Damage Case (2006)
[Miranda] Previously on Grey's Anatomy...
I slept with George. It was a horrible mistake.
But I have no interest in obstetrics or gynecology Dr. Shepherd.
Your ass is mine until I say otherwise.
We spent the night at Callie's last night, so we figured we'd spend the night here.
You're falling for a vet.
I'm also dating. You. If you still want to.
He was listless and hadn't eaten all day.
Let's have a look. Hey.
Hey, is he sick again? Yeah.
[Meredith] We all go through life like bulls in a china shop.
A chip here, a crack there.
Doing damage to ourselves.
To other people.
So, uh, I don't cook.
Nobody asked you to cook.
I know, I'm just saying that, you know, I don't cook, so you don't have to cook.
I don't expect you to cook for me.
OK. You. Sit there.
I want you to drink this and try really hard to act like you aren't scary and damaged.
I'm not scary and damaged.
Yeah, you are. No. I'm not scary or damaged.
All right. Why don't you tell me about your family?
Me not wanting to talk about my family, does not make me scary or damaged.
Tell me about the last guy you slept with.
[Meredith]The problem is trying to figure out how to control the damage we have done.
Or that's been done to us.
What did you say to him? Nothing. I fled the scene.
You didn't tell him about George or Derek?
No. You like him.
I could like him.
Is the sex any good?
I don't know.
Four dates and two sleepovers at his place and no sex?
Not even a kiss good night.
Oh, I am proud.
I am like a proud mama.
Shut up. [Izzie chuckles]
Sometimes the damage catches us by surprise.
Oh, my God. Did that just happen?
I'm having a seizure.
I am clearly mid-seizure. I'm seizing.
Oh, my God. She didn't even wash her hands.
Oh, my God.
[Meredith] Sometimes we think we can fix the damage.
All I'm saying is if she needs to pee she could at least wear a bra.
Or maybe wait until she's alone.
For the love of everything sanitary, could she wash her hands? She's a surgeon.
You said you were blocking the sink. I think you're exaggerating.
She peed. Naked peeing. Ask Meredith. Meredith?
That's right, I forgot, you're not talking to her.
If you were she'd tell you that Callie crosses the line.
So crossed the line. So freaking crossed.
We're still pretending that you're not seeing a patient, right?
People, what's with all the evil misery?
Live and let live.
You're cheerful. Oh, come on.
You are. How's that possible?
I scrubbed in on a four-hour paraesophageal hernia last night.
Then I got laid.
And now, three ambulances are coming in full of bloody broken car crash victims, all who need to be cut open.
So, I'm cheery!
[Meredith] And sometimes the damage is something we can't even see.
Sorry, sir, I...
Hey. How's my dog?
Much better. Finn's running tests. Good.
[Meredith] Our dog. What?
Our dog. You said "my dog." He's our dog.
Yeah, whatever. Are you mad at me or something?
[siren wailing] Now's not the time.
25-year-old restrained driver, Noah Reynolds.
Vitals stable. Right knee pain.
Curtain three. Noah? You still alive?
I'm still alive, baby!
My wife's side took all of the impact.
[Noah] Her parents were in the other car.
Some jerk slammed into them and then they slammed into us.
On three. One. Two. Three.
22-year-old pregnant restrained passenger T-boned on her side.
Prolonged extrication in the field. BP 90 over 50. Pulse in the 80s.
[Miranda] Trauma room one. Trauma? No. I'm fine. Really.
You don't have to go to all that trouble. I am fine.
The air bags went off. If you could just check on my baby and my family.
My husband. Noah? You saw Mama breathing, right?
And Daddy? Where the hell's Daddy?
Mama and Daddy are still alive, right?
They're in the next ambulance.
They're alive, right?
Please don't move, ma'am. [woman] Mama and Daddy, I need to know.
Yeah, I'll ask someone about... Mama.
Driver and front-seat passenger both early 50s, both restrained, both stable.
