Grey's Anatomy s06e07 Episode Script
Give Peace a Chance
[Derek.]
Ask most surgeons why they became surgeons and they usually tell you the same thing: It was for the high.
The rush.
The thrill that comes from cutting someone open and saving their life.
For me, it was different.
Take care of yourself.
Maybe because I grew up in a house with four sisters.
No, definitely because I grew up in a house with four sisters.
Because it was the quiet that drew me to surgery.
- How you doing? - Fine.
- Did Meredith say something to you? - She mentioned you're down about the merger, lack of a Cardio God.
Your wife is dead, as soon as her liver grows back.
Be glad she did.
That's why I put you on my service.
You need a God.
Neuro God, right here.
Godly? Your entire day consists of putting shunts in people.
- Today, temporal lobectomy.
- Hmm.
[Richard.]
our schedule for months now.
Hospitals across the country have reported substantial savings - How bad is it today? - The chief's implementing a computer model for scheduling our surgeries from now on.
Something about efficiency and progress.
to make sure this was the right decision, I have enlisted one of our own to do a trial run for the last month.
Dr.
Sloan? I know what you're all thinking.
"It's a machine.
It doesn't know me, doesn't know what I like.
" But after using this new system for the past month, I gotta say, people, I'm a convert.
This computer knows me better than I know me.
Chief, this thing's rearranged my schedule for the week.
I mean, haven't we had enough change here already? Change is good, everyone.
Embrace it.
You two need to stop bickering.
It's unattractive.
[Derek.]
The operating room is a quiet place.
Peaceful.
It has to be in order for us to stay alert, anticipate complications.
- Your ass is in my way.
- I was in the OR all night sewing a hang glider's intestines together.
I'm kinda sore.
- I kinda don't care.
Move.
- [Grunts.]
[Cristina.]
Hey.
I just got a call from Swender's office.
Izzie has an IL-2 treatment this week that she hasn't called back to confirm.
- And? - And she's your wife.
Who could die.
She'll show up.
She's a crappy wife, but she's not an idiot.
OK, well, it's Thursday at 10:00.
So you know.
Don't worry, being ditched by cancer wife won't change my mind.
You're still a douche.
[Derek.]
When you stand in the OR, your patient open on the table, all the world's noise, all the worry that it brings, disappears.
Dr.
Shepherd? Isaac, if you don't stop calling me Dr.
Shepherd, - I'm gonna have to cut you off.
- Right, forgot.
Derek.
- Thanks.
- I have the scans.
- I didn't order any.
- They're for consult.
- But I can come back if you're busy.
- No, it's OK.
[Derek.]
A calm settles over you time passing without thought.
For that moment, you feel completely at peace.
It's a tumor in the spinal cord.
Possibly a hemangioblastoma.
- You've seen them before? - Not this big.
You see how the tumor's worked its way up the spine? - It's taken over the blood supply.
- Hmm.
Perfect tumor.
Do you know if the patient has leg function? - Yes.
- Incredible.
He shouldn't be walking, should be paralyzed.
Dead.
You'd have to operate quickly to take the tumor out? I'd love to operate on this.
But no.
You'd have to cut the cord, paralyze the patient, to kill the tumor.
Who's the doctor on this one? - You.
- I'm sorry? These are my scans.
The tumor's mine.
I'd like you to take it out.
I'd like you to try.
One doctor said it was bad circulation, a pinched nerve.
When the pain started to interfere with work, - I decided to run an MRI on myself.
- Isaac, had I known this was your scan, - I wouldn't - I have been to every doctor, Derek.
Every time, it's the same thing.
They look at the tumor and they're defeated.
But not you.
You were inspired.
That's why I know I was right to come and work here.
- I needed to meet you.
- You got a job here to meet me? I have researched every neurosurgeon in this country.
I know their statistics, I know who wins the most prizes.
But I also know who takes the most risks.
That's you.
Isaac, I know you believe I can take this tumor out.
I wish I could.
- But this surgery will kill you.
- Take the scans, look them over.
But stop your mind before the part where it gets to "No.
" Think "yes," yes? Shepherd, I've been paging you.
Shunt patient, OR Two.
Screw the shunt, let's operate on that.
You know what this is about, right? You're no longer Daddy's favorite, so you've gone in search of a crazy-ass tumor to get his love back.
Actually, it's about my patient.
Haven't made up my mind yet.
I'm just looking.
- Isaac has a cord tumor? - It's awesome, look.
Awesome in a bad way.
It's eaten five levels of his spine.
Wait, you're not seriously considering trying to take it out? - Of course he is! He's Shepherd.
- It's a bad case of telephone, right? Isaac's got a bone spur or herniated disc not a He diagnosed an osteosarcoma case for me a month ago.
I thought it was a shadow, but it was a tiny lesion on an x-ray.
That says more about you than it does him.
I'm sorry.
Do you even know who Isaac is? - No idea.
- What's everyone? A spinal tumor? I read about a case at Mayo where the surgery took 17 hours.
The head surgeon had four rotating assistants, one of whom just administered fluids.
You know what, don't try to Lexopedia your way on this.
This is my tumor.
- What happened to the patient at Mayo? - He died.
- That's why it only took 17 hours.
- Isaac has an inoperable tumor? - It's Isaac's tumor? - OK, yeah, boo-hoo.
OK? - Who says it's inoperable? - Cristina.
Come on, it's all the way up to T2.
[Lexie.]
You need three or four assistants Why aren't you all at your surgeries? Go, get to your ORs.
Don't screw with my schedule on day one.
- I haven't made a decision.
- No rush.
I'm a patient man.
Everyone said you'd found the great white of tumors, - but I just had to see it for myself.
- And now that you have? You want my fellow attending answer or my fellow surgeon answer? - Fellow surgeon.
- [Scoffs.]
This tumor is dangerous, complicated, smart, beautiful.
This tumor is the reason I got into medicine in the first place.
To successfully take out this tumor would be an achievement you could hang your hat on for the rest of your career.
You could retire on this tumor.
I wouldn't go near it.
It's a beast.
It's a malpractice suit waiting to happen.
Even if we could get his insurance to cover it.
Did I mention he was an employee? Our pro bono budget can't cover high-risk surgeries for every employee.
- We're not a charity.
- What happened to you? - Excuse me? - There was a time you'd have convinced me to do this.
Now, your first instinct is no? - What happened to you? - You came to me as chief of surgery, and I said no.
As for my medical opinion, it is still no.
There is such a thing as an inoperable tumor.
- What if it's not? I get in there - There is no way! Anything other than cutting the cord would kill this man! How many times you want me to say it? You're not operating on an inoperable tumor! It's a tough job, Derek.
You sure you still want it? [Meredith.]
So what did you do? [Sighs.]
I scheduled the surgery.
I'm taking out the tumor.
Microsurgery is about precision.
The microscope changes perspective radically.
Hand-eye coordination can be learned, but right now, I need naturals.
