Grey's Anatomy s06e18 Episode Script

[Down-tempo music plays.]
[Exhales.]
[Owen.]
Dying isn't easy.
The body was designed to stay alive.
Thick skulls strong hearts keen senses.
[Alarm beeping.]
- [Groaning.]
- Morning.
Morning.
[Groans.]
[Owen.]
When the body starts to fail medicine takes over.
Morning.
Kim, Sean.
How're you feeling? Ready.
Today's the day.
How are you doing? OK.
[Owen.]
Surgeons are arrogant enough to think there's no one we can't save.
- You need a consult? - Kim Allan.
She has stage-four large cell lung cancer.
I removed a second mass from her right lung about two months ago, but tests show the cancer had spread to her lymph nodes and to her liver.
She was readmitted last week with pulmonary edema.
I drained as much fluid as I could, but she's having a tough time breathing.
That's too bad.
You gonna have to intubate her? - She doesn't want that.
- You have to treat her palliatively.
I don't see what else we can do for her.
- She wants us to help her die.
- [Owen.]
Like I said, dying isn't easy.
Since the state requires two physicians' signatures, I've asked Dr.
Hunt to look over your chart.
OK.
Her prognosis says that she has less than six months to live.
I have informed her of her treatment options.
She has met with a psychologist who has determined that she is mentally fit.
And this can serve as her second oral request.
OK.
[gasping.]
You have to say it.
Washington State says I have to hear you ask two times at least 15 days apart.
It's so weird.
It's like I'm applying to die.
- If you're having second thoughts - You saw how bad it got last night.
It's just gonna get worse.
[Exhaling.]
I would like to end my life through physician-assisted suicide.
Excuse me, um I'm just gonna go see what's up.
[Kim.]
Dr.
Altman? How long does it take? To die? Once I take the barbiturates.
Can we not talk about this? It's just, um We're not there yet.
We are there, Sean.
[Exhaling.]
We are.
[Teddy.]
Kim, to answer your question about 45 minutes.
It takes about 45 minutes to die.
Three dates.
No sex.
Just talking.
Do you have any idea how much you can learn about someone if you remain upright? I bet you didn't know Teddy hates the word "moist.
" Hates it.
Would really prefer people say "damp.
" You hear me? I'm growing again.
I'm, like, grown.
[Arizona.]
She's making cartilage from scratch.
She's preoccupied these days.
It's super hot.
- I'm gonna be late.
- Bye.
[Groans.]
She doesn't want kids.
Arizona doesn't want kids.
In her womb, in her house.
Ever.
- She told me.
- What did you say? Nothing.
We're doing so great.
I don't want to ruin it by being the crazy desperate girl with the aching womb.
Better than being the crazy childless woman who sits at the playground watching the children play.
They have laws for people like that.
You gotta tell her.
[Moans.]
So in the third quarter of the collection, rate of Medicaid was what percent again? Hey.
Would you excuse me one second? OK.
You have 30 seconds.
OK.
So this woman comes into the ER with abdominal pain.
She's had it on and off for about six months, and a lot of doctors have told her it's either an ulcer or gastritis.
Get to the point.
You have 15 seconds.
So it occurs to me that the nausea is probably caused - by a positional shift - CSF.
Brain tumor.
Got it.
Not just any brain tumor.
She's got this huge, beautiful ependymoma.
- So Shadow Shepherd - Dr.
Nelson.
OK, Shadow Shepherd is going to do intraventricular resection and let me assist.
And I may even get to debulk the tumor.
That's it? OK, sorry for the interruption.
So where were we? Percentage third quarter Medicaid.
What was the rate of return? - How close? - Two minutes.
- It's Nicole, right? - Three guys waiting on an ambulance? - Must be Nicole behind the wheel.
- Have you seen her ass? Man, I'd love to hit that.
- [Avery.]
Morning, chief.
- Sorry about that, chief.
It's quite all right.
And I am not the chief.
[Siren approaching.]
- [Mark.]
Hey, Nicole! - Hey.
Nick Kelsey, 32, injured skiing off a helicopter.
