I Will Follow You Into the Dark (2009)
[Derek] Previously on Grey's Anatomy:
[Cristina] You got some problems. You got some big problems.
[Callie] I kissed a peds surgeon. Calliope, this is Julie. My date.
I'm seeing Lexie.
Oh, my God, I think I broke it! This is Patient X.
She's a 29-year-old female we misdiagnosed with anemia.
I'm applying for a fellowship in Pediatric Sur...
Which is not what we had discussed!
[Rob] Where's my wife? You killed her!
You're a murderer.
[Meredith] Every surgeon I know has a shadow.
A dark cloud of fear and doubt that follows even the best of us into the OR.
[Alex] Dude, he is fried. [Meredith] He is not fried.
He lost a patient and got a lawsuit all in one week, he just needs time.
He's been there for three days. The cushions are bonding to his ass.
And he's eating all my cereal. [Izzie] He's taking stock.
Something huge and life-altering happened to him, and he's taking stock, figuring out his next move.
We shouldn't judge and rush him.
Whatever. Sylvia Plath's picking out the marshmallows. They're the best part.
I'm pretty sure he's sitting on my keys.
I'd ask him to move, but he looks so... comfy.
You guys are cowards.
You're eating, that's good. Appetite is good.
You know what else is good? Showering. Cleansing. Water.
Are you thinking you'll shower, go in to the hospital?
[Derek] I have to for the deposition.
I have to go explain in detail how I killed a man's pregnant wife.
That's good. Not the killing part, but the... I think you'll feel better once you...
...go to... work.
He'll be fine.
[Meredith] We pretend the shadow isn't there.
Hoping that if we save more lives, master harder techniques, run faster and farther, it'll get tired and give up the chase.
But like they say...
You can't outrun your shadow.
Hey. [both gasping, screaming]
I dreamt once I was falling out a window, hanging on to the drapes.
I woke up pulling Meredith's hair.
So we have a trauma coming, a trampling on a football field.
I don't need your help. I'm on your service today.
I'm telling you, Dr. Yang, to take care of that elbow.
There you are. What happened to you?
I tripped and fell. It's fine. No, no, it's not.
It's... It's nothing. It was an accident. What's wrong with you?
Derek won't get off the couch.
[scoffs] So the weaker sex.
It's still swollen. I'd give it another day rest.
I haven't operated in days. Don't hit with your scalpel hand.
Have you talked to him? He threw the first punch.
You did catch him at a bad time. So he lost a patient. Boo-hoo.
We're surgeons, we're men, we lose patients.
Doesn't give him the right to go around behaving like a drunk frat boy.
Now I'm supposed to go crawling back, begging for his forgiveness?
What... What are you doing? Shh, shh, shh.
I went Say Anything on the ped surgeon in front of the ped surgeon's date, so I am hiding from the ped surgeon. Mature.
You got in a fist fight. No judging.
Hand! Oh, God, I'm sorry. I forgot.
I am so sorry, I feel terrible, about everything, about the fight, and your hand, and Derek and...
He's not doing so well, I think you should talk to him.
I should talk to him?! Mm-hmm.
Look at you, with your stethoscope around your neck, charting...
I can totally see you in ten years, little salt and pepper in your hair, big shot attending...
You're gonna be a rockstar, Alex.
What is this? What?
I can't fantasize about my boyfriend and his bright, bright future?
Shut up. Dr. Stevens?
We've been working on the Patient X case and we have a couple of ideas.
Great. Let's get to work.
What's this Patient X that's taking the interns?
When's it gonna be over? I need minions to do my crap work.
Some new teaching thing.
We're killing ourselves to get OR. When is the last time Izzie held a scalpel?
She's falling behind. She's like the new O'Malley.
Izzie's nothing like O'Malley. Hello...
OK, O'Malley, you're in the clinic, Grey and Yang, with me. Karev, you're in the pit with Hunt.
Dr. Bailey, I'm on trauma today. Save it, Yang. Hunt wants Karev.
Oh! Sir, there you are.
Shepherd planning to grace us with his presence?
Yes, he's fine.
Sir! I've been trying to page you all morning.
I could use help on a case. No peds today?
Must be slumming. Excuse me? Sir...