The passenger has some leg and arm pain, the driver has chest pain.
Dang it all to heck!
Excuse my French, honey, but I need some whatever kind of horse pills you've got, because this hurts like the dickens!
Uh, that would be Mama? Mama! You OK?
I am in pain!
Get off. Get off! Sir, I need to clear your spine.
My spine is fine and you can sew up my head later.
Where's my girl? Milly. Daddy?
The hillbilly picnic.
Could everybody shut up for a minute? I'm trying to find a fetal heartbeat.
OK hold on. Is the baby OK? [Cristina] Hold on.
The baby's heart rate is 152 and strong. It's... It's OK.
They're both good. They're good. Thank the Lord.
Thank the Lord they're all right.
[Meredith] Dr. Bailey, another car crash victim.
That's him! That's the guy who hit us!
I'll kill him! I'm going to get you!
You son of a bitch! Big Jim, just hold your horses!
He's hurt. He's already hurt.
Don't ask me to be neighborly!
Trauma three. Page Ortho and Neuro. O'Malley, give her a hand.
What are you doing, young man?
I'm just trying to examine you. I don't think so.
[whispers] I don't have any panties on.
I do not know you well enough to let you see my good girl.
Get me a lady doctor.
I need a chick over here!
Marshall Stone, surgical intern at Mercy West.
Page Ortho to look at his wrist and contact CT.
Yes, Dr. Shepherd.
[Derek] Marshall, I'm going to say three words to you, OK?
Then I want you to repeat them back to Dr. Grey. Can you do that?
OK. OK. Bat, orange, car.
You think you can remember that?
Here. He has a closed head injury.
Watch for vomiting, confusion and loss of consciousness, OK?
All right. Good.
Derek? Not now.
Let me know when you get the CT report back.
Marshall, can you remember those words?
And this is the father, Big Jim.
I don't call him Big Jim. The family, they call him Big Jim.
Oh, stupid hicks.
Really? Being Southern makes you stupid? He owns half of Alabama.
Yeah. And I bet he even washes his hands after he pees.
That's uncalled for! This is a place of business.
Discharge the mother and father.
Karev, get the husband to the OR for surgery.
Dr. Karev, there you are.
You're supposed to be up on the OB-GYN rounding up my patients.
Yeah, I got paged. 911.
Pregnant mom. Car accident. Very serious.
Pity. I've got three surgeries on the board.
I was going to ask you to scrub in, but, guess you should stay by that pregnant lady's side all day.
You see to it, Dr. Bailey?
Karev, go find your patient. Stevens, scrub in on Noah's patella fracture.
The She-Shepherd just walks in and pulls me off surgery?
You burn the She-Shepherd, she burns back. Go.
The CT won't hurt the baby or nothing? It won't hurt the baby... or nothing.
OK, on three. One, two, three, up.
I was having a shower today. A baby shower.
That's why Mama and Daddy are in town.
Because I'm having a baby.
How nice is that? Nice.
What are you doing here? I'm captain of the vagina squad.
This nice man is going to take care of you now and he really likes to talk, so chat away. [Milly] It was nice meeting you.
Not cool, Yang. What does she mean? Captain?
And what kind of squad are you on?
You shouldn't be reading your own chart.
I want to find out what caused me to swerve my car into oncoming traffic and not be able to remember it.
Those people, the ones I hit, they're going to be OK, right?
No serious complications? Uh, they're still checking them out.
Dr. Torres? Yeah?
I heard you're performing the Noah Reynolds surgery.
Yes. Well, I'm your intern.
So, whenever you're ready. OK, well, head up and prep the OR.
I need to put on a splint.
Did you wash your hands? What?
You washed your hands, right? Of course, I washed my hands.
No. No. Of course you did.
Marshall, this is going to hurt a little bit, OK?
[winces] My ETOH and tox screens were pristine so I wasn't drinking or... under the influence. Ow.
OK, we get the CT result back yet?
My GCS was 13. Why haven't I had a CT?
