01x07 - The Self Destruct Button


1x07: The Self Destruct Button

Original Airdate: 5/8/2005

Written by: Kip Koenig

Directed by: Darnell Martin

(Meredith is in bed, naked, her alarm starts going off. Derek reaches around her to cuddle.)

MVO: Ok, anyone who says you can sleep when you die, tell them to come talk to me after a few months as an intern. Of course, it's not just the job that keeps us up all night.

Meredith: You have to get up now.

Derek: What? My God, what time is it?

(She rolls on top of him)

Meredith: It's 5:20, and I have pre-rounds. And you have to leave before they see you.

Derek: Oh, come on, now. Why don't you just let them see?

(He rolls on top of her)

Meredith: No!

Derek: Please!

Meredith: No, No!

(Izzie is watching coffee percolate in the kitchen when George enters)

George: You get any sleep?

Izzie: Oh, she could oil the bedsprings as a courtesy or at least buy a padded headboard.

George: So who's the guy?

Izzie: You think it was just one guy doing all that work?

George: Yeah, do you mind if I don't think about that?

Izzie: Oh, jealous?

George: I'm not jealous.

Izzie: Well, I am. But at least I know she'll be having a long day at work.

(Derek tries to sneak out but Izzie and George see him)

Izzie: Well, at least we know brain surgery isn't his only skill.

George: They can't be...He's her boss.

Izzie: We're late. He's all of our boss. You know she has been scrubbing in a lot lately on his surgeries.

George: No, Meredith wouldn't sleep with him just to...No.

Izzie: Well, if she's not ashamed of it, why is she keeping it a secret?

George: Maybe she didn't. Maybe it just happened. You know, spontaneously, last night.

(Meredith enters kitchen)

Meredith: Hi. Good morning.

Izzie: Morning. Hey, so it sounded like you were having some pretty radical s*x last night, all night long. Who was the guy?

Meredith: no one you know.

Izzie: We're late. Let's go.

MVO: I mean, if life's so hard already, why do we bring more trouble down on ourselves? What's up with the need to hit the self-destruct button?

(They arrive at work and get out of the car. Cristina is on the parking lot on her motorcycle.)

Meredith: Yikes, wouldn't want to meet you in a dark alley.

Cristina: Right back at ya.

(Alex jogs up)

Izzie: A run? You run?

Alex: Every day, babe, every day.

Meredith: Not suffering enough?

Alex: What doesn't kill you, makes you stronger.

Cristina: Don't go acting all indefatigable. You're dragging like the rest of us. Oh, what is that, professional weakness, Dr. Yang?

Cristina: It's called the flu.

Alex: Yeah.

(Interns are in the locker room)

George: I'm gonna need a major rush to make it through this day. I need a kick-ass surgery.

Alex: Ooh, you a bad boy last night, George?

Izzie: That would be Meredith.

Alex: You a bad boy, Meredith?

Cristina: Do tell.

Meredith: Nothing to tell.

Cristina: That says it all, huh?

(Izzie slams locker door)

Meredith: Sorry, I have a s*x life.

Alex: Don't apologize. Embrace it. Share it. Count me in.

Izzie: Yeah, next time, just let me know if I need to go to a hotel so I can get some sleep.

Meredith: Am I missing something?

George: You were just a little loud.

(Everyone leaves except Meredith and Cristina)

Cristina: Do they know its McDreamy keeping them up all night?

Meredith: I hope not. I already have Bailey riding me, I don't need my roommates thinking I'm getting special treatment.

(All interns are in hallway with Bailey. Meredith yawns)

Bailey: O'Malley, Yang, Karev, go on to clinic.

(George and Bailey watch Derek putting in eye drops through the window)

Bailey: O'Malley, patients are waiting. You two come with me. Izzie, you're hanging with me today. Good morning, Dr. Shepherd.

Derek: Dr. Bailey. Late night, Grey?

Meredith: No, caffeine just hasn't kicked in yet. If you're at all religious, you would want to start praying it kicks in soon. There's a consult in the pit. Girl with a fever and abdominal pain. After that, Nicholas in 3311 needs his meds. Mr. Moeller's IV fell out, and he's a hard stick. Postops in 1337, 3342, 3363, and 2381.

Meredith: 381. 3342, 3363, and 23...

Bailey: Why are you still standing in front of me? (Meredith leaves) (To Izzie) You look more like me than you right now. What's the matter?

Izzie: Nothing

Woman: Help! I need immediate help.

Bailey: What's the problem?

Woman: My damn boyfriend swallowed my keys.

Man: (With difficulty) I didn't want her to leave.

Bailey: Locate the lady's keys.

(Meredith is examining a girl about 18. Claire Rice is biting her nails. )

Mrs. Rice: I think she got some bug on her trip to Mexico with her friends. I told her not to go to a Third-World country, but does she ever listen?

Mr. Rice: She's been weak ever since and she's lost weight.

