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Crash Into Me, Part 2

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At the end of the day, the experience of practicing medicine bears little resemblance to the dream. 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. The ills we couldn't cure. The lives we ruined or failed to save. At the end of the day, the reality is nothing like we hope. The reality is, at the end of the day, more often than not, turned inside out and upside down. Some days, the whole world seems upside down. And then, somehow, improbably and when you least expect it, the world rights itself again.

Crash Into Me, Part 2 is the tenth episode and mid-season finale of the fourth season and the 71st overall episode of Grey's Anatomy.

Short SummaryEdit

Tragedy abounds for everyone at Seattle Grace as they all continue in efforts to get the paramedic out of the overturned ambulance, stop the bleeding of a man who won't quit, and a bigot with a Nazi tattoo on his stomach. On the personal side, Rebecca returns to spend time with Alex, Miranda's husband finds it harder to wait for her while she's in surgery, and Cristina still tries to get on Hahn's good side, even though Bailey has put her elsewhere.

Full SummaryEdit

While Meredith talks about how practicing medicine feels at the end of the day, Meredith and Cristina are dancing.

Alex is in his bedroom kissing Ava, who backs off and wonders how he can be okay after such an intense day.

Cristina tells Lexie in the OR that she did a good job today. It was't easy, but she was brave.

Callie is watching Mark, who appears to be awful.

Izzie appears to feel awful as well as she's lying in bed. George comforts her.

Meredith tells Derek she doesn't want him to see other people. That may not be enough for him, but she's trying here.

Richard is overseeing the ambulance wrackage being taken away.

Earlier that day, Richard is overseeing the damage in the ambulance bay. Meredith is cutitng open Ray's shirt.

Lexie rushes to cover Nick's artery with her hands. They're shocked. Nick didn't think it would actually happen. Neither did she.

Rose tells Derek that the local tech is five hours away. Derek can't remove the probe from the tumor because he can't do that without the navigational system and leaving them in for too long would mean risking swelling. Derek tells his intern, Steve, to run to the nurses' station and get them computer technicians. Rose tells Derek she did three semesters of computer science before she switched to nursing, so if it's something basic she might be able to fix it. He says he'd feel better about it if her voice weren't shaking, but Rose says that just is because she's an imperfect, nervous person. It doesn't mean she can't do it. Since there's no one to top her experience, he tells her to give it a shot. She appreciates the voice of confidence.

Richard is holding the portable ultrasound screen while Meredith tries to give him a clear view of the heart. Ray asks her to close Stan's eyes. Meredith does so and says she's sorry. Richard gets the right frame and confirms the pericardium is full of blood. He requests a pericardiocenthesis kit and someone from cardio.

Bailey is quickly scrubbing out and she asks Cristina to take the patient to post-op. Cristina wants to tell her it was wrong to take her off Hahn's service, but George comes in to inform them that there's something wrong with Shane. Bailey asks George to go ask Tucker nicely to wait. He says he will.

Mark keeps on flirting with Erica, who thinks it's flat-out inappropriate. She thinks he would've lost his job a long time ago if he were looking homely. A nurse informs Erica that the Chief needs her in the ambulance bay. Erica takes Izzie.

Nick can't reach his call button without moving too much. He can reach his phone and Lexie tells him to dial 8, which directs her to the nurses' station. He holds the phone up to Lexie's ear. She asks to page Yang and Sloan and then decides to call this a code blue. Nick realizes what a code blue is, but Lexie just figured they could use all the help they can get. The nurses come in.

A pager goes off in Bailey's OR and Bailey says she doesn't care, she's going to have lunch with her husband. The nurse informs her it's Cristina's; Lexie is paging her 911. Another nurse tells her that Lexie apparently wrongly called a code blue. Bailey tells Cristina to go, suddenly not needing her here anymore.