- Vital signs are stable.
- Wasn't the helicopter that did it.
- It was the avalanche.
- Idiotic either way.
He's got two idiot friends coming in behind him but he's got the worst of it.
Open fracture to the left tibia and left hip fracture.
What are you looking at, chachi? What happened? We were in the middle of a consult.
You're her doctor.
You shouldn't push her to do that.
I offered her options.
I told her about hospice.
She doesn't want to die a slow death hooked up to machines or be so heavily sedated she might as well be dead.
And I have to say, I don't blame her.
This is an act of mercy.
Act of mercy? You're killing her.
Just so you're clear, by writing that prescription, you're killing that woman.
All right, then.
- I'll find someone else.
- [Down-tempo music plays.]
[Jets rumbling.]
Watch it, watch it! Heads up! [Man.]
You need to work on your passing game, Hunt, you ball hog.
You need to work on your game! - [Teddy.]
On your four! - [Man.]
No! - [Man 2.]
Not a chance, major! - Get it! - Watch out, watch out, watch out! - I got him! I got him! [Cheering.]
Break it up, break it up, break it up, you two.
We're only down by three.
- Yeah, because you suck! - [Teddy.]
Don't be insubordinate.
Sir, you suck, sir.
- I mean, Dan, you play like my grandma.
- Whatever.
[Helicopter passing overhead.]
Get your battle rattle.
Time to go to work.
Owen, come on! I need to reduce this ankle dislocation.
Give him ten of morphine.
We need to treat his frostbite.
You like the tips of your fingers? - Yes, please.
- You jumped out a helicopter on skis? Yeah.
You can't get powder like that anywhere else.
I'm seeing fluid around your kidney.
We're gonna need to do a CT of your abdomen.
Do what you gotta do.
Me and the guys are running with the bulls in Pamplona next year.
Gotta be up on my feet.
Hey, Phil, tell those doctors they need to fix you up so you can run with the bulls next year! - You're an active guy.
- Once a year, anyhow.
Better than nothing.
Once a year, we live like men.
- You almost died like men.
- On my count.
One, two, three! Big-ass car bomb waxed half their unit.
They tried to evac, but it turned into an insurgent fire-fight.
GSW to the abdomen.
Let's stabilize him till we get him to an OR.
Get me some wet bandages and an occlusive dressing.
All out of those.
[Owen.]
OK, uh some wet towels and, uh That.
We'll close him with this.
Gekko, give me that roll of two-inch tape.
I need a laryngoscope and E-T tube.
I need to intubate! - Finish this! - [Gekko.]
I'm on it! Pupils fixed and dilated.
He's way past go.
Who's next? [Man 2.]
Over here, sir! Colonel Mooney, sir, sandstorm's coming.
Command's ordered us to move back.
- [Dan.]
You're kidding me.
When? - [Man.]
Now, sir.
All right.
People, secure your patients.
I almost have my guy stabilized.
[Dan.]
You'll ride with him on the medevac.
Take my amputation and the head trauma too.
Hunt, we'll take your GSW in the APC.
Let's move! - Want me to go? - No, I'm fine.
- You hate helicopters.
- I know.
I'm fine.
I'll see you back there.
- See you back there.
- Yep.
Shall we scan him first? See what kind of damage we're dealing with in case we need an OR.
- He's got some abdominal bruising.
- Yeah.
Yeah, OK.
You take this.
Uh, get him up to CT.
How come you didn't get hurt in the avalanche? Never got off the helicopter.
Was about to jump when the avalanche started.
You missed it, Tommy.
Friggin' awesome! [Nick.]
Yeah, Tommy, friggin' awesome! Yeah, Tommy, friggin' awesome.
Dr.
Altman said you requested to lower your pain meds? They make me fuzzy.
I don't want to be fuzzy today.
- Did she tell you? - That you're going home? Yeah.
- [Kim.]
I changed my mind.
- What? No, no, not about I just I want to do it here.
In the hospital.
I don't want Sean to have to deal with my body afterwards.
Don't worry about that stuff.