Claire: Barely.

Mr. Rice: And this morning, she passed out in the shower.

Meredith: When was the trip?

Claire: A couple weeks ago. I'm really fine. I just have a fever.

Meredith: Ok, well, will you lie back for an exam for me?

Claire: No, please, I don't need an exam. Just give me some antibiotics and send me home.

Meredith: Well, maybe it is just a fever, but they called down for a surgeon, so I have to give the ok to let you go. So just let me do the exam.

Mr. Rice: Do the exam.

Claire: No. This is crazy. I'm fine.

Mrs. Rice: For God's sake, Claire, I don't want to spend my entire day here.

Meredith: You know, actually, Mrs. Rice, this might be easier if we had some privacy. So would you two mind leaving the room?

Mr. Rice: That's fine.

(Hospital admitting)

Digby: Digby. Digby Owens. I have an appointment.

Alex: Excuse me, sir, uh, you're bleeding. You mind if I...

Digby: Sure, sure. Have a look.

Alex: That's a gunshot.

Digby: Yeah.

Alex: We got a gunshot wound. We got to get him down to the pit.

(Cristina runs up with wheelchair)

Alex: Sit, Mr...

Digby: Uh, Digby. All right, but it isn't an emergency. I scheduled it.

Alex: What, the gunshot?

Digby: Yeah. My buddy shot me.

Cristina: Buddy?

Digby: Yeah, just as a favor.

Cristina: On purpose?

Digby: Hell, yeah. I mean he wasn't trying to hurt me or nothing, but you know...

Alex: But why?

Digby: I like the scars.

(Alex is cleaning Digby's wound)

Digby: Look, everyone in town has tats, but my art is about commitment.

Alex: So, this is your art, huh?

Digby: Damn straight.

Cristina: Damn stupid. The bullet went all the way through.

Digby: Bounced off my ribs. I have another one still in my shoulder. Nice, huh?

Cristina: (Sarcastically) You could hang it in the Louvre.

Digby: I have an ethos. Why do anything unless you're willing to go one step further than anybody else?

Alex: What doesn't kill you makes you stronger.

Digby: Exactly. And pain is the great divide. My coach used to say, it's all about how we process pain.

Alex: Football?

Digby: Wrestling, Iowa State.

Alex: Iowa, 141.

Digby: 157.

Alex: You got to be more than 180 now.

Digby: I'd like to see you get back under 145.

Cristina: Excuse me, but thinking of you men in tights makes me want to...puke.

Alex: There's a flu going around the hospital.

Digby: Somewhat ironic.

(Meredith examining Claire.)

Claire: Ow. Don't push so hard.

Meredith: Can you lift your shirt so I can examine your stomach?

(She lifts her shirt to reveal pink scars)

Meredith: Where did you get these? Claire...you've had surgery recently. These scars are still pink.

Claire: Don't tell my parents.

Meredith: You did this in Mexico so your parents wouldn't know? What did you have done?

(George with a young child, her foot is twitching)

George: Ahh. And you noticed her foot twitching? Come on, Jamie.

Jamie: My foot.

George: Oh, yeah. About three months ago?

Mrs. Hayes: Just a little. We took her to County Hospital and she got the CT scan, which showed her...

George: Brain abnormality. Here, you can put it...And the twitching has gotten worse?

Mr. Hayes: A lot worse. They just don't have the proper equipment back home to figure out what's wrong.

George: You did a... you did a good thing.

Jamie: Show Mommy.

George: Yes, your mommy.

Jamie: Show Mommy and Daddy.

George: Ok, you did a good thing by coming all this way, Mr. and Mrs. Hayes. You sit tight Jamie, ok? I'm gonna bring in Dr. Shepherd to see you, ok.

Jamie: Shepherd.

George: Ok? Dr. Shepherd. Ok? He's the brain specialist.

Jamie: Mommy and Daddy.

Mrs. Hayes: Doctor? Is he good, this Dr. Shepherd?

George: At just about everything.

(Bailey and Izzie looking at films of the man who swallowed his girlfriend's keys.)

Bailey: I assume the lady needs her keys to leave this guy's sorry ass behind.

Izzie: Yeah.

Bailey: Well, help her out.

(Start to walk through hall)

Izzie: He needs a bronchoscopy.

Bailey: See one, do one, teach one. You've seen one. It's time to do one.

Izzie: Alone? Seriously? Thanks. I mean, the vote of confidence in my skills and all. I didn't think you well, anyone was noticing how hard I've been working...

Bailey: Izzie? Go.

Izzie: Yeah.

(Bailey runs into Meredith)

Meredith: You paged?

Bailey: Where are we?

Meredith: I did the consult, did the IV, the meds, the Postops, everything.

Bailey: How is your pit patient?

Meredith: She's febrile and has peritoneal signs.

(Cristina walks by)

Bailey: you all right, Dr. Yang?