Each one of you will get a chance to guide this pen through the hole in the cup, making a mark closest to the president's nose and doesn't hit the side of the cup gets to scrub in.
Who wants to go first? Take your time.
[Yawns.]
- [Taps.]
- [Derek.]
Oh, wow.
- [Steve.]
Do-over? - [Derek.]
No do-overs.
- Way to go, Two.
- [Derek.]
Concentrate, take your time.
Next.
Here you go.
Just take your time, we've got nothing but time.
No, next.
Somebody, please.
Well off the mark.
How'd you get into this program? - [Derek.]
Mr.
Confident.
- [Yawns grandly.]
[Groans.]
Next.
Next.
Next.
Next.
Next.
Disappointed.
So disappointed.
Ooh Here we go.
[Taps.]
Nicely done.
Somebody improves on that, I'll be out of a job.
Well, guess you might need to retire then.
OK.
- [Groans.]
- OK.
Dr.
Avery, you'll be scrubbing in.
[Woman.]
I'll check and see what they have available.
Word on the OR floor is that you've gone rogue.
I'm doing a surgery I fully believe in.
- To piss off the chief.
- When did Richard become your BFF? - He's not my BFF.
He's the chief.
- For now.
- You going rogue? - I'm doing a surgery I believe in.
Against the chief's orders.
He'll freak.
There's a computer schedule saying I'm doing craniotomies all day.
- He is not gonna find out.
- No.
Shh.
Don't say any more.
- 'Cause me, the chief, secrets - Hey, I think it is bad-ass.
Come on, let's go.
Should I be offended? I've been trying to come up with a good reason why you paged every resident to the skills lab but me, me, your sister.
- Your sister, Derek.
- You're on my service.
Little Grey, I didn't page you because I have another job for you.
You gave me the idea, actually.
I need somebody in the OR whose gonna remind me to take breaks.
Bend my legs, to drink water.
I will be your patient, essentially.
- You want me to be your doctor? - If Dr.
Sloan's OK with you - giving up his service, of course.
- You love me.
- This is a once in a lifetime tumor.
- Go get your rogue on.
You're nervous about being in there that long? - Me, too.
- What do you have to be nervous about? - Shepherd didn't even let you compete.
- No, that's because he needs me to maintain his care while we're in there.
- I'm his doctor, basically.
- Wow.
So you fell for that.
It sounds sounds more like you're his bitch.
What? No, I'm That is I'm not You're gonna need to take a break eventually.
And you're gonna need to stretch.
You're gonna need to pee.
And when you do, I'll be there to take over.
Yeah, I don't take breaks.
You seriously think you're gonna last all day in there? I've done it before.
Yeah.
But that's because I know to stop taking fluids before a long surgery.
Have fun playing nurse.
It sounds neat.
I don't know.
I think lzzie had it right.
Get fired, run away, die.
Mer, I'll call you back.
- Is that what I think it is? - What? No.
No, no.
No.
No! - Gimme - [sighs.]
- A diaper? - It's for the surgery.
Please don't tell anybody about this.
Genius.
You never have to leave the OR, you can hydrate all you want.
You're mocking me.
Fine.
Whatever.
- It's not like I was gonna use it.
- Of course you are.
This is the definition of hardcore.
You're like an astronaut.
This is surgery, NASA-style.
Put it on.
Right now.
I'll guard the door.
Anybody opens their mouth and they're fired.
You, too.
Dr.
Shepherd, I was just describing our new schedule to some of our board members.
This must be Mrs.
Taylor.
She's undergoing a craniotomy.
It's Mr.
Taylor, chief.
We're still working out a few kinks, clearly.
We should go.
Keep the trains running on time.
Nice meeting you all.
- Mm-hmm.
- Mm-hmm.
[Water running.]
Isaac, if I get in there and it looks too dangerous to remove, the responsible thing is to close you back up.
No, don't close me up.
If you get in, if it's too complicated, cut the cord.
Paralyze me if you must.
I survived a war.
Did you know that? I survived a war where they put bodies into mass graves where there's once a playground.
I survived the death of my family, my parents, my brothers and sisters.
Then I survived the death of my wife and child when they starved to death in a refugee camp.
I survived the loss of my country, of hearing my mother tongue spoken, of knowing what it feels like to have a place to call home.
I survived.
And I will survive the loss of my legs.
If I have to, I'll survive it.
OK? - But, Derek - Yes? There is always a way.
When things look like there's no way, there's a way.
To do the impossible.
To survive the unsurvivable.
There's always a way.
And you You and I have this in common.
We're inspired.
In the face of the impossible, we're inspired.
So if I can offer one piece of advice to the world's foremost neuro-surgeon today, if you become frightened, instead become inspired.
Mmm? OK, I'm ready now.
Put me to sleep.
[Woman.]
One hour, 13 minutes on the surgical clock.
The dura's opened.
Let's get our first look at the tumor.
[Jackson.]
Wow.
That's, um Wow.
[Derek.]
The vessels are more intricate than the MRI showed.
There's no way to get to the tumor out without rupturing one - and killing the cord.
- So what do we do? I think if we start at T-2, I could avoid hitting the feeding vessels, so maybe I should go in lower.
OK, there's less vascularity around T7, so that does seem better, no? It does seem better.
And he'd only get function loss below the chest.
I run the risk of rupturing the anterior spinal artery there.
- Probably.
The tumor tapers off there.
- Higher is better maybe? Either way I risk sending him into hemodynamic collapse - He's not talking to us, is he? - Not at all.
T2 shows less potential for bleeding, at T3 the vessels increased.
[Door shuts.]
- I'm sorry about the contest.
- Who told you about that? No one.
Well, I overheard people talking in the pit.
- It sounded hard.
- It wasn't hard.
It was a moment of You know what? We don't have to discuss it.
Watching Lexie in a diaper is punishment enough.
What? Lexie is wearing what? Well, that that is a reason you should be glad you're not down there.
No, that is the reason I want to be down there.
- What? - Lexie gets to pee in a diaper, - and I don't.
- You want to pee in a diaper? Oh, God.
No.
I want to have to pee in a diaper.
To be in a surgery so difficult and so long that my only option is to put on a diaper and pee in it.
Are they just gonna let him stare at that thing all day? He hasn't made a single cut.
If I clip the draining veins without getting the feeders, they'll burst Dr.
Shepherd, I really think it's time for you to take a break.
It's been over eight hours.
I could go into the tumor, here, but I might cut the artery.
- Dr.
Shepherd.
- Dude, if you need a break, take one.
I don't need one.
I'm hardcore.
- Are you wearing a diaper? - Shut up.
- At least bend your legs.
- You can't bring yourself to use it.
Shut up! Shut the hell up! I don't need a break.
If you do, take one.
Either of you open your mouths again, you're out of the OR.
Bathroom break! - Um, Dr.
Shepherd? - What? OK.
I'm sure this is a completely authorized surgery, but I thought you might like to know that the chief is scheduled to do a surgery across the hall in OR 3 shortly.
