First, do no harm. As doctors, we pledge to live by this oath. But harm happens and then guilt happens. And there is no oath for how to deal with that. Guilt never goes anywhere on its own, it brings its friends - doubt and insecurity. First do no harm, easier said than done. We can take all the oaths in the world, but the fact is, most of us do harm all the time. Sometimes even when we're trying to help, we do more harm than good. And then the guilt rears its ugly head. What you do with that guilt is up to you. We're left with a choice. Either let the guilt throw you back into the behavior that got you into trouble in the first place, or learn from the guilt and do your best to move on.

Oh, the Guilt is the fifth episode of the third season and the 41st overall episode of Grey's Anatomy.

Short SummaryEdit

Derek and Addison finalize the divorce, Burke abstains from surgeries as Bailey comes under fire at the M&M. Meredith tries to decide whether to tell Derek she broke up with Finn and Callie reveals a secret to Meredith.

Full SummaryEdit

Izzie is cooking breakfast for Meredith and George. Izzie jokes about what she should do now that she's a millionaire. She spills orange juice on the check from Denny and Meredith tells Izzie she needs to put it in the bank, because it's making her nervous. Izzie say she will, but she has to go to the hospital first to clean out her locker.

In the locker room, Meredith is talking about how Izzie is losing it. Izzie says she fine and that Meredith is the one with problems, since Meredith hasn't told Derek that she broke up with Finn.

Callie and Mark are laying together in bed. George is texting Callie, and Mark asks if that's her boyfriend. Callie says she doesn't have a boyfriend.

Bailey is telling the interns that they need to be at the M&M in 10 minutes, even if they haven't finished their rounds. They are all excited to go, but Bailey tells them the M&M is a serious meeting to discuss the mistakes that have been made and how the hospital can improve. Bailey is interrupted by Mr. and Mrs. Nyles, who got lost on their way to admitting. Mrs. Nyles is scheduled for a mastectomy tomorrow. They have a newborn and Bailey compliments him. It's clear Mrs. Nyles is upset, as she says he isn't so cute at 4 in the morning. Bailey shows them to their room and gives them advice on how the feed. The interns discuss how sad it is a 30 year old woman has breast cancer. Cristina tells them to focus and get ready to see their bosses get yelled at. Burke runs into Cristina and she asks if he has any surgeries today, because she is ready when he needs her. Burke says no and walks away.

Going into the M&M, George runs into Callie. He asks if she wants to sit with him during the event, and she says no and walks away. George tells Meredith how she is trying to make him feel guilty about blowing her off the other night. Dr. Webber starts the meeting, with patient #34986 who died of a complications following a heart transplant last month. The interns soon realize this is Denny.

Izzie is cleaning out her locker and she sees her stethoscope. She puts the ear pieces in and listens to her own heart.

Burke is presenting the case about Denny. He says the cause of death during the autopsy was identified as an embolus that dislodged itself from the suture line of the transplant, which causes a CVA with brain stem herniation. One doctor asks if that's the line the hospital is going with, the he died of CVA. Burke says it isn't a line, that's the truth. Someone else asks if his left ventricle has been weakened by the LVAD malfunction. Burke says his heart was weakened by his Congestive Heart Failure. Dr.Savoy stands up and says everyone knows that the LVAD was cut by an intern. Burke says that remains unclear, and Dr. Savoy says Burke doesn't know because he was in the ER with a gunshot wound. He asks why Dr. Bailey isn't talking, because she was the resident on the case. Bailey stands up to talk. Dr. Savoy asks her if her judgment was clouded by the fact she recently had a baby and her hormone levels and sleep derivation could have played a role in this. Webber reminds everyone that this is not to place blame, but to help everyone improve their medical care. Dr. Savoy continues to press Bailey about why her interns were running around without her supervision. She says she was busy with the shooting and he asks her why her interns have no respect for her authority. Alex stands up and tells him he has no idea what he's talking about. Then, the interns see that Izzie is in the back, listening to the discussion.

Derek and Addison are at a divorce lawyer. Derek says he doesn't want the real estate; Addison can have it all since he had a relationship with Meredith, not an affair. Addison tries to tell him that it was more than a one-night stand, but she fails to do so.

Back at the M&M, everyone comforts Izzie and tells her she shouldn't have been there to hear that. She says she is fine and that she wasn't cut out to be a doctor. She starts to leave. George tells her either she goes home or they'll call her mother. She says she'll be in the locker room for the rest of the day. Webber asks why Izzie was there. George asks if he can be with Izzie for the rest of the day because she needs someone. They all apologize to Dr. Bailey for what happened in the M&M and she tells them they don't get to apologize for her mistake.

