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Meredith: There's this family in Italy
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who never slept.
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They suffered from a genetic disease
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that kept them awake for months,
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until their bodies just shut down.
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Even after all these years,
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scientists still
don't really know why we sleep.
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We just know we have to sleep.
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Because without it,
we make poor decisions,
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we say things we shouldn't.
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And sometimes we see things
that aren't there.
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Synced & corrected by -robtor-
www.addic7ed.com
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♪ ♪
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What do we got?
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Meredith: MVC with abdominal trauma,
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severely hypotensive since he arrived.
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FAST exam show a fluid
in the upper right quadrant,
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lots of it.
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It's gonna be a long night.
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Don't say that.
I haven't slept in 48 hours.
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Thought I saw you go home earlier.
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You did. I got off an 18-hour shift
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to go home to find Zola,
who is boycotting sleep,
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and Ellis, who had an earache.
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By the time I got the last one down,
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I got the call. Where were you?
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- Uh, four-hour lysis of adhesions.
- Ugh.
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Then a triple-A ruptured in the ICU.
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Pierce and I had to do
a balloon catheter bedside
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before we rush him to the O.R.
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- Oh, that sounds...
- Then a GSW to the abdomen
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that Edwards caught...
a duodenal repair.
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Wa... How long have you been here?
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What day is it?
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[Chuckles]
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Scalpel.
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How do you know when you're
too tired to operate?
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Right about when
you make your first mistake.
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I hate that answer.
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You don't. You just keep going.
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Don't love that one, either.
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♪ ♪
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Okay, um, Edwards,
grab a hemostat to lift.
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Dividing the fascia.
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[Monitor beeping rapidly]
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Okay, Edwards, get lap pads in here.
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Get in there.
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We got massive bleeding here.
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Okay, we're gonna need a bookwalter now.
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Edwards, I can't see a thing.
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I'm trying. Ohh!
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- Ho!
- Whoo!
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Wipe.
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- Got it, got it.
- Thank you.
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Okay, let's get more lap pads in there.
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Let's bring in another suction,
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and we're gonna need the cell saver.
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Richard: Good evening, surgeons.
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I heard we've got a good one.
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I'm here to give you
another set of hands.
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Yeah, we could use it
if you're available.
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[Chuckling] Available? I'm primed.
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I napped all afternoon,
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ate a balanced supper,
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and just had a cup of coffee.
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- Well, that's nice.
- Did you?
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All right, someone tell me
what we've got on our table tonight.
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A mess, sir.
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Stephanie: Uh, Grade IV liver lac,
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portal triad looks intact.
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We've just packed all four quadrants.
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Wow! That liver's...
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Destroyed. Like I said, a mess.
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Okay, hematoma's tracking into Zone 2.
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Edwards, let's right medial
visceral rotation.
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Got it. Medium clip, please.
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How many units has he had?
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We've gone through at least a dozen.
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He's bleeding out
everything we pour into him.
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- Clamp.
- Okay, keep suctioning.
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- Other lap.
- Retractor.
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Richard: Suction right there.
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I need two more clamps.
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You know, back in the day,
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I would always come
into the hospital overnight,
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even if I wasn't on call.
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That's when the most
interesting surgeries came in.
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Best learning opportunities, am I right?
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Yeah. Yes, sir. Bovie up.
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I'll never forget this case
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back when I was a second-year resident.
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It was about 3:00 in the morning,
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and I'd been on my feet
for about 42 hours.
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Owen: Right angle.
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This fella came into the E.R.
with terrible abdominal pains...
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claimed that an alien baby was inside,
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eating its way out.
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[Laughs weakly] That's funny.
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Uh, Dr. Grey, do you see this?
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This kidney's cracked in half.
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Exactly. It was his kidney.
102
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Well, a kidney stone.
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It was the size of a coconut.
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It was six hours in the O.R.
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Uh, this seems like
a Grade 4 injury to me.
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Any way we can salvage it?
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- No.
- Yes.
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If someone could clarify...
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Okay, it was the size of a dinosaur egg.
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It almost glowed.
111
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Actually, sir, I was talking about this.
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This liver is shredded.
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We don't have the time
or the blood volume
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to spend an hour fixing a kidney.
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We could better control
the extra blood loss
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if we fix the kidney.
117
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Well, there will be no blood loss
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if we just take the kidney out.
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I'm very happy to keep discussing it,
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but really I think
a final decision would be good.
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Take the kidney out.
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Richard: You know what, Grey?
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Le... Let's hold on for a minute, okay?
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The patient doesn't have a minute.
125
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Should I clamp the hilum?
126
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No, we're gonna do
a partial nephrectomy.
127
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That would be useless.
128
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- And why is that?
- What?
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Well, I wasn't asking for myself.
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I was asking for Edwards. Why is that?
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What does Edwards have to do with this?
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Well, she's our resident here.
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This is an excellent teaching case,
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and she'd benefit if you'd elaborate.
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It's fine, really.
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Richard, please...
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Now, look, you and Dr. Hunt
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are Chiefs of General
and Trauma Surgery.
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Yeah, and if we don't make a decision,
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we're gonna be here all night.
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I'm going to repair the kidney. Suture.
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- Hunt!
- All right, now, look, you two
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should want this resident
to learn from this patient.
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Owen, if you do this,
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Edwards is gonna learn from this patient
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when he's a cadaver in my lab.
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Dr. Webber, I'm sorry.
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You're tired.
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No, it's not... It's just...
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[Sighs]
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Fine. Let's do the partial.
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Good.
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Stephanie: Retractor.
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Edwards.
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Yes, sir?
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Tell me about the patient.
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Uh, okay.
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He came into the E.R. unconscious.
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No, no. Tell me his name.
160
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Well, he didn't have any I.D.,
so as of now he's John Doe.
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A car sped up the freeway,
ramped the wrong way,
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smashed into another car.
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One guys's in O.R. 5,
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and the other one's right here.
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So, do we have the reckless driver,
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or do we have the innocent victim?
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We don't know.
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So, we don't know
if this man had a family,
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we don't know if he was
running away from something,
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and we don't know if he was
the good guy or the bad guy.
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[Sighs] We know nothing.
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What do we need to know
in order to do our jobs
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and not simply be mechanics?
174
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[Sternly] How are we...
We're not being mechanics!
175
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You're treating this patient
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like a sack of organs on a table!
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Now, here's what we're gonna do.
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We're gonna play a game.
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And how is this
the best use of our energy?
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Now, here's how we start.
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This patient is no longer John Doe.
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Who is he, then?
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Basin.
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We make him someone.
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Anyone we want.
186
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What is he doing?
187
00:07:04,319 --> 00:07:05,252
He likes to teach.
188
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When he's pissed,
he really likes to teach.
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Surgicel, please.
190
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All right, first things first.
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We need a name. Who's got one?
192
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[Exhales sharply]
193
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Brandon.
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00:07:17,392 --> 00:07:18,799
- All right, Brandon.
- Mm-hmm.
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00:07:18,834 --> 00:07:19,934
Now, who is he?
196
00:07:19,968 --> 00:07:22,736
Uh, I think he's the guy in I.T.
who parks next to me.
197
00:07:34,483 --> 00:07:37,184
Okay, is he a good guy, someone we like?
198
00:07:37,219 --> 00:07:38,352
I don't know. We've never spoken.
199
00:07:38,386 --> 00:07:40,488
Okay, well, then pick someone else
200
00:07:40,522 --> 00:07:42,122
and make them someone good,
201
00:07:42,157 --> 00:07:44,158
and they don't have to be a male.
202
00:07:44,192 --> 00:07:45,526
All right.
203
00:07:45,560 --> 00:07:47,928
How about Joanie?
204
00:07:57,105 --> 00:07:58,264
Now, why Joanie?
205
00:07:59,007 --> 00:08:00,441
'Cause you didn't like Brandon.
206
00:08:04,746 --> 00:08:06,046
How about Gail?
207
00:08:08,049 --> 00:08:09,183
Gail's nice.
208
00:08:11,686 --> 00:08:12,987
Let's go with Gail.
209
00:08:19,094 --> 00:08:20,494
[Cello begins playing]
210
00:08:20,529 --> 00:08:23,163
She's 45... No.
211
00:08:23,198 --> 00:08:25,194
She's 46.
212
00:08:27,202 --> 00:08:29,703
What is it we like about Gail?
213
00:08:29,738 --> 00:08:31,205
And be specific.
214
00:08:31,239 --> 00:08:32,172
I mean, do not stop
215
00:08:32,207 --> 00:08:34,108
until you picture this woman
on the table,
216
00:08:34,142 --> 00:08:36,277
until you can truly see her.
217
00:08:36,311 --> 00:08:38,546
Do not stop until we can hear her voice
218
00:08:38,580 --> 00:08:40,214
and what she has to say.
219
00:08:44,986 --> 00:08:47,254
Well, this is going to be fun.
220
00:08:52,211 --> 00:08:53,811
So, who is Gail?
221
00:08:53,846 --> 00:08:56,314
Why do we like her?
