Grey's Anatomy s08e22 Episode Script
Let the Bad Times Roll
Taxi! Carpe diem.
That was hell.
Actual physical hell.
I think I went a tad overboard.
How annoying is carpe diem? A lot overboard.
They took something from me.
Yeah, that wasn't an exam.
That was an interrogation.
Like, way way overboard.
- The mind games.
- Trick questions.
It felt like Al Qaeda in there.
How are you supposed to plan a life, a career, a family, if you're always carpe-ing the diem? Next test is june.
June's not bad.
Oh.
What's done is done.
Let's just not even talk about it anymore.
If we all seized every moment of every day, there wouldn't be doctors.
Who would sit through med school? Anyone know how Alex did? Anyone know if Alex made it? Made it? What do you mean, made it? We'd all be too busy living in the now.
Whatever that means.
Hey.
You okay? I'm I'm not sure.
I-I hope you're not worried about last night.
I'm not worried about last night.
I'm worried because I checked with some of my friends on the committee and one of your Seattle Grace doctors didn't pass.
Any idea who? he'll blame me forever.
Welcome to the American Medical Board of Surgery Certifying Examination.
We'll give you four separate scenarios in 3 30-minute sessions, To pass the test, you must pass two of the three sessions.
- Now you can fail a session and still pass.
- Still pass.
But examiners are not permitted to indicate whether you passed or failed each session.
You'll be rated on your ability to diagnose, manage treatment, handle the unexpected Basically, the strength of your constitution in crisis.
And when we move on to the, uh, next scenario, th-there's no doubling back, meaning, once a question is asked You can't go back.
Understood, sir.
Are you in a hurry, Dr Yang? No, sir.
Just ready when you are.
Mm-hmm.
So then, a 65-year-old woman is being seen by her primary care physician for a workup of osteoporosis when she is found to have elevated calcium.
Her P.
T.
H.
level was well above normal.
Her doctor sends her to you.
Elevated calcium and P.
T.
H.
would indicate primary hyperparathyroidism.
I would offer the patient a para thyroidectomy.
And first I would explore the right side.
If that gland is large I would biopsy it.
Um, after doing the biopsy, I would Hang-hang on.
What-what did the pathologist report say? Path comes back with parathyroid hyperplasia.
Uh Um, and how large was the gland? How much longer are we gonna give this Dr.
Karev? Next, I would resect it and explore the other glands.
Aggressive choice.
Well, I suppose I could wait for the I.
P.
M.
before taking further actions.
Mm-hmm.
Are you sure you're okay with that? Yes, I'm okay with that.
Mm-hmm.
If the I.
P.
M showed P.
T.
H.
levels in the normal range Dr.
Grey? I would feel comfortable concluding the procedure.
Dude, there's no other way? Helicopter.
Magic carpet.
That lane is open.
That's the bus lane.
I don't see any buses.
I'll get a ticket.
Come on, man.
I'll give you double any ticket.
What about my insurance? Come on, man.
Just take the bus lane.
- Nah.
- How far are we? Catch the game last night? Come on.
Move.
I heard it went 11 innings.
Move! Move.
Look out.
Move.
Come on.
Come on.
Okay, who wants more pancakes? You haven't had any.
Sit down.
I can't sit still.
He's taking his test right now.
It's cute, you being nervous for Jackson.
You want some more juice? It's paternal.
You're a natural father.
Are you sure you don't want anything? I could make some bacon We should have a baby.
Don't freak out.
I-I mean, I like this.
I like you, I like your kid, and I like your kid's moms.
And I You-you know, you-you don't have to say anything right now.
Just g-go back to worrying about Jackson, and we-we can talk about this later.
Um, I would say no rush, but, you know, actually, my F.
S.
H.
levels would suggest that rushing a little might not be the worst thing in the world.
Julia wants to have a baby with Mark.
Oh, I can't even deal with that right now.
Wow.
I should've picked him up myself.
I mean, I what's wrong with me? Okay, I thought he was your brother's best friend, not yours.
We were all super close, and he was my rock when Tim died.
I just oh, god.
I let my rock take a cab.
Oh, so you let him take a cab.
Well, I mean, listen, he just flew in from Tibet and he has cancer.
I mean, the least I could do is pick him up at the baggage claim.
Hey, hey, hey, hey, hey, okay, you need to chill out.
- Wh - Look, I know that you're worried, but as far as cancers go, I mean, his is very slow growing.
He told you he found out, what, six months ago? I mean he could be fine.
- Yeah.
- Yeah.
Well, with you in the O.
R.
, I'm not worried.
You're gonna love him, and he's gonna love you.
Well, I'm taking his tumor out.
It's the least he could do.
Phoenix.
Nick! Hey.
Oh, it's good to see you.
Ohh.
Wait.
What's with the cane? Tumor, man.
It hurts to walk.
Already? But you were only diagnosed six months ago.
Did I say months? I meant years.
So you must be the wife.
Yeah.
Good to meet you.
Good to meet you, too.
Julia went all F.
S.
H.
on me this morning.
Is that a sexual term? You know what? Never You know what? I don't want to know.
She wants a baby.
She wants my baby.
What did you say? Nothing.
It's crazy.
Until you think about it and realize it's kind of genius.
I love Julia.
I want Sofia to have some siblings to grow up with.
Why wouldn't I do it? Are you asking me if you should have a baby? Well, you think I shouldn't? Have a baby or ask me if you should have a baby? So you think I should do it? Well, do you want Julia to be in your life forever? You think I shouldn't? Uh, do you have to answer that right now? Hey.
Answer what? We were just talking about the, uh, cranioplasty.
Oh.
It's exciting, right? Yeah.
Charlie Konner, 37.
Uh, he fell off the roof six months ago.
He presents for repair of a skull bone defect that occurred secondary to surgical removal of part of his skull.
Um, we waited several months for the swelling to s-subside before Wh uh, what-what were you doing, um, anyway? Being an idiot.
B you gonna fix it next time? No, I want the roofers to fix it next time like they had to do it this time because humpty-dumpty almost killed himself.
Wh you want to pay for it? Okay, we have mirrored the healthy skull and created a custom titanium plate that we will secure to the bone.
Titanium.
Like the terminator.
And I'll take fat from the belly and fill in the gaps, pull your face into shape.
So, doc, what are you using to fasten the new skull into place, - hexagonal screws? - Yes.
You know your stuff.
Yeah, we could do this in my garage, save me a few grand.
You got a 2-millimeter bit? Do I have a 2-millimeter bit? Please don't encourage him.
What? No.
I am counting on you to treat these candidates extremely well.
Show them whatever they want to see.
- Really woo them.
- Woo? Yeah, woo.
You know, uh What about me says "Woo"? After the boards, we might be losing some very good doctors to other programs.
Now if that happens, we need to be sure that we have some fresh talent ready and willing to take their place, so I am asking you, as chief, please woo their socks off.
For you, just this once, I will woo.
Uh, their socks off? D-don't push it.
Hi.
Hey.
Hey, um, so, uh do you have any word on what Cristina's plans are for next year? No.
No, not yet.
Oh.
Oh, okay.
Um will you keep me posted? I will.
Good.
Thanks.
The first session was so easy.
I want to punch your face.
Hey.
Hi.
I am, uh, so, so sorry to interrupt.
I'm, uh, I'm Dr.
Karev.
I was stuck in Seattle with a patient, and, uh, well, I don't want to bore you with a bunch of travel crap Your time was set for 9:00 this morning.
We were here.
We called your name.
Yeah, I was with a patient.