Cristina: Fine. On my way back to clinic.

(Cristina walks away looking very sick)

Meredith: I think she had some sort of illegal surgery done in Mexico.

Bailey: Botched abortion?

Meredith: No! She has four laparoscopic scars on her abdomen and won't say what they're from, the parents are clueless.

Bailey: She's a minor.

Meredith: Seventeen. Freshman in college.

Bailey: You order up for a CT?

Meredith: Yes.

Bailey: So while she's there, the nurses couldn't get a Foley on Mr. Garay. He may need a Coude cath if you can't get a normal one in there. Write up postop notes on all surgical-floor patients that had surgery within the last 24 hours. Be sure to document their EKG's and x-rays. Hunt them down if you can't find them.

Meredith: Right away.

(Cristina is standing the hallway still sick and Burke walks up)

Burke: Hey. Whoa. Got the flu?

Cristina: Yeah, and thanks for it. It's making my life so much easier.

Burke: I didn't give it to you. It's all over the hospital. You should be in bed.

Cristina: Disease, diagnosis and prescription from one man.

Burke: Seriously, I'll give you a ride home.

Cristina: This is not gonna make me go home. You go home.

Burke: But I feel fine.

(Burke shrugs then feels his glands)

(George is walking through hallway, runs up to Izzie)

George: Hey, hey, hey. Have you seen Shepherd?

Izzie: Not as up close as Meredith has.

George: What? Are you trying to get her in trouble? She's our friend.

Izzie: George, this program will make or break our careers. Some of us will make it through, and some of us won't. And that decision depends entirely on recommendations from doctors like Shepherd. There is a reason we don't sleep with the attendings.

George: It's not her fault, ok. It's Shepherd's. He's the attending, he should know better. He's taking advantage of her.

Izzie: It didn't exactly sound like anything was happening against her will last night.

(Derek in surgery)

Derek: Ok, I think we're in good shape here.

Nurse: I think so, Dr. Shepherd.

Derek: Looks good.

(George is watching from the scrub room, an x-ray tech enters)

X-ray Tech: Here you go, doc. The kid's CTs just arrived from County. Thanks.

(Dr. Taylor enters)

Dr. Taylor: Excuse me.

George: Sorry, Dr. Taylor.

(He enters surgery)

X-ray Tech: That would be bourbon.

George: What?

X-ray Tech: I smelled it too. And he's the best anesthesiologist on the staff. I'll worry when he's too juiced to do his crossword puzzle.

(Dr. Taylor starts working on his crossword puzzle)

Derek: Will you close up for me? Thank you everyone.

(In the hall outside of the surgery)

George: Dr. Shepherd...

Derek: I got to get some coffee.

George: Jamie Hayes has been admitted. The little girl with the brain abnormality.

Derek: How's she presenting?

George: She has what looks like continuous seizure activity in her left foot. Her balance is off. Her parents have come along way to find out what's wrong.

(Derek looks at CT films)

Derek: How old are there?

George: Three months old.

Derek: I need new ones. Her brain could look dramatically different today.

George: Ok, I'll order them...

Derek: Thank you.

(Elevator door closes)

George: ...doc.

(Alex and Burke looking at Digby's x-rays.)

Burke: And that?

Alex: That's a bullet from a previous gunshot.

Burke: Previous gunshot? Ok.

Alex: No reason to take it out.

Burke: No, the guy likes pain.

Alex: It's his ethos.

Burke: Pain as an ethos? Wait, I think I know this guy.

(Bailey walks in, Burke shows her the x-rays)

Burke: You remember this guy?

Bailey: Hey, the tattooed masochist.

Burke: Had himself shot again.

Bailey: Glad to see he's still stupid.

Alex: It's his ethos.

Burke: Let's go tell him what he gets to do today.

(Meredith has been sitting at a desk unnoticed)

Meredith: Dr. Bailey? Claire Rice's abdominal CTs.

Bailey: Is this girl fat?

Meredith: Not at all. She's a normal college kid.

Bailey: So, what do you see?

Meredith: Her stomach's stapled. She's had a gastric bypass.

Bailey: And a bad one, at that.

(Bailey and Meredith in the hall talking to Mr. And Mrs. Rice.)

Meredith: Gastric bypass is a procedure normally done on obese patients to help them lose weight.

Mr. Rice: Claire? She doesn't need to lose weight.

Mrs. Rice: Are you kidding? This means the world to her. (To Meredith and Bailey) But it is so typical of this girl to take the easy way out. She's done it with everything since she was a little kid.

Bailey: Mrs. Rice, nothing about this is gonna be easy. She's gonna face a lifelong struggle with malnutrition unless she has surgery to reverse the procedure.

Mrs. Rice: Do the surgery. (To Mr. Rice) I told her to watch the freshman 15. Don't eat junk, exercise. But when she came home Christmas, who had to take her out and buy her a brand new pair of size 6 jeans because she couldn't get in the ones I got her last summer?