So if you're planning on doing something, anything, you might want to do it soon.
Thank you, Dr.
Bailey.
Stevens.
Izzie Stevens.
I know she's not at home.
You have to try her cell.
Fine, just No.
Tomorrow at 10:00.
Don't cancel it.
She'll be there.
- What? - You missed the contest this morning.
- The one you tanked? - Whatever.
Shepherd has assigned us to round on his cancelled craniotomies.
And, as much as I'd rather watch his super-secret surgery from the gallery, I can handle it myself if you wanna, you know, deal with your lzzie stuff.
I respected you more when you called her cancer wife.
At least it was honest.
- I'm trying to be human.
- You think if I'm not there you might get to do some big bad neuro and tell Shepherd you did it solo.
Which, by the way, makes you the douche.
You know what? I tried.
Go ahead, throw away your marriage.
- I will be rounding.
- I'll be rounding.
[Mark.]
This is why you don't go rogue.
Look at him.
He's cracked.
I coulda told you this was gonna happen.
Don't be smug.
This is one of our people's lives at stake.
This is so depressing.
Ten hours staring into a spine, he can't figure out what to do.
[Richard.]
What did you just say? What? No, I didn't Did I? [Richard.]
Robbins! Dr.
Shepherd.
Dr.
Shepherd, am I to understand that you cancelled your surgeries today to operate on a spinal cord tumor? Dr.
Shepherd! The rate of infection for this patient is increasing every second you keep him open, not to mention the thousands of dollars you're wasting standing here doing nothing.
So I am demanding that you close this man up.
Close him up and relinquish the OR.
Right now, Derek.
OK.
That's it.
Let's close him up.
[Beeps.]
No way of taking it out without risking your life.
And to cut the cord, at this point, I just won't do it.
You're still walking, Isaac.
Let's reassess in a few months.
I understand.
You worked hard today.
You're tired.
- I'm sorry.
- You'll try again tomorrow.
Tomorrow? No, I can't try again.
The tumor is inoperable.
I can't fix this.
Go home.
Sleep on it.
We'll talk more tomorrow.
[Chuckles.]
- I don't understand.
- There's nothing to understand.
I stood there for ten hours, staring.
In the OR? You stood for ten hours and did nothing? Yeah.
OK.
Let's talk about you now.
- How was your day? - My day? Oh, my day was You know, I slept and I ate an entire box of cereal.
I left three voicemails for lzzie.
I'm sure she won't return any of them.
I started and gave up on Anna Karenina for the 15th time.
- You want to talk about the tumor.
- I do.
Admit it, I'm a surgery junkie.
It was more vascular than the MRI showed.
But you were able to do the decompression? - Yes.
- But you weren't able to find - a plane to dissect? - No plane, nothing.
It was just - No path.
Nothing distinct.
- Why? Because it was just It You know what? What are you doing? Just watch and learn.
OK.
- The tumor is here.
- Now you've completely lost your mind.
T7 goes all the way up to T2.
- You're drawing on the wall! - I opened the posterior column, it's chaos.
I didn't know what vessel was connected to the tumor or to the cord.
So what I did was Start here and the anterior spinal artery could rupture cord could die.
Here, you risk catching the radicular artery under the tumor, - cord dies.
- But why not cut the draining veins, - at the top, expose the arteries.
- The draining veins are very thin.
You slip up, they burst.
He leaves my OR a quadriplegic.
- I might as well cut the cord.
- Which you didn't do.
- No.
- Even though Isaac said you could.
- You knew it would save his life.
- He still has function in his legs.
No, but what I mean is you didn't cut the cord.
You stood in the OR for ten hours.
You knew the chief would stop you.
Anybody else would have.
And you didn't.
So there must be a reason why.
[Indistinct murmuring.]
[Richard.]
This patient understands what cutting the cord means? The loss of function in both legs, and possibly more? We have to cut the cord to kill the tumor.
There's no other way.
[Sighs.]
OK.
That'll only take an hour or two.
You can have OR 1.
Hunt needs it right after, so you'll have enough time.
- [Derek.]
Thank you.
- Good luck.
- We're not cutting the cord.
- We're not? Mm-mm.
The mistake I made yesterday was that I wanted a plan.
There can be no plan.
I just have to pick a point and cut.
But what you said yesterday, if you cut an artery or hit the cord [sighs.]
Isaac wants us to take the risk.
He wants a cure.
And it's our job to try.
See you in the OR.
This is bad.
This is really, really bad.
Are you kidding? No one at Mercy West was this bad-ass.
This isn't bad-ass! This is You saw him yesterday.
He was spinning himself in circles, mumbling like some crazy psych patient.
And he was mean.
Well, he's your psych patient now.
Deal with it, diaper genie.
Hey, I wore a diaper yesterday, yes.
And I will wear one today.
If it helps get Dr.
Shepherd through this surgery, I will wear a diaper.
My diaper is awesome.
My diaper is hardcore.
You wish you had the balls to wear my diaper.
I'm gonna wear it, and I'm gonna wear it with pride.
And if I have to pee in it, oh, I'll pee.
Because I am a surgeon.
This is America.
And I will do what needs to be done.
So you can kiss my hardcore diaper-wearing ass.
You woke me from a nap.
This better be good.
Napping during the day? That's good.
You'll need the rest.
A redo retroperitoneal sarcoma? - That's like a 12-hour surgery.
- Fifteen, if things get ugly.
Go! Gear up! - Ah! Dr.
Hunt.
I need a favor.
- Yeah? [Breathing fast.]
Cristina - No.
No! - Shepherd needs the OR.
I put on a diaper.
OK.
I've gotten the plane.
Ready to make our first cut.
I heard you needed some support.
You need people to talk to.
Experienced surgeons.
You can't say no because I'm in charge, and this is what I'm prescribing.
Thank you, Dr.
Grey.
OK.
Let's start.
Making the first cut.
[Monitor beeping.]
- What, did you paralyze him? - [Derek.]
No.
One vessel down.
Settle in.
We have many more to go.
I still hear some wheezing.
Let's start you on another breathing treatment.
Dr.
Karev, can I see you for a minute? [Alex.]
I'm a little busy.
Dr.
Karev, it's important.
You need to go.
It's past ten.
You're checking your watch every five seconds.
You're distracted.
- Just go, I'll finish up here.
- Shut the hell up.
Alex, come here.
You don't know me.
Why are you all up in my face about this? Because there's a girl sitting down there on the third floor - waiting for her guy.
- She doesn't want to see me, OK? She bailed.
She didn't even tell me to my face.
She left a note.
So stop acting like you know anything about it and let me get back to my job! - OK? - If you're sure about that, then fine.
Don't go.
But you better be 100 percent sure she's not hoping you show up.
Because right now, you are making a choice.
You.
Not her.
So you better be at peace with that.
[Derek.]
I've cleared a path at T-5.
- If I continue along this plane - [monitor beeps rapidly.]
MEP losing amplitude.
What just happened? [Derek.]
