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Don't Let's Start

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Trauma is messy. Chaotic. Looking at a body that's been reduced to a bloody pulp, it might seem difficult to know where to start. Luckily, some very clever person developed a protocol: the ABCs. Airway, breathing, circulation. The ABCs keep your patient alive so you can figure out how to tackle the rest of the mess. If only all of life's problems could be solved with an intubation tube. The ABCs of trauma are a handy tool for keeping a patient alive, but they're only a starting point. Once the patient's airway, breathing, and circulation are all clear and accounted for, the real work begins. The messy work. There's no telling how long it's gonna take to clean up that chaos once you've begun, because sometimes, you don't know what you're in for. You don't know exactly what you're about to face. You don't know what secrets the body in front of you holds and whether, by the time it's all over, if there's anything left worth saving.

Don't Let's Start is the sixth episode of the eleventh season and the 226th overall episode of Grey's Anatomy.

Short SummaryEdit

Owen becomes invested in a patient when he realizes she may have served in the military, April's mother pays her daughter a visit and bonds with Jackson, and Derek plans a family dinner. Meanwhile, a patient's diagnosis causes Bailey to reconsider her own health issues and Dr. Herman drops a bombshell on Arizona.

Full SummaryEdit

April moves around the ER, checking in on patients and directing doctors. Paramedics bring in a carjacking victim who was seriously injured, but she is more concerned with her car.

Derek and Meredith are examining a shared patient. Maggie comes up and tells Meredith that she finished looking through Ellis's journals. Maggie says she got a good sense of Ellis as a surgeon, if not as a person. After she walks away, Derek questions why Maggie is still calling Meredith Dr. Grey. Meredith says that that's her name. Derek says Meredith should invite Maggie over for dinner, because it's what people do.

April leaves a trauma bay and says the patient needs an ortho consult. Jackson walks up behind her and tells her that her mom's flight got in early, so he brought her to the hospital. April is shocked that he would do that, but Jackson says she wanted to see April. He set her up in the attendings' lounge and tells April to page him when she's free. April is still shocked as he walks away.

As Arizona gets dressed for her day in a lounge, Callie questions if this is where she's been staying. She thought Arizona had gone to a hotel. Arizona says with Dr. Herman breathing down her neck day and night, it was easier just to stay at the hospital. Plus, where she sleeps is no longer Callie's concern. Callie says she didn't kick Arizona out. She never said that Arizona had to go. Arizona counters that she just made it clear that being around her is suffocating Callie. Callie gets a page and asks Arizona if she's told anyone and if she thinks they should. Arizona ask if they could just wait and not tell anyone. Callie says they'll do whatever she wants. Arizona reminds her that she didn't want any of this and excuses herself for rounds.

Ben is pestering Bailey because she skipped eating breakfast. Bailey says she didn’t have time. She's too busy. He sticks a donut in her mouth so she can take a bite and she says he's her favorite resident. Bailey and Ben approach Jeremy Weaver, who is being seen by Maggie. He is smiling despite having chest pains. His tests came back mostly fine, but his belly is still tender, so Bailey starts to examine him. He believes he just has heartburn. Bailey asks what he had to eat that day. He says coffee and she says he skipped breakfast today, too, looking pointedly at Ben. But he continues, saying he also had pancakes, sausage, eggs, and energy drinks. He would have had more, but he's been having trouble swallowing lately. Bailey wants to admit him for observation and orders tests. Before she can walk away, Ben hands her the donut and tells her to finish it.

Melissa's co-workers are talking to Jo. They do computer repair at Office Hub. Keith says he found her on his way into work. She was just lying on the ground, not moving. Jo asks about family and history. They admit that they don’t know her well.

Jo goes back into the ER bay where Owen is tending to Melissa. Callie comes in for the ortho consult and is shocked at what she sees. Owen says she won't make it to an OR with as much blood as she has in her belly. They need to open her up right there. They prepare to pack her abdomen and Owen makes the incision. Callie asks him if he's sure he wants to do that and he says he's sure he has to and he cuts into her abdomen, releasing a torrent of blood. In the OR, they continue to work on her abdomen. Callie says she's finished cleaning out the tibia fracture and she'll do the repair tomorrow. Owen asks if they have any information. Jo says there's no ID. The only emergency contact number her work has is her own number. Callie says they know something else: she's a veteran. She has an Operation Iraqi Freedom 2011-2012 tattoo. Callie recognizes it because she's been examining a lot of veterans lately. Owen says it should have never happened to her and Jo says it should never happen to anyone.

April comes into the lounge and greets her mother. They hug. April asks how her flight was and her mom says it wasn't as good as her ride over as her chauffeur has the prettiest eyes. Jackson thanks her. Her mom then presents the zoo animal decals she found in the airport gift shop. She says they'll go with whatever color they're painting, which she assumes will be gender neutral. They admit that they haven't had time to think about colors. April says that the ER is a madhouse and she needs to get back down there, but she'll try to get back for dinner. Her mom thought she could take the afternoon off so they could look at paint samples and set up a baby registry. People have been asking about it. April wonders how her mom thought that she could just take an afternoon off, knowing what she does. Jackson steps up and says he has a super light day, so he can do all those things with her. April says he doesn't have to, but he insists that it's not a problem. They say it'll be fun.