Dr. Grey? CT was backed up.
And he's lucid now, so... So get it done! Now!
Hey. Daisy Duke's case was boring me to tears.
So, um, you got any good hearts that I can cut open?
Or, you know, bad hearts that we can make good?
[woman on PA] Dr. Stevens, Dr. Howard Stevens, 1435.
Burke? Use words.
You fell asleep.
This morning. In the on-call room.
I fell asleep after we, you know... Not after.
Oh. I'm... sorry.
I was really tired. Seriously.
Seriously, my bad. I'm really sorry.
Don't let this threaten your manhood. Oh, this is not...
I am very confident in my manhood, thank you very much. good, you should be, because, I mean...
I fell asleep because I had already finished.
I hadn't finished.
I was tired.
It's not like I did this on purpose.
Did you stay in the hospital last night on purpose?
You weren't on-call. It was a paraesophageal hernia.
I had never seen one.
I'm a surgeon first, just like you.
No. No. Not just like me. I am a person first.
Someone page me? Denny?
[woman] He collapsed.
Too far, too fast. What were you doing?
Real bright, huh? Your LVAD battery is almost dead.
Um, get him to his room, I'll get Dr. Burke.
Let's get him up now. Nice and easy on one, two, three.
Now, Denny, you knew that LVAD wasn't a cure.
I want to go home.
I want to go home yesterday.
I know this is hard to hear, but that's just not an option at this point.
Since when do you get to decide what's an option in my life and what isn't?
My heart may be on your battery packs, but it's still my heart.
It's my decision. It's my damn life.
It is your life.
And it is your life that is at stake.
And it is your life that will end if you continue to push like you did today.
You said the LVAD would make me better.
I told you the LVAD would buy you more time. And it will.
If you respect its limitations and your own.
I want to go home.
What do we do?
We put him on a tight leash.
Tell the nurses to keep an eye on him.
Make sure he doesn't take any more endurance hikes in the stairwell.
Preston, what do we do?
The damage to his body we can try to control, but the damage to his spirit...
For a man like Denny to lie on this bed for years on end...
That's not something we could really understand.
And his feelings about it aren't something we should try to control.
Give him room, Izzie.
Just give him room to grieve.
[Cristina] You finally got Melanie to shut up?
Finally. Thanks for that.
How's she doing? Images coming up now.
Is that a teardrop fracture? No head bleed, though. That's good.
Look at her lungs. Is that her liver?
[Cristina] How is she alive?
Karev, page Shepherd, Burke, Montgomery-Shepherd, the Chief and every surgeon with an available hand and get an OR opened.
Go! Melanie? Mel...
Get me a stretcher. Let's pull her out of there now!
Hey, have you seen Izzie?
She was supposed to prep an OR for Noah's surgery and she bailed.
Mr. And Mrs. Johnson? Dr. O'Malley!
That little girl right there says she's going to fix Noah's leg all by herself.
And she just gave him a big old shot for his pain. I really like her.
Mr. And Mrs. Johnson? Big Jim?
Is it Mel? Yes, ma'am, it is.
When your daughter came into the OR, her body was over-pumping her bloodstream with adrenaline, which kept her conscious and alert and, uh, pain-free.
During the CT scan, she was still for a longer period of time and so her body relaxed.
And the adrenaline stopped flowing, which allowed her to succumb to the full extent of her injuries, which...
More suction here. Clamp.
Karev, sit down. I can't see.
The only thing I want you to do is sit at that fetal monitor and watch that baby's heartbeat.
So now I'm a baby-sitter?
Addison, we're ready for you.
We are going to do everything we can.
Uterus is protected. Baby's heartbeat?
OK, baby's safe. You can proceed with the mother.
[Preston] Lungs are damaged pretty badly. [rapid beeping]
Pressure just bottomed out.
[Richard] Let's transfuse.
[Miranda] Four quadrant packing! Come on, people, get me some lap pads.