Tricia Shelley, 31, Megan Shelley, 27, Michael Shelley, 23.
Genetic testing revealed they all carry the CDH1 gene for hereditary diffuse gastric cancer.
Which means what, Dr. Grey?
Which means they all have a 3-in-4 chance of developing the cancer.
Dr. Bailey's taken tumors out of everyone on our mother's side.
Unfortunately, it's a highly aggressive cancer, the tumors grow quickly, by the time I get in... Our family's tree's down to a branch.
How is... Uncle Bud doing?
And Aunt Helen? Dead.
What about the Minnesota cousin? Not dead!
She's 90 pounds and in hospice, Meg. Still. Not dead yet.
So, uh, you've decided you're ready to take the next step.
We've made a pact, we're all in this together.
Cut our stomachs out, Dr. Bailey.
Beth Dearborn, 17-year-old with a history of seizures, had a grand mal during band performance, started seizing on arrival.
Push two of lorazepam.
She's in v-fib! Charge the paddles to 200.
The v-fib could be from the seizure. If she's not in v-fib, she'll flatline.
You got a pulse? I don't think so. It's hard to tell.
Lorazepam's not working. What do we do?
We shock her and save her or shock her and kill her.
What the hell. Clear!
Sinus tach. Good call, Dr. Hunt.
The odds are 50-50 shot.
Oh, no... it happened again?
I'm Dr. Robbins, the pediatric surgeon on call, this is Dr. Hunt.
You got beat up while marching, I'm going to check for internal injuries.
I seized during the performance? But I took my meds...
Relax, it's not like you crapped your pants.
It is like I crapped my pants. I had a seizure in front of the entire band.
It is exactly like I crapped my pants. They're going to kill me.
Who? Seizure patrol.
You're the seizure patrol? I'm first clarinet, he's drum major.
Whenever Beth has a seizure, we drop our instruments, roll her on her side so she doesn't choke on her tongue.
We were in the Northwest Regional Parade. We were favored to win.
Yeah, until Beth took down the snare drum, woodwinds... the tubas tried to avoid her but she was in formation.
Yeah. Why don't you go call her parents?
I'm gonna run some tests, but she's coded once, so watch her, standby with a crash cart. You want me to baby-sit?
That's an intern job. I don't see any interns around.
Patient X, a previously healthy 29-year-old female presented with stable vital signs, a normal physical exam, with symptoms of right upper quadrant pain, nausea, and hallucinations.
Head CT, chest X-ray, CBC were normal, but chemistries revealed an elevated LDH.
You are this girl's doctor, she comes to you, scared, doesn't know what's wrong, you have to diagnose her. What do you do next?
What test do you run? A retic count or peripheral smear?
You'd be wasting your time. The CBC was normal, remember?
You said there was abdominal pain, what about an upper Gl?
That is exactly what Patient X's doctor did next.
What does this tell us?
What is this? Side effects and complications from prophylactic gastrectomy, so post-op you know what to expect.
Malnourishment, weakness, fatigue... dumping syndrome?
That doesn't sound good. Possible anal leakage?!
A gastrectomy isn't like getting your appendix out.
We're changing the way your digestive system works, a serious adjustment.
I'm president of my frat, have a girlfriend, go snowboarding!
How am I supposed to do that when I'm a weak old man with anal leakage!?
You know how important this is to Trish.
Trish has run our lives since we were kids, she decides where we go to dinner, vacation, where we do Thanksgiving...
I'm 23. If I don't want to butcher myself, she can't make me.
So you'd rather die like Mom? Or Grandpa? Or Uncle Bud?
It's not quick, Mike. It's a slow, painful way to go.
There's a 1-in-4 shot we don't get it, right?
That's something! Don't be stupid.
You are doing this, we discussed... You're not in charge of me anymore!
I didn't realize it was such a big deal.
I just... I need a little time to think about it, OK?
No, Callahan on the bypass, Levin on the appy.
Damn craniotomy. Where the hell is Shepherd?!
You can't rely on Shepherd. Is there anything I can do?
My neurosurgeon has been missing for days, I have no head of cardio, general surgeons quitting on me left and right, surgeries piling up like dead fish and no surgeons!
Now would be a bad time to tell you my hand's still out of commission and I can't operate.