222
00:08:56,348 --> 00:08:59,350
And why would we go to such
lengths to save her life?
223
00:08:59,385 --> 00:09:01,352
I'm sorry, shouldn't we want to save her
224
00:09:01,387 --> 00:09:02,954
even if we don't like her?
225
00:09:02,988 --> 00:09:05,156
Yes, but let's make it
easier on ourselves.
226
00:09:05,190 --> 00:09:08,960
I mean, we need to fill Gail in.
227
00:09:08,994 --> 00:09:10,128
I mean, really give her something
228
00:09:10,162 --> 00:09:12,063
that we can sink our teeth into.
229
00:09:13,032 --> 00:09:15,141
Does she have hobbies, or...?
230
00:09:16,235 --> 00:09:17,669
Or is she known for something?
231
00:09:17,703 --> 00:09:19,704
Right lobe is still bleeding.
232
00:09:19,738 --> 00:09:21,272
- Over here, too.
- Okay. Large clip.
233
00:09:22,741 --> 00:09:26,277
Well, what if Gail plays the cello?
234
00:09:27,079 --> 00:09:28,528
Edwards?
235
00:09:29,548 --> 00:09:31,382
Uh, sure.
236
00:09:31,417 --> 00:09:34,953
[Cello playing]
237
00:09:34,987 --> 00:09:37,622
Gail: My mother forced me to learn.
238
00:09:37,656 --> 00:09:39,157
Something about learning an instrument
239
00:09:39,191 --> 00:09:40,629
would helped instill discipline.
240
00:09:40,664 --> 00:09:43,194
♪ ♪
241
00:09:43,228 --> 00:09:44,896
- [Monitor beeping rapidly]
- Remove the top blades.
242
00:09:44,930 --> 00:09:46,798
- What are you doing?
- Remove them. Scissors.
243
00:09:46,832 --> 00:09:48,466
The pringle didn't make a dent
in the bleeding,
244
00:09:48,500 --> 00:09:50,168
so I'm gonna try and create
more exposure
245
00:09:50,202 --> 00:09:50,969
with a subcostal... 10 blade.
246
00:09:51,003 --> 00:09:52,403
Because that's what this guy needs
247
00:09:52,438 --> 00:09:53,871
is more incisions to bleed from.
248
00:09:53,906 --> 00:09:55,740
Okay, suction is blocked. Fix it now.
249
00:09:55,774 --> 00:09:56,641
Okay, uh, what else?
250
00:09:56,675 --> 00:09:58,710
Okay, we need to make Gail more real.
251
00:09:58,744 --> 00:10:00,044
Okay, she plays the cello.
252
00:10:00,079 --> 00:10:01,746
Someone answer him. I'm too exhausted.
253
00:10:01,780 --> 00:10:03,181
- Well, you started it.
- You're the one who was...
254
00:10:03,215 --> 00:10:04,115
Oh, my God.
255
00:10:04,149 --> 00:10:06,184
Dr. Webber,
I have a question about Gail.
256
00:10:06,218 --> 00:10:08,052
Okay, well, go ahead,
Edwards, and don't be shy.
257
00:10:08,087 --> 00:10:11,522
[Sighs] Uh, does Gail...
258
00:10:11,557 --> 00:10:13,491
have a dog?
259
00:10:14,960 --> 00:10:17,095
Excellent question, but no.
260
00:10:17,129 --> 00:10:19,731
Gail doesn't have time for a dog.
261
00:10:19,765 --> 00:10:22,166
She's got two... no, three young kids,
262
00:10:22,201 --> 00:10:24,168
so her house is already mayhem.
263
00:10:24,203 --> 00:10:25,103
Three boys?
264
00:10:25,137 --> 00:10:26,337
No, no.
265
00:10:26,698 --> 00:10:29,240
Two boys and a girl.
266
00:10:29,749 --> 00:10:31,109
That's nice, right?
267
00:10:31,143 --> 00:10:33,511
Gail: Hey, stop terrorizing your sister!
268
00:10:33,545 --> 00:10:34,746
Don't make me come over there!
269
00:10:34,780 --> 00:10:36,347
[Children argue in distance]
270
00:10:38,117 --> 00:10:42,397
Hey! You're the oldest, act like it.
271
00:10:43,489 --> 00:10:47,225
Boy, you roll your eyes again,
I'm gonna shut 'em for good.
272
00:10:47,259 --> 00:10:49,560
I imagine Gail's work keeps her sane.
273
00:10:49,595 --> 00:10:52,196
Does anyone have any idea
what she does for a living?
274
00:10:52,231 --> 00:10:55,600
Um, maybe... she's an engineer?
275
00:10:55,634 --> 00:10:59,871
Or something with research, politics.
276
00:10:59,905 --> 00:11:02,140
Maybe she's whatever
Dr. Webber says she is.
277
00:11:02,174 --> 00:11:04,409
Gail dreams of being Principal Cello
278
00:11:04,443 --> 00:11:06,403
for the Chicago Symphony.
279
00:11:07,112 --> 00:11:10,782
She practices relentlessly
every morning and night.
280
00:11:10,816 --> 00:11:12,250
But in between,
281
00:11:12,284 --> 00:11:14,118
she teaches music
to kids in the neighborhood,
282
00:11:14,153 --> 00:11:17,388
and she helps lead the local
high-school orchestra.
283
00:11:17,423 --> 00:11:19,957
♪ ♪
284
00:11:19,992 --> 00:11:22,894
Ugh, if you could just hear
this one student of mine
285
00:11:22,928 --> 00:11:25,763
play Bach's Sonata Number 1 in G Minor,
286
00:11:25,798 --> 00:11:27,331
Fuga Allegro.
287
00:11:27,366 --> 00:11:29,167
She learned it just like that.
288
00:11:29,201 --> 00:11:30,768
[Monitors beeping rapidly]
289
00:11:30,803 --> 00:11:32,070
Pressure's dropping.
290
00:11:32,104 --> 00:11:33,071
And it's gonna continue to drop.
291
00:11:33,105 --> 00:11:34,772
He's still bleeding
despite any move we make.
292
00:11:34,807 --> 00:11:36,741
We should just cut our losses and stop.
293
00:11:36,775 --> 00:11:37,642
Damage control?
294
00:11:37,676 --> 00:11:39,343
Trust me, we should just pack him up,
295
00:11:39,378 --> 00:11:41,345
and when he's stronger
we can come back in and finish.
296
00:11:41,380 --> 00:11:43,448
Owen: No, we're gonna concentrate
on the retrohepatic area.
297
00:11:43,482 --> 00:11:45,183
We're gonna try and repair
the vascular injuries
298
00:11:45,217 --> 00:11:46,784
that are in there first.
299
00:11:46,819 --> 00:11:47,785
I agree with Hunt.
300
00:11:47,820 --> 00:11:49,787
Well, how do you expect
to even see anything
301
00:11:49,822 --> 00:11:51,422
behind this liver to get a clamp in?
302
00:11:51,457 --> 00:11:53,324
Trust me, we close
and let the body heal.
303
00:11:53,358 --> 00:11:55,960
Somebody call up to ICU
and let them know we're coming.
304
00:11:55,994 --> 00:11:57,595
We should keep going in here,
305
00:11:57,629 --> 00:12:00,264
try and repair the damage, okay?
306
00:12:00,299 --> 00:12:01,432
At this point,
this patient wouldn't survive
307
00:12:01,467 --> 00:12:02,934
the elevator ride to the ICU.
308
00:12:02,968 --> 00:12:04,435
Look at this liver... At this point,
309
00:12:04,470 --> 00:12:06,270
this patient is not surviving anything!
310
00:12:06,305 --> 00:12:08,172
So you want to give up now?
311
00:12:08,207 --> 00:12:10,374
Leave Gail to die in a bed upstairs?
312
00:12:10,409 --> 00:12:12,110
Is it better if Gail dies on the table?
313
00:12:12,144 --> 00:12:14,612
Stephanie: It's better if Gail lives.
314
00:12:20,385 --> 00:12:21,853
What if we call UNOS?
315
00:12:21,887 --> 00:12:22,620
Wh... Really?
316
00:12:22,654 --> 00:12:23,988
Oh, wait. Can we really list him
317
00:12:24,022 --> 00:12:25,156
for an emergent liver transplant?
318
00:12:25,190 --> 00:12:26,457
- No!
- Why not?
319
00:12:26,492 --> 00:12:28,292
You know why not!
320
00:12:28,327 --> 00:12:30,228
He'll be dead before a liver
even gets here.
321
00:12:30,262 --> 00:12:31,963
And if he's not, he'd be too unstable,
322
00:12:31,997 --> 00:12:33,364
and he'd reject it immediately.
323
00:12:33,398 --> 00:12:34,665
It would be a waste.
324
00:12:34,700 --> 00:12:36,901
We'd be taking an organ from a stable,
325
00:12:36,935 --> 00:12:39,403
far better candidate
who could really use it.
326
00:12:39,438 --> 00:12:40,505
- Edwards.
- Hmm?
