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You Don't Know What You've Got Till It's Gone

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You Don't Know What You've Got Till It's Gone is the fourth episode of the sixth season and the 102nd overall episode of Private Practice.

Short SummaryEdit

Sheldon fears the worst when a little girl goes missing from the ER. Addison and Jake have a disagreement about one of his patients and a new doctor joins the team at Saint Ambrose. Meanwhile, Stephanie questions Sam about his past with Addison.

Full SummaryEdit

Charlotte is sitting behind her desk. She looks hot. She throws up in the trash can and rinses her mouth afterwards. She opens the door with the trash can in her hand, running into Dr. Peterson, who's here to see her for a job interview. She empties the trash can and invites him in. He says she can call him James. She says it feels warm in here. He asks if she's okay. She says yes, but she's dealing with a situation. She hears a touch of south in him. She's gonna be honest. She wants him for the job. She knows he's a hotshot and that he probably doesn't want the job because St. Ambrose is a relatively sleepy ER in Santa Monica, but he's young and she will allow him to run the department eventually rather than stand in the back behind other hotshots with decades more experience than him. She needs to throw up again and wonders where her trash can is. He says it's outside. She goes to get it as James smiles.

Addison comes downstairs. Jake, who's reading on the couch, is surprised that Henry's fallen asleep already as it's only dinner time. Addison comes closer and says it could be something else time. They kiss as Addison thinks she hears rain, which means mudslides and car crashes and everyone's water breaking at the same time. Jake insists it's not raining as it doesn't rain in L.A. this time of year. As he says that, there's thunder and lightning. Addison sighs. Then her cellphone rings. It's the ER. Seconds later, his phone rings too. Jake says he'll call the nanny.

James is running to the ER through the rain. A car drives by and stops. A highly pregnant woman gets out of the car from behind the wheel and yells for someone to come help them. James asks her if she's okay. She replies it's not her, it's about her husband, who can't move his legs. James asks a nurse for a gurney and a collar. He introduces himself to the husband, who thinks it's nothing. The woman yells not to mind her, she'll just push the kid out at the gas station. 

James wheels in the woman, followed by nurses wheeling in her husband. He asks for two adjoining beds at the desk. Charlotte tells the nurse James is their new ER doc. Charlotte says he has no idea how happy she is to have him here. A pale man walks up and says he's supposed to meet his doctor, right after which he collapses. James catches him and puts him in a wheelchair. James recalls Charlotte said this was a sleepy ER. Charlotte says it's an exceptional night due to the rain. She then throws up all over his shoes. She apologizes and welcomes him to St. Ambrose.

Cooper and Mason are playing a game. Mason is winning as Cooper gets a text about a patient at the hospital. He says Mason's gonna have to continue playing with the sitter, but Mason says he doesn't need one. Cooper doesn't agree.

Sam and Stephanie are making out in a closet. Sam is really nervous, never having done this before. She finds that hard to believe. He likes his bed better. Stephanie says it's all they got since her break is over in 15 minutes, so she suggests he shut her up. She turns off the light. 

James is treating Sarah Nelson. Her father Ron says he was packing her bags upstairs as it was Sarah's weekend with him. He had no idea she was practicing high jumps off the basement chairs. Sarah says she's gonna be at the Olympics. Cooper comes in and sees Sarah, knowing it's the Olympics thing again. He introduces himself to James. James says what tests he's going to order and Cooper seems to disagree. He asks James to have a word outside.

Cooper says they don't need a skeleton series because Cooper has treated Sarah since she was born. James says he's not objective then. Seeing the many injuries on the short period of time, James is thinking about abuse. Cooper says he'd know that. James insists there's a protocol for a reason, so he has to contact DCFS if he has any suspicion. Cooper apologizes and says he probably overreacted because he's too attached. Cooper then suggests he make the call because he can expedite it. James would appreciate that as they could use the bed.

Violet has just put Lucas to sleep in her bed. Clara, the nanny, appears in the doorway and suggests it's time to put Lucas back into his own bed, because this makes it impossible for her to make Lucas fall asleep in his own bed. Clara thinks Lucas need structure now more than ever. Violet says it's psychologically debatable what Lucas needs. Violet says her opinion is noted though, and she'll consider it. Outside, there's lightning as Violet wishes Clara a good night. Violet gets a call from the hospital and she calls Clara back to the room. Violet apologizes for taking a tone with her, especially since she's been around way more since Pete died. Clara interrupts her, already knowing she got paged back to work.