Leave me on the board, chief. I won't let you down.
I could do that craniotomy.
Put Dr. Nelson on the craniotomy.
Appreciate it, John. It... It's Jim.
You must be new. Welcome to Seattle Grace.
I've been here ten years.
I was interim chief of neuro before Shepherd in his red cape swooped in from New York.
Mark Sloan, plastics. We've met. Three times.
I don't know why Mr. Bimm ever let her join band.
Not like she's a master flautist... OK, get out!
Mr. Bimm said to stay until her... I got it! I'm seizure patrol now.
Your friends are asses. They're not my friends.
Once you spazz out in school, friends are hard to come by.
You can't help the epilepsy, but nobody made you join the marching band.
It's spreading nerd on nerd. I like being in the band.
It's the one thing I'm good at. What'd you do in high school?
I wrestled. You're a wrestler?
You wearing tights under that? It was a long time ago.
That was high school, I'm a surgeon now.
How would you feel if you seized every time you went into the operating room?
You realize, as your doctor, I'm not recommending this, right?
I need to get through my surgeries today.
You're gonna get through them, just hurt later.
You heard of a Dr. Nelson in neuro?
Oh, yeah. [chuckles] Shadow Shepherd.
Shadow Shepherd? Yeah.
He's a solid surgeon, but sort of the JV player to Shepherd's varsity.
The B team to Shepherd's A. The bricklayer to Shepherd's architect.
I get it.
Just 'cause the guy doesn't publish fancy clinical trials, or take on flashy surgeries, or have creepy perfect hair, he's less of a man?
How'd it go with the lawyers?
They told me my death rate.
These are the people I saved.
These are the people I killed.
Most of those were terminal when they came to you, you were their last chance.
And you take on impossible cases. Look at the clinical trial.
There's so many people.
More than Dahmer, Manson and Bundy combined.
You're not looking at the big picture.
This is the big picture.
Shepherd! Thank God you're back.
Can you swing two brain biopsies? I'm not operating.
I know you've got a big lawsuit breathing down your neck, I know you lost a patient, but I need you back, doing the job I hired you to do. I am not operating.
I'm not asking, I'm telling as Chief Surgeon, if you don't get back into that OR today, Shepherd...
And he just walked out. Without saying a word.
Hunt won't look at me since he went all Apocalypse Now this morning.
Had to get scalpel happy in that patient's brain and can't face it.
He thinks I'm this wilting flower. I'm the strong one.
I'm the strong one. If I had that stomach cancer gene?
I'd get that gastrectomy. I face things, I don't walk away.
Derek walks away. Maybe walking away is the answer.
It's not emotional, it's science. Have a problem, don't ignore it.
If you have to pee, and you ignore it, it does go away.
[Izzie, chuckling] You guys are hilarious!
Do you even know what she just said? Or what she just said?
I see you guys in 50 years in a nursing home, just talking at each other with your hearing aids off. Hi-larious.
Oh! I love lunch.
What the hell?
[steady beep] Beth?
After I take out the stomach I'll do what, Yang?
Sew the esophageal anastomosis. Or the other option is, Grey?
You could staple the anastomosis. Now why would I want to do that?
Fistula rates can be higher when you hand sew.
You might say that using the old stapler is sort of my specialty.
Thought your specialty was baby-sitting. I'm sure you'd rather be doing that.
Frankly, sir, I feel like I am.
[Cristina] Excuse me, sir, I think you should feel this.
Tell me that's not what I think it is.
Wait, I think I got it. Liver enzymes are normal, cardiac workup's negative...
If LDH is a false positive... It's a trick question.
What? She's fine. Patient X is fine.
She's not fine. Her SED rate is slightly elevated.
Did we check for autoimmune disease? ANA and CRP were negative.
At worst, she's got an anxiety disorder. The girl is totally fine.
She is not fine!
She had hallucinations.
She had visual, auditory and tactile hallucinations about her dead fiancÚ.
She thought she could talk to him and touch him.
She is not fine.
You're missing something.
You're not looking in the right place. Go back, figure out what you're missing.
She has it? Trish has cancer?
The cancer was stage one. We got to it so early, the gastrectomy was curative.
She had her endoscopy a few months ago.
It was an aggressive cancer that grew quickly.
