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A Change is Gonna Come

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In the practice of medicine, change is inevitable. New surgical techniques are created. Procedures are updated. Levels of expertise increase. Innovation is everything. Nothing remains the same for long. We either adapt to change, or we get left behind. Change, we don’t like it. We fear it but we can't stop it from coming. We either adapt to change or we get left behind. It hurts to grow. Anybody who tells you it doesn’t is lying. But here's the truth: sometimes the more things change, the more they stay the same. And sometimes, oh, sometimes change is good. Sometimes change is everything.

A Change is Gonna Come is the first episode of the fourth season and the 62nd overall episode of Grey's Anatomy.

Short SummaryEdit

Meredith, Cristina, Izzie, and Alex get their own interns while George repeats his internship along with Lexie Grey, Meredith's half-sister. Izzie saves a deer. Bailey struggles as the number 2 girl, jealous of Callie for being chief resident.

Full SummaryEdit

In his office, the Chief puts on his glasses and starts reading at his desk.

George enters the locker room and finds his locker.

Cristina’s interns walk up to her, she turns to look at them and starts repeating Bailey’s speech from their first day as interns: “I have five rules. Memorize them. Rule number one, don't bother sucking up, I already hate you. That's not gonna change.”

All of the other now-residents are doing the same with their interns.

Izzie tells them rule number 2: trauma protocols, phone lists, pagers and how they are supposed to answer every page at a run. Then starts to leave expecting her interns to follow her, but they don’t so she tells them they are supposed to do so.

Alex walks through the hall and tells his interns: “Your first shift starts now and lasts 36 hours. You're grunts, nobodies, the bottom of the surgical food chain. You run labs, you write orders, you work every second night until you drop, and you don't complain.” He enjoys himself as he says it.

Meredith shows the interns the on-call rooms, and repeats Bailey’s third rule, only with a little change: “On call rooms. Sleep when you can, where you can. You know, but not with anybody. Not attendings...especially not attendings. Sleeping with attendings...not a good idea. Where was I?” George, who turns out to be Meredith’s intern, completes rule number three: “Rule number three. If you're sleeping, do not wake you unless a patient's actually dying.”

Cristina again, tells rule number four: “The dying patient better not be dead when I get there, because not only will you have killed someone, you will have woken me for no good reason. Are we clear?” Repeating her half sister’s question in her first day, Lexie raises her hand and says that was only four rules. Cristina says rule number 5, “When I move, you move.” An awkward silence follows because her pager doesn’t go off, and her interns just stand there expecting something to happen. Cristina yells “Go!” and they all leave.

Meredith, Cristina, Izzie, and Alex talk about the new interns, Cristina says she hates them, Izzie thinks she was a mess while Alex thinks he’s the new nazi. George walks up to Meredith and says he wants to talk to her. Izzie interrupts to ask him about his vacation, George barely answers and Izzie starts talking about how she spent the 17 days they had off alone, because Meredith and Cristina went to Hawaii on Cristina’s honeymoon, Alex drove in Rebecca’s direction. Cristina complains on how everyone is whiny when she was the one left at the altar.

A few interns come to the hallway, but before they can sit down Meredith, Alex, Izzie and Cristina tell them to get out since it’s “residents only”. George says he should leave too then, and even when the others call him back, he goes away without talking to Meredith.

Meredith asks Cristina if she’s seen Burke, and Cristina asks if she’s seen Derek. Neither of them has seen them or talked to them in the 17 days, and they both say they are fine with it.

Bailey walks up to where Derek is standing. He tells her he’s supposed to tell Cristina about Burke’s resignation, to which she says he has to be honest. Then Derek asks her if she wants to have a drink later, she says he has no-one to talk to now that Addison is gone and he and Grey “aren’t smelling each other on elevators”. He says he has people to talk to, asks the chief to go for a drink and gets another no for answer. Mark wants to have a drink but Derek says he didn’t say anything about a drink. The chief wants to talk to Bailey, but she refuses.

