|“||There’s this family in Italy, who never slept. They suffered from a genetic disease that kept them awake, for months. Until their bodies just shut down. Even after all these years, scientists still don’t really know why we sleep. We just know we have to sleep, because without it, we make poor decisions, we say things we shouldn’t, and sometimes, we see things that aren’t there. We’ve all hit that point of exhaustion. The point where nothing makes sense anymore. Your body hurts, your brain becomes foggy, and you feel like you’re trapped in a tunnel. When all you want is your bed. So, how do you keep going? How do you not just sit down and give up? Sometimes it’s easy. Sometimes you play games in your head. You make up someone. Someone good. Whatever you need. To keep you going.||”|
A difficult surgery brings back pivotal memories for Meredith, Richard, Owen, and Stephanie, as they work together to save a life.
Meredith's voice over talks about what a lack of sleep can do to you. You make bad decisions. You say things you shouldn't. And sometimes, you see things that aren't there.
The OR staff enters an emtpy OR and starts prepping it for an emergent procedure. As the patient's brought in, Meredith comes out of the scrub room and gets gowned and gloved. Owen comes in and asks what they got. Meredith replies MVC with major abdominal trauma. Stephanie comes in and says the last exam showed lots of fluid in the right upper quadrant. It's going to be long night. Meredith hates to hear that since she hasn't slept for 48 hours. She got off an 18-hour shift and Zola was boycotting sleep while Ellis had an earache. By the time she got the last one down, she got the call for this surgery. Owen has completed a long list of surgeries so it feels like he's been here for days. Stephanie asks when you know you're too tired to operate. Owen says when you make your first mistake, while Meredith says you just gotta keep going anyway. Stephanie doesn't like both answers. Meredith makes the first cut and starts dividing the fascia. They all take lap pads and start packing in an attempt to control the bleeding. Blood squirts out of the body cavity and Stephanie manages to stop it while Owen asks for more lap pads.
Richard comes in and offers another set of hands. He napped all afternoon, had a balanced supper, and he just had a cup of coffee. Richard asks what they got. Meredith replies a mess and Stephanie says grade IV liver lac. They packed all four quadrants. Richard wants to perform a right medial visceral rotation and Stephanie helps him. The patient's still bleeding out despite all the units of blood they gave him. Richard says back in the day, he always came into the hospital overnight because that's when the interesting surgeries happened. He recalls a case in his second year when a guy claimed there was an alien baby eating his way out of his belly. The others are too focused to react. Richard says the cause of the pain was a huge kidney stone. Stephanie asks if there's any way they can salvage the kidney, which is cracked in half. Meredith says no, but Owen says yes. Meredith says they don't have the time or blood volume to try and salvage the kidney, so she wants to take it out. Owen wants a partial nephrectomy. Meredith says that's useless. Richard asks why so Stephanie can learn. Meredith's not in the mood. Owen decides to repair the kidney. Richard wants them to teach Edwards. Meredith angrily says Edwards can learn from this in her cadaver anatomy lab if they try to repair the kidney, but then agrees to the partial nephrectomy.
Richard looks at the patient and asks Stephanie to tell him about the name. Stephanie says he's John Doe. Owen says two cars smashed into one another on the freeway, and this is one of the drivers. Richard asks if they have the reckless driver or the victim, or if he has a family. Richard asks what they need to know in order to make this patient a human being instead of just a sack of organs. He says they're going to play a game. They're going to make this patient into anyone they want. He asks them to come up with a name. Stephanie suggests Brandon from IT, but they don't know much about him. After rejecting Joanie, Richard suggests Gail. She's 46. He asks them to picture her life and her voice until they can actually hear her. Richard envisions the patient as Gail, who turns her head towards him and tells him this is going to be fun.
Richard wonders what would make them go to such great lengths to save Gail. Stephanie says because that's what they're supposed to do. Richard wants them to make easier on themselves. They need be able to sink their teeth into Gail. Meredith announces the right lobe is still bleeding. Richard says that Gail plays the cello. Richard stares into the distance.