You get that.
We all have patients, Dr.
Karev, yet, here we were.
So what, I-I-I just fail? The first of three sessions, yes, which means you need perfect scores in the next two sessions.
How are you everywhere? How'd it go for you in there? Look, baby, I know you were shocked.
Shocked? Shocked at the sight of my mother half naked with a senior attending at my hospital? No, far from it.
Okay? I mean, it's kind of par for the course for you, right, mom? But every door that I open, every-every corner that I turn, there you are.
I know I'm your mother, but I'm also a woman.
- I have needs.
- Mm.
If you don't want to talk about this like an adult, don't bring it up.
Wait a second.
Did I bring it up? Did I bring it up? Don't play games.
Just talk to me.
Just leave me alone! I'm in the middle of my freakin' boards.
Are you following me, mom? I'm the examiner in the room right next to yours.
Of course you are.
After that, I might mobilize the small intestine to create a roux limb, and open up the pancreatic duct longitudinally from the tail to the neck? The patient has died.
Moving on to the next scenario.
Um, can we can we go back - just-just for a second? - We're moving on, Dr.
Kepner.
- A 38-year-old male with a history - Yeah, but-but if we could just go back, just for one second so that I can clarify.
You have a 40-year-old man who complains of rectal pain and burning with defecation and occasionally some blood in the bowel movement.
I would do a rigid sigmoidoscopy to make sure there were no lesions in the rectum.
Squeamish, Dr.
Grey? No, not at all.
Good, then let's pick up the answers, shall we? Of course.
If there were lesions in the rectum, I would do an incisional biopsy and begin to fulgurate I would cover the bowel with omentum and close the fascia primarily.
The sutures tear right through the fascia.
In that case, I would use through the full thickness of the abdominal wall.
Moving on.
Because I would make sure the area - was adequately drained and closed - Dr.
Kepner Because if it leaked, and if the leak was early, I would re-explore the patient and repair the leak, making sure that if that if Once a question is finished, it's finished.
Finished.
Yes, I know.
I'm sorry.
I just really need you to understand that if the leak was late, I would obtain an abdominal C.
T.
just to make sure, and also, if it wasn't if it wasn't drained god.
Um, can you hang on just for a second? It's just so incredibly hot in here.
Ohh! Oh, god.
Oh, god.
Can we move on, Dr.
Kepner? Would you allow us that courtesy? Yes.
Yes.
Great.
Thank you.
Now a 38-year-old male with a history of diabetes I'm sorry.
I'm sorry.
I'm sorry.
Just-just-just Just-just one last thing going back to the beginning, 'cause you you heard what I said about finding the pancreatic duct, right? Because I just I really want to make sure you know that I would drain the anastomosis, r Well, I-I that patient should be stable! They just Why won't you tell me? Just just-just tell me! How am I supposed to answer this question without the full information? Please t Um Look, I'm-I'm, um, I'm-I'm a really good doctor.
I am.
I just-I need I need all the information.
I'm I'm a really good doctor.
Um, no free air.
The spleen the spleen looks fine.
There is some perihepatic fluid I'm sorry.
Are you guys hearing this noise next door? It's very distracting.
If we could just ask them to keep it down.
If you get distracted this easily, I think it calls to question your ability to function in a high-volume O.
R.
Certainly calls it into question.
It is not that at all.
Okay? It's just my Um Never mind.
Let's wait for traffic to die down.
We wouldn't want to throw you off your game, Dr.
Avery.
I'm fine.
Let's just I would stop the patient's continuous bleeding with a portacaval shunt.
Your patient is now in a coma.
That's highly unlikely, but, uh, in that case, I would suspect a hepatic encephalopathy and check an ammonia level to confirm.
I'll save you the trouble.
It's confirmed.
I would check the patient's medication Medication Okay, then I'd start on lactulose and neomycin.
- The patient - Still not getting better? Then I would do a shunt revision with a stent graft.
Stent graft? Yes, a stent graft.
Mm.
Well Risky move, Dr.
Yang.
Well moving on.
Did you have something to add, Dr.
Yang? Nope.
All good.
Mm-hmm.
Does that hurt? Nope.
- What about - Ow.
Yeah.
That's what happens when you wait six years to get treated.
Ohh.
So she's not shy.
Yeah, I know.
I never went for shy.
Yeah.
I've been working with a naturopath.
I figured I'd try the nontraditional route.
- It helped.
- Oh.
It did.
But the pain started to kick up, so I saw a real doctor.
And he was gonna send me to an orthopedic surgeon, but then I was like, "Hold up.
" "Yuma Robbins just married one of those.
" Not that it was a real wedding.
Excuse me? Oh, um, she thinks you're serious.
Oh, I am serious.
Tucson's already married.
Mm-hmm.
To him.
She loves me.
We were 10, it was in my tree house, and we had rings made of crabgrass.
You're probably the last guy I ever kissed.
It was a beautiful ceremony.
Tim officiated, her brother.
He made me swear to stop pulling the streamers off of her bike.
Mm.
It was an issue for a while.
Yeah, I'm a little concerned about how much pain you're in.
So I am going to order some new scans.
These are how old? I had to finish up a project on the guys who carry all the tourists' crap up K-2.
With a cane? I stayed at base camp.
Play through the pain, right? - No.
- Anybody? Is she always like that or am I dying? No, you are going to be fine, because she is a genius with a scalpel.
She'll be in and out, and you won't even know it.
- And they're not even gonna use drugs.
- Oh.
Nope, nope, just, um, chamomile tea.
You are so damn cute.
How does she get through a work day with you around? I don't know.
I forgot how much I missed you.
Me, too.
And our surgical rotations often allow flexibility to set aside consecutive days for research projects and field work if necessary.
Any questions? Would I have to share an office? We don't h I'll have to check on that.
Are parking spaces assigned for attendings, or do we have to, like, find our own? I'll have to check on that.
All right, we just need to screw this down and then adjust it to fit.
Well Mark said that I get to graft the fat.
How cool is that? Yeah, that's cool.
I'm gonna be your big brother for 30 seconds.
Okay.
Uh, Julia wants to have a baby with Mark.
She what? What did she say? Well, I don't know.
What do you mean, you don't know? Wh-what did he say? How did it go down? My 30 seconds of brotherly advice is over.
I gotta go check on a patient.
No, I oh, does he want to do it? I mean, did it seem like he was excited about it? Or does he seem like, "That's an insane idea"? Because it is.
Yeah, you know what? I D I hope you told him that it's an insane idea.
Are all your questions gross? Gross? What do you mean, gross? Uh, they keep asking me about bowels and bloody stools? It's general surgery.
What do you expect? You're not helping, at all.
My guy is a freakin' fossil.
The last time he was in the O.
R.
, it was lit by candles.
Maybe I'll just live in here, in this stall, in my filth till I die.
Sick woman in here.
Go away.
Uh, I-I really need to get in there.
Uh, sorry.
Closed for maintenance.
- Please let me in.
- Come back later! Hey, the applicants keep asking to see the gym.
Should I show it to 'em? 'Cause I don't want the, you know, cobwebs and sweaty menthol stench to scare them When did I become the advice columnist? - Touchy, touchy.
- Well, I'm sorry.
It's just, no one can seem to make up their own mind today.
Oh, people do make up their own minds, they just need a little help getting there.
What do you mean? Okay, if someone comes to me with a problem - Yeah.
- I give them a metaphor.
A metaphor? A figure of speech which Yes, I know what a metaphor is.
- Fantastic.
- Thank you.