The Chief announces they have three traumas coming, and tells Callie to prepare her residents, then asks where they are. Callie says she paged them, and then asks Bailey about them. Bailey only says “When I page them, they come running”, after the chief leaves Callie says she shouldn’t have said that.

Meredith, Cristina, Alex, and Izzie finally get there, Meredith sees Derek but there’s no Burke with him. They are told to monitor their interns. Cristina calls her interns by numbers: 1, 2, 3 and 4. Number 3 is Lexie, Meredith’s half sister. Meredith laughs at this and then George says he doesn’t respond to being called a number. She tells him to go wait for the ambulance and asks the rest of her interns to go with her. Alex tells his interns to just stand against the wall unless he calls them. And Izzie explains that it’s a trauma situation and if they have questions they should ask her. Her interns talk behind her back, saying they got stuck with the dud of a resident who “freaked out and killed a guy and had to go on probation.”

George and Lexie talks, she asks which resident is Meredith Grey. He tells her he hasn’t told Meredith about her yet, and Lexie realizes he knows who she is. She asks him what Meredith is like, but then overhears Bailey talking to Meredith and finally finds out who her sister is.

Ambulances arrive, Cristina walks up to one of them but it’s a dead guy. She tells her interns if they want to see a dead guy, and then when she’s about to call him, the man gasps. Meredith and Bailey take the second ambulance, which brings a pregnant woman whose arm was cut clean. Alex goes to the third ambulance in which comes a man with a knee injury, who talks about the accident and says he’s hungry.

Meredith tries to go inside the hospital with the pregnant woman, but Lexie cuts her path and introduces herself.

Meredith tells George about her sister, and realizes he already knew about her and didn’t tell her. He says he has a lot going on. Izzie enters the room and asks Meredith if she needs some help, her interns are following her. Meredith tells her it’s a bit crowded. Mark comes into the room too see the patient and says there’s a chance of good recovery, but they still haven’t found the arm.

Alex and Callie are treating Joey, the guy with the injured knee, who is still saying he wants something to eat, which Callie interprets as a good sign. Alex asks if he’s going to need surgery, but Callie says no. While they are looking at the man’s X rays, he starts eating cotton balls.

Izzie comes in and introduces Cristina to her interns, then comes up to her and whispers if there’s anything she can do because she’s a fraud as a teacher. Cristina says no, and tells her to go be a fraud somewhere else. Izzie and her interns leave. Lexis enters the rooms bringing the x-rays. She starts telling Cristina that she met Meredith, her sister. Cristina looks at the not-dead guy’s x-rays and says she needs Dr. Shepherd.

Derek walks up to Meredith. She hangs up and tells him about the severed arm she can’t find. Lexie walks up and apologizes to Meredith about blocking the ER doors, explaining she was nervous about meeting her. Derek realizes he knows Lexie and tells her she’s the girl from the bar. Lexie recognizes him, and Meredith, somewhat upset, says she is the girl from the bar and storms away. Lexie says her sister hates her, Derek find out Meredith and Lexie are half-sister. Then Lexie tells him Cristina needs him for a consult.

Callie and George talk about his first day as an intern, she says he could be the rock star intern, or maybe the daddy intern. He reacts to that last thing asking what she had just said. Callie says she’s not pregnant, but she might be. George doesn’t look happy and she says she’s just trying to cheer him up, that her being pregnant is a good thing. George says his having a bad day, she says a bad month and that she loves him. He doesn’t say it back.

A little boy and his father enter the ER, the little boy with blood on his t-shirt and screaming for help, the father says they found and arm. Meredith takes the arm and leaves. The boy keeps asking for help, saying “She’s in the truck and she’s hurt”. Izzie walks up to him and after checking the blood on his t-shirt isn’t the boy’s, she tells her interns to get gloves, iv’s, trauma gowns and they all go to the truck. When they get to the truck, they find a deer inside.

After a few moments, Izzie decides to treat the deer. She tells her interns to get some things to treat the deer. They don’t move, but she says “when I move you move!” and they go away.

