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We go into medicine because we want to save lives. We go into medicine because we want to do good. We go into medicine for the rush... for the high... for the ride. But, what we rememeber at the end of most days are the losses. What we lay awake at night replaying is the pain we caused or failed to cure. The lives we ruined or failed to save. So the experience of practicing medicine rarely resembles the goal. The experience too often is ass backwards and upside-down.

Crash Into Me, Part 1 is the ninth episode of the fourth season and the 70th overall episode of Grey's Anatomy.

Short SummaryEdit

An accident involving two ambulances causes chaos at Seattle Grace. Cristina and Izzie compete for cardio, Richard and Meredith treat two paramedics stuck in an ambulance, Derek and George help a paramedic with seizures, Rebecca Pope returns and sneaks into a surgery and Lexie finds herself in a sticky situation with a patient.

Full SummaryEdit

Cristina is dancing in Meredith's room. Meredith is watching her, but she's too tense to dance. Cristina says that's why they're dancing and encourages her to join. Meredith says she has a problem with Derek dating other women. If she had any sense at all, she'd stop with the break-up sex. Cristina tells Meredith to shut up. Meredith gives in and starts dancing. She decides to tell Derek she doesn't want him to see other people. Izzie opens the door and watches them.

Izzie goes to see George, who's sleeping on the floor in the living room. She's sick of Cristina and Meredith's friendship being rubbed in everyone's faces. She thinks she and George should be the happy, dancing people. She decides to go in early and go kick ass at cardio. It'll piss off Cristina, but she doesn't mind.

Tucker tells Bailey she's just never home, but she needs to finish her rotation schedule first. He repeats his statement. She says she's here in the morning and at nights, but he doesn't think that's enough. She reminds him that she's Chief Resident now. He yells that he's loading the dishwasher. They calm down as Tuck is in the room and Bailey reminds him he volunteered to stay home and take care of the baby. Bailey gets ready to leave for work. He wants to talk. She tells him to drop the baby off at his mom and meet her lunch. He reluctantly agrees.

Meredith and Derek are getting dressed again in a supply closet. She's talking about not caring about Lexie and Thatcher, but Derek comments she talks about them an awful lot for someone who doesn't care. He says she cares because she's her. He kisses her. She has a meeting with Sloan to get to. She turns around at the door, but decides not to tell him. She leaves.

Alex and Lexie are both late for their meeting with Sloan. Lexie says she's not speaking to him. He pushes her against a wall and kisses her, but she says she's still not talking to him. As he says she doesn't have to, Meredith walks by and tells them they're late for Sloan.

Sloan has gathered a lot of doctors and nurses in Nick Hanscom's room. He removed a carotid body tumor. Mark is impressed by his own success, but there's only a delicate flap of skin between his carotid artery and the outside world. Mark is worried that the artery could blow. If that happens, Mark says it's their job to stop the bleeding and then page him. Nick says they all look scared. Mark says that's encouraged. Nick says it's been nice meeting them in case he dies. Mark tells everyone to be as confident as Nick.

The paramedics unload Jacob Nolston, a cardio patient, from the ambulance and Izzie and Cristina start bickering over who gets to take the case. The paramedics get ready to leave as there's a pile-up on the freeway, so they're busy. As Cristina and Izzie continue bickering, Meredith notices another ambulance approaching at high speed. She yells to move and they rush aside as the ambulance crashes into the other one, which tumbles across the ambulance bay.

Jacob's leg got impaled by a piece of metal from the crash. They rush him inside as Callie comes outside to see what happened. Meredith and Callie check on the paramedics in the upside down ambulance. Ray is upside down in his chair, Stan is lying on the roof. The doctors see he's bleeding from his abdomen. Meredith wants to get them out, but Callie tells her they need to wait for the fire department. Bailey needs Callie's help at the other ambulance, so she instructs Meredith to page someone to help her and keep the paramedics talking. Stan begs her not to leave. Meredith asks someone to page the Chief.

