to him.
Show of hands ... who knows the steps of an open appendectomy?
Dr. Bailey, your call schedule.
Sorry it was so, uh ... So, Bailey, I know you've taken over
Dr. Webber's islet cell trial.
Mm-hmm.
And I wanted to offer you some protected time for your research.
I can reduce your O.R. schedule, lighten your teaching load, make sure you get that time that you need.
How does that sound?
You telling me I don't manage my time well?
No. No. No, no, no.
I-I just wanted to make sure that your research got the time ... Oh, you're telling me how to use my time?
N-not at all. I wouldn't.
I just ... I'm sorry. Just forget I mentioned it.
Oh, now I don't get the time?
No, you do. You do. You can ... You-you can ... just do what ... Nah, unh-unh.
No, leave it up. Leave it up.
I'll just do the meniscus repair myself.
Great.
And now I lose a procedure.
This is worse than being an intern.
Yeah, being chief resident sucks.
I did it once.
Well, how'd you do it?
How'd you get them to listen to you?
Uh, I didn't. I sucked.
Look, it's ... it's not about making friends, but it is about getting them on your side.
You want to be the person they come to, not the one they run from.
You know, kinda like your little contest.
You know, getting them to compete for good outcomes.
I know. It's awful, right?
No, that was a good idea. They thrive on competition.
You gave them what they needed.
And either way, the patient wins.
That ... was a good idea.
Okay.
That wasn't your idea, was it?
No.
Well ... don't give up.
You'll be great.
Or maybe you won't.
I never was.
It's perfect.
It's a perfect millard rotation ... on a pig.
This pig ... is now more attractive than your average pig.
I deserve to do it.
I'm ready. I can do it.
I deserve it.
You're right.
You go, gunther.
Next step?
You.
Lift up peritoneum, open transversely, and enlarge the incision.
Enlarge how?
With sc ... with scissors?
Are you asking me or telling me?
With scissors.
Okay. Okay, good.
Then what?
You.
Pull out and isolate the appendix ... Mm-hmm.
Cross-clamp it at the base, and ... And go on.
I can't remember.
Unacceptable.
God. You should know this.
Cross-clamp the appendix at the base ... Yeah, you already did that. Okay? Hurry up.
He's dying now.
Tie off or li ... wait. Ligate ... Hurry. You're losing him. Beep.
Wait.
Beep.
Wait. Hang on.
Beep.
Wait.
Beep.
Wait.
Beeeeeep.
Call the morgue, moron. He's dead.
Okay, who's next?
You.
Open transversely, enlarge with scissors, insert retractors, deliver appendix, cross-clamp at the base.
Hey, so ... you going in for your mitral valve?
Oh, my mitral valve turned into an appy.
Oh, right. Well ... Good luck.
Oh, so ... Does that mean you'll be home tonight?
I mean, an appy's what, two hours, tops, right?
Right.
Oh, that-that is true.
Oh, do you want me to pick something up?
Or I can. Chinese?
Oh, fine. Wh-whatever.
No, no, you choose.
Do chinese. Chinese is great.
Good. Right.
Well ... good luck.
And you, too, Grey.
You have to talk about it because clearly, you can't talk about anything.
You two are like bad roommates.
How? How do I bring it up?
I mean, does he even want me to bring it up?
And what ... and what is there to talk about?
'Cause it's done.
I can't undo it. It's-it's done.
Yeah, but it's not.
Oh, we have surgery.
Don't screw it up.
Ah, you, too.
Did you know Sam's wife took care of him after his last two surgeries?
She died of a stroke last year, so Jason dropped out of college one semester before graduating.
He was happy to do it 'cause it's just the two of them ... What the hell, Kepner? Why are you telling me this?
Talking to patients is your job, Alex, because they're more than just ... an easy "A" or some bet you can win.
It's your job.
No, it's not. Not anymore.
My job is to open him up and fix him, and if I can't do it, no one's gonna do it for me.
It's on me.
So I can spend time talking to him or I can use that time figuring out what I'm gonna do when I open him up.
Which one do you want me to do?
You're really nervous.
That's why you didn't want to work on a kid today.
Look, you'll be fine.
You're ready.
I mean, you feel ready, right?
I am thoroughly enjoying this book, Karev.
That's great.
Hopefully, I'll finish it in there, because as long as I'm reading, it means that you're not screwing up.
Will I finish this book today?
Yes, sir.
All right.
Have you got the pre-op scans?
I already looked them over.
I want to look again.
I think you should do the surgery.
Why?
Because we're not a team right now.
What happens if the aneurysm ruptures?
Put a temporary clip on the feeding artery.
And if the aneurysm still bleeds?
I gain control of the common carotid in the neck.
What kind of clip are you gonna go with?
I won't know till I get in there.
You're ready. Let's go.
What are you doing?
You're the lead surgeon.
You're on that side.
Yeah.
You practiced it the other way, didn't you?
Is there a problem?
No, sir.
10-blade.
What are you doing now?
Are we still doing the thing where I have to tell you every little move ... Never gets old.
What are you doing now?
Blunt separation of the oblique muscles.
Neat.
You know, you ... you have a kid and you-you worry a lot about screwing 'em up.
Like something that you do or say or something you don't say will change 'em forever.
Yes, ma'am.
