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Change of Heart

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Over the past twenty years, one of the most valuable tools a doctor has is the algorithm. Your patient's main complaint goes into a box and then the formula helps you to decide what to do next. But what happens when the problem doesn't fit into a box? Well, you're suddenly on your own. Unexpectedly, with about a thousand paths to choose from. So what do you do? How do you decide when you're left in the dark? How do you make sure you're not making the worst mistake of someone's life? You close your eyes. You block out everyone and everything around you and you pray that the voice inside you is right. Because once you've decided, you can't ever go back.

Change of Heart is the 21st episode of the tenth season and the 217th overall episode of Grey's Anatomy.

Short SummaryEdit

Jackson is given the daunting task of delivering disappointing news to the doctors. Meanwhile, Derek's sister Amelia drops by for a surprise visit, Richard surprises Catherine in Boston and when Bailey gets frustrated by the slow pace of her research, she makes a risky decision.

Full SummaryEdit

At the airport of Boston, Meredith and Owen are sitting in their seat on the plane. Cristina's seat is empty. They're both on the phone. Meredith tells Derek Cristina was supposed to fly out with them and that she didn't show. Owen tells Meredith Cristina's phone is still off. Meredith tells Derek that Cristina only said that that's how it goes after the award ceremony. And that the winner's speech was a 20 minute ode to himself. The flight attendant tells Meredith they're shutting the doors, but Owen says it'll only take a minute. Meredith keeps on dishing the winner's research and the flight attendant tells her she has to put her phone away. "I heard you," Meredith says and she tells Derek she'll call him later.

At the dreamhouse, Derek tells his kids that their mother hung up on them. He asks Zola to put her shoes on. Suddenly, someone knocks on the door. Derek opens and Amelia walks in. She knows she should've called, but she knows he would have said no if she would have. She can't believe how grown up Zola has gotten and she's delighted to see her nephew for the first time. "Hello to you too," Derek says. He hasn't spoken to her in two months. Amelia says a thing happened. James proposed to her. She shows him the ring and he reacts happily surprised. He congratulates her and she says she freaked. "I'm sure you did," he says. She clarifies she didn't leave-the-country-freaked, but she realized there's the possibility she may be facing a different kind of life, the kind that he and Meredith have. So she thought she'd come over and visit to see what it's like and get unfreaked. Hopefully. She thinks he's mad, but he is in fact happy. He tells his kids that auntie Amelia will play with them while he goes to work. He hands over Bailey to Amelia, who realizes he's really not mad. He tells her Bailey's feeding schedule is up on the refridgerator and that Zola likes to stick stuff up her nose, so she'll have to keep an eye on that. He smilingly tells her he'll see her later and leaves her with the kids.

In their bedroom, Callie and Arizona are planning the pregnancy. They want to do the insemination in May, so the baby will be born in February. April comes in to borrow some toothpaste. Callie plans to take off the spring to recover and nurse and then Arizona can take off the summer. Arizona agrees, saying that that works if she puts Alex in charge of peds. April comes out of their bathroom and asks if they're sure about that, because then Alex will be in charge of the new interns. She proposes to postpone the insemination, but Callie tells her to get out of her vagina. "Right," April says and she leaves. Callie says these two nights with April feel like 10.

Alex and Jo are naked and kissing. She says there are pre-rounds to get to, but he ignores this. They kiss, but she knows he has to work too and realizes he's avoiding something. He got a really good offer from Lebackes to work at his private practice. She thinks it's great, so she questions why he doesn't look like it's great. He's supposed to give them an answer by the end of the day and he doesn't know how to tell Robbins, who'll be pissed. Jo tells him to be pleasant, confident, and firm. He has to smile and tell her how excited he is about this great, new opportunity. If she starts making her scary, angry face, he has to distract her with a compliment. She gets out of bed with the blanket wrapped around her body and he asks if the compliment thing works. She nods and he replies she looks sexy. She drops the blanket and says it's doesn't work on her as she disappears into the bathroom with a cheeky smile. He follows her.

Shane is presenting Francesca McNeil's case. She's had an LVAD, but there's no damage repair. Luckily, Jeff Russell informs them that a donor heart has become available. Jon doesn't remember who Jeff is again, and Arizona explains he's the head of cardiothoracic surgery and that he'll be performing the transplant since Dr. Yang is not back yet. Jon questions how they can know if Jeff is as good as Yang. Russell replies he's an attending while she's a fellow, so he is as good. Alex comes in and assures the parents that he and Arizona will be in the OR all the time, so she's in good hands. Sabine asks about Link, who's lying in the same room. Leah just finished her exam and tells them that his heart pump is working good. Ivy is having a video conversation with Link and says it's good that he's getting better. Link asks the doctors when Ivy can come back into their room. Arizona watches Ivy, who's lying in the room next door, and explains that she's still sick so she'll need to stay in a separate room for a little bit longer. Arizona tells the parents that Ivy is still in rejection and that she's still on the UNOS transplant list. She assures them they're watching Ivy very closely.