We can make this place like home.
You know? Get rid of all these machines and get some of our stuff, my quilt, some pictures.
Some wine.
- Can we have wine? - I don't see why not.
- If you need wine - [Kim.]
I don't.
maybe you don't want - I don't need wine.
I want wine.
But I think you're gonna need it.
You seem scared.
Are you scared? [gasping.]
Stop worrying about me.
All these things are happening, and I'm making all these choices, and I have no idea how you're feeling.
- I'm not feeling anything.
- [Kim.]
Sean! I'm talking about where I'm gonna die.
You have to be feeling something! I'll go home and get the stuff.
Sean Red or white? Red.
In a wine glass, not a plastic cup.
OK.
It never changes.
You have the same fights.
I mean, even when you're dying, you have the same fights.
You want to know how they're feeling, and they don't want to tell you.
- Sorry.
- Don't be.
I think they don't know.
When you ask them how they're feeling, and they don't want to tell you, and you think they're being difficult? I think they really don't know.
OK, relax.
Deep breaths.
Deep breaths.
Good.
Where do you stand on physician-assisted suicide? I'm not opposed to it.
As long as we're talking about controversial stuff, let's get something straight: Arena Football is not real football.
Mark.
Mark, wait.
This is not me getting to know you.
This is I have a patient who's terminal.
She wants to die, and she wants my help.
And I want yours.
[Exhales.]
See that? The tumor's pressing down on the floor of the fourth ventricle, which is causing the nausea.
So you debulk the tumor, and then you move on to the stalk? No.
You debulk the tumor.
Dr.
Shepherd has requested these scans.
His schedule has freed up.
He's decided to do the resection himself.
Oh, no! That's my I am debulking.
- It's my tumor.
- It's Dr.
Shepherd's tumor now.
- Dr.
Hunt, can I help you? - No.
No, I got it.
Oscar-four-kilo, this is echo-five-golf.
Oscar-four-kilo, this is echo-five-golf.
- Anything, sergeant? - No, sir.
I think it's the storm.
Well, they know we're coming, right? All right.
- Where are we going? - Green Zone, baby.
They'll stabilize you.
Then you are going to a hospital in Germany, and then you're gonna go home.
OK? - Teddy get there yet? - No word.
[Chuckling.]
Don't worry, I'm sure your girl's just fine.
Stop it.
I'm serious.
We're friends.
- Keep telling yourself that.
- [Bomb exploding.]
[Grunting.]
[Dan.]
Hunt! You all right, Hunt?! - [Owen.]
I'm OK! You OK? - [Dan.]
Yeah.
We must've hit an IED.
- How're the patients? - I don't know.
I gotta find 'em all.
[Exhales.]
Everyone's gone.
We lost Gekko.
Dan? Dan! [Cristina, echoing.]
Owen? Owen? - Owen.
- What? You paged.
When you did Kim Allan's evaluation, did you scope her? - What? Wait, is that her chart? - Dr.
Altman's patient, who, according to this, you ordered pulmonary function tests one week ago.
I'd like to know if, during that evaluation, you did a bronchoscopy.
- Is there a problem? - Answer the question! - Why are you interrogating me? - PFTs can give you false positives, and a patient may kill herself due to incorrect data.
- It's routine, so we probably did.
- Probably is good enough for you? Probably is good enough for Dr.
Altman? What is going on? Are? Owen.
- [Tommy.]
Did you call Lani? - Um, you should call your wife.
She'll freak.
Tommy, call her when I go in.
Downplay it.
It's a broken leg.
A little frostbite on your fingers, but nothing terrible.
You're about to - [screams.]
scream really loud.
That was worse than when I broke my ankle on Kilimanjaro.
- [Mark.]
You climbed Kilimanjaro? - Couple years ago.
I made it to the summit, while these guys got altitude sickness - half a mile from the top.
- [Chuckling.]
You guys are hardcore.
We gotta be.
I sell insurance.
Phil and Tommy are accountants.
[Gasps.]
These trips are all we got to keep our blood moving.
