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What Happens Next

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What Happens Next is the eighth episode of the fourth season and the 62nd overall episode of Private Practice.

Short SummaryEdit

Charlotte chooses to suffer in silence as she tries to deal with the emotional aftermath of the attack, as Addison struggles to keep the events of that night a secret, while Cooper and the doctors of Oceanside Wellness fight their own demons arising from the assault.

Full SummaryEdit

At St. Ambrose Hospital, Charlotte walks down the hallway with doctors and nurses staring at her. She's wearing sunglasses and her arm is in a plaster cast. As she opens the door to her office, she remembers the attack and walks away.

Addison is staring at Sam, who's lying next to her in bed. He notices this, and asks if she's ready to talk now. She says she can't, and even though Sam insists he can keep a secret, she decided to keep her promise to Charlotte. He proposes to play doctor and patient, so she can tell him and he can keep it secret because of the doctor-patient confidentiality. She kisses him and then walks out of the bed, and he sighs.

Violet meets Addison, Sam, Amelia and Sheldon in the kitchen at the practice and asks if they've talked to Charlotte. Addison left her a couple of messages, but she didn't call her back. They start discussing about what they should say to her. Sheldon says he sent her flowers, and Violet regrets she hadn't thought of that. A fatigued Cooper enters, and he tells them that Charlotte first went to the hospital but is now parking downstairs. He asks them not to act weirdly, and Addison jokes he's setting a great example. As they're talking about how she looks, Charlotte enters, creating an awkward silence. "Take a good look then get over it," she says. They stare at her while she takes yogurt out of the fridge, and she asks them to stay away from her if they're all going to act nervous and annoying around her. She walks away, and Cooper yells that they all acted weird even though he told them not to. He leaves too, and Addison says she thinks it's too early for her to be back. Violet says it's therapeutically good she faced everybody, stated her needs and told them off. Sheldon agrees it's good that she's trying to regain control of her life.

Cooper enters a trauma room at the hospital, where he tells the patient he was paged that everything is going to be fine. Pete drains the fluid from her abdomen. Elisa, the patient, thanks him and tells her dad she's okay, but he asks Cooper if she really is, thinking her cancer has come back. Cooper says they need a CT to confirm that. Elisa tells her Papi not to worry, but he does anyway. He says her body can't take any more chemo. Pete suggests to try different techniques, but Cooper tells Diego that Elisa's lymphome is curable, even after a relapse. Diego says he doesn't believe in Western medicine, which is why he's going to take his daughter to a shaman.

Addison's been looking for Charlotte and finally finds her in the lounge. She asks if Charlotte would like to get coffee, but Charlotte passes. Charlotte says they're not friends. Addison tells Charlotte that she needs a new pelvic exam, as well as followup labs, and more HIV drugs. Charlotte says she'll take care of that herself. Addison says they could be friends so she can be there for Charlotte. The only thing Charlotte needs from her is to keep her mouth shut about what happened.

Pete and Cooper are arguing over Diego wanting a shaman. Cooper's against it, but Pete thinks it could work. Pete tells Cooper to open his mind if he wants to help Elisa.

Sheldon is in session with Rachel and Nick. She feels like her health issues have robbed him of his youth. She thinks it's unfair for him. First it was her diabetes, then the breast cancer. She thinks caring care of her is exhausting. She's afraid he's going to resent her. Nick says that's crazy, but Sheldon asks how he relieves the stress. Nick admits they fight. Sheldon asks why that makes him uncomfortable. Rachel starts crying and wants to grab a tissue, but the box is empty. As Sheldon goes to grab a new one, Rachel starts hitting Nick. Nick makes her stop and tells Sheldon that she doesn't mean to.

Sheldon's told Addison about Rachel and Nick. The rage made him think that she's an addict. Addison says Rachel's on drugs, but only to manage her diabetes and kidney problems. Addison thinks Rachel's an incredible woman, very resilient. Sheldon says she's abusive. Addison doesn't think it's big a deal, because Nick's a big man and Rachel was a ballerina. Sheldon insists that something's going on.

Cooper enters Violet's office and tells her that Charlotte is having nightmares, not eating, and refusing to talk about the police investigation. Violet says she's just trying to put herself back together. Cooper says none of the usual shrink talks helps him. Violet says it's not about him. He should back off. He decides to hang out on Violet's couch.

Sheldon's at Nick and Rachel's house with Nick. He tells Nick to report the abuse. Nick refuses. Rachel's fine most of the time, and he can handle her when she's not. Nick tells Sheldon he can't understand since he's not married. He talks about how he met Rachel when he wrote an article on ballet. He won't ever give up on her.