Jeremy says he has clients to see all over town and then he has to pick up his kid and take her to volleyball before seeing two more clients. Bailey understands as she also has a busy schedule. He asks her to let him go as he believes he's fit as a fiddle. Ben says his labs show several markers of poor health. Jeremy asks if they're going to believe him or science. Bailey says he has an honest face, but she and science go way back. They want to run more tests. Jeremy asks if they can skip some steps. They explain that they're trying to avoiding sticking a tube down his throat, but he says they can stick a tube wherever they want if it'll get him out of there faster. They agree.

Dr. Herman shows Arizona the scans of Waldo Pfeiffer, gestational age: 23 weeks. He has a particularly nasty congenital cystic adenomatoid malformation, which is pressing on his heart and lungs. It hasn't responded to steroid treatment and he's developing hydrops. She says that this is what fetal surgery was created for. They’re going to open the mother and then incise the uterus. Then they'll cut into the fetus to remove the CCAM and put him right back where he was and he'll hopefully be carried to term. Dr. Herman says Arizona has a consult in 20 minutes. She needs to make it fast and get back there, so that they can go over each step of the procedure. Arizona thanks her, but Herman says it's because it took her so long to wrap her head around a fetal valvuloplasty. She asks if Arizona's ready and Arizona says she is.

Derek is looking at a scan and tells Maggie that the bleed should reabsorb itself, so he doesn't need to operate. Maggie thanks him and tells him that Meredith invited her to dinner. Derek is excited. Maggie says she was so excited about it that she forgot to ask if she should bring anything. He says for her just to bring herself and asks if there's anything she doesn't eat. She says there's nothing at all. He asks about pot roast and she says that's great. Richard opens the door and there's an awkward moment as he asks Derek for a consult. Maggie says they're done and leaves. Derek then asks Richard what he's doing tomorrow night.

As Bailey works the scope in Jeremy's throat, she tells Ben that it could be him and what if they drew his blood right now. Ben says he could say the same about her, but he also doesn't want to change a single thing about her, so he won't. Bailey says she doesn't want to change anything about him either. She likes him alive, not dead on the toilet trying to pass a deep fried onion blossom. He's shocked that she’d even say that. They find a tumor inside Jeremy's esophagus and it's very large.

Arizona comes into the room with Herman and sits down. She says that the consult went off without a hitch, but the mom was nervous, so Arizona wanted to make sure she was okay. She sees that Herman has a blank face, so she says she's ready to prep for the surgery. Herman says there's been a change of plans. She's going home. She gives Arizona the materials and tells her to internalize them. She's made notes in the margins because her technique is better than what's in the material itself. She also leaves Arizona in charge of her service. Arizona asks if everything's okay, but Herman says it's personal. Arizona wonders what if she has questions, but Herman says they'll all be answered in the materials and she'll see Arizona tomorrow.

Jeremy's wife is with him, telling him she's always told him to take more walks and maybe have a salad instead of all the Philly cheesesteaks. Bailey and Ben come in and they stop talking, because they know that they aren't bringing good news. Bailey tells him about his tumor, saying it's early-stage adenocarcinoma. Jeremy says he came in for heartburn. Bailey says that's likely what he had, but all the food he’d been eating caused intense acid reflux, which damaged his esophagus and made it the perfect home for cancer. They're going to keep him overnight for tests and then they'll operate to remove his esophagus and replace it with part of his colon, hopefully curing the cancer. Jeremy says that he will be fine. He tells his wife to go get their daughter, Erin and tell her what's going on without scaring her.

April comes home to find her mother and Jackson surrounded with baby stuff. She says they've been busy. Her mom says they were just going to start a registry, but they saw a mobile and the next thing she knew, they had filled a shopping cart. Jackson says they actually had a pretty good day. April's mother says she’s quite fun. April sees the crib and notes that it didn't come from a store. Her mom says that four generations of Kepner babies have slept in it. She asks how she got it there. Her mom says shipping cost a fortune, but she wanted to be there to see April's face when she saw it, so she called Jackson. April is shocked that she called Jackson. Her mom says she's hungry and April asks why they waited for her, because she called and told them she'd be late. Jackson says they lost track of time. Her mom says she'll just go to the kitchen and whip something up. April says she didn't go to the store because she thought they'd be going out. Karen says she can figure something out. April snaps and says she doesn't need her mother to whip something out. She didn't need her mom to come set up her entire nursery and she doesn't need her mother's help. Jackson tells her that that's not fair.