327
00:12:40,539 --> 00:12:41,472
Tell me the indications
328
00:12:41,507 --> 00:12:43,875
for an emergent
traumatic liver transplant.
329
00:12:43,909 --> 00:12:45,476
[Sighs] Acute hepatic failure,
330
00:12:45,511 --> 00:12:47,411
portal vein thrombosis,
uncontrollable hemorrhage.
331
00:12:47,446 --> 00:12:48,279
Exactly.
332
00:12:48,313 --> 00:12:49,914
And I don't remember many case studies
333
00:12:49,948 --> 00:12:51,249
of this procedure being successful.
334
00:12:51,283 --> 00:12:52,917
Which is why we're not doing it.
335
00:12:52,951 --> 00:12:54,652
Richard: I disagree with your decision.
336
00:12:54,686 --> 00:12:55,887
Well, I'm sorry, but...
337
00:12:55,921 --> 00:12:58,022
- But what?
- But he's not your patient!
338
00:12:58,056 --> 00:12:59,490
My hands are in his body.
339
00:12:59,525 --> 00:13:01,092
I would think that would make him
340
00:13:01,126 --> 00:13:02,894
as much my patient
as yours or Dr. Hunt's.
341
00:13:02,928 --> 00:13:04,695
But it's still my call.
342
00:13:04,730 --> 00:13:06,531
Look, we've got three attendings here,
343
00:13:06,565 --> 00:13:08,232
and a senior resident.
344
00:13:08,566 --> 00:13:10,334
We need to discuss the options.
345
00:13:10,369 --> 00:13:11,402
- No, we don't.
- Why not?
346
00:13:11,436 --> 00:13:13,871
Because you also have
the Chief of General Surgery
347
00:13:13,906 --> 00:13:16,774
in here, Dr. Webber, and I outrank you.
348
00:13:16,808 --> 00:13:19,010
[Cello music stops]
349
00:13:19,044 --> 00:13:20,244
[Monitor beeping steadily]
350
00:13:20,279 --> 00:13:21,779
[Sighs]
351
00:13:21,813 --> 00:13:23,314
Of course.
352
00:13:25,484 --> 00:13:27,285
And I'm saying no.
353
00:13:27,319 --> 00:13:29,453
We are not listing him for a transplant,
354
00:13:29,488 --> 00:13:31,422
and we're done talking about it.
355
00:13:31,456 --> 00:13:34,725
Do you think you can stop
this retrohepatic bleed?
356
00:13:34,760 --> 00:13:35,893
I can try.
357
00:13:35,928 --> 00:13:37,395
Okay, if it doesn't work,
358
00:13:37,429 --> 00:13:38,396
it's up to the ICU.
359
00:13:38,430 --> 00:13:40,698
If you're not on board,
feel free to leave.
360
00:13:40,732 --> 00:13:43,267
[Cello music resumes]
361
00:13:54,442 --> 00:13:56,767
Okay, medium clips. Another one.
362
00:13:57,487 --> 00:13:58,799
Another!
363
00:13:59,133 --> 00:14:01,101
I mean, this isn't working.
The clips aren't even holding.
364
00:14:01,135 --> 00:14:01,968
[Sighs]
365
00:14:02,003 --> 00:14:03,270
Stephanie: Sure hope it was worth it.
366
00:14:03,304 --> 00:14:04,671
What?
367
00:14:04,705 --> 00:14:05,805
Whatever this guy was doing
368
00:14:05,840 --> 00:14:07,974
that put him on the road
in the middle of the night.
369
00:14:08,009 --> 00:14:09,776
Richard: Well, maybe
she didn't have a choice.
370
00:14:09,810 --> 00:14:11,478
"She"?
371
00:14:11,512 --> 00:14:13,013
Oh, Gail. We're still playing.
372
00:14:13,047 --> 00:14:14,447
Maybe money becomes tight,
373
00:14:14,482 --> 00:14:16,750
she picks up extra work at night.
374
00:14:16,784 --> 00:14:18,752
Gail: Their father left for the war,
375
00:14:18,786 --> 00:14:21,288
and I couldn't say no
when the boys wanted to go
376
00:14:21,322 --> 00:14:23,423
to a science camp at the museum.
377
00:14:23,457 --> 00:14:25,292
Or, uh, she takes her shift
in the evening
378
00:14:25,326 --> 00:14:28,161
at a reception desk at a nearby hotel.
379
00:14:28,195 --> 00:14:30,452
It... It isn't all night,
but it's late enough.
380
00:14:30,486 --> 00:14:31,619
How much longer?
381
00:14:31,653 --> 00:14:33,199
[Sighs] I need
a little more visualization.
382
00:14:33,234 --> 00:14:35,368
Mobilize the liver
more anteriorly, please.
383
00:14:35,403 --> 00:14:36,685
Yeah, on it.
384
00:14:37,672 --> 00:14:39,372
You know, this isn't working.
385
00:14:39,407 --> 00:14:40,774
Just give me a minute.
386
00:14:41,642 --> 00:14:42,943
Hold on.
387
00:14:42,977 --> 00:14:44,477
- Why don't you take your turn?
- Excuse me?
388
00:14:44,512 --> 00:14:46,947
Try the game. I mean,
turn John Doe into someone.
389
00:14:46,981 --> 00:14:47,814
[Chuckles]
390
00:14:47,848 --> 00:14:50,116
I-I-I'm not good at making people up.
391
00:14:50,151 --> 00:14:51,551
Richard: I'm sure
you can think of someone.
392
00:14:51,585 --> 00:14:52,385
Richard, I don't need to.
393
00:14:52,420 --> 00:14:54,054
I operated on hundreds of John Does
394
00:14:54,088 --> 00:14:55,455
when I was in the army,
and I did just fine.
395
00:14:55,489 --> 00:14:56,156
Malleable.
396
00:14:56,190 --> 00:14:57,624
Megan: Load of crap.
397
00:14:57,658 --> 00:15:00,327
I call load of crap...
giant load of crap.
398
00:15:00,361 --> 00:15:01,194
On what?
399
00:15:01,228 --> 00:15:02,963
Whenever we had a John Doe on the table,
400
00:15:02,997 --> 00:15:04,497
the first thing you would do
is yell at someone
401
00:15:04,532 --> 00:15:05,665
to go find the patient's tags.
402
00:15:05,700 --> 00:15:07,734
Maybe 'cause I didn't want
to have to do all the paperwork.
403
00:15:07,768 --> 00:15:08,868
Uh-huh.
404
00:15:08,903 --> 00:15:10,003
Where the hell is that rummel?
405
00:15:10,037 --> 00:15:11,237
Maybe ask for it nicely
406
00:15:11,272 --> 00:15:13,039
and someone will bring it to you.
407
00:15:13,074 --> 00:15:15,642
I already did, and I shouldn't
have to ask twice.
408
00:15:15,676 --> 00:15:16,643
Dad would say that.
409
00:15:16,677 --> 00:15:18,545
Oh, God! You turned into Dad!
410
00:15:18,579 --> 00:15:20,246
[Chuckling] That is a thing
anyone would say.
411
00:15:20,281 --> 00:15:22,682
You've got his nose and his chin
412
00:15:22,717 --> 00:15:24,250
and his unreasonably high expectations
413
00:15:24,285 --> 00:15:25,845
- of everyone around you...
- You know what?
414
00:15:25,879 --> 00:15:27,687
...that no one
could possibly live up to.
415
00:15:27,722 --> 00:15:30,190
But not his beard... His beard was good.
416
00:15:30,224 --> 00:15:31,992
Yours is just sad.
417
00:15:32,026 --> 00:15:33,059
My beard is fine.
418
00:15:33,094 --> 00:15:33,893
Actually, I shaved this morn...
419
00:15:33,928 --> 00:15:35,562
Why am I even explaining this to you?
420
00:15:35,596 --> 00:15:37,197
Feel free to stop.
421
00:15:37,231 --> 00:15:38,031
[Exhales sharply]
422
00:15:38,065 --> 00:15:39,766
I need that rummel tourniquet now!
423
00:15:39,800 --> 00:15:41,868
[Suctioning]
424
00:15:44,872 --> 00:15:46,206
Screw it. I can't reach it.
425
00:15:46,240 --> 00:15:47,774
Okay, I'm gonna open the chest.
426
00:15:47,808 --> 00:15:49,042
- Scissors.
- What? Why?
427
00:15:49,076 --> 00:15:51,111
Total hepatic vascular isolation.
428
00:15:51,145 --> 00:15:53,880
We're gonna completely stop
the blood supply to the liver,
429
00:15:53,914 --> 00:15:55,281
find the source of the bleeding,
and then we'll repair it.
430
00:15:55,316 --> 00:15:56,616
Richard: All right, that's smart.
431
00:15:56,650 --> 00:15:59,019
That'll give you
infrapericardial control.
432
00:15:59,053 --> 00:16:00,420
Cutting him from stem to stern right now
433
00:16:00,454 --> 00:16:02,022
is completely reckless.
434
00:16:02,056 --> 00:16:04,224
Just get control of the IVC
from above and below the liver
435
00:16:04,258 --> 00:16:06,192
from the incision we've already made!
