11x02 - Puzzle With a Piece Missing

[bunniefuu]

[Indistinct conversations]

[Horn blares]

Oh, boy. Hold on one second.

I got lost here yesterday.

[Siren wails in distance]

Maggie: I love puzzles. Since I was a kid.

Nope, your present hasn't come yet.

What is this present?

[Chuckles]

You keep saying I'll know it when I see it.

When am I gonna see it?

[Horns honking]

Yes, mom, I am still at work.

I've got all the last guy's caseload, plus new patients.

There's almost no time for research.

Yes, I've made friends.

"What are their names," mom?

My record for the Friday New York Times crossword Is 11 minutes... when I was 13.

I'm still trying to b*at that.

Why do I need to make friends? I'm here to run a department.

Okay, that sounds braggy.

I just mean once I pick a puzzle up, I can't put it down until it's solved.

No, I haven't talked to her yet.

I don't think I'm going to.

[Chuckles]

I've gotten by just fine without a sister.

I don't need one now.

At least not this one.

[Sighs] I was curious. I picked up the rock.

I saw what was underneath it. I'm gonna put the rock back.

It was stupid to have picked it up in the first place.

No, I'm just saying I don't need answers about my birth mom.

I have a family. I have the best family I could ask for.

I have you guys.

Dad. Dad, stop crying.

I'm not coming home. Mom. Tell him I'm not coming home.

[Cellphone chimes, vibrates]

Oh, guys, I love you. I got to go.

I think puzzles are why I went into medicine.

That's most of what medicine is.

Gather all available information...

How long has she been down?

Less than a minute.

She brady'd, and then she went into asystole.

[Cries]

We started CPR.

Assess the problem...

That's not gonna do it. Let me.

You focus your attention...

[Monitor beeping rapidly]

sh**t, I'm gonna break her ribs.

Sorry, Marjorie. Hold on.

V-fib. Paddles, please. Charge 100.

[Paddles charge]

Charged.

Clear.

[Thump]

[Sobs]

[Beeping continues]

Charge 200.

Charging.

Clear.

[Beeping, thump]

[Steady beeping]

And you solve the puzzle.

Thank you. Thank you.

[Elevator bell dings]

People are a harder puzzle.

There's never one right answer.

Oh, no, thanks. I'm going down.

Me, too.

And you never have all of the information.

I mean down the stairs. You know, heart health.

You both work here. You can't keep avoiding her.

I came here to work. That's what I'm gonna do.

When I have to work with Dr. Grey, I will.

I don't think that's all you came here for.

Look, can we go back to before I opened my mouth about my personal problems?

And we can just be work colleagues.

Can we do that, please?

Number 32 down is "cornpone."

Took me forever.

[Door opens]

Jo: [Sighs] when are you gonna talk to Lebackes?

Not till I'm sure I have my old job back.

Dr. Willis?

I thought this board appointment was a done deal.

Thank you.

But now that I have to compete for it...

Dr. Willis.

I think Lebackes will understand. I just have to find the right moment.

Dr. Willis.

I think she's talking to you.

Oh, hi!

I think you're with me today. You ready for rounds?

Yes. Sorry, but it's... it's Wilson, not Willie.

Oh, god. I'm so sorry.

[Chuckles] That's okay.

Wilson. What's first?

Jo. Josephine.

Not your name.

What patient is first?

Right. Uh... [Clears throat] Dr. Bailey needs a consult.

[Screams]

[Monitor beeping]

Dr. Bailey.

This is Robbie McCutcheon, 22.

No medical history or cardiac risk factors.

Robbie is currently trying to pass a pretty impressive kidney stone.

Hi, Robbie. I'm Dr. Pierce.

[Screams]

Oh, you hang in there, Robbie.

He's scheduled for a percutaneous nephrolithotomy to remove the stone.

Too big to pass on his own?

I had a child once.

I'd rather have four more than do what he's trying to do.

[Screams]

Hang in there, Robbie.

Hang in there, Robbie.

Jo: Robbie's been having fairly sustained runs of v-tach.

Dr. Bailey ordered a cardiac panel and a stat EKG.

Robbie, is the pain just in your stomach, or does your chest hurt, too?

Chest.

Um, get me 80 milligrams I.V. sotalol and 6 of morphine.