Now the next time someone comes to you with a problem, you just give them a metaphor.
Any kind of metaphor? See? That's the beauty of it.
They'll draw some meaning from it, and it'll help them make the decision they were gonna make in the first place.
I'll stick with being honest.
Thank you.
Suit yourself, but when they take your advice and it doesn't work out, honesty can bite you in the ass.
Ooh.
If you don't mind, it is a men's room.
What? What? You're supposed to be doctors.
I've seen your things.
You've seen mine.
It's all just flesh and cartilage.
Get over it! Ugh! April, wh Oh, hey, Jackson.
How's it going? Not so good.
You? I am dying in there.
I am actually failing.
You, too? 'cause mine is a total fiasco.
They think I'm insane! Oh, they're toying with me.
I am self-destructing into a puddle of sweat.
I don't know what's wrong with me.
Oh, I know exactly what is wrong with me and I still can't reel it in.
I broke my promise to Jesus and now I can't even talk to him a-and I need him.
He's the only one who can calm me down! Why the hell did you do it? - Why'd you let me? - I don't know! - You said it was okay.
- I know! I knew you'd regret it! Stop yelling! Why are you yelling at me?! Because I'm all messed up now, too.
I mean, what am I? I'm-I'm now the guy that made you break your promise to Jesus? I am not that guy! All right? That guy is gross.
Okay? It's all very unbecoming, especially for an Avery.
What? Are you are you honestly comparing breaking my promise to Jesus with putting a tiny dent in your family crest? You're right.
You're right, and I'm sorry.
My mom is the examiner in the room right next to mine.
It's throwing me.
Oh, god.
I know.
It's-it's I'm worried about my mom and what she's gonna think if I fail.
It's pathetic.
- Right? - No.
God, no, Jackson.
It's not pathetic.
That's the most important relationship in your life.
The problem isn't that I broke my promise.
That's not the problem.
The problem is The problem is That it felt good.
It felt good.
I shouldn't have taken advantage.
Taken advantage? What? Oh, we should we should go.
Taken advantage? I kissed you, remember? Yeah, but I kissed you back.
Yeah, but then I unbuttoned your shirt.
Yeah, and then I pulled up that skirt.
Yeah, but then I kissed your neck.
Yeah.
And then I took off your shirt.
And I But then I unbuckled your belt.
And then I slipped my hand up your back.
And I wrapped my arms around your neck.
And then I Then you Then I Oh, no.
He's not gonna Oh, yes, he is.
Oh! Oh, no, no.
Oh, my god.
I told you.
Disgusting.
Dr.
Bailey, where are the candidates? Oh, over there destroying my appetite.
You know, I never thought I would've said this, but we need to keep our people, people.
- Mm-hmm.
- Right? We haven't put in all this training and put up with all their nonsense to go groveling at the feet of bread sniffers.
Kepner's already gotten job offers - at four different programs.
- Oh.
Well, Grey's not going anywhere.
Not without Yang anyway.
Cristina has options.
My contact in Boston may have mentioned that Meredith said their program's her first choice.
You're building a house.
Harvard has an excellent neurosurgery department.
W And they have plenty of really nice houses.
Don't be all cryptic and then just walk away.
Meredith? Uh, I lied to you.
About what? I'm not okay.
I might be dying.
I think our daughter tried to kill me with her flu for being a bad mother.
Why didn't you tell me before? I'm failing, Derek, and I and I-I don't think I can go back in there.
I just can't I mean Will you still love me if I fail? You want me to yell at you or tell you to come home? I want you to tell me what to do.
The test is a mirror.
What are you talking about? The test it's a mirror.
Reflecting my sickly incompetence? Are you saying I won't like myself if I give up right now, that I won't be able to look myself in the mirror if I quit? Whatever you decide, I will still love you.
No, you won't.
Nobody loves a quitter.
Good luck, Meredith.
You find out the patient has advanced metastatic disease and is terminal.
What do you do? Honestly? I'd pray for them.
I know that's not the right answer, but it's what I'd do first.
Or at least if you asked me yesterday, that's what I'd do.
Now I'm not so sure if he's listening.
Dr.
Kepner, this is highly inappropriate.
Yeah, well, so is having premarital sex in the men's room with a really good friend, but that just happened, so You know, I have been surrounded by scientists for a decade now, holding back my feelings about my relationship with god 'cause I was afraid of being laughed at or judged or considered less of a doctor.
I was hiding, ashamed to admit that I love him, that his is the one relationship I count on.
And now now I'm not sure if I just screwed that up or freed myself from its limitations.
I The one thing I know for sure, though, is I think I'm done hiding.
Dr.
Kepner, we asked you a question.
Yes, I would do a palliative endoscopic stenting.
If that failed and the patient was still alive and having pain, I would do a biliary-enteric bypass.
After that, I might A 30-year-old female comes in with third-degree burns.
You've checked her airway and started fluid resuscitation with D-5 N.
S.
fluids.
Actually, I would use L.
R.
for fluid resuscitation, not N.
S.
uh, saline has too much chloride, and that could cause acidosis in my patient.
Okay.
So you've started your patient on a liter of L.
R.
Thanks for assisting, Bailey.
You know, Nick did a big spread in "National geographic" once on this school for orphan girls in Calcutta, and he-he sent them a bunch of cameras.
I think that it was polaroids so they wouldn't have to pay for the film to get processed But anyways, you know, a couple of those girls actually became photographers.
Like professionals.
Isn't that amazing? We're not going to kill your friend.
What? I know.
I'm just I'm saying Hey, does he save puppies, too? Less sarcasm.
A little more focus.
Oh, shoot.
We were supposed to bring snack today to the day care - for all the kids.
- Today? Yeah, that mom from psych asked if we would switch with her, and I said we would, and then I forgot.
You need to write this stuff down.
I - I know.
I know.
I am so sorry.
- I Sorry.
You didn't forget snack today, did you? No, I'm seeing mets in the vessels.
Look at this.
Damn.
And if they're here They're gonna be everywhere.
The temporalis muscle is atrophied.
Any idea why, Dr.
Grey? Uh, lack of use? It had nowhere to attach since the bone was gone.
That's right.
It's too late for this muscle.
It's missed its chance to attach.
Why are we talking about the temporalis? Teachable moment, Dr.
Sloan.
Stay out of it.
Once you inject the fat into Charlie's temple, the muscle will Again with the muscle? Yeah, the once healthy muscle will slowly wither to nothing all alone, surrounded by a thick layer of fat.
Very crafty, Dr.
Shepherd.
Message received, loud and clear.
They had snack.
And now I have 2 pounds of strawberries for no reason.
Why-why is Teddy here? Oh, honey.
We did a pet-scan, and, um Nick has intradural mets.
They've spread into his lymph nodes.
They've even gone into his heart.
He has a cardiac tumor, which looks like it might have invaded into the right ventricle.
At this point, there's very little that we can do.
I-I would be concerned about Crohn's disease but differential diagnosis could be P.
U.
D.
, ulcerative colitis, or appendicitis.
Dr.
Grey? I'm sorry.
I can't I'd locate the fistula endoscopically, then inject fibrin glue.
What about an abscess? What about it? Well, apparently, you have ruled it out.
It just feels a bit cavalier, doesn't it? If you say so.
I'm having a hard time understanding why I would open her up when I could treat it endoscopically.
Precisely my question, Dr.
Yang.
I've treated this condition a dozen times.
And I a thousand times.
If you would rather I open her up and do tube duodenostomy, that's fine, too.