I was just thinking that you're totally determining the course of this kid's life.
You will determine whether or not this kid gets made fun of for his looks, or if he cries at his school picture every year.
And today you will decide ... who he goes to the prom with, and who he will marry or if ... I mean, if he gets married at all, ir if he dies alone, unattractive and unloved.
Did-did you want me to call Sloan?
Okay, I've isolated the aneurysm.
I can see the whole neck.
What is that?
It's an angled 7 millimeter.
I'd go smaller, use a straight one.
No.
No?
You only get one shot at this.
Use a smaller clip.
I may need the extra length.
You could hit one of the perforators.
Not if I look where I'm going.
Put the clip down.
What are you doing now?
I am isolating the appendix.
And now?
I am cross-clamping the appendix at the base.
And what are you doing now?
Okay, you can get as pissed as you want, but there is a reason that I'm having you do all this.
I want to ... Shh.
I beg your pardon?
I don't ... I-I ... I can't remember what comes next.
Anastomosis is holding.
Nice work.
Okay. We gotta run the bowel.
Make sure there isn't any ... Ooh.
Okay, crap. Uh ... Okay, uh ... Cautery.
Lift up peritoneum, open transversely ... All right, this is what I am talking about.
Enlarge with scissors ... Why would I have you replace ... Deliver the appendix ... A mitral valve ... Cross-clamp ... When you can't even remember a ... Cross-clamp ... I can if you just please shut up.
I can't tell if any of this is viable.
Well, what about here? I mean, this looks ... No, it's crap.
Is the fluorescein in? Have we started the dye?
Starting now.
It's in.
Lights. Now. k*ll the lights.
Use the 5 millimeter.
I'm looking right at it, Derek.
You have to trust me.
No, I've done it hundreds of times.
Use a smaller clip.
Damn it.
Okay, I'm gonna do the matador move.
Can I have the needle and the penfield retractor?
I've got the suction.
Okay, everybody, stop.
Okay. It's holding.
Holding perfectly.
Okay, suction, please.
Come on.
Come on. Give me something.
Alex, there's not enough.
Shut up.
Lights.
I can't remember the next step.
Well, you might remember this the next time you're screaming at an intern for skipping the fundamentals.
Will you just do it, please?
Take your time.
It'll come back.
No, it won't. Honestly. I can stand here all day.
It's not gonna ... Oh, my god. You don't know, either.
Oh, don't try to make this about me.
Okay, then tell me what to do.
You should know what to do.
So should you.
Well, it's been even longer since I've done one.
Well, I need your help.
We need to be helping her right now.
You probably want to ligate at the proximal edge, apply a straight clamp, and lay down a purse-string suture at the base.
Of course.
Right. Thank you. I got it.
I got it.
No shame.
No shame at all.
You're still the goober.
It's gunther.
Sure.
Uh, I can't ... If I close him, I'm leaving him to die.
He'll die of sepsis.
Uh, can I revascularize?
Uh, I can ... I can find the clot, I can do a transverse ar-arteriotomy and bypass the vessels.
No. There's, uh ... there's way too much dead bowel.
Do I pull it? I mean ... do I pull it all?
Put him ... put him on a ... a transplant list?
Hope for ... What do I do?
Do I close him and let him go?
Let's close.
Thank you. Thank you so much.
That's, uh ... Fine.
Can we make a deal?
Let us never speak of this.
Deal.
Night.
Do you want me to talk to him?
No.
You did everything you could.
You really did.
He won't be able to understand that, but I do.
And you should, too.
I don't want to go home.
I don't, either.
Do we really have to talk about it?
Yes, you do.
Maybe I'll come over later.
Oh, that would be great.
No, actually, that would be bad, because that would mean my marriage is over.
Here you go.
Did you finish your shift?
All right. So who lost the bet?
Not me. My b*mb was defused perfectly.
My appy was flawless.
Except it was finished by a nurse.
Who told you that?
Karev's guy didn't even wake up. Septic shock.
Oh, you blew a bowel resection?
That's like misspelling your own name.
Hey, guys.
No, it's Karev.
Sorry, dude. Enjoy that skills lab.
Can I just point out that Jackson
Never even touched his patient?
Sloan did the whole procedure.
What does "between you and me" mean?
So it would seem to me that he loses by forfeit.
Loser.
Forfeit.
I don't think that that's ... You want a rematch?
We could go again tomorrow.
And the next day.
And the next day.
Nurse's station.
Uh, Dr. Bailey. Hold up, please.
Uh ... okay.
I learned in the army that a leader is only as good as the people around him.
Now you are one of the best people on this team.
And ... I just want to make sure that I ... have you on my side.
Have I done something wrong?
No.
Is there something in my job performance that prompts you to ask me this?
N-no.
Or do you just need me to like you?
It's not that.
Are you sure?
C-carry on, Dr. Bailey.
If you want to be mad at someone, be mad at me.
I'm not mad at you.
Yes, you are.
Everyone knows who to be mad at.
The only thing Meredith did to me was to give my wife a little more time, and I'm damn sure gonna spend it with her.
I'm happy, Bailey.
I'd like you to be happy for me, too.
I'll try.
You're gonna have to give me a while.
I'll wait.
Well ... that was good.
Mm-hmm.
You know, I'll get the dishes.
No, no, no, I'll do it.