Woman: Yes, doctor.

Robbie, I'm going to need you to take some deep breaths.

[Straining] It hurts.

I know.

[Grunts]

Bundle branch block re-entrant v-tach.

He's at risk for sudden cardiac death?

[Groans]

Breathe, Robbie.

[Breathing deeply]

Maggie: Just relax.

[Steady beeping]

Good.

Okay, you got a normal sinus rhythm.

He's at risk for even minor surgery.

You'll have to postpone until I can do a full work-up.

He'll need an echo. Who's next?

Rita, Eric.

All settled in?

Getting there.

Hit it, Milton.

Wilson.

[Elevator bell dings]

God. Sorry.

Rita Choudry, 35, 33 weeks pregnant, admitted for low sats and bed rest.

Forever.

Really? I have to be here until this baby comes out?

Yes, you do. Tell me why.

Rita suffers from Ebstein's malformation.

Which is?

A congenital malformation of the tricuspid valve.

Arizona: Excuse me, Dr. Pierce.

Do you mind if we play through?

Absolutely.

You have a patient here, too.

Baby girl Choudry, EDD 6 weeks.

She suffers from double inlet left ventricle, which will require immediate heart surgery when she's born and fetal monitoring until then, which is why we've admitted her mom.

Maggie: And also because...

I know. I know. Because the strain of childbirth might cause my crappy heart to poop out.

I just need to be sure you know the risks.

And the risks are having this baby could k*ll me.

Please stop saying it.

I've heard it, and I refuse to believe it, right, hon?

Yep.

Well, get settled, relax.

You'll be seeing way too much of us.

[Chuckles]

Her chances are that bad?

There's a good possibility she'll die trying to have this baby.

She was strongly advised against it.

Then why take the case?

Because she decided to have it anyway.

And I like my chances better than hers.

That sounds braggy.

No, it sounds badass.

[Elevator bell dings]

What's next?

Marjorie Reed, 88, stage IV small cell cancer of the lung with mets to the liver.

Marjorie, how you doing now?

She says her stomach hurts, but I think she's doing better, thanks to you.

Thank you again.

Mom! I'm gonna go get some tea!

I'll be right back, okay?

You gave us a big scare this morning.

No more of that, okay?

That happens again, I want to die.

Oh, please, please, let me die.

Grey's Anatomy 11x02
Puzzle With a Piece Missing

Marjorie, do you know where you are?

Do you know...

You think... [Chuckles]

You ask me if I'm out of my mind?

I'm... I wouldn't say...

[Chuckles]

Yes.

I've lived 88 years, 65 of them with my husband.

More with him than without.

We taught English in Japan for awhile.

[Chuckles] Looks like here, Japan.

So green.

We taught English.

Did I say that?

Yes, you did.

Oh.

Now I live in this ugly room with these ugly machines, alone.

Ohh. Oh. But hurting constantly.

Uh, these dr*gs you give me make me forget.

I'm forgetting my life.

It was beautiful, my life.

I earned a better end than this.

There are forms you can sign.

Oh. Jeannie won't let me.

She'd never forgive herself if she didn't do everything she could.

Bless her heart, but she's scared.

Always has been.

Hmm.

Where she gets it, I have no idea.

And... Am I out of my mind? No.

When it's my time, I should get to die remembering my life.

Shouldn't I?

[Indistinct conversations]

I don't understand. Can't we override the daughter?

She has power of attorney and the mother won't do it.

And unless she has a signed DNR, we are legally required to do...

To do everything we can to save her.

Even though I almost k*lled her this morning trying to do it.

Then talk to the daughter.

It's trickier than that.

Jeannie: She's better, right?

She seems better.

Jeannie, I'm afraid she's not.

Your mother's cancer has progressed beyond what we can hope to treat or cure.

But she survived this morning and...

She is in incredible pain, and the process of resuscitation is so hard on her.

Jo: If it happens again...

What? What is she saying?

I'm afraid it's only a matter of time now, and your mother deserv...

Jeannie: Is she saying I should let her die?

No! You're her doctor.

You do whatever you have to do to keep her alive, To save her, right?

You're her doctors, right?

Of course.

You don't speak to a patient unless I tell you to, is that understood?

I was just trying to help...

You don't counsel a patient's family on patient care, understood?

I got it.