Meredith is upset because Derek invited Richard to dinner. She says the dinner was already a bad idea, but now he's made it worse. Maggie doesn't want to know Richard. Derek says he did it because he's their friend and family and that’s one of the reasons why she didn't want to leave Seattle in the first place, because of her family and her roots. Meredith is upset that she has to have dinner with the sister she doesn't know and the bio dad she hates because he gave up the chance to work with Obama. Meredith says he'll be playing that card until the end of time. He calls for a time out. He apologizes. He’s just trying to help. He has a big family. It's crazy and messy, but it's good. He wants her to have that. Also, Zola needs more black people in the family because he's running out of ways to braid her hair and Bailey won’t show him any more. Meredith says that if he wants Richard to come to dinner, he needs to call Pierce and see if she's okay with it. She says he won, so he should accept the win and not push for more.

Arizona is in the NICU. Alex comes up to her and reminds her that he doesn’t need her checking his work. She says not to get territorial. One of Herman's patients was in there and she’s learning the steps of the surgery for tomorrow from a journal article, or rather, from the chicken scratch in the margins. Arizona suspects that Herman is trying to haze her or set her up for failure or kill her. Alex says no one forced her to do it, so she can't pout because it's kind of hard and the teacher's mean. Arizona picks up her stuff and leaves.

Melissa wakes up as Jo is checking on her. Jo explains where she is and Melissa again asks about her car and if they found it. Jo tells her just to try to sleep.

Bailey is stretching by a bench when Maggie passes by and stops. She says she didn't know Bailey's a runner. Bailey says she usually just takes a spin class, but she wanted to get some fresh air for a change. Maggie notes that it's gorgeous. She says she was only going to go another three miles, but she could stretch it out if Bailey wants to go with her. Bailey says that she just picked up a new audiobook, recommended by Oprah. Maggie says to tell her how it is and jogs away. Bailey starts to jog in the opposite direction.

April says Jackson is the last person who can lecture her about avoiding her mother. He says that his mother is a nightmare and hers is the sweetest person he's ever met. April says what she did wasn't sweet; it was condescending. Jackson says she's overreacting. April says her mom just decided that they needed help, but Jackson says he does need the help. He called her. He doesn't know how to take care of a baby. And she knows everything and so does April and it's easy for them, but his family wasn't that way. He says their kid will have that, provided April doesn't drive her mom away first.

Callie finds Jo, who tells her that the OR is ready for Melissa's tibia repair and the police are getting her statement. Callie sees her crying in her room and walks in. She asks if she's okay. Melissa says they found her car in pieces in a chop shop. It's gone. Callie says it's all replaceable and she should be glad she didn't get killed. She says if she hadn't been asleep. Jo asks if she remembers what happened. Melissa says she was sleeping and they broke a window and pulled her out. She tried to hold on, but she got stuck in the door. They dragged her for a while before beating her and then she couldn't hold on anymore. Callie asks why she didn't just let them take it and Melissa says that everything was in that car.

As they scrub in for Melissa's surgery, Jo tells Callie and Owen that she suspects that Melissa was living in her car. Callie says that Jo said she has a job. Jo says you can have a job and not have a home. That just makes it worse. She says try going through high school living in your car. You have to lie all the time and you can't have anyone over. You have to make up excuses for why you don;t have a bathroom and can't tell anyone because then they look at you like you're weird. Owen tells her to find him when she wakes up and leaves. Callie asks Jo about her living in her car in high school. Jo says that that's the look.

Arizona is prepping for her surgery when Herman walks in, followed by Alex. She asks about it and Herman says that Alex expressed interest. Herman says they're happy to have him in there and she hopes that Arizona studied. She warns Arizona that she didn't sleep well the previous night, so her patience will be thin.

Maggie is shocked that Richard is coming to the dinner. Derek says he invited Richard. She says she can't make it. Derek says that she came there to find out about Ellis, so she should talk to someone who actually knew her, like Richard. He says to come to dinner with them because it'll be less pressure, like a baby step. She gets paged and says she'll think about it before walking away.

Melissa is awake and she asks if it's about how she'll pay for her hospital stay because Callie, Owen, and Jo are all in there. Callie say it's not. They're concerned, but she interrupts that she has some insurance left, but the paperwork was all in her car. She says she'll figure it out. Jo then bluntly asks her if she's living in her car. Callie chastises her, but Jo says she doesn't know how else to ask. Melissa says it was only going to be temporary. When she got out of the Army, the job she had lined up was gone and her fiancé was gone, along with the apartment they shared. Office Hub was the only job she could get and it doesn't pay well enough for her to afford rent, so she was making it work living in her car. But now the car's gone, along with her cash, her clothes, and her savings, because she can't open a bank account without an address, so everything she has is gone, but if she can't get back to work, she'll lose her job, too. Owen says there are programs just for homeless veterans. She says she's not homeless. It's only temporary. Owen says they'll get her into dependable housing and everything after that will be easier. Melissa says that's not for her. Owen says she served in Iraq. She corrects that she fixed computers in the Green Zone. There are guys who served in combat who are much worse off than she is physically. She's met guys who have been on the streets since Vietnam. She was carjacked in Seattle. A nurse comes in and says she has some visitors, her co-workers from Office Hub. She asks the doctors to leave and not to say anything to her co-workers. Callie and Jo leave, but Owen tries one last time. Before he can say anything, she says she'll figure it out. She always does and she asks him to leave.