Derek and Cristina are viewing the x-rays. The man’s been internally decapitated. Derek says 90% of these cases die in the field, and he hasn’t seen one live. He tells the man about his situation and tells him to blink once for yes or twice for no. He then asks if he understands him. The man blinks yes. Derek asks Cristina to find his family and find out if he’s an organ donor.

Alex is telling his interns to finish treating Joey, when Callie arrives andasks how the patient is doing. Alex asks her if she can assign him something better because this case isn’t even surgical. Callie says no.

Meredith tells the woman with the severed arm that they found the arm and are checking If they can reattach it. Kathy tells her she’s alone, that she decided to have the baby alone after getting tired of waiting for the right guy to appear, and she needs her arm. Mark enters the room and says they are going to reattach it.

Izzie is treating the deer just as if it were a person, and the boy’s father tells her she doesn’t need to perform make-believe medicine, because his son is a big boy. Michael, the little boy, asks her not to let the deer die and that Izzie can save her. The father says his son needs to grow up and face things. Izzie replies she’s not helping Michael but Bambi.

Meredith is cleaning up Kathy’s arm when Cristina enters to tell her there are no signs of Burke. She notices the severed arm and Meredith tells her to get away from it. Cristina goes on saying she hasn’t seen Burke and that she won’t care if she never sees him again. Meredith tells her she’s seen Derek and Derek’s seen her, and it was awkward since he knows Lexie; and that even more awkward is that her half sister is Cristina’s intern. Izzie enters the room, says her interns think she’s a loser. Alex enters saying Callie’s a bitch for not letting him off his patient who has nothing wrong apart from being a nut job. Izzie asks if they know anything about deer, and Alex replies that they taste good. George opens the door but doesn’t enter. Cristina tells him about what’s going on, but he just says that Dr. Sloan is ready for the arm and leaves. The rest talk about George being an ass, and Alex says he has nothing to complain because the new female interns are hot, especially Lexie. Meredith tells him to get out before she hurts him. Cristina laughs. Alex says he’s going to Bailey over Callie’s head, to which Cristina replies Callie is over Bailey’s head. Meredith says that Bailey is over everyone’s head spiritually.

The Chief tries to talk to Bailey about Chief Residency, but she avoids the subject by asking him about his wife.

Cristina tells Derek she called the guy’s family and they are on their way. Derek asks her if she want’s to have a drink later on and asks her a reason why they can’t hang out after Cristina says no. She tells Derek she doesn’t like him, not because of Meredith but because he’s him. Derek asks him how Meredith is and Cristina says she’s fine. Derek says that’s her problem, she’s always “fine”. Cristina says they are fine people, they do fine, they are fine. Then, she asks about Burke and Derek finally tells her Dr Burke handed in his letter of resignation and asked him to tell Cristina.

Alex walks up to her and notices she’s doing research on the circulatory system of a deer. Bailey comes up and Alex asks her if she needs and extra set of hand in the OR. She tells him to talk to Callie. Callie walks up to them and tells Alex off, he leaves. Callie tells Bailey she doesn’t know how Bailey got them to respect her,then leaves.

Izzie asks Bailey if she knows anything about the anatomy of a deer. Bailey says “Not my intern, not my business, not anymore”, and leaves too.

Cristina tells Henry’s family about his condition, and that when they see him it could be the last time they see him alive. They enter Henry’s room, they wish him good luck and his wife says he loves him. Henry winks three times and his wife asks what three blinks mean. They realize it’s “I love you”. Derek says it’s time to go but before they leave the room, Henry’s daughter walks over to her father and blinks three times.

Izzie runs into George and asks him why he’s avoiding her. He says he’s on his way to surgery. Izzie tells him she said she loves him and he didn’t even say one word. George says he’s been there, exactly where he was a year ago, and that he’s freaking out. Izzie says they are all freaking out, and that she’s obsessed with saving Bambi. George gets upset because he thinks she is calling him Bambi, Izzie says she’s Bambi lost in the forest all alone, and then George leaves.