Now you've made that woman think that we are pushing for her mother to die.

I got it. I'm sorry.

Okay.

I just had to bring the thunder.

Bring the thunder?

When you seem really nice or young or pretty, sometimes people don't take you seriously.

You have to help them understand who they're dealing with.

You have to bring the thunder.

If you don't do this, you should.

You're really pretty. What's next?

Robbie McCutcheon's cardiac echo came back.

[Breathes deeply] Well, that sucks.

What sucks?

Robbie has dilated cardiomyopathy.

Should get cardiac anesthesia involved before you operate.

[Screams]

Oh, hang in there.

We're gonna have to before that boy tries to push a pencil eraser through his... pin hole.

If you don't mind, I'd like to send out for Robbie's full exome panel.

Just out of curiosity.

You want to know if his cardiomyopathy is genetic?

It's a little project I'm working on.

I can run it for you.

You have a genome lab here?

Jo: We did. The board just voted...

We do, and I still have a set of keys.

And if the board has a problem with that, you have them come talk to me, and I'll tell them what hole they can push that through!

[Elevator bell dings]

[Robbie groaning]

[Sighs]

Was she bringing the thunder or did we just piss her off?

Dr. Bailey doesn't need to bring anything.

She is the thunder.

Oh.

The board just voted to shut down her genome lab, then they promised her a seat on the board, but she's probably gonna lose it to another surgeon.

Wow. Rightfully pissed.

Well, there's two sides to every...

What's next?

[Cellphone chimes, vibrates]

Uh, Rita Choudry's complaining of back pain.

Who is Dr. Karev?

Why?

He's paging me for a consult.

Oh, that's, uh, the guy that's gonna take Bailey's board seat.

Uh, you saw me talking to him this morning.

He's in private practice, but he's gonna be appointed to the board, so he'll be coming back.

Okay. First Rita, then Dr. Karev.

Rita: I don't know.

I've had a lot of lower back pain throughout this whole pregnancy, but this is different.

It's high in the center and it burns.

All right, Rita.

Dr...

Wilson.

Sorry. It's weird. I'm really good with names.

Really?

Dr. Wilson is gonna take you for a C.T.

Okay?

Is there... Is there something wrong?

Not necessarily.

Back pain can mean a lot of things.

Could just mean you're pregnant.

[Chuckles]

♪ You see 'em coming at you every night ♪

This kid's had persistent hypoxia and occasional PVCs.

Could you check his cardiac function?

We'll just take a look.

Who are you?

How is it you and I haven't met yet?

I've been here less than a month.

Maggie Pierce, new head of cardio.

Well, don't be afraid to dance, Maggie.

Oh, I'm not afraid. I'm just not going to.

People are great here... really fun.

Right, Karev?

Karev worked here.

I know.

And I hear congratulations are in order. The board?

What's that?

Nothing.

I said I hear congratulations are in order!

No.

For what?

I hear you've been appointed to our board.

Well, that's not really... it's, uh...

Stop the music.

♪ You give it... ♪

[Music stops]

[All groan]

Something you want to tell me?

Was that...

I was gonna talk to you at the right time.

Are you quitting my practice?

No, I've just been offered a...

Are you quitting my practice?

I... Might be.

I chose you!

I selected you to have the keys to the premier imperforate-anus practice in the nation, And you take another job behind my back?

I was gonna talk...

You are not quitting my practice.

I am f*ring you from my practice.

I'm not seeing any cardiac abnormalities, so... and I am gonna tell your tale of disloyalty far and wide, my friend.

I will make sure that everybody knows that you're as deceitful as you are stupid.

I'm, uh... Just gonna go.

[Indistinct conversations]

Watson.

That is not my name.

You were indiscrete and stupid, and you are off my service.

Wait, what?

Karev's your boyfriend, right?

I've been...

Yeah, he is. I could tell.

But you just met me and apparently felt it appropriate to casually share confidential information about your boyfriend's career and then fail to tell me it was confidential, so I just used it to make small talk.

And now I don't ever need to learn your name because you are off my service.

Is this you bringing more thunder?

No, no. No, this is me being pissed.

Because I can't trust you.

Go swap with a resident I can trust.

And you just got your boyfriend fired.

Dr. Pierce, did you ask for all of Dr. Yang's chart on the McNeil family?