It's more invasive, but fine.
Mm-hmm.
Dr.
Grey.
Dr.
Grey, we're gonna have to call this.
You can take the exam again next year.
And we won't we won't count this as a failure - so please - Okay, you're doctors.
You can't handle a little vomit? Dr.
Grey, it it's really okay I would repair it with an abdominal approach, reduce the size of the hernia contents, excise the sac, close the hiatus, and perform a floppy nissen for antireflux and gastropexy.
But ask me something else, because I've known that answer since I was, like 12 years old.
My mother practically invented the floppy nissen.
So keep them coming, but don't go easy on me.
All right.
A 40-year-old man presents with a suspicious lesion on his left temporal, sent in by his in Whew.
Pigmented lesion? You seem awfully sure of yourself.
I'm sorry.
Is that a question? Do you feel threatened? Oh, have we moved on to psychology? I find your hostility curious.
And I'm curious as to why you think me hostile.
You know, if you don't agree with my approach, I wish you would voice your issues.
I-I don't disagree.
I don't believe you.
Are you calling me a liar, sir? Fine.
You know what? Earlier when I said I was okay with that open procedure, I wasn't.
That might have been okay when, like, hawkeye and B.
J.
did it on "M-a-s-h," but this being the new century and all, I would have, as I said earlier, treated it endoscopically.
Then you lied earlier.
You know what? Oh, god.
I can answer these questions any way you want using medical techniques from any era.
So how about we just, you know, pick a decade you're comfortable with and go from there? Well, then It's been a pleasure being witness to such genius.
I can now finally retire knowing that such advanced and creative minds are at work in the surgical field, hmm? That's it? Oh, I think we've had enough of an education today, Dr.
Yang.
But there's still 20 minutes.
No need.
Oh best of luck.
I'd do a biopsy.
Path shows L.
C.
I.
S.
What's your best mastectomy approach? I'd make a periareolar incision to preserve the inframammary fold.
But wait.
Did you say L.
C.
I.
S.
? Yes, lobular carcinoma in situ.
You wouldn't do a mastectomy.
You'd observe and repeat mammos.
You already did a skin sparing mastectomy.
That was a trick question.
You had all the facts to answer.
Yeah, but my answer was wrong.
I'm gonna fail because of a trick question? The questions are designed to get your response You gotta be kidding me? You missed your first session.
You're lucky to be even getting this chance.
Yeah, I missed my first session for the best freakin' reason.
I was with a patient.
For months with this kid who who doesn't have a chance, not a chance.
And we give them a chance and we try everything, and then when there's nothing left to do, I'm supposed to just walk away from his mother? I had to be there.
I had to.
And what what did I miss here, a few more hypothetical trick questions? What are you staring at? You guys are doctors.
You're supposed to decide if I'm gonna be a doctor, and you can't understand that? Thank you, Dr.
Karev.
It's Karev.
Can you at least tell me if I passed? Thank you.
Thank you.
Taxi.
Well, you-you don't want to miss your flight.
No, I don't want to miss my flight.
I better go.
Richard, I don't regret last night one bit.
Neither do I.
It's just bad timing.
You know, we live in different cities.
It's-it's too complicated right now.
Yeah, bad timing.
Bye, Richard.
Bye, Catherine.
Safe flight.
Oh, uh, call me if you hear any more about the boards.
Oh, I will, and call me when you get home, let me know you got there okay.
I will.
Are you going to the trauma and critical care conference in May? In New Orleans? I'm speaking at it.
Me, too.
I'm at the Sonait house.
Where are they putting you up? Um Windsor court.
Oh, no.
Sonait house is much better.
The breakfast biscuits will make you jump up and down.
When do you fly in? Uh, I think it's Thursday.
I fly in Thursday, too.
I can't believe it.
My whole Charlie is back.
You people are miracle workers.
So how long till I'm back on the ladder? - I-I just got a tile saw - Uh-huh.
And I'm gonna mosaic the stucco.
You ca Dr.
Shepherd, talk some sense into him.
It's really not my place.
But if you want to say something to your husband, please, by all means, you should do it.
I know how much you love to work on the house, but listen to me, you are clumsy.
And I can't stand the thought of almost losing you again.
So would you just take a second and what's left of your brain and think about how I felt about it, how scared I was to lose you forever? You're right.
I'm sorry, babe.
I'll-I'll-I'll find a new hobby.
Right, something something we can do together, like, uh, bowling.
Oh, no, um, I I hate bowling.
But you never even tried it.
Well, you can hate something without trying it.
Oh.
Hey.
Hey.
Thanks, uh, for today.
For-for letting me, uh You did a good job in there.
Thanks.
You okay? I love you.
Oh, g oh, my god.
That just came fly-flying out of my face like it was s-s-some kind of I-I l I love you.
I just god.
Did it again.
I I-I-I-I love you.
I-I do.
I just I-I love you.
And I have been trying not to say it.
I have been trying so hard to just mash it down and ignore it and not say it.
And Jackson is a great guy.
He-he is, and he he's gorgeous, and-and he's younger than you, and he doesn't have any grandkids or-or babies with his lesbian B.
F.
F.
S and he's an Avery, and-and he liked me, you know? He he really liked me.
But it was never gonna work out Because I-I love you.
I am so in love with you.
And you're-you're you're in me.
It's you're like it's it's like you're a disease.
It's like I am infected by Mark Sloan.
And I just can't I can't think about anything or anybody, and I can't sleep.
I can't breathe.
I can't eat.
And I love you.
I just I love you all the time, just every minute of every day.
And I-I-I I-I love you.
God, that feels good, just to-to say that to j I am I feel so much better.
Just I love you.
Mark? Hey, Lexie.
I thought you said the lobby.
You ready? Hey there, sunshine.
You feeling okay? Yeah.
You know, just groggy.
You guys got good drugs in this place.
Good.
What the hell were you thinking? - Dude - You're an idiot.
You should have called me.
I mean, wh-why didn't you call me? I'm a doctor.
What do you think I do all day long? Instead you go to some quack in Tibet.
I mean, you should've freakin' called me! Naturopathy works, too, flagstaff.
Whoa.
It's not flagstaff! And it's not Phoenix and it's not Tempe.
It's Arizona Robbins, M.
D.
Do you know what that means? How do you spell it? It's not funny, Nick.
Nothing is funny.
You're dying! And you know what hell it was when Tim died because you were there, and-and you and I barely made it through that.
So to do nothing for six years and then to come when it's too late, I I Why do you think I didn't come to you sooner? As if after Tim died, I could You think I don't know how this must feel for you? You're an idiot! I couldn't have helped Tim, but I could've helped you! I'll admit, the romans had a point.
You've gotta live life.
Ugh.
Gotta pee.
Gotta pee.
Gotta pee.
Gotta pee.
Gotta pee.
What time you got? Oh! It's supposed to come online at midnight.
I mean, it's four minutes late.
Come on, people.
Crazy doctors, they crashed the system.
I already know I failed, so I don't know why I keep hitting the refresh button.
And living means that every morning when you wake up you have to choose Okay, if anyone failed, was me, because my guy had a vendetta.
Please.
I've got the odds on failure.
Are any of you on call? I've got a trauma.
No! Wait.
Wait.
Wait.
I passed.
I passed.
I passed! I passed! I passed! Yes! I passed! I passed! Oh, my god! Yeah! Between seizing what life offers in the moment and forging ahead, no matter the weather - Alex? - It's not coming up.
Here.
Here.
Use mine.
Oh, unh! Yes! Wait.
Wait.