Mark tells Derek he’s really up for a drink if he needs to talk about Meredith. He says he was lucky because she had jerked him around. Derek tells him he doesn’t know what he’s talking about and tells him: “ Meredith's mother never wanted her, and her father was never man enough to hang around. She has a right to be damaged, and us, together, it's a big step for her. Her best friend gets left on the altar, and all she sees now is things like this, they don't work. She panics. She wants this. She doesn't know how to have it. And you know what? That's not her fault. So don't ever talk to me about Meredith Grey again, because you do not know what you're talking about. And I don't need a friend.”

The anaesthesiologist tells Kathy to count back from a hundred, but she says she’s not ready, that she doesn’t want to be alone anymore. Meredith tries to calm her down, saying it’s better to be alone and feel like a success that to be in a relationship and feel like a failure all the time; so they’ll take care of her arm and then figure out the rest later. Kathy starts counting back.

Joey starts choking, Alex feels his abdomen and finds out it’s rigid. He asks someone to page Dr Bailey.

Michael’s father is trying to explain him that hamburgers and meatballs are meat, and that he’s eating cow, but the little boy doesn’t really understand. Izzie asks one of her interns to ventilate the deer and after the father says it’s ridiculous what she’s doing she says it’s not childish or ridiculous to hold on to hope, and that his sons just want to believe things can work out for the best. She paddles the deer and it stands up on the truck.

Mark and Meredith are operating Nancy when she starts having contractions. Mark tells George to call OB, but he answers there’s no time because Nancy’s water broke and she’s crowning. George delivers the baby successfully and Meredith congratulates him. Mark says they are all heroes and if no-one minds he’d like to save the woman’s arms since she’s going to need it.

Derek is performing surgery on Henry when Lexie notices he is moving. Cristina tells her to grab his feet without contaminating the sterile field. Cristina holds his neck. She kneels beside Henry and tells him: “You cannot move. Do you hear me? This is not an option. Everything is not gonna be fine if you move. It will be the opposite of fine. You cannot leave the people you love. They need you. Not just the memory that you love them.”

Callie enters and asks how her patient wound up in this OR and no-one informed her. Bailey answers: “Dr. Karev didn't page you because he knows how to prioritize. Ten minutes ago, this patient was coding from a perfed abdomen. Under the circumstances, Dr. Karev's quick thinking is the reason that your patient is even still alive.” Callie tells Alex she expects a fully dictated chart before he leaves, and leaves the OR. Bailey finds coins inside Joey’s abdomen, and says he must suffer from pica, an uncontrollable urge to eat any and everything. Richard enters the OR to talk to Bailey.

George and Lexie look at the babies in the nursery while they talk. George tells her he delivered one of the babies, and Lexie can’t understand why he isn’t excited. Lexie tells him things like not passing the intern test happen, and it’s nobody’s fault. George tells her about everything that happened during that time that lead to him not passing his intern exam, and Lexie tells him her story: “Lexie: I didn't plan on being here. I was all set for an internship at Mass Gen. And then, my mother gets the hiccups, and I'm at a funeral. You know, we all have problems. Moms die ,and dads drink so much that they don't even know what year they're in, and sisters...I...I didn't even know that there was a Meredith Grey until a couple of months ago. And she won't...she doesn't even want to talk to me. I don't want to be here. You know, I...I'd giving anything to not be here. You know, to...to have my life work out the way I planned, to even have time to ask, "what about me?" So you...you change. You...you get over it. I'm here now, so...and you...you delivered a baby today. So, stop feeling sorry for yourself.” George says she’s kind of awesome, and as the scenes fades away, we see Meredith watching them from the other end of the hallway.

The Chief tells Alex to go make sure Psych is prepared to consult on Joey, Alex leaves and Richard tells Bailey they are going to talk wheter she likes it or not. He says he knows she’s angry and disappoint, but Bailey says she’s not angry or disappointed but speechless because he didn’t think she would’ve made and excellent chief resident. Richards says he knows, but that she’ll make an ever more excellent surgeon and that the reason he didn’t choose her to be Chief Resident is because that way she’ll be stuck with paperwork and he’d rather see her in the OR.