The fact we took her stomach today... It saved your sister's life.
The reason Trish decides everything, Thanksgiving, dinners, vacations...
She's the only one left who knows how to cook a turkey, Mike.
She's the only one left who likes planning vacations, who ever remembers to make dinner reservations.
She's in charge of us because everyone else is dead.
I want it. Now.
I want the surgery right now.
Why is she coding when she seizes? It doesn't make sense.
Not this young. Her heart should be fine.
Beth coded before her seizure not during. I saw her heart go into v-fib.
She's 17 with no heart history, Karev. I saw it on the monitor.
You think you saw it on the monitor. Seizures are chaotic. Doctors panic...
I didn't panic. I know what I saw.
You suggesting I tell her parents she's been wrongly treated for six years?
We should run a cardiac workup with an EP study.
You want me to deliberately shock a perfectly healthy heart? Absolutely not!
Dr. Hunt? If right, it'd explain the coding.
If he's wrong, it will kill her! I'm not wrong!
Then it's your call, Karev.
Maybe Cristina's right.
Maybe trying to teach the interns is pointless.
Don't listen to Cristina. She thinks because you'd rather teach than take out a gallbladder, that you're the new me.
O'Malley the sequel. O'Malley 2.0.
You read more journals and do more research and log more hours in the skills lab than any other resident here.
You never give up trying to be a better doctor.
And you don't step on other people to do it.
I would be lucky to be the new you.
You gonna tell me about Patient X?
I know what we missed. I gotta go, George.
She had enlarged lymph nodes, but it's not mono.
What if we missed a malignancy in her brain?
You ruled that out with the CT. That was a mistake.
I'd like an MRl with contrast, maybe biopsy a lymph node.
Whatever's wrong, it's already in her brain.
[Cristina] Clamp's going in.
[Meredith] I don't feel any masses.
2- O vicryl please.
Sir, if I may one more time, I think stapling would be a better choice.
Dr. Bailey, you no longer wish to be a surgeon in this hospital.
So leave the technical calls up to me.
I was expressing my opinion what would be best for my patient.
You don't get an opinion! This is my patient because it's my hospital.
When it's your hospital you make decisions, but until then, this is my hospital and I want all of you people to do what I say!
2- O vicryl, please.
You're gonna be OK. You're in really good hands.
I'm going to ask you one more time, Karev.
Are you sure about this?
Then you're on crash cart.
If you're wrong...
...be ready to use it.
Your path report came back clear, there were no cancerous cells in your stomach. How's your pain?
The wound hurts a little... not too bad, right?
Don't you remember how much pain Mom was in at the end?
You used to help me wet her lips with an ice cube.
It was awful. She couldn't even drink.
She had so many tubes everywhere.
I don't remember. I was two years old when Mom died.
The only reason I know it was sad and horrible is because you tell me all the time.
I don't have nightmares about funerals.
I don't freak out and think it's cancer every time I have indigestion. You do.
Mike... This is your fear.
It's not mine.
So just let me decide when I'm scared.
Let's take the pace down to 300. Vitals are still stable.
This is pointless. The study is showing no sign of arrhythmia.
Wait. She's in v-tach. Let's pace her out of it at 330.
BP's down to 60 over 10. 340. Damn it.
Karev, get in there, now.
Wait, hold the shock.
She's coming out of it.
This could be ARVC. The right ventricle's causing arrhythmia.
The brain doesn't get oxygen. And she seizes. Oh, my God.
Karev, you just saved this girl's life.
It's OK. It's OK, just breathe.
Put the paddles down and breathe.
It's OK... it's OK.
Well, it wasn't easy.
Not only did I push through my hare lip reconstruction and a tympanoplasty, but I pulled out a burn graft so beautiful it could bring a man to tears.
You haven't heard from Shepherd, have you?
No, sir. I haven't.
Sir, I have tried to let it go, I know it's not personal, I understand it's very hard for you, I understand you're under a great deal of pressure, but the way you yelled at me in the OR, today, in front of my residents?
Not OK, sir. Not OK at all.
Now you and me, we're going to have to find a way to work together so you...
Not talking to me now?
That's just real mature, sir.
We have a diagnosis.
Go ahead, Dr. Grey.