Nick asks Lexie if she's doing okay, because she doesn't look too well. The nurses are having trouble finding a good vein to start a blood transfusion. Lexie's hand slips as Cristina comes in. She reminds Lexie to keep applying pressure. They can't take Nick to the OR as there's no OR available. Lexie asks Tyler to go get more blood. Cristina leaves to go get Sloan, but she tells Lexie that she can do this.

Mark is trying to teach Alex, but he notices he's looking up at the gallery all the time. He then looks up himself and recognizes Ava as the face he built. Mark says he's busted as Cristina comes in to inform him Nick's artery blew. Mark leaves and tells Alex to finish up here. He decides to have turned this OR around as soon as possible as he's going to bring down his patient.

George finds Tucker, who already realizes Bailey can't make lunch. George says she can, but it's gonna be a little later. Tucker's heard that before. George says she's having a bad day because she's saving a white supremacist and that Bailey asked him nicely to wait, with a please, which Tucker must know she doesn't use frequently. Tucker smiles and agrees to wait, but he wants George to tell Bailey not to keep him waiting long.  

On their way to the ambulance bay, Izzie and Erica pass Mr. Nolston's family. Izzie wants to update them, but Hahn sighs and says she wants Izzie to think like a surgeon instead of a social worker. A surgeon updates the family after the crisis has passed. Izzie says she's right and apologizes. She follows Hahn outside.

Steve returns to Derek's OR, where Rose is having trouble. She has to reconnect some wires, but she doesn't have the steadiest hands and Derek talking to her is not helping. Derek says he's got steady hands and tells Steve to take over from him, also requiring very steady hands. Derek asks Rose to tell him what to do.

George returns to Bailey's OR and she's relieved to hear Tucker agreed to wait. She informs him the hepatic vein was injured. She asks the anesthesiologist to check for a new murmur. Bailey sends George back out to ask Tucker to wait a little longer. Bailey tells Shane she's about the reach the highest she can rise. The monitor starts beeping and she rightly guesses an air embolus.

Richard is informing Erica. Meredith has to do the pericardiocenthesis. Erica tells her she's gotta be careful, or she could cause a cardiac rupture or five other ways to kill Ray. Meredith tells Ray not to listen to them and she tells Erica to shut up. Erica sends Izzie to get an 18 gauge needle.

Callie asks if Alex if he's doing okay. He says his nose itches, which she says is the anxiety. Suddenly there's a lot of blood and she asks what he did. He says he was only irrigating. The blood's coming from his chest. He moves rapidly to control the damage. Ava looks worried and Alex asks to page Hahn and Sloan.

Lexie asks Nick for more gauze. Nick asks if the blood's going in faster than it's going out, because he's feeling a little queasy and weak. Lexie transfers to the new gauze and he wonders if he should be calling people. As Sloan comes in, Lexie says she thinks the bleeding stopped. Mark checks and confirms she seems to have gotten it under control. There's a possibility of it bleeding again, but Mark's gonna close it up before it can. Mark informs them there will be an OR soon. He leaves to get OR 3 prepped and tells Lexie and Cristina to prep the patient. Mark tells Lexie she did good. Nick tells Lexie he's totally in love with her now.

Erica gets paged back to her OR. She asks Stevens to page the cardiac fellow and get an OR ready.

George finds Tucker, who's not surprised. George tells him the surgery is a little more complicated than anticipated. Tucker agrees to wait, but he wants George to tell Bailey he's sick and tired of her choosing everything over him and their marriage. He's finished after this time and he's only staying to tell her that himself.

Mark comes in and asks Alex what he did. Alex cut the table, which apparently he shouldn't have done. Mark asks if he was showing off for his girlfriend and says he's screwed. Callie says it's not Alex's fault as one of the heart grafts blew. She's holding the left coronary with a clamp. Erica comes in and they inform her on what happened. Alex wants to help, but Mark won't let him do anything more than suctioning.