No, no, I-I've got them.
You know, I've been feeling, uh ... terrible.
Okay.
No, I mean it.
I know.
Do you want to talk about it?
Did you have the spring rolls?
We should never have been in that O.R. together today.
What do you mean?
We're not a team, anywhere.
And when we get Zola back, before we get that phone call, we need to figure out if we can be one, if we can even be together.
So now's the time to say how you feel.
I can't. I'm gonna say things that are, uh ... Oh, Derek, just say it.
Whatever it is, we can deal with it.
I can accept the consequences.
Meredith, you have never accepted a consequence in your life.
Since the moment you switched those files, you haven't suffered one bit ... That is not true.
While those around you have lost their jobs and lost their reputations.
And I lost Zola.
So did I!
Because you do things ... without a thought, you just dive in and never give a damn how deep the water is or who you're gonna land on.
I know I messed up, but all of this happened before Zola was even in the picture.
Don't you think I've changed?
I don't think you can change. You stole the baby, Meredith.
Oh. I told you why I did that.
What do you need, for me to say I'm sorry?
I need you to be sorry.
Of course I'm sorry.
You did it again today in the O.R.
What? I had a successful surgery today.
You refused to listen to me!
I didn't listen to you because I didn't need to listen to you.
I knew what I was doing and I was right.
You just couldn't trust me.
Why should I ever trust you?
Why should I trust you?
You ended my trial, you set back my career, you nearly ended your own, you destroyed Richard's.
I have no reason to trust you.
Well, then why are you with me?
Because of that.
Because I meant that!
I promised I wouldn't run.
I promised I would love you.
Even when you hate me.
Even when I hate you.
I am trying, Meredith.
I am trying, but you make it so damn hard.
I understand.
And I don't want you to keep the promise, not if you don't want to, and not if you can't trust me with our daughter.
I do. I trust you with Zola.
Well, you just said ... That's not what I said.
I know that you took her to protect her.
I know that you altered the trial for Adele and for Richard.
You stood in front of a b*llet for me.
I know why you do all of it.
It's what I love about you.
And what you hate about me.
Yeah.
So you can't trust me at work?
No, I can't.
Well, that's easy, then.
So we just don't work together.
So what are you saying?
I'm off your service. That's my consequence.
If we want to stay together, with or without Zola, we just can't work together.
Sometimes it happens in an instant.
We step up.
We become a leader. We see a path forward.
Never again.
I told you not to order from that place.
Their floors are disgusting.
Yeah, but then you always say you like their spring rolls.
Don't-don't say ... Don't say it.
Oh. Ohh.
Oh.
Thank you.
I'm not gonna kiss you.
Let's go to bed.
Oh, no, no.
No, I-I want to stay here.
Come on. Let's go to bed.
Oh, no. It feels good here. It feels good here.
Okay. Come here.
There you go.
Ohh.
There you go.
We see a path, and we take it ... even when we have no idea where we're going.
Okay, let's get started.
Yeah, let's do it.
Got a lot of standing around to do today.
He's right, people.
Starting today, fifth-year residents rotate in as lead surgeons.
We've alerted the morgue.
On that day, you have to be ready for anything.
Attendings, you will observe and stay silent.
Offer help only when you absolutely have to.
Yeah, before you help them swim, let 'em sink a little.
But there's one thing you can never quite prepare for ... The next order of business ... effective 9:00 A. M. this morning, I have resigned as chief of surgery of Seattle Grace Mercy West hospital.
I will stay on the surgical staff.
I will turn this meeting over to the new chief of surgery, Dr. Owen Hunt.
The day when you step down.
Thanks, Dr. Webber.
I know this comes as a surprise to all of you, too.
And I appreciate, over the next couple of days, your help and your patience.
Um, so now I have your call schedules, but I can have them dist ... Wait. What happened?
Why did it happen?
Is this the board? Are they forcing you to step down?
Hmm?
Hunt.
You're the new chief of surgery.
Nice.
Hey. What's going on? Anything new on Zola?
Oh, no. We were supposed to hear yesterday, and then yesterday, they said today, so is it up yet?
Oh, don't know. You okay?
I have no choice. I'm clipping my first aneurysm today.
Well, I've got a valve replacement.
My valve replacement.
Altman just has to shut up and watch.
I hope I get a good O.R.
Is it up yet?
Not yet.
Hey, you heard about Zola?
I haven't heard anything.
And she's clipping her first aneurysm.
Are you sure you don't want to start with something simpler?
Yeah, like juggling chain saws?
Oh, thanks. That's helping.
Hey, is it up yet?
Is it up yet?
It's going up now.
Hey, you heard anything?
Haven't heard anything.
How are you even here?
Well, there's nothing I can do, and I have to do something, so I might as well do this.
It's up.
O.R. 3. Yes!
Mm. I love O.R. 3.
Wait. Bowel resection? I thought you had a peds case.
I switched last minute.
You can't just switch.
Oh, plastics. I thought you were the gunther.
Wasting all your capital on boob jobs, huh?
It's a cleft lip.
I'm changing a kid's life today.
Look at Kepner, she's fixing a bum knee.
Ooh. Way to sh**t for the stars, kid.
Okay, guys.
Uh, you also start teaching skills labs today.
I made up a schedule for the month.