Addison tells Pam that she's only at 4 centimeters. James comes in and tells Todd that his X-rays look fine. Todd shows James he can move his legs again. Addison welcomes James and informs him about Todd's sympathetic symptoms each time Pam is pregnant. They list what happened to him during the first pregnancies. James asks if all the symptoms stopped as soon as the baby came, which Pam confirms. James says he would still like to get a neuro consult.

Charlotte finds Mason at the nurses station. James asks her if he's her son. She confirms. Mason says the babysitter got rear-ended, as no one in Los Angeles can drive in the rain. Amelia comes over and start walking.

She says she would like to make an appointment with Todd later this week. James says he noticed Todd has symmetrical increase of his reflex. Amelia says that's nondiagnostic and repeats she wants to see Todd later his week at her office. Amelia tells him to send Todd home as she walks off. James then asks a nurse to get a CT of Todd's cervical spine anyway. "It's game time, baby," James says.

Sheldon, all dressed up in a tuxedo, runs into the ER. He introduces himself to James, who paged him about Nick Calhoun, a patient of his. Sheldon asks if he attempted suicide because Nick has a history of depression, but James says it's just an adverse reaction to new meds. James gives him the chart and leaves Sheldon with Nick. Nick tells Sheldon he's feeling better now, but he's worried he has to stop the treatment. Sheldon says an adverse reaction is common, adjusting the dose may solve it. Nick is relieved, because he feels like the treatment's working. Sheldon asks about his sexual urges and thoughts of children. Nick says they're happening less and he feels like he's getting more control over them. He's hoping he might end up normal. Sheldon says it's all about progress, which he definitely is making.

Pam is panting and wonders why this is more painful than the other three deliveries she did. Addison says every pregnancy is different. Stephanie comes in and introduces herself as Pam's nurse. Addison warns her not to inform the parents about the baby's sex. Stephanie asks them how long they been together. Pam replies 15 years and asks Addison how long it's been with her and Dr. Bennett. Addison says she's seeing someone else now, and so is Sam. Stephanie is visibly surprised about the fact that Addison dated Sam. Pam feels embarrassed, but Stephanie says it's fine. Pam demands Todd's hand to squeeze as she feels another contraction coming.

Jake apologizes to Megan because it took so long to get her a bed. She derives from his facial expression that it happened again. Jake apologizes and confirms she lost the baby. Megan sighs. She made it to twelve weeks, so she told people. Jake informs her the miscarriage was incomplete, so he's going to have to perform a D&C once an OR opens up. Megan says her husband is out of town and asks when they can try again. Jake says it's best to do this one step at a time.

Violet is in the ER and asks James for Sarah Nelson. James thinks she's from DCFS, but Violet says she's a psychiatrist. Cooper comes over and guides her to Sarah's bed. James says they had an agreement to call DCFS, but Cooper says he only agreed to making a call and he thinks Violet is more than qualified to evaluate Sarah. They start arguing about the protocol, so Charlotte comes over to see what's going on. Charlotte sides with Cooper, as DCFS could take hours and they're slammed. Ron Nelson wonders why his daughter needs a psychiatrist as Sarah's mother comes running in. She goes to comfort her daughter. Sarah wonders why everyone is so mad. Dana asks if she can take her daughter home after the cast is done. Ron reminds her Sarah is with him this weekend, but Dana doesn't want to let Sarah stay with him anymore. She's going to sue him for sole custody. Sarah get upset from the arguing. James throws the parents out.

Violet sits down with Sarah and apologizes for all the yelling earlier. Violet says Sarah loves her daddy very much. And her mommy too, Sarah says. Sarah says they yell a lot though. Violet asks if they yell at her sometimes. Her mother did once when she colored on the wall and her father always says it makes him worry when she hurts herself. Violet concludes they yell at each other most of the time, to which Sarah agrees. Sarah says it's been like that since her dad was bad and her mother won't forgive him. Violet asks how she feels when they fight. Sarah says it makes her want to run away.