All doctors leave the room. Russell asks Arizona to page him when the heart is a go, and he leaves. Shane asks about Dr. Yang. Arizona hasn't heard anything from her. Shane asks if anyone has heard from her. Arizona dodges the question and simply tells him to make sure Frankie is ready and prepped. He and Leah leave. Arizona asks Alex why he's hovering and what's wrong with his face, as he's smiling weirdly. He compliments her hair and she immediately knows he has something to tell her, so she asks what he did.

After Derek finishes talking to a nurse, Jackson, who's working on a computer, asks him if Derek is going back to a more regular surgical schedule. Derek confirms and asks why. The Foundation asked Jackson to report back on the running surgical research projects because they want to know which ones are actually getting results. Derek figures out they're going to shut down the ones that aren't and he starts to defend his research. Jackson assures him he's looking at all the projects, not just Derek's. Jackson only wants to make these decisions now before the Foundation starts doing it for them. Derek reminds him he and Callie have a presidential seal of approval.

Meredith and Owen walk into the ER. April starts talking to Meredith, who warns her to stay away from her. Nonetheless, April asks about Cristina and says how bad she would feel if she were Cristina. Meredith yells at her to stop it and loudly starts insulting the Averys, whom she considers April to be part of, as they robbed Cristina. Before she leaves, she reminds April that she told her to stay away from her today.

Alex is telling Arizona about Lebackes' offer. She asks if he's decided yet, but he hasn't. He tells her they need to know by tonight. She stays silent. He expected her to start yelling or something. They get paged for Frankie's heart, that's on its way.

Braden's parents are desperate. Two days ago he was fine, now he's having difficulties to breathe. Stephanie explains the chemo they gave Braden obliterated the bone marrow, which contained the enzyme-deficient cells, but such a mile of dose of chemo wouldn't make him sick. They believe he has picked up a viral infection. David doesn't get how that could've happened, as Braden is in isolation. Bailey replies Braden has no immune system. They've taken every precaution, but he is in a hospital after all. The parents start thinking about stopping treatment and just letting him get better by letting him rest. Bailey interrupts and says they've been through this. Braden could get sicker before he'll get better. They're still on track for this afternoon. "When you'll inject an HIV virus into our very sick little boy," David says. Bailey starts saying the HIV virus is deactivated and that they just need to hang on a little while longer.

Dr. Russell is about to cut open Frankie's chest. Arizona and Alex are with him in the OR. Before he can cut, Cristina comes in and says she got it from here. Russell is surprised to see her and proposes to do the surgery so she can take a load off, as she must be tired. Cristina replies she's been on Frankie's case since the very beginning, so she will do it. "Tough loss last night, Yang. Must've stung. Better luck next time," Russell says before he leaves. Cristina tells the others it was an honor just to be nominated. Alex, Arizona, Shane, and Leah silently look at her as she starts cutting.

In Boston, Richard is sitting in the waiting room of Catherine's office. She swings open the doors and asks what he's doing here. They happily kiss and he replies he likes to keep her guessing. She tells him to get in her office before she does something that could embarrass Henry, her secretary.

Inside her office, they kiss again. He says he should surprise her more often, but she says she's not that surprised. She expected him to come by to find out why Dr. Yang didn't get her award. He claims he planned the trip a long time ago to offer her some getaway after the tiring ceremony, but he confirms that it would have been a nice feature if the weekend was like a victory lap to celebrate Yang's big win. He's sure the weekend will have other nice features. They kiss again. He tells her to finish what she was doing while he'll sit down and watch the magic. After, they'll go to dinner. "Yes, Dr. Webber," she says.

Jackson bumps into April and they have short, awkward conversation about how they're doing. April asks if he's talked to Cristina. They were both shocked when they found out she didn't win. She says she needs to come home tonight. He thinks she wants to talk, but in reality, she wants to come pick up her iPod. She went running this morning and missed it. She notices he looks stressed and he tells her he's got to compile a report for the Foundation about the value of people's research, as they're not gonna be able to keep all of them. April can't believe they first deny Cristina her award and then start talking about shutting down her research. He starts objecting as she gets paged. "Classy move, Avery family. Way to keep it all about the medicine," she says as she starts walking away.

In the ER, she joins Owen on Sam Roane's case. Sam walked cross-country for the past three months, only stopping for sleep and the pickup that took him out. Jo updates her on the case as Callie is cutting the bandages the paramedics used to splint Sam's right lower extremity. Sam tells them he started walking from Wilmington and that he did it to really commit to something and follow it through the end. And then he got hit by a truck. Callie sees the leg and says the femural fracture must have transected the femoral artery. They need to move to the OR now.