In surgery, Herman says they're about to meet Waldo. She asks Arizona what the next step is. Arizona recites it. Herman says she did read her notes. Herman says she'll do the bolus and tells Arizona to grab Waldo's arm so they can attach the monitor. When the monitor starts displaying his heart rate, Alex says it's amazing. Herman says now they're ready to cut into his chest. Every step counts, so she has Arizona recite the next step. Arizona says it, but she misses one part, which Herman immediately corrects her on. She asks if Arizona even read her notes. Arizona says she did and it told her to prepare for bradycardia. Herman stares at her for a moment before telling her to proceed. They find the mass and the bradycardia starts. Herman has Arizona tell her why they use that approach. When she explains, Herman says that's not what her notes said. Arizona says not in those words, but Herman wants it exactly in her words, not just the gist of it. She wants to know that her exact words are imbedded in Arizona's brain. Alex tells Herman that she gets it. Herman says they're just getting to the good part. He doesn't want to have to leave now. Herman says that her notes said that before her approach, 50% of the time, there was cardiac arrest. She says it feels strange to touch a baby before he's even born and asks Arizona if she knows that it feels like. It's privilege, great privilege.

Ben sees Bailey limping and asks her what happened. Bailey says it's nothing. Ben asks if she fell. She says she's fine. Maggie comes in just as Ben says she's limping and says she hopes Bailey didn't overdo it. Ben asks what and Maggie says that Bailey was jogging. They ran into each other. Bailey asks if they're going to go operate or just sit around talking about it.

Richard asks Meredith if Derek talked to her about him coming to the dinner. He ask what she thinks because he's not 100% convinced. Meredith says it might seem too pushy. She thinks she might call it off.

Derek asks Richard and Meredith what’s wrong with them. They can't uninvite someone to dinner, especially after what he had to do to get her there. He says he has an aneurysm to clip and he'll see both of them tonight. Richard says he'll bring dessert and Meredith says that'll be nice.

April and Stephanie meet and ambulance. April tells her to start the work up and she'll be right there as she sees her mother sitting on a bench outside. April says she thought her mom's flight wasn’t until later that afternoon. Karen says she pushed it. April owes her an apology and she won't leave until she gets one. She says April was rude and she raised her better than that. She knows April is busy and works hard. April says she won't apologize for the life she has. Her mom stops her and says she's made choices very different from the ones she made and it's scary. She says it's scary every time a mother sees her child do something she hasn't done herself, but that doesn't mean she's not proud. The more she sees April in this world, this work, this marriage, the prouder she is. She has no understanding of what April does, but she knows a lot about babies. She doesn't want to take anything away from April, but she does want to help her and she gets to do that because she's a grandma and also her mother. April sits down next to her mom and apologizes. April asks if she can call her if she has questions. Karen says she supposes she can if she must.

Arizona approaches Alex in the NICU and thanks him for having her back in the OR. Alex says she can't let Herman talk to her like that. She knows. He says to do something about it, but she can't. She tells him that she and Callie are splitting up. There's a lot of reasons why it happened, but her taking the fellowship might have been the nail in the coffin. She traded her marriage for that job and it's pretty much all she has now, so it has to work out. She needs it to work. He says okay, but then says it's not okay. He saw what happened. Herman has it in for Arizona. She's either looking for a reason to fire Arizona or she's going to make her miserable. He says she'll probably fire Arizona either way, so she has nothing to lose.

Owen goes into Melissa's room with pamphlets. She starts to object, but he asks her what rank she was when she got out. She says Private First Class. He says he was a major, so she's going to listen if only because he outranks her. They also have the military in common. He says he did two tours as a surgeon. He gave what he had to offer, just like she did. She did computers because that's what she had to give. She served. And she deserves the help and gratitude that's offered to her. She's wrong if she believes that by accepting it, she's taking it away from the next guy. She says that he has friends at the VA. If she wants to make sure they're getting the help they need, she can volunteer, but she needs to take care of herself first. That's how she can serve now. Melissa says she understands.

Maggie starts the incision on Jeremy. He's 42, but has the esophagus of an 80 year old. Ben questions Bailey going jogging. She says she only went half a mile and she can barely walk and it's embarrassing. Maggie says she shouldn't be embarrassed and she hopes Bailey doesn't give up. She says that no matter when you start something like that, it's going to be hard. You have to take baby steps. Jeremy starts to code. They take measures to save him, but they're unsuccessful.

Maggie and Bailey have to tell his wife that he didn't make it. She cries and her daughter holds her.