Mr. Rice: Tina, you know, she tries so hard. She does. She gets good grades. She gets A's.

Mrs. Rice: She has illegal surgery in Mexico.

Bailey: Unfortunately, there were complications with the bypass.

Mr. Rice: What do you mean?

Bailey: She has what looks like an abscess under her diaphragm, and edema, which is a swelling of the bowel wall. I can't say for certain she'll recover completely.

Mr. Rice: Just do whatever you have to do to make her well, ok?

(Derek is in Jamie's room)

Derek: you look like a princess. Do you know you're a princess?

Jamie: It's not lipstick.

Derek: It's not lipstick? No, it's not lipstick. Want to do my shoulder? Oh, good.

Jamie: And nose?

Derek: We're gonna find out what's causing these seizures. Does MRI know we're coming down?

George: You said CT.

Derek: Now I'm saying MRI.

George: It's available.

Derek: Good.

Mr. Hayes: Doctor, is she gonna need surgery?

Derek: I don't know yet.

Mr. Hayes: It's just that my wife and I, we both work and I don't know if our insurance...

Mrs. Hayes: We know it can be very expensive.

Derek: I don't want you to worry about that.

(Jamie legs starts twitching quickly.)

Derek: It's a focal, left-side seizure. Ok, let's get the diazepam running now, please.

Nurse: Diazepam, IV.

Derek: Tourniquet please. Jaime, here's what we're gonna do. We're gonna put this on your arm, ok? Isn't that fun? Here, we're gonna put that right there, like that. And this is gonna feel cold. This is a butterfly. Butterfly fly lands right there. Good. Blanket for the butterfly. Good, nicely done.

(Jamie's leg stops twitching)

Derek: It's amazing stuff, isn't it?

Mrs. Hayes: Um-hmm.

Derek: Hey, you like spaceships?

Jamie: Yeah.

Derek: You do? Ok, should we take Captain O'Malley, my first lieutenant, to the spaceship MRI. Let's go.

(Izzie prepares for the procedure on the man who swallowed the keys)

Izzie: It'll be safer to wait until your lunch digests before we do the procedure.

Woman: Perfect, this is just perfect. I was hoping to be in Portland right now.

Izzie: You're gonna be under conscious sedation JP, which means you'll be awake, but groggy.

JP: Wait, wait. Is this gonna hurt?

Izzie: You'll have some discomfort but we'll give you something for the pain.

Woman: Do you know how stupid you make me look.

JP: I thought you would think this is funny.

Woman: Funny?

JP: Romantic?

Woman: Like the therapist thing was funny and romantic?

JP: That was funny.

Woman: No, that was sad. He called my therapist pretending to be his therapist, to find out what I'd said about him.

Izzie: That's a little passive-aggressive, JP?

Woman: A little? He is the king of passive-aggressive. And he's manipulative...and needy...

Izzie: Well, that's the trifecta.

JP: What do I win? (Izzie shakes her head) What?

(Digby is waiting on a gurney in the hallway when Burke and Alex walk up)

Digby: Doc!

Burke: I'd prefer we stop meeting like this, Mr. Owens.

Digby: Digby. So how's the trumpet playing?

Burke: Very safe, compared to your hobby. Getting shot is a little more risky.

Alex: That's kind of the point.

Burke: He's running a fever.

Alex: Due to the extra stress on his body from the gunshot.

Burke: Digby, the impact of the bullet on your chest fractured a rib and caused a hemopneumothorax.

Digby: That sucks, I guess.

Alex: Well, there's blood in your collapsed lung.

Burke: The price of body art went up since your last gunshot.

Digby: Ah, no pain, no gain, right?

Burke: That's one way to look at it.

Alex: We have that in common, you docs and me.

Burke: Do we?

Digby: Yeah, the way you guys push, push, and push. When I was wrestling, if you wanted to pin me, you was gonna have to kill me.

Alex: Iowa style.

Digby: Iowa State style. Back home, we were sworn enemies. But in Seattle, man, we're brothers. So, what are we gonna do about this, um...hemopneumo-Jurassics?

Alex: We're gonna insert a chest tube to drain the blood, then re-inflate your lung.

Burke: Oh, please...tell me I get to watch.

(Burke leaves)

Alex: Oh, man, Iowa style.

(Claire's mom enters her room angrily)

Claire: Before you guys start, I know you're mad.

Mrs. Rice: Disbelief, Claire, just disbelief.

Mr. Rice: I'm just concerned. Where did you get the idea to do this?

Claire: The internet.

Mrs. Rice: But, honey, there is a healthy way to lose weight.

Claire: Yeah, I tried that, but...it doesn't work for me like it does for you.

Mr. Rice: Hey, you don't need to lose weight.

Mrs. Rice: What are you eating? And how much have you been working out? I mean, you know, most of the time, when people hit their target weight, they have to work to stay there.