While Derek is looking at scans, Meredith is ranting to him about the ceremony. She wanted to make a scene, but Cristina just sat there, applauding for the winner. She has no idea where Cristina is now until she gets a text. "She's in OR 1," she says. Meredith then sees the scan. It's a spinal schwannoma, extended into the retropleural space. "Is that for me?" she asks. He tells her they're overdue for a date. OR 3, she in fresh scrubs, he in his ferry boat scrup cap. He asks if she's in, but she's worried about the kids. He tells her his sister is with them, but Meredith is still a little hesitant given Amelia's history with drugs. He tells her the tumor involves the great vessels. She knows what he's doing, and it's working. She's in.

Callie, Jo, and April are in the OR. They need to relieve pressure on the leg. Owen comes in and tells them that Cristina is in OR 1 with Robbins and Karev. As she starts cutting into the leg, Callie asks Jo if she's put on boot covers before she came in. Just as Jo asks why she would do that, a large volume of blood flows out of the leg onto her shoes. As everybody starts laughing. Now that the blood is in her socks, she gets why she should have. "That never gets old," a laughing Callie says.

Teresa Morris and Sabine McNeil are having coffee together, talking about their sick children. Teresa doesn't understand how Sabine can deal with her three sick kids, as she's barely keeping it together with just one kid. Stephanie comes in, asking for this afternoon's consent forms. She asks for a moment as she hasn't signed them yet. As she signs them, Sabine starts talking about how your kids trust their parents, while they can't help them. That's the doctors' job. Then, after weeks, stuff that is supposed to make them better is not working. That makes her wonder if these doctors really know what's best for their kids. Teresa stops signing as Sabine asks herself if she'll ever go home with her kids. She apologizes to Stephanie for her words. Stephanie reminds Teresa that she has a couple more papers to sign.

Cristina has finished the transplantation and Arizona is admiring and complimenting her work in an attempt to cheer her up. Karev, Murphy, and Ross join in. Cristina shocks the heart with the paddles, saying it should start pumping any minute. Leah asks when it'll happen and Shane replies it usually does right after the blood flow is restored, so any second now. Nothing happens and both Arizona and Cristina massage it, but still nothing happens. Leah asks if it shouldn't be contracting by now, but Cristina simply continues heart massage.

Cristina wants to know what UNOS has to say about the heart, but a nurse tells her they're still waiting for a call back. Leah doesn't understand how this could happen and Arizona explains they must have injured it when they were removing it from the donor. A frustrated Cristina throws her surgical instrument across the OR. The nurse informs them that UNOS called and said that there is another heart available. It's in Portland. Arizona says she and Alex will go get it, because they can't risk another screw-up. Alex says the two of them don't need to go, but she orders him to come. Arizona asks if Cristina is okay, and she answers she is. As Arizona and Alex leave, Shane comments Frankie's been on bypass for hours, but Cristina replies it'll stay that way. She orders Leah and Shane to stay in the OR to monitor Frankie closely and to page her if anything changes.

Catherine finishes her work and Richard wants to know if she really thought Richard only came to Boston to find out why Yang didn't win. She knows he's a proud papa, she's his prize student, so she knows it's important to him. "It's important to the whole hospital," he says. He thought i'd be important to her too, since she's an investor in the hospital. It is, which is why she thinks it's good that there's an impartial committee. He coughs and says it's not that impartial, as it makes no sense that she lost. He read all nominated papers and there's no comparison to her, so unless she blew some statistical calculation or some some gross error buried way down in the data, she should've won. "You know as well as I do that none of them even holds a candle to what Yang's been doing," he says.

Meredith finds Cristina in a hospital hallway and first tells her she's glad that she's alive. She then asks whom she has to go after, as she assures Cristina she's in her corner. Cristina is busy, but Meredith says she can't be in Cristina's corner if she disappears on her. A nurse comes over and tells Cristina that they're asking for her in the CCU, as Ivy McNeil's sats dropped below 70.

Cristina rushes into the CCU, where Jon McNeil is relieved to see that she's back. Cristina takes a listen to Ivy's heart and tells Jon that her heart is failing. They need to intubate. Ivy tells Link, who's lying in the room next to her, not to look. Sabine, who's in Link's room, closes the curtains. Jon assures his daughter he's with her.

Meredith and Derek are operating. Meredith is worried about Cristina as she only said two words to her, but Derek points out she was pulled into an emergency. He thinks she's fine. They then start enjoying the moment, which is the first time they've spend so much time alone together in weeks. Jackson comes in, interrupting their moment, to ask if she really needs a lab 5 days a week for her research. Derek urges her to say yes, which she does. She asks why and he informs her that they're trimming research. Meredith starts bitching about the Foundation some more, saying they can't decide about who can get something. 