He sees Gail playing the cello while she says her mother forced her to learn. Something about learning an instrument would teach her discipline. While Richard keeps seeing her as she plays the violin, Owen tells the others to remove the top blades. The pringle didn't make a dent in the bleeding, so he's gonna try to get more exposure with a subcostal. Meredith objects, because the patient doesn't need another incision to bleed from. Richard wants more things to make Gail more real. Owen and Meredith don't feel like playing along, but Stephanie asks if Gail has a dog. He says no. Gail doesn't have time for a dog. She's got three kids, so her house is a mayhem already. She has two boys and a girl.
Richard envisions Gail as she stops playing the cello to tell her sons to stop terrorizing her sister. He envisions her and her children in an OR gallery, where she tells her oldest son to behave like that. Richard tells the others that he imagines that Gail's work is what keeps her sane. He asks if anyone has an idea what she does for a living. Stephanie suggests engineer, but Meredith says Webber should just say what she is. He says she dreams about being principal cello for the Chicago Symphony. She practices every morning and night. In between, she teaches music to kids in the neighborhood and she helps lead the high school orchestra. Richard envisions Gail praising one of her students. The beeping monitor snaps him back to reality. Meredith thinks they should count their losses, pack him, and come back later. Owen wants to focus on the retrohepatic area and repair the vascular damage there. Meredith thinks there's no way to get visualization, so they should pack the patient and get him to the ICU. Richard keeps envisioning Gail and sides with Hunt. The patient won't survive the ride to the ICU so they should continue. After looking at Gail, Richard suggests they call UNOS. Meredith says he'll be dead before a liver gets here, or he'd be too unstable not to reject it immediately. They'd be stealing a liver from a good candidate. Richard asks Edwards about the indicators for an emergent liver transplant. She replies acute hepatic failure, portal vein thrombosis, and unstoppable bleeding. Owen can't recall many studies that say that it'd work. Meredith says they're not doing it. This is her patient, so her call. Richard wants to discuss the options, but Meredith says she outranks him and she says no. Owen thinks he can take care of the retrohepatic bleed. If that doesn't work, the patient goes to the ICU. If Richard's not on board with that plan, he can leave. He decides to stay and start working.
The clips aren't holding. Stephanie was hoping that whatever put this guy on the road in the middle of the night was worth it. Richard is still picturing him as Gail. He suggests she has to work nights for the extra money. He visualizes the patient as Gail and she tells him she couldn't say no to her boys when they wanted to go to a science camp while their father was away for the war. Richard tells the others that Gail works late shifts at a reception desk at a hotel. Owen needs more visualization. Richard says this isn't working and tells Owen it's his turn to turn John Doe into someone. Owen says he's operated on hundreds of John Does in the army so he's good, but he visualizes himself back in the desert.
He's operating in a field hospital with his sister. She says that's a load of crap. Whenever they were operating on a John Doe, Owen would always yell at someone to find their tags. Owen claims he did that to avoid the paperwork. Megan then notices he's slowly becoming their father. He's got his nose and chin and unreasonably high expectations of everyone around him. What he doesn't have is his father's beard. That one was good, but his is just sad. Owen asks for a rummel tourniquet.
A scrub nurse gives it to him. Since he can't reach the bleed, he wants to open the patient chest for a total hepatic vascular isolation. They can repair the source of the bleed while the blood supply's completely cut off. Meredith says he can just control the IVC from above and below the liver from the incision they already made. Owen says any trauma surgeon would agree with him. He tells Stephanie to perform the sternotomy. It doesn't have to be pretty, just fast. They're racing against the clock.
He hears Megan laughing. He visualizes them back in the field hospital. She tells him they're losing, because he's suturing like a dumb tortoise with his beefy, fat hands. Owen says he's trying to teach, which she's never done. She knows that he doesn't know what to do next with his patient.
Owen stops and expresses his doubt. The patient is still bleeding. Meredith reminds him he said he could do it, so he has to do it.
Back in the imaginary field hospital, Megan asks him what's wrong. She gives him a look that reminds him of his mother. He tells her to go away. She says he's the one who brought her here. He usually only does that when he feels guilty. She asks if he feels bad about being nice to Nathan. Owen snaps he doesn't feel guilty about anything. She comments that that's a first. She asks what's wrong. She guesses it's got something to do with his wife. Or is he gonna choke someone again?