It's up on the board in my office.
In your what?
When did we get this?
Uh, we didn't.
It's for the chief resident, actually.
This is good. I can sleep on this.
Yeah, I got that on Craigslist. It's-it's mine.
We got a fridge?
Okay, guys.
Uh, why is my name on this?
These are this month's intern skills labs.
Each of you has been given one skills lab to teach.
No, I can't teach today. I'm on a mitral valve.
Okay, well, then just switch with one of these guys.
Aneurysm.
Bowel resection.
I got a baby's face.
Guys, come on. I-I-I-I divided these up fairly.
You come on. Every surgery we do this year could end up on the oral boards.
And they love picking the crappy outcomes.
This could affect which fellowship I get.
I mean, it's not just life or death, April.
Now it's our careers.
Okay, how's this?
Whoever has the worst outcome today teaches all the skills labs for the whole month.
That's good.
I'm in.
That's terrible.
You guys get this e-mail?
You know, that's disgusting.
No, no, no. There will be no wagering on patient outcomes.
That-that-that's an order.
So you're out, then?
You know, okay, just ... everyone out of my office.
Whoa. Webber resigned.
He's no longer chief of surgery.
Dr. Owen Hunt is now chief of surgery.
What?
That the Alzheimer's trial?
Heard from the FDA?
I'm sending it to Phoenix.
Carl Baumann is taking over. I'm blacklisted.
I may never do another clinical trial ever again.
Yeah, I've been blacklisted, too.
And now you're gonna let them fire you?
I fired myself.
It's one thing, taking the blame for Meredith and losing the trial, but ... Why are you doing this to yourself?
You know, I came to ask if you heard anything about your little girl?
No, I have not.
This isn't right.
Hope you hear soon.
How does he not tell me he's chief of surgery?
Well, is it because you ... Didn't have his baby?
I mean, has he said anything?
No. We haven't talked about it.
At all?
Is that bad? That's bad, right?
Well, I mean, it's just ... Oh, hey.
Oh, hey. Uh, i-is it true?
Uh ... yeah.
Oh, my god. When did ... Well, uh, Webber talked to me last night, but ... I was gonna tell you, but you were already asleep, and then this morning, you had already gone ... Oh, yeah. Um, m-my mitral valve.
Right. Right.
Right, sorry.
Sorry. Good luck.
No! No. Oh, god, you ... You, you're the ... uh, w ... Uh, this is great. We should celebrate.
Uh, I guess so, yeah.
Um ... dinner?
Oh, my surgery.
Mitral valve takes, like, a minimum of seven hours.
Oh. Sometime.
Okay?
I gotta ... Oh, congratulations.
Thanks. Yeah.
Congratu ... Congratulations.
Yeah, that was bad.
Hey. I need an intern to assist on my bowel resection.
Well, everyone's booked, so good luck finding someone.
Isn't that your job?
No, my job is making the schedule that you screwed up.
Ah, Karev.
Uh, I just saw that you turned down my 3 month old's esophageal atresia surgery for Webber's, uh ... I'm-I'm so sorry.
I was trying to say Webber's bowel resection, but then I fell asleep.
I just thought I could use more practice with bowel resections.
No, you're trying to pad your boards with good outcomes, so you went for the easy "A."
You keep that up, and you're gonna lowball yourself out of the fellowship.
Is that what you're doing?
Or is this about winning that stupid bet?
Just find me an intern.
Karev, you ready for your surgery?
Uh, I think so, sir.
Kepner's having a little trouble getting it staffed.
What's the problem? I've been treating Sam Kenton for years.
I don't want to have to postpone him.
Uh, no, sir. No, sir. I will find someone to assist.
I'll get it covered, even if I have to do it myself.
Well, great.
Great.
So if Rob's out of surgery, then I'll pick him up from school, but if not, then I'll text you, and you can drop him at Kathy's.
Yeah, thanks so much. Okay, bye.
Sorry, I just ... Have to make sure we got the kids squared away.
I totally understand.
You have kids?
Uh, let's get back to your surgery.
So I will locate the aneurysm, which is the bulge in the wall of your artery.
And then I will take a steel clip, which is like a tiny clothespin, and I'm gonna place it across the neck of the aneurysm.
And that will stop the blood supply.
That way, we don't have to worry about a rupture.
How do you know if you fixed it?
Well, we do what we call a matador move.
I'll take a needle, and I poke the dome of the aneurysm.
And if we see a tiny amount of blood, then we know it was successful.
And if it wasn't successful, it bursts.
Possibly.
And I die.
Not if I get it clipped.
And what's your success rate?
How many have you done?
This will be my first.
I sort of wish you lied about that.
Yeah, well, after today, her success rate will be 100%.
Dr. Grey is the best we have, and I'll be there the whole time.
Do you have any other questions?
No.
No, thanks.
Try and rest easy.
I'll see you after.
Thank you for that.
Have you heard anything from the social worker?
No. Have you?
No.
I'm worried, if we haven't heard back by now, that it's not gonna go our way.
Well, I'll call again.
No, don't. We've called too much.
Derek.
Yes.
What if we don't get Zola back?
I mean, what happens to us?
What do you want to do? Do you want to stay together?
We have a surgery.
Let's just focus on that.
You.
Ruth Bennet, 50, mitral valve replacement patient, complained overnight of stomach pains.