Alex finds Jo and asks if she'll be done soon so they can go home. She corrects that he means his house. He owns it and she just crashes there. He never actually asked her to move in. He never complained, but he never asked. Alex says he feels like he's in trouble. Jo says that she's actually in trouble, because when their relationship changes, she doesn't have anywhere to go. She used to be so careful. Alex asks what's changing. He thought they were good. She says things always change. You can't hold on to anything you don't want to lose. Right now, she feels like she has a bed in a house and it's good, but it's not her bed. It's his bed and she hates that she doesn't want to lose it. Alex assures her that she's got him. He's not going anywhere except home with her.

Derek asks Meredith if she took the pot roast out of the oven as they set the table. Meredith says she turned the oven off because she doesn't want it to get cold. He says he'll take it out because she's not really a chef. She questions if he is and he says he's better than she is. Meredith says he's not better than she is. He asks if she's ever cooked a meal before. Meredith calls for a time out, but then doesn't say something. Derek says she has to say something when she calls a time out. It's not a mute button. She says it is right now. She says she needs a time out. She needs a break from him, the fighting, the pot roast. The table's not set, the candles aren't lit, their guests will be there in half an hour, and she still needs to shower. She needs a time out. He smirks and says he could use a shower, too.

April finds Jackson in the nursery reading a baby book and asks him how it is. He says it's the scariest thing he's ever read. She tells him she was a jerk that day. He says she was. April says he's supposed to say she wasn't the jerk, he was, but he says he wasn't the jerk here. She tells him to get up because she wants to sit in the rocking chair. She asks him if he built it. He says he did it twice, actually, and he's pretty sure there's something wrong with the directions. April says it's perfect. She stands up and tells him he's going to be a great daddy. They kiss and he thanks her.

Bailey looks at a tablet in bed and tells Ben she's dying. Ben says she shouldn't read horror stories before bed. She says she ran her labs. Her cholesterol is high and her other results are problematic. She says she tells people every day how important it is to take care of themselves, but she isn't hearing it herself. She needs to make some changes, starting right now. Ben says not right now, because if she tries to go jogging right now, she'll never be able to walk again. She punches him and defends that it's good cardio.

Meredith and Derek are having sex in the shower.

Richard is at the door with dessert, but there's no answer. Maggie comes up behind him. He says he rang the bell and no one answered. They said 8:00 and the table is set. Maggie says she brought wine, but Richard says he's an alcoholic. Maggie says it was a mistake to come and she's going to leave. Before she can leave, he says he screwed up and apologizes. 31 years ago, he had a kid and no one told him. He's known her for two months now. Most parents mess up a lot in the first few months and it's fine because the kid's too young to notice or remember. But Maggie's old enough to be hurt by it. He wants to take it back. Maggie says he has the wrong idea. She's not angry at him for being a bad father. He's not her dad. He's just the man who made it possible for her to exist. Her dad is her present. Richard is her genetic history. She didn't need him to be a good father. She just needed him to be honest with her from the start, instead of letting her walk around for weeks like a fool without a clue, letting her confide in him. She goes to leave and he says he didn't know what to do and he's sorry about that. She says okay, but leaves him with a good night. Derek comes outside and says he lost track of time.

Arizona finds Herman and asks to talk to her. Herman says she wanted to talk to Arizona as well. Arizona says she wasn't kidding when she said she wants the fellowship and today's surgery only confirmed it. Herman has Arizona close the door. Arizona says no matter how much she needs or wants the fellowship, she refuses to spend the whole year with Herman speaking to her the way she does. Herman says they won't have a year together. Arizona says that's just great and goes to leave. Herman then continues that she'll be dead in six months, causing Arizona to turn back around in shock. Herman says she has a brain tumor. It's inoperable. She thought she had longer, but it's growing. She'll start to show symptoms soon and after that, she will die. Arizona asks who knows about it, if Owen or anyone else knows. Herman says fetal surgery is a new field. The few who practice it are basically making it up as they go along. The things she's scribbled down in the margins are only in her brain. No one else has them. So she can fight to write papers and try to get them published or she can use the time she has left to teach Arizona a year's worth of medicine in six months. Or Arizona can tell Hunt and the board and it'll all go away forever. Arizona says she doesn't know how to feel about it. Herman tells her to hurry up and decide as they don't have any time to waste.

CastEdit

  • Meredith Grey
  • Alex Karev
  • Miranda Bailey
  • Richard Webber
  • Callie Torres
  • Owen Hunt
  • Arizona Robbins
  • April Kepner
  • Jackson Avery
  • Jo Wilson
  • April Kepner and Stephanie Edwards
  • Derek Shepherd
  • Nicole Herman
  • Ben Warren
  • Karen Kepner
  • Maggie Pierce
  • Melissa
  • Jeremy Weaver
  • Ellen Weaver
  • Keith
  • Jacki
  • Keith, Jacki, and Caroline
  • Erin and Ellen Weaver
  • Paramedic Nicole Cummins
  • Nurse

Main CastEdit

Guest StarsEdit

Co-StarringEdit

Medical NotesEdit

ER PatientEdit

  • Diagnosis:
  • Treatment:

April sent Stephanie to take care of a patient who was vomiting in bed five. She asked her to rule out obstruction.