(Meredith is looking on)

Claire: Everyone gains weight in college, Mom. It's...it's stressful. There's...there's not enough time for exercise. I just thought if I wasn't worried about my diet, then...I could focus more on my studies.

Mrs. Rice: So you took yet another shortcut? Life doesn't work that way, Claire.

Mr. Rice: Tina!

Mrs. Rice: What? You want to argue this?

(He shuts up)

Mrs. Rice: (To Meredith) She has so much potential id she would just apply herself...

Meredith: Ok. Ok, I think we should focus on taking care of your daughter. And, Claire, your parents agree, the best thing to do is to reverse the bypass.

Claire: No! No, it's my body. I do not want surgery again. Please?

Meredith: There were serious complications. And this is about your health.

Claire: But I'd rather be thin.

Mrs. Rice: Well, I'm afraid the choice isn't up to you.

(Jamie is in CT scan and Derek and her parents are looking at the results)

Derek: It's called Rasmussen's encephalitis. What it amounts to is that this side of her brain...(Points to screen) This part's all healthy, working perfectly. This black part of the brain, this...all of that is dead, or dying. The condition has gotten radically worse since her CT scans three months ago. Left untreated, the disease is gonna kill her.

Mrs. Hayes: How soon?

Derek: Too soon.

Mr. Hayes: So is there a cure?

Derek: The treatment requires the diseased portion of her brain be removed and sealed off. See, eventually, the spinal fluid will fill the cavity.

Mr. Hayes: R-Remove? But, I mean, that's...

Derek: Half her brain, yes.

Mrs. Hayes: Half her brain. That...seems impossible.

Derek: Her age makes it possible. Her brain's not fully developed, so the remaining neurons will compensate for the loss.

(Mrs. Hayes runs out, George follows)

Mr. Hayes: But will she be normal?

(Derek and Mr. Hayes walk out. Jamie is on a gurney in the hall.)

Derek: There are risks to any surgery. And this is, you know, a major one. But if we're successful, Jamie could walk out of this hospital in a couple weeks, go on to live a relatively normal life. Look, I know this is a lot to digest. The important thing to remember is that we can save her life.

Mrs. Hayes: Thank you.

(Mr. and Mrs. Hayes go with Jamie)

Derek: Dr. O'Malley?

George: Yes? What? (Sounds irritated)

Derek: I'm sorry to bother you but if the parents consent I thought you'd like to scrub in on the hemispherectomy. Are you in, or not?

George: Uh, in.

Derek: Good.

(Meredith is standing in hallway eating a cookie and looking nauseous.)

George: Yang. I'm scrubbing in on a hemispherectomy with Shepherd.

Cristina: Get out! I would kill for that.

George: We're gonna cut out half a girl's brain and it's going to work. It's outrageous. Almost makes it hard to hate him.

Cristina: Why do you hate him?

George: Oh, no reason.

Cristina: You know about him and Meredith?

George: You know?

Cristina: When are you gonna figure out that I know everything?

(Izzie walks up stairs)

George (To Izzie) She knows.

Izzie: What, about doctor-cest?

Cristina: It's been going on for, like ever.

Izzie: Seriously?

George: And you didn't tell us?

Cristina: Ooh, you're a gossip, huh?

George: I am not!

Izzie: I am.

(Arrive at hospital coffee shop)

George: He's about to go into major brain surgery on no sleep? Not very responsible.

Cristina: Jealous much? s*x all night isn't about being responsible.

Izzie: No, it's about s*x all night. I can't believe you're not more pissed off about this, you of all people.

Cristina: Well, she works hard all day. She's good at her job. Why should you care how she unwinds? I mean, you like to bake all night. Some people like to drink. Others like an occasional screaming orgasm.

(Alex walks up)

Alex: Yeah, we do. Forget I said that. Pretend like I'm not here. Continue. (To Cristina) You look like you need to be spoon-fed.

Cristina: You look like Alex.

George: Yeah, about drinking, Dr. Taylor, the anesthesiologist... (Nods to where Dr. Taylor is standing nearby) Do you think he drinks?

Cristina: I said, whatever gets you through the day.

George: I mean here, at work. Earlier, I thought I smelled...Do you think...? I mean, his patients trust that...So I should say something, right?

Alex: It's a can of worms, George. Weren't we talking about s*x, anyway?

George: Doofus.

Izzie: Ew.

(Burke in a trauma room, working on Digby)

Digby: This is gonna leave a pretty sexy scar, huh?

Burke: Don't get any more crazy ideas.

(Alex takes a Polaroid picture.)

Digby: You really think my ideas are crazy?

Burke: I'm leaning that way.

Alex: We wrestle, he plays trumpet.

Digby: Hey, I feel pretty dizzy.

Burke: You've lost some blood.

Digby: This, too, shall pass. Hey... How come I don't see you down at the Mat in Belltown?