Owen yells to shut up, realizing too late he's yelling at Meredith instead of Megan. Richard calls him on it. The entire OR freezes as Owen imagines Megan walking around there. She thinks Meredith's what wrong with him. She likes Meredith. He should have married her, because then he'd have kids. Owen says he doesn't want to marry her. He wants to save this patient. Megan asks who he is anyway. He's been throwing out some bold moves. He's monopolizing the OR and wasting resources and personnel. Owen says it's not a waste if it saves the patient. She wonders why he won't just call it since he knows where this is headed. Owen says you don't stop until you save the patient or find out that they're dead. Megan looks Owen in the eyes and tells him that this guy is not her. He nods. The OR unfreezes and they continue working. Stephanie sees bruising on the patient's neck and face. Meredith wants to pack the guy. Owen imagines Megan again and tells her he misses her, but she tells him to cut it out and focus. She tells him that he knows what he has to do. Owen snaps back into reality and asks for a DeBakey clamp. He tells Stephanie to call UNOS and send them everything they have on this patient. Stephanie leaves the OR. Owen says a transplant is the only thing that will save this patient. He's taking the liver out since it's only doing damage. Meredith orders him not to make that cut, but he ignores her and takes the liver out. He puts it in a basin and sees Megan smiling at him.
Meredith says they decided not to list this guy. Owen says she decided that. Meredith wonders how the patient's going to live without a liver. Richard says it wasn't working in his body, so taking it out while waiting for a new one does no damage. Meredith says they don't even know if they'll get a match. Owen wants a portacaval shunt to bypass the blood flow. It'll buy them an hour. Owen imagines Gail is tough. Richard says she's tough as nails. She was on her feet 16 hours a day and wouldn't let up, even when her back pain started keeping her up at night.
He sees Gail as she says she thought it was her mattress, which was at least 15 years old. She replaced it, but that didn't help. Richard says her bag rattles all the time because she carries around a bottle of aspirin with her. The monitor beeping brings him back to the patient. Meredith says there are bleeders. Stephanie comes back and says he's listed as 1A. He's an easy match so fingers crossed. Stephanie notices there's blood in the ET tube and the lab tech mentioned his platelets were clumping, so she was thinking... The others interrupt her and argue over the source of the bleed. Stephanie thinks something else is going on, too.
Little Stephanie is standing behind her and tells her that they can't hear her. If she wants them to listen, she's got to be louder. The attendings have found that the source of the bleed is the azygos vein. Meredith doesn't trust Owen to take care of it. Little Stephanie encourages Stephanie to speak up. Stephanie says she doesn't think the patient is decompensating because of the DIC. She thinks the patient has a platelet disorder. The labs already showed abnormalities and they can confirm her suspicions with a blood sample. Owen tells her to help him suction for now. Meredith still wants to take the patient up to the ICU. Stephanie envisions her younger self reading from a medical textbook, saying that won't work. Stephanie tells Meredith that, but Meredith doesn't listen. Little Stephanie reminds Stephanie that nurse Paula would tell her to speak up if she's got something to say. Stephanie yells to listen to her. Repairing the azygos won't stop the bleeding and he'd still deteriorate in the ICU. This patient has idiopathic thrombocytopenic purpura. Owen says that's rare. Little Stephanie reads the statistics from her textbook and Stephanie says it's more common than they think. Owen says the body's just shutting down because of the trauma, but Stephanie says he just thinks that because all he sees is trauma. She sees a body that's attacking itself. The body just chews up all the platelets they administer. They need to administer steroids to stop that. Owen says that could become toxic since the liver's not there to metabolize them. Stephanie says she knows all about this, and if it were her on the table, she'd want to survive. Little Stephanie is glad. Owen asks how she knows all this. Little Stephanie says that when you're stuck in a bed your whole childhood, you kind of become obsessed with the thing that put you there. Stephanie says she reads a lot. Richard compliments her catch. Meredith asks a nurse to send up a blood sample and give the patient prednisone. Owen still thinks this is a reach.
A nurse comes in with a camera. They might have an ID. A woman called because her husband never came home and she saw the news. The nurse takes a picture of the guy's face as the patient goes into V-tach. As they're rushing to fix this, Richard sees Gail as she realizes that this back pain isn't normal. Also, it's not just her back. Meredith thinks this is happening because Owen took out the liver. Richard says they still have time. He envisions Gail lying on the table. She tells him something's really wrong.