Vessel burst, might be connected - If there's not enough blood - I could've paralyzed a patient.
Suction, please.
Suction.
- Oh, no.
- What? Cristina, what is it? Easy.
Careful! - More suction.
- [Jackson.]
Too much blood.
- We're losing him.
- I should've cut the cord.
- This is too risky.
- Wait, it's back.
- Amplitude's up.
- [Lexie.]
The cord didn't stroke out? - You didn't paralyze him? - Vessel was connected to the tumor.
- We're OK.
- [Sighs.]
- Nice work, Derek.
- Thanks.
- [Lexie.]
Dr.
Shepherd? - [Derek.]
Take off my mask.
- [Lexie.]
What? - Take off my mask.
Take off my mask! [Retches.]
Get in there.
Take a breath and get back in there.
- You can do this.
- You really should drink something.
- [Derek.]
I'm fine.
- You're not fine.
You're dehydrated and stressed.
Drink something.
- I said I'm fine.
- Drink the water.
I said drink it! [Door opens.]
- Dr.
Hunt? - Chief.
- Shouldn't you be in OR 1? - Yes, actually, but I swapped with Torres.
She has an emergency laparotomy.
- Dr.
Torres is doing a laparotomy? - What am I doing? What? I just heard my name.
- Chief - He didn't cut the cord.
- Bailey'll stop him at the door.
- She's in the OR with Shepherd.
Then who's at the door? Oh, my God.
- No.
Whoa - Move.
- No.
- Dr.
Robbins.
I said no.
Dr.
Shepherd is operating inside a man's spinal cord right now.
Even the most minor disturbance could cause him to make a mistake on that patient.
A patient who works here and whose life I would like to see Dr.
Shepherd save.
So no.
You don't get to go in there and be a bully.
Not today, chief.
Not on my watch.
OK, I totally thought that was gonna end different.
- [Sobs.]
- Yeah, more like that.
[Derek.]
Dr.
Bailey, care to fill us in? No, I would not.
Because anything outside of this OR is not your concern.
Your only concern is this patient.
Now, keep going.
[Ticking.]
- [Derek.]
Damn it.
- What is it? I can't tell which one of these vessels feeds the cord and which one feeds the tumor.
- I have to do a blind cut.
- Like a trip wire? I cut the wrong one, the entire cord strokes out.
- [Sighs.]
We'll come back to this later.
- Later? You could finish the surgery only to cut the wrong one? - This will have been for nothing? - Exactly.
Thanks for pointing that out.
[Clock ticking.]
- [Arizona.]
How many inches left? - Oh, less than two.
So if I do my math, we've got four to five more hours.
- [Jackson.]
Crap.
Oh, crap, oh, crap.
- [Derek.]
What is it? It's my hand.
It's cramping.
Dammit.
[Derek.]
Don't move.
Don't move - [monitor beeping rapidly.]
- BP's dropping! OK, we're touching the cord.
If we disturb it any more we run - Pulse is down to 52.
- It's getting worse, guys.
- [Derek.]
Easy, easy, easy, don't - OK.
It's OK.
Just stay still.
I'm gonna reach in.
Hey, close your eyes and breathe.
- OK? It's just a spasm.
- [Arizona.]
BP's back up 100 over 68.
Have you had anything to drink today, Dr.
Avery? What? Muscle cramps are a sign of dehydration.
You went without fluids so Dr.
Grey couldn't get her hands on the retractor, isn't that right? Yeah.
Sorry.
Sorry.
Don't apologize.
Just step aside.
Dr.
Grey, take over.
Easy.
- [Lexie.]
Good.
OK.
- [Derek.]
Easy.
Hmm.
A or B? Dr.
Grey? - A or B? - You're done? You got it all out? Except for the blind cut.
Just have to pick one and we're good to go.
A or B? - You're kidding.
- You're stalling.
Dr.
Avery? I don't like to gamble.
Dr.
Sloan? So you can blame it on me for the rest of your life? This is all you.
Right.
My call.
Great.
- He's deciding which one to cut.
- [Owen.]
Guessing which one.
- No logical way to make that call.
- I can't look.
I Oh, my God, Mer, this is so good.
Eeny, meeny, miney, moe, catch a tiger by its toe Are you playing Eeny Meeny Miney Moe? - [Chuckling.]
Yeah.
- [Lexie chuckling.]
No.
Yeah, yeah, yeah.
It's a bad idea? - [Chuckles.]
- [Derek.]
We'll see.
[Sighs.]
OK.
OK.
[Derek.]
Ask most surgeons why they became surgeons.
They usually tell you the same thing.
The high, the rush, the thrill of the cut.
For me, it was the quiet.
- Come on, Shepherd.
- Oh, my God.
Oh, my God.
Oh, my God! Please don't be wrong.
OK [gasps.]
He cut! He made the cut! Cristina, was it the right one? Cristina! Tell me! Cristina! Oh, no.
No.
Oh, no, no, no, no, no, no, no - No - Isaac, what is it? I can I can move my toes.
It didn't work, did it? - You couldn't do it.
- No, no.
We got the tumor.
It's gone.
- But I can move my toes.
- Because we saved the cord.
It was a successful surgery.
You're gonna be fine.
I knew you would try, but - I'm going to be OK? - Yes.
[Chuckling.]
I'm actually going to be OK? - Yes.
- [Chuckles.]
You're a good man, Derek.
You're a very good man.
[Derek.]
Peace isn't a permanent state.
It exists in moments.
Fleeting.
Gone before we even knew it was there.
Shepherd finished the surgery.
And I took care of all the pre-ops, so we're good to go.
She didn't show.
She can't be this stupid.
I mean, it saved her life.
The IL-2 saved her life.
And she didn't show up.
She [whimpering.]
She didn't show up.
[Sniffles.]
Who doesn't show up? [Derek.]
We can experience it at any time.
In a stranger's act of kindness.
- A task that requires complete focus.
- [Taps.]
[Owen.]
You're standing too close.
- No, I'm not.
- Yes, you are.
- I'll show you.
- You? Look at your hands.
They're hams.
Mine are tiny little geniuses.
It's not about the hands.
It's about the body.
You know, your stance.
Tilt your head.
Here.
Then - Your eye-line.
- Uh-huh.
You stand too close, you throw everything else off.
[Taps.]
Good.
Go again.
[Derek.]
Or simply the comfort of an old routine.
We can't keep doing this, Richard.
I'm tired of fighting you.
Let's try and put this behind us and move on.
I can, if you can.
You're fired.
Immediately.
Get the hell out of my hospital.
[Inhales, exhales.]
Go home.
Sleep on it.
We'll talk more tomorrow.
[Derek.]
Every day, we all experience these moments of peace.
The trick is to know when they're happening so that we can embrace them.
Live in them.
- [Laughs.]
- [Sighs.]
OK.
So I've heard almost everything from Cristina, but I want to hear your version.
So start from the beginning and tell me everything.
Derek? Derek? [Derek.]