Amelia brings Charlotte some doughnuts. Amelia wants to ask something, but Charlotte interrupts her and tells her she better not ask if she's okay. Amelia says when she first quit drugs, she took up running. She'd go for miles, until one morning, she got clipped by a minivan. Then she started craving pills again. Amelia was thinking maybe Charlotte's craving pills again. Amelia invites Charlotte to come to meetings with her, but Charlotte says she has an incredibly high pain treshold from growing up with two brothers.

Sheldon gets on an elevator with Sheldon. He says he got Nick to bring Rachel and asks Addison to check her out. She will. Addison stops the elevator and asks him if he thinks Charlotte's okay. She admits they're not close, so she doesn't know what to do. Sheldon says that is because Addison saw her that night, in her most fragile state. Addison's a living reminder about that night. She needs to find a more indirect way to help Charlotte.

Cooper and Pete arrive at the trailer park, where a shaman is working with Elisa. Pete thanks Diego for letting them observe and gives him a piece of quartz, which he's been told is a powerful healer. He worked with shamans in Congo. Cooper's still cynical. Diego says Western medicine's failed him. Elisa starts wheezing. Diego says that's the bad energy leaving her body. Pete feels no pulse and goes to call an ambulance while Cooper starts CPR.

Pete and Cooper walk into the waiting area and tell Diego that Elisa was in hypotensive shock when she arrived at the hospital, so she needed surgery. They made a tiny incision in the sack around her heart to drain the fluid. She's in recovery now. Carlos asks if she can come home, but Pete replies she has to stay here for a couple nights. Diego says she was brought here against his wishes. He wants her discharged, but Pete says she can't be moved until the draining tube is removed. Cooper tells Diego the facts and says chemo is the only way, but Pete sides with Diego and says they can work something out. Cooper doesn't care. He'll get a judge to order Elisa's chemo.

Addison and Sam are having sex as she decides to tell him her secret. She tells him she did a rape kit, which the victim didn't want. She was upset, but Addison thought she might want the DNA later. She hid it in a hospital refrigator, but she didn't report it. Sam says that's illegal and wonders why she did that. He then realizes that it's about Charlotte and that she made Addison promise not to report it.

Sam hesitates outside Violet's office until she notices his staring. He comes in and says he has a thing he can't tell her or anyone, but despite that, he needs her to get what he's saying. He tells Violet to talk to Charlotte because she needs help. He needs her to do what shrinks do.

Pete tells Cooper that Elisa's hanging in there. Cooper says threatening the father was the only way he'd leave Elisa at the hospital. Pete points out that refusing treatment on religious grounds is Diego's right, so Cooper would likely lose anyway. Pete says he's worried about Elisa, too, but tearing her family apart won't help her. Pete says Elisa and Diego have a right to refuse treatment. If Cooper goes through court to force chemo, Pete will testify on their behalf. 

Addison's about to do an ultrasound on Rachel, who admits that sometimes she can't control herself. Addison found high levels of testosterone in Rachel's blood, which could mean a tumor of the adrenal glands or lungs, which she ruled out, or metastatic breast cancer. Rachel says she had a mastectomy ten years ago. Addison says left-behind cells could have formed a met in her ovaries, resulting in the testorone levels and sudden rages. The only way to know for sure is surgery, but that's ill-advised for someone in Rachel's health. Rachel says she wants it for Nick. She can't hurt him anymore.

Pete enters Charlotte's office and says it's been a few days. He should check out her injuries. Charlotte says they'r fine. He says it'll be fast then. She decides to get it over with. He closes the blinds and checks her out. Her facial injuries are healing up well. He then checks out her back, which is a difficult moment for her. Pete comments that Cooper did a crap job replacing the bandage, but she confesses she did it herself. Pete takes off the bandage and cleans out the wound. He applies a new bandage. Charlotte then says she's got it from here. Pete asks her to let him know when it needs to be changed again and leaves.

Cooper enters the kitchen and asks Charlotte if she wants to get lunch. She wonders why people can't leave her alone. She knows he came in here to check up on her. She needs everybody to back off. He says he's her fiancé, so he's in this with her. She bounces back that he has no idea. She can't breathe with the way he's looking at her. She runs out.

Sheldon tells Nick that Addison will remove Rachel's tumor and decide on post-op treatment. If all goes well, her testosterone levels will decrease and she'll have more control over her anger. However, if the surgery isn't successful, her rage will continue. Nick says they'll get through it. Sheldon says there's obviously a lot of love, but he thinks it's time for him to start counseling Nick to walk away. Nick says no one stays together anymore, but people should fight for each other. This is what love is supposed to be. He's never walking away.