The patient's in V-fib. Richard takes the internal paddles and shocks the heart once. It has no effect. After one dose of epi, he shocks again. As it's still not successful, he gets ready to do it again. The nurse returns and says that the wife ID'd her husband. His name is Carl Henley. Meredith asks if there are children. The nurse replies there's a little girl and boy, who are downstairs with their mother. As Richard shocks the heart again, Meredith sees herself and her two oldest kids entering Dillard Medical Center. Meredith wonders what to do now. The shunt put too much strain on the heart. Owen thinks it'll hold for another hour. Also, Carl probably has ITP. Meredith hates that Richard and Owen just took over during the surgery. While she envisions her children in the waiting room with a social worker, Richard tells her she's been negative all surgery long, shooting down every approach. Meredith says she's not massaging this heart for exercise. Richard shocks the heart as Meredith says she's done everything to keep Carl alive. The fact that he's alive is a miracle, considering the shape he came in in. Richard says he didn't teach her to stand around and play safe. As long as Gail's on the table... Meredith says it's Carl. Meredith envisions Zola asking the social worker where her mother and father are, then says someone should go talk to Carl's family. They need to be prepared for what's about to happen. Suddenly, the rhythm returns. It's faint, but it'll do for now. Owen wants to close him up and get him to the ICU. It's time to compromise, for all of them.
Meredith steps back as she's flooded with flashbacks of the day Derek died. She experiences a vivid flashback of that night. She approaches her children, who are happy to finally see her. She hugs them and Zola asks where daddy is. Meredith tells them that daddy got in an accident when he was driving his car. Zola asks he's hurt and if they're fixing him. Meredith and the others continue working on Carl as Meredith still relives the experience. Meredith tells her children that the doctors can't fix daddy. Zola says she should go in and fix daddy then, but Meredith says she can't do that because no one can fix him anymore. Daddy died. Meredith hugs her children and holds their hands. She slowly steps back into the OR, letting go of their hands and putting her surgical mask back on.
After the experience, Meredith realizes that Richard didn't make Gail up. He says you come up with whatever helps. No matter who, it's always someone good. Richard sees Gail again. She tells him, her oldest son, that there was nothing he could have done since he was only 10 years old.
Richard says his mother hated doctors, or maybe she just didn't want to worry them. They all thought everything was fine, because life as they knew it continued. They had to listen to that damn cello all day, every day. She'd play it for hours. She'd shut the bedroom door and tell them not to knock unless someone was bleeding or something was on fire. Richard hated the constant classical music, until one day, the house went silent. Then he missed it. That's when he knew something was wrong. Stephanie asks what was wrong. Richard thinks she can figure that out on her own. He gives her the symptoms. Stephanie guesses around before asking if there were signs of jaundice. There were. Stephanie guesses gallstones or hepatitis, but Meredith says it was pancreatic cancer, stage III or IV. Richard says she had six months. Owen says they can close without him, but he wants to stay. Meredith then says they should stop closing. She knows she's been pushing to close him, but she thinks they can save him right now. They can try an autotransplant. If they ditch the right lobe, repair the left, and graft the remaining vessels, it'll work. They have total access now, so it's easier than it was before. Owen says it's risky in trauma. Meredith says it's a Hail Mary. She and Webber will work on the liver while Stephanie and Owen work on the anastomoses.
While working on the liver, Owen sees Megan smiling at him. He smiles back at her. He looks away for a second, and then finds she's disappeared. Meredith sees her children as she's working on the liver. She smiles at them. As Meredith and Richard return to the table with the liver, Stephanie and her younger self also smile at each other. They put the liver in.
They've closed Carl up. They're all exhausted. Owen compliments Meredith's save. She says she should have thought of it sooner. Stephanie leaves with the patient to take him up to the ICU. Meredith and Richard stay behind in the OR. She apologizes for things she said during the surgery. She has to learn to push past exhaustion. Richard says she did. Meredith asks if he's always done that with his mother. He says no, because he was trained to depersonalize the patient. Tissue was tissue, faces were covered, and blood was a mess on the floor. They were to stay focused. Meredith asks what changed. He says they lost a patient. He went along to inform the family. He was numb. He watched them sob and comfort each other, and it didn't affect him at all. That patient died from the same thing his mother died from, and he was a robot. Afterwards, he started changing the rules and it made him a better surgeon. He sees Gail standing behind Meredith as she says that he's saved her now, about a thousand times. He supposes he did. He takes off his scrub cap and wishes her a good night. He walks out.