Charlotte compliments Sheldon's suit as James tells him it's time to send Nick home. Sheldon says he would like to observe him a bit more, but the waiting room is full so James says they need the bed. He knows what's wrong with Nick and says that another couple of hours won't make any difference. James doesn't believe Nick can be healed, which upsets Sheldon. Nick hasn't done anything yet, but James is sure it will happen eventually. He says he wants the bed cleared for someone who matters.

Violet tells Dana and Ron that Sarah is okay, but in order to finish her evaluation, she needs to talk to the two of them. Dana says it's all Ron's fault and they start arguing about what went wrong in their marriage. Sarah gets out of the bed and yells at them to stop it. Dana apologizes and gets her back into bed. Ron says Violet can start with him.

Cooper finds Mason standing in the hallway, holding a stethoscope against a wall. He read a creepy story about people getting buried alive in walls, so he's listening if anyone's in there. Cooper says it's too busy here for that without anyone noticing. Mason overheard that Dana wants sole custody over Sarah and he wonders what would happen if Cooper and Charlotte ever were to split up. He loves Charlotte too and he wonders about the babies. Cooper tells him he and Charlotte have made it through so much together, and they came out even stronger and more in love. That means they're a badass family unit. Nothing's gonna change that. Mason smiles and Cooper takes him somewhere.

Addison wants to talk to Stephanie, but she has already prepared everything for the delivery. Addison says she's terrific. Stephanie is happy to hear that. Addison brings up the Sam thing, but Stephanie understands that everyone has a past. Addison stresses that it's in the past and she thinks it would be nice to go back to being just friends, which they have been for 20 years. Stephanie didn't realize they knew each other for that long, which doesn't really seem to please her. Addison says she's happy that things won't be awkward, since they're going to see each other a lot. Stephanie says she loves being on Addison's rotation, but Addison meant because she's dating her next-door neighbor. Another fact Stephanie wasn't aware of. Addison asks what Sam did tell Stephanie about her. Stephanie says absolutely nothing. 

Ron says he screwed up in the most pedestrian way. He screwed his assistant. His second mistake was telling Dana, who threw him out. They haven't tried counseling. Violet says anger is difficult to work through. Ron was hoping to shield Sarah, but Violet says they're not doing that at all. They're fighting right in front of her. Ron says he's fighting for Sarah, because it seems like Dana is trying to keep Sarah away from him on purpose. Sarah is the best thing he will ever do with his life. He would never hurt his child.

Sam and Addison meet in the cafetaria. Addison tells she accidentally made Stephanie be mad at him. Addison apologizes, because she didn't think she told Stephanie anything she didn't already know. Sam sighs and walks out as Jake comes in. Addison asks about Megan. They talk about the case and Addison thinks it may be time for Megan to stop trying. Addison knows from experience how hard it is to know when to stop trying, which is why women need guidance from their doctor. Jake says he doesn't condescend to his patients as he thinks they're smart enough to make wise decisions themselves. Addison says it's hard to do that when all you see is a future with a baby. Jake says Megan will just go to another doctor. Addison says to let her, because then at least he's not part of the problem. She thinks he's giving Megan false hope because he either doesn't like to say no or because he likes winning too much. She says there's a tipping point. Jake reminds her she thought his judgment was fine when she was his patient. Addison says she made the decision to stop on her own, because she's a doctor and she knows when it's going too far. She questions if he knows that too. Jake is hurt and says he's going to see if an OR's opened up.

Dana gets off an elevator carrying ice cream. Violet sees her and asks her to sit down together. Dana and Ron start fighting again about their marriage. Violet stops them and says this right here is what's destroying their daughter. Their fighting is going to make her into the kind of person who's gonna sit on a therapist's couch in 10 years, wondering why she can't form any adult relationship. When they fight in front of or over her, they make her feel like it's wrong to love both parents equally, which is as damaging psychologically as throwing punches. If they want to get a divorce, fine, but they should stop fighting. Dana goes to bring Sarah her ice cream.