Pete checks in with Elisa. She feels much better and says she's ready to go home. Pete says she needs to rest first. She heard about the judge. She doesn't want chemo. Pete asks if she believes the shaman can heal her. He wants to know what she believes. She says she doesn't want chemo.

Sam finds Addison on her deck. She couldn't sleep. He tells her it's going to be okay. Violet will talk to Charlotte. Addison worries that someone will find the Jane Doe bag in the lab frig. Sam says she only wanted to help a friend. Sam says they'll wait for Violet to come through.

Charlotte enters the kitchen where Sheldon's made a fresh pot of coffee. Sheldon says she can help herself to it. Charlotte thanks him for letting her be, unlike everybody else. Sheldon says he'd do nothing for her anytime. He walks off. Violet enters and says she knows how hard it can be to re-integrate after you've been victimized, so she's there in case Charlotte wants to talk. Violet truly believes in the therapeutic process, because it really helped her after Katie attacked her. Charlotte tells her she's damaged goods. She has no business telling people how to run their lives.

As he's getting ready for bed, Pete asks Violet if she has tricks to get a 14 year old to talk. Violet says even adults can be reluctant to talk about stuff, because talking about it makes it real. Pete says he's always been an open book. Violet decides to open up. She wants to tell him about being raped in college, but he says he's always suspected it happened to her. They've been through so much and he's seen her react. Violet asks why he didn't say anything. He figured she'd talk about when she was ready. Violet says she's probably wrong, but she asks Pete if Charlotte was raped. He admits that he thinks she's right.

Cooper gets in bed with Charlotte. He wants to cuddle, but she tells him not to. He asks her what he can do. She tells him to lie really close to her without touching her. He does so.

Addison's scrubbing in as Sheldon enters the scrub room. He wishes her luck and tells her that Nick and Rachel are special. His parents got divorced when he was a teenager. He talks to his mother every week, but he's barely talked to his surgeon father after he washed out of his ER rotation. Addison enters the OR.

Pete, Cooper, and Diego are in Elisa's room with a judge. Diego says he's seen a shaman heal people. The judge asks Elisa what she wants. She replies what his father wants. Cooper says that Elisa's mother would have wanted the chemo. Pete tells the judge that he's seen the shaman work. Cooper insists on chemo. The judge says she needs to take the religious beliefs into account. Cooper wonders what kind of father stands by as their child dies. Elisa tells him to stop it. If she has more chemo, her family won't make it. Her treatment's bankrupted them. She's heard her father begging people on the phone to keep the power on. She sees him skipping meals so his children can eat. Elisa says the shaman won't save her. She doesn't share his beliefs. She's not afraid. The shaman can take her to her mother. The judge says they all know what needs to be done.

Violet enters Sheldon's office and asks him if he thinks she doesn't know what's true anymore because she was attacked. Sheldon thinks working through that experience made her a better therapist. Violet says Sam asked her to talk to Charlotte and the way he said it made her project her own stuff on Charlotte. He asks what stuff. Violet wishes Sheldon had been there that night so they could compare notes. Sheldon says he was busy with a rapist. He derives from Violet's face that she suspects Charlotte was raped.

Elisa's all set for her chemo, but a shaman is present for the healing ritual as well. Pete enters the room as Charlotte joins Cooper in the hallway. He thanks her for bending the rules for this. He knows he should leave her alone, but he can't do that. He knows her. As they watch the ritual, he takes her hand.

Charlotte enters her office at the hospital. She sits down and starts her computer as she lets it all sink in.

Addison and Sheldon enter Rachel's room with bad news. The tumor was bigger than imaging showed, and Addison couldn't resect it all. Rachel asks how long she has. Addison says not as long as she wants. There are testosterone blocking agents they could try, but they aren't very effective. Rachel asks if there's nothing she can do. Sheldon says she can move to hospice care, where there are people who know how to manage her anger and keep her safe. Nick gets angry and says they can manage at home. Rachel says that's not true. She's dying. Nick says he wants whatever time they have left together. He doesn't care what she does to him. She does. He says the hospice people don't know how to take care of her. Rachel says he can tell them how when he comes to visit her. Sheldon will find a place where she can go. Rachel tells Nick it's the right thing, and he knows it. For once, she wants to take care of him.

Violet enters Charlotte's office. She says it was an Indian summer in her junior year. She'd left the window open because it was the only way she'd cool down enough to fall asleep. When she first felt his breath on her, she thought there was finally a breeze. She then opened her eyes. He wrapped a hand around his throat and used the other to rip off her panties. He whispered "shh, shh, shh." He told her not to make a sound. When he finished, he slammed her head against the wall until her hair was sticky with blood. She thought that if she stayed quiet, she'd be okay. Things like that don't happen to people like them. She just wanted Charlotte to know that she gets it. She's here for Charlotte. She leaves. Charlotte then wipes everything off her desk and continues to ravage her office as she screams and cries.

