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Deterioration of the Fight or Flight Response

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Human beings need a lot to feel alive. Family. Love. Sex. But we only need one thing to actually be alive. We need a beating a heart. When our heart is threatened, we respond in one of two ways. We either run or we attack. There's a scientific term for this. Fight... or flight. It's instinct. We can't control it. Or can we?

Deterioration of the Fight or Flight Response is the twenty-sixth episode of the second season and the 35th overall episode of Grey's Anatomy.

Short SummaryEdit

Cristina gets assigned to a trauma all by herself. Izzie and George wait for Burke to arrive and help Denny get the heart, but they do not realize that Burke has been shot and has to undergo surgery. Meanwhile, the Chief's niece Camille has been admitted to the hospital.

Full SummaryEdit

While Bailey's checking Burke's shoulder, Denny's flatlining.

Derek is overlooking the lobby.

Burke starts looking around as he's about to be put on a gurney.

Izzie stands in Denny's room with the cut LVAD wire in her hand. George says they need to call a code. He can't feel a pulse. Izzie stops him and says she has a plan. If they call a code, Denny will be rushes to surgery and they'll replace his LVAD. Then he'll stabilize and he won't get the heart. Denny will die waiting for another heart. George says this is crazy. Izzie threatens to break George's bones if he calls the code. Izzie says he has to choose between leaving or helping her.

While the shooter's taken into the ER, where Cristina offers Richard to help. He tells her to go run trauma 2. She's on it. She leaves right when Bailey comes in with Burke. She says he has a GWS to the right shoulder and that he's lost a lot of blood. Richard directs her to trauma 1 and tells her to keep the blinds closed since Yang is on the floor.

In trauma 2, the ER physician says the patient has a self-inflicted GSW to the head. He shot himself after emptying his clip. Cristina is excited to be running this.

Richard tells Burke to lie down, but he says he's fine and he tries to get up. Bailey says he is the patient now. Burke seems surprised to see Bailey and asks her when she got here. Richard asks to have Shepherd paged.

Cristina watches as Derek walks by. When he opens the door to enter trauma 1, she sees the patient is Burke. She tells the ER physician to take over compressions and leaves. She enters trauma 2. Bailey tells her they got this.

Cristina returns to her trauma bay and takes over compressions. She refuses to let Petey die. He won't get off that easily. She wants to tell his family that she tried everything to save his miserable life.

Back at Mercy West, Alex tells Hahn they should hear back from Burke any minute. Erica says he said that half an hour ago. Erica decides she's going in to get the heart when they hit the hour mark.

Bailey says there's no exit wound. Derek tells Burke the bullet is in dangerous property, so they're going to check his hand function. Richard asks Burke to squeeze his fingers, but Burke can't do that. Cristina comes in and says her guy's upstairs. Bailey tells her to wait outside. Cristina refuses to do that. Burke asks the doctors for a moment. Richard says only a moment. They all leave. Cristina says she's not mad at him anymore for kicking her off the transplant. All that matters is that he gets through this. She's here for him, whatever he needs. He needs her to go check on Denny. She leaves to go do that.

Addison meets with Adele. She's keeping this secret from Richard. Adele says she was chaperoning a prom for her niece and they had a little bit of situation. Addison reads the chart. Camille lost consciousness during sexual intercourse. Camille assures Adele that she's fine. Camille's friends and boyfriend arrive. They are worried. Brian says he used a condom.

While Izzie's ventilating Denny, Meredith comes in to answer George's 911 page. George says they need help. Cristina comes in and wonders what the hell is going on. George tells them what Izzie did. Izzie explains her plan. Izzie says everything will be fine when Burke gets here. Cristina then says that Burke got shot.

Izzie is losing her mind over the fact that Burke is not coming. She realizes Denny's going to die. She killed him. Meredith says they can't call anyone, because then Izzie will get kicked out of the program. Cristina wants to leave, because Burke could die as well. Cristina and George blame Izzie, who says she was just doing what she thought was best. Meredith yells at them to shut up. No one is leaving and no one is dying. "Thank you," Denny says. He thinks they should listen to Meredith, because it seems like she has a plan. She needs a minute.

Adele is waiting with Camille's friends. She's not going to call Camille's parents because her mother can get a little hysterical. Adele sees Richard and tells Brian to disappear. Adele calls for Richard, who then sees Camille's in the exam room. 

Adele's talking to Richard about Camille losing her virginity. Richard doesn't want to hear it. Addison comes over and says the bleeding has stopped, but she's worried by the pelvic exam. Richard says Camille was diagnosed with ovarian cancer three years ago. They removed one ovary in an attempt to keep her fertile. Her checkups since have been clean. Addison tells them not to worry until they have to. Richard then sees Brian and chases after him.