Bailey enters the ambulance that crashed into the other one. Paramedic Shane tells her the patient is doing worse than he is because he started coding right after they picked him up. He says Mary, the driver, had some kind of seizure. Callie opens the door and asks for help. Bailey finds the patient has no pulse. Bailey wants to check Shane's injuries, but he says no and asks if Mary's okay. Callie says she's alive, but she looks postictal and she has an elbow dislocation. Shane says they were talking when she started convulsing and then they slammed into the other rig. Bailey wants to check out Shane now, but he says he can walk. He says his upper abdomen is injured, but he has a strange request. He wants a guy doctor.

Lexie is examining Nick. He's strong and stable, which he likes to hear. Nick says she's pretty. He gets to notice these things now as his girlfriend broke up with him. She left him because he didn't make her laugh anymore. Lexie concludes she left him because of the tumor, which she thinks sucks. He agrees and asks if she's seeing someone. She says kind of. He asks if it's a nice guy. Lexie says he's a nice guy disguised as a jerk. Nick says that's the same type as his girlfriend, who turned out to be a narcissist. Nick asks if she really loves this guy, even though he doesn't have a super cool exposed artery. Lexie chuckles and says she does.

Derek asks Rose what's going on in the pit as she just cleared out the board. She says she canceled the elective surgeries to make room for emergent ones since two ambulances crashed into each other. Derek asks if they're friends yet. He likes to think they are. She asks why. He says that if they are friends, he can tell about the licorice stuck in her teeth. She thanks him for that.

Jacob's family arrives in the ER and they ask what happened to his leg. He says it doesn't hurt. Izzie inform them the ambulances crashed. Lucy, Jacob's daughter, asks if his heart is okay. Izzie tells her they're working really hard to make it better. Erica arrives and Yang presents the case. Erica tells Izzie to go get Torres for the leg and tells her to work with her, as she only needs one resident today.

Bailey tries to get Shane to allow her to examine him, but he won't let her even touch him. Richard arrives and introduces himself to Shane, but Shane also does not want to be touched by Richard. Shane says he wants a different doctor. Bailey doesn't understand, but Richard understands he wants a white doctor. He does his very best to manage his anger and asks Bailey to handle this.

Callie is examing Mary's elbow. Derek comes in for her consult. Mary wonders why she got a seizure as she's never had one before. She's fine, except that she caused this accident. Derek asks George to schedule an MRI. Mary asks about Shane and Callie informs her he's with Bailey. Callie gets ready to fix the arm. Derek promises to let Mary know if he has any more info. Callie pops the shoulder back in.

Firemen arrive in the ambulance bay. Richard asks the trapped paramedics how they're doing. They want to get out of there, but Richard is afraid keeping still is the best thing they can do for now. Stan asks Richard if his legs are broken. Richard says he can't see them. Stan says he can't feel anything and Ray notices his ears are bleeding. Stan asks Richard to get his wife. She's an X-ray tech. Ray tells Stan not to die. 

Richard and Meredith get up and he tells her to get Stan's wife. Richard says that the moment they move Stan, he's gonna bleed out. All the medicine in the world won't save him, so Stan's wife should get here soon if she wants to see him alive.

The firemen only need a few more minutes to free the paramedics. Richard checks on them. Stan asks Ray to talk to him. He wants to hold on until Sara comes. Ray says he doesn't have to hold on as he's not dying, but Richard tells Ray to talk to Stan. Ray starts talking about the night Stan met Sara. They had a bet over the song lyrics of "I can see clearly now". They start singing in and Richard helps them remember the lyrics. Stan says that when Ray gets out of here, he's got a great story to tell. Chicks love stories like that. Stan asks him not to tell Sara they were talking about that right before he died. Richard tells Stan to hold on.

Erica tells Mark she has a patient with a sternal infection and she's going to remove the sternum, so she needs to know if Mark is available to manipulate the pectoral muscles in order not to leave a hole in the man's chest. Mark wants to know if she's available for a drink afterwards. She mentions time is a factor her and she's looking for a yes or no answer. He says he is as well. Erica came to him because legend has it he's the best in plastics, but if sleazy come-ons is what she's in for all afternoon, she'll find the second best. Mark tells her he'll clear his schedule for her. She thanks him. Mark tells Alex to finish up stitching their patient's face and to clear his schedule afterwards. He walks out and Alex suddenly sees Ava appearing in the doorway. Alex tells his patient he'll be right back.