Sheldon visists Detective Price at the police station. He says he thinks he knows whom Lee McHenry raped.

Addison retrieves the Jane Doe bag from the lab fridge with Sam by her side. She then makes the call to have the pelvic washings processed.

Charlotte goes to Amelia's office. Amelia notices how distraught she is. Charlotte asks if Amelia will go to a meeting with her. Amelia replies she's right behind her. She grabs her stuff and follows Charlotte.

CastEdit

  • Addison Montgomery
  • Pete Wilder
  • Cooper Freedman
  • Charlotte King
  • Sheldon Wallace
  • Amelia Shepherd
  • Sam Bennett
  • Violet Turner
  • Nick
  • Diego
  • Rachel
  • Joe Price
  • Elisa
  • Judge Hansen
  • Nurse (right)
  • Carlos (right)
  • Shaman (right)

Main CastEdit

Guest StarsEdit

Co-StarringEdit

Medical NotesEdit

ElisaEdit

  • Diagnosis:
    • Lymphoma
    • Tumor
  • Treatment:
    • Chemotherapy
    • Surgery

Elisa, 14, came into the ER with fluid build-up around her heart. Pete removed the fluid to relieve the pressure. Her father was afraid her cancer was back and Cooper said he believed the lymphoma tissue had invaded the pericardium. Her father said chemo was hard on the last two times and he had lost faith in western medicine. He wanted to take her to a shaman instead. During the ceremony with the shaman, Elisa had trouble breathing. Pete couldn't feel a pulse, so he and Cooper started CPR and called an ambulance. She was in hypotensive shock and was taken into surgery when she got to the hospital to put a hole into the sac around her heart to drain the fluid. Her father wanted to continue with the shaman, but Cooper said he would go to a judge and get him to order Elisa's chemo. Pete said he wouldn't help Elisa by tearing her family apart. Elisa talked to Pete after she woke up and he asked her if she believes that a shaman will heal her. She just said she didn't want chemo. She later admitted that she didn't believe the shaman would heal her, but she didn't want any more chemo because she'd watch her treatment bankrupt her family. The judge ordered the chemo.

Charlotte KingEdit

  • Diagnosis:
  • Treatment:
    • Bandage

Addison told Charlotte she needed another pelvic exam to check on healing and continued HIV meds. Charlotte insisted she could handle it all herself. Pete later examined Charlotte to check on her healing. He changed the bandage on her back. Addison admitted to Sam that she had collected a rape kit and called to turn it over to the police.

RachelEdit

  • Diagnosis:
    • Diabetes
    • Breast cancer
    • Kidney problems
    • Metastatic tumor
  • Treatment:
    • Medication
    • Surgery
    • Hospice care

Rachel had diabetes and had also survived breast cancer. She was also being treated for kidney problems caused by that. Addison ran some tests which revealed high levels of testosterone, which she said could be caused by metastatic breast cancer. Addison said it could be the cause of her rages. Addison said the only way to confirm and treat would be to go in and look around. Rachel decided she wanted to do that and Addison would have to remove the tumor in stages. In surgery, Addison wasn't able to resect the whole tumor and had to tell Rachel that she'd die. She decided to enter hospice treatment so that her husband wouldn't have to deal with her continued rages.

Rachel and NickEdit

  • Diagnosis:
  • Treatment:
    • Marriage counseling

Rachel and Nick came to talk to Sheldon. Rachel had multiple health issues and she was worried the stress of it would make Nick resent her. Sheldon asked what he does to relieve the stress. They admitted that they fight and then Sheldon witnessed Rachel hitting Nick multiple times. Sheldon advised Nick to come forward about the abuse, but he said it doesn't happen often and he'd deny it if the police asked him about it.

MusicEdit

Song Performer Scene
"Stumble on the Line" Andy Zipf
"The Moon is Down" Radical Face
"Watermark" Sleeping at Last

Notes and TriviaEdit

Private Practice 4x08 Promo00:31

Private Practice 4x08 Promo

  • This episode scored 8.21 million viewers.

GalleryEdit

Episode StillsEdit

QuotesEdit

(Charlotte walks into Amelia's office, crying. Amelia stands up from her chair, worried about Charlotte)
Amelia: Charlotte, what happened?
Charlotte: Would you go to a meeting with me?
Amelia: Right behind you.
(They leave the office.)

See AlsoEdit

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

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