An Honest Mistake (2009)
[Meredith] There's a thing that happens when people find out you're a doctor.
Did you... [stammering]
...patter? Propose? No. Not yet.
[whispering] You'll be the first to know.
They stop seeing you as a person and begin to see you as something bigger than you are. How's she doing?
She's, uh... OK.
They have to see us that way, as gods.
Otherwise we're just like everyone else.
Unsure, flawed, normal.
How's she doing? No change. This the MCA Doppler?
Yeah. Can I get you anything? Coffee?
I'm fine, thanks.
So we act strong, we remain stoic.
We hide the fact that we're all too human.
He still beating himself up? Addison thinks he's still beating himself up.
Alex... The head of Neuro hasn't left his patient's bedside for three days. He's fine.
I thought Addison left. She put her brother on a plane.
Admit it, her hanging around your guy, it bugs.
It doesn't bug. You bug. [monitors beeping]
Karev, page Addison. Tell her I need her to stay.
OK, it bugs a little.
The lack of blood flow is causing the mini-strokes and aphasia.
We can't put the surgery off any longer. I'll do a repair called an EC-IC bypass.
And that will fix the strokes? She'll be better after this?
I'm hoping it will work, yes. [Jen] But, uh...
They wouldn't operate unless it were safe for the baby. Dr. Montgomery?
Your blood pressure's high, but I'll be there to monitor you and the baby.
Get some rest. We'll see you soon.
Thank you for staying. Least I could do for saving Archie.
I know what we said before about the baby, but if something should happen, if it comes down to a choice, save my wife.
We can make another baby. We can't make another her.
Fifty-two-year-old male, fell down stairs.
Five days post-op from a cholecystectomy which looks to have caused the fall.
Why would having your gallbladder removed cause a fall?
A non-laparoscopic cholie?
Sir, what hospital did you have your operation at?
Here. My surgeon was Dr. Campbell. That explains it.
Excuse us for a moment.
All right, what?
[sighing] Campbell was Seattle Grace's first female surgeon.
Mostly she just sits in her office and spreads prestige around.
She still does the routine surgery now and then.
Botches routine surgery. I'll page the chief.
No, page Campbell. It's her patient. And let her maim the guy again?
Page someone who knows how to operate, instead of some dinosaur who refuses to retire her scalpel and go join her friends in Boca.
The dinosaur is here.
No need to page me.
So did you scope her out yet? Who?
Arizona. Oh, right.
I haven't had a chance to swing by Peds and ask the nurse to point out the attending who kissed my friend in a bar bathroom.
At least you're still good for coffee. Not for you.
Coffee. Why, thank you, Mark. That's not for you either.
Good morning, Dr. Grey. You can keep your secret coffee.
Until you tell Derek, our relationship continues to consist of hiding in the attic and me smuggling snacks past Mer.
Know what that makes you? Your boyfriend?
Anne Frank. I'm dating Anne Frank, and I'm tired of it.
I want to go downstairs. I wanna tell the Germans to kiss my ass.
I'm gonna tell him. Soon. When I do, you'll be my date to the wedding.
Derek proposed? Not yet. But when he does.
This is the first step in the start of a new life.
How are we feeling? Positive? Confident?
I am good. Great.
You take care of your own feelings. Peds Surgery is super competitive.
Why I'm armed with letters of recommendation to put the competition to shame. Shepherd says I'm talented.
Sloan finds it an honor to work with me...
What does the chief think? I'm still working on that.
Chief's recommendation matters. Everyone on the committee...
I know! You calm down. I've got it under control.
Good. Because speaking on behalf of me, we couldn't be more excited to have you. Yay.
Chief? Just a friendly nudge.
Your recommendation is due by the end of the day.
I'll remind Patricia. You have written it?
You'll get your recommendation.
I need more time. No.
Don't get me wrong. I am honored that you asked me over all the other residents, but it's not easy distilling a doctor of your stature to 500 words or less.
I chose you because you're the only one to do this without screwing up. Don't.
[stammering] Make sure he planes the patio...