Where is April? Or closing the curtains and shutting out the day.
That was hell.
Actual physical hell.
I think I went a tad overboard.
How annoying is carpe diem? A lot overboard.
They took something from me.
Yeah, that wasn't an exam.
That was an interrogation.
Like, way way overboard.
- The mind games.
- Trick questions.
It felt like Al Qaeda in there.
How are you supposed to plan a life, a career, a family, if you're always carpe-ing the diem? Next test is june.
June's not bad.
Oh.
What's done is done.
Let's just not even talk about it anymore.
If we all seized every moment of every day, there wouldn't be doctors.
Who would sit through med school? Anyone know how Alex did? Anyone know if Alex made it? Made it? What do you mean, made it? We'd all be too busy living in the now.
Whatever that means.
Hey.
You okay? I'm I'm not sure.
I-I hope you're not worried about last night.
I'm not worried about last night.
I'm worried because I checked with some of my friends on the committee and one of your Seattle Grace doctors didn't pass.
Any idea who? he'll blame me forever.
Welcome to the American Medical Board of Surgery Certifying Examination.
We'll give you four separate scenarios in 3 30-minute sessions, To pass the test, you must pass two of the three sessions.
- Now you can fail a session and still pass.
- Still pass.
But examiners are not permitted to indicate whether you passed or failed each session.
You'll be rated on your ability to diagnose, manage treatment, handle the unexpected Basically, the strength of your constitution in crisis.
And when we move on to the, uh, next scenario, th-there's no doubling back, meaning, once a question is asked You can't go back.
Understood, sir.
Are you in a hurry, Dr Yang? No, sir.
Just ready when you are.
Mm-hmm.
So then, a 65-year-old woman is being seen by her primary care physician for a workup of osteoporosis when she is found to have elevated calcium.
Her P.
T.
H.
level was well above normal.
Her doctor sends her to you.
Elevated calcium and P.
T.
H.
would indicate primary hyperparathyroidism.
I would offer the patient a para thyroidectomy.
And first I would explore the right side.
If that gland is large I would biopsy it.
Um, after doing the biopsy, I would Hang-hang on.
What-what did the pathologist report say? Path comes back with parathyroid hyperplasia.
Uh Um, and how large was the gland? How much longer are we gonna give this Dr.
Karev? Next, I would resect it and explore the other glands.
Aggressive choice.
Well, I suppose I could wait for the I.
P.
M.
before taking further actions.
Mm-hmm.
Are you sure you're okay with that? Yes, I'm okay with that.
Mm-hmm.
If the I.
P.
M showed P.
T.
H.
levels in the normal range Dr.
Grey? I would feel comfortable concluding the procedure.
Dude, there's no other way? Helicopter.
Magic carpet.
That lane is open.
That's the bus lane.
I don't see any buses.
I'll get a ticket.
Come on, man.
I'll give you double any ticket.
What about my insurance? Come on, man.
Just take the bus lane.
- Nah.
- How far are we? Catch the game last night? Come on.
Move.
I heard it went 11 innings.
Move! Move.
Look out.
Move.
Come on.
Come on.
Okay, who wants more pancakes? You haven't had any.
Sit down.
I can't sit still.
He's taking his test right now.
It's cute, you being nervous for Jackson.
You want some more juice? It's paternal.
You're a natural father.
Are you sure you don't want anything? I could make some bacon We should have a baby.
Don't freak out.
I-I mean, I like this.
I like you, I like your kid, and I like your kid's moms.
And I You-you know, you-you don't have to say anything right now.
Just g-go back to worrying about Jackson, and we-we can talk about this later.
Um, I would say no rush, but, you know, actually, my F.
S.
H.
levels would suggest that rushing a little might not be the worst thing in the world.
Julia wants to have a baby with Mark.
Oh, I can't even deal with that right now.
Wow.
I should've picked him up myself.
I mean, I what's wrong with me? Okay, I thought he was your brother's best friend, not yours.
We were all super close, and he was my rock when Tim died.
I just oh, god.
I let my rock take a cab.
Oh, so you let him take a cab.
Well, I mean, listen, he just flew in from Tibet and he has cancer.
I mean, the least I could do is pick him up at the baggage claim.
Hey, hey, hey, hey, hey, okay, you need to chill out.
- Wh - Look, I know that you're worried, but as far as cancers go, I mean, his is very slow growing.
He told you he found out, what, six months ago? I mean he could be fine.
- Yeah.
- Yeah.
Well, with you in the O.
R.
, I'm not worried.
You're gonna love him, and he's gonna love you.
Well, I'm taking his tumor out.
It's the least he could do.
Phoenix.
Nick! Hey.
Oh, it's good to see you.
Ohh.
Wait.
What's with the cane? Tumor, man.
It hurts to walk.
Already? But you were only diagnosed six months ago.
Did I say months? I meant years.
So you must be the wife.
Yeah.
Good to meet you.
Good to meet you, too.
Julia went all F.
S.
H.
on me this morning.
Is that a sexual term? You know what? Never You know what? I don't want to know.
She wants a baby.
She wants my baby.
What did you say? Nothing.
It's crazy.
Until you think about it and realize it's kind of genius.
I love Julia.
I want Sofia to have some siblings to grow up with.
Why wouldn't I do it? Are you asking me if you should have a baby? Well, you think I shouldn't? Have a baby or ask me if you should have a baby? So you think I should do it? Well, do you want Julia to be in your life forever? You think I shouldn't? Uh, do you have to answer that right now? Hey.
Answer what? We were just talking about the, uh, cranioplasty.
Oh.
It's exciting, right? Yeah.
Charlie Konner, 37.
Uh, he fell off the roof six months ago.
He presents for repair of a skull bone defect that occurred secondary to surgical removal of part of his skull.
Um, we waited several months for the swelling to s-subside before Wh uh, what-what were you doing, um, anyway? Being an idiot.
B you gonna fix it next time? No, I want the roofers to fix it next time like they had to do it this time because humpty-dumpty almost killed himself.
Wh you want to pay for it? Okay, we have mirrored the healthy skull and created a custom titanium plate that we will secure to the bone.
Titanium.
Like the terminator.
And I'll take fat from the belly and fill in the gaps, pull your face into shape.
So, doc, what are you using to fasten the new skull into place, - hexagonal screws? - Yes.
You know your stuff.
Yeah, we could do this in my garage, save me a few grand.
You got a 2-millimeter bit? Do I have a 2-millimeter bit? Please don't encourage him.
What? No.
I am counting on you to treat these candidates extremely well.
Show them whatever they want to see.
- Really woo them.
- Woo? Yeah, woo.
You know, uh What about me says "Woo"? After the boards, we might be losing some very good doctors to other programs.
Now if that happens, we need to be sure that we have some fresh talent ready and willing to take their place, so I am asking you, as chief, please woo their socks off.
For you, just this once, I will woo.
Uh, their socks off? D-don't push it.
Hi.
Hey.
Hey, um, so, uh do you have any word on what Cristina's plans are for next year? No.
No, not yet.
Oh.
Oh, okay.
Um will you keep me posted? I will.
Good.
Thanks.
The first session was so easy.
I want to punch your face.
Hey.
Hi.
I am, uh, so, so sorry to interrupt.
I'm, uh, I'm Dr.
Karev.
I was stuck in Seattle with a patient, and, uh, well, I don't want to bore you with a bunch of travel crap Your time was set for 9:00 this morning.
We were here.
We called your name.
Yeah, I was with a patient.
You get that.
We all have patients, Dr.