And finally, let them go.
[Pops, fizzles.]
Ask most surgeons why they became surgeons and they usually tell you the same thing: It was for the high.
The rush.
The thrill that comes from cutting someone open and saving their life.
For me, it was different.
Take care of yourself.
Maybe because I grew up in a house with four sisters.
No, definitely because I grew up in a house with four sisters.
Because it was the quiet that drew me to surgery.
- How you doing? - Fine.
- Did Meredith say something to you? - She mentioned you're down about the merger, lack of a Cardio God.
Your wife is dead, as soon as her liver grows back.
Be glad she did.
That's why I put you on my service.
You need a God.
Neuro God, right here.
Godly? Your entire day consists of putting shunts in people.
- Today, temporal lobectomy.
- Hmm.
[Richard.]
our schedule for months now.
Hospitals across the country have reported substantial savings - How bad is it today? - The chief's implementing a computer model for scheduling our surgeries from now on.
Something about efficiency and progress.
to make sure this was the right decision, I have enlisted one of our own to do a trial run for the last month.
Dr.
Sloan? I know what you're all thinking.
"It's a machine.
It doesn't know me, doesn't know what I like.
" But after using this new system for the past month, I gotta say, people, I'm a convert.
This computer knows me better than I know me.
Chief, this thing's rearranged my schedule for the week.
I mean, haven't we had enough change here already? Change is good, everyone.
Embrace it.
You two need to stop bickering.
It's unattractive.
[Derek.]
The operating room is a quiet place.
Peaceful.
It has to be in order for us to stay alert, anticipate complications.
- Your ass is in my way.
- I was in the OR all night sewing a hang glider's intestines together.
I'm kinda sore.
- I kinda don't care.
Move.
- [Grunts.]
[Cristina.]
Hey.
I just got a call from Swender's office.
Izzie has an IL-2 treatment this week that she hasn't called back to confirm.
- And? - And she's your wife.
Who could die.
She'll show up.
She's a crappy wife, but she's not an idiot.
OK, well, it's Thursday at 10:00.
So you know.
Don't worry, being ditched by cancer wife won't change my mind.
You're still a douche.
[Derek.]
When you stand in the OR, your patient open on the table, all the world's noise, all the worry that it brings, disappears.
Dr.
Shepherd? Isaac, if you don't stop calling me Dr.
Shepherd, - I'm gonna have to cut you off.
- Right, forgot.
Derek.
- Thanks.
- I have the scans.
- I didn't order any.
- They're for consult.
- But I can come back if you're busy.
- No, it's OK.
[Derek.]
A calm settles over you time passing without thought.
For that moment, you feel completely at peace.
It's a tumor in the spinal cord.
Possibly a hemangioblastoma.
- You've seen them before? - Not this big.
You see how the tumor's worked its way up the spine? - It's taken over the blood supply.
- Hmm.
Perfect tumor.
Do you know if the patient has leg function? - Yes.
- Incredible.
He shouldn't be walking, should be paralyzed.
Dead.
You'd have to operate quickly to take the tumor out? I'd love to operate on this.
But no.
You'd have to cut the cord, paralyze the patient, to kill the tumor.
Who's the doctor on this one? - You.
- I'm sorry? These are my scans.
The tumor's mine.
I'd like you to take it out.
I'd like you to try.
One doctor said it was bad circulation, a pinched nerve.
When the pain started to interfere with work, - I decided to run an MRI on myself.
- Isaac, had I known this was your scan, - I wouldn't - I have been to every doctor, Derek.
Every time, it's the same thing.
They look at the tumor and they're defeated.
But not you.
You were inspired.
That's why I know I was right to come and work here.
- I needed to meet you.
- You got a job here to meet me? I have researched every neurosurgeon in this country.
I know their statistics, I know who wins the most prizes.
But I also know who takes the most risks.
That's you.
Isaac, I know you believe I can take this tumor out.
I wish I could.
- But this surgery will kill you.
- Take the scans, look them over.
But stop your mind before the part where it gets to "No.
" Think "yes," yes? Shepherd, I've been paging you.
Shunt patient, OR Two.
Screw the shunt, let's operate on that.
You know what this is about, right? You're no longer Daddy's favorite, so you've gone in search of a crazy-ass tumor to get his love back.
Actually, it's about my patient.
Haven't made up my mind yet.
I'm just looking.
- Isaac has a cord tumor? - It's awesome, look.
Awesome in a bad way.
It's eaten five levels of his spine.
Wait, you're not seriously considering trying to take it out? - Of course he is! He's Shepherd.
- It's a bad case of telephone, right? Isaac's got a bone spur or herniated disc not a He diagnosed an osteosarcoma case for me a month ago.
I thought it was a shadow, but it was a tiny lesion on an x-ray.
That says more about you than it does him.
I'm sorry.
Do you even know who Isaac is? - No idea.
- What's everyone? A spinal tumor? I read about a case at Mayo where the surgery took 17 hours.
The head surgeon had four rotating assistants, one of whom just administered fluids.
You know what, don't try to Lexopedia your way on this.
This is my tumor.
- What happened to the patient at Mayo? - He died.
- That's why it only took 17 hours.
- Isaac has an inoperable tumor? - It's Isaac's tumor? - OK, yeah, boo-hoo.
OK? - Who says it's inoperable? - Cristina.
Come on, it's all the way up to T2.
[Lexie.]
You need three or four assistants Why aren't you all at your surgeries? Go, get to your ORs.
Don't screw with my schedule on day one.
- I haven't made a decision.
- No rush.
I'm a patient man.
Everyone said you'd found the great white of tumors, - but I just had to see it for myself.
- And now that you have? You want my fellow attending answer or my fellow surgeon answer? - Fellow surgeon.
- [Scoffs.]
This tumor is dangerous, complicated, smart, beautiful.
This tumor is the reason I got into medicine in the first place.
To successfully take out this tumor would be an achievement you could hang your hat on for the rest of your career.
You could retire on this tumor.
I wouldn't go near it.
It's a beast.
It's a malpractice suit waiting to happen.
Even if we could get his insurance to cover it.
Did I mention he was an employee? Our pro bono budget can't cover high-risk surgeries for every employee.
- We're not a charity.
- What happened to you? - Excuse me? - There was a time you'd have convinced me to do this.
Now, your first instinct is no? - What happened to you? - You came to me as chief of surgery, and I said no.
As for my medical opinion, it is still no.
There is such a thing as an inoperable tumor.
- What if it's not? I get in there - There is no way! Anything other than cutting the cord would kill this man! How many times you want me to say it? You're not operating on an inoperable tumor! It's a tough job, Derek.
You sure you still want it? [Meredith.]
So what did you do? [Sighs.]
I scheduled the surgery.
I'm taking out the tumor.
Microsurgery is about precision.
The microscope changes perspective radically.
Hand-eye coordination can be learned, but right now, I need naturals.
Each one of you will get a chance to guide this pen through the hole in the cup, making a mark closest to the president's nose and doesn't hit the side of the cup gets to scrub in.