Alex: Oh, man, no time.

Digby: Bro, make time. I'll be expecting you.

Alex: I'm there.

(Bailey and Meredith operating on Claire)

Bailey: Handle with care. This thing's... (Hands her bowel)

Meredith: Full of gunk. I know.

Bailey: We need to free the bowel from the adhesions caused from the abscess. This poor girl. What was she thinking?

Meredith: She wants her mother's approval. She wanted to please her.

Bailey: And this damage is the result? Here, resect that.

Meredith: Needle-tip Bovie, please. (Hands bowel back to Bailey)

Bailey: When you're done here, you have postops waiting.

Meredith: I know, Dr. Bailey.

Bailey: Cristina's got the flu. So, you need to pick up the slack in clinic.

Meredith: Look, I'll mop the floors, ok? (Bailey glares at her) Sorry, that was inappropriate.

Bailey: It's not the only thing that's inappropriate. While we're on the subject, you care to tell me what you think you're doing?

Meredith: Look, I'll jump through hoops if you want me to. But what I do what I leave this hospital is my business.

Bailey: Half this hospital knows your business. Flu isn't the only virus spreading around here.

Meredith: I made a choice, and I know you don't respect me for that choice. But I'll live with the consequences.

Bailey: Then I'll have lots of hoops for you to jump through.

Meredith: I've done everything you've asked me to do. I may not do it your way but it gets done. So whatever else you got, bring it on.

(Claire's bowel burst, spraying Meredith with toxic waste)

(People in gallery are laughing and saying "Ew")

Bailey: Ok, Dr. Grey, now that you've drained the organ, we can attempt to repair it.

Meredith: Now my day is perfect.

(Jamie getting ready to go into surgery, her parents saying good-bye. George and Derek scrubbing in)

Mrs. Hayes: Ok, bye.

(Scrub room)

George: I appreciate this. The chance to scrub in on this kind of procedure is, well...Yeah, I appreciate it.

Nurse: Here you go. Triple espresso, not too hot.

Derek: Oh, I love you, seriously.

Dr. Taylor: Ah, coffee, where would medicine be without it, huh?

Derek: I hope you have a new crossword, Taylor. We're gonna be here a while.

Dr. Taylor: (Pointing to crossword in his pocket) Never go without. Big day for you, kid. Congrats.

George: Thanks.

Derek: (To Jamie) Hey, princess. You ready to take a nap?

Dr. Taylor: Hey, look what I got.

Derek: Blow bubbles, that's it. Just breathe in. Oh, that's it.

Derek: (To George) What?

George: Do you smell...?

Derek: Smell what? I have a mask.

George: Uh...I'm sorry, Dr. Taylor, but did you just...? Have you been drinking?

Dr. Taylor? I beg your pardon?

Derek: What?

George: Do you smell...I...I smell alcohol.

Dr. Taylor: Where the hell do you get off accusing me of something like that?

Derek: George, you're out of line.

George: There are rules. You know, there are rules for a reason. You just...There is a 2-year-old girl on this table. You shouldn't take advantage of someone else's vulnerability.

Dr. Taylor: Look, I don't need some punk intern telling me what's at stake here. Get him out of here, Shep. (George and Dr. Taylor look at Derek) Shep?

Derek: You're out, George.

(George leaves)

Derek: (To Dr. Taylor) You damn well better be ready, Taylor.

Dr. Taylor: I wouldn't be here if I wasn't.

(Izzie retrieving keys from JP's throat)

Woman: Do you really, seriously want to know why I'm leaving?! Seriously? How about when you started insisting that I quit my job, right when I started to make more money than you? That should have been the last straw. No, no. The last straw should have been when I found out that those mysterious phone calls that you've been getting that you kept denying were from other women were really coming from your mother. This isn't healthy.

Izzie: Just, hold still, please.

Woman: Don't you dare try to patch this up!

Izzie: Could the both of you please stop?

Woman: You don't love me, JP. You love to smother me. And if I could just get you to admit that, then I could leave you with an ounce of respect.

Izzie: Athena, I let you stay in here to keep him calm. So, if you're just gonna keep...

Athena: Check that. I can't respect a man desperate enough to swallow my exit strategy. That is the last straw!

Izzie: Michelle, can you get her out of here?

Michelle: Ma'am?

Athena: Fine!

Michelle: C'mon.

(JP starts choking)

Athena: What? What's happening?

Izzie: The keys moved farther down.

Athena: Oh, my God, what does that mean? (To JP) What did you do? Don't you dare die, JP!

Izzie: Please! Please, just shut up!

Athena: Breathe, JP. Just breathe.

Izzie: Got it. (Lifts the keys out) Very impressive, JP.

Athena: Is he ok? Is he gonna be ok?

Izzie: Yeah, he'll be fine.

(JP smiles and laughs at Athena)

Athena: You lit...you did that on purpose, didn't you?