Karev, yet, here we were.
So what, I-I-I just fail? The first of three sessions, yes, which means you need perfect scores in the next two sessions.
How are you everywhere? How'd it go for you in there? Look, baby, I know you were shocked.
Shocked? Shocked at the sight of my mother half naked with a senior attending at my hospital? No, far from it.
Okay? I mean, it's kind of par for the course for you, right, mom? But every door that I open, every-every corner that I turn, there you are.
I know I'm your mother, but I'm also a woman.
- I have needs.
- Mm.
If you don't want to talk about this like an adult, don't bring it up.
Wait a second.
Did I bring it up? Did I bring it up? Don't play games.
Just talk to me.
Just leave me alone! I'm in the middle of my freakin' boards.
Are you following me, mom? I'm the examiner in the room right next to yours.
Of course you are.
After that, I might mobilize the small intestine to create a roux limb, and open up the pancreatic duct longitudinally from the tail to the neck? The patient has died.
Moving on to the next scenario.
Um, can we can we go back - just-just for a second? - We're moving on, Dr.
Kepner.
- A 38-year-old male with a history - Yeah, but-but if we could just go back, just for one second so that I can clarify.
You have a 40-year-old man who complains of rectal pain and burning with defecation and occasionally some blood in the bowel movement.
I would do a rigid sigmoidoscopy to make sure there were no lesions in the rectum.
Squeamish, Dr.
Grey? No, not at all.
Good, then let's pick up the answers, shall we? Of course.
If there were lesions in the rectum, I would do an incisional biopsy and begin to fulgurate I would cover the bowel with omentum and close the fascia primarily.
The sutures tear right through the fascia.
In that case, I would use through the full thickness of the abdominal wall.
Moving on.
Because I would make sure the area - was adequately drained and closed - Dr.
Kepner Because if it leaked, and if the leak was early, I would re-explore the patient and repair the leak, making sure that if that if Once a question is finished, it's finished.
Finished.
Yes, I know.
I'm sorry.
I just really need you to understand that if the leak was late, I would obtain an abdominal C.
T.
just to make sure, and also, if it wasn't if it wasn't drained god.
Um, can you hang on just for a second? It's just so incredibly hot in here.
Ohh! Oh, god.
Oh, god.
Can we move on, Dr.
Kepner? Would you allow us that courtesy? Yes.
Yes.
Great.
Thank you.
Now a 38-year-old male with a history of diabetes I'm sorry.
I'm sorry.
I'm sorry.
Just-just-just Just-just one last thing going back to the beginning, 'cause you you heard what I said about finding the pancreatic duct, right? Because I just I really want to make sure you know that I would drain the anastomosis, r Well, I-I that patient should be stable! They just Why won't you tell me? Just just-just tell me! How am I supposed to answer this question without the full information? Please t Um Look, I'm-I'm, um, I'm-I'm a really good doctor.
I am.
I just-I need I need all the information.
I'm I'm a really good doctor.
Um, no free air.
The spleen the spleen looks fine.
There is some perihepatic fluid I'm sorry.
Are you guys hearing this noise next door? It's very distracting.
If we could just ask them to keep it down.
If you get distracted this easily, I think it calls to question your ability to function in a high-volume O.
R.
Certainly calls it into question.
It is not that at all.
Okay? It's just my Um Never mind.
Let's wait for traffic to die down.
We wouldn't want to throw you off your game, Dr.
Avery.
I'm fine.
Let's just I would stop the patient's continuous bleeding with a portacaval shunt.
Your patient is now in a coma.
That's highly unlikely, but, uh, in that case, I would suspect a hepatic encephalopathy and check an ammonia level to confirm.
I'll save you the trouble.
It's confirmed.
I would check the patient's medication Medication Okay, then I'd start on lactulose and neomycin.
- The patient - Still not getting better? Then I would do a shunt revision with a stent graft.
Stent graft? Yes, a stent graft.
Mm.
Well Risky move, Dr.
Yang.
Well moving on.
Did you have something to add, Dr.
Yang? Nope.
All good.
Mm-hmm.
Does that hurt? Nope.
- What about - Ow.
Yeah.
That's what happens when you wait six years to get treated.
Ohh.
So she's not shy.
Yeah, I know.
I never went for shy.
Yeah.
I've been working with a naturopath.
I figured I'd try the nontraditional route.
- It helped.
- Oh.
It did.
But the pain started to kick up, so I saw a real doctor.
And he was gonna send me to an orthopedic surgeon, but then I was like, "Hold up.
" "Yuma Robbins just married one of those.
" Not that it was a real wedding.
Excuse me? Oh, um, she thinks you're serious.
Oh, I am serious.
Tucson's already married.
Mm-hmm.
To him.
She loves me.
We were 10, it was in my tree house, and we had rings made of crabgrass.
You're probably the last guy I ever kissed.
It was a beautiful ceremony.
Tim officiated, her brother.
He made me swear to stop pulling the streamers off of her bike.
Mm.
It was an issue for a while.
Yeah, I'm a little concerned about how much pain you're in.
So I am going to order some new scans.
These are how old? I had to finish up a project on the guys who carry all the tourists' crap up K-2.
With a cane? I stayed at base camp.
Play through the pain, right? - No.
- Anybody? Is she always like that or am I dying? No, you are going to be fine, because she is a genius with a scalpel.
She'll be in and out, and you won't even know it.
- And they're not even gonna use drugs.
- Oh.
Nope, nope, just, um, chamomile tea.
You are so damn cute.
How does she get through a work day with you around? I don't know.
I forgot how much I missed you.
Me, too.
And our surgical rotations often allow flexibility to set aside consecutive days for research projects and field work if necessary.
Any questions? Would I have to share an office? We don't h I'll have to check on that.
Are parking spaces assigned for attendings, or do we have to, like, find our own? I'll have to check on that.
All right, we just need to screw this down and then adjust it to fit.
Well Mark said that I get to graft the fat.
How cool is that? Yeah, that's cool.
I'm gonna be your big brother for 30 seconds.
Okay.
Uh, Julia wants to have a baby with Mark.
She what? What did she say? Well, I don't know.
What do you mean, you don't know? Wh-what did he say? How did it go down? My 30 seconds of brotherly advice is over.
I gotta go check on a patient.
No, I oh, does he want to do it? I mean, did it seem like he was excited about it? Or does he seem like, "That's an insane idea"? Because it is.
Yeah, you know what? I D I hope you told him that it's an insane idea.
Are all your questions gross? Gross? What do you mean, gross? Uh, they keep asking me about bowels and bloody stools? It's general surgery.
What do you expect? You're not helping, at all.
My guy is a freakin' fossil.
The last time he was in the O.
R.
, it was lit by candles.
Maybe I'll just live in here, in this stall, in my filth till I die.
Sick woman in here.
Go away.
Uh, I-I really need to get in there.
Uh, sorry.
Closed for maintenance.
- Please let me in.
- Come back later! Hey, the applicants keep asking to see the gym.
Should I show it to 'em? 'Cause I don't want the, you know, cobwebs and sweaty menthol stench to scare them When did I become the advice columnist? - Touchy, touchy.
- Well, I'm sorry.
It's just, no one can seem to make up their own mind today.
Oh, people do make up their own minds, they just need a little help getting there.
What do you mean? Okay, if someone comes to me with a problem - Yeah.
- I give them a metaphor.
A metaphor? A figure of speech which Yes, I know what a metaphor is.
- Fantastic.
- Thank you.
Now the next time someone comes to you with a problem, you just give them a metaphor.