Patient X. An elevated LDH was our only clue.
We found out she had enlarged lymph nodes and a mole, which was biopsied.
Meanwhile, this MRl with contrast showed a met on her right temporal lobe.
The biopsy revealed dividing cells.
That, coupled with further staging tests, led to our final diagnosis of metastatic melanoma with mets to the liver, skin, and brain.
Your prognosis? With chemo and radiation...
...a few months. At best. The girl's toast.
Survival rate's five percent.
If I were her I'd go on a really good vacation.
Good job, everybody.
The last contest, we got a prize. What's our prize?
You think every time you hand someone a death sentence there's a prize?
The prize is, you didn't screw it up this time.
The prize is, you people actually did something right.
The prize is, you were doctors today! You are doctors. That is the prize.
Adele, what are you doing here? Conference room, Richard. Now.
You too, Miranda. Let's go.
It's a pacemaker. It's gonna regulate your abnormal arrhythmias, so you won't have any more seizures.
So... I'm not sick anymore?
A wrestler fixed me.
Not exactly. You have a serious heart condition, we're gonna set you up with a cardiologist...
But no one has to know. I won't be frothing at the mouth, I don't have to wear a bracelet to school.
I can cover this with a shirt. Yeah. That's something.
It's everything. Once people see you as sick, they don't see anything else.
Mr. Bimm just called. We didn't get a trophy.
There's next season.
Yeah, we were thinking, maybe you should try out for choir or debate.
Something requiring less movement. We're just worried for your safety.
You don't have to be. We fixed her. Epileptic bone.
There's no such thing as an epileptic bone.
Are you a doctor?
So she's like... totally normal now?
Dude, none of you are normal. You're freaking band nerds.
[Adele] Of all the petty, ridiculous, infantile...
Are you running a hospital or a playground?
Adele, I will not be spoken to... Hospital or playground?!
Hospital. Then start acting like the chief of a hospital and apologize to that woman. Right now.
Sorry. You call that an apology!?
Now you better not leave this room until you work this out.
If I have to drag myself here through rush hour traffic again to police this damn jungle gym... Adele, you've made your point.
And you wipe that smile off your face. You're no better.
Tattling on a man to his wife.
When you have your stomach out, you can't eat sugar.
If he's doing this because he doesn't want to give up damn jelly beans...
It's more than that. Or football or girls or snowboarding, whatever, it doesn't matter.
Not compared to the alternative. We'll be as vigilant as we can.
Use every screening tool available. That won't be necessary.
Mikey's gonna have the surgery. Maybe not today, but I'm gonna be on him like glue, to my dying breath, until he does.
[Meredith] And if he just wants to be left alone?
You don't leave the people you love alone, Dr. Grey.
That idiot may not know it, but my fear is what's going to save his life.
[# Rachael Yamagata: Duet]
I learned a lot, diagnosing a patient from beginning to end.
So... thank you for teaching us.
What would you say?
To Patient X. How would you break the news?
I would say that I was very sorry and that there were support groups...
I don't know. What do you say to somebody who's going to...
You say they have a choice.
They can run away and hide from it, or they can face it.
You say to be around people who love them, it's gonna be the toughest fight of their life, no one should do it alone.
And then you give them the odds, and even though a five percent survival rate is bad, it's really bad, you say...
You say... [Lexie] Screw the odds.
People die of the hiccups.
My mother died of the hiccups.
Survival rate for that is, what, 100 percent?
The odds are that she should be alive right now.
The odds are that the odds mean crap.
So people should face it and they should fight.
Maybe not those words.
No... exactly those words.
Thank you, Dr. Grey.
How's she doing?
Uh, she's stable. Hmm.
You did a hell of a job.
The chief's gonna hear about it. Pretty impressive for a resident.
Fix that attitude, you could be the future of this hospital, the one to watch. You go, Karev!
Hunt's letting me do the distal anastomosis on his fem-pop.
That's awesome. It's crazy.
They told me I could be the future of this hospital, the resident to watch.
I mean, I'm not the kind of guy who...
I don't rise, OK? I sink to the bottom.
And now I'm getting all this... this respect.
And... And you... you gotta stop wasting your time with this Patient X crap.