Meredith's plan is to confirm Denny's condition themselves. They can get the blood work and do the echo. No one has to know what Izzie did. Cristina has done an echo on her own. Burke taught her. Cristina refuses to be involved. Izzie asks what if Cristina were her. Cristina says she wouldn't fall in love with a patient. Izzie points out she did fall in love with an attending. Meredith says you can't choose who you fall in love with. George scoffs and agrees.

Burke opens his eyes. Derek and Richard tell him that his hand is cold. Preston says he always has cold hands. Derek and Richard take a look at the scan. The bullet could be lodged in the brachial plexus. It's dangerous. They'll have to do an angiogram. Meanwhile, Burke keeps on whispering that he's always cold. His monitor starts beeping rapidly. They find his right lung has collapsed, but they quickly have it re-inflated. Derek tells Burke to stay with them.

At Mercy West, Alex is on the phone with Meredith, who tells him Burke has been shot, meaning they're gonna have to do those tests themselves. Alex says they only have a couple of minutes left, and that Hahn won't wait. Meredith tells Alex to stall her, but Alex refuses to get involved in this. He doesn't care if Denny gets the heart. Meredith tells him to do this for Izzie. He says he's not guaranteeing anything.

While Addison's doing an ultrasound on Camille, her friends asks her about the sex. Camille says it was perfect. Addison asks Camille if she's had any abdominal pain or nausea. Her friend says Camille's been fine, but Addison derives from Camille's face that that is not true. She hasn't been fine for a month or so. She really wanted to go prom. She didn't want to be the girl with cancer again. Addison has bad news.

Addison sits down with Adele, who was trying to remember the night she lost her virginity. She remembers who it was with and that it happened when she was 18, but she can't remember the details. Sadly, Addison remembers all the details of her first time. It wasn't really bad, but good and really good only came later. Adele says Camille's just getting started. She hasn't seen what good is. She needs to hear that Camille has a chance to see what the good stuff is. Unfortunately, Addison has bad news for her.

Cristina's doing the echo on Denny. His left ventricle's shot and he's barely pushing blood out. Izzie says she's sorry. She knows Cristina is worried about Burke. She asks Cristina to try and understand her. She loves Denny. Cristina says she's never even seen Denny outside the hospital, so she doesn't know him. Izzie disagrees. She might not live with him, but she knows him. There's possibility here. She chose to stay instead of run. Cristina says a sane person, someone who values herself and her career, would have chosen to run. Denny softly says a sane person would marry him.

Izzie's not sure if she heard that correctly. She asks Denny to wake up, but the monitor starts beeping. Cristina checks his heart. There's still movement so it's not flatline. She says they should shock him. They charge the paddles to 200 and shock him.

Alex just told Erica about Burke, but she doesn't care. She gets ready to open the donor up. Alex says SGH is still waiting for the test results, but Erica says she's not. She slices open the donor's chest.

Richard finds the lobby filled with high school students. Claire and Natalie made some calls and the news spread. Since Camille can't miss her prom, they decided to bring the prom to her. Richard tells everyone to listen up. He tells everyone to come back tomorrow, in smaller groups. Richard apologizes, but he can't have teenagers roaming the halls. Natalie and Claire are painfully aware that people are dying here.

Derek checks up on Burke, who tells him he's developing numbness in his fourth and fifth finger. Derek tells him there's a pseudoaneurysm in the subclavian artery. They're gonna wait a few days and hope it doesn't grow. Burke takes a look and says that even if it stays at this size, there's too much damage. Derek says they can go in and relieve the compression on the nerves. Burke knows the surgery could cause damage to the nerves, meaning he could lose his entire arm function. He asks Derek if he can do this. Derek thinks so, but he's not sure. Burke wonders what to do. Derek says it's not like him to ask those questions. Burke says it's unlike him not to have the answers.

Adele is mad at Richard for sending those kids away. She just told her sister that her baby's cancer is back. She needs Richard to bend his precious rules for her. She's never asked him anything. She never said anything about his long hours. She looked away while he was having an affair and she sobered him up when that woman left him. She stayed with him when everyone told her she'd be better off without him. She's telling him to put the needs of his family above those of his other patients. If not, he can find a new place to sleep.

Addison follows Derek, but he says not now and walks off.