These stomach pains, what did you do?
You.
We tested her cardiac enzymes, ran an echo.
Both were normal.
Did anyone touch her stomach?
No one touched the patient?
Are you guys the slow class?
Palpating the patient's abdomen is first, before tests or labs.
Basics, people. Fundamentals.
I'm all about not skipping steps.
Ow.
Oh, sorry.
Does it hurt more or less when I take my hand away?
M-more.
See? Basics.
You should be doing this in your sleep.
Take, uh, Mrs. Bennet for a triple-contrast C.T.
Try not to get lost.
He just seems so little.
I mean, I thought it could wait.
I understand, but I assure you that now is the right time.
By fixing those muscles early, his maxilla, his whole upper jaw, will have a real shot at forming properly.
But he'll have a scar?
Well, I'm gonna do what's called a straight-line repair.
So that'll leave a little scar, which I'll hide right in the contour of his lip right here.
And then over time, it'll fade altogether.
Shouldn't even be noticeable.
Then he'll look even more handsome than he does right now, if that's possible.
He is a pretty handsome guy, isn't he?
He certainly is. Yes, you are.
You want to wait here with your mama while I go get you all set up?
Yeah?
I'll come back this afternoon, all right, buddy?
Thank you, Dr. Avery.
My pleasure.
He'll do great.
Excellent.
You couldn't have been clearer, you answered her questions, you eased her fears.
Thanks. That's, um ... Mark Sloan's gonna do the surgery, though.
How's that?
It's not you. You're great. You're the gunther.
But you're planning a straight-line repair, and I'd rather the kid get a millard rotation so that we don't risk the lip shortening over time.
But I was actually ... For the kid's sake, I-I gotta have Sloan do it.
He's-he's an artist.
Dr. Robbins, uh, it's my procedure.
I'm sorry, Avery.
Just not this time.
Uh, this is Sam Kenton, 55.
He's here for a bowel resection due to chronic mesenteric ischemia.
This is Sam's third surgery with us.
Third time's the charm.
And this is Sam's son Jason.
Jason should be in school instead of here, playing nursemaid.
It's one semester. Think how much money I'm saving you.
Well, I'm worried, you're not getting any smarter.
Kid's not very smart.
Wonder where I get that from.
Did he just call me stupid?
I think he did.
Sam's been Dr. Webber's patient since ... Kepner, just give me the b*llet, okay?
Sam Kenton, 55, presents with chronic mesenteric ischemia.
Um, nonresponsive to revascularization.
Scheduled for an exploratory laparotomy and possible bowel resection.
Oh, it's so sad.
I mean, how many years was he chief for?
11.
I mean, are we supposed to all pretend we don't know what really happened?
Oh, why did he cover for her?
I mean, what's his deal with her?
D-d ... Hey. Hi.
Good morning, ladies.
Uh, uh, so what's the system here?
Does everybody have a spot or ... Oh, anywhere is fine.
Oh, all right, then.
Right ... here.
And I will see you this afternoon.
You all have an excellent day.
You, too.
Already am.
I mean, he's trying so hard.
He talked to his sandwich.
Well, what are ... Uh, doctor ... uh, sorry. Chief.
Um, Larry Jennings sent you this bottle of scotch to say congratulations.
Oh. Thanks. Just, uh, put it somewhere.
Okay. Uh, and, Dr. Torres, I need to push my meniscus repair to tomorrow.
I have to teach a skills lab.
A skills lab over a surgery?
Yeah, and then I have to assist Karev ... uh ... on a bowel resection.
You should be delegating that stuff.
I tried, but no one would cover it.
Don't try, Kepner. Just order them.
Leadership isn't about making friends.
Oh, well, then I'm doing it right. Mm.
That was nice. Very chief-y.
Dr. Hunt.
May I have my call schedule, please?
Sorry? My call schedule, which I usually get at the staff meeting, but I didn't, because you said you would distribute them, but you haven't, so I had to come find you, and you're not very easy to find, not unlike my call schedule.
So may I have my call schedule, please?
J ... of course.
I ... just as soon as ... Thank you.
That was way less chief-y there.
Okay. What did I do?
Oh, nothing. Nothing.
She was Webber's right-hand man.
She'd hate anyone in your position.
Yeah, I know it's not about making friends, but you really want Bailey as your enemy?
I was right.
Ruth Bennet's scans show appendicitis.
The morons missed it.
I'm turfing her to general surgery for an appendectomy.
Why don't you do the appy?
Where do I start?
Because it's general surgery, and I'm on cardio.
Because it's first-year surgery, and I'm a fifth year.
Because ... You know what? This is great.
I mean, Ruth has a heart condition, and we have to monitor her anyway.
and because of her C. O. P. D. , she has to have an open appy, and we don't want some moron doing it.
And you get a procedure.
Thank you.
It's a very basic procedure.
But you love the basics.
And you're all about the fundamentals.
Can I ask you something, um, just about his recovery, specifically the, like, bathroom part?
Will I need to be in there with him?
'cause my mom was here for his other surgeries, and ... Right.
I'll do it. I'll totally do whatever he needs.
I just want to be prepared, you know, 'cause ... He'll be embarrassed and I'll ... Well, neither of us is gonna like it.