436
00:16:06,227 --> 00:16:08,128
Yeah, that is what the textbooks
would tell you to do,
437
00:16:08,162 --> 00:16:09,629
but any trauma surgeon will tell you
438
00:16:09,663 --> 00:16:11,197
it will not work without a sternotomy.
439
00:16:11,232 --> 00:16:13,066
Edwards, it's all you.
440
00:16:13,100 --> 00:16:14,134
Saw.
441
00:16:14,168 --> 00:16:16,136
Doesn't have to be pretty, just fast.
442
00:16:16,170 --> 00:16:18,071
[Whirring]
443
00:16:20,608 --> 00:16:22,242
We're racing against the clock here.
444
00:16:22,276 --> 00:16:23,109
[Megan chuckles]
445
00:16:23,144 --> 00:16:24,077
I'd love to know what is so hilarious
446
00:16:24,111 --> 00:16:26,246
when my patient is fighting
for his life!
447
00:16:26,280 --> 00:16:29,616
"Trauma surgery is fast
and a race against time."
448
00:16:29,650 --> 00:16:32,118
If it's a race, you're losing,
449
00:16:32,153 --> 00:16:34,154
because you suture like a dumb tortoise.
450
00:16:34,188 --> 00:16:35,455
I like my sutures to hold.
451
00:16:35,489 --> 00:16:37,724
Oh, and your beefy, fat hands
slow you down?
452
00:16:37,758 --> 00:16:40,326
Do they have to special-order
those gloves for you?
453
00:16:40,361 --> 00:16:41,506
I am trying to teach.
454
00:16:41,540 --> 00:16:43,096
You've never supervised trainees,
455
00:16:43,130 --> 00:16:44,130
so you don't get it.
456
00:16:44,165 --> 00:16:45,165
Oh, I get it.
457
00:16:45,199 --> 00:16:46,666
Enough to know that you
don't know what to do next
458
00:16:46,700 --> 00:16:48,234
with your patient.
459
00:16:48,269 --> 00:16:49,702
Am I right?
460
00:16:55,142 --> 00:16:57,010
Why are you stopping?
I don't know if this is gonna work.
461
00:16:57,044 --> 00:16:58,278
He's still bleeding.
462
00:16:58,312 --> 00:16:59,145
I wanted to close,
463
00:16:59,180 --> 00:17:00,680
and you said
you could isolate the liver.
464
00:17:00,714 --> 00:17:01,781
I know, but...
465
00:17:01,816 --> 00:17:02,916
Then do it.
466
00:17:04,151 --> 00:17:05,718
- Megan: What's wrong?
- Nothing.
467
00:17:08,389 --> 00:17:09,255
Stop.
468
00:17:09,290 --> 00:17:10,323
I'm not doing anything.
469
00:17:10,357 --> 00:17:12,158
You're giving me that look,
and I don't like it.
470
00:17:12,193 --> 00:17:13,159
Mom does it, too.
471
00:17:13,194 --> 00:17:14,928
Well, you should call Mom more.
472
00:17:14,962 --> 00:17:16,329
Will you just go away?
473
00:17:16,363 --> 00:17:17,697
You're the one that brought me here,
474
00:17:17,731 --> 00:17:19,466
and you usually only bring me around
475
00:17:19,500 --> 00:17:20,500
when you feel guilty.
476
00:17:20,534 --> 00:17:21,234
[Sighs]
477
00:17:21,268 --> 00:17:22,869
Why are you guilty, Eeyore?
478
00:17:22,903 --> 00:17:24,137
I am working.
479
00:17:24,171 --> 00:17:25,672
Is it Nathan?
480
00:17:25,706 --> 00:17:28,675
You feel bad
about being nice to him lately.
481
00:17:28,709 --> 00:17:29,509
Nope.
482
00:17:29,543 --> 00:17:30,510
It's fine.
483
00:17:30,544 --> 00:17:33,279
Well, I mean... it's not fine.
484
00:17:33,314 --> 00:17:34,681
He cheated on your little sister, but...
485
00:17:34,715 --> 00:17:35,982
I don't feel guilty about anything!
486
00:17:36,016 --> 00:17:38,885
[Chuckling] Oh, well, that's a first.
487
00:17:38,919 --> 00:17:40,720
Well, something wrong.
488
00:17:40,754 --> 00:17:42,188
What is it, then?
489
00:17:43,424 --> 00:17:45,358
New wife isn't working out?
490
00:17:45,392 --> 00:17:47,127
I'm done talking to you.
491
00:17:47,872 --> 00:17:49,896
You're not gonna
choke anybody again, are you?
492
00:17:49,930 --> 00:17:51,664
Will you shut up?!
Shut up for God's sakes.
493
00:17:51,699 --> 00:17:53,032
Hunt!
494
00:17:53,067 --> 00:17:54,711
Uh, uh...
495
00:17:55,784 --> 00:17:57,798
Suction's full. Change it, please.
496
00:17:59,373 --> 00:18:00,206
Obviously.
497
00:18:00,241 --> 00:18:02,041
Megan: She's what's wrong with you!
498
00:18:02,076 --> 00:18:03,576
No!
499
00:18:04,168 --> 00:18:05,545
What happened?
500
00:18:05,579 --> 00:18:06,880
[Sighs] An affair?
501
00:18:06,914 --> 00:18:08,681
No, we're... we're just friends.
502
00:18:08,716 --> 00:18:10,609
Mm, well...
503
00:18:11,785 --> 00:18:12,852
I like her.
504
00:18:12,887 --> 00:18:14,154
Yeah, well, good for you.
505
00:18:14,188 --> 00:18:15,355
Hmm.
506
00:18:15,389 --> 00:18:16,856
You should have married her.
507
00:18:16,891 --> 00:18:17,423
[Sighs]
508
00:18:17,458 --> 00:18:18,224
Then you'd have kids.
509
00:18:18,259 --> 00:18:20,260
I didn't want to marry her, okay?
510
00:18:20,294 --> 00:18:22,162
I just... I wanted it...
511
00:18:22,196 --> 00:18:23,596
I'm trying to save this guy's life here.
512
00:18:23,631 --> 00:18:25,365
Who the hell is this guy anyway?
513
00:18:25,399 --> 00:18:26,566
What does that matter?
514
00:18:26,600 --> 00:18:29,335
Uh, because I can see his
liver... or what's left of it.
515
00:18:29,370 --> 00:18:33,206
You've really been throwing out
some bold moves.
516
00:18:33,240 --> 00:18:34,774
You're monopolizing the O.R.,
517
00:18:34,808 --> 00:18:37,410
you're wasting hospital
resources and personnel.
518
00:18:37,444 --> 00:18:39,245
It's not a waste if we save the patient.
519
00:18:39,280 --> 00:18:40,914
Owen, why won't you call it?
520
00:18:40,948 --> 00:18:42,115
I mean, you know where this is headed.
521
00:18:42,149 --> 00:18:43,116
Because you don't stop, okay?
522
00:18:43,150 --> 00:18:45,585
You don't stop until
you've got the final answer.
523
00:18:45,619 --> 00:18:49,289
You don't stop until
you've saved them, or y...
524
00:18:49,323 --> 00:18:51,168
you find out that they're...
525
00:18:51,825 --> 00:18:53,359
that they're dead.
526
00:18:53,394 --> 00:18:56,563
♪ ♪
527
00:18:57,998 --> 00:18:59,249
Owen.
528
00:19:00,634 --> 00:19:02,268
This guy isn't me.
529
00:19:09,476 --> 00:19:10,977
[Monitor beeping rapidly]
530
00:19:11,011 --> 00:19:12,545
- Meredith: Pressure's dropping.
- I know.
531
00:19:12,580 --> 00:19:14,113
Surgicel, EVARREST.
532
00:19:14,148 --> 00:19:15,381
Let's give him 10 units of cryo.
533
00:19:15,416 --> 00:19:16,482
I see bruising on his neck and face.
534
00:19:16,517 --> 00:19:19,319
Okay, let's pack him,
get ready to bring him upstairs.
535
00:19:19,353 --> 00:19:21,154
- I miss you.
- No.
536
00:19:21,188 --> 00:19:22,488
Cut it out.
537
00:19:22,523 --> 00:19:24,123
You have to focus.
538
00:19:27,261 --> 00:19:28,595
You know what you have to do.
539
00:19:33,500 --> 00:19:35,568
- DeBakey clamp.
- What are you doing?
540
00:19:35,603 --> 00:19:36,975
Edwards, call the UNOS.
541
00:19:37,010 --> 00:19:38,771
Send them everything
we have on this patient.
542
00:19:38,806 --> 00:19:40,117
- I'm sorry?
- What?
543
00:19:40,151 --> 00:19:41,074
Go now!
544
00:19:42,676 --> 00:19:44,611
- Owen.
- Webber's right.
545
00:19:44,645 --> 00:19:46,312
Transplant's the only way
to save this patient.
546
00:19:46,347 --> 00:19:48,848
I'm removing his liver.
It's only making him worse.
547
00:19:48,882 --> 00:19:51,484
- Scissors.