In another OR, April is saying how her fight with Jackson isn't something they can just get over or forget about. Callie has heard her say that a lot of times already. She and Jo finish the ex-fix and she says that sadly, their work is done here. Owen doesn't seem to want them to go, as he'll be only one April can talk to then. Jo asks Callie if they don't have to review the ex-fix's measurements with images. They do, but they will do it in radiology, so they can stay out of Kepner and Hunt's way and where there is more light and bigger screens. Owen still objects that they're almost done, but Callie tells him to take his time and leaves with Jo. Owen sighs and April seems to realize they're fleeing from her.

Teresa is yelling at David. She wants to go as she doesn't want her son to be guinea pig for Bailey's cure. Stephanie is working things out inside the bubble with Braden while she hears the parents discussing the matter. The mother is terrified about the fact that the therapy is based on HIV, but the father insists that it's deactivated. Stephanie tells them she needs to do one more blood draw, but the mother tells her they're done with the treatment, as it's only killing him. Stephanie and David try to talk to Teresa, but she tells Stephanie to tell Bailey that they've changed their minds. There won't be injecting Braden with anything today.

Alex and Arizona are on a plane together. She starts talking about the last time they were on a plane together, the first time they met. Alex cuts her off and tells her that he knows she only brought him on the plane to talk him out of taking the job at the private practice. He tells her to say what she has to say so they can get it over with. She keeps on talking about the first time they met. He interrupts her and says he knows she thinks he's choosing money over substance and that it's a waste of his talent. He assures her that he thought it through and points out that he already stayed in Seattle once for her. He has to start thinking about what he wants and he says he deserves this job.

In the OR, Leah and Shane are talking about Cristina. He says Cristina is a surgeon who cares more about her patients than about an award. They check with the anesthesiologist and realize that Frankie is acidotic. They treat this, but Leah then sees she's bleeding from the suture lines. Shane tells a nurse to page Yang.

Cristina tells Jon that Ivy's lungs are doing better due to the intubation, but she needs to place a special line to get a more accurate measurement of her heart. She suggests he leave during this procedure, but he refuses. He remembers she ran into the CCU after Frankie's surgery and asks about his other daughter. She tells him that there was a complication with Frankie's donor heart, but she informs him a second donor heart is on its way. She wanted to keep Frankie in the OR until the heart arrives. Jon asks if that's safe. It is, as Leah and Shane are monitoring her closely. A nurse then informs her that the resident are on the phone from the OR. She tells the nurse to put them on speaker and tells Ross to update her, adding that the kids' father is with her. Shane informs her on Frankie's condition. Cristina once again advises Jon to step out, but he's staying. While placing Ivy's special line, she tells Shane they need to stop to bleeding. If not, they're in for the triand of death. She tells Shane to throw a horizontal mattress stitch, but she warns him to be careful with Frankie's tissues, which are extremely friable. 

In the OR, Shane tells Leah to throw the stitch as she's on the right side of the table. Through the speakerphone, Cristina warns her that she only has one chance, or else she could rip through the aorta, which is essential to connecting the new heart when it arrives. Leah wants Shane to throw the stitch, as she's only placed it on a bowel before. Shane can't do it, as he's on the wrong side of the table and he assures her she can do it. 

In the CCU, Cristina and Jon are listening, but everything remains quiet. She calls their names and after some silence, they tell her they stopped the bleeding. They're relieved and Cristina tells Jon both of his daughters are fine.

Richard tells Catherine that Yang always gets results, and this no exception. He asks her to make him understand why she didn't want the award, because his read is that she clearly should've won. Catherine can't believe he is being this naive. She says the Harper Avery Foundation co-owns the hospital she works for. "She could never win that award," she says.

In the OR, Leah is doubtful about how long the suture will hold. Cristina comes in and Shane tells her Frankie is now oozing from the IVC. He asks if they should throw another stitch, but Cristina says that if they keep throwing stitches, Frankie will start dissecting all over the place. They need to get her off the table. Leah questions how they can do that, as she's supposed to have the transplant. Cristina says she wouldn't survive it in this state. Then the phone rings. It's Robbins. Cristina asks how they're doing.

In Portland, Arizona tells Cristina the heart is out and they're on the move. Alex is putting the heart in a bag with ice water. Arizona orders a nurse to call the pilot and let him know that they're on their way. Alex asks if this is how it's going to be now: radio silence till the end of his fellowship. She tells him she brought him here because she trusted his skills to properly procure the heart. On the plane, she started feeling sad because he'll be leaving soon and she will miss him. She's happy and proud of him and she  shared a memory because she was feeling sentimental. They put the heart in a box and he tells her that he'll still have hospital priviliges, so she'll see him around. "Shut up, Karev, moment's ruined," Arizona says. They take off with the heart.