George returns to Bailey's OR and informs her Tucker is waiting, but that he's finished and that this was the last time he'll allow her to choose everything over their marriage. Bailey says she wants to be with him right now, but if she leaves this man is going to die. She tells George to go back and tell Tucker that she took a vow to save lives, like he took a vow for better or for worse. It's his job as a husband to understand that and stand by her. She's standing by her vow. She's holding him to his vow and if he leaves right now, he might find himself wounded and in need of a surgeon, who hopefully is as married to her vows as she is. She tells George to tell him that.

Derek says the wire's in, but the navigational system is not working. Rose tells him to stop looking at her like she killed his patient, because she did her best. He says she didn't. He tells her to calm down, take a breathe and think about what she missed. She forgot to press the restart button. She does so and the machine works. Everyone applauds.

Nick says he never thought he'd die like this. Lexie and Cristina says he's not going to die. He's always thought they got some sort of say or feeling over how they're doing to die, and he doesn't have that feeling, so he trusts that he won't die. Nick says he doesn't feel too good and then starts bleeding again. Cristina checks and says he had a stroke. She says they have to move now, but carefully. Lexie starts to cry, but Cristina says she can't because it's not over yet.

Meredith finds the right spot and Richard gives her the needle. Richard walks her through it. Ray is worried, but Meredith says this is going to make him better. Ray wants her to tell Sara that he's sorry about Stan. Meredith tells him to tell her himself. Ray asks her to wait again. He's trying not to be scared as he doesn't want to die scared. Richard says it's got to be scared, because that means you still got something to lose. Meredith confesses she's scared as well. Ray says that's good and says he's ready. Meredith does the procedure.

Erica realizes she failed to check the grafts and says it was stupid of her. Mark says it's fascinating that she's as unkind to herself as she is to anyone else. Cristina comes in to inform Mark that Nick's artery blew again and that he appears to be having a left-sided CVA. Nick and Lexie are waiting behind her in the hallway, but since Erica is nowhere near done, Mark tells them to get Nick to a sterile procedure room. Callie says she's done so she can help with Nick. Mark asks her to help set up the procedure room. They leave and Erica keeps telling herself that Jacob has four children.

Meredith has put the needle too deep and she has to adjust her angle. She does it right and the syringe fills up with blood. Now that Ray is stabilized, the firemen can get ready to cut him out. Meredith gets out of the wrackage. As the firemen start freeing Ray, Richard finds Meredith has cut herself, but she stayed calm, focused, and efficient. He says it's impressive. She admits she was scared, but he says she did it anyway.

Izzie is being told that there's no OR, but she says she needs one for the Chief of Surgery. A nurse goes to check again as Jacob's family comes over. Izzie says she doesn't now, but she believes he's still in surgery. Izzie knows she promised to keep them updated, but she's on another case now. Mrs. Nolston wonders if she had bad mentors who didn't teach her how to be a good doctor or bad parents who didn't teach her how to be a human being. The nurse returns and tells Izzie that OR 2 is available. While Mrs. Nolston asks the nurse to go check on her husband, Izzie shares a look with Jacob's worried daughter.

George just delivered Bailey's words, but he suggests Tucker waits so he and Bailey can have this very important conversation in a proper way. Tucker says his marriage is falling apart and she's sending him to save it, so it's cleary not that important to her. She's always busy saving lives. Tucker asks him to go ask Bailey when "soon" is gonna come and then walks off.

Meredith walks past Sara, who recognizes her and asks her about Ray. Meredith tells her Ray is in surgery. Sara says she has to get out of here, but she asks Meredith to tell Ray that she's sorry that she can't stay. Meredith tells her that Ray wanted her to tell Sara that he's sorry that he couldn't save Stan, just in case he can't make it. Sara hopes Ray makes it, but she can't stay here when she knows her dead husband is here somewhere. Meredith points out that if Ray wakes up, he has no one, and Sara will go home and she'll have no one. She thinks it's better to have someone, even though it's the most painful thing she's ever done.

Bailey asks George if Shane's skin looks a little jagged, because that would she would have to reposition the skin so that it approximates more correctly. If she does that, the swastika tattoo might be unrecognizable. George agrees it looks jagged. Bailey figures out that Tucker left and asks for a scalpel.