Who wants to go first? Take your time.
[Yawns.]
- [Taps.]
- [Derek.]
Oh, wow.
- [Steve.]
Do-over? - [Derek.]
No do-overs.
- Way to go, Two.
- [Derek.]
Concentrate, take your time.
Next.
Here you go.
Just take your time, we've got nothing but time.
No, next.
Somebody, please.
Well off the mark.
How'd you get into this program? - [Derek.]
Mr.
Confident.
- [Yawns grandly.]
[Groans.]
Next.
Next.
Next.
Next.
Next.
Disappointed.
So disappointed.
Ooh Here we go.
[Taps.]
Nicely done.
Somebody improves on that, I'll be out of a job.
Well, guess you might need to retire then.
OK.
- [Groans.]
- OK.
Dr.
Avery, you'll be scrubbing in.
[Woman.]
I'll check and see what they have available.
Word on the OR floor is that you've gone rogue.
I'm doing a surgery I fully believe in.
- To piss off the chief.
- When did Richard become your BFF? - He's not my BFF.
He's the chief.
- For now.
- You going rogue? - I'm doing a surgery I believe in.
Against the chief's orders.
He'll freak.
There's a computer schedule saying I'm doing craniotomies all day.
- He is not gonna find out.
- No.
Shh.
Don't say any more.
- 'Cause me, the chief, secrets - Hey, I think it is bad-ass.
Come on, let's go.
Should I be offended? I've been trying to come up with a good reason why you paged every resident to the skills lab but me, me, your sister.
- Your sister, Derek.
- You're on my service.
Little Grey, I didn't page you because I have another job for you.
You gave me the idea, actually.
I need somebody in the OR whose gonna remind me to take breaks.
Bend my legs, to drink water.
I will be your patient, essentially.
- You want me to be your doctor? - If Dr.
Sloan's OK with you - giving up his service, of course.
- You love me.
- This is a once in a lifetime tumor.
- Go get your rogue on.
You're nervous about being in there that long? - Me, too.
- What do you have to be nervous about? - Shepherd didn't even let you compete.
- No, that's because he needs me to maintain his care while we're in there.
- I'm his doctor, basically.
- Wow.
So you fell for that.
It sounds sounds more like you're his bitch.
What? No, I'm That is I'm not You're gonna need to take a break eventually.
And you're gonna need to stretch.
You're gonna need to pee.
And when you do, I'll be there to take over.
Yeah, I don't take breaks.
You seriously think you're gonna last all day in there? I've done it before.
Yeah.
But that's because I know to stop taking fluids before a long surgery.
Have fun playing nurse.
It sounds neat.
I don't know.
I think lzzie had it right.
Get fired, run away, die.
Mer, I'll call you back.
- Is that what I think it is? - What? No.
No, no.
No.
No! - Gimme - [sighs.]
- A diaper? - It's for the surgery.
Please don't tell anybody about this.
Genius.
You never have to leave the OR, you can hydrate all you want.
You're mocking me.
Fine.
Whatever.
- It's not like I was gonna use it.
- Of course you are.
This is the definition of hardcore.
You're like an astronaut.
This is surgery, NASA-style.
Put it on.
Right now.
I'll guard the door.
Anybody opens their mouth and they're fired.
You, too.
Dr.
Shepherd, I was just describing our new schedule to some of our board members.
This must be Mrs.
Taylor.
She's undergoing a craniotomy.
It's Mr.
Taylor, chief.
We're still working out a few kinks, clearly.
We should go.
Keep the trains running on time.
Nice meeting you all.
- Mm-hmm.
- Mm-hmm.
[Water running.]
Isaac, if I get in there and it looks too dangerous to remove, the responsible thing is to close you back up.
No, don't close me up.
If you get in, if it's too complicated, cut the cord.
Paralyze me if you must.
I survived a war.
Did you know that? I survived a war where they put bodies into mass graves where there's once a playground.
I survived the death of my family, my parents, my brothers and sisters.
Then I survived the death of my wife and child when they starved to death in a refugee camp.
I survived the loss of my country, of hearing my mother tongue spoken, of knowing what it feels like to have a place to call home.
I survived.
And I will survive the loss of my legs.
If I have to, I'll survive it.
OK? - But, Derek - Yes? There is always a way.
When things look like there's no way, there's a way.
To do the impossible.
To survive the unsurvivable.
There's always a way.
And you You and I have this in common.
We're inspired.
In the face of the impossible, we're inspired.
So if I can offer one piece of advice to the world's foremost neuro-surgeon today, if you become frightened, instead become inspired.
Mmm? OK, I'm ready now.
Put me to sleep.
[Woman.]
One hour, 13 minutes on the surgical clock.
The dura's opened.
Let's get our first look at the tumor.
[Jackson.]
Wow.
That's, um Wow.
[Derek.]
The vessels are more intricate than the MRI showed.
There's no way to get to the tumor out without rupturing one - and killing the cord.
- So what do we do? I think if we start at T-2, I could avoid hitting the feeding vessels, so maybe I should go in lower.
OK, there's less vascularity around T7, so that does seem better, no? It does seem better.
And he'd only get function loss below the chest.
I run the risk of rupturing the anterior spinal artery there.
- Probably.
The tumor tapers off there.
- Higher is better maybe? Either way I risk sending him into hemodynamic collapse - He's not talking to us, is he? - Not at all.
T2 shows less potential for bleeding, at T3 the vessels increased.
[Door shuts.]
- I'm sorry about the contest.
- Who told you about that? No one.
Well, I overheard people talking in the pit.
- It sounded hard.
- It wasn't hard.
It was a moment of You know what? We don't have to discuss it.
Watching Lexie in a diaper is punishment enough.
What? Lexie is wearing what? Well, that that is a reason you should be glad you're not down there.
No, that is the reason I want to be down there.
- What? - Lexie gets to pee in a diaper, - and I don't.
- You want to pee in a diaper? Oh, God.
No.
I want to have to pee in a diaper.
To be in a surgery so difficult and so long that my only option is to put on a diaper and pee in it.
Are they just gonna let him stare at that thing all day? He hasn't made a single cut.
If I clip the draining veins without getting the feeders, they'll burst Dr.
Shepherd, I really think it's time for you to take a break.
It's been over eight hours.
I could go into the tumor, here, but I might cut the artery.
- Dr.
Shepherd.
- Dude, if you need a break, take one.
I don't need one.
I'm hardcore.
- Are you wearing a diaper? - Shut up.
- At least bend your legs.
- You can't bring yourself to use it.
Shut up! Shut the hell up! I don't need a break.
If you do, take one.
Either of you open your mouths again, you're out of the OR.
Bathroom break! - Um, Dr.
Shepherd? - What? OK.
I'm sure this is a completely authorized surgery, but I thought you might like to know that the chief is scheduled to do a surgery across the hall in OR 3 shortly.
So if you're planning on doing something, anything, you might want to do it soon.