He enters an lounge. He leans against the wall and sighs. Richard is sitting on the couch and tells him there's never a good place to hide in the hospital. Derek sits down with him. Derek says he wants to get some perspective, but it seems like he's unable to. Richard tells him about Camille. She's 17 and she's going to die. He admits that he had an affair with Ellis Grey 25 years ago. Today, he found out that his wife knew the entire time. Adele stayed with him. Derek says he respects Burke. He's an arrogant man who thinks he's God in the OR, but he's decent and honorable. Now Derek has to decide what to do. He can't get perspective. He can't be responsible for it. Richard tells Derek he's an honorable and decent man as well. Too honorable and decent to run. Richard confesses he wishes that his coffee was bourbon.

Bailey checks up on Burke and asks if there's anything she can get for him. He really wants Cristina with him. Bailey wonders where Cristina is. She wonders where all her suck-ups are. She wonders why they aren't here, fetching him ice chips and morphine. She figures out that Burke knows something. She asks him what he's done with her suck-ups.

Meredith decides to start dopamine and dobutamine drips. Denny says he feels like his chest's running away. They put an oxygen mask on him. Denny's in SVT. Cristina tells Izzie to stop pumping. She's trying to listen to Denny's heart. Meredith's looking for a medicine. She'll know it when she sees it. George says she's looking for the one that stops the heart. Izzie explains to Denny that it only stops the heart for 6 seconds. George looks it up and tells Meredith it's adenosine. Cristina announces that Denny's heart is speeding up. Izzie yells Denny can't take this for much longer. Meredith finds the drug. George tells Cristina to left Denny's arm while he administers it. He's seen the nurses do that. Denny is panicking. He thinks he's going to die. Izzie says that's just the medicine. No one in the room is certain if they did the right thing. The monitor shows flatline for a couple of seconds. Then there's a heartbeat again. Denny wheezes. Bailey appears in the doorway and tells them they better have a good explanation for this.

Bailey tells them to step away from the patient. They all step back except for Izzie, who keeps pumping the heart. Bailey sees the cut LVAD wire. She tells Olivia to take over from Izzie. Izzie needs to leave the room. Izzie refuses to let Olivia take over. Bailey then tells Olivia to stay with Izzie and help her when she'll let her.

Outside the room, Bailey asks Meredith, Cristina, and George where their rational thought and cognitive thinking was. No one in their sane mind would have helped Izzie. She doesn't allow any of them to speak, since she doesn't want to testify against any of them in court. She then tells Cristina to go to Burke since he was asking for her. Cristina leaves. Bailey asks if they ran labs. Meredith says yes. Bailey tells George to go get the results without talking to anyone. She then asks Meredith to come with her.

Cristina is watching Burke in his room. He opens his eyes and sees her. She says he look goods and takes a look at his films. She immediately realizes what's going on. Burke tells her Shepherd wants to wait it out and see if the numbness subsides. Or he could let him operate. He could lose all hand function, meaning he can never operate again. Burke needs Cristina to tell him what she thinks he should do. She says she told Bailey she'd be back. She says she'll think about this and leaves.

Cristina finds a quiet on-call room. She takes a moment to gather herself, taking deep breaths.

Bailey asks Denny how he's feeling. He says really good, like a really healthy person. Denny says he cut his own LVAD wires. He went rogue all by himself. Bailey tells him not to waste energy on lying as he's weak enough already as it is. Izzie asks Bailey if she's gonna sign the charts and talk to the transplant coordinator so Denny gets the heart. George comes in with the labs. Izzie thinks he deserves to move up to 1A status. Bailey says she takes her medical advice from doctors. Izzie is just a visitor now. Bailey will decide when she is a doctor again. She orders Olivia to take over the heart pump. This time, Izzie lets her.

Bailey finds Richard to ask him a hypothetical question. What if someone on staff deliberately unhooked a transplant candidate from his LVAD in an attempt to worsen his condition so he gets moved up on the list? Richard thinks she wants to tell him what's going on exactly, but she tells him he'll want this to stay hypothetical. She's thinking that if it were true, he'd be duty-bound to report it and the hospital would be in danger of losing its accreditation as a transplant site. If the patient got worse, would it be unethical for him to receive the heart? Richard asks how bad it is. Bailey says the patient would be dead by the time a new LVAD got delivered. Richard says their responsibility is to the patient. If he's at the top of the list medically, he deserves the heart. However, practically, Richard expects to be given names if this weren't hypothetical, and there would be severe consequences. She understands.