Any kind of metaphor? See? That's the beauty of it.
They'll draw some meaning from it, and it'll help them make the decision they were gonna make in the first place.
I'll stick with being honest.
Thank you.
Suit yourself, but when they take your advice and it doesn't work out, honesty can bite you in the ass.
Ooh.
If you don't mind, it is a men's room.
What? What? You're supposed to be doctors.
I've seen your things.
You've seen mine.
It's all just flesh and cartilage.
Get over it! Ugh! April, wh Oh, hey, Jackson.
How's it going? Not so good.
You? I am dying in there.
I am actually failing.
You, too? 'cause mine is a total fiasco.
They think I'm insane! Oh, they're toying with me.
I am self-destructing into a puddle of sweat.
I don't know what's wrong with me.
Oh, I know exactly what is wrong with me and I still can't reel it in.
I broke my promise to Jesus and now I can't even talk to him a-and I need him.
He's the only one who can calm me down! Why the hell did you do it? - Why'd you let me? - I don't know! - You said it was okay.
- I know! I knew you'd regret it! Stop yelling! Why are you yelling at me?! Because I'm all messed up now, too.
I mean, what am I? I'm-I'm now the guy that made you break your promise to Jesus? I am not that guy! All right? That guy is gross.
Okay? It's all very unbecoming, especially for an Avery.
What? Are you are you honestly comparing breaking my promise to Jesus with putting a tiny dent in your family crest? You're right.
You're right, and I'm sorry.
My mom is the examiner in the room right next to mine.
It's throwing me.
Oh, god.
I know.
It's-it's I'm worried about my mom and what she's gonna think if I fail.
It's pathetic.
- Right? - No.
God, no, Jackson.
It's not pathetic.
That's the most important relationship in your life.
The problem isn't that I broke my promise.
That's not the problem.
The problem is The problem is That it felt good.
It felt good.
I shouldn't have taken advantage.
Taken advantage? What? Oh, we should we should go.
Taken advantage? I kissed you, remember? Yeah, but I kissed you back.
Yeah, but then I unbuttoned your shirt.
Yeah, and then I pulled up that skirt.
Yeah, but then I kissed your neck.
Yeah.
And then I took off your shirt.
And I But then I unbuckled your belt.
And then I slipped my hand up your back.
And I wrapped my arms around your neck.
And then I Then you Then I Oh, no.
He's not gonna Oh, yes, he is.
Oh! Oh, no, no.
Oh, my god.
I told you.
Disgusting.
Dr.
Bailey, where are the candidates? Oh, over there destroying my appetite.
You know, I never thought I would've said this, but we need to keep our people, people.
- Mm-hmm.
- Right? We haven't put in all this training and put up with all their nonsense to go groveling at the feet of bread sniffers.
Kepner's already gotten job offers - at four different programs.
- Oh.
Well, Grey's not going anywhere.
Not without Yang anyway.
Cristina has options.
My contact in Boston may have mentioned that Meredith said their program's her first choice.
You're building a house.
Harvard has an excellent neurosurgery department.
W And they have plenty of really nice houses.
Don't be all cryptic and then just walk away.
Meredith? Uh, I lied to you.
About what? I'm not okay.
I might be dying.
I think our daughter tried to kill me with her flu for being a bad mother.
Why didn't you tell me before? I'm failing, Derek, and I and I-I don't think I can go back in there.
I just can't I mean Will you still love me if I fail? You want me to yell at you or tell you to come home? I want you to tell me what to do.
The test is a mirror.
What are you talking about? The test it's a mirror.
Reflecting my sickly incompetence? Are you saying I won't like myself if I give up right now, that I won't be able to look myself in the mirror if I quit? Whatever you decide, I will still love you.
No, you won't.
Nobody loves a quitter.
Good luck, Meredith.
You find out the patient has advanced metastatic disease and is terminal.
What do you do? Honestly? I'd pray for them.
I know that's not the right answer, but it's what I'd do first.
Or at least if you asked me yesterday, that's what I'd do.
Now I'm not so sure if he's listening.
Dr.
Kepner, this is highly inappropriate.
Yeah, well, so is having premarital sex in the men's room with a really good friend, but that just happened, so You know, I have been surrounded by scientists for a decade now, holding back my feelings about my relationship with god 'cause I was afraid of being laughed at or judged or considered less of a doctor.
I was hiding, ashamed to admit that I love him, that his is the one relationship I count on.
And now now I'm not sure if I just screwed that up or freed myself from its limitations.
I The one thing I know for sure, though, is I think I'm done hiding.
Dr.
Kepner, we asked you a question.
Yes, I would do a palliative endoscopic stenting.
If that failed and the patient was still alive and having pain, I would do a biliary-enteric bypass.
After that, I might A 30-year-old female comes in with third-degree burns.
You've checked her airway and started fluid resuscitation with D-5 N.
S.
fluids.
Actually, I would use L.
R.
for fluid resuscitation, not N.
S.
uh, saline has too much chloride, and that could cause acidosis in my patient.
Okay.
So you've started your patient on a liter of L.
R.
Thanks for assisting, Bailey.
You know, Nick did a big spread in "National geographic" once on this school for orphan girls in Calcutta, and he-he sent them a bunch of cameras.
I think that it was polaroids so they wouldn't have to pay for the film to get processed But anyways, you know, a couple of those girls actually became photographers.
Like professionals.
Isn't that amazing? We're not going to kill your friend.
What? I know.
I'm just I'm saying Hey, does he save puppies, too? Less sarcasm.
A little more focus.
Oh, shoot.
We were supposed to bring snack today to the day care - for all the kids.
- Today? Yeah, that mom from psych asked if we would switch with her, and I said we would, and then I forgot.
You need to write this stuff down.
I - I know.
I know.
I am so sorry.
- I Sorry.
You didn't forget snack today, did you? No, I'm seeing mets in the vessels.
Look at this.
Damn.
And if they're here They're gonna be everywhere.
The temporalis muscle is atrophied.
Any idea why, Dr.
Grey? Uh, lack of use? It had nowhere to attach since the bone was gone.
That's right.
It's too late for this muscle.
It's missed its chance to attach.
Why are we talking about the temporalis? Teachable moment, Dr.
Sloan.
Stay out of it.
Once you inject the fat into Charlie's temple, the muscle will Again with the muscle? Yeah, the once healthy muscle will slowly wither to nothing all alone, surrounded by a thick layer of fat.
Very crafty, Dr.
Shepherd.
Message received, loud and clear.
They had snack.
And now I have 2 pounds of strawberries for no reason.
Why-why is Teddy here? Oh, honey.
We did a pet-scan, and, um Nick has intradural mets.
They've spread into his lymph nodes.
They've even gone into his heart.
He has a cardiac tumor, which looks like it might have invaded into the right ventricle.
At this point, there's very little that we can do.
I-I would be concerned about Crohn's disease but differential diagnosis could be P.
U.
D.
, ulcerative colitis, or appendicitis.
Dr.
Grey? I'm sorry.
I can't I'd locate the fistula endoscopically, then inject fibrin glue.
What about an abscess? What about it? Well, apparently, you have ruled it out.
It just feels a bit cavalier, doesn't it? If you say so.
I'm having a hard time understanding why I would open her up when I could treat it endoscopically.
Precisely my question, Dr.
Yang.
I've treated this condition a dozen times.
And I a thousand times.
If you would rather I open her up and do tube duodenostomy, that's fine, too.
It's more invasive, but fine.
Mm-hmm.
Dr.