Y-yes. I did link McNeil's transplant the day Yang left.

I know. I just wondered why you needed access to the rest of the family's.

I mean, three kids in one family with cardiomyopathy?

It just bugged me why no one found out why.

Hmm. It bugged us, too.

Dr. Yang ran every imaginable test, including a full exome panel.

Now, you really think you could find something that she didn't?

Do you think that's impossible?

I think in most cases, this disease is idiopathic, and its cause remains a mystery.

I think the McNeils have been through a year of hell.

Unless you have something new to tell them, they're gonna build up their hopes for nothing.

I think we should leave them alone to heal.

Yes, sir.

Thank you.

[Indistinct conversations]

[Cash register beeping]

Hi.

Hello.

Hello.

Who are you?

Zola, sweetie. Zola, sweetie. Come on over here.

Come and sit down right here. Dr. Pierce, right?

Dr. Shepherd. Nice to meet you.

Hi.

You've met Dr. Grey.

Yes. Hi.

We've met.

Who is this?

Uh, this is our daughter, Zola.

Oh.

Hi, Zola. I'm Maggie.

Oh.

[Chuckles]

I hear you're going to run the new brain-mapping initiative at the N.I.H. That's very exciting.

Uh, I'm... I'm not.

Oh. I'm sorry. I was misinformed.

I'm really k*lling it today.

We have two children. Their lives are here.

Being away from my family is... uh, it's untenable for me.

I totally understand.

My family's back in Boston. It's very hard being away.

Isn't that gonna get cold?

Would you like to join us?

I'm gonna... I have to talk to Dr. Webber.

Nice to meet you both.

This big secret is why you ended up at a meeting in the first place.

Look, I...

May I join you?

Um...

Amelia Shepherd, do you know Dr. Maggie Pierce?

Weird, you're the second Dr. Shepherd I've met today.

Derek is my brother.

I'm sorry. Is everyone in this room somehow related?

[Laughs]

I'm gonna leave you two alone. Nice meeting you.

[Clears throat]

Meredith Grey has an adopted daughter.

Uh, I-I know this.

Well, I didn't.

Zola came to them as a patient through the African Exchange Program.

Spina bifida. And they adopted her.

Oh, my god, just stop.

I'm sorry?

It's easier when she's just a rude bitchy person I don't care to know, but she keeps getting...

She adopted a beautiful, surgically needy African orphan.

It's annoying. [Sighs]

Should I talk to her? What do you think? Honestly.

I think she's more than you bargained for.

But I think when the world gives you more than you bargain for...

You usually end up glad you got it.

You're staring.

Isn't it funny?

She adopts a kid, her mother gives one up.

You have no idea what the story was there?

I never knew anything about it.

[Sighs]

I do know this...

Based on what I know about Ellis, leaving you would have been the most difficult decision of her life.

How well did you know her?

Jo: Dr. Pierce, bad news.

You're off my service.

I know, just look, though.

Oh, god. Let me find Dr. Robbins.

I'll go talk to them.

Okay.

Callie: The fellowship committee wants an answer tonight?

Sorry, Dr. Robbins?

One minute, okay?

Listen, I am... I'm surprised that you're surprised by this.

I mean, it's a natural extension of what I already do.

I'm surprised because it came out of the blue.

No, I thought about it for awhile.

I mean, I need something new.

We're having another kid. That's not new?

This is different. It has nothing to do with that.

It does, though. I have research.

With you at work and then the fellowship, how do we have time for a new baby? How?

Well, you know what? I haven't said yes yet.

But you're going to.

Listen to me. I haven't made up my mind.

Oh, see, I thought you had.

I thought we were having a kid.

I'm sorry.

About what?

I wasn't listening.

[Sighs] You're nice and full of crap.

How's it going?

Not good.

You're having an aortic dissection.

There's a tear in the inner wall of your aorta that causes blood to force the vessel apart.

Oh, god, I knew it.

What about the baby?

Arizona: The baby needs to come out.

An O.B. will do an emergency C-section, and then Dr. Pierce will prepare the dissection.

But isn't she too little? Can she handle the surgery?

We don't have a choice.

If I don't operate, you'll die.

Just make sure that my baby is...

Rita, please! Please stop talking about the baby!