Yeah, there, um, there are a couple of possible outcomes.
And it all just sort of depends on what Dr. Karev finds during surgery.
So I'll just ... I'll have him come and-and talk you through them, okay?
Is that guy cool?
He seems a little ... douchey.
He's good, very good.
He can be a little douchey ... but he's a good guy, and a very good surgeon.
Thanks.
Meredith, uh ... Oh, I'm sorry.
I'm sorry. I never meant for any of this to ... I know what you wanted to do for me.
But ... I do.
I saw you were clipping your first aneurysm, wanted to say good luck.
I am trying to figure out what clip to use.
Well, you can't, not until you see it.
Every aneurysm is different, a different approach.
You'll know what to do once you get in there.
It's a big deal ... a resident's first aneurysm clip.
Derek's leads the whole O.R. in a round of applause.
I ... don't know that he'll do that today, but ... You two all right?
I, uh, I only ask because if you can't communicate with your attending, you have no business being in that O.R. , no matter how prepared you are.
We're okay.
We're fine.
All right.
I need your pig.
I have to remember how to do an open appendectomy.
No. Does a pig even have an appendix?
Uh, let's find out.
Who wants an aneurysm?
I'm about to have one. I have to do an appy.
On a pig? Does a pig even have one?
On a person.
I haven't thought about one in ... three years.
Oh, well, come on. Who wants to trade?
I'll do anything.
Unh-unh. Clipping those things is like defusing a b*mb.
One wrong move, and it explodes.
Well, I'm worried about Derek exploding.
Can I have your pig?
No.
How about just the head, huh?
Want to clip an aneurysm?
Good luck, MacGyver.
Oh, there you are. Alex ... Does a pig have an appendix?
I don't know.
I thought you were teaching my skills lab.
I am. I just left them to practice whipstitches. Alex ... Stop. Turn out the lights. Close the door.
Check this out.
Injected fluorescein dye ... it makes any viable part of the bowel glow.
Nice.
Yeah, in high school, I had a metallica poster just like this.
You might win the bet.
Yeah, with a color-coded colon.
No kidding.
I have a b*mb to defuse.
This is crazy.
I gotta find a book or a skills l ... Oh, skills lab.
I gotta get some instruments.
I'm just gonna use the head, all right?
Will you talk to Jason Kenton? He has some questions ... I'm busy.
Turning a pig into a lava lamp?
My patient ... It's not my job. You talk to him.
Show of hands ... who knows the steps of an open appendectomy?
Dr. Bailey, your call schedule.
Sorry it was so, uh ... So, Bailey, I know you've taken over
Dr. Webber's islet cell trial.
Mm-hmm.
And I wanted to offer you some protected time for your research.
I can reduce your O.R. schedule, lighten your teaching load, make sure you get that time that you need.
How does that sound?
You telling me I don't manage my time well?
No. No. No, no, no.
I-I just wanted to make sure that your research got the time ... Oh, you're telling me how to use my time?
N-not at all. I wouldn't.
I just ... I'm sorry. Just forget I mentioned it.
Oh, now I don't get the time?
No, you do. You do. You can ... You-you can ... just do what ... Nah, unh-unh.
No, leave it up. Leave it up.
I'll just do the meniscus repair myself.
Great.
And now I lose a procedure.
This is worse than being an intern.
Yeah, being chief resident sucks.
I did it once.
Well, how'd you do it?
How'd you get them to listen to you?
Uh, I didn't. I sucked.
Look, it's ... it's not about making friends, but it is about getting them on your side.
You want to be the person they come to, not the one they run from.
You know, kinda like your little contest.
You know, getting them to compete for good outcomes.
I know. It's awful, right?
No, that was a good idea. They thrive on competition.
You gave them what they needed.
And either way, the patient wins.
That ... was a good idea.
Okay.
That wasn't your idea, was it?
No.
Well ... don't give up.
You'll be great.
Or maybe you won't.
I never was.
It's perfect.
It's a perfect millard rotation ... on a pig.
This pig ... is now more attractive than your average pig.
I deserve to do it.
I'm ready. I can do it.
I deserve it.
You're right.
You go, gunther.
Next step?
You.
Lift up peritoneum, open transversely, and enlarge the incision.
Enlarge how?
With sc ... with scissors?
Are you asking me or telling me?
With scissors.
Okay. Okay, good.
Then what?
You.
Pull out and isolate the appendix ... Mm-hmm.
Cross-clamp it at the base, and ... And go on.
I can't remember.
Unacceptable.
God. You should know this.
Cross-clamp the appendix at the base ... Yeah, you already did that. Okay? Hurry up.
He's dying now.
Tie off or li ... wait. Ligate ... Hurry. You're losing him. Beep.
Wait.
Beep.
Wait. Hang on.
Beep.
Wait.
Beep.
Wait.
Beeeeeep.
Call the morgue, moron. He's dead.
Okay, who's next?
You.
Open transversely, enlarge with scissors, insert retractors, deliver appendix, cross-clamp at the base.
Hey, so ... you going in for your mitral valve?
Oh, my mitral valve turned into an appy.
Oh, right. Well ... Good luck.
Oh, so ... Does that mean you'll be home tonight?
I mean, an appy's what, two hours, tops, right?
Right.
Oh, that-that is true.
Oh, do you want me to pick something up?