Grey.
Dr.
Grey, we're gonna have to call this.
You can take the exam again next year.
And we won't we won't count this as a failure - so please - Okay, you're doctors.
You can't handle a little vomit? Dr.
Grey, it it's really okay I would repair it with an abdominal approach, reduce the size of the hernia contents, excise the sac, close the hiatus, and perform a floppy nissen for antireflux and gastropexy.
But ask me something else, because I've known that answer since I was, like 12 years old.
My mother practically invented the floppy nissen.
So keep them coming, but don't go easy on me.
All right.
A 40-year-old man presents with a suspicious lesion on his left temporal, sent in by his in Whew.
Pigmented lesion? You seem awfully sure of yourself.
I'm sorry.
Is that a question? Do you feel threatened? Oh, have we moved on to psychology? I find your hostility curious.
And I'm curious as to why you think me hostile.
You know, if you don't agree with my approach, I wish you would voice your issues.
I-I don't disagree.
I don't believe you.
Are you calling me a liar, sir? Fine.
You know what? Earlier when I said I was okay with that open procedure, I wasn't.
That might have been okay when, like, hawkeye and B.
J.
did it on "M-a-s-h," but this being the new century and all, I would have, as I said earlier, treated it endoscopically.
Then you lied earlier.
You know what? Oh, god.
I can answer these questions any way you want using medical techniques from any era.
So how about we just, you know, pick a decade you're comfortable with and go from there? Well, then It's been a pleasure being witness to such genius.
I can now finally retire knowing that such advanced and creative minds are at work in the surgical field, hmm? That's it? Oh, I think we've had enough of an education today, Dr.
Yang.
But there's still 20 minutes.
No need.
Oh best of luck.
I'd do a biopsy.
Path shows L.
C.
I.
S.
What's your best mastectomy approach? I'd make a periareolar incision to preserve the inframammary fold.
But wait.
Did you say L.
C.
I.
S.
? Yes, lobular carcinoma in situ.
You wouldn't do a mastectomy.
You'd observe and repeat mammos.
You already did a skin sparing mastectomy.
That was a trick question.
You had all the facts to answer.
Yeah, but my answer was wrong.
I'm gonna fail because of a trick question? The questions are designed to get your response You gotta be kidding me? You missed your first session.
You're lucky to be even getting this chance.
Yeah, I missed my first session for the best freakin' reason.
I was with a patient.
For months with this kid who who doesn't have a chance, not a chance.
And we give them a chance and we try everything, and then when there's nothing left to do, I'm supposed to just walk away from his mother? I had to be there.
I had to.
And what what did I miss here, a few more hypothetical trick questions? What are you staring at? You guys are doctors.
You're supposed to decide if I'm gonna be a doctor, and you can't understand that? Thank you, Dr.
Karev.
It's Karev.
Can you at least tell me if I passed? Thank you.
Thank you.
Taxi.
Well, you-you don't want to miss your flight.
No, I don't want to miss my flight.
I better go.
Richard, I don't regret last night one bit.
Neither do I.
It's just bad timing.
You know, we live in different cities.
It's-it's too complicated right now.
Yeah, bad timing.
Bye, Richard.
Bye, Catherine.
Safe flight.
Oh, uh, call me if you hear any more about the boards.
Oh, I will, and call me when you get home, let me know you got there okay.
I will.
Are you going to the trauma and critical care conference in May? In New Orleans? I'm speaking at it.
Me, too.
I'm at the Sonait house.
Where are they putting you up? Um Windsor court.
Oh, no.
Sonait house is much better.
The breakfast biscuits will make you jump up and down.
When do you fly in? Uh, I think it's Thursday.
I fly in Thursday, too.
I can't believe it.
My whole Charlie is back.
You people are miracle workers.
So how long till I'm back on the ladder? - I-I just got a tile saw - Uh-huh.
And I'm gonna mosaic the stucco.
You ca Dr.
Shepherd, talk some sense into him.
It's really not my place.
But if you want to say something to your husband, please, by all means, you should do it.
I know how much you love to work on the house, but listen to me, you are clumsy.
And I can't stand the thought of almost losing you again.
So would you just take a second and what's left of your brain and think about how I felt about it, how scared I was to lose you forever? You're right.
I'm sorry, babe.
I'll-I'll-I'll find a new hobby.
Right, something something we can do together, like, uh, bowling.
Oh, no, um, I I hate bowling.
But you never even tried it.
Well, you can hate something without trying it.
Oh.
Hey.
Hey.
Thanks, uh, for today.
For-for letting me, uh You did a good job in there.
Thanks.
You okay? I love you.
Oh, g oh, my god.
That just came fly-flying out of my face like it was s-s-some kind of I-I l I love you.
I just god.
Did it again.
I I-I-I-I love you.
I-I do.
I just I-I love you.
And I have been trying not to say it.
I have been trying so hard to just mash it down and ignore it and not say it.
And Jackson is a great guy.
He-he is, and he he's gorgeous, and-and he's younger than you, and he doesn't have any grandkids or-or babies with his lesbian B.
F.
F.
S and he's an Avery, and-and he liked me, you know? He he really liked me.
But it was never gonna work out Because I-I love you.
I am so in love with you.
And you're-you're you're in me.
It's you're like it's it's like you're a disease.
It's like I am infected by Mark Sloan.
And I just can't I can't think about anything or anybody, and I can't sleep.
I can't breathe.
I can't eat.
And I love you.
I just I love you all the time, just every minute of every day.
And I-I-I I-I love you.
God, that feels good, just to-to say that to j I am I feel so much better.
Just I love you.
Mark? Hey, Lexie.
I thought you said the lobby.
You ready? Hey there, sunshine.
You feeling okay? Yeah.
You know, just groggy.
You guys got good drugs in this place.
Good.
What the hell were you thinking? - Dude - You're an idiot.
You should have called me.
I mean, wh-why didn't you call me? I'm a doctor.
What do you think I do all day long? Instead you go to some quack in Tibet.
I mean, you should've freakin' called me! Naturopathy works, too, flagstaff.
Whoa.
It's not flagstaff! And it's not Phoenix and it's not Tempe.
It's Arizona Robbins, M.
D.
Do you know what that means? How do you spell it? It's not funny, Nick.
Nothing is funny.
You're dying! And you know what hell it was when Tim died because you were there, and-and you and I barely made it through that.
So to do nothing for six years and then to come when it's too late, I I Why do you think I didn't come to you sooner? As if after Tim died, I could You think I don't know how this must feel for you? You're an idiot! I couldn't have helped Tim, but I could've helped you! I'll admit, the romans had a point.
You've gotta live life.
Ugh.
Gotta pee.
Gotta pee.
Gotta pee.
Gotta pee.
Gotta pee.
What time you got? Oh! It's supposed to come online at midnight.
I mean, it's four minutes late.
Come on, people.
Crazy doctors, they crashed the system.
I already know I failed, so I don't know why I keep hitting the refresh button.
And living means that every morning when you wake up you have to choose Okay, if anyone failed, was me, because my guy had a vendetta.
Please.
I've got the odds on failure.
Are any of you on call? I've got a trauma.
No! Wait.
Wait.
Wait.
I passed.
I passed.
I passed! I passed! I passed! Yes! I passed! I passed! Oh, my god! Yeah! Between seizing what life offers in the moment and forging ahead, no matter the weather - Alex? - It's not coming up.
Here.
Here.
Use mine.
Oh, unh! Yes! Wait.
Wait.
Where is April? Or closing the curtains and shutting out the day.