Mark walks up to Derek and says he’s the one who needs a friend. He says he didn’t go to Seattle for Addison or to be chief, but to get Derek back. They both smile when they realize what Mark’s just said, and he says he want’s to take it back now but he can’t. Derek says maybe they should have a drink, but not that day. Izzie talks to her interns: “I know you didn't wake up this morning expecting this was how your first day was gonna go. You thought you'd get to reattach an arm or observe brain surgery. Instead you helped save the life of a deer. You can bitch and complain about it, or you can adjust your expectations. 'Cause like it or not, you're stuck with me. And I'm the kind of doctor who lets a little kid convince her she can do the impossible. Oh, plus, when I woke up this morning, I thought today was gonna go a lot differently, too. I thought I was gonna get the good interns. Instead I get stuck with the duds. So I have to adjust my expectations as well.”

Cristina watches Henry’s family when they go in to talk to him after the surgery.

George enters the locker room and everyone is looking at him. They tell him they heard he delivered a baby, and Lexie remarks that it was on his first day as an intern. They are all amazed at what George did, and ask him how he felt, he starts telling them feeling better about himself.

Cristina is sitting there alone and Alex walks in and sits next to her. He shows her the bag of coins that came out of Joey’s stomach. Cristina says “No kidding?” but she looks sad. They sit in silence for a few seconds until Alex says he misses Rebecca, and Cristina says she misses Burke. Then Alex asks her if she wants some money, and they smile.

Bailey is leaving and walks past Callie. Callie asks if she wants to humiliate her some more, that she gets she sucks at her job. Bailey just says she hopes tomorrow is better.

Meredith comes out of the elevator. Derek and Lexie are each on one side of the hallway. They both call out for her. She looks at both of them and walks away with Derek. Meredith and Derek break up.

Derek says they are broken up as he walks up to Meredith. They start kissing and say “A break up kiss”, and then “some break up sex”.

Izzie answers the door and it's George. George says he loves her too.

CastEdit

  • Meredith Grey
  • Cristina Yang
  • Izzie Stevens
  • Alex Karev
  • George O'Malley
  • Miranda Bailey
  • Richard Webber
  • Callie Torres
  • Mark Sloan
  • Lexie Grey
  • Derek Shepherd
  • Chris
  • Clara Flynn
  • Nancy Walters
  • Joey
  • Intern Laura (front)
  • Intern Dani
  • Intern Claire
  • Intern Graziella
  • Intern Megan (left, with Intern Lucy)
  • Intern Mitch
  • Intern Lucy
  • Intern Leo Byrider
  • Intern Pierce (left)
  • Anesthesiologist (right)
  • Paramedic #1
  • Paramedic #2 (left, with Miranda Bailey)
  • Paramedic #3 (left, with Alex Karev and Callie Torres)
  • Michael
  • Henry Flynn
  • Bobby Flynn
  • Tina Flynn
  • Intern Steve Mostow

Main CastEdit

Guest StarsEdit

Co-StarringEdit

UncreditedEdit

Medical NotesEdit

Callie's PatientEdit

  • Diagnosis:
  • Treatment:

Callie was seen attending to a patient in the ER.

Henry FlynnEdit

  • Diagnosis:
    • Internal decapitation
  • Treatment:
    • Surgical re-attachment

Henry was presumed dead at the site of the car accident he was in, so he was brought to the ER to be pronounced dead. However, as he was pronounced dead, he took a breath, leading Cristina to say that he wasn't dead. They took him into the ER, where an x-ray revealed internal decapitation. The back of his skull wasn't connected to his spine. He needed surgery to re-attach his skull to his spine. His surgery went well and he was stable post-op.

Nancy WaltersEdit

  • Diagnosis:
    • Pregnancy
    • Amputated arm
  • Treatment:
    • Vaginal delivery
    • Surgical re-attachment

Nancy, 34, was 35 weeks pregnant. She had a complete upper arm amputation. The wound was clean, so Mark believed he could re-attach the arm. She was stable, but having contractions. In surgery to re-attach her arm, she started having stronger contractions and her baby was born. Her arm was successfully re-attached.