In Owen's OR, only a few more sutures are needed. April tells him the patient got hit while crossing highway 519, he could see the water. Since he was walking from ocean to ocean, he was so freaking close. She says it's not fair, as making a commitment is supposed to mean something and then a pickup truck just takes you out. She starts crying and Owen gets worried over. She confesses she feels like this fight with Jackson is the fight she doesn't know how they'll recover from. Owen tells her that some fight, you just can get past. With him and Cristina, it was about kids, but with her and Avery, this is only their first fight. They'll get past it, and then something else will come and they'll fight about it, but they will recover, every time. This fight is not their pickup truck. This calmed her down and they continue operating.

Bailey is explaining everything about her gene therapy to Jackson. She's preparing the virus that she has to inject into Braden's body within the next four to six hours, and then, theoretically, the magic will happen. Jackson says that's the problem though: so far, all of her project has been theoretical. The Foundation needs actual results. He needs her to show him anything concrete that will show him that she's getting actual results. She knows there will be results once she can deliver this gene therapy to her bubble boy, but a feeling isn't enough for him. He sees her face and decided to wait for today's results. Stephanie comes in and asks if she has a minute. 

Richard is yelling at Catherine for having encouraged Yang, telling her she was a front runner, while she knew Cristina was nothing but window dressing. Catherine says she was not just window dressing, as she was nominated for a prestigious award that brought publicity to her and the hospital. Richard blames her for having used Yang and he asks her if any doctor from Grey Sloan will ever win a Harper Avery Award. She asks if he wants her to remind him why there is a Grey Sloan Memorial Hospital in the first place, or if she should just take her 24 million dollars and go home. She says she's extremely attracted to his idealism, but this is business and she does not appreciate him travelling across country harangue her about the fact that his price pony didn't get a ribbon. She tells him that Yang got the votes to make him feel better. Now he asks if she is this naive. Did she really think that is why he came across country, why he planned a weekend with all the things she loved? He says he made reservations at Cipriani's because he knows she loves it there. He was gonna wait till just before the dessert, when a waiter would bring her a glass of champagne. And he was going to tell her how much he loves her and how right for one another they are. How she makes him excited to be alive, how she gives him a reason to get up each morning and say a thankful prayer every night. He was gonna ask her to be by his side for the rest of their lives. That's why he came, to do all of that. He takes ring box out of his pocket and puts it on her desk. "And now I'm leaving," he says. He leaves and she opens the box.

Sabine asks Cristina to repeat something. Cristina explains that Dr. Robbins is on her way with a new heart for Frankie, but Ivy's deterioration has caused her to shoot up to the top of the transplant list. Ivy happens to be a perfect match for the heart en route as well, so the heart could be redirected to her under the circumstances. Medically speaking, Frankie's condition is declining rapidly. Technically, Ivy is more stable, which would give the heart a better chance of surviving. The parents question if they shouldn't give the heart to their child who's doing worst, but they realize it might be a waste. They can't decide which one of their children gets a child and which one doesn't. Cristina says Frankie can be fitted with a artificial heart for now. The parents can't choose, so they tell her that she should decide. They won't pick between two of their three amazing children. Cristina has to decide.

Cristina is in a X-ray viewing room, trying to make the decision. Owen comes in and she updates him on the two girls. He asks her why she didn't call. She says Meredith already talked to her and that she just wanted to be alone, but he wasn't talking about the award. He heard about the McNeils and she should've called him for the decision, as no surgeon should make such decision on their own. That's why there's a Chief of Surgery, but she claims she can decide this because she knows her patients and their conditions. Owen says she doesn't have to, but she says she does. She looks at some scans.

Cristina walks into the OR and tells Leah and Shane to start sectioning off the vessels as Owen comes in carrying a Gustafson artificial heart. Cristina tells them to get Frankie off the table immediately and that they're reallocating the coming heart to Ivy, who's being prepped by Russell. 

Meredith and Derek are walking down a hallway while being on the phone with Amelia, who asks them if they'll be home for dinner. They will, and she can't wait. Meredith is happy that there will be dinner waiting for them on their dining room table when they get home. Derek reminds himself that he needs to thank his sister for allowing him to spend an entire day alone with his wife. Meredith says Amelia is not a permanent solution, but Derek says they have a spare bedroom and they could give her hospital priviliges. Meredith points out it wouldn't give her more time for child care. Derek knows it's not permanent, but it allowed them to have an entire day without dropping any balls. They think that Amelia even might put their kids to bed, and they disappear in an on-call room for "dessert".

In the scrub, Alex asks Arizona why she isn't trying to make him stay. She wants to focus on the transplant, but she says she of course wants him to stay, but it sounds like a great job opportunity. And he was right, she already stood in his way once, so if he wants to leave, he should leave because it's the next best thing for him, because he's exited about this job and ready to go do great things. "And collect a really big paycheck," she says. She says he has a really big decision to make and tells him not to screw this one up. They get in the OR.