Plates the... We'll get him piano lessons. Yes.
[Jen] Only puddle shell... uh.
[struggles] Only public...
Public school so he doesn't become a snob, I know.
But I don't have to. You're gonna be there to make sure I don't turn him into a jerk.
I love just...
I know. You love me.
And I love you. I'll see you in a few.
Her blood pressure's higher than it was yesterday.
We can't wait. I know...
You want me to be aware. You're a good doctor. So am I.
Let's just be good together.
Your and my guy work well together. My guy works well with everyone.
Dr. Stevens? Yes.
Think we'll get to scrub in on a surgery?
You think you're capable of holding someone's life in your hands when you could barely finish the intern bowl? Really? Come on.
Dr. Stevens, remember me? Yes.
I was here a couple of days ago when you told me I might have cancer.
You sent me to an oncologist, who sent me to an immunologist, who then sent me to some other ologist I never heard of before I set foot in this deathtrap. 80 thousand dollars in tests later, the only thing wrong with me is that I'm anemic!
Anemic? My lawyer seems to think that someone here mislabeled the blood.
Switched it with someone else's. I was told not to come here, but my conscience wanted to make sure you went through those files of everybody who was here at the clinic that day.
Of course we will. I'm so sorry.
Don't apologize to me. I'm just anemic.
You apologize to that dying person.
[Meredith] Middle cerebral artery? [Derek] Yes, after I connect the STA, we will close. Baby's having spontaneous decels.
Mom's hypotensive. I don't know how much they can handle.
MCA's bleeding. It shouldn't contribute.
Pressure's dropping. The baby's gonna need to come out.
Almost done. Wait. Not me that can't wait.
The decels are getting more frequent. A fetus can't handle three surgeries. We have to get the baby out.
He's too young to come out. Last decel lasted a full 30 seconds.
Let's go. I'm taking him out.
Ten-blade. [Derek] Leave the baby in.
Done. I'm done.
You've got a minor fracture so you won't need surgery.
You should on your feet within a few weeks.
I don't know what I was thinking. The wound wasn't healing as fast...
Next time, you call me, John.
Dr. Yang, explain to my patient what you feel I should have done differently in order to avoid this complication. Don't be shy, Dr. Yang.
OK. Well, patients status post minimally invasive procedures have been shown to have decreased post-surgical discomfort...
In human please, Dr. Yang.
This surgery should have been done laparoscopically.
Dr. Hunt, perhaps you can explain to Dr. Yang why I chose to do the surgery this way.
Although some doctors prefer to use the new technology, there are others who believe it's more risky since we can't see or move around as much during the surgery.
It's half a dozen either way.
Bravo, Dr. Hunt.
Do you understand, John? Yes.
I have no doubt you did the right thing by me.
Wonderful. Now, Dr. Yang, please take our patient to CT.
Maybe you'll learn something in the process.
While I confer with Dr. Hunt about our course of treatment.
I'm on a deadline. Sadie Harris mislabeled a patient's blood sample. The clinic's getting sued.
Good thing Sadie no longer works here. No, it's not.
Because it isn't just her. The interns, all of them, they're capable of the same mistake. They are dangerous and they are bad.
Don't tell me I'm overly emotional and it isn't personal!
Because it is personal! I've worked so hard to teach them, and... and it is personal. Stevens.
I thought the same thing about you every day for the first year you worked here. Know what the chief told me?
You don't get much rest, do you, Dr. Shepherd?
Did you hear yourself just then? Oh, my God!
Oh, my God! I can talk!
I know! Listen to you!
And the baby? How's the baby?
The baby's stable. However, your new labs show that you're pre-eclamptic.
We hoped to keep it from progressing to this stage, but stress of surgery was a lot on your body. So do we need to be worried?
Come on! Dr. Shepherd, please tell me we're done being worried.
First moment of hope they've had in a week.
Pre-eclampsia is serious. You're too close to this patient.
Stop fighting me on this. We had a victory. Focus on that.
We give the family all the information. That's our job, Derek.
Looks like my guy won that round. Meredith?