- Do not make that cut!
548
00:19:58,459 --> 00:19:59,892
Basin.
549
00:20:03,697 --> 00:20:05,465
[Suctioning]
550
00:20:12,906 --> 00:20:15,375
Clips, please. Boki.
551
00:20:15,409 --> 00:20:18,444
♪ ♪
552
00:20:27,198 --> 00:20:28,665
We decided not to list him.
553
00:20:28,700 --> 00:20:30,334
No, you did.
554
00:20:30,686 --> 00:20:33,421
And we were never supposed
to take out the whole liver.
555
00:20:33,450 --> 00:20:34,283
How the hell is the patient
556
00:20:34,317 --> 00:20:35,451
supposed to survive without a liver?
557
00:20:35,485 --> 00:20:38,087
Okay, his liver already wasn't
working in his body, Grey.
558
00:20:38,121 --> 00:20:39,521
Removing it while we wait for a match
559
00:20:39,556 --> 00:20:41,023
won't make much of a difference.
560
00:20:41,057 --> 00:20:42,991
Well, how do we know a match
is even gonna come through?
561
00:20:43,026 --> 00:20:43,859
We don't,
562
00:20:43,893 --> 00:20:45,494
but we're gonna do a portacaval shunt
563
00:20:45,528 --> 00:20:46,762
to bypass the blood supply.
564
00:20:46,796 --> 00:20:48,330
That should give us an hour or so.
565
00:20:48,364 --> 00:20:49,565
[Exhales sharply]
566
00:20:49,599 --> 00:20:51,767
I imagine Gail is pretty tough, right?
567
00:20:51,801 --> 00:20:53,235
[Cello plays]
568
00:20:53,269 --> 00:20:56,405
Gail is tough as nails...
on her feet 16 hours a day.
569
00:20:56,439 --> 00:20:58,907
She wouldn't let up
even when the pain in her back
570
00:20:58,942 --> 00:21:00,509
started keeping her up at night.
571
00:21:00,543 --> 00:21:03,445
Gail: You know,
I thought it was my mattress.
572
00:21:03,480 --> 00:21:06,281
The thing must have been
at least 15 years old,
573
00:21:06,316 --> 00:21:10,352
so I replaced it,
but that didn't help much.
574
00:21:10,386 --> 00:21:13,689
She's one of those people
whose bag rattles all the time
575
00:21:13,723 --> 00:21:16,525
because she carries around
a bottle of aspirin
576
00:21:16,559 --> 00:21:18,527
everywhere she goes.
577
00:21:18,561 --> 00:21:20,429
[Monitor beeping rapidly]
578
00:21:20,463 --> 00:21:21,563
We got bleeders.
579
00:21:21,598 --> 00:21:22,865
When you said an hour,
did you mean a minute and a half?
580
00:21:22,899 --> 00:21:23,932
Hang two more units.
581
00:21:23,967 --> 00:21:24,867
UNOS has everything.
582
00:21:24,901 --> 00:21:27,069
Richard: Okay,
did they agree to list him?
583
00:21:27,103 --> 00:21:29,481
He's listed as 1A,
and he's a fairly easy match,
584
00:21:29,516 --> 00:21:30,475
so fingers crossed.
585
00:21:30,509 --> 00:21:32,040
There's blood in his ET tube and nares.
586
00:21:32,075 --> 00:21:33,475
Check his coags and a D-dimer!
587
00:21:33,510 --> 00:21:34,977
Also, the lab tech mentioned
his platelets
588
00:21:35,011 --> 00:21:36,311
were clumping, so I was thinking...
589
00:21:36,346 --> 00:21:37,946
Edwards, you were right.
590
00:21:37,981 --> 00:21:40,415
Looks like he's in DIC.
Let's jump back in.
591
00:21:40,450 --> 00:21:41,416
No, actually, that's not what I...
592
00:21:41,451 --> 00:21:42,618
The azygos is bleeding.
593
00:21:42,652 --> 00:21:43,952
Owen: It can't be. I clamped it.
594
00:21:43,987 --> 00:21:45,020
Well, it's bleeding again.
595
00:21:45,054 --> 00:21:46,755
[Sighs] It must be coming
from his renal vein.
596
00:21:46,790 --> 00:21:48,624
Richard: Let me see if
I can feel it from where I am...
597
00:21:48,658 --> 00:21:50,159
got a better angle.
598
00:21:50,193 --> 00:21:51,660
Something else might be going on.
599
00:21:51,694 --> 00:21:54,563
There is blood in his urine now, too.
600
00:21:54,597 --> 00:21:56,064
And the neck bruises.
601
00:21:56,099 --> 00:21:58,000
They can't hear you.
602
00:21:58,034 --> 00:22:01,637
If you want them to listen,
like, really listen,
603
00:22:01,671 --> 00:22:03,839
you got to be louder.
604
00:22:03,873 --> 00:22:04,840
Richard: Found it.
605
00:22:04,874 --> 00:22:07,276
It is small, but it's definitely
a venous bleed.
606
00:22:07,310 --> 00:22:09,344
Meredith: Really? Is it the azygos?
607
00:22:09,379 --> 00:22:10,679
It is.
608
00:22:10,713 --> 00:22:12,114
- Owen: I got it. Give me a tie.
- I got it.
609
00:22:12,148 --> 00:22:13,649
- You don't trust me?
- Not really.
610
00:22:13,683 --> 00:22:15,117
I did what was best for the patient.
611
00:22:15,151 --> 00:22:16,518
No, you lost your damn mind.
612
00:22:16,553 --> 00:22:18,453
This tissue's falling apart in my hands.
613
00:22:19,907 --> 00:22:20,856
We'll clamp this,
614
00:22:20,890 --> 00:22:22,491
and then I'm gonna secure it with a tie.
615
00:22:22,525 --> 00:22:23,625
Move your hands, please.
616
00:22:23,660 --> 00:22:24,226
Dr. Hunt.
617
00:22:24,260 --> 00:22:25,661
Just a second, Edwards!
618
00:22:25,695 --> 00:22:27,830
Just tell him! You know what it is.
619
00:22:27,864 --> 00:22:31,500
I don't think the patient's
decompensating because of DIC.
620
00:22:31,534 --> 00:22:33,502
We spent months reading about it.
621
00:22:33,536 --> 00:22:35,537
You know it. It's... It's...
622
00:22:35,572 --> 00:22:36,371
It's his platelets.
623
00:22:36,406 --> 00:22:37,773
We'll just... We'll give him more.
624
00:22:37,807 --> 00:22:40,142
No, the patient has a platelet disorder.
625
00:22:40,176 --> 00:22:42,044
There's this cool lab test
626
00:22:42,078 --> 00:22:43,846
that helps prove
the platelets don't clump.
627
00:22:43,880 --> 00:22:45,681
The lab already saw abnormal findings,
628
00:22:45,715 --> 00:22:47,649
and they can confirm it
with the blood sample.
629
00:22:47,684 --> 00:22:48,784
Okay, fine, fine.
630
00:22:48,818 --> 00:22:50,385
Just... For now, just get
in there with some suction,
631
00:22:50,420 --> 00:22:51,520
so I can see what I'm doing.
632
00:22:51,554 --> 00:22:52,788
Damn it.
633
00:22:52,822 --> 00:22:53,889
Meredith: It's too friable.
634
00:22:53,923 --> 00:22:55,357
We need to take him up to ICU
635
00:22:55,391 --> 00:22:57,459
until we find a more permanent solution.
636
00:22:57,493 --> 00:22:59,061
That won't work!
637
00:22:59,095 --> 00:23:02,865
According to chapter 21 of
"Hemostasis and Thrombosis"...
638
00:23:02,899 --> 00:23:03,866
"Hemostasis and Thrombosis."
639
00:23:03,900 --> 00:23:05,701
Dr. Grey, if we close him,
640
00:23:05,735 --> 00:23:06,702
he's gonna get worse.
641
00:23:06,736 --> 00:23:07,903
Owen: Okay, push bicarb.
642
00:23:07,937 --> 00:23:10,239
You know what Nurse Paula would say.
643
00:23:10,273 --> 00:23:11,240
Meredith: Owen,
he can't handle any more.
644
00:23:11,274 --> 00:23:14,576
She'd yell, "If you got
something to say"...
645
00:23:14,611 --> 00:23:15,911
Owen: I-I think he can. I think...
646
00:23:15,945 --> 00:23:17,412
... "speak up!"
647
00:23:17,447 --> 00:23:18,847
I think I'm gonna watch you
kill this patient.
648
00:23:18,882 --> 00:23:20,682
Okay, stop, all of you! Listen to me!
649
00:23:26,189 --> 00:23:27,856
Something you needed to say?
650
00:23:29,192 --> 00:23:32,728
Repairing the azygos
won't stop his bleeding at all.
651
00:23:32,762 --> 00:23:35,597
And you can take him to the ICU,
but he's still deteriorating.
652
00:23:35,632 --> 00:23:37,566
This patient has an autoimmune disease,
653
00:23:37,600 --> 00:23:41,236
specifically idiopathic
thrombocytopenic purpura.