Thank you, Dr.
Bailey.
Stevens.
Izzie Stevens.
I know she's not at home.
You have to try her cell.
Fine, just No.
Tomorrow at 10:00.
Don't cancel it.
She'll be there.
- What? - You missed the contest this morning.
- The one you tanked? - Whatever.
Shepherd has assigned us to round on his cancelled craniotomies.
And, as much as I'd rather watch his super-secret surgery from the gallery, I can handle it myself if you wanna, you know, deal with your lzzie stuff.
I respected you more when you called her cancer wife.
At least it was honest.
- I'm trying to be human.
- You think if I'm not there you might get to do some big bad neuro and tell Shepherd you did it solo.
Which, by the way, makes you the douche.
You know what? I tried.
Go ahead, throw away your marriage.
- I will be rounding.
- I'll be rounding.
[Mark.]
This is why you don't go rogue.
Look at him.
He's cracked.
I coulda told you this was gonna happen.
Don't be smug.
This is one of our people's lives at stake.
This is so depressing.
Ten hours staring into a spine, he can't figure out what to do.
[Richard.]
What did you just say? What? No, I didn't Did I? [Richard.]
Robbins! Dr.
Shepherd.
Dr.
Shepherd, am I to understand that you cancelled your surgeries today to operate on a spinal cord tumor? Dr.
Shepherd! The rate of infection for this patient is increasing every second you keep him open, not to mention the thousands of dollars you're wasting standing here doing nothing.
So I am demanding that you close this man up.
Close him up and relinquish the OR.
Right now, Derek.
OK.
That's it.
Let's close him up.
[Beeps.]
No way of taking it out without risking your life.
And to cut the cord, at this point, I just won't do it.
You're still walking, Isaac.
Let's reassess in a few months.
I understand.
You worked hard today.
You're tired.
- I'm sorry.
- You'll try again tomorrow.
Tomorrow? No, I can't try again.
The tumor is inoperable.
I can't fix this.
Go home.
Sleep on it.
We'll talk more tomorrow.
[Chuckles.]
- I don't understand.
- There's nothing to understand.
I stood there for ten hours, staring.
In the OR? You stood for ten hours and did nothing? Yeah.
OK.
Let's talk about you now.
- How was your day? - My day? Oh, my day was You know, I slept and I ate an entire box of cereal.
I left three voicemails for lzzie.
I'm sure she won't return any of them.
I started and gave up on Anna Karenina for the 15th time.
- You want to talk about the tumor.
- I do.
Admit it, I'm a surgery junkie.
It was more vascular than the MRI showed.
But you were able to do the decompression? - Yes.
- But you weren't able to find - a plane to dissect? - No plane, nothing.
It was just - No path.
Nothing distinct.
- Why? Because it was just It You know what? What are you doing? Just watch and learn.
OK.
- The tumor is here.
- Now you've completely lost your mind.
T7 goes all the way up to T2.
- You're drawing on the wall! - I opened the posterior column, it's chaos.
I didn't know what vessel was connected to the tumor or to the cord.
So what I did was Start here and the anterior spinal artery could rupture cord could die.
Here, you risk catching the radicular artery under the tumor, - cord dies.
- But why not cut the draining veins, - at the top, expose the arteries.
- The draining veins are very thin.
You slip up, they burst.
He leaves my OR a quadriplegic.
- I might as well cut the cord.
- Which you didn't do.
- No.
- Even though Isaac said you could.
- You knew it would save his life.
- He still has function in his legs.
No, but what I mean is you didn't cut the cord.
You stood in the OR for ten hours.
You knew the chief would stop you.
Anybody else would have.
And you didn't.
So there must be a reason why.
[Indistinct murmuring.]
[Richard.]
This patient understands what cutting the cord means? The loss of function in both legs, and possibly more? We have to cut the cord to kill the tumor.
There's no other way.
[Sighs.]
OK.
That'll only take an hour or two.
You can have OR 1.
Hunt needs it right after, so you'll have enough time.
- [Derek.]
Thank you.
- Good luck.
- We're not cutting the cord.
- We're not? Mm-mm.
The mistake I made yesterday was that I wanted a plan.
There can be no plan.
I just have to pick a point and cut.
But what you said yesterday, if you cut an artery or hit the cord [sighs.]
Isaac wants us to take the risk.
He wants a cure.
And it's our job to try.
See you in the OR.
This is bad.
This is really, really bad.
Are you kidding? No one at Mercy West was this bad-ass.
This isn't bad-ass! This is You saw him yesterday.
He was spinning himself in circles, mumbling like some crazy psych patient.
And he was mean.
Well, he's your psych patient now.
Deal with it, diaper genie.
Hey, I wore a diaper yesterday, yes.
And I will wear one today.
If it helps get Dr.
Shepherd through this surgery, I will wear a diaper.
My diaper is awesome.
My diaper is hardcore.
You wish you had the balls to wear my diaper.
I'm gonna wear it, and I'm gonna wear it with pride.
And if I have to pee in it, oh, I'll pee.
Because I am a surgeon.
This is America.
And I will do what needs to be done.
So you can kiss my hardcore diaper-wearing ass.
You woke me from a nap.
This better be good.
Napping during the day? That's good.
You'll need the rest.
A redo retroperitoneal sarcoma? - That's like a 12-hour surgery.
- Fifteen, if things get ugly.
Go! Gear up! - Ah! Dr.
Hunt.
I need a favor.
- Yeah? [Breathing fast.]
Cristina - No.
No! - Shepherd needs the OR.
I put on a diaper.
OK.
I've gotten the plane.
Ready to make our first cut.
I heard you needed some support.
You need people to talk to.
Experienced surgeons.
You can't say no because I'm in charge, and this is what I'm prescribing.
Thank you, Dr.
Grey.
OK.
Let's start.
Making the first cut.
[Monitor beeping.]
- What, did you paralyze him? - [Derek.]
No.
One vessel down.
Settle in.
We have many more to go.
I still hear some wheezing.
Let's start you on another breathing treatment.
Dr.
Karev, can I see you for a minute? [Alex.]
I'm a little busy.
Dr.
Karev, it's important.
You need to go.
It's past ten.
You're checking your watch every five seconds.
You're distracted.
- Just go, I'll finish up here.
- Shut the hell up.
Alex, come here.
You don't know me.
Why are you all up in my face about this? Because there's a girl sitting down there on the third floor - waiting for her guy.
- She doesn't want to see me, OK? She bailed.
She didn't even tell me to my face.
She left a note.
So stop acting like you know anything about it and let me get back to my job! - OK? - If you're sure about that, then fine.
Don't go.
But you better be 100 percent sure she's not hoping you show up.
Because right now, you are making a choice.
You.
Not her.
So you better be at peace with that.
[Derek.]
I've cleared a path at T-5.
- If I continue along this plane - [monitor beeps rapidly.]
MEP losing amplitude.
What just happened? [Derek.]
Vessel burst, might be connected - If there's not enough blood - I could've paralyzed a patient.