Show them the picture of you on top of Kili with the rubber chicken.
That doesn't look like you on a mountain.
Oh, sorry.
That's my daughter, Hannah.
Ladybug for Halloween.
You telling me you don't want one of those? You stole my surgery, right out from under me.
It wasn't your surgery.
It was Nelson's surgery.
[April.]
It's beyond Nelson's skill level.
- Right? I mean, that's what you said.
- My diagnosis, my tumor, my debulking.
Can I scrub in at least? You're on Nelson's service.
If I switch you, it's gonna look like favoritism.
- Dr.
Nelson's been given an aneurysm.
- You stop talking! - Calm down, people are staring.
- You stole my surgery.
He stole my surgery! - Everything OK? - Yeah.
It's fine.
Everything's, uh fine.
Have you had lunch yet today? I'm headed down.
I can't eat in the cafeteria anymore.
Vultures won't leave me alone.
- Vultures? - People need things from me.
Seems like everybody has a pressing problem that can't wait.
- Shepherd, you have a minute? - See? [Down-tempo music plays.]
My lunch is making me sad, and I haven't started eating it yet.
- [Mark.]
Say something.
- Shut up.
I was gonna go for lasagna.
I don't know why I didn't pull the trigger.
- Say it.
- Shut up! - Say what? - Nothing! Hello? OK, then.
You don't say it, you're gonna regret it for a long, long - Enough! - OK.
What is it with you two? - What is your problem?! - Teddy You go to Shepherd behind my back about a patient you don't even know.
You have no idea what she's been dealing with, the kind of pain that she's in, pain that's only gonna be worse after I ram a tube down her throat because you're having some problem with her exercising her legal right to die.
So I want to know what the hell is your problem? You missed it.
Altman tore Hunt a new one in the cafeteria.
The whole hospital's talking about it.
Not to me.
I walk in a room, and all the conversation grinds to a halt.
Come on.
You don't talk locker-room talk in front of the coach.
I'm not the coach anymore, I'm a player.
I take a shower like everybody else.
Richard.
You're a little bit like everybody else, but mostly, you're still the coach.
It's a sign of respect.
You'd be wrong to take it any other way.
You know the drill.
We've put you in a twilight state.
Next, we're gonna spray lidocaine in the back of your throat - and pass the scope - [Sean.]
I don't get it.
She had this test last week.
Is there a chance the results are wrong? - It's very unlikely.
- But it's possible? You wouldn't put her through this again for no reason.
You must think there's a chance the tests were wrong.
There are questions being raised that have nothing to do with By who? Raised by who? - Sean - [Sean.]
Just talk to me! 'Cause I'm standing here thinking my wife is gonna die today, and if that's not gonna happen, if there's a chance that she might get better Your wife isn't gonna get better.
This test is unnecessary, and the hospital is covering its ass.
- Thank you.
- No problem.
Julie, can you find out if Dr.
Bailey's on her way? OK, doctor.
If I wasn't happily married, I'd hit her.
I'd hit her hard.
Sir, I think what you wanted to say was "hit that.
" I don't think you wanted to say that at all.
[Richard clears throat.]
I hear Shepherd took your surgery.
- How'd you hear that? - Apparently, you yell really loud.
Well, I have to hold a retractor for Shadow Shepherd while Derek debulks my tumor.
So yes, I yell very loud.
Yeah, well, the key is to think of yourself - as one of the Whos down in Whoville.
- What? You know, when the Grinch came down and stole their presents, they didn't let that ruin Christmas for them.
Instead, they came out on Christmas morning, and they sang.
You're gonna go into that surgery and you're gonna sing.
[Laughs.]
Sing, Cindy Lou.
Sing.
Your scalp lac is small enough that shooting in lidocaine would be more painful than throwing in a couple staples.
- Is this gonna hurt like my fingers? - Not too much.
[Screams.]
- [Dan screaming.]
- [Owen.]
Sorry.
Sorry! OK, that's it.
Got it.
The hand was swelling so much, it would have popped the finger off.
What? You still trying to save the arm.
You gotta tourniquet it.