654
00:23:41,271 --> 00:23:43,272
I.T.P. is extremely rare.
655
00:23:43,306 --> 00:23:46,041
According to a study in Ko...
656
00:23:46,075 --> 00:23:47,342
Kuwait.
657
00:23:47,377 --> 00:23:48,710
...Kuwait,
658
00:23:48,745 --> 00:23:51,747
there's an incidence of 125 cases
659
00:23:51,781 --> 00:23:54,850
per 1 million people per year.
660
00:23:54,884 --> 00:23:56,685
It's more common than we think.
661
00:23:56,719 --> 00:23:59,388
Edwards, the body is shutting
down because of the trauma.
662
00:23:59,422 --> 00:24:00,722
- Talk fast.
- That is because
663
00:24:00,757 --> 00:24:02,357
the trauma is the only thing you see,
664
00:24:02,392 --> 00:24:04,559
because trauma is all
that you are used to seeing.
665
00:24:04,594 --> 00:24:06,929
I see a body that's attacking
itself from the inside,
666
00:24:06,963 --> 00:24:08,764
and every time we give him blood,
667
00:24:08,798 --> 00:24:10,766
his body chews up the platelets
one by one.
668
00:24:10,800 --> 00:24:12,634
It's like we're filling a giant tank
669
00:24:12,669 --> 00:24:14,536
with a hole in it,
670
00:24:14,570 --> 00:24:15,871
and the only thing
we need to do to stop it
671
00:24:15,905 --> 00:24:18,540
is to give him steroids, a lot of them
672
00:24:18,574 --> 00:24:19,741
as soon as possible.
673
00:24:19,776 --> 00:24:21,643
- He doesn't have a liver.
- Thanks to you.
674
00:24:21,678 --> 00:24:23,812
If we administer steroids,
675
00:24:23,846 --> 00:24:25,213
then without being able to metabolize,
676
00:24:25,248 --> 00:24:27,316
- it could become toxic.
- And before you argue
677
00:24:27,350 --> 00:24:28,250
about how risky it is,
678
00:24:28,284 --> 00:24:29,751
let me just say
we have very little time,
679
00:24:29,786 --> 00:24:30,619
and you should listen to me,
680
00:24:30,653 --> 00:24:31,687
because I know all about this stuff.
681
00:24:31,721 --> 00:24:34,222
If I were on the table,
I'd want the risky thing.
682
00:24:34,257 --> 00:24:35,324
I'd want to survive.
683
00:24:35,358 --> 00:24:36,091
Yes.
684
00:24:38,761 --> 00:24:40,407
Where did you get all this again?
685
00:24:40,442 --> 00:24:43,465
When you're stuck in a bed
for your whole childhood,
686
00:24:43,499 --> 00:24:44,933
you kind of get obsessed
687
00:24:44,968 --> 00:24:46,702
with the thing that put you there.
688
00:24:47,770 --> 00:24:50,739
I read... a lot.
689
00:24:51,241 --> 00:24:52,960
Good catch, Edwards.
690
00:24:54,377 --> 00:24:55,410
Thank you.
691
00:25:01,818 --> 00:25:02,985
Send up a blood sample
692
00:25:03,019 --> 00:25:04,586
and give him a gram of prednisone.
693
00:25:04,620 --> 00:25:05,654
This is a reach.
694
00:25:05,688 --> 00:25:07,589
Well, then you and Webber
should be all over it.
695
00:25:07,623 --> 00:25:08,824
And we'll need some more platelets.
696
00:25:10,360 --> 00:25:12,694
Dr. Grey, we might have an I.D.
697
00:25:12,729 --> 00:25:14,096
A woman came in, said
her husband was working late,
698
00:25:14,130 --> 00:25:15,097
then he never came home.
699
00:25:15,131 --> 00:25:16,298
She saw the news.
700
00:25:16,332 --> 00:25:17,399
Go ahead.
701
00:25:21,537 --> 00:25:22,938
[Camera shutter clicks]
702
00:25:22,972 --> 00:25:24,473
[Monitor beeping rapidly]
703
00:25:24,507 --> 00:25:25,774
Richard: He's in V-tach.
704
00:25:29,579 --> 00:25:31,782
Gail: I mean, this really hurts.
705
00:25:32,482 --> 00:25:34,850
This isn't normal, is it?
706
00:25:35,210 --> 00:25:37,652
And it's not just my back.
707
00:25:37,687 --> 00:25:39,121
Meredith: I can barely get a pulse.
708
00:25:39,155 --> 00:25:41,023
Push 300 of amiodarone.
709
00:25:41,057 --> 00:25:42,491
Stephanie: Did we push the steroids?
710
00:25:42,525 --> 00:25:43,725
It won't matter.
It's because of his liver,
711
00:25:43,760 --> 00:25:45,293
or the fact that he doesn't have one.
712
00:25:45,328 --> 00:25:46,962
Okay, internal paddles on stand by.
713
00:25:46,996 --> 00:25:48,497
Look, we still have time.
714
00:25:48,531 --> 00:25:50,173
Go find out if he belongs to them.
715
00:25:51,694 --> 00:25:53,637
Something's wrong...
716
00:25:55,371 --> 00:25:56,738
really wrong.
717
00:26:00,386 --> 00:26:02,892
He's in V-fib! Starting heart massage.
718
00:26:02,993 --> 00:26:04,027
Okay, internal paddles?
719
00:26:04,061 --> 00:26:05,695
Saline! Charge to 20.
720
00:26:05,730 --> 00:26:07,030
- [Paddles whine]
- Okay, clear.
721
00:26:07,064 --> 00:26:08,064
[Thump]
722
00:26:09,967 --> 00:26:10,867
No change.
723
00:26:10,901 --> 00:26:14,104
Ah, push one of epi. Let's charge to 30.
724
00:26:14,138 --> 00:26:15,605
- [Paddles whine]
- Clear!
725
00:26:15,639 --> 00:26:16,373
[Thump]
726
00:26:16,407 --> 00:26:18,641
Ah, damn it! Push another epi.
727
00:26:18,676 --> 00:26:19,976
Nurse: It's him!
728
00:26:20,010 --> 00:26:21,544
The wife confirmed the I.D.
from the photo.
729
00:26:21,579 --> 00:26:22,946
What's his name?
730
00:26:22,980 --> 00:26:25,749
Carl. Carl Henley.
731
00:26:25,783 --> 00:26:28,413
Are we done with Gail? Is Gail Carl now?
732
00:26:29,854 --> 00:26:30,820
Are there children?
733
00:26:30,855 --> 00:26:32,088
A little boy and a girl.
734
00:26:32,123 --> 00:26:34,157
They're with her
downstairs in the lobby.
735
00:26:34,191 --> 00:26:36,059
[Siren wails]
736
00:26:36,093 --> 00:26:38,862
♪ ♪
737
00:26:43,367 --> 00:26:45,101
Richard: Okay, charge to 50!
738
00:26:45,136 --> 00:26:46,836
[Paddles whine]
739
00:26:46,871 --> 00:26:47,637
Clear!
740
00:26:47,671 --> 00:26:49,272
[Thump]
741
00:26:49,306 --> 00:26:50,206
Still no pulse.
742
00:26:50,241 --> 00:26:52,108
The shunt put too much strain
on his heart.
743
00:26:52,143 --> 00:26:53,309
The liver's only been out
for 20 minutes.
744
00:26:53,344 --> 00:26:55,845
The shunt will bypass everything
for at least another hour.
745
00:26:55,880 --> 00:26:57,580
And then what? We still have no donor.
746
00:26:57,615 --> 00:26:59,349
Not to mention, Carl probably has I.T.P.
747
00:26:59,383 --> 00:27:00,817
And how was I supposed to know that?
748
00:27:00,851 --> 00:27:02,352
Edwards didn't have a problem
figuring it out.
749
00:27:02,386 --> 00:27:03,953
Can Edwards not be involved?
750
00:27:03,988 --> 00:27:06,666
Every step of the way
you and Webber just took over.
751
00:27:07,057 --> 00:27:08,291
Grey, what is your problem?
752
00:27:08,325 --> 00:27:09,759
My problem?
753
00:27:09,794 --> 00:27:11,594
[Indistinct voices]
754
00:27:11,629 --> 00:27:14,164
♪ ♪
755
00:27:14,198 --> 00:27:15,432
Richard: Ever since I walked
into this O.R.,
756
00:27:15,466 --> 00:27:16,933
you've been negative at every step,
757
00:27:16,967 --> 00:27:18,168
shooting down every approach.
758
00:27:18,202 --> 00:27:19,669
What do you think I'm doing right now,
759
00:27:19,703 --> 00:27:21,204
massaging this heart for exercise?
760
00:27:21,238 --> 00:27:22,172
Stephanie: Dr. Grey, you've been
doing that for a while.
761
00:27:22,206 --> 00:27:23,039
You want me to take over?
762
00:27:23,073 --> 00:27:24,674
No! Go again at 50.