[Richard] Cross clamp the aorta. [Preston] Clamp. Got it.
[Richard] There's too much bleeding. Shepherd?
Damage control. Addison?
If you want the baby to live, damage control.
Burke? Damage control.
Everyone knows the rules.
We're gonna move as rapidly as possible.
Don't worry about finishing repairs.
For now we're on crisis management, just get it done.
Once she reaches the triangle, we stop.
Why's he talking about triangle?
Blood stops clotting, her muscles produce acid and her organs get cold.
You're talking about the triangle of death?
A ruptured abdominal aortic aneurysm.
I scrubbed in on an abdominal aortic aneurysm.
It was a 12-hour surgery.
I had already worked 30 hours, but I didn't want to miss it.
I fell asleep for... a second behind the wheel.
I closed my eyes for a second at the red light. A second.
It was only 12 hours.
I'd done it before.
We've all done it before.
Does this mean...
Are we actually saying that, uh... today... this morning... because I stayed in the OR to save a life...
I may have killed a pregnant woman?
[door opens] [woman] Dr. Grey?
You ordered a CT on Marshall Stone?
We're going to need a moment.
I'm backed up here with five patients.
We need a moment.
Izzie, please. Come on, Denny, just...
And not the crappy, processed, waxy kind, but the good Swiss chocolate from the gift shop that costs way too much money, but is totally worth it.
Try it. And exhibit B. Tabloids.
Good old-fashioned trashy celebrity gossip rags.
Damn it, Izzie, stop it!
Just stop it!
You think I'm feeling sorry for myself, right?
Poor sad sack Denny just needs a little perspective.
You do need a little perspective.
You have no idea what it is to lose what I have lost.
I know loss, Denny. No you don't!
I'm a man.
I'm a strong, virile horse of a man stuck in the body of some weak, sick bastard that I don't know, like, or recognize.
Now if you knew what that feels like, you would have never convinced me to let a battery run my heart.
If you knew what it feels like, Izzie...
you would have let me go.
Systolic's 82. No better. [Miranda] How's the spleen, Chief?
Unsalvageable, I'm afraid. Karev!
Frequent decels and loss of variability.
[Addison] The baby's fading. PH is down 7.1. Core temp 93 degrees.
OK, we've reached the triangle, people. Hands out.
[man] Still oozing.
We're not trying for perfection! [Derek] Just give me a second, please.
Damn it, stop! Everybody stop!
Cristina, let it go.
Slow. Erratic. But it's a heartbeat.
Baby's holding steady.
Bring out the plastic.
Plastic? We're not going to close?
We're going to keep her open, cover her with plastic, and get her to the ICU.
And then what? Then we'll see if she survives.
[Derek] OK. We'll take care of you, all right?
How the hell do you let a patient get that far off your watch?
I turned my back for a second. He was in the damned gallery!
He's a surgical intern... I don't care if he's surgeon general.
In this hospital, he's a patient with a head injury who needs a CT.
In this hospital, he's a scared guy who does not need to see the massive internal injuries of the woman he rammed with his car!
This is your fault. You had him and you lost him!
You got to take responsibility for your actions for once in your life!
[Miranda] We've given her medications to help her blood clot and to help counteract the acid buildup.
We're slowly raising her body temperature with warming blankets, warmed IV fluids, and blood products.
How long is she going to have to be like that?
You know, with... Open like that?
We want her to regain as much strength as possible before we operate again.
But at the same time, we want to repair the damage as soon as possible.
So it's a balancing act.
I'm sorry. I don't quite know what you mean.
Melanie will die if we don't get her back to surgery soon enough.
And Melanie will die if we take her back to surgery too soon.
A balancing act.
A balancing act.
Uh, Yang, call me if she starts actively bleeding.
Karev. Where are you going?
What? She's in ICU. There's nothing I can do.
You can sit and watch that fetal monitor.
You can't be serious. She's circling the drain.
You know how long a baby can survive inside its dead mother? Five minutes.