Cristina and Owen have finished putting in the artificial heart and right when she says she's going to check up on Russell and Ivy, a monitor starts beeping and Cristina realizes Frankie's heart ruptured. They need to reopen her chest.

Stephanie asks Bailey if Braden could die now, which Bailey says is possible. Stephanie asks if it often happens with experimental treatments that parents withdraw their consent. Bailey tells her to stop talking, but Stephanie wonders what she should do with the halfly-signed consent forms. Bailey loudly repeats that she should stop talking and says she will deal with the consent forms. Stephanie gives her the forms and Bailey looks at the mother's signature.

Cristina is trying to get one suture to hold while the anesthesiologist checks Frankie's pupils. They're fixed and nonreactive. Owen tells Cristina they've been at this for almost an hour and she realizes they have to give up.

Cristina tells Sabine and Jon that Ivy's transplant went perfectly and her post-op echo is completely normal. Owen says she should be awake soon. The parents ask about Frankie. Cristina and Owen remain silent and the parents start crying. A crying Sabine yells at Cristina that they trusted her. "What the hell did you do to our child?" she asks. Owen says they're sorry for their loss. The parents get into their children's room, as they need to be with them now.

Leah is sitting on a staircase, seemingly sad. Shane sits down and says her suture hold. "So?" she asks. He says he's never seen vessels that friable and he's been around a lot of diseased hearts. He says she did an amazing thing. She says the kid died, but he replies it wasn't something that she did.

The board, except for Richard, Owen, and Cristina, have come together to discuss the Foundation wanting to cut the research projects. Arizona, Meredith, and Derek agree it's ridiculous, as there hospital is about innovation. They want to fight the decision, but Jackson reminds them that the Foundation owns the place, they're just the managing board. The best they can do is guide them to make the right decision. The only way they can do that is by making the decision themselves. He gives them the rapport he made, which lists all project's budgets versus the progress to date, best to worst. He invites them to take a look, but the decision is pretty clear to him. Alex knocks on the door, but thinks he's interrupting so he says he'll come back later. Arizona urges him to come in though, and Derek asks if everything's okay. He just wanted to let them know that his fellowship is almost done and that he got an offer from Lebackes' pediatric surgery clinic. He gave it some serious consideration and he's decided to take it, so he guesses this is his notice. Jackson and Callie seem quite shocked while Derek and Meredith smile at him, glad for his opportunity. Arizona seems sad he's leaving.

Owen is calling Cristina, asking her not to disappear on him again. Richard gets off an elevator and asks him to talk. Owen asks if it can wait, but Richard says it can't.

At Alex's house, Jo is trying to scrub the blood off her shoes. Alex appears in the doorway and tells her he took the job. She agrees it's going to be awesome and hugs and kisses him. He sees her shoes and guesses compartment syndrome. She confirms and he says Torres loves that trick. He advises her to toss the shoes. She says he's right, as he can now afford to buy her new ones. 

Meredith and Derek get home and see their living room is a mess. He asks a tired Amelia what happened. She tells them the kids are asleep and totally fine. He notices she's emotional and asks her what's going on. She says she can't do this. "The children broke your sister," Derek says. Amelia says it's not them. She didn't come here to see how their perfect little life worked, she came here to see if she could do it, the whole kids, family, and career thing, because she wants that. With James. But she's wrecked after one day. "It goes on the list of things I suck at because... I can't," she says as she starts crying and runs to the guest bedroom. Meredith says she knew this was too good to be true and she tells him to go fix his sister while she orders takeout.

Jackson comes home and finds April in the kitchen. He thinks she's here to talk, but she shows him her iPod. He sighs and she says she'll see him tomorrow. Before she leaves, he says he regretted the things he said the other night. He's sorry that  he hurt her feelings, and she apologizes too. He says she should come back home then, as this is a conversation they'll always gonna have to have. It's part of who they are, so it's gonna take some talking. But they got married, they love each other, and they made vows to push through things like this. She knows and says she loves him too. He says that if she believes in God, then she believes that he made him her husband, who shares her values, which he does. He believes people shouldn't kill or steal, he believes you should be truthful and treat others the way you want to be treated. She agrees. So, he says, we can push through this problem then, because at core, they believe the same things. Until she thinks about telling their children how unbelievably loved they are by the creator of the universe, who also made them, and she can just see Jackson standing there, judging and dismissive, and she can't just get past it. He asks if they can just take a break from their hypothetical children, but April says they're not hypothetical anymore, because she's pregnant.