She walks into the scrub room while the voice over wonders how you can keep going when you're so exhausted that all you want is your bed. The answer is you make up someone in your head, someone good. As she's scrubbing out, she sees Derek in the scrub room with her. He tells her hi and smiles at her. The vision is disrupted when a nurse comes in. Meredith dries her hands and walks out.
The nurse enters the empty OR, which is ready for a new patient.
- Ellen Pompeo as Dr. Meredith Grey
- Justin Chambers as Dr. Alex Karev (credit only)
- Chandra Wilson as Dr. Miranda Bailey (credit only)
- James Pickens, Jr. as Dr. Richard Webber
- Kevin McKidd as Dr. Owen Hunt
- Jessica Capshaw as Dr. Arizona Robbins (credit only)
- Sarah Drew as Dr. April Kepner (credit only)
- Jesse Williams as Dr. Jackson Avery (credit only)
- Caterina Scorsone as Dr. Amelia Shepherd (credit only)
- Camilla Luddington as Dr. Jo Wilson (credit only)
- Jerrika Hinton as Dr. Stephanie Edwards
- Kelly McCreary as Dr. Maggie Pierce (credit only)
- Jason George as Dr. Ben Warren (credit only)
- Martin Henderson as Dr. Nathan Riggs (credit only)
- Giacomo Gianniotti as Dr. Andrew DeLuca (credit only)
- Kendall Joy Hall as Little Steph Edwards
- Cassidy Brown as Dillard Nurse
- Olivia-Diane Joseph as O.R. Nurse
- JoAnna Rhambo as Scrub Nurse
- Aniela Gumbs as Zola
- Abdominal trauma
- Grade IV liver laceration
- Retrohepatic bleed
- Venous bleed
- Idiopathic thrombocytopeniaic purpura
- Exploratory laparotomy
- Partial nephrectomy
- Liver autotransplant
Carl came into the hospital after a car accident. He had trauma to his abdomen and free fluid. His liver had a grade IV laceration. His kidney was also severely injured, so they did a partial nephrectomy. When they reached a critical point, Meredith wanted to close and take him to ICU until he was stronger. However, she gave Owen the chance to repair his kidney first. Owen then clamped off all blood flow to the liver to try to repair the damage. When he couldn't control it, he decided to remove the liver and call UNOS to get him on the donor list. Stephanie then noticed his platelets weren't clamping, a sign of an autoimmune disease called idiopathic thrombocytopeniaic purpura. It was destroying his platelets, so they needed to give him steroids. They sent a blood sample to the lab to confirm. He started crashing, but they were able to resuscitate. They prepared to close him. However, before they could finish closing, Meredith had the idea to use the liver they'd removed, separate the part that was damaged beyond repair, and then auto-transplant it. They did so successfully and then moved Carl to the ICU.
- Pancreatic cancer
Gail, 46, was Richard's mother. She started experiencing severe back pain. She thought it was her mattress, so she replaced it, but it didn't help, so she used aspirin to control the pain. Eventually, it got worse. She was eventually diagnosed with advanced pancreatic cancer. She was given six months to live.
|"Drag Me Down (Instrumental)"||Brooklyn Duo||
|"Sonata No. 1 In G Minor, BWV 1001 - II. Fuga - Allegro"||Johann Sebastian Bach||
|"All of Your Glory"||Broods||
Notes and TriviaEdit
- This episode's title originated from the song The Room Where It Happens, originally from the musical Hamilton.
- This episode scored 7.25 million viewers.
- The table read for this episode took place on September 21, 2016.
- This can be considered a bottle episode.
- Patrick Dempsey appears as Derek Shepherd via modified archive footage.
Behind the ScenesEdit
- Zola: Where's Daddy? Is he here?
- Meredith: Remember Daddy was driving in his car?