- If I do, you'll lose it.
- It's not about the arm.
If I can tie off that brachial artery Owen! It's not about the arm.
You're right.
I know.
You're right.
Dan, listen to me.
The back of this truck, it is trashed.
Most of the supplies, all of the morphine.
There's no morphine, no lidocaine.
You bring whiskey? [Both laughing.]
[Screaming.]
OK, we got it.
We got it.
We got it.
No I don't think we do.
[Muted.]
Dr.
Hunt? Dr.
Hunt? Kim Allan's bronchoscopy confirmed that nothing more can be done.
Sloan signed off.
He did his due diligence, but it's over.
You're not gonna kill him.
I won't let you kill him.
- You're not gonna kill him.
- Dr.
Hunt! The patient in question is a woman, and no one is trying to kill her.
She's choosing to die.
You should go home.
- I have a surgery.
- You're done for the day.
Go home.
OK.
OK.
Can you can you hold this? - Can you put pressure there? - I don't [Owen panting.]
- OK, I'm gonna have to move you.
- I can't.
I can't.
I'm too tired.
No, no, no! Dan, wake up! Wake up! I have to.
It's gonna hurt like hell, but I have to find something to pack this wound till someone comes.
Someone's coming? Someone's coming? OK, here we go.
Here we go.
- OK, here we go.
- [Screaming.]
Please, please! Please! Please! [sobbing.]
Sorry.
I'm sorry.
Sorry.
I'm sorry.
There we go.
There we go.
Hypothermia.
[Groans.]
That's the last one.
Stop that.
Someone is coming.
Help is coming.
You've been saying that for hours.
[shivering.]
I'm coagulopathic.
I'm probably acidotic.
I'm in the triad of death.
No one is coming.
- If I could just move you.
- I need you.
I need you to say a Hail Mary with me.
Dan.
- I don't know it.
- That's OK.
It's OK.
Just say it with me.
- Hail Mary - Hail Mary full of grace.
full of grace.
- The Lord is with Thee.
- The Lord is with Thee.
- Blessed art thou among women - Blessed art thou among women blessed is the fruit of thy womb, Jesus.
blessed is the fruit of thy womb, Jesus.
- Holy Mary, Mother of God.
- Holy Mary, Mother of God.
- Pray for us sinners - Pray for us sinners now and the hour of our death.
now and the hour of our death.
- Amen.
- Amen.
Make sure Lisa gets my ring.
All right? Don't give up, Dan.
Don't use it to propose to Altman or something.
But you should propose to Altman.
You know, you two You should.
- You should.
- Shut up.
I'm engaged to Beth.
And you, you're gonna give that ring to Lisa.
OK? - Come on.
Come on.
- No.
- Move your hand.
- No.
- That's an order, soldier.
- No, sir.
[Thunder rumbling.]
They're working on Nick's kidney.
I was able to stabilize his legs, but it's gonna be a long recovery process.
You may need to let his wife know it's a little bit more than a broken leg.
Yeah.
I told my wife, and she's calling Lani.
My wife can handle her better.
So you summited Kili, you run with the bulls, but you're scared of your friend's wife? I was scared on Kili.
- I hated every minute of it.
- So why do it? Nick and Phil.
They're my boys.
And they love adventure.
Me? I got a kid.
And bad knees.
But I can't ruin it.
We're a team, you know? - So you just suck it up? - Close my eyes and hope I don't die.
I can't actually give you the drugs, but you can have this prescription filled in the hospital pharmacy.
Again, I want to emphasize there are other options.
We can make you comfortable.
- I just have one question.
- Owen, no.
What if they find a cure? I know that it's a long shot, but isn't saving your life worth gambling on a long shot? - Dr.
Hunt, I will call security if - Let her answer.
I'd like to hear the answer.
Maybe you have to be dying to understand, but there's this thing that happens where death stops being scary.
What starts being scary is hope.
'Cause it's not true.
Even if they found a cure for cancer tomorrow it's too late for me.
And hanging onto hope, it may make you feel better but it just makes me feel alone.