Alex tells Ava he doesn't have time for coffee right now. She recalls he at least had time for her when she was his patient. She thought that was because he liked her. Alex says he has to finish up with this patient and then he gets to scrub in. Ava asks if she can watch. He says he can get in trouble for that, but she points out he's never been a rule follower. She says please, which convinces him.

The firemen are ready, but Richard asks them to hold off one moment as Stan's wife has arrived. She lies down and greets him, but he's almost lost consciousness.

Callie tells Jacob that the metal has impaled his femur, so she's going to fix that while Hahn and Sloan repair the damage to his sternum. Jacob wonders why this is all happening. He says his kids shouldn't see him like this, as children aren't supposed to worry about their dad. They aren't supposed to comfort their mom. Izzie tells him his kids are fine. They're taking care of each other. They just want their dad to get better. He asks Izzie to keep them updated while he's in surgery, because his wife gets panicky if she doesn't know what's going on. Izzie will do that.

Bailey asks Erica if she can have Yang for something important. Erica asks Callie if she can steal Stevens from her service. Callie says she'll give her away for free. Erica tells Bailey Yang's all hers. Erica calls Yang and Stevens and informs Cristina that Bailey has requested her, so Izzie has to take over prepping their patient. Cristina starts to object, but Erica tells her to take it up with Bailey.

Derek and George wait for Mary's scans. Derek asks George what's going on with Izzie and George. George wonders why he's interested in that and then realizes Derek is clinging because he misses Meredith. Derek claims he's just making small talk. The scans come about and Derek sees a tumor.

Bailey is just sitting by Shane's side. He says he's in pain. She says someone will come eventually to save the master race from extinction. Cristina comes over to talk to Bailey. She hopes Bailey has a very good reason for pulling her off Hahn's service. Bailey says she's not black, nor white. Shane sees her and sighs. Bailey reminds him that he has had medical training, so he knows his internal injuries need to be taken care off. Bailey asks Cristina to give Shane the best medical care, as it's the law. She walks off and Cristina wants to start her exam. Shane covers his abdomen and says he thought Bailey might take offense. Cristina pulls up his shirt, revealing a Swastika tattoo.

Sara is crying and talking to Stan. Meredith and Richard watch from a distance and she says she's never seen Sara before. Before today, Sara was a complete stranger to her. She's never met her before and yet Meredith is the one who handed her the worst day of her life. That's who Meredith is in her story. Richard says that's the job. Meredith knows. Richard tells her to look at him. He tells her she feels helpless today, which makes you fight on other days and glad that you have a chance to do anything at all. She better take it in. A fireman takes Sara away as she breaks down. Richard says it's time.

Shane is about to get a CT taken. Cristina is acting a little rough, making him remind her he's in pain. She reminds him he's on morphine and it's not like he's in a concentration camp or anything. Shane says he got the tattoo when he was young and drunk. He doesn't regret it, but Cristina has got to treat him the way she treats everybody else. He thinks that's the beauty of this country. Cristina activates the scanner.

Mary is told they're gonna drill in her skull. George informs her about the minimally invasive surgery. Mary says it's weird to be on the other side of it all and asks about her colleagues, but then gets another seizure. Derek and George rush to help her.

Izzie in the OR with Alex and sees Rebecca in the gallery and asks Alex if he wants to get kicked from the program. Alex says she wanted to do see what he does. Izzie thought he was seeing Lexie, but he states he's popular. Erica says she's sure he's talking about fascinating stuff, but she'd like to focus on saving the patient. She makes the first cut.

Lexie enters Nick room. He asked for her because she's bored. Lexie reminds him she's an intern so she's gotta learn things. He says she can learn about his artery. Lexie agrees to talk, but she's taking his vitals. He wants her to help plot his revenge against his girlfriend. He wants to play the "I'm dying" card to get her here and then flash her the artery. Lexie laughs and says that's mean.