ER PatientEdit

  • Diagnosis:
    • Abdominal pain
  • Treatment:

Derek did a neuro check on a patient in bed three who was in an MVC. It came back clear, but she complained of abdominal pain, so April sent Meredith to check on her. Derek told the patient he believed she was fine, but he ordered a head CT and Meredith ordered an abdominal CT.

Jeremy WeaverEdit

  • Diagnosis:
    • Adenocarcinoma
  • Treatment:
    • Esophagectomy

Jeremy, 42, came into the ER with chest pain. April sent Maggie to check on him. She ruled out heart attack and dissection, but since his belly was tender, she had Bailey check him out. He believed he just had heartburn. He told them he'd been having trouble swallowing lately, so they admitted him for observation and ordered tests. After his labs came back with several red flags, Bailey wanted to do a Barium swallow study, but to get himself out faster, Jeremy said they could skip straight to the EGD. The scope revealed a large tumor in Jeremy's esophagus. The food he was eating caused acid reflux which made his esophagus a great place for cancer to grow. They planned to remove his esophagus and replace it with a portion of his colon. However, shortly after they started the surgery, Jeremy coded and was unable to be saved.

MelissaEdit

  • Diagnosis:
    • Lacerations
    • Contusions
    • Open tibia fracture
    • Internal bleeding
  • Treatment:
    • Laparotomy
    • Tibia repair

Melissa was brought into the ER after a carjacking, which left her with multiple lacerations and contusions as well as severe internal bleeding and a broken leg. She had been dragged alongside the car and then was punched and kicked by the carjackers. She started crashing in the trauma room and Owen performed an emergency laparotomy as she didn't have time to be taken to an OR first. After she was stabilized, she was taken to an OR where her internal injuries were treated. Callie also cleaned out her leg fracture and said she'd do the repair tomorrow. The tibia repair was then performed successfully.

Waldo PfeifferEdit

  • Diagnosis:
    • Congenital cystic adenomatoid malformation
  • Treatment:
    • Steroids
    • Fetal surgery

Waldo, 23 weeks gestation, was diagnosed with CCAM, which was pressing on his lungs. He hadn't responded to steroid treatment and was developing hydrops. They had to open his mother's uterus and then cut into his abdomen to remove the CCAM before closing.

Pierce's PatientEdit

  • Diagnosis:
    • Chronic subdural hematoma
  • Treatment:

Derek consulted on one of Pierce's patients and said the patient had a chronic subdural hematoma, which would reabsorb on its own.

Arizona's PatientEdit

  • Diagnosis:
  • Treatment:

Arizona had a consult. It went well, but the mom was nervous.

Herman's PatientEdit

  • Diagnosis:
  • Treatment:

Arizona was in the NICU, checking on one of Herman's patients who had landed there.

MVC PatientEdit

  • Diagnosis:
  • Treatment:

A 47-year-old male was brought into the hospital after being a passenger in an MVC. April sent Stephanie to do his workup.

Miranda BaileyEdit

  • Diagnosis:
  • Treatment:
    • Lifestyle changes

Bailey ran labs on herself and revealed several red flags, so she decided she needed to make some changes to her lifestyle.

Nicole HermanEdit

  • Diagnosis:
    • Brain tumor
  • Doctors:
  • Treatment:

Dr. Herman revealed to Arizona that she has an inoperable brain tumor and has only six months to live.

MusicEdit

Song Performer Scene
"Not Loving You" Mary J. Blige
  • Derek tells Meredith he wants her to have a big family, like he has. She accepts to have the dinner party with Pierce and Richard.
  • Arizona spouts about her fellowship. Alex tells her to suck it up as it was her own choice to take it.
  • Jo calms Melissa as she wakes up. Melissa is concerned about her car.
"Long Hard Look" Mary J. Blige
  • Bailey punches Ben as she decides to change her lifestyle.
  • Meredith and Derek take a shower together.
  • Maggie meets Richard, who's waiting outside of Meredith and Derek's house. Richard apologizes to her for being a bad father.
  • She says she's not mad at him for that. She's mad at him for not telling her the truth sooner.

Notes and TriviaEdit

Grey's Anatomy 11x06 Promo "Don’t Let’s Start" (HD)00:20

Grey's Anatomy 11x06 Promo "Don’t Let’s Start" (HD)

  • This episode's title originated from the song Don't Let's Start, originally sung by They Might Be Giants.
  • This episode scored 8.08 million viewers.
  • This episode was filmed from September 18 to September 30, 2014.
  • Arizona telling Alex, "Don't get all Sharks and Jets on me." is a clear reference to West Side Story, in which the rival gangs are the Sharks and the Jets.