Karev, can you go get Jen's blood test results?
Give me a reason why I shouldn't go to the chief.
What? The surgery was a success. He made a mistake in her first.
He caused complications. He feels responsible.
Tell me why I shouldn't go to the chief.
During the trial, he lost patients. It affected him.
For the better, I think. He cares more, if that's possible.
You just have to trust him.
I haven't seen you around. Well, I've been avoiding you.
I know, it's so weird.
You share a kiss with a woman you've never seen...
Honestly, this is a new adventure, one I'm so ready to take, for the second time, and... [sighing] Anyway.
Do you want to go on a date with me?
Wait, Erica and you. She was your first?
OK. So then I guess my answer is no.
I'm sorry. Wait. What?
You kissed me, out of nowhere, in a bathroom.
OK, this is what I try to avoid.
You're all exploring and experimenting and...
Yay! This is a really exciting time for you.
But I work in Peds. I spend my entire day around newborns.
So I try not to in my personal life.
Thanks for asking, though. I'm super flattered.
As discussed. Thank you.
[scoffing] Newborn. I'm not a newborn.
I'm a senior resident. I'm a great surgeon.
I'm a divorcee, for God's sake.
I'm, uh... looking for you to agree with me here, Bailey.
Bailey? The chief, he wrote me a form letter of recommendation.
That's insane. He's chief, you're Bailey.
"Pleasant in the OR and enjoyed by the nurses.
She's completed a serviceable amount of research.
A fine addition to any program." Fine! He used the word "fine."
A blank page would mean more. I pulled off a 12-person domino surgery.
I took out and put back six of a dying girl's organs!
I am Dr. Bailey. I am better than fine!
At least he didn't call you a baby.
Just a minute more, Mr. Terzian.
Oh... Done tending to Her Highness?
You're tough on people.
It's good to hold such high standards, but this is medicine.
No one's perfect. She's stubborn and out of touch.
Forty years experience means nothing? Not if you don't use them correctly.
She wants to be old and keep operating? Fine.
Just keep up with the medicine. Cristina, this is one case.
You can't judge someone based on one case.
That patient deserves to know his doctor, no matter whose feelings it happens to hurt.
Laparoscopic or open, none of us should have made that mistake.
[sighing] You realize you're charging one of our hospital's most respected surgeons with negligence.
Dr. Hunt, do you agree with Dr. Yang's assessment?
This is Dr. Yang's call. I'm asking you, Dr. Hunt.
Campbell outranks me, sir.
I think it would be best for you to discuss it with her directly.
Very well. Page Dr. Campbell.
I want to speak to that patient before surgery.
Way to take a stand.
There he is, the legend himself.
How are you, legend?
Are you drunk? Should I be worried about you?
He's got his sense of humor back. How's your patient?
She's good, stable. Today's the first day in a long time I remember what it feels like to be good at my job.
You? Come on, you're like the Dalai Lama of surgery.
People from all over the world come to let you cut into them. Know what else?
You look good doing it. I like the facial hair, by the way.
Keep it that length. No more, no less. Stop.
Derek, there's something we need to discuss.
Go ahead and have sex with Addison. Addison?
Go for it. I don't want to.
Really? What did you want to discuss?
How's my mother? Bitter.
What's so wrong is how much the chief and your mother fought.
Sex must have been great. Saying that, that's wrong.
What's wrong? Our entire healthcare system? 'Cause I agree.
Here it is. "March 3, 1979.
Assisted Margaret Campbell on a splenectomy.
Impressive resume, adequate technique." See? Hack! Even then.
You're working with Margaret Campbell? Yeah. Ye Oldy Timey thinks she's sane enough to do surgery. That's what I like about your mom.
She wasn't Alzheimer-y and still operating.
Do me a favor and shoot me if I start making mistakes on patients and think it's kosher to cut. Sounds like Shepherd.
Alex. Please, my guy's right.
Your guy nicked an aneurysm and is trying to cover his ass.
Your guy needs to shut up. [both pagers beeping]
[Jen crying, gasping] [monitor beeping]
What happened? Bypass must have blown.