Richard explains to the paramedics that they're about to free them. They're gonna assess on who to free first, but Ray insists they first get to Stan. Stan says he's gonna be okay and thinks he might just get out of here paralyzed. He asks if Richard if that can happen. Richard looks at the damage and doesn't respond. Meredith jumps in and says it's possible. Ray believes it. Stan makes sure Sara is inside so she doesn't see any of this. He wants to look at Meredith while it happens. He and Ray hold hands and Stan says "let's do this". The paramedics tell each other to try and live. The firemen start to free them, but Stan yells stop.

Meredith makes the firemen stop. He says to look at Ray's back. The oxygen regulator is embedded in his back and he's gonna bleed out if they move him. Ray says he's still conscious but his pulse is weak. Richard and Meredith suspect he has a cardiac tamponade. If they move him, the regulator could enlarge the tear in the heart. RIchard decides to stabilize him in the ambulance. Richard tells Stan he's a hero for saving Ray's life, but he has succumbed to his wounds. Richard gives instructions but Meredith can't look away from Stan.

Shane's scans reveal and intraperitoneal bleeding. His liver is ruptured, but Bailey suspects the laparotomy is gonna be straightforward. Cristina thinks that means she can get back to Hahn, but Bailey says she has to work on this man with her. Cristina says she's not needed and tells her about the giant swastike. Her stepfather's parents died in Auschwitz. Bailey sighs and says she and Cristina will do this and consider themselves having risen above.

Callie removes the piece of metal from Jacob's leg as Lexie sits in the gallery next to Ava. Izzie whispers that Alex is busted as both girls smile and wave at him. Erica says she's never seen Mark's technique before. He says he learned it from a doctor who died last year, which felt to him like losing his own father. Erica reminds him they're not on a date and continues operating.

Shane says he won't consent to the surgery. Bailey says he'll die without it. Shane demands that there be a white doctor in the room so they won't kill him on the table. "No offense," he adds. Bailey can't believe he said that.

Bailey finds Derek, who's about to go into surgery with George. She says she needs George. They wonder why. She says she's rising above, because she has to operate on a white supremacist who demanded a white doctor. Derek says she can have George. She tells George to get Shane to sign the consent and have him anesthetized and ready. Derek reminds Bailey she's well within her rights to pass this on to somebody else, but she says that would make her like him, and she's not like him.

Rose is still putting supplies in the scrub room and apologizes to Derek for being behind on her schedule. He says he's early, so he's actually in her way, not the other way around. She tells him not to let it happen again. She notices he's staring at her ring around her necklace, which comes off as staring at her chest. She says she used to wear the engagement ring around her finger when she was engaged. The stone in it was her grandmother's and she doesn't want to lose it. He says he's sorry about her engagement and asks if it got broken off recently. She says that's a personal question, but he reminds her they're friends since the licorice incident. She says it happened a year ago, but there's no need to be sorry as it was never gonna work out. He asks how come. She was always clear on what she wanted whereas he wasn't, and there's no way to build a future on that. He understands that.

Ray starts panicking. Richard reminds him to stay completely still. Meredith tells him to look at her instead of Stan. She wants to hear him say that he's not going to die today. Richard says he needs a pericardiocenthesis, but they need an ultrasound to confirm if it's a cardiac tamponade. Meredith says she can get inside the ambulance.

Shane has been put under as Bailey enters the OR. She steps up to the table and closes her eyes. She's calling on Jesus and wishes not to be disturbed. She asks for the scalpel, looks at Shane's face and starts cutting across the swastika.

Tucker arrives in the waiting area and tries to call Bailey when he sees she's not in the lobby.

Ava tells Lexie she's amazed by the surgery. She asks Lexie if she's a surgeon. Lexie says she's an intern and asks about her. Ava confesses she's not supposed to be there, but the guy she's sort of seeing is operating and she wanted to see it. Lexie thinks she's talking about Sloan and she gets that, as he's hot, but Ava says she's not with him. She points at Alex and says she's with him. Ava asks Lexie if she knows him. Lexie says no. Alex looks up at them from the OR.

Bailey's pager goes off and she remembers she's supposed to have lunch with her husband. Instead, she's elbow deep in a nazi's gut. She says no one better ever call her "nazi" again.