While waiting for an elevator, Dr. Savoy apologizes and says it's nothing personal. Mr. Nyles comes over and thanks Bailey for the advice to feed his son. He asks if Bailey can talk to his wife, because she is nervous about the mastectomy and is thinking about a lumpectomy instead. He asks if Bailey can talk her into and she says that isn't her job, but she'll send up their plastic surgeon to discuss reconstructive options.

Burke tries to talk to Webber about his hand, but Webber asks Burke to help him focus the staff. Webber says they respond to him because he's a leader.

Meredith runs into Derek. She asks how he is and he asks her the same. Then, Addison pages Meredith and she says she needs to go. Addison tells Meredith that she is just Dr. Montgomery now, as the divorce was finalized that morning. Addison and Meredith go in to see a patient, who has a foreign object stuck inside of her. Sonya has her ex-husband Adam caught inside of her. A piercing of his is caught inside of her. Sonya says they are divorced, but because they work in the same field they run into each other a lot.

Cristina talks to Burke about the M&M. Burke says he tried to talk to the Chief about his hand, but he couldn't. He says he isn't going to do surgeries anymore, only paperwork.

Izzie says she knows she the crazy intern. George says they should talk about what she's going to do with her money. Izzie and George see Sonya and Adam. Addison says it's good to have Izzie back. She says she isn't back, but she asks her if she's rich. Izzie asks Addison if she ever feels guilty for being rich. Addison tells her to just deposit the check and the guilt will work itself out.

Meredith and Derek see each other again in the hallway. Meredith says he's everywhere and he apologizes, saying for once it's actually not on purpose. Meredith shows Derek Sonya's x-ray. He asks what it is, and she says a divorced couple who was going on it. Meredith then asks about Derek and Addison's divorce. Derek says it was time. He asks how Finn is, and Meredith says he's fine.

Mark is talking to Mrs. Nyles about implant options. She says she can't deal with it right now and tells her husband to pick. He says he doesn't care. Mr. Nyles asks Bailey what's wrong with his wife. Bailey says she has cancer. He says she won't tell him what's wrong and he just wants his old wife back.

Sonya and Adam are getting more x-rays. Sonya tells Adam that they need to stop doing this. She is remarried now and the only time they were happy in their marriage is when they were having sex. Their daughter, Jennifer, comes into the room and is shocked to see her parents together. Meredith asks her to wait in the car. Jennifer tells them they need to pay for her therapy, new car, and rent. Adam agrees, but Sonya says Jennifer is old enough to know that her parents are sexual beings and that they make mistakes. Jennifer says she doesn't call this a mistake, she calls it her mother being a slut. Addison then comes in and explains that Sonya's IUD got caught on Tom's piercing.

Addison and Mark are talking about the divorce. Mark wants to know who got the brownstone. Mark wants to know because he left his bike in the basement and he wants to know who to talk to to get it back. Addison tells him to buy a new bike. Mark assumes Derek got the Hamptons house then, enough though he hates the Hamptons. Mark say if Derek gave her the brownstone and the Hamptons, then Addison must have not told Derek about their relationship yet. He says if Addison keeps playing the good guy, then he just looks like a tool who seduced his best friend's wife.

Izzie says she's going to buy Burke and Bailey presents. George suggests a CD, and Izzie says she's a multi-millionaire. Meredith suggests a house, in the Bahamas. This leads Alex to suggest buying the Bahamas- or at least a Bahama. Because you know, with 8 million dollars you should buy an island. Cristina responds by reminding Alex that he's an intern- and asking when he'd have time to go to his Bahama. He says he'd quit, but Cristina reminds him that he is a surgeon and that he operates.

(...more to come)


  • Meredith Grey
  • Cristina Yang
  • Izzie Stevens
  • Alex Karev
  • George O'Malley
  • Miranda Bailey
  • Richard Webber
  • Addison Montgomery
  • Callie Torres
  • Mark Sloan
  • Preston Burke
  • Derek Shepherd
  • Sonya Cowlman
  • Adam Morris
  • Anna Nyles
  • Mr. Nyles
  • Jennifer Morris
  • Matthew Savoy
  • Nurse Kate (center)
  • Mediator
  • Dr. #1 (front left)
  • Dr. #2 (right rear)

Main CastEdit

Guest Stars Edit


Medical NotesEdit

Anna NylesEdit

  • Diagnosis:
    • Stage 2B breast cancer
  • Treatment:
    • Mastectomy
    • Breast reconstruction

Anna, 30, was scheduled for a mastectomy to treat her breast cancer. She was unsure about that plan and thought she might go for a lumpectomy instead, so she had a plastics consult to talk about reconstructive options.

Denny Duquette, Jr.Edit

  • Diagnosis:
    • Congestive heart failure
    • Stroke
  • Treatment:

Denny's case was presented at the morbidity and mortality report.