- Zola: Yeah, is he coming home soon?
- Meredith: No, he was in an accident.
- Zola: Oh. Well, is he hurt?
- Meredith: He was.
- Zola: Are the doctors fixing him? Is he going to surgery?
- Meredith: No, they can't fix him.
- Zola: Then you should go in there and fix him.
- Meredith: Zola...
- Zola: You fix everyone.
- Meredith: Zola, I can't fix him.
- Zola: Why?
- Meredith: I can't fix him because... because no one can fix him... because he's dead, Zola. Daddy died.
- Meredith: Have you always done that with your mother?
- Richard: I didn't used to. Back then, I was trained to depersonalize the patient. Tissue was tissue, faces were covered, and blood was a mess on the floor. We were to stay focused, and our hands were inside just mannequins.
- Meredith: So, what changed?
- Richard: One afternoon, I was in the OR, and we lost a patient on the table, and I went along to inform the family, you know, tell them the horrible news, and I was numb. I watched them sob and hold each other and it didn't affect me, at all. That patient died from the same thing my mother died from, and I was a robot. After that, I started changing the rules, and it made me a better surgeon.
- Meredith: You've saved her now, about 1,000 times.
- Richard: I suppose.
- Richard: Ever since I walked into this OR, you've been negative at every step, shooting down every approach.
- Meredith: What do you think I'm doing right now, massaging this heart for exercise?
- Little Stephanie: When you're stuck in a bed for your whole childhood, you kind of get obsessed with the thing that put you there.
- Meredith: You didn't make Gail up.
- Richard: You come up with what you need to. Whatever helps, an old patient...
- Meredith: Someone good.
- Gail: It's okay, son. You were only 10 years old. There was nothing you could do.
- Richard: My mother, she hated doctors. Or at least that's what she said. You know, I think she just didn't want to worry us. We thought everything was fine. She still taught music classes every day, yelled at us about our homework, fixed us dinner. We grew up listening to that damn cello all day, every day. She played it for hours. Bach, Vivaldi, Elgar... She would shut the bedroom door and tell us not to knock unless someone was bleeding or something's on fire. I hated it, that constant drone of classical music, until one day it stopped. The house was silent. I missed it. That's when I knew it meant something was wrong.
- Megan: If it's a race, you're losing, because you suture like a dumb tortoise.
- Owen: I like my sutures to hold.
- Megan: Oh, and your beefy, fat hands slow you down? Do they have to special-order those gloves for you?
- Owen: Stop.
- Megan: I'm not doing anything.
- Owen: You're giving me that look, and I don't like it. Mom does it, too.
- Megan: Well, you should call Mom more.
- Owen: Will you just go away?
- Megan: You're the one that brought me here, and you usually only bring me around when you feel guilty. Why are you guilty, Eeyore?
- Owen: I am working.
- Megan: Is it Nathan? You feel bad about being nice to him lately.
- Owen: Nope.
- Megan: It's fine. Well, I mean, it's not fine. He cheated on your little sister, but...
- Owen: I don't feel guilty about anything!
- Megan: Oh, well, that's a first. Well, something's wrong. What is it, then? New wife isn't working out?
- Owen: I'm done talking to you.
- Megan: You're not gonna choke anybody again, are you?
A complete overview of this episode's crew can be found here.
|Grey's Anatomy Season 13|
|#01||"Undo"||#09||"You Haven't Done Nothin'"||#17||"Till I Hear It From You"|
|#02||"Catastrophe and the Cure"||#10||"You Can Look (But You'd Better Not Touch)"||#18||"Be Still, My Soul"|
|#03||"I Ain't No Miracle Worker"||#11||"Jukebox Hero"||#19||"What's Inside"|
|#04||"Falling Slowly"||#12||"None of Your Business"||#20||"In the Air Tonight"|
|#05||"Both Sides Now"||#13||"It Only Gets Much Worse"||#21||"Don't Stop Me Now"|
|#06||"Roar"||#14||"Back Where You Belong"||#22||"Leave It Inside"|
|#07||"Why Try to Change Me Now"||#15||"Civil War"||#23||"True Colors"|
|#08||"The Room Where It Happens"||#16||"Who Is He (And What Is He To You)?"||#24||"Ring of Fire"|
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