GalleryEdit

Episode StillsEdit

Behind the ScenesEdit

QuotesEdit

Maggie: Dr. Grey, I have your... Our... Ellis' journals.
Meredith: You went through them already?
Maggie: Yeah, I've had them for a while. Got a good sense of her as a surgeon, if not as a person. So, thank you.
Meredith: Sure.
Maggie: Okay.
(Maggie walks off.)
Derek: She still calls you "Dr. Grey"?
Meredith: That's my name.
Derek: We should invite her over... For dinner.
Meredith: Why?
Derek: She's family.
Meredith: Ish.
Derek: Dinner tomorrow night. It's what people do.
Meredith: What people?

Jeremy: I'm fit as a fiddle.
Ben: Well, that's not what your labs say. Uh, cholesterol is in the 300s. Your triglycerides are worse. Your BP's too high, and your blood sugar is in the pre-diabetic range.
Jeremy: Who are you gonna believe, me or science?
Miranda: Okay, you've got an honest face, but science and I go way back.

Nicole: This is Waldo Pfeiffer, gestational age 23 weeks. In addition to an incredibly unfortunate first name, Waldo's dealing with a particularly nasty CCAM.

Derek: He's family, and this is one of the reasons why you didn't want to leave Seattle in the first place, remember? You have family here, roots.
Meredith: Are you kidding me?!
Derek: What?
Meredith: I have to have dinner with the sister I don't know and the bio-dad she hates because you gave up your chance to work for Obama?! You're gonna play that card? Of course you are because you'll be playing that card until the end of freaking time!
Derek: Time-out.
Meredith: No, I am so sick of your passive-aggressive...
Derek: Time-out. I'm sorry. I shouldn't have said that. I am just trying to help out here. I'm trying to help you, and I am trying to help them. I come from a big family. It's crazy, it's messy, but it's good, and I want that for you. I want you to have that. She's your sister, and he's practically your father. And Zola needs more black people in the family because I'm running out of ways to braid her hair and Bailey won't show me any more.
Meredith: Fine.

April: Uh, you're the last person who gets to lecture me on avoiding my mother.
Jackson: That's not true. My mother is a nightmare, and yours is the sweetest person I've ever met.
April: No, what happened last night was not sweet. It was condescending.
Jackson: Come on, you're overreacting.
April: Yes, 'cause she just decided that I needed her help.
Jackson: I needed help. I asked her for it, okay? I have no idea what the hell I'm doing here. I just spent four hours in that baby store, and my mind was blown. Do you know how much I don't know about having babies? So much. And she knows everything and so do you, and it's easy for you guys. My family was not built that way. I didn't have grandparents falling over themselves trying to... love me, but lucky for us, our kid will. That is, provided that you do not drive her away first.

Jo: The car was the first thing she asked about when she woke up. She said she was asleep in it when she was attacked. It sounds like it's all she had.
Owen: So you're saying she's homeless?
Jo: I'm saying I think she's living in her car, so, yeah.
Callie: Well, I thought you said she had a job.
Jo: No, you can have a job and not have a home. That just makes it even worse. I mean, try going through high school living in your car. You got to lie all the time, you can never have anyone over, you have to make up excuses why, you have no bathroom, and then you know what? You can't even tell anybody 'cause then they just look at you like you're weird and pitiful.
Owen: Find me when she wakes up.
Callie: Okay.
(Owen leaves.)
Callie: You lived in your car in high school?
Jo: See, that's the look.

Nicole: And why is this important? Why this approach?
Arizona: 'Cause if the CCAM starts to pop out, then this little guy is at risk for heart failure.
Nicole: That's not what my notes said.
Arizona: Well, not in those words, but...
Nicole: I want my words. I want my exact words. You're giving me the gist. I'm not interested in your interpretation of my notes. I want to know that the specific words that I wrote are now embedded in your brain. That's what this is all about. That's what this fellowship is all about. If you're only interested in learning the gist of...
Alex: All right, she gets the point.
Nicole: Dr. Karev, we're just getting to the good part. You don't want to have to leave now.

Nicole: Feels strange, doesn't it? To touch a baby before he's even born? You know what it feels like Privilege. Great privilege.

Karen: You owe me an apology. And I'm not leaving until I get one.
April: I owe you an apology?
Karen: You were rude, and I raised you better. I understand you're very busy, and I understand you work hard, but...
April: Mom, I am not going to apologize for having the life that I want, even if you think...
Karen: April Kepner! You have made choices that are very different from mine, and it's scary. Any mother who watches her child do something she hasn't done herself... It's scary. But that doesn't mean I haven't been proud of you, and the more I see you in this world, in this work, in this marriage... The prouder I am. I have no earthly understanding of what it is you do, but I know a lot about babies, and I don't want to take anything away from you. I just want to help you. And I get to do that because I am a grandma. And I am also... your mother.
April: I'm sorry.
Karen: Thank you.
April: So, can I... Can I call you if I have questions?
Karen: Well, I suppose. If you must.