Page Addison, meet us in the OR! I told them everything was OK.
Dr. Shepherd? I don't understand. He said the surgery was a success.
I'll give you an update as soon as we can, OK?
[sighing] The swelling's not going down.
[Meredith] Maybe the ventriculostomy is plugged.
No. Damn it!
[Derek sighing deeply]
I have to take out the temporal lobe.
Won't that kill her? No.
She could lose some of her speech, memory and vocal pattern.
The brain can rewire. I've done it before to stop seizures.
[Meredith] Have you done it before for this?
[monitor beeping faster]
I'm doing it now. Baby's got decels.
What are we doing here, Derek?
What are we supposed to say? "Shepherd's cutting out parts of your wife's brain. She'll pull through?"
Tell him the truth. Dr. Shepherd is doing everything he can to save your wife and child. The guy's life ended. Tell him that.
Alex, just be...
The baby's having heart fluctuations, but Dr. Montgomery is taking every precaution to avoid an early delivery.
And my wife? Dr. Shepherd is trying to get the bleeding under control, but we won't know more until the surgery's finished.
But she won't die?
Please tell me she won't die.
Shepherd is doing everything to make sure your wife lives.
[Alex] Dr. Shepherd is doing absolutely everything he can.
We should get back.
Right. Of course. Thanks.
Thank you. Your guy sucks.
Mr. Terzian, your scans show a change from Dr. Campbell's original assessment.
There was a complication from the surgery, a lacerated bile duct and artery. You'll need another surgery to repair it.
Is that all? [Richard] Yes, that's all.
Oh, thank God!
I thought when they told me the chief of surgery was coming, I was a goner for sure.
[Richard] We simply wanted to make you aware that it's within your rights to request a change of surgeon.
Dr. Campbell's not available? She's available.
[sighing] No, thank you. I choose Dr. Campbell.
Very well. Dr. Campbell. Richard.
Sir, with all due respect, I don't think the patient's clear what happened.
You heard the patient. He wants his doctor.
But sir... Back down, Yang.
I just need you to tell me if it's worthy of Dr. Bailey.
Bailey's an ass. She doesn't listen to residents when they have important information about interns.
You're missing the point of the exercise, to say nice things.
You still hang out here?
George, just say she's dependable. Say she's selfless.
Everything she was until she wasn't. Just...
You should probably go.
Thank you. Hm.
It's been years since I've had you in my OR, chief.
I seem to remember an incident with a clamp being dropped into an open body cavity.
You're never gonna let me live that one down.
A good teacher never lets up on her students. Although, I've often wondered how the upcoming classes learn anything with the way we teach these days.
Attendings seem more concerned with inspiring their students, using encouragement and validation and so forth, instead of instilling them with the fear and shame that causes one to remember anything in the first place.
Dr. Hunt, you come from the military.
Wouldn't you say the rigid aspects of your training helped you become the doctor you are today? Yes. Very much so.
Dr. Yang, on the other hand, something tells me fear is not something you have often faced in the OR.
I'd appreciate any opportunity to learn.
Wonderful. Let us begin then.
Tell me how you'd do a pulmonary embolectomy.
I'd insert a steerable catheter into the femoral vein and position a fluoroscope adjacent to the embolus.
What would you do if the power should suddenly go out?
Or if you had to operate in a hospital that couldn't afford a fluoroscope?
It's like a calculator. Because there's a machine to do it for them, children shouldn't have to learn simple arithmetic?
If it would help them avoid mistakes like this one.
Out of my OR!
I said get out! Out!
This is still my OR!
She's bleeding into the frontal lobe. If I can stop the bleed, save the rest of the brain, she'll have a chance.
[monitors beeping eratically]
Decels are getting longer.
[Addison] I have to deliver the baby. [panting] No. Just...
If you cut her, she'll bleed. I can save her.
I have to cut out the frontal lobe. What?
Derek, no. Stop. Derek. You've done enough.
Can she live without frontal and temporal?
Yes. [Addison] No, Derek, she can't.