Izzie: Can I offer you some advice? Get in your car and go, for all of our sakes.

JP: You never gonna find where I parked it.

(She grabs the keys and leaves.)

(Meredith and Bailey are walking through the hall)

Meredith: I need a shower.

Bailey: I need a shower. You need to go tell that girl's parents what kind of kid they're getting back.

Meredith: You're not gonna let me shower first?

Bailey: That would be a hoop, would it not?

Meredith: It would qualify.

Bailey: Shower first, then.

(Meredith enters locker room, Izzie and Cristina are inside.)

Izzie: Ew, what smells?

Meredith: That would be me, or more specifically, my patient's insides all over me.

Izzie: That makes me strangely happy.

Cristina: Oh, God. Oh, Meredith, you smell like...

Izzie: Karma.

Meredith: What?

Izzie: Nothing.

Cristina: Something vile is stuck in your hair. You know, just go stand over there, please.

Meredith: Ugh, how much do I love being a surgeon right now?

Izzie: Karma.

Meredith: What does karma have to do with anything?

Izzie: I'm just saying, you've been given all the best surgeries. And now you smell like putrid goo. And you're giving off a stench. Karma's a bitch.

Bailey: (Entering locker room) Dr. Shepherd needs an intern in surgery. Which one of you is clear?

Cristina: I'm good, Dr. Bailey, where do you want me?

Bailey: You need to lie down somewhere.

Cristina: I'm fine, I'm completely healthy.

Bailey: Grey?

Izzie: Of course.

Meredith: What is your problem?

Izzie: Um, you! 'Cause apparently you can help Dr. McDreamy in ways the rest of us can't.

Meredith: You did not just say...

Izzie: Yes, I did!

Bailey: Hey! (To Cristina) Hemispherectomy in OR 1 with Dr. Shepherd. Go.

(Cristina and then Izzie leave)

Bailey: Apparently, I'm not the only one with hoops.

(Burke at desk, Alex enters)

Alex: Doctor. Digby's postop CBC shows a severe spike in the white blood cell count.

Burke: What is it?

Alex: It's 27, with 16 percent bands.

Burke: Something else is wrong. That's a little high for simple stress. Check for any other possible sources of infection or recent illness.

(Derek on Jamie's OR)

Derek: All right, we're gonna start the procedure with the left temporal lobectomy. Thanks for joining us, Dr. Yang. After the temporal, we'll do the frontal, and then the occipital.

(Cristina looks up to see George watching from the gallery. Dr. Taylor is working on his crossword puzzle.)

(Meredith walking through the hall with Mr. and Mrs. Rice.)

Meredith: We were able to reverse the gastric bypass, but we did lose a significant portion of her bowel. And because of the short gut syndrome, Claire will never eat normally again.

Mr. Rice: Ok, wait, do...? How do we help her here?

Meredith: Well, getting proper nutrition will be a lifelong problem for Claire.

Mrs. Rice: Great, as if we already don't have our hands full with her.

Meredith: She gets good grades. She stays out of trouble. She's smart. I just think she feels like nothing she does is good enough for you.

Mrs. Rice: If you somehow think that I'm responsible for this...

Meredith: I think Claire is killing herself to please you.

Mrs. Rice: Oh, please. You have no idea what's going on in that girl's mind.

Meredith: You're her mother. She worships the ground you walk on. She didn't do this for herself.

Mrs. Rice: I think that this situation is completely...

Mr. Rice: Tina...Shut up.

(Meredith and Mrs. Rice look shocked as Mr. Rice walks away)

(Alex enters Digby's room; he is curled up under a blanket and visibly sweating.)

Alex: What is it?

Digby: I'm freezing, doc. I-I cant stop shaking.

Nurse (Olivia): His temp's way up, and BP's dropping, doctor.

Alex: All right, Digby, have you had any recent illnesses, new piercings, tattoos, wounds?

Digby: New tat on my calf.

(Alex flips back blanket to reveal an extremely infected tattoo of a spider on his calf)

Alex: Ew.

Digby: Oh, my God. It was nowhere near that nasty this morning.

Alex: But it was infected? Why didn't you say anything?

Digby: Ah, it was nothing. I'm not here to complain about a little pain.

Alex: The infection's been exacerbated by the stress on your body from the gunshot. (To Olivia) Get him to ICU. We'll get you started on some antibiotics.

(Jamie's OR)

Derek: From the frontal lobectomy, I'm going to encounter a, uh...

(Jamie although sedated is blinking)

Cristina: We'll encounter the anterior cerebral artery.

Derek: Yes, so we're gonna need to, uh...

(Jamie blinks again)

Cristina: The branches of the artery need to be coagulated and divided.

Derek: You know, Taylor, her anesthesia's awful light. (No response from Taylor, Jamie still blinking) Come on, Taylor, s-she's waking up.