Izzie and Richard pack Ray's heart with lap pads. Richard urges him to fight.

Erica repeatedly tells Jacob not to die.

Mary isn't doing too good in Derek's OR either.

Nick codes in Mark's procedure room and Lexie begs him to live.

Meredith and Sara enters Ray's room. Sara says he looks bad, but Richard says his heart and lungs were compromised, but he's young so they can hope he might just be fine. Sara walks up to Ray, who wakes up. She tells him she's here.

George tells Shane, who's checking out his "new" tattoo, that they took care of every injury. He should make a full recovery. Shane looks at his tattoo and says it's not a full recovery. He thinks Bailey did this on purpose. George doesn't understand, since Mary, his partner, is black. Shane says he's not the devil. He's just a guy with a belief system, and he has a good time saving lives with Mary. Now, if she wanted to date his brother, he'd have a problem, but many people feel that way. George tells him that a black woman saved his life at a great personal cost, so next time he's looking at his tattoo and thinking how white people are better, he should think about that. Between them, if George had been alone in that OR, Shane would be dead now, and since they're sharing belief systems, George believes the world would be a better place then.

Izzie appears in the doorway of Jacob's room and asks Alex how he's doing. Alex informs her he's starting to rally. Jacob's wife sees Izzie and asks her to go. She walks off and Alex sees Rebecca in the hallway.

Cristina finds Bailey and asks her if she's not going home. Bailey says it's easier at this point to just wait till Tucker's asleep. Cristina says she rose above too today, which is why she hasn't said anything. What Bailey did today was an abuse of power. She used Cristina because of the color of her skin. She compromised the quality of her education because of her skin color and she resents it.

Rose and Derek are scrubbing out. She says he saved Mary's life, but he says he only fixed her brain. She is the one who actually saved Rose's life. He leans in closer to grab a towel. They share a look and then kiss. They smile as they stop and Rose thanks him. Her voice is shaking.

Lexie is sitting by Nick's bedside as the procedure room is being cleaned up and Nick's body bag is closed. Tyler informs her that his parents are on a plane from California. Lexie is gonna wait for them.

Meredith finds Derek and tells him she doesn't want him to date other people. That may not be enough for him, but she's trying here. She confesses she's scared as hell to want him, but here she is, wanting him anyway. Fear means she's still got something to lose, and she doesn't want to lose him. He wants to say something, but she tells him not to say anything. He can say it tomorrow, because now she's just happy with her progress. She walks off.

Alex is in his bedroom kissing Ava, who backs off and wonders how he can be okay after such an intense day. He leans in and starts kissing her again. She wonders if he doesn't want to talk. He wonders if he should talk about the guy almost bleeding out or because he got suspended for a week because she was there. He addresses her as Rebecca, but she says it's Ava. He says she's here to play dress up. Rebecca has a husband and a baby and she has a life. He's screwing the girl she talked to in the gallery, and she may be a bigger wreck than he is, but at least she doesn't have a husband or gets him suspended or pretends to be someone else. Alex says that if she stopped for a minute and asked herself the truth, she'd realize she's not here to talk. They start kissing again.

Cristina enters the procedure room where Lexie is still sitting next to Nick. Cristina tells her she did a good job. It wasn't easy, but it was brave. Lexie says they killed him. The hospital, Sloan. They killed him, because they were not prepared. Cristina says that happens sometimes. Lexie asks if she has any idea how backwards that is. Cristina says they help more than they hurt. Lexie is teary-eyed and says she has no one.

Callie is watching Mark. Erica sits down with them and says it's gonna sound bizarre at this point, but she asks if there's any chance they wanna get a drink with her. Callie realizes she needs a friend. Mark agrees to. Erica asks him not to hit on her, but he can't promise that. She asks if it's possible if she says please, but Callie says he still can't promise it then. Erica says fine and they take off.