[Whispering.]
I don't want to die alone.
OK? I am not afraid of this.
Why are you? Why are you so afraid to let me die? [Down-tempo music plays.]
[Sean.]
Dr.
Hunt? The pharmacy wouldn't take my insurance card.
There was some problem, so I had to go to a cash machine.
And I'm running around trying to get enough cash to buy the pills that are gonna kill my wife.
[Sighs.]
Anyway here they are.
There'll be a moment when she dies, her face will relax, and all that pain that she was in will be gone.
And you will feel relief.
Relief for her, relief for you.
You will know with absolute certainty that you did the right thing.
Just for a moment.
[Shivering.]
You gotta let me go, Owen.
OK? You gotta let me go, please.
This hurts.
It hurts.
It's OK.
It's OK.
It's OK.
Look at me.
OK.
You gotta do it.
You gotta do it.
I can't make you do it.
OK.
Please, it hurts.
It hurts.
It hurts, it's OK.
It's OK.
It's OK.
OK.
You gotta do it.
[Dan coughing.]
[Choking.]
You have to hold on to that moment, because all the rest of it is just your own garbage.
You'll be in physical therapy for six months, but, with luck, you'll be ready for your trip next year.
- Pamplona, baby! - Pamplona! Pamplona! Oh, come on.
He hates this stuff.
The adrenaline, the adventure.
He does this just for you guys because you guys love it, and he loves you.
And that's my rant for the day.
I'm sorry.
I like to see people keep their legs.
Ignore me.
[Phil.]
I'm starting my own business.
Keeps my blood pumping.
- I'm with Tommy.
- [Down-tempo music plays.]
Sorry, Nick.
I can't believe you guys.
I almost died jumping out of a damn helicopter when I really wanted to go wine-tasting in Napa.
Napa! [All laughing.]
Napa! Place looks different.
Something's different.
- Something I can help you with? - You were jealous of her today.
- I'm sorry.
- Meredith.
That's why you stole her surgery.
You miss the pace of back-to-back surgeries, the adrenaline.
Yeah, I do.
Schedule yourself one surgery a day.
In the morning, early, an hour before anyone else.
So at the very least, you start your day good, you start your day cutting.
You don't have to sign all the paperwork.
Patricia is an excellent forger.
If you eat alone in the cafeteria, you are a sitting duck.
You need to eat with someone else.
That way, people are more likely to leave you alone.
- You can eat with me.
- [Chuckling.]
Thank you.
[Owen.]
Living is better than dying.
Until it's not.
I'm scared.
[Whispering.]
Come here.
[Owen.]
But even if letting a person die is the right thing to do it's not what surgeons are built for.
We are arrogant and competitive.
[Sighs.]
I'm sorry.
I know you're mad at me.
I'm not mad.
- I'm in Whoville.
- Whoville? Whoville.
[Owen.]
We don't like to lose.
Um This is really hard for me to say 'cause I really care about you and Oh, my God, you're breaking up with me.
Mark? Is it Mark? Are you sleeping with Mark again? Are you one of those fake lesbians having a vacation in lesbian land? No.
Stop.
God, it's not bad.
This thing I have to tell you isn't bad.
Um I just I want to have a baby.
At some point in my life.
That's all.
I really I have to have a baby.
[Owen.]
And death feels like a loss even when we know it's not.
[Knocking on door.]
[Owen.]
We know it's time.
- We know it's right.
- Hey, there.
- Hey.
- Come in.
I helped my patient die today.
You wanna talk about it? No.
[Down-tempo music plays.]
[Owen.]
We know we did everything we could.
[Dan.]
It's OK.
You gotta do it.
You gotta do it.
I can't make you do it.
You gotta do it.
OK.
[Coughing.]
[Choking.]
What are you? [Gasping.]
I couldn't sleep.
Are you OK? [Owen.]
But it's hard to shake the feeling that you could have done more.
Yeah.
I'm fine.
Go back to bed.
Owen - What are you thinking? - Nothing.
Nothing.
Go back to bed.
[Helicopter blades whirring.]