Bailey is watching Braden in his bubble. Stephanie joins her and asks if they now just cross their fingers and hope he gets better. "Guess so," Bailey says and then wishes Stephanie a good night. When Stephanie's gone, Bailey takes the bag with the gene therapy out of her pocket and looks at the sick boy.

Owen finds Cristina in the shower of an attending lounge. She's still wearing her scrubs and OR gown. He tells her the McNeils are very sick kids and any of them would be looking at a death sentence without her. She knows she made the right call, he doesn't have to tell her that. It was an impossible decison and she stands by it. She did everything exactly as she was supposed to and she did it perfectly. He asks her what is wrong. "What's the point, Owen? What's the point of anything?" she asks. He then tells her she won the Harper Avery. She got the most votes, Richard just told him. The politics screwed her and the Foundation's relationship with the hospital, they used her. She never stood a chance. She gets out of the shower and gives him her wet scrub cap.

A wet Cristina walks out of the hospital and walks off into the night. 

CastEdit

  • Meredith Grey
  • Cristina Yang
  • Alex Karev
  • Miranda Bailey
  • Richard Webber
  • Callie Torres
  • Owen Hunt
  • Arizona Robbins
  • April Kepner
  • Jackson Avery
  • Jo Wilson
  • Shane Ross
  • Stephanie Edwards
  • Leah Murphy
  • Derek Shepherd
  • Catherine Avery
  • Amelia Shepherd
  • Jeff Russell
  • David Morris
  • Sabine McNeil
  • Teresa Morris
  • Jon McNeil
  • Sam Roane
  • Anesthesiologist
  • Circulating Nurse
  • CCU Nurse
  • OR Nurse
  • Flight Attendant
  • Francesca McNeil
  • Ivy McNeil
  • Link McNeil
  • Braden Morris

Main CastEdit

Guest StarsEdit

Co-StarringEdit

Medical NotesEdit

Francesca McNeilEdit

  • Diagnosis:
    • End-stage heart failure
  • Treatment:
    • Heart Transplant
    • Total artificial heart

Two days after her LVAD was inserted, Frankie's heart was still heavily damaged. However, a heart was available for transplant and was brought to GSM for Frankie. However, the heart was damaged during retrieval, so they weren't able to close her. Another heart became available, but while Alex and Arizona went to retrieve it, Frankie's sister, Ivy, declined, bumping her status up. Cristina made the decision to give the second heart to Ivy and attempt a total artificial heart on Frankie. That procedure failed and Frankie was pronounced dead in the OR.

Lincoln McNeilEdit

  • Diagnosis:
    • End-stage heart failure
  • Treatment:
    • Drug-eluting heart pump

Link was doing well, with good breath sounds and his echo was clear. His heart pump was working exactly as it was meant to.

Ivy McNeilEdit

  • Diagnosis:
    • Donor heart rejection
    • Global systolic dysfunction
  • Treatment:
    • Anti-rejection meds
    • Intubation
    • Etomidate
    • Heart Transplant

Ivy was still in full rejection. While her sister was in surgery to receive a heart transplant, Ivy declined rapidly. Her status was moved up. So when the replacement heart for Frankie was retrieved, it was redirected to Ivy. The transplant was performed successfully.

Braden MorrisEdit

  • Diagnosis:
    • Viral infection
  • Treatment:

After receiving chemo to kill off the enzyme-deficient cells, Braden came down with a viral infection, causing his parents to question whether or not they should continue with the gene therapy treatment. After a conversation with Sabine McNeil, Teresa withdrew consent for the gene therapy.

Sam RoaneEdit

  • Diagnosis:
    • Blunt Trauma
    • Deformity to the right lower extremity
    • Compartment Syndrome
  • Treatment:
    • Splinting
    • External fixation

Same Roane, 23, was attempting to walk across the country, ocean to ocean, when he was hit by a pickup truck. His leg was severely broken, severing his femoral artery. He was taken from the ER into surgery where an external fixator was placed while his other injuries were repaired.

Lenny GordonEdit

  • Diagnosis:
    • Spinal Schwannoma
  • Treatment: 

Derek and Meredith scrubbed in together to remove a spinal schwannoma.

MusicEdit

Song Performer Scene
"Blister in the Sun"

Radiant Life Perspective

(originally by Violent Femmes)

  • Meredith talks to Derek on the phone while Owen tries calling Cristina
  • Derek answers the door to find Amelia there
  • Derek leaves the kids with Amelia
"Ordinary World"

Joy Williams

(originally by Duran Duran)

  • The doctors prepare to move Frankie when she declines and they re-open
  • Stephanie and Bailey talk about Braden
  • Frankie is pronounced dead
  • Cristina and Owen talk to the McNeils
"What's on Your Mind (Pure Energy)"

Joe Gil

(originally by Information Society)