Derek is operating on Mary. As he's about to access the tumor, there's a technical problem with one of the monitors that was displaying the scans. Rose says there must be something wrong with the stereotactic. Derek can't believe the navigational system is dead. They want to get another machine, but Derek says he can't remove the probe with navigational machine. He asks to call the company and have them get over here asap.

Meredith crawls into the ambulance over Stan's body, for which she apologizes to him, and inches her way towards Ray. He's deteriorating. Richard tells her to just get in there and not to worry about Stan.

Lexie enters Nick's room and greets him. He asks if she's gonna call him strong and stable again. She hopes so and puts on her gloves. He notices something's wrong with her. She sighs and he figures out her boyfriend turned out to be just a jerk. He says he's sorry. As she removes the bandage, he asks if she wants him to help her plot her revenge. Lexie says okay. Nick says she has to go out with, making her ex wonder what Nick has that he doesn't have. Then she can mention the exposed carotid artery. Lexie laughs and as he imitates her boyfriend realizing he can't top the exposed artery, the artery bursts and blood gushes out all over Lexie.

CastEdit

  • Meredith Grey
  • Cristina Yang
  • Izzie Stevens
  • Alex Karev
  • George O'Malley
  • Miranda Bailey
  • Richard Webber
  • Callie Torres
  • Mark Sloan
  • Lexie Grey
  • Erica Hahn
  • Derek Shepherd
  • Ava
  • Shane
  • Tucker Jones
  • Nurse Rose
  • Jacob Nolston
  • Stan Giamatti
  • Mary Daltrey
  • Mrs. Nolston (right)
  • Nick Hanscom
  • Paramedic Ray Sutera (center)
  • Sara Giamatti
  • Lucy Nolston
  • Sandra Nolston (right)
  • Garrett Nolston

Main CastEdit

Guest StarsEdit

Co-StarringEdit

Medical NotesEdit

Nick HanscomEdit

  • Diagnosis:
    • Carotid tumor
    • Blown artery
  • Treatment:

Nick had had a large carotid tumor removed from his neck, leaving only a flap of skin between his carotid artery and the outside world, which left him at great risk for hemorrhage. Mark ordered whoever was in the room if that happened to stop the bleeding and then page him. Later that day, Nick laughed heavily and his artery blew with only Lexie in the room.

Jacob NolstonEdit

  • Diagnosis:
    • Leg laceration
    • Sternal infection
  • Treatment:
    • Sternum removal
    • Chest reconstruction
    • Foreign body extraction

Jacob, 47, had had double bypass surgery two weeks prior. He was febrile and had pain and tenderness at his incision sites. Before he could be taken inside the hospital, his leg was impaled by a piece of metal when an ambulance crashed into another ambulance in the ambulance bay. Cristina diagnosed a sternal infection and Hahn told Izzie to page Callie to remove the shrapnel in his leg. Erica determined that she'd have to remove the sternum and paged Mark to manipulate his pectoral muscles to cover the gap. Callie said she'd remove the metal, which was embedded in his femur, while they did his chest surgery. They took him into surgery.

Ray SuteraEdit

  • Diagnosis:
  • Treatment:

Ray was injured when another ambulance crashed into the ambulance he was in. Callie told Meredith to page someone to help her take care of him and Stan. When they started to pull the ambulances apart, Stan stopped them because he noticed that Ray had an oxygen regulator imbedded in his back, which had caused a tear in his heart. So they had to stop moving until they could stabilize his heart before getting him out of the rig. They suspected cardiac tamponade and got an ultrasound to confirm.

Stan GiamattiEdit

  • Diagnosis:
    • Severe bleeding
    • Paralysis
  • Treatment:

Stan was injured when the ambulance he was in was hit by another ambulance. Callie told Meredith to page someone to help her take care of him and Ray. He told Webber that he couldn't feel his legs and wondered if he was paralyzed. His body was trapped in the door, but he was unable to feel that and he was bleeding from his ears. Richard determined that no matter what they did, as soon as they moved him, he would bleed out and there would be no chance they could save him. When they started to lift the ambulance, he bled out and died.