Alex is on the phone in the hallway as Hahn passes him with the heart. He stops her. She figures out that UNOS gave the heart to Seattle Grace. The transplant coordinator already called and stopped Hahn's guy from being prepped. Hahn says her patient has two kids. He deserves this heart. Alex is truly sorry. Hahn gives him the heart. Alex says they have a chopper waiting on the roof. "And?" Hahn asks.

Derek tells Burke he could take up fishing, which is a lot more fun than surgery. Burke says he has 80% hand function now. Derek says that's not enough for Burke, who doesn't fish.

The chopper arrives on Seattle Grace's helipad. Alex and Hahn get out.

Denny's transported to the OR. At the doors, Bailey takes over the heart pump from Olivia. Izzie and Denny hold hands until he's taken past the doors.

Burke is put on the OR table. He asks for Derek, who says he doesn't need to be thanked. Burke was gonna ask him not to kill him. Richard chuckles. Derek says he'll do his best. The anesthesiologist then puts him under.

Hahn takes Denny's heart out of his chest. The left ventricle is excessively dilated. He wouldn't have lasted another hour with that heart.

In the other OR, Derek removes the aneurysm from the nerve cluster. A nurse informs him the NAPs are dropping. His arterial pressure is also down 50%. Richard asks Derek if he cut the nerve root. Derek doesn't see any discontinuity. He suggests a reflex test. There's no reflex. Derek says he'd know if he had severed a nerve. Richard asks if the arm is paralyzed. Derek has to do a wake-up test to be sure. Derek says there's only one person who could help him see if he's damaged the relay or not, and that's Burke. Richard says Burke has been through a lot of trauma today, but Derek is trying to spare him from the trauma he's gonna have when he's told he's paralyzed.

George, Izzie, Cristina, and Meredith are sitting on the floor underneath the OR board. George feels like they're being treated like children. Meredith says what they did is way in need of a time-out. Cristina says they could get kicked out of the program for this. Izzie says not them. She did this. Izzie thinks she should maybe run, but she'd rather run towards somebody than running away. Richard comes over and tells Cristina that Derek is asking for her. Cristina says she's in a time-out. Richard says that's over. She gets up and leaves with Richard. Izzie brings up Denny asking her to marry him. The others assure her it really happened. She gets up and announches she's checking on Denny.

In Derek's OR, the anesthesiologist tells Derek that Burke should wake up soon. Cristina is not sure what she has to do. Derek says Burke will be disoriented, so he'll fight the intubation. They can't numb the arm because they need Burke to move his fingers. Cristina has to keep Burke focused.

Meredith thanks George for calling him about Izzie. It meant something to her. He says it didn't mean anything. She says sorry. He yells at her to stop saying that she's sorry. He admits that he knew she didn't feel that way about him, even during the sex. He knew and he still let it happen, because he figured that one night with her was better than never. So, she can stop saying she's sorry, because she didn't know any better. He did. He's sorry. He barely dares to look at her as he repeats he's sorry.

Back in the OR, Cristina keeps talking to Burke until he opens his eyes. He starts fighting the intubation. Cristina backs away as the others hold him down. Derek and Richard urge her to talk to him to calm him down, but she can't bring herself to do it.

Alex compliments Hahn's work as she's finished putting the new heart in, but the hard part is still to come. They take Denny off bypass. The heart doesn't start to beat on its own, so Erica starts massaging it.

Burke is grunting and straining while Derek urges Cristina to talk to him. Derek leans over Burke's face and tells him to calm down. Derek says there was a complication, so they need him to move his right fingers.

Bailey shocks the heart, but there's no response. She tries again, but still no response. Alex looks up at the gallery and sees Izzie there.

Derek keeps on encouraging Burke to move his fingers while Erica tries to get Denny's heart going with Izzie looking on from the gallery.

CastEdit

  • Meredith Grey
  • Cristina Yang
  • Izzie Stevens
  • Alex Karev
  • George O'Malley
  • Miranda Bailey
  • Richard Webber
  • Addison Montgomery-Shepherd
  • Preston Burke
  • Derek Shepherd
  • Denny Duquette
  • Adele Webber
  • Erica Hahn
  • Camille Travis
  • Claire
  • Natalie (right, with Claire)
  • Nurse Olivia Harper
  • Brian
  • ER Resident
  • Anesthesiologist
  • Nurse Linda (second from left, with Miranda Bailey, Preston Burke, and Richard Webber)

Main CastEdit

Guest StarsEdit

Co-StarringEdit

FeaturingEdit

Medical NotesEdit

Preston BurkeEdit

  • Diagnosis:
    • Gunshot wound
    • Brachial plexus injury
    • Collapsed lung
    • Pseudoaneurysm
  • Treatment:
    • Surgery

Burke was shot in his right shoulder outside the hospital. They brought him into the ER, where he was confused about what had happened, so they paged Derek. The bullet was lodged in the brachial plexus. His lung collapsed, but was quickly re-inflated. When his fingers started to go numb, Derek said it was due to a pseudoaneurysm. The were going to wait to make sure it wouldn't grow and if it did, he'd have to have surgery. Derek later took him into surgery. While operating, Derek determined that he needed to have Burke awake to determine if he damaged any nerves.