Or I can. Chinese?
Oh, fine. Wh-whatever.
No, no, you choose.
Do chinese. Chinese is great.
Good. Right.
Well ... good luck.
And you, too, Grey.
You have to talk about it because clearly, you can't talk about anything.
You two are like bad roommates.
How? How do I bring it up?
I mean, does he even want me to bring it up?
And what ... and what is there to talk about?
'Cause it's done.
I can't undo it. It's-it's done.
Yeah, but it's not.
Oh, we have surgery.
Don't screw it up.
Ah, you, too.
Did you know Sam's wife took care of him after his last two surgeries?
She died of a stroke last year, so Jason dropped out of college one semester before graduating.
He was happy to do it 'cause it's just the two of them ... What the hell, Kepner? Why are you telling me this?
Talking to patients is your job, Alex, because they're more than just ... an easy "A" or some bet you can win.
It's your job.
No, it's not. Not anymore.
My job is to open him up and fix him, and if I can't do it, no one's gonna do it for me.
It's on me.
So I can spend time talking to him or I can use that time figuring out what I'm gonna do when I open him up.
Which one do you want me to do?
You're really nervous.
That's why you didn't want to work on a kid today.
Look, you'll be fine.
You're ready.
I mean, you feel ready, right?
I am thoroughly enjoying this book, Karev.
That's great.
Hopefully, I'll finish it in there, because as long as I'm reading, it means that you're not screwing up.
Will I finish this book today?
Yes, sir.
All right.
Have you got the pre-op scans?
I already looked them over.
I want to look again.
I think you should do the surgery.
Why?
Because we're not a team right now.
What happens if the aneurysm ruptures?
Put a temporary clip on the feeding artery.
And if the aneurysm still bleeds?
I gain control of the common carotid in the neck.
What kind of clip are you gonna go with?
I won't know till I get in there.
You're ready. Let's go.
What are you doing?
You're the lead surgeon.
You're on that side.
Yeah.
You practiced it the other way, didn't you?
Is there a problem?
No, sir.
10-blade.
What are you doing now?
Are we still doing the thing where I have to tell you every little move ... Never gets old.
What are you doing now?
Blunt separation of the oblique muscles.
Neat.
You know, you ... you have a kid and you-you worry a lot about screwing 'em up.
Like something that you do or say or something you don't say will change 'em forever.
Yes, ma'am.
I was just thinking that you're totally determining the course of this kid's life.
You will determine whether or not this kid gets made fun of for his looks, or if he cries at his school picture every year.
And today you will decide ... who he goes to the prom with, and who he will marry or if ... I mean, if he gets married at all, ir if he dies alone, unattractive and unloved.
Did-did you want me to call Sloan?
Okay, I've isolated the aneurysm.
I can see the whole neck.
What is that?
It's an angled 7 millimeter.
I'd go smaller, use a straight one.
No.
No?
You only get one shot at this.
Use a smaller clip.
I may need the extra length.
You could hit one of the perforators.
Not if I look where I'm going.
Put the clip down.
What are you doing now?
I am isolating the appendix.
And now?
I am cross-clamping the appendix at the base.
And what are you doing now?
Okay, you can get as pissed as you want, but there is a reason that I'm having you do all this.
I want to ... Shh.
I beg your pardon?
I don't ... I-I ... I can't remember what comes next.
Anastomosis is holding.
Nice work.
Okay. We gotta run the bowel.
Make sure there isn't any ... Ooh.
Okay, crap. Uh ... Okay, uh ... Cautery.
Lift up peritoneum, open transversely ... All right, this is what I am talking about.
Enlarge with scissors ... Why would I have you replace ... Deliver the appendix ... A mitral valve ... Cross-clamp ... When you can't even remember a ... Cross-clamp ... I can if you just please shut up.
I can't tell if any of this is viable.
Well, what about here? I mean, this looks ... No, it's crap.
Is the fluorescein in? Have we started the dye?
Starting now.
It's in.
Lights. Now. k*ll the lights.
Use the 5 millimeter.
I'm looking right at it, Derek.
You have to trust me.
No, I've done it hundreds of times.
Use a smaller clip.
Damn it.
Okay, I'm gonna do the matador move.
Can I have the needle and the penfield retractor?
I've got the suction.
Okay, everybody, stop.
Okay. It's holding.
Holding perfectly.
Okay, suction, please.
Come on.
Come on. Give me something.
Alex, there's not enough.
Shut up.
Lights.
I can't remember the next step.
Well, you might remember this the next time you're screaming at an intern for skipping the fundamentals.
Will you just do it, please?
Take your time.
It'll come back.
No, it won't. Honestly. I can stand here all day.
It's not gonna ... Oh, my god. You don't know, either.
Oh, don't try to make this about me.
Okay, then tell me what to do.
You should know what to do.
So should you.
Well, it's been even longer since I've done one.
Well, I need your help.
We need to be helping her right now.
You probably want to ligate at the proximal edge, apply a straight clamp, and lay down a purse-string suture at the base.
Of course.
Right. Thank you. I got it.
I got it.
No shame.
No shame at all.
You're still the goober.
It's gunther.
Sure.
Uh, I can't ... If I close him, I'm leaving him to die.
He'll die of sepsis.
Uh, can I revascularize?