I told you not to do this! I knew something like this would happen!

Eric?

Maggie: Eric!

Step outside. Please.

Arizona: I'm gonna call up and let them know we're coming.

Okay?

[Crying]

Edwards, Whitton, get her ready to move.

[Indistinct talking over P.A.]

I know this is scary, but it's happening.

And the only thing she needs right now is your support.

I can't do it anymore. I can't support her k*lling herself!

She doesn't want to lose a child.

We already lost our child.

Five years ago. Madeleine. She was 2.

They were walking down a sidewalk.

Maddie wanted to run.

Rita let go of her hand so she could run.

Maddie tripped, she hit her head, and she was gone.

Four feet away from her mother.

Just a freak thing, you know?

But Rita will always believe it's because she let go of her hand.

I'm sorry.

And then when Rita got her diagnosis, I never thought we'd have another child.

We knew with her heart what it would do to her.

And when she got pregnant, it was an accident.

And I begged.

I begged her not to have the baby, but she just...

She wouldn't let it go.

Yeah, now I'm gonna lose them both.

Eric, nobody wants it this way, least of all Rita.

She made a hard choice for the sake of the baby.

We just need to have the faith that she has.

Arizona: Okay, they're ready for us.

We're gonna do our best for her, okay?

[Monitor beeping]

How do you feel?

I wish she could have cooked it a little longer.

How do you feel?

I wish I was anywhere else.

Good luck.

You, too.

How's that baby doing?

Baby's cyanotic and apneic. Dr. Robbins?

Let's get to work on Rita.

We need to get the baby's airway cleared.

Let's get her breathing and get her to the O.R.

You ready?

Mm-hmm.

Okay, she's breathing. She's ready to move.

Robbins, keep me posted.

I will.

Scalpel.

Dacron graft and 4-0 prolene, please.

Damn it. Damn it. It's tearing more.

Pledget.

When we're done here, I'd like you to remember that you are...

Off your service. I know.

You want me to leave now, I'll leave now.

Another pledget.

All right. Let's see if this heart will start.

Internal paddles, please.

Any update from Robbins? How's the baby?

Dr. Robbins can't talk.

That can't be good.

[Flatline]

Okay, charge to 10, please.

All right, everybody, cross your fingers, pray, do whatever you do.

[Paddles charge]

And... Clear.

[Thump]

[Flatline]

Again?

Wait.

[Heart beats]

[Monitor beeping]

We have sinus.

Thanks, everybody.

I got to go check on that baby. Can you close?

Can I close?

You're a third-year resident.

Can you close a midline sternotomy?

Can I trust you to do that?

Yes.

Yes, absolutely I can.

[Flatline]

Arizona: She's flatline.

Suction. I can't even see the field.

Come on. Come on.

What happened?

I'm losing her.

There's a solution. We'll find it. Talk me through it.

I was banding the pulmonary artery together when it perfed through her vessels.

Okay, can you try a systemic to pulmonary artery shunt?

It won't help. They're both too small...

To take the pulmonary pressure.

It's not in her vessels. It's something else.

It's the ventricle. I can do a septation.

Separate her one good ventricle...

Into two ventricles.

Septation has a pretty high mortality rate.

Well, she currently has zero chance of survival.

So this is better.

This is better. Let's start bypass.

Push heparin and get me my loops.

[Telephone rings]

Woman: Nurses' station.

How's Rita Choudry?

Good. Easy closure. She's in post-op.

You can check my work.

[Cellphone chimes, vibrates]

How's the baby?

It got complicated.

I'm going to the E.R. for a consult.

I'll come with you.

You can go home.

You're off my service.

See, I wanted to talk to you about that.

Hey, it's Dr. Blabbermouth.

Dr. Karev, I am sorry...

Next time, maybe don't speak up till you know what you're talking about.

Look, it's my fault.

I sent her in there with half the story. It's me you should be pissed at.

Okay, well, now I'm pissed at you.

Sorry. I didn't know she was gonna say anything.

Why did you even tell her in the first place?

Alex, I said...

Now I got no job.

[Elevator bell dings]

[Siren wails in distance]

Dr. Shepherd, I was called for a cardio consult.

Was that you or the other Dr. Shepherd?

Coming through.

I love you.

[Chuckles] Thank you.