Sonya CowlmanEdit

  • Diagnosis:
    • Foreign body
  • Treatment:
    • Controlled extraction

Sonya came in with a foreign body stuck inside her. The object was her ex-husband. He had a penile piercing which got hooked on her IUD while they were having sex and got lodged in her vaginal wall. They used x-rays to manipulate the two until they were able to separate them.

Adam MorrisEdit

  • Diagnosis:
    • Myocardial infarction
    • Aortic dissection
  • Treatment:
    • Surgery

Adam had a heart attack and his aorta dissected, requiring emergency surgery. His surgery went well and he was expected to make a full recovery.


Song Performer Scene
"Clonie" Nellie McKay
  • Izzie is making breakfast when George and Meredith come in.
  • George and Meredith are shocked when Izzie spills juice on the check.
  • She says she's going to the hospital to clean out her locker.
"Kaleidoscope" Kate Havnevik
  • Meredith shows Derek an x-ray and asks if it's blurry.
  • She mentions that she heard his divorce was final.
  • He asks her about Finn.
"Wild is the Wind" The Second Band
  • Izzie talks to the other interns about what to do with the money.
  • Callie tells Meredith she slept with another guy and doesn't know if she should tell George.
  • Meredith doesn't know if she should tell Derek about Finn.
  • They each make their own decision.
"Be Good or Be Gone" Fionn Regan
  • Bailey talks to Anna about her treatment.
  • Addison tells Derek Mark wasn't a one-night stand.
  • Derek gets on the elevator with Meredith, who tells him she broke up with Finn.
"Don't Mistake Me" Keisha White
  • George takes movies to Callie's. She says they were broken up and closes the door.
  • Mark and Addison are in bed together. He says she doesn't have to feel guilty now.
  • Izzie decides she's not ready to deposit the check because she doesn't know what to do it.

Notes and TriviaEdit

Grey's Anatomy Oh, The Guilt Promo 200:29

Grey's Anatomy Oh, The Guilt Promo 2

  • This episode's title originated from the song Oh, the Guilt, originally sung by Nirvana.
  • This episode scored 22.05 million viewers
  • In the locker room scene Meredith's mini whiteboard on the inside of her locker door states that she is scheduled to "eat eye boogies" at 2pm
  • Denny was patient number 34986.
  • It is revealed that George has Izzie's mother's telephone number on his cellphone and Meredith is aware she lives "a few hours away".


Episode StillsEdit


Izzie: Morning.
George: I thought we were all done with the whole muffin thing.
Izzie: This isn't muffins. This is breakfast.
Meredith: Are you okay?
Izzie: Of course I’m okay. I’m a millionaire. Fruit? What do you guys think about B&B's? I'm thinking about opening B&B in Vermont where the foliage is, you know?
George: Maybe you should go back to sleep.
Izzie: Can't. I'm going to the hospital.
Meredith: Are you going to talk to the Chief?
Izzie: I'm going to clean out my locker. I could buy a hotel. How much do you think a hotel costs? :(Izzie pours orange juice and spills it on her check)
George: That is 8 million... (He quickly cleans up the juice.) Eight million dollars does not like to have juice spilled on it.

Meredith: (about Izzie) She almost battered and deep-fried an 8.5 million dollar check.
Cristina: For That kind of money I'd buy my own hospital and stock it full of sick people. Valvuloplasties and ruptured aneurysms.
George: You're a psycho.

Lawyer: Derek says that neither of you brought any assets into the marriage.
Addison: Well I had my trust fund, and a sparkling personality uh, and a futon couch.
Derek: Yes, Addison had a very ugly, very heavy, futon couch.
Addison: Whatever happened to that couch?
Derek: We gave it to Mark. She can have him.
Addison: I don't want him.
Derek: Okay, well that's settled. What else?
Lawyer: Aside from Addison's trust fund which will remain in her name, we'll split everything, stocks, bonds, 401K's down the middle. The only thing that gets complicated is the real estate.
Derek: Well, let me make this simple. I'd like to keep my trailer and the land is Seattle. Addison can keep the rest.
Addison: Hold on...
Lawyer: That's the house in the Hampton's and the Brownstone overlooking central park. That's very generous of you.
Addison: Hold on. He's up to something. I came here to fight over CD's and books. Go to war over a crystal vase. What are you up to Derek?
Derek: The divorce is my fault, let me take responsibility.
Addison: We both had affairs.
Derek: You had a one night stand with Mark.
Addison: Actually it was...
Derek: Okay it was two nights. You made a mistake. Meredith and I, we had a relationship. Make these changes. I'll sign them today.

Mark: She told you. I've known you my whole life, I grew up with you so I know what you're thinking. That there is a year of your life wasted. Trying to make it work with Addison and you could have been with Meredith. That you could be happy right now. That all this, everything. That you and Meredith could have had a real chance. Still, I thought you should know the truth. Thought I owed you that, as a friend.
Derek: You're not my friend.

See AlsoEdit

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

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