Uh, I can ... I can find the clot, I can do a transverse ar-arteriotomy and bypass the vessels.
No. There's, uh ... there's way too much dead bowel.
Do I pull it? I mean ... do I pull it all?
Put him ... put him on a ... a transplant list?
Hope for ... What do I do?
Do I close him and let him go?
Let's close.
Thank you. Thank you so much.
That's, uh ... Fine.
Can we make a deal?
Let us never speak of this.
Deal.
Night.
Do you want me to talk to him?
No.
You did everything you could.
You really did.
He won't be able to understand that, but I do.
And you should, too.
I don't want to go home.
I don't, either.
Do we really have to talk about it?
Yes, you do.
Maybe I'll come over later.
Oh, that would be great.
No, actually, that would be bad, because that would mean my marriage is over.
Here you go.
Did you finish your shift?
All right. So who lost the bet?
Not me. My b*mb was defused perfectly.
My appy was flawless.
Except it was finished by a nurse.
Who told you that?
Karev's guy didn't even wake up. Septic shock.
Oh, you blew a bowel resection?
That's like misspelling your own name.
Hey, guys.
No, it's Karev.
Sorry, dude. Enjoy that skills lab.
Can I just point out that Jackson
Never even touched his patient?
Sloan did the whole procedure.
What does "between you and me" mean?
So it would seem to me that he loses by forfeit.
Loser.
Forfeit.
I don't think that that's ... You want a rematch?
We could go again tomorrow.
And the next day.
And the next day.
Nurse's station.
Uh, Dr. Bailey. Hold up, please.
Uh ... okay.
I learned in the army that a leader is only as good as the people around him.
Now you are one of the best people on this team.
And ... I just want to make sure that I ... have you on my side.
Have I done something wrong?
No.
Is there something in my job performance that prompts you to ask me this?
N-no.
Or do you just need me to like you?
It's not that.
Are you sure?
C-carry on, Dr. Bailey.
If you want to be mad at someone, be mad at me.
I'm not mad at you.
Yes, you are.
Everyone knows who to be mad at.
The only thing Meredith did to me was to give my wife a little more time, and I'm damn sure gonna spend it with her.
I'm happy, Bailey.
I'd like you to be happy for me, too.
I'll try.
You're gonna have to give me a while.
I'll wait.
Well ... that was good.
Mm-hmm.
You know, I'll get the dishes.
No, no, no, I'll do it.
No, no, I-I've got them.
You know, I've been feeling, uh ... terrible.
Okay.
No, I mean it.
I know.
Do you want to talk about it?
Did you have the spring rolls?
We should never have been in that O.R. together today.
What do you mean?
We're not a team, anywhere.
And when we get Zola back, before we get that phone call, we need to figure out if we can be one, if we can even be together.
So now's the time to say how you feel.
I can't. I'm gonna say things that are, uh ... Oh, Derek, just say it.
Whatever it is, we can deal with it.
I can accept the consequences.
Meredith, you have never accepted a consequence in your life.
Since the moment you switched those files, you haven't suffered one bit ... That is not true.
While those around you have lost their jobs and lost their reputations.
And I lost Zola.
So did I!
Because you do things ... without a thought, you just dive in and never give a damn how deep the water is or who you're gonna land on.
I know I messed up, but all of this happened before Zola was even in the picture.
Don't you think I've changed?
I don't think you can change. You stole the baby, Meredith.
Oh. I told you why I did that.
What do you need, for me to say I'm sorry?
I need you to be sorry.
Of course I'm sorry.
You did it again today in the O.R.
What? I had a successful surgery today.
You refused to listen to me!
I didn't listen to you because I didn't need to listen to you.
I knew what I was doing and I was right.
You just couldn't trust me.
Why should I ever trust you?
Why should I trust you?
You ended my trial, you set back my career, you nearly ended your own, you destroyed Richard's.
I have no reason to trust you.
Well, then why are you with me?
Because of that.
Because I meant that!
I promised I wouldn't run.
I promised I would love you.
Even when you hate me.
Even when I hate you.
I am trying, Meredith.
I am trying, but you make it so damn hard.
I understand.
And I don't want you to keep the promise, not if you don't want to, and not if you can't trust me with our daughter.
I do. I trust you with Zola.
Well, you just said ... That's not what I said.
I know that you took her to protect her.
I know that you altered the trial for Adele and for Richard.
You stood in front of a b*llet for me.
I know why you do all of it.
It's what I love about you.
And what you hate about me.
Yeah.
So you can't trust me at work?
No, I can't.
Well, that's easy, then.
So we just don't work together.
So what are you saying?
I'm off your service. That's my consequence.
If we want to stay together, with or without Zola, we just can't work together.
Sometimes it happens in an instant.
We step up.
We become a leader. We see a path forward.
Never again.
I told you not to order from that place.
Their floors are disgusting.
Yeah, but then you always say you like their spring rolls.
Don't-don't say ... Don't say it.
Oh. Ohh.
Oh.
Thank you.
I'm not gonna kiss you.
Let's go to bed.
Oh, no, no.
No, I-I want to stay here.
Come on. Let's go to bed.
Oh, no. It feels good here. It feels good here.
Okay. Come here.
There you go.
Ohh.
There you go.
We see a path, and we take it ... even when we have no idea where we're going.