Cristina enters Meredith's house. She brought booze and gestures at someone to follow her. Lexie walks into the living room. Cristina tells Meredith she's got no one. Lexie is holding the limes for the tequila. Lexie smiles at Meredith and Cristina encourages Meredith to talk to her. Meredith says she's drinking and she asks Lexie is she's drinking too. Lexie says a drink would be good and Meredith does her best to smile at her.

George knocks on Izzie's door and enters the room. He lies down on bed with her. She was Hahn's right hand today. George says that's great, but she says she thinks a patient feels better if they know their kids aren't terrified. She thinks they do better in surgery if they know their wives aren't panicking. Those things matter. She's never gonna be Cristina, or Erica Hahn. She's not kick-ass. He thanks God for that. She tells him she loves him. He loves her too. She says they're not gonna make this work. He says marriage is hard and next time he does it, he wants it to be forever. He thinks it's their timing rather than their chemistry. So they're saying maybe someday it can happen. He says yeah.

Meredith, Cristina, and Lexie are dancing it out in the living room. George and Izzie appear in the doorway and Meredith tells them it's a dance party. She asks if he wants to dance. He takes her hand and they join in on the dance party.

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
  • Mrs. Nolston
  • Mary Daltrey
  • Stan Giamatti
  • Nick Hanscom
  • Ray Sutera
  • Sara Giamatti
  • Intern Steve
  • Anesthesiologist
  • Nurse Kate
  • Nurse Jolene
  • Nurse Ginger
  • Nurse Tyler
  • Lucy
  • Sandra (Center)
  • Garrett (Right)
  • O.R. Nurse

Main CastEdit

Guest StarsEdit

Co-StarringEdit

Medical NotesEdit

Ray SuteraEdit

  • Diagnosis:
    • Cardiac tamponade
  • Treatment:
    • Pericardiocentesis
    • Surgery

Meredith had climbed into the rig with Ray to use an ultrasound to diagnosed his problem. His pericardium was full of blood, so they needed to do pericardiocentesis. When Erica was paged away, she had the cardio fellow paged to operate on Ray once he was freed. Meredith did the pericardiocentesis, but it took a second try to get the needle positioned properly. Once the blood was drained, the got him out of the rig and took him into the hospital for surgery. Ray survived the surgery and woke up afterward.

Nick HanscomEdit

  • Diagnosis:
    • Carotid bleed
    • Stroke
  • Treatment:
    • Pressure dressing
    • Surgery

Lexie managed to stop the bleeding on Nick's artery and had him call the nurses' station and had them page Mark and Cristina and called a code blue. His veins had gone flaccid due to extreme blood loss, so they had trouble getting a vein to transfuse. Despite blood being transfused, Nick started to feel faint from blood loss. Lexie believed she had the bleeding stopped, but there was a possibility it would start bleeding again, so Mark wanted him rushed into surgery. He had them put a pressure dressing on the wound in the meantime. Before he could be taken into the OR, he had a stroke and they rushed him to the OR, but it was occupied, so they moved him to a sterile procedure room. Despite their best efforts, Nick died.

Mary DaltreyEdit

  • Diagnosis:
    • Brain tumor
  • Treatment:
    • Cookie craniotomy

Derek was stuck in Mary's surgery because the navigation computer was still not working. When they were unable to get a tech from the company to come out, Nurse Rose took a shot at fixing it. Rose was able to get it working again and Derek finished removing the tumor successfully.

ShaneEdit

  • Diagnosis:
    • Internal bleeding
    • Hepatic vein injury
    • Air embolus
    • Bowel perforation
  • Treatment:
    • Surgery

Shane's surgery had just been completed when his pressure bottomed out, so they had to go back in. He had multiple complications, but despite them, Bailey was able to save his life. He woke up after his surgery and was doing well.