I'm sorry... no one has ever called my brother "the other Dr. Shepherd."

It's beautiful. I called you.

Over here.

This is Tracey, early 20s, possible minor ischemic stroke.

A-a stroke? I gave her a stroke?

After sexual activity.

Amelia: Tracey, could you squeeze my fingers?

Really hard. It's okay. I've got you.

Just relax.

Any more history?

We don't have a last name.

We just met, like, an hour ago at the gym.

We went to my place.

What? We hit it off.

Like gangbusters.

Sorry, but was this sexual activity pretty vigorous?

It was really good. At one point, we were...

That's all I need. And then it was over, And... and... and she went all wonky like this.

Do people get strokes from sex?

Almost never.

So, was it just... Me?

What answer are you hoping for?

Maggie: Did she say if she was on the pill?

We used a condom. I'm not stupid.

I'm looking for possible risk factors for stroke.

Birth-control pills can increase the risk of blood clots.

There was no I.D.?

Oh, I couldn't find her purse.

Tracey, can you tell us your last name?

Re-re... [stammering]

Regger? Roger?

Yeah, I did this for 10 minutes, guys.

She was at the gym. Did she have headphones?

Uh, yeah. This is hers.

She'd have to register that thing to put music on it.

Get a serial number, call the company, get a name, and get a history.

Woman: On it.

Nice one, Sherlock.

I'll get an echo and some chest films. [Cellphone chimes, vibrates]

Okay, meantime, let's get a head C.T. and a bilateral carotid artery doppler.

April: Mm-hmm.

[Indistinct talking over P.A.]

What the hell is she doing?

Marjorie got hypotensive. Grey was here.

She decided to put in a central line to give her pressors.

Dr. Pierce, Dr. Bailey told me you ordered an exome panel for her patient.

They caught me. And I threw you under the bus. Sorry.

Jackson: Yeah, Dr. Bailey's genome-research program has been discontinued.

You know, I heard that.

And I have to say, I think it's stupid.

Genome mapping is like getting the answers in the back of the book.

It is the key to so many medical solutions.

Closing that program makes your board look like a bunch of morons.

Have you met Dr. Avery?

Yeah, plastics, right?

Dr. Avery is also a voting member on the board.

[Clears throat]

Of course you are.

Yeah, I like her. [Chuckles]

You put a central line in my patient without notifying me first.

There wasn't time.

There was time to ask a nurse to tell me.

Doesn't work like that here, Pierce.

I don't need your permission to keep her from dying.

She's right, Dr. Pierce.

Damn it.

[Indistinct conversations]

Listen, I get that I'm new.

I get that you don't know me, but I'm gonna demand that you listen to me.

Like it or not, I am the chief of cardiothoracic surgery.

You can't even look at me when I'm talking to you.

Dr. Margaret Pierce? [Ukulele plays]

[To tune of "Yankee Doodle"] ♪
We're so proud, we'll shout it loud ♪
♪ 'Cause we've no doubt that you'll be ♪
♪ Doing great as chief of cardiothoracic surgery ♪
♪ Maggie, we are so impressed ♪
♪ you're our favorite surgeon ♪
♪ we send you our best wishes fro-o-o-m ♪

It's a gift.

♪ This giant singing sturgeon ♪

From my parents.

♪ We love you, Maggi-e-e-e-e-e ♪

[Laughter, applause]

[Thunder rumbling]

It was... No, it was hilarious!

Everyone thought it was hilarious.

The timing could have been better.

[Siren wails in distance]

It was incredibly cheesy, and I loved it.

It was perfect. Thank you.

Nothing, I'm just...

I just miss you guys.

No, nothing happened, mom. I just...

[Voice breaking] I think it might have been a mistake coming here.

I don't feel like I can be myself.

Dad, don't start crying.

I got to go.

[Thunder rumbling]

[Siren wailing]

So, Tracey's coming around.

She was lucky... minor stroke.

Nerve responses returning, no signs of deficits, But we still don't know...

What caused it, right?

Uh-huh.

No signs of cardiovascular disease, No signs of carotid disease.

So I thought...

Are you listening?

Sorry.

I was thinking I have had good sex, but I've never had put-you-in-the-hospital sex.

I feel like I'm missing out.

So, I was thinking, could the clot be coming from some...