This baby isn't getting any oxygen.
You want to save Jen, you feel like you have to, but not this way.
I can save them both. She will live.
Not as the person her husband and child need her to be.
She'll lose everything about her that makes her human.
Meredith. Are you sure you can do this?
I have no choice. Bipolars. Baby's heart rate is bottoming out.
Damn it, Derek! This has gone too far.
Taking the frontal lobe out, even if she lives, you're creating a monster.
You don't get to play God here!
Jen is gone, but this baby has a chance to live. Let her go.
Let it go. Please, let...
I'm taking the baby out. Put down the scalpel, Addison!
[monitors beeping erratically]
You put down the scalpel.
Addison, put the scalpel down. [Addison] You put the scalpel down!
Get off the scalpel, Addison! Take it off!
Meredith... Do not go anywhere.
Derek, don't do this. Do not touch my patient, Addison.
[monitors beeping eratically]
Derek, look at me. You don't have to do this.
Jen's gone. It's too late. You can't save her. She's gone.
We can save the baby.
Derek, look at me.
Certain surgeries get the best of all of us.
I made a mistake.
A careless mistake.
And for that, I am sorry.
But I am only human, as human as any of us.
And for that, I do not apologize.
Margaret, you don't have... No need to discuss it further.
No need at all.
Chief, we need you in OR 1! Karev?
Right now, sir! [Richard sighing]
I was fired. From the Army.
They call it an honorable discharge, but they knew it was my time, even though I didn't.
I'm grateful to them for that.
[monitors beeping eratically]
The baby's still in distress. I need to take it out.
Wait. Just wait. The bleeding could stop.
The baby could stabilize. We do a C-section now, she'll die.
She is dead, Derek. Please, just wait.
Most of her brain is gone. For all intents and purposes, she's dead.
Karev, page Dr. Friedman's team. Tell her we have a preemie on the way.
[Derek] Why are you cutting?
Meredith, get some more blood. She needs more blood.
Get more blood.
She needs more blood. No more blood, Derek.
[Richard] No more blood.
You're smart to get it looked at, but it doesn't look too suspicious to me.
Even combined with high LDH levels? Oh.
That could be caused by anything, mono, exercise even.
Coupled with neurological episodes? Hallucinations?
There we go. All done.
You and I both see patients do this everyday.
Find something suspicious, convince themselves they're sick.
But as doctors, you and I both know that it's our job to remain worry-free until we have proof that says otherwise. That's what you should do.
Relax. By this time tomorrow, you'll be laughing at the fact you thought anything was wrong.
He looks strong.
[Arizona] He definitely has a chance. Let's get him intubated.
[Addison] Placenta. [machines flatlining]
[Alex] The steroids we gave your wife allowed your baby's lungs to mature.
That, combined with the three extra days that Dr. Shepherd took to do the surgery, makes us very hopeful that he'll survive.
I don't understand. She just died?
Yeah, I know. You said that. Um...
I'm asking how she died.
We believe your wife's high blood pressure caused the bypass to fail.
That caused the bleeding and swelling in the brain.
Dr. Shepherd did everything he could. There was too much damage to her brain.
That's when Dr. Montgomery stepped in to deliver the baby.
You said it was a routine procedure, that she would be fine.
Then there was a complication.
And you said you fixed that.
But then the baby got sick, and that made Jen sick.
But then you said you fixed that, too.
And now she's dead.
I'm sorry. Stop saying you're sorry!
You killed her!
You're a murderer! A murderer!
Where's my wife?
I want my wife!
[sobbing] I want my wife!
[gasping] I want...
[George] I know it's bad. But I tried.
You're just very complex, and word-defying.
That is a letter of recommendation! O'Malley? Take pointers from O'Malley?
You'd be hard-pressed to find a better person to take pointers from.
Chief? Chief! Exactly!
I am the chief of surgery. I don't have time to write letters to pump your ego.
My head of Neuro is called a murderer, I have to fire my general surgeon because she won't retire, interns are mixing up blood samples in your clinic, and you want me to spend my time writing a recommendation so you can leave me?