Jacob NolstonEdit

  • Diagnosis:
    • Sternal infection
    • Cardiac bleeding
    • Cardiac infection
  • Treatment:
    • Sternum removal
    • Chest reconstruction

Jacob's sternum had been cleared out and Mark got started resconstructing his chest to cover the defect. Mark and Erica left Callie and Alex to close, but when he started bleeding, they paged Mark and Erica back to the OR. One of the heart grafts blew, so Erica had to fix it. She discovered that the infection had gone to his heart and had to go back in to repair the damage. He survived the surgery and was stable afterward.

Meredith GreyEdit

  • Diagnosis:
    • Cuts
  • Treatment:
    • Stitches

Meredith got cut on the glass while crawling in the ambulance. Richard said she could use a few stitches.

MusicEdit

Song Performer Scene
"Creator" Santogold
"Circles" Natalie Walker
"Feel It Coming" Sara Melson

The dance in the living room at the end of the episode. Meredith, Cristina and Lexie are dancing, then George and Izzie joins in.

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 17.78 million viewers.
  • Curiously, Theo Rossi is credited as a guest star while his character died the previous episode, so he only makes a scarce appearance, whereas Ray Ford, who appears throughout the entire episode, is just credited as a co-star.
  • This episode marks the end of calling Bailey 'the Nazi'.
  • This episode, along with the first part, was nominated for an Emmy Award for Outstanding Makeup for a Single-Camera Series (Non-prosthetic).

GalleryEdit

Episode StillsEdit

QuotesEdit

Erica: Basically, there's about six different ways she could kill him.
Ray: Are they talking about me?
Meredith: No, don't listen to them Ray. Dr. Hahn, shut up.

Miranda: You need to go back out there and tell him that I took a vow... a vow to save lives. He might also remember that he took a vow for better or for worse. You tell him that it's his job as a husband to understand that. You tell him I am standing by my vow for better or for worse. You tell him I am holding him to his vow.

Izzie: Do you want me to keep the family informed?
Erica: I want you to think like a surgeon. You're thinking like a social worker. If you wanna be a social worker you can save yourself a lot of effort because the training is two years not 12. If you wanna be a surgeon, you can update the family when the crisis has passed.

Miranda: A person can only rise so high. Now I'm rising above, but there's a ceiling and I'm about to hit it.

Erica: This is gonna sound bizzare. I realize at this point that this is gonna sound bizzare, but any chance you people wanna get a drink with me?
Mark: Why would we wanna do that?
Callie: She's saying she needs a friend.
Mark: Okay, fine. Let's drink.

Cristina: You did a good job today. That was not easy. What you did was not easy, it was brave.
Lexie: We killed him. The hospital, Sloan, us... we were not prepared.
Cristina: Yeah... yeah, that happens sometimes.
Lexie: That's... do you have any idea how backwards that is?
Cristina: We help more than we hurt.
Lexie: I have no one.

Meredith: I don't want you to date other people. It may not be enough for you, but I'm trying here so I don't want you to date anybody but me. That's it. Except, I'm scared as hell to want you, but here I am, wanting you anyway. And fear means I have something to lose, right? And I don't want to lose you.

Cristina: But now the day is over. And I'm done. What you did, pulling me off Hahn's surgery, was an abuse of power. You know, you needed help, okay. But you used me because of the color of my skin? I mean, you compromised the quality of my education, because of my color. I resent it.

George: Well, Dr. Bailey did save your life today. A black woman saved your life, at a great personal cost. So maybe next time you're looking at your tattoo and you're thinking how much better all these white guys are better than everyone else. You might wanna think about that. Cause between you and me, if I had been alone in that O.R., you would probably be dead right now. And since we are sharing belief systems, I believe that if you were dead, the world would be a better place.

Richard: It's good to be scared. It means you still have something to lose.

Miranda: You tell him that if he's thinking about leaving right now, he might find himself hurt and wounded and needing an operation, and he may not get a surgeon who is as married to her vows as I am.
George: Can't I just do some charts?

Erica: Promise not to hit on me?
Mark: I can't promise that.
Callie: He can't promise that.

See AlsoEdit

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

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