I mean, I don't want a stroke, but I'd like to get close.

The clot could have come from someplace else.

Guess that's what you call one mind-blowing orgasm.

Are you done?

I have one more.

He nearly screwed her brains out. I'm done.

And I found one in her leg.

[Sighs] I have not had sex in a long time.

[Sighs] You're preaching to the choir, sister.

The clot in her left leg meant there must be a hole in her heart.

[Computer beeping]

Through which the clot in her leg, with help from pressure changes during very good sex, traveled from the right to the left chamber of her heart, on up to her brain.

Now I just have to plug the hole like... this.

Amelia: Nice catch, doctor.

Or should I say...

♪ Chief of cardiothoracic surgery ♪

Oh, dear god. You heard.

[Amelia chuckles]

Your parents sound like very sweet people.

They are. They're very sweet and very funny And nothing at all like me.

No understanding of what I do or why I like doing it.

Oh, I know that feeling.

I always felt like the odd man out.

I have three sisters and a brother.

They are all very put together, and I... kind of a mess.

It wasn't until I met Meredith I had a sister I could relate to.

Really?

Not at first. You know?

She's... hard to get to know, but she's worth knowing.

Really.

Dr. Pierce.

Dr. Bailey...

You are not on...

On your service. Yes.

Dr. Bailey asked to see you when you're finished.

[Computer beeping] I apprehended the culprit.

RAF1 mutation right there.

That little orange bastard caused Robbie's cardiomyopathy.

RAF1. Since when?

Well, it was just isolated a month ago by a doctor in Australia, and the screening panel was updated last week.

So, until a week ago.

We didn't know what caused cardiomyopathy.

Is this what you wanted?

Yes!

Genetic profiling is a rapidly growing science.

New findings crop up every single day.

For example, three months ago, there were only 33 known genetic causes for cardiomyopathy.

Today, there are 34.

This right here... This is the genetic mutation that gave your kids cardiomyopathy.

Sabine: That's what made our kids sick?

Yes.

There's... So it isn't our house.

It isn't the water.

It isn't anything, uh, we did.

It wasn't me.

No, Sabine, it wasn't you. Sabine.

[Sniffles]

Everything that you have done has made your kids healthier and safer.

You did everything you could.

Dr. Yang did everything she could.

No one could have known about this.

Okay.

Why... Why did you keep looking?

I just... When I find a puzzle, it's very hard for me to put it down.

[Cellphone chimes, vibrates]

Son of a bitch. I'm sorry. I-I got to go.

Thank you.

Sabine: Thank you so much.

[Rapid beeping]

I need that crash cart in here!

Wait. Wait. Wait, wait.

Wait for what?

Get off.

I got it! I got her!

You got to go harder than that, Pierce.

She's my patient.

I know what she can take.

Okay, let me in. I have to shock her.

I have this.

Pierce, you're not helping her.

Dr. Grey, she can't take the defibrillation.

I got this.

Marjorie.

You're all right. You're okay.

I'm here with you. It's okay.

Pierce, you're letting her die.

Pierce.

You're okay.

Pierce!

It's okay.

[Beeping continues]

You're okay.

[Flatline]

Time of death.

Time of death, Dr. Grey.

Nurse, what is the time?

20:42.

Time of death... 20:42.

Owen: [in distance] Pierce.

Pierce. Pierce, hold up.

Chief.

I just wanted to say thank you for what you did for the McNeils.

You gave them... some peace.

And [sighs] I'm glad you're here, so... Thank you.

You and Yang did all the hard work.

I just got to bring it over the finish line.

Meredith: Chief.

I think you should know that Dr. Pierce just slow-coded a patient right in front of me.

What? Grey, that is a...

I watched it happen.

She deliberately withheld care from a coding patient.

Her CPR was totally ineffectual and she would not let me defibrillate.

Slow down.

Dr. Grey.

You let that woman die.

Grey, slow down! Pierce.

Dr. Grey has been doubting my effectiveness and undermining my authority since the minute I got here.

Maybe I'm being judged too harshly against my predecessor or maybe she just doesn't like me, but I can only say to her what I will say to my patient's family...

I did everything in my power as a physician to help her, but I am sorry to say she's gone.

Are we finished, Chief?

For now.

Grey, wait.

If you want to get me fired, go ahead. I don't care.