Leave you? Sir, I am applying for a fellowship in pediatric surgery.
Which is not what we had discussed! Do you know how much time you wasted?
The amount of work it takes to groom someone?
You were to become the next me! You wanted me to become the next you.
I am not your son or your daughter.
You don't pin all your hopes and dreams on me, sir!
I'm seeing Lexie.
I'm sleeping with her too, but it's more than that. We're happy.
OK, that's... Maybe I deserved that.
You know what? I didn't. You have no right to tell me who I can sleep with.
You're worried about your legacy. But I am not your legacy!
And me applying to Peds is not... You are not listening to me.
[Miranda] Oh, my goodness!
Come on. Come on! Come on, stop. Come on!
[groaning] [Owen] Come on.
It's done. [panting, groaning]
That's her guy.
I'd do a pulmonary arteriotomy, directly visualize the clot and use atraumatic forceps to extract it.
That's how I'd do a pulmonary embolectomy without a fluoroscope.
The fact that you felt the need to come tell me that tells me you're a much better surgeon than I first thought.
I've decided today's surgery was my last.
You look at me like you won't wake up one day not that far from now, so much faster than you can imagine, and find that you are me.
When you can't cut anymore, what will you have?
I was a god.
In this OR. Holding a scalpel.
I was a god.
What will you have?
I don't see anyone burning the place down.
That's how they do it.
Do everything right. As soon as you look away, they screw it up.
Hey, I'm sorry. I was busy earlier.
With myself, I was busy, so I'm sorry.
I called you an ass. And you were right.
I think I just needed to vent.
[sighing] I'm sick of this place. Hell, I just watched Derek Shepherd beat up a man because he's so sick of it. That's the way it works.
The patients we lose, the mistakes we make, that's how we learn.
It's the only way it's ever been done. Figure out a better way, and you will be a better doctor than us.
[Meredith] Patients see us as gods.
Izzie? Or they see us as monsters.
But the fact is, we're just people.
OK, well, it's not broken.
But you should ice it. Lots and lots of ice. Goodbye.
[Lexie sighing] I'm so sorry. It was worth it.
No. It wasn't.
[stammering] Maybe a little.
We screw up.
We lose our way.
I have experience to give. Calliope?
Life experience. Like I was married. Did you know that?
Or that I was in the Peace Corps. Botswana.
It convinced me to go to med school. And I've experienced the joy of cooking.
I make an excellent chicken piccata, in addition to many other delicious meals you'd be lucky to experience. That you can't open your eyes to see that makes you a little inexperienced.
Um... Calliope, this is Julie. Hi.
Even the best of us have our off days.
Letter of recommendation. Callie told me about the chief's.
I figured it was the least I can do before getting on a plane back to LA.
Addison Montgomery, thank you! Don't thank me. Just kick ass.
Don't make me regret writing you are the most promising young Peds surgeon I've ever had the pleasure of working with.
Still, we move forward.
Today, you were a teacher to someone who needed to learn, but you were also a bully to someone who needed compassion. You were both.
I wasn't a bully.
And... I was right.
You're a lot like her. Stubborn, opinionated, smart.
Forty years from now I'll have to pry that scalpel out of your hand, too.
From my cold dead hands.
You're missing the point.
I wanna be around 40 years from now.
We don't rest on our laurels or celebrate lives we've saved in the past.
Because there's always some other patient that needs our help.
So we force ourselves to keep trying, to keep learning.
You're unmotivated, careless, selfish, distracted, and pretty much the people in this hospital I'd least trust with my life.
But that's the way it's supposed to be. You're interns. You're babies.
And you're all lucky to work here. We're all lucky because we save lives.
Every day, we get to save lives. That's our job, and...
[sighing] It's not something a lot of people get to do, so...
In the hope that... Let's begin.
...maybe... New game.
...someday... This is Patient X.
She's a 29-year-old female we misdiagnosed with anemia the first time she came to us.
Let's not make the same mistake again.
...we'll come just a little bit closer to the gods our patients need us to be.