763
00:27:24,708 --> 00:27:26,476
- [Paddles whine]
- Richard: Okay. Clear!
764
00:27:26,510 --> 00:27:28,545
- [Thump]
- [Groans]
765
00:27:28,579 --> 00:27:30,947
I've done everything I can
to keep Carl alive.
766
00:27:30,981 --> 00:27:32,782
It's a miracle he's come this far
767
00:27:32,817 --> 00:27:34,384
considering the shape he was in
when he got here
768
00:27:34,418 --> 00:27:35,618
and all these Hail Marys.
769
00:27:35,653 --> 00:27:38,556
Since when have I taught you to
stand around and play it safe?
770
00:27:38,641 --> 00:27:39,863
You taught me to do no harm.
771
00:27:39,983 --> 00:27:41,994
Look, as long as Gail
is on this table, you will...
772
00:27:42,029 --> 00:27:44,794
Carl! His name is Carl.
773
00:27:46,163 --> 00:27:48,064
Zola: [Echoing] Where is Mommy?
774
00:27:48,098 --> 00:27:50,233
[Echoing] She's
with the doctors, sweetie.
775
00:27:50,267 --> 00:27:51,801
Is my Daddy with them?
776
00:27:52,544 --> 00:27:55,305
Let's just wait for your mom
to come back, okay?
777
00:27:57,654 --> 00:27:59,355
Someone should go talk to the family.
778
00:27:59,389 --> 00:28:00,923
We're in the middle
of resuscitating him.
779
00:28:00,957 --> 00:28:03,292
Someone needs to tell them
what's happening
780
00:28:03,326 --> 00:28:05,461
and prepare them
for what's about to happen.
781
00:28:05,495 --> 00:28:08,464
[Monitor beeping rhythmically]
782
00:28:08,498 --> 00:28:10,433
- We've got a rhythm!
- [Sighing] Will it last?
783
00:28:10,467 --> 00:28:12,134
Owen: It's faint, but it'll do for now.
784
00:28:12,169 --> 00:28:14,370
Okay, let's close him
and rush him to the ICU.
785
00:28:14,404 --> 00:28:15,438
With no liver.
786
00:28:15,472 --> 00:28:17,273
It's our only option.
787
00:28:17,307 --> 00:28:20,676
It's time to compromise...
for all of us.
788
00:28:22,245 --> 00:28:24,346
[Children talking indistinctly]
789
00:28:29,086 --> 00:28:30,786
[Sirens wail in distance]
790
00:28:30,821 --> 00:28:33,255
♪ ♪
791
00:28:46,060 --> 00:28:47,803
Hey, guys.
792
00:28:47,838 --> 00:28:49,287
Hey.
793
00:28:53,364 --> 00:28:56,011
Where's Daddy? Is he here?
794
00:28:56,876 --> 00:28:59,949
Remember, Daddy was driving...
795
00:28:59,983 --> 00:29:01,450
in his car?
796
00:29:01,485 --> 00:29:03,919
Yeah, is he coming home soon?
797
00:29:03,954 --> 00:29:05,020
[Inhales sharply]
798
00:29:05,055 --> 00:29:07,389
No, he was in an accident.
799
00:29:09,059 --> 00:29:10,188
Oh.
800
00:29:11,628 --> 00:29:13,757
Well, is he hurt?
801
00:29:14,464 --> 00:29:16,196
He was.
802
00:29:17,033 --> 00:29:21,137
Are the doctors fixing him?
Is he going to surgery?
803
00:29:21,171 --> 00:29:23,472
He's hyperkalemic. Push calcium.
804
00:29:23,507 --> 00:29:24,874
And one amp of bicarb!
805
00:29:24,908 --> 00:29:25,708
How are his M.A.P.s?
806
00:29:25,742 --> 00:29:27,009
Barely in the 50s.
807
00:29:33,517 --> 00:29:35,351
[Sighs]
808
00:29:35,385 --> 00:29:37,458
No, they can't fix him.
809
00:29:39,189 --> 00:29:41,390
Then you should go in there and fix him.
810
00:29:41,424 --> 00:29:42,391
Zola...
811
00:29:42,425 --> 00:29:44,627
You fix everyone.
812
00:29:49,699 --> 00:29:52,334
Zola, I can't fix him.
813
00:29:52,369 --> 00:29:53,869
Why?
814
00:29:58,108 --> 00:30:00,509
I can't fix him
815
00:30:00,544 --> 00:30:02,444
because...
816
00:30:04,614 --> 00:30:06,549
[Voice breaking]
because no one can fix him...
817
00:30:10,554 --> 00:30:13,055
...because he's dead, Zola.
818
00:30:16,593 --> 00:30:17,793
Daddy died.
819
00:30:56,499 --> 00:30:58,367
You didn't make Gail up.
820
00:31:02,239 --> 00:31:04,225
You come up with what you need to.
821
00:31:05,308 --> 00:31:06,775
Whatever helps...
822
00:31:06,810 --> 00:31:08,143
an old patient.
823
00:31:08,428 --> 00:31:09,845
"Someone good."
824
00:31:15,752 --> 00:31:17,786
Gail: It's okay, son.
825
00:31:17,821 --> 00:31:22,558
You were only 10 years old.
There was nothing you could do.
826
00:31:29,364 --> 00:31:30,331
[Sighs]
827
00:31:30,365 --> 00:31:32,903
My mother... She hated doctors.
828
00:31:33,271 --> 00:31:35,105
Or at least that's what she said.
829
00:31:35,684 --> 00:31:37,808
You know, I think she just
didn't want to worry us.
830
00:31:38,459 --> 00:31:40,627
We thought everything was fine.
831
00:31:40,661 --> 00:31:42,696
Okay. Wound-vac, please.
832
00:31:42,730 --> 00:31:45,765
She still taught music classes
every day,
833
00:31:45,800 --> 00:31:49,636
yelled at us about our homework,
fixed us dinner.
834
00:31:49,670 --> 00:31:53,606
We grew up listing to that
damn cello all day, every day.
835
00:31:53,641 --> 00:31:56,443
[Cello plays]
836
00:31:56,477 --> 00:31:57,862
She played it for hours...
837
00:31:58,732 --> 00:32:00,199
Bach...
838
00:32:00,514 --> 00:32:01,861
Vivaldi...
839
00:32:02,396 --> 00:32:03,768
Elgar.
840
00:32:05,151 --> 00:32:07,070
She would shut the bedroom door
841
00:32:07,654 --> 00:32:09,755
and tell us not to knock
842
00:32:09,789 --> 00:32:13,258
unless someone was bleeding
or something's on fire.
843
00:32:13,293 --> 00:32:14,426
[Laughs]
844
00:32:14,724 --> 00:32:16,365
I hated it...
845
00:32:17,224 --> 00:32:20,593
that constant drone of classical music,
846
00:32:20,834 --> 00:32:22,968
until one day it stopped.
847
00:32:23,002 --> 00:32:25,070
[Music stops]
848
00:32:25,104 --> 00:32:26,338
The house was silent.
849
00:32:29,475 --> 00:32:30,592
I missed it.
850
00:32:32,345 --> 00:32:34,580
That's when I knew
it meant something was wrong.
851
00:32:35,064 --> 00:32:36,915
What was wrong with her?
852
00:32:37,657 --> 00:32:40,352
You're the doctor, you tell me.
853
00:32:40,386 --> 00:32:41,820
46-year-old woman...
854
00:32:41,855 --> 00:32:43,956
backache, sudden weight loss,
855
00:32:43,990 --> 00:32:45,190
fatigue...
856
00:32:45,225 --> 00:32:46,633
Multiple myeloma?
857
00:32:47,327 --> 00:32:49,027
Breast cancer?
858
00:32:49,593 --> 00:32:53,432
Or... were there any signs of jaundice?
859
00:32:53,466 --> 00:32:55,934
Good question. Yes, there was.
860
00:32:55,969 --> 00:32:57,803
Was it gallstones?
861
00:32:57,837 --> 00:32:59,705
Did one of them get trapped
in her bile duct?
862
00:32:59,739 --> 00:33:00,906
No.
863
00:33:04,376 --> 00:33:05,777
It wasn't hepatitis, was it?
864
00:33:07,847 --> 00:33:11,750
It was pancreatic cancer.
Stage III or IV.
865
00:33:14,020 --> 00:33:15,284
She had six months.
866
00:33:20,393 --> 00:33:22,527
Pretty sure we're almost done
here if you need to take...
867
00:33:22,562 --> 00:33:23,462
I'm fine.
868
00:33:24,530 --> 00:33:26,865
We just need
to finish the... the closure.
869
00:33:26,900 --> 00:33:28,800
The three of us can handle it.
870
00:33:28,835 --> 00:33:29,701
Wait.
871
00:33:33,106 --> 00:33:34,539
We should stop closing.
872
00:33:34,574 --> 00:33:35,908
Well, you've been pushing
to close him for hours.
873
00:33:35,942 --> 00:33:37,075
I know, and now I'm pushing to stay open
874
00:33:37,110 --> 00:33:39,478
because I think we can save him
right here, right now.