They go to Sarah's bed, only to find Cooper charting in it. He asks them where Sarah is. The X-rays are back and the cast's been placed, he's been waiting to get her discharged. Ron notices her rain coat is gone. Dana says she wasn't gone for too long and the nurses were all around. They start calling Sarah's name. Dana starts looking around the ER, drawing everyone's attention. Charlotte calls for security and calls a code pink.

The ER is crowded. Charlotte is talking to the desk nurse, who hasn't seen Sarah because of the great influx of patients. Charlotte tells Dana and Ron that the hospital's on lockdown, allowing security to search every inch of every floor. No one can leave the hospital without being checked. The video footage from the security cameras is being checked already. Meanwhile, James gets Todd's CT back and asks Charlotte for directions to the ORs.

James walks into Amelia's OR with Todd's scans. He asks her to look at them. She does so and asks another doctor to close up the patient before walking out.

Pam is mad and tells Todd they're never having sex again, all the while he tries to calm her down. Addison comes in and informs her that the baby's not getting enough oxygen, so they need to perform a C-section right away. They need to do it right here, since all the ORs are full. Amelia and James come in and Amelia says his symptoms were more than anxiety alone. He has an infection next to his spinal cord. They take him to surgery right away.

Sheldon notices the activity in the ER and asks Charlotte what's going on. She tells him a little girl's missing. Sheldon immediately walks up to Nick's bed, but Nick's just sitting there. He claims he wanted to check up on him. Nick asks if he can go home. Sheldon says yes. Nick signs the discharge papers and asks if they can't find the little girl. He heard about it. Sheldon says no. It's clear that Nick knows Sheldon suspected him, so Sheldon apologizes about that. He was just worried, but that doesn't mean the meds aren't working. Nick gets it. He would've thought it was him, too. Nick walks out.

Addison tells Pam to hang in there. Pam is worried about her husband. Her blood pressure drops to 70, but Stephanie knows how to handle that without all too much help from Addison. Jake comes over and offers to help, which Addison accepts as there's been a uteran artery laceration. Jake's going to hand-tie the vessel while Addison takes care of the baby. Pam's pressure goes back up after Jake's done and she regains consciousness. She asks about the baby, whom Addison is trying to get to breathe. The baby girl eventually does and they all smile in relief. Pam is emotional to finally have a girl. A curtain is pulled aside and Megan is standing there, watching. Upon the seeing Pam's joy, she starts crying. Jake hugs her to comfort her and takes her back to her bed.

Mason wakes up in a lounge in the hospital. Cooper hugs him tightly. Mason figures something happened. Cooper says his patient is missing from the ER. Mason offers to help look for her. He says they can go look together. 

Sam runs into Stephanie, but she walks past him, saying she's busy. He asks her to hold up so he can explain himself. She tells him to give it his best shot, but he doesn't say anything. She tells him to save it and walks off.

Addison thanks Jake for his help and asks how many times he's gonna let Megan go through this, because she saw how devestated Megan was and every time they try, it'll get worse. Jake says he knows Megan and her husband, they moved here because he was the only doctor willing to give it a try. Addison says some women just can't get pregnant. Not if you give up on them, Jake says. Addison says she doesn't give up on her patients, but this is insane because he's playing the odds way too far in favor of doing more damage than good, and Megan is the one who will suffer from that. Jake shuts her up, saying he's one of the best in what he does. He didn't ask for her opinion and he doesn't want it.

Violet finishes up talking to Ron and Dana. She goes to Cooper and says she gave Dana a sedative. Cooper wants to put a GPS on Mason. Violet understands. She already called the nanny three times to check on Lucas. They see James bringing Ron and Dana some coffee. Cooper calls him a douche. Violet says he's just doing his job. Cooper thinks Pete did it better. Violet says she's the one who told Charlotte to hire a new ER attending as James rushes to the new patient that's brought in. Now, seeing James right in front of her, it's difficult.

Amelia asks Charlotte about Sarah. Charlotte says they're still looking. She heard Amelia made a pretty slick diagnosis, the epidural abscess with progressing neurological symptoms. James told her that if she had caught it an hour later, Todd would've never walked again. A detective interrupts the conversation as he needs to talk to Charlotte.