Suction, please.
Suction.
- Oh, no.
- What? Cristina, what is it? Easy.
Careful! - More suction.
- [Jackson.]
Too much blood.
- We're losing him.
- I should've cut the cord.
- This is too risky.
- Wait, it's back.
- Amplitude's up.
- [Lexie.]
The cord didn't stroke out? - You didn't paralyze him? - Vessel was connected to the tumor.
- We're OK.
- [Sighs.]
- Nice work, Derek.
- Thanks.
- [Lexie.]
Dr.
Shepherd? - [Derek.]
Take off my mask.
- [Lexie.]
What? - Take off my mask.
Take off my mask! [Retches.]
Get in there.
Take a breath and get back in there.
- You can do this.
- You really should drink something.
- [Derek.]
I'm fine.
- You're not fine.
You're dehydrated and stressed.
Drink something.
- I said I'm fine.
- Drink the water.
I said drink it! [Door opens.]
- Dr.
Hunt? - Chief.
- Shouldn't you be in OR 1? - Yes, actually, but I swapped with Torres.
She has an emergency laparotomy.
- Dr.
Torres is doing a laparotomy? - What am I doing? What? I just heard my name.
- Chief - He didn't cut the cord.
- Bailey'll stop him at the door.
- She's in the OR with Shepherd.
Then who's at the door? Oh, my God.
- No.
Whoa - Move.
- No.
- Dr.
Robbins.
I said no.
Dr.
Shepherd is operating inside a man's spinal cord right now.
Even the most minor disturbance could cause him to make a mistake on that patient.
A patient who works here and whose life I would like to see Dr.
Shepherd save.
So no.
You don't get to go in there and be a bully.
Not today, chief.
Not on my watch.
OK, I totally thought that was gonna end different.
- [Sobs.]
- Yeah, more like that.
[Derek.]
Dr.
Bailey, care to fill us in? No, I would not.
Because anything outside of this OR is not your concern.
Your only concern is this patient.
Now, keep going.
[Ticking.]
- [Derek.]
Damn it.
- What is it? I can't tell which one of these vessels feeds the cord and which one feeds the tumor.
- I have to do a blind cut.
- Like a trip wire? I cut the wrong one, the entire cord strokes out.
- [Sighs.]
We'll come back to this later.
- Later? You could finish the surgery only to cut the wrong one? - This will have been for nothing? - Exactly.
Thanks for pointing that out.
[Clock ticking.]
- [Arizona.]
How many inches left? - Oh, less than two.
So if I do my math, we've got four to five more hours.
- [Jackson.]
Crap.
Oh, crap, oh, crap.
- [Derek.]
What is it? It's my hand.
It's cramping.
Dammit.
[Derek.]
Don't move.
Don't move - [monitor beeping rapidly.]
- BP's dropping! OK, we're touching the cord.
If we disturb it any more we run - Pulse is down to 52.
- It's getting worse, guys.
- [Derek.]
Easy, easy, easy, don't - OK.
It's OK.
Just stay still.
I'm gonna reach in.
Hey, close your eyes and breathe.
- OK? It's just a spasm.
- [Arizona.]
BP's back up 100 over 68.
Have you had anything to drink today, Dr.
Avery? What? Muscle cramps are a sign of dehydration.
You went without fluids so Dr.
Grey couldn't get her hands on the retractor, isn't that right? Yeah.
Sorry.
Sorry.
Don't apologize.
Just step aside.
Dr.
Grey, take over.
Easy.
- [Lexie.]
Good.
OK.
- [Derek.]
Easy.
Hmm.
A or B? Dr.
Grey? - A or B? - You're done? You got it all out? Except for the blind cut.
Just have to pick one and we're good to go.
A or B? - You're kidding.
- You're stalling.
Dr.
Avery? I don't like to gamble.
Dr.
Sloan? So you can blame it on me for the rest of your life? This is all you.
Right.
My call.
Great.
- He's deciding which one to cut.
- [Owen.]
Guessing which one.
- No logical way to make that call.
- I can't look.
I Oh, my God, Mer, this is so good.
Eeny, meeny, miney, moe, catch a tiger by its toe Are you playing Eeny Meeny Miney Moe? - [Chuckling.]
Yeah.
- [Lexie chuckling.]
No.
Yeah, yeah, yeah.
It's a bad idea? - [Chuckles.]
- [Derek.]
We'll see.
[Sighs.]
OK.
OK.
[Derek.]
Ask most surgeons why they became surgeons.
They usually tell you the same thing.
The high, the rush, the thrill of the cut.
For me, it was the quiet.
- Come on, Shepherd.
- Oh, my God.
Oh, my God.
Oh, my God! Please don't be wrong.
OK [gasps.]
He cut! He made the cut! Cristina, was it the right one? Cristina! Tell me! Cristina! Oh, no.
No.
Oh, no, no, no, no, no, no, no - No - Isaac, what is it? I can I can move my toes.
It didn't work, did it? - You couldn't do it.
- No, no.
We got the tumor.
It's gone.
- But I can move my toes.
- Because we saved the cord.
It was a successful surgery.
You're gonna be fine.
I knew you would try, but - I'm going to be OK? - Yes.
[Chuckling.]
I'm actually going to be OK? - Yes.
- [Chuckles.]
You're a good man, Derek.
You're a very good man.
[Derek.]
Peace isn't a permanent state.
It exists in moments.
Fleeting.
Gone before we even knew it was there.
Shepherd finished the surgery.
And I took care of all the pre-ops, so we're good to go.
She didn't show.
She can't be this stupid.
I mean, it saved her life.
The IL-2 saved her life.
And she didn't show up.
She [whimpering.]
She didn't show up.
[Sniffles.]
Who doesn't show up? [Derek.]
We can experience it at any time.
In a stranger's act of kindness.
- A task that requires complete focus.
- [Taps.]
[Owen.]
You're standing too close.
- No, I'm not.
- Yes, you are.
- I'll show you.
- You? Look at your hands.
They're hams.
Mine are tiny little geniuses.
It's not about the hands.
It's about the body.
You know, your stance.
Tilt your head.
Here.
Then - Your eye-line.
- Uh-huh.
You stand too close, you throw everything else off.
[Taps.]
Good.
Go again.
[Derek.]
Or simply the comfort of an old routine.
We can't keep doing this, Richard.
I'm tired of fighting you.
Let's try and put this behind us and move on.
I can, if you can.
You're fired.
Immediately.
Get the hell out of my hospital.
[Inhales, exhales.]
Go home.
Sleep on it.
We'll talk more tomorrow.
[Derek.]
Every day, we all experience these moments of peace.
The trick is to know when they're happening so that we can embrace them.
Live in them.
- [Laughs.]
- [Sighs.]
OK.
So I've heard almost everything from Cristina, but I want to hear your version.
So start from the beginning and tell me everything.
Derek? Derek? [Derek.]
And finally, let them go.
[Pops, fizzles.]