If you want to tell that woman what I did, fine.

But tell her the whole truth.

Her mother begged me in no uncertain terms to end her suffering naturally.

She would have signed papers to that effect, but her daughter wouldn't allow her to.

Her daughter was too scared to realize that she was keeping her alive and in agony.

I did what my patient and I decided was in her best interest.

You look me in the eye and tell me you wouldn't have done the same thing.

Jeannie: Is she all right, my mother?

I went for dinner and some errands, but when I came...

Jeannie. I'm sorry.

Your mother's heart stopped again, and I...

I...

Dr. Pierce did everything in her power.

Despite all our efforts and capabilities, we weren't able to save your mother.

I am very sorry for your loss.

[Crying]

I'm saying that I think you're right.

You know, maybe this is something that I can give up So that we can have, you know...

Hey. How's she doing?

Oh, um, no signs of cyanosis or congestive heart failure.

So far, so good.

Nice work.

You, too.

You should go see her.

[Monitor beeping]

Thank you, doctor.

So?

So, I'm gonna pass on the fellowship.

No, you're not. You can't.

What?

Look, I was wrong this morning.

This isn't a sacrifice that you should have to make.

We can figure this out.

If it makes you happy, that will benefit our kid...

Kids more than anything.

So, you think I should do it?

I think you have to.

[Gasps]

[Laughs]

Oh! Thank you.

Goodnight, Dr. Robbins, Dr. Torres.

Where... where's the baby? Is the baby...

The baby's fine. She's beautiful.

[Sighs deeply]

Thanks to you, she's fine.

Maggie: I'll let you know as soon as you can go see her.

Looks like a full recovery, and we found her parents, Sherlock.

They're on their way in from Arizona.

Can I ask you guys something?

We just hooked up the one time, but I wanted to ask her out because she was really cool, you know, before she went all derp.

Should I hang out till she wakes up, or does that make me look, like, clingy?

[Elevator bell dings]

Um, that's... Sweet.

Well... I was once the girl who went home with the guy she met an hour ago.

If this had been me, you would be the last person I'd want to see.

Oh.

Okay.

Yeah, maybe run into her at the gym.

Maybe learn her last name. Maybe invite her to dinner.

Yeah.

Can I have your number?

Go.

Go.

Most puzzles come down to one last missing piece of information.

Whether it's the answer to a medical mystery...

Pierce figured out what happened to the McNeil kids?

Mm-hmm.

That's surprising.

She solved it. She did what Yang couldn't do, and she hates me.

Hi.

[Gasps]

I finished your post-ops. Anything else?

You don't take no for an answer.

So you're insubordinate, as well as everything else.

No.

No?

No!

I am not insubordinate or untrustworthy.

I think We got off to a bad start.

I made a mistake. I should have told you the whole story.

But I came here to learn, and I learned a crap ton from you today, so I decided I deserved a second chance, And you weren't gonna give me one, so I gave myself one.

Or to the question of who you are, where you fit...

Is this your thunder?

Yeah.

All right, Wilson.

I'll see you in the morning.

You called me by my name.

I did.

You keep checking your watch.

Did you write my name on your wrist?

I did.

I appreciate the effort.

It all comes down to that last piece.

Grey, wait. Can I talk to you?

Tomorrow. I'm heading home.

There's something I should tell you.

You know what? I've heard enough.

It's fine. We're fine. You're fine.

My mother was Ellis Grey.

That's why the final piece of a jigsaw puzzle is so satisfying to place.

I know. I'm sorry.

We... this isn't fair to you.

And we got off to a bad start, but I'm here to work.

And if I'm gonna be here, I got to be who I am.

So I need you to know the whole story.

I was put up for adoption in Boston.

In Boston?

Yes.

And I was adopted by a very nice couple... an amazing couple.

They are my parents, but my mother... My mother...

I found out a year ago.

My mother is your mother, Ellis Grey.

Unless, of course, the piece doesn't quite fit.

What do you want?

What?

What are you after here?

I know it sounds like...

You're five years younger than me.

If my mother were pregnant, I would have known.

You're wrong.

Just...

Or you're lying.

What? What? Just listen.

Stay away from me.

[Siren wailing]

That can make you wish you'd never opened the puzzle in the first place.

[Thunder rumbles]