ShaneEdit

  • Diagnosis:
    • Intraperitoneal bleeding
    • Liver rupture
  • Treatment:
    • Laparotomy

Shane was injured when the ambulance he was in crashed into another ambulance. He insisted that he didn't need help and wouldn't let Bailey examine him, despite having pain in his upper abdomen. He initially said he just wanted a male doctor, but they quickly realized that he actually wanted a white doctor. He had severe internal bleeding, which needed surgery, but he refused to sign consent until Bailey agreed to get a white doctor in the OR with her to make sure they couldn't kill him.

Ambulance PatientEdit

  • Diagnosis:
  • Treatment:

While on his way to the hospital, the patient in the ambulance started coding and since the ambulance crashed, he was pronounced dead on arrival.

Mary DaltreyEdit

  • Diagnosis:
    • Seizure
    • Elbow dislocation
    • Brain tumor
  • Treatment:
    • Elbow reduction
    • Cookie craniotomy

While driving an ambulance, Mary had a seizure and crashed into another ambulance. She was postictal when Callie examined her and Callie diagnosed an elbow dislocation and said she had a weak pulse. Inside the hospital, she was conscious and told Derek she'd never had a seizure before. Callie reduced her elbow dislocation and they took her for an MRI. The MRI revealed a tumor in her brain. Derek planned to do minimally invasive surgery using a scope to remove the tumor. Before she could be taken into surgery, she had another seizure. While he was operating, the navigational system he was using crashed, leaving him blind in her brain.

Mark's PatientEdit

  • Diagnosis:
    • Facial laceration
  • Treatment:
    • Stitches

Mark left Alex to finish doing stitches on one of his patients.

MusicEdit

Song Performer Scene
"Movie Star" Róisín Murphy
"Some Surprise" The Cake Sale
"Where I Stood" Missy Higgins
"Let Me Out" Ben's Brother
"All the World (I Tell Myself)" Correatown
"Revival" Soulsavers

Notes and TriviaEdit

Grey's Anatomy - 400:30

Grey's Anatomy - 4.09 Crash Into Me - Promo

  • This episode's title originated from the song Crash Into Me, originally sung by Dave Matthews Band.
  • This episode scored 14.11 million viewers.
  • The ambulance crash was filmed at the Sepulveda Dam.
  • This episode, along with the second part, was nominated for an Emmy Award for Outstanding Makeup for a Single-Camera Series (Non-prosthetic).

GalleryEdit

Episode StillsEdit

QuotesEdit

(Hahn asked Mark for help with a patient)
Hahn: Can you make time?
Mark: Can you make time for a drink with me after?
Hahn: Did I mention time is a factor here? I´m looking for a Yes or No answer.
Mark: As am I.
Hahn: This may be enjoyable to you, Dr. Sloan, but I´ve got a patient in serious condition. I came to you, because legend has it, that you´re the best in plastics. But if bad jokes and sleazy come-ons or what are I'm in for all afternoon, I´ll page whoever is second best.
Mark: Dr. Hahn... I apologize. And I´ll clear my schedule.
Hahn: Thank you. OR 1.

Izzie: I'm going to go in early. I'm going to get on hard-core, Erica-Hahn cardio and I'm gonna kick ass at it. And when I kick ass at cardio, it's going to piss Cristina off, but it won't matter, because I'll be a kick-ass cardio god.

Erica: I'm sure whatever you're talking about is endlessly exciting, but I kind of had my mind set on saving a life today.
Alex: Sorry.

Izzie: I'm so sick of Meredith and Cristina and their stupid love affair with each other that they have to rub in everyone's faces.

Erica: What, are we, on a date here? I was complimenting your surgical skills, Dr. Sloan. Not looking through a window into your wounded soul.

Miranda: I'm rising above and do not want to be crossed while I'm busy rising.

Meredith: I've never seen her before. I've worked in this hospital all this time and before today she was a complete stranger to me.
Richard: It happens, it's a big hospital.
Meredith: I've never met her before and I'm the person who handed her the worst day of her life. In her story that's who I am. That's who I'll always be.
Richard: That's the job.
Meredith: That's the job, I know.
Richard: Look at me. This day, this day you feel helpless. This day makes all those other days when you fight to save a life and lose. This day makes you grateful you have a chance to do anything at all. You take it in.

See AlsoEdit

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

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