JoeyEdit

  • Diagnosis:
    • Shattered kneecap
    • Perforated abdomen
    • Pica
  • Treatment:
    • Splinting
    • Surgery
    • Psych consult

Joey, 45, was brought into the ER after being in a car accident. He had injured his knee. They gave him pain meds and took an x-ray. He didn't need surgery for his knee, but it was splinted. They later noticed that he was eating multiple non-food items. He had to be rushed into surgery to remove the non-food items from his digestive tract. They determined that he had pica, the impulse to eat non-food items. After his surgery, they got him a psych consult.

DeerEdit

  • Diagnosis:
    • Chest lacerations
    • Laceration on the haunches
  • Treatment:
    • Ventilation

Izzie worked hard to save the life of a deer who had been hit by a car. She started an IV and had an intern ventilate. Then she defibrillated, after which the deer stood upright and seemed to be fine. She was then taken by animal control.

MusicEdit

Song Performer Scene
"Breathe In, Breathe Out" Mat Kearney
"To Build a Home" Cinematic Orchestra
"Reasons to Love You" Meiko
"23" Blonde Redhead
"Knock 'Em Out" Lily Allen
"Oversleeping" I'm From Barcelona

Notes and TriviaEdit

Grey's Anatomy Season 4 premiere promo new01:00

Grey's Anatomy Season 4 premiere promo new

  • This episode's title originated from the song A Change is Gonna Come, originally sung by Sam Cooke.
  • This episode scored 20.93 million viewers.
  • The season 4 DVD set includes an audio commentary for this episode by Chyler Leigh and producer Karin Gleason.
  • On George's original first day, he took down Bailey's rules. When Meredith recited the rules, she forgot one and he showed her the very same notebook with the rules.
  • Pica was last mentioned by Raj Sen when discussing possible explanations for R. Hubble in the episode Enough is Enough.

GalleryEdit

Episode StillsEdit

QuotesEdit

Izzie: Don't you see? I'm Bambi. I'm Bambi, George. If anyone in this situation is a sad little cartoon character, it's me. I'm all alone in the forest, all alone in the forest, George. And my mother's been shot by a hunter and where are you? Where the hell are you?

Derek: (to Lexie) You're the girl from the bar.
Meredith: Girl from the bar? I'm the girl from the bar!

Derek: We're broken up.
Meredith: It's done. (They start kissing.)
Derek: Break-up kiss.
Meredith: Break-up kiss.
Derek: Let's have break-up sex.
Meredith: Yeah, let's have break-up sex.

Alex: I'm going over Callie's head to Bailey.
Cristina: Callie is over Bailey's head...
Meredith: Spiritually, Bailey's over everyone's head.

Derek: Meredith's mother never wanted her and her father was never man enough to hang around. She has a right to be damaged. And us, together? It's a big step for her. Her best friend gets left at the altar, and all she sees now is, things like this, they don't work. She panics. She wants this, she doesn't know how to have it. And you know what? It's not her fault. So don't ever talk to me about Meredith Grey again because you do not know what you are talking about. And I don't want a friend.

Izzie: I know you didn't wake up this morning expecting this was how your first day was gonna go. You thought you'd get to re-attach an arm or observe brain surgery; instead you helped save the life of a deer. You can bitch and complain about it, or you can adjust your expectations. 'Cause like it or not, you are stuck with me and I'm the kind of doctor who lets little kids convince her she can do the impossible. Oh! Plus, when I woke up this morning, I thought today was gonna go a lot differently too. I thought I was gonna get the good interns. Instead, I get stuck with the duds! So I'll have to adjust my expectations as well.

Derek: How is Meredith, anyway?
Cristina: Fine.
Derek: She's always fine. That's her problem.
Cristina: We're fine people. We do fine. We're fine.

See AlsoEdit

A complete overview of this episode's crew can be found here.

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