Denny Duquette, Jr.Edit

  • Diagnosis:
    • Congestive heart failure
    • Pulmonary edema
  • Treatment:
    • Adenosine
    • Heart transplant

After cutting Denny's LVAD wires, Izzie started manually pumping his heart, allowing his condition to worsen. An echo revealed that his left ventricle was barely pumping out blood. They used adenosine to stabilize his heart. Tests confirmed that his heart had worsened enough to up his status and put him ahead to get the heart and Erica Hahn performed the transplant.

PeteyEdit

  • Diagnosis:
    • Gunshot wound
  • Treatment:
    • Attempted resuscitation

Petey shot himself in the head and was taken to the ER. Cristina attempted resuscitation, but her efforts were unsuccessful.

Organ DonorEdit

  • Diagnosis:
    • Brain death
  • Treatment:
    • Life support
    • Organ harvest

The organ donor was still on life support as they waited for a ruling on who would get the heart. When the allotted hour passed, Erica operated to remove his heart.

Camille TravisEdit

  • Diagnosis:
    • Ovarian cancer
  • Treatment:

Camille, 17, lost consciousness while having sex. She'd had ovarian cancer three years prior and they removed one ovary. Addison did an ultrasound and discovered that her cancer had returned. She'd been having symptoms for a month, but ignored them because she wanted to go to prom.

MusicEdit

Song Performer Scene
"Universe & U (Acoustic Extravaganza Version)" KT Tunstall
  • Derek and Dr. Weber are talking about Meredith and her mother.
"Look at Her Face" The Coral Sea
"Through the Backyards" Au Revoir Simone
"How We Operate" Gomez

Notes and TriviaEdit

2.26 - "Deterioration of the Fight or..00:32

2.26 - "Deterioration of the Fight or..." - Trailer

  • This episode's title originated from the song Deterioration of the Fight or Flight Response, originally sung by The Flaming Lips.
  • Bailey says "Do not pass go!", as an allusion to the board game Monopoly.
  • This episode scored 22.50 million viewers.
  • This is the first episode to be narrated by multiple cast members

GalleryEdit

Episode StillsEdit

QuotesEdit

Bailey: Where is Cristina? Where are... where are all the little suck-ups?
Burke: Excuse me?
Bailey: My interns. My ass-kissing, surgery-hungry, competitive suck-ups. Where are they? Why aren’t they here fetching you ice chips and morphine? Where are they? You know something.
Burke: I'm a patient.
Bailey: Preston Xavier Burke, what have you done with my suck-ups?

Cristina: Hey! We stick together, we all did this. Nobody's a victim. We stick together. Dammit!
Izzie: Thank you.
Cristina: You're welcome.

Adele: If you don't want to bend your precious rules for Camille, fine. Don't do it for her, do it for me. Do it for your wife who never asks you for anything, who says nothing about your long hours, who looks the other way while you have an affair with another woman, who sobered you up when that woman left you, who stayed with you when everyone said I'd be better off alone. I'm not asking you, I'm telling you. You're going to make this up to Camille. You're going to prioritize the needs of your family above the needs of your other patients or... Or you're going to find a new place to sleep.

Meredith: Thank you... for calling me about Izzie.
George: I didn't do you any favors.
Meredith: But it meant something. That you called. It meant something to me.
George: It didn't mean anything.
Meredith: Right, okay. Sorry.
George: Stop saying you're sorry! You wanna know something? I knew. I knew you didn't feel that way about me, even during... when we were in bed I knew. I knew and I still let it happen, because, um... well, I figured one night with you was better than never. So, will you just stop saying that you're sorry? 'Cause you didn't know any better, but I did. And I still let it happen. I'm sorry. I'm sorry, Meredith.

Bailey: You fools... had better have a good explanation for this.

Izzie: You press that code button and I will hurt you. Not a lot, because we're friends. But enough so that things will break and you lie on the floor out of my way.
George: Izzie.
Izzie: You have a decision to make. You can stay here and help me with this, or you can leave. What's it gonna be, George?

See AlsoEdit

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

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