  • Shane gives Leah a pep talk
  • The board decides which research to cut
  • Alex gives the board notice that he's leaving
  • Richard finds Owen to tell him what Catherine told him
"We Built This City"

Jill Andrews & Aron Wright

(originally by Starship)

  • April tells Jackson she's pregnant
  • Bailey and Stephanie watch Braden
  • After Stephanie leaves, Bailey pulls out the syringe and looks at it
  • Owen finds Cristina in the shower and tells her she had the votes
  • Cristina walks out of the hospital

Notes and TriviaEdit

Grey's Anatomy 10x21 - Season 10 Episode 21 Preview Promo "Change of Heart" (HD)00:30

Grey's Anatomy 10x21 - Season 10 Episode 21 Preview Promo "Change of Heart" (HD)

  • This episode's title originated from the song Change of Heart, originally sung by Cyndi Lauper.
  • This episode scored 7.99 million viewers.
  • Filming for this episode was scheduled from March 10 to March 21, 2014.
  • According to the promo, this episode is the beginning of the farewell to Cristina Yang.
  • This episode marks the first time since Have You Seen Me Lately? that a character from Private Practice crosses over to Grey's Anatomy.
  • The song used in the promo for this episode is "This Ain't Goodbye" by Train.
  • The plane scene with Arizona and Alex mirrors their scene from Sympathy for the Devil, to which Arizona even refers.
  • According to on-screen documents and several monitors, this episode takes place on March 19, 2014, but this is more likely the date of filming rather than the in-universe time, as earlier episodes took place in April.

GalleryEdit

Episode StillsEdit

Behind the ScenesEdit

QuotesEdit

April: You're back!
Meredith: You're gonna wanna stay away from me today.
April: Where's Cristina? She must be devastated, if I were her I'd be faced first in a pile of chocolate chip cookies.
Meredith: Stop it! Cristina Yang doesn't need your pity! She was robbed and you robbed her!
April: Oh, I did?
Meredith: Yes, you! You're an Avery by association. That pack of fools can't tell their asses from their elbows.

Jackson: Can we please just take a break from our hypothetical children?
April: No we can't! Because they're not hypothetical anymore. Jackson, I'm pregnant.

Callie: Okay, so I take off the spring, recover, nurse, and then you take off the summer.
Arizona: And then I put Karev in charge of peds. I think that works.
April: You sure about that? Cause if you're gone in the summer, you're gone when the new interns start. You really want Karev in charge of all the new kids? Maybe push off the insemination until July...
Callie: Kepner. Kepner. Get out of my vagina.

Arizona: What's wrong with your face?
Alex: I like your hair.
Arizona: Oh, what did you do?

Derek: We're overdue for a date. OR 3, you in fresh scrubs, me in a ferry boat scrub cap. You in?
Meredith: Well, this could take hours. What about the kids?
Derek: Amy's with them.
Meredith: We have a babysitter named Amy?
Derek: Amy, my sister.
Meredith: The junkie?
Derek: She's a recovering addict and she loves kids.

Arizona: Alex, I brought you here today because I trusted your skills to properly procure this heart and then we got on that plane and I started feeling sad because you're leaving soon and I will miss you. I didn't bring you today to school you. I'm proud of you and all I wanted was to share a freakin' memory! Okay? I was being sentimental.
Alex: Oh. You know if I take the job, I'm still gonna have hospital privileges. You'll see me around.
Arizona: Shut up, Karev. Moment's ruined.

Richard: You used her! She was never gonna win that damn thing for a second! Nobody from Grey Sloan Memorial will ever win a Harper Avery, will they? Ever?
Catherine: Do you want me to remind you why there is a Grey Sloan Memorial Hospital? Or should I just take my 24 million dollars and go home? What draws me to you, Richard, is your idealism. I find it extremely attractive. But this is business and I do not appreciate your coming all the way across country to harangue me about the fact that your prize pony didn't get a ribbon! And if it makes you feel better: she had the votes.

Amelia: I can't do this.
Meredith: The children broke your sister.
Amelia: It's not them. I didn't come down here to see how your perfect life worked. I came to see if I could do it. The whole freaking' thing. Kids, marriage, and the full-time careers, because I want that. With James. And I am wrecked after one day! It goes on the list of things that I suck at!

Jackson: Can we just please take a break from our hypothetical children?
April: No, we can't because they're not hypothetical anymore. Jackson, I'm pregnant.

Owen: You made the right decision. You made the right call.
Cristina: I know I made the right call. You don't have to tell me. It was an impossible decision and I stand by it. I did everything exactly as I was supposed to. I did it perfectly.
Owen: So what is wrong?
Cristina: What's the point, Owen? What's the point of anything?
Owen: You won. The Harper Avery. You got the most votes. Richard just told me. The politics screwed you. The foundation's relationship with us. They used you. You never stood a chance.

See AlsoEdit

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

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