Alex... I know you like teaching, but you need to start treating real patients with real surgeries because once they see you as weak, it's over, and Iz...
...you could be a great surgeon.
We could be great together.
You just, you gotta stop screwing around.
I don't wanna be the future of this hospital if you're not with me. OK?
You told Adele on me? You stopped speaking to me.
That didn't exactly leave me many options.
Would you have reacted like this if I left general surgery for neuro?
Or cardio? I don't follow.
Is it because you regard peds as a soft specialty, is that what's bothering you?
That's ridiculous. Maybe. But...
It seems that every time I do something you perceive as "soft," like having a baby, taking some time off to see my baby, specializing in babies... I'm dead to you.
Wanna know what I think? Not particularly.
I think you're scared that you've gone soft.
You blame this hospital's decline on it. Know what I think?
You're gonna tell me. It's not doing you one bit of good!
Surgeons are dropping like dominoes.
So, maybe it's time you got in touch with your feminine side.
Maybe you need a little soft.
You still shouldn't have ratted me out.
Sorry. Me, too.
What are you doing?
Assigning myself to trauma with you tomorrow.
I'm a big girl. I can handle my share of trauma.
And I get to decide when I've had enough.
It's gonna take a lot more than a bad dream to scare me off.
It is more than a bad dream.
[# Shady Bard: Treeology]
I know I have no business asking you for anything, but I need your help.
I need you to bring Derek back.
And he's not "fine."
Sometimes people just want to be left alone.
He's planning to propose.
He's been carrying around a big ring for weeks.
That's not a man who wants to be left alone.
I just thought you should know.
Yes, the odds are against us. I'm a one woman wrecking ball.
All I do is break you. Your hand, penis, relationships, your life...
I'd say our survival rate is about three percent. And that's bad.
But it's not nothing.
I don't think we should give up on this. Not yet...
You think you broke me, Little Grey?
You're the one who put me back together.
Mark. I've got a couple of Shepherd's post-ops to check in on, but after that, feel like a drink? How about a rain check, John?
So I've had quite a day. Got my ass handed to me by Alex Karev.
A second year resident. Which is humbling for a surgeon, especially a know-it-all... We don't have to do this, be friends.
It's a big hospital, lots of floors, lots of places to hide.
I'm perfectly OK with doing that for the next few years.
You're not hearing me, Calliope.
Sometimes I panic in the moment, I call it wrong.
I misjudge a situation.
So if you're up for it, I'd like to take you to dinner.
My schedule's kind of insane right now, so... I'll get back to you.
How's, uh, tomorrow?
[# Piers Faccini: A Storm Is Going To Come]
Good night, Iz. Night.
I've been keeping my distance 'cause you're with Alex.
I just want to let you know I'm still here. I still care.
And you don't want to talk about it?
OK. Good night. Night.
You don't like me very much, do you?
Uh... No. That's good.
It's good. Because I need to tell you something.
I need to tell you because I need to tell somebody and... you're a robot.
You can take it.
I can't tell you here. OK.
I can't... OK.
You cleaned all of your clothes out of the house.
Go home, Meredith. Just go home.
How long are you planning on hiding out here?
That's what you're doing. You're hiding.
You made a mistake, she's dead. You can't hide from that.
I'm not hiding, I'm done.
I'm done operating.
Oh, OK, so you're just quitting?
You should understand, you wrote the book on quitting, running, hiding... You've written a lot of books, Meredith.
That may be true, but I'm here now.
You're here now? [chuckles]
You wanted me out since I moved in. That is not true.
You are incapable of anything that resembles commitment.
You lied to me. You said you were healthier, you were healed.
There's no fixing you. You're a lemon.
Derek Shepherd, you are drunk.
And you're angry. And I've been there, so I get it.
That doesn't give you the right... Go home.
You don't get to... This is what you want, I'm giving you an out. Go!
I'm not going anywhere. I said leave! Meredith, leave!
I know there's a ring.
What? The chief told me.
I know there's a ring.
You want the ring?
Here's your ring.
[Meredith] Every surgeon has a shadow.
That the best you've got? I'm not bailing. We're in this together.
Go home, Meredith.
And the only way to get rid of a shadow...
...is to turn off the lights, to stop running from the darkness...
...and face what you fear...
[no audible dialogue]