Ron is pacing in the ER as Violet is talking to Dana. He thinks it's good that it's stopped raining, because he thinks she might've gotten scared of the thunder and just hid. Charlotte and the detective approach. They found Sarah's raincoat on a bench out front. Charlotte says it means Sarah's no longer at the hospital. The case has been turned over to the police. As of now, Sarah is a missing person. Ron breaks down and Dana comforts him.

James sits down with Charlotte at the nurses station. He says it was one hell of a night. Charlotte says he did good, but he thinks he pissed off some people. Charlotte says the doctor he replaced pissed off people too, but she never held that against him. James can't stop thinking about Sarah and her parents. He guesses Charlotte's thirteen to fourteen weeks along. Charlotte asks how he knows that. He says he's a really good doctor, and she gagged on his shoes.

Sam finds Stephanie, who says she's not the jealous type. She's really not, but she doesn't like being played. Sam says he's not doing that. She lists all the things she found out today. He didn't think it would matter because it's over. She asks how recently. He says four months. She asks why it ended. He hesitates, and then replies she turned him down when he proposed. Stephanie seriously thought he was the one. She thought he was amazing after their first date, thinking he was the man of her dreams. But he's on the rebound and he has a lot of bagage and he's just mess, she says. And because he's a heart surgeon with his looks and because he's a truly kind man with a wonderful spirit, every woman who meets him feels like she did after their first date. She can't believe she let it happen to herself as well. Sam says he didn't mean that to happen, but she says no one ever does. He says he really does like her. They agree she's fantastic. She says bye and walks out.

Megan wakes up after surgery with Jake by her side. He says it all went fine. She asks if they found the girl. Jake has to say no. Megan feels for the parents. Jake says there are other ways to give her a child to share her life with. He thinks it's time they talked about other options.

Addison takes the baby to Todd's bed. He's amazed as well that they have a girl. Addison tells him Pam is fine, she's sleeping it off. Todd can't hold her yet, but Addison suggests he settles for a kiss. So he does.

As Addison is bringing the baby back to the nursery, Jake comes over and asks if she's going home. She can't believe that that's how he's apologizing. He says he's not, because he has nothing to apologize for. He says it won't be the last time they disagree. She says they're still fighting. He says he's not opposed to angry sex.

In the parking lot, Amelia tells James it was a good catch. He thanks her. She appreciates him giving her the credit, but she would prefer if he didn't do that anymore in the future. She stands by the call she made at the time, given the information she had. She respects his instincts, but she'll take her own credit. He says he need a couple of drinks. She says she knows that feeling. He says he was hoping to buy her drinks, given the inappropriate kindness he showed her earlier, which won't happen again. She says she doesn't drink and asks if he's ever seen an anencephalic baby. She reveals she give birth to one not too long ago. She held him for a couple of minutes and then she donated his organs. She took him out of her arms and took him apart. So, if she would let herself drink, she would never stop. She knows he's asking her out because he thinks they're about the same age and they could have fun. She might've made the same mistake if she were him, but they're not the same age. She's about 100 years older than she looks. She tells him to enjoy his drinks and gets in his car.

Dana and Ron are still sitting in the waiting area of the ER. After some time, Violet goes to ask them if they need a ride home. Dana says they can't go home. Violet says the hospital's been searched and the police has taken statements. There's nothing more for them to do here. Ron wonders what happens if Sarah comes back here and they're not there. Violet tells them Sarah is not gonna come back here. Dana and Ron comfort each other.

CastEdit

  • Addison Montgomery
  • Jake Reilly
  • Cooper Freedman
  • Charlotte King
  • Sheldon Wallace
  • Amelia Shepherd
  • Mason Warner
  • Sam Bennett
  • Violet Turner
  • James Peterson
  • Pam Reiter
  • Nick Calhoun
  • Stephanie Kemp
  • Megan Stewart
  • Ron Nelson
  • Dana Nelson
  • Todd Reiter
  • Clara
  • Triage Nurse Karen
  • Security Guard
  • Sarah Nelson
  • Lucas Wilder

Main CastEdit

Guest StarsEdit

Co-StarringEdit

Medical NotesEdit

Todd ReiterEdit

  • Diagnosis:
    • Transient weakness
    • Epidural abscess
  • Treatment:
    • Surgery

Todd couldn't move his legs, so his pregnant wife drove them both to the hospital. She said it was all in his head because he'd experienced symptoms like that with all her previous pregnancies. His x-ray was clear and he was able to move his legs again. But James called Amelia for a consult. She tried to delay the consult, but James ordered a CT. The CT revealed an infection by his spinal cord and they rushed him to surgery. The surgery was successful and Todd was awake and stable afterward.