Minutes not seconds, Karev.
Look at Melanie. Look at her.
Now look around. All the doctors and nurses, even her parents.
Their sole job is to care of Melanie.
My job is to care for that baby.
I have a surgery scheduled, so when I step foot on that elevator and leave, you are going to be the only person on this entire floor responsible for that baby.
Do not let me down, Karev.
Her organs are bleeding, damaged, exposed, and covered in plastic wrap.
Poor Marshall. I mean, one minute you're a surgeon, the next you've destroyed an entire family.
Last month, I fell asleep in the parking lot.
On a bench. I couldn't even make it to the car.
I fell asleep at a restaurant.
At a table while I was on a date.
I fell asleep during sex. Izzie.
Hey, Callie's looking for you. You blew off her surgery.
No. I... I had a patient. Denny. I... I had to go.
You were hanging out with Denny? Oh, please.
Do not talk to me about standards.
The girl can't even wash her hands.
[Cristina] Don't worry about Bambi.
If Burke forgave me for sleeping during sex, George can forgive you for crying.
But Burke hasn't forgiven you.
I found Izzie. She said she had a patient.
I knew you'd take her side. What?
[sighs] He needs an IV.
She's mad at you.
I... I didn't know you were awake.
What did you do? Uh, has...
Has anyone talked to you about your wife? About what's happening?
What's happening? Uh...
You know, I can't really, uh, wrap my brain around what's happening.
You know, I'm from here. Uh, Seattle.
And, uh... you know, I go away to college and I come back married to this big-haired, drawling Southern girl.
And everyone I know thinks I'm crazy.
But I love her.
I just... I love her.
And, uh... what's happening is that my... big-haired Southern girl could be dying.
And... I can't think about that.
You know, I need... I need to think about something else.
I mean, it doesn't... matter so much.
Something that doesn't... doesn't have me burying my 22-year-old wife and baby.
So, uh, so...
What the hell did you do?
I believed my friend when she told me that Dr. Torres doesn't wash her hands.
Well, I hope that's not true.
Seeing as she just, uh... performed surgery on me and all.
You paged me. CT results.
Good, thank you.
All right, let's see what we've got here.
Marshall, everything checks out fine.
Your short-term memory loss was a result of the concussion.
But to be safe, I want to keep you here overnight for observation, all right?
I have to apologize.
To the woman's family.
I have to tell them I'm sorry for what I did.
You should get some rest.
I never should have told you about George.
No, it's fine, I'm glad I know. About him.
And the vet. You really get around.
What did you just say to me?
I don't remember ever asking you to forgive me.
So was the knitting a phase? Who's next? Alex?
Because I hear he likes to sleep around.
You two have that in common.
You don't get to call me a whore.
When I met you, I thought I had found the person that I was going to spend the rest of my life with!
I was done.
So all the boys and all the bars and all the obvious daddy issues, who cared?
Because I was done.
You left me. You chose Addison.
I'm all glued back together now.
I make no apologies for how I chose to repair what you broke.
You don't get to call me a whore.
This thing with us is finished. It's over.
Yeah. It's done. It is done.
Her temperature is 95.4 degrees and her pH is 7.28.
Definitely clotting better.
But some of the wounds are still oozing.
Well, still a fine line.
She may not be quite stable enough.
Y'all don't have to whisper.
I'm sitting right here. I can hear you anyway.
And she's my baby.
She's my little girl.
It's a big decision like this.
Going back in.
Sewing up her... organs.
It's the kind of decision that a mama ought to be involved in.
I mean, all her life, she's asked me everything.
From... what color dress she ought to wear to her kindergarten dance to what she ought to name her baby.
Because I'm her mama.
And it's my job to have an opinion.
It's my job to have an answer.
I may not have an answer here, but...
I'm still her mama.
You just don't have to whisper.
What do you think, Dr. Bailey?
I think if we wait much longer she'll go into multiple organ failure.