875
00:33:39,512 --> 00:33:41,647
Meredith, we've tried everything.
876
00:33:41,681 --> 00:33:43,548
We haven't tried a liver transplant.
877
00:33:43,583 --> 00:33:45,083
But we don't have a donor liver.
878
00:33:45,118 --> 00:33:46,385
We have a liver there. Boki.
879
00:33:47,482 --> 00:33:50,589
The right lobe is completely destroyed.
880
00:33:50,623 --> 00:33:52,591
We do a partial liver transplant.
881
00:33:52,616 --> 00:33:55,394
Look, we ditch the right lobe,
we repair the left,
882
00:33:55,428 --> 00:33:56,695
and graft the remaining vessels.
883
00:33:56,729 --> 00:33:57,729
It'll work.
884
00:33:57,764 --> 00:34:00,432
But we couldn't repair it
inside of his body.
885
00:34:00,466 --> 00:34:01,667
How are we gonna do it on the outside?
886
00:34:01,701 --> 00:34:03,835
The main damage was behind it
where we couldn't reach it.
887
00:34:03,870 --> 00:34:06,571
Now we have total access. This'll work.
888
00:34:06,606 --> 00:34:10,676
We've done liver autotransplants
with tumors, but with trauma?
889
00:34:10,710 --> 00:34:13,445
It's risky. I've never seen it done.
890
00:34:13,479 --> 00:34:15,514
Because people give up by now.
891
00:34:15,548 --> 00:34:16,515
It's a Hail Mary.
892
00:34:20,820 --> 00:34:23,522
Hail Mary. Your turn.
893
00:34:23,556 --> 00:34:25,757
Okay, great. Webber, you and I
are gonna go at that back table.
894
00:34:25,792 --> 00:34:27,526
I need a scrub nurse and irrigation.
895
00:34:27,560 --> 00:34:29,294
And, Edwards, you and Hunt
are gonna go prep
896
00:34:29,329 --> 00:34:30,362
for the anastomoses.
897
00:34:30,396 --> 00:34:31,697
We got to work really fast.
898
00:34:31,731 --> 00:34:34,199
[Monitor beeping]
899
00:34:34,233 --> 00:34:36,535
♪ ♪
900
00:34:41,441 --> 00:34:43,608
♪ Darling, I know ♪
901
00:34:43,643 --> 00:34:50,582
♪ You only cry when you're alone ♪
902
00:34:50,616 --> 00:34:52,718
♪ Darling, I know ♪
903
00:34:52,752 --> 00:34:59,157
♪ You only laugh to keep it all in ♪
904
00:34:59,192 --> 00:35:03,662
♪ It's scaring the both of us,
the things that we've seen ♪
905
00:35:03,696 --> 00:35:08,400
♪ The places we know we must go ♪
906
00:35:08,434 --> 00:35:13,271
♪ But I've only loved one person
through all ♪
907
00:35:16,976 --> 00:35:21,346
♪ Don't need an apology
to make it right ♪
908
00:35:21,381 --> 00:35:25,650
♪ I just need you as a whole ♪
909
00:35:25,685 --> 00:35:30,288
♪ Don't want an apology
to make it right ♪
910
00:35:30,323 --> 00:35:36,261
♪ I want you in all of your glory ♪
911
00:35:36,295 --> 00:35:40,499
♪ All of your glory ♪
912
00:35:48,574 --> 00:35:52,611
♪ Don't need an apology
to make it right ♪
913
00:35:52,645 --> 00:35:57,682
♪ I just need you as a whole ♪
914
00:35:57,717 --> 00:36:01,520
♪ Don't want an apology
to make it right ♪
915
00:36:01,554 --> 00:36:06,391
♪ I want you in all of your glory ♪
916
00:36:06,426 --> 00:36:10,662
♪ Don't need an apology
to make it right ♪
917
00:36:10,696 --> 00:36:15,467
♪ I just need you as a whole ♪
918
00:36:15,501 --> 00:36:18,637
[Sighs] Nice save, Grey.
919
00:36:18,671 --> 00:36:20,238
Should have thought of it sooner.
920
00:36:20,273 --> 00:36:21,373
♪ I want you in all of your glory ♪
921
00:36:21,407 --> 00:36:23,241
All right, I'll get him up to ICU,
922
00:36:23,276 --> 00:36:26,711
and... then I can update the family.
923
00:36:26,746 --> 00:36:28,080
- ♪ All of your glory ♪
- I can update the family.
924
00:36:28,114 --> 00:36:29,714
Thank you, Edwards. Thank you.
925
00:36:29,749 --> 00:36:31,883
Richard: All right, let's go. Thank you.
926
00:36:31,918 --> 00:36:34,986
♪ ♪
927
00:36:38,524 --> 00:36:43,829
♪ Oh, all of your glory ♪
928
00:36:48,301 --> 00:36:51,369
Sorry for things that I said.
929
00:36:51,404 --> 00:36:53,001
Ah, it's okay.
930
00:36:53,873 --> 00:36:55,507
No, it's not.
931
00:36:55,541 --> 00:36:56,942
You were right.
932
00:36:56,976 --> 00:36:58,376
I was tired,
933
00:36:58,411 --> 00:37:01,246
but I have to learn to push past it.
934
00:37:01,280 --> 00:37:02,981
And you did.
935
00:37:06,486 --> 00:37:08,753
Have you always done that
with your mother?
936
00:37:08,788 --> 00:37:09,809
I didn't used to.
937
00:37:10,656 --> 00:37:12,187
Back then...
938
00:37:12,892 --> 00:37:17,129
I was trained
to depersonalize the patient.
939
00:37:17,834 --> 00:37:21,733
Tissue was tissue, faces were covered,
940
00:37:21,767 --> 00:37:23,946
and blood was a mess on the floor.
941
00:37:24,470 --> 00:37:27,439
We were to stay focused,
942
00:37:27,473 --> 00:37:30,542
and our hands were inside
just mannequins.
943
00:37:32,311 --> 00:37:33,597
So, what changed?
944
00:37:34,447 --> 00:37:36,314
One afternoon, I was in the O.R.,
945
00:37:36,349 --> 00:37:38,650
and we lost a patient on the table,
946
00:37:38,949 --> 00:37:41,486
and I went along to inform the family,
947
00:37:41,521 --> 00:37:43,697
you know, tell them the horrible news,
948
00:37:44,824 --> 00:37:46,334
and I was numb.
949
00:37:47,593 --> 00:37:51,663
I watched them sob
and hold each other and...
950
00:37:51,697 --> 00:37:53,832
and it didn't affect me...
951
00:37:53,866 --> 00:37:55,190
at all.
952
00:37:56,495 --> 00:37:58,303
That patient died from the same thing
953
00:37:58,337 --> 00:37:59,800
my mother died from,
954
00:38:00,706 --> 00:38:02,215
and I was a robot.
955
00:38:05,378 --> 00:38:06,696
After that...
956
00:38:08,314 --> 00:38:10,848
I started changing the rules,
957
00:38:12,618 --> 00:38:14,166
and it made me a better surgeon.
958
00:38:14,954 --> 00:38:17,358
We've all hit that point of exhaustion,
959
00:38:18,558 --> 00:38:21,426
the point where
nothing makes sense anymore.
960
00:38:23,503 --> 00:38:25,471
You've saved her now...
961
00:38:28,226 --> 00:38:29,935
...about 1,000 times.
962
00:38:29,969 --> 00:38:32,204
[Chuckles]
963
00:38:32,238 --> 00:38:33,387
I suppose.
964
00:38:34,126 --> 00:38:35,660
[Sighs]
965
00:38:37,630 --> 00:38:38,897
Good night, Meredith.
966
00:38:40,579 --> 00:38:41,946
Good night.
967
00:38:41,982 --> 00:38:44,550
Your body hurts,
your brain becomes foggy,
968
00:38:44,750 --> 00:38:47,037
and you feel like
you're trapped in a tunnel...
969
00:38:49,689 --> 00:38:51,955
...when all you want is your bed.
970
00:38:52,731 --> 00:38:56,032
So... how do you keep going?
971
00:38:59,098 --> 00:39:01,733
How do you not just sit down
and give up?
972
00:39:01,767 --> 00:39:03,168
[Water runs]
973
00:39:06,552 --> 00:39:07,954
Sometimes it's easy.
974
00:39:08,814 --> 00:39:11,416
Sometimes you play games in your head.
975
00:39:14,880 --> 00:39:16,897
You make up someone...
976
00:39:18,017 --> 00:39:19,430
someone good.
977
00:39:20,246 --> 00:39:21,300
Hi.
978
00:39:31,564 --> 00:39:33,598
[Door opens]
979
00:39:33,799 --> 00:39:34,566
I'm sorry.
980
00:39:34,600 --> 00:39:36,501
I didn't think anyone was in here.
981
00:39:36,535 --> 00:39:38,370
Whatever you need...
982
00:39:38,404 --> 00:39:40,405
It's all yours.
983
00:39:40,439 --> 00:39:42,411
...to keep you going.
984
00:39:54,542 --> 00:40:02,411
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