Pam ReiterEdit

  • Diagnosis:
    • Pregnancy
    • Uterine artery laceration
  • Treatment:
    • C-section delivery

Pam came into the ER in labor. Addison examined her and said they'd move her up to L&D as soon as they could. When she had trouble, Addison said she needed a c-section, which she had to perform down in the ER because all the ORs were full. A uterine artery was lacerated during the c-section, but Jake was able to stop the bleeding and both Pam and the baby were healthy.

Nick CalhounEdit

  • Diagnosis:
    • Pedophilia
    • Depression
    • Dehydration
  • Treatment:
    • Anti-depressants

Nick came to the ER to meet up with Sheldon, but he passed out just inside the door. He had an adverse reaction to one of his meds. He worried that he'd have to stop taking his meds, which he felt were working, but Sheldon said it's common to have reactions and it's often just about adjusting the dose. Sheldon adjusted the meds and wanted to keep Nick for observation, but James said he couldn't be helped and said they didn't have room and told Sheldon to discharge him. Sheldon discharged him and Nick left the hospital.

Sarah NelsonEdit

  • Diagnosis:
    • Colles' fracture
  • Treatment:
    • Casting

Sarah, 6, broke her wrist jumping down the stairs. Because she'd had three injuries in two months, James wanted to run a skeletal series in addition to the wrist x-ray. Cooper convinced him to let him call in Violet instead. Violet spoke to Sarah about her home life. Her biggest problem was that her parents were constantly fighting in front of her. Her wrist was casted and she was set to be discharged when she disappeared.

Megan StewartEdit

  • Diagnosis:
    • Miscarriage
  • Treatment:
    • D&C

Megan had had a miscarriage at 12 weeks. It was incomplete, so Jake said he'd have to do a D&C. Megan was more interested in when she could start trying again. Jake said they should talk about it later. He did the D&C and it went well. Then he suggested that they discuss other options for her to become a mom.

Dana NelsonEdit

  • Diagnosis:
  • Treatment:
    • Sedative

Dana was given a sedative in the ER after her daughter disappeared to calm her down.

MusicEdit

Song Performer Scene
"These Days" Dr. Dog
  • James smiles in Charlotte's office.
  • Jake and Addison want to make out, but a storm and calls from the ER make them change plans.
  • James helps a couple outside the ER.
  • The ER is really busy. Charlotte welcomes him.
"Breaking the Yearlings" Shearwater
  • Cooper assures Mason he and Charlotte won't break up.
  • Stephanie and Addison talk about Sam, revealing more things Sam didn't tell Stephanie.
  • Violet talks to Ron.
  • Addison tells Sam about her talk with Stephanie. She also thinks Jake's going too far with Megan.
"Hold Me Now" Lazlo Bane
  • Stephanie says goodbye to Sam.
  • Jake talks to Megan about other options.
  • Addison shows Todd his daughter.
  • Addison tells Jake they're still fighting.
  • James asks Amelia to have drinks, but she declines.
  • Violet tells Ron and Dana it's time to go home.

Notes and TriviaEdit

Private Practice 6x04 Promo "You Don't Know What You've Got Till It's Gone" HD00:30

Private Practice 6x04 Promo "You Don't Know What You've Got Till It's Gone" HD

  • This episode scored 4.58 million viewers.
  • This episode is focused on James Peterson, making it the only season 6 episode not to focus on a main character.
  • This is the first episode since his birth not to feature Henry Montgomery.

GalleryEdit

Episode StillsEdit

QuotesEdit

Addison: We're still fighting.
Jake: I'm not opposed to angry sex.

Cooper: We are badass. We are a badass family unit. You, me, the triplets and Charlotte. Nothing's going to change that.

Charlotte: Damn, Sheldon. You look like James Bond.
Sheldon: Which one? I was always partial to Sean Connery.

See AlsoEdit

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

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