OK. If it's all right with you, Mrs. Johnson, we think it's time to go and finish what we started.
[steady beeping] [Derek] OK. I'm done.
[Richard] Yang. Come and start washing out the abdominal cavity.
[Preston] Bleeding's controlled in the chest.
I had to restrict a part of her lung but...
Fetal heart rate's down to 80! [Richard] Mom's heart rate's slowing.
[woman] 48 and dropping. Ruptured retroperitoneal hematoma.
She's bleeding out! Idioventricular rhythm. Any BP?
Trying. Nothing's registering.
Yang, get your hands in here and hold pressure.
Fetal heart rate at 60! Heart's fibrillating.
Dr. Webber, can you see the source of the bleed?
Hand me the internal paddles.
We're losing the baby! Charge to 20! Clear!
We're chasing our tails. Get Addison Shepherd!
Melanie's crashing. [Addison] It's right there.
You hear me? She's crashing.
I'm elbow deep in a patient's uterus. What do you want me to do?
Leave her and her child to die? I'm doing my job.
And I'm doing mine.
Do what you can. I'll be there as soon as I'm done.
OK, people, let's speed it up!
They'll know where to find us... when there's news?
They'll know we're here?
Is there something I should be doing, someone I should talk with? Something?
You're doing everything you can do, Big Jim.
I know this isn't the best time, but Marshall would very much like the chance to apologize to the family if they'll let him.
He's one of us, George.
Shepherd's still in surgery. I told her to hurry.
[Richard] How's her heart? Asystole.
How long has she been down? Five minutes.
Well, I'm gonna do a C-section. Glove.
I need to get that baby out. Tell me what to do.
Yang. We're going to... pack away the intestines.
I'll expose the uterus. OK, call Pediatrics!
Open the uterus with a midline vertical incision.
Make sure you don't cut the fetus.
[Miranda] OK, go.
[Richard] Baby doesn't look good.
How are we doing on the mother?
Oh, she's still bleeding pretty profusely.
[Miranda] I can't get it controlled.
She's not coming back.
Time of death, 19:48.
I am sorry.
I am so...
You're going to get in trouble.
I don't care.
I'm not going to cheer up for you.
You don't have to cheer up.
I'm not here for me.
I'm here for you. OK?
[Meredith] We're all damaged, it seems.
Some of us more than others.
You must be tired.
I'm tired too.
[Meredith] We carry the damage with us from childhood.
Then, as grown-ups, we give as good as we get.
[Addison] Good work, Karev.
Yeah. Kid's alive. Without a mother.
[Meredith] Ultimately, we all do damage.
See you at home?
OK. See you. OK.
[Meredith] And then... we set about the business of fixing... whatever we can.
Would it be wrong for me to feel you up right now?
Not so much.
Such a dirty boy.
I washed my hands.
I... I went down to the kitchen and I washed my hands.
I didn't wash my hands in the bathroom because those girls were staring at me like I was a rodent or something.
Like I was in high school and I was... having the naked dream, only it was actually happening.
I didn't even know they were home.
I washed my hands.
You have to stand up for me.
You have to say I washed my hands.
You're driving me crazy with the hovering.
This could be a mistake.
You're a really nice guy and...
you... you don't want to get involved with me.
If you knew me... Scary.
Finn. And damaged. See? I told you.
If you knew me?
If you knew my family?
If I told you the guys that I've slept with lately?
The scary and damage may actually be more than you can handle.
My mother's dead.
She got cancer when I was ten and she suffered for a really long time.
And then she died.
And my father never recovered.
It's kind of like he died with her, except that his body's above-ground and permanently placed in front of the TV with a bottle of Scotch in his lap.
The last woman I slept with was my wife, but she died too.
It was a car crash, so it was quick.
She didn't suffer, which I appreciated.
I'm thinking that my luck is beginning to change because I've met you.
And you like dogs and you enjoy pony births, and you have the ability to save lives.
I never said I wasn't scary and damaged too.