Arizona: Callie and I are splitting up. And there are a lot of reasons why it happened, but taking this fellowship might've been the nail in the coffin. I traded my marriage for this job, and it's pretty much all I have right now, so it has to work. I need it to work.
Alex: Okay... No, screw that. It's not okay. I saw what happened in there. She's got it in for you. She's either looking for a reason to fire you, or she's gonna grind you down and make you miserable trying to please her. She'll probably fire you either way. What do you got to lose?

Owen: What rank were you when you got out?
Melissa: PFC.
Owen: Well, I was a Major, so you're gonna listen to me if for no other reason than I outrank you. But mostly because we have this in common. I served, just like you. I did two tours as a surgeon with an army forward surgical team. I gave what I had to offer. So did you. I patched up guys. I can no more, you know, re-jigger a hard drive...
Melissa: Reformat.
Owen: What?
Melissa: Reformat a hard drive.
Owen: You gave what you had to give. You served. And you deserve all the help and gratitude that's offered to you. But if you think that by accepting this help you're taking it away from the next guy, you are wrong.
Melissa: But there are so many guys out there.
Owen: If you want to make sure these guys get help, I have friends at the V.A. You can volunteer. There's so much you can do, but to start, you have to get up on your own feet. That is how you help.That is how you serve. Understood?
Melissa: Yes, sir.

Ben: You went jogging?
Miranda: Yes, I jogged... Half a mile, and now I can barely walk, and that's embarrassing enough without you acting like I took a rocket to the moon!
Maggie: You shouldn't be embarrassed. I hope you don't give up. The thing is, no matter when you start something like this, it's gonna be hard. Just, you have to start. And take baby steps.
Miranda: Is that a short joke?

Alex: Let's go home.
Jo: You mean, go to your house.
Alex: What?
Jo: Well, it's your house. I just crash there, right? I mean, you never asked me to move in. You never complained but never...
Alex: Did I do something? 'Cause I feel like I'm in trouble.
Jo: No, I'm in trouble 'cause when this changes I don't have anyplace to be. God... I used to be so careful.
Alex: Wait, um... What's changing? I thought we were good.
Jo: Yes, but it all changes, Alex. It always does. You can't hold on to anything that you don't want to lose. Right now, I feel like I have... A bed and a house. And it is so good. But my bed isn't my bed. It's your bed. And I hate that I don't want to lose it.
Alex: Hey. Look at me. You got me. I swear to God. I'm not going anywhere except home with you. Come on. Let's go home.

April: How's the baby book?
Jackson: Um... It's the scariest thing I've ever read.
April: I was a jerk today.
Jackson: Yeah, you were.
April: Uh, so, this is the part where you say, "no, you weren't the jerk. I was the jerk."
Jackson: Yeah, but I wasn't, and you were.

Maggie: I brought wine.
Richard: I'm an alcoholic.

Richard: I screwed up. I'm sorry. Look, 31 years ago, I had a kid. And nobody told me. I've known you for only, what, two months. Two months. Most parents mess up a lot in those first few months, and it's fine because t-their kid's too young to... to notice or remember. But you... I hurt you, and I know that. And all I want to do... Is just take it back, okay?
Maggie: You've got the wrong idea. I'm not angry with you for being a bad father. You're not my dad. You are just a man who slept with a woman and made it possible for me to be born. My dad is my present. You are my past. You are my genetic history. I didn't need you to be a good father. I just needed you to be honest with me... From the start, instead of letting me walk around here for weeks like a fool, without a clue, letting me confide in you.
Richard: I didn't know what to do. And I'll never be anything but sorry for that.

Arizona: Can I talk to you?
Nicole: Actually, I wanted to talk to you.
Arizona: Dr. Herman, I wasn't kidding when I said that I... That I... that I wanted this fellowship, and today's surgery only confirmed that more for me.
Nicole: Close the door.
Arizona: But no matter how much I need or want this fellowship, I refuse to spend the year with you speaking to me the way that you speak to me.
Nicole: We won't have a year together.
Arizona: Fine. Great. Thanks.
Nicole: I'll be dead in six months. I have a brain tumor. It's inoperable. I thought I had longer, but it's growing. Soon, I will show symptoms, and after that, I will die.
Arizona: Who knows about this? Hunt? Uh, anyone?
Nicole: Fetal surgery is a new field. The few of us who are practicing it are basically inventing it as we go along. The things I know, the things I scribble down in the margins, no one has them. They're not in any textbook. They're only in my brain. So I can fight to write papers and try to get them published, or I can use the time I have left to try to teach you a year's worth of medicine in six months. Or... You can tell Hunt and the board, and it all goes away forever.
Arizona: I don't know how to feel about this.
Nicole: Well, hurry up and decide. We don't have any time to waste.

See AlsoEdit

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

Start a Discussion Discussions about Don't Let's Start

  • Don't let's Start Recap Discussion

    23 messages
    • I think she could be good at it if it's what makes her heart sing. I think Maggie was spot on. I understand her being angry at Richard an...
    • I actually did not seem so bold, but I think this conversation will have value or something, long term. Yeah, I've seen them, but really w...

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