Cristina: Dr. Taylor? Uh, he's asleep!

Derek: (Screaming) Taylor! Dr. Taylor!

Dr. Taylor: Huh? Oh, God, sorry. Sorry, I'm on it. My bad, Shep.

Derek: He was right, wasn't he?

Dr. Taylor: Aw, I nodded off. Come on.

Derek: Yeah, whatever you got to do to get through the day, right?

Dr. Taylor: Steph, get me some coffee.

Steph: Yes, doctor.

Dr. Taylor: I'll be fine. It won't happen again.

Derek: Yeah, not in here, it won't. Uh, Steph, call Dr. Pennington. Hopkins, take over until she gets here. Get out of here and get it together.

(Burke running through hallway, Alex is working on Digby)

Burke: What happened?

Alex: He went into multi-system organ failure, secondary to overwhelming sepsis. Now he's all...

Burke: Fix his BP, that should help his mental status.

Alex: He's maxed out on pressors. We got V-tach.

Burke: He's looking bad. Put the defib pads on him and give him 150 of amnioterone.

Alex: I lost his pulse.

Burke: Defib! Get the pads! Give me the paddles and charge to 200. Clear. (Shocks Digby) Again at 300. Clear. (Shocks again)

(Alex and Burke continue shocking and performing CPR on Digby)

(Jamie's OR)

Derek: This packing, we hope, will prevent hemorrhaging. Dr. Yang, do you want to add something to that?

Cristina: It will allow the cerebral spinal fluid to eventually fill the cavity.

Derek: Hmm, very nice.

Derek: You two, you wanna close up?

Doctor: Yes, doctor.

Derek: I'm gonna go to bed.

Cristina: That was unreal. I mean, that's...that's all there is. I...I was feeling sick until I came here.

Derek: I was tired. Now I'm tired again. It's back to reality.

(Derek points to gallery and motions George to come outside)

Derek: Let me explain.

George: It's fine.

Derek: No, there is a code among doctors. We're not supposed to ask each other questions, not within the walls of this hospital.

George: Ok, I was out of line.

Derek: No, you weren't. I was. I was out of line. Somebody should have taken responsibility. It should have been the guy doing the cutting. It should have been me. You didn't deserve what happened to you today. You did the right thing code or no code.

(Derek extends his hand for George to shake, George hesitates then shakes his hand)

Derek: You saw me leave the house this morning, didn't you?

George: Oh, was that you?

Derek: Hmm. I'm not using her. And I don't favor her.

George: She's pretty great, you know.

Derek: Mm-hmm. So, come on, lets go tell Jamie's parents she's gonna be fine, barring any complications.

(Meredith is wheeling Claire through the hallway)

Claire: Did you fix me?

Meredith: No, not completely.

Claire: So, I won't get fat?

Meredith: No.

Claire: Oh. That's awesome.

Meredith: Claire, I've asked social services to contact your parents.

Claire: Why?

Meredith: They can help you.

Claire: With what?

Meredith: You don't know this yet, but life isn't supposed to be like this. It's not supposed to be this hard.

(Digby is still flatlined)

Burke: Time of death, 20:49.

Alex: The first guy I ever met out here from back home.

(Alex picks up and looks at the Polaroid then throws it on the gurney)

(Seattle night scenes)

(Izzie is frosting a cake when Meredith enters the house)

Meredith: I thought you'd be asleep by now.

(Meredith looks in fridge)

Izzie: Yeah, well, I'm not. If you wait a few minutes, you can have a piece of cake. Baked it chock-full of love. Actually, chock-full of unrelenting, all consuming rage and hostility, but it's still tasty.

Meredith: So you know?

Izzie: I know.

Meredith: Well, do you want the long, sordid version, or do you want the short version, where I started sleeping with a guy who turned out to be my boss?

Izzie: Neither.

Meredith: Izzie, cut me some slack here.

Izzie: No. You want to Dartmouth. Your mother is Ellis Grey. You grew up... Look at his house! You know, you walk into the OR, and there isn't anyone who doubts that you should be there. I grew up in a trailer park. I went to state school. I put myself through med school by posing in my underwear. You know, I walk into the OR, and everyone hopes I'm the nurse. Y-you have their respect without even trying, and you're throwing it away for...what? A few good surgeries?

Meredith: No. It's not about the surgeries. It's not about getting ahead.

Izzie: Then what? A little hot s*x? You're willing to ruin your credibility over that? I mean, Meredith, what the hell are you doing? (Izzie stares at Meredith who rolls her eyes) Oh, my God. You're falling for him.

Meredith: I am not.

Izzie: Oh, you so are.

Meredith: No, I'm not.

Izzie: You so are. Damn it, you poor girl.

Meredith: You know, it's just that he's just so...And I'm just...I'm having a hard time.

Izzie: Wow, you're all, uh, mushy and...warm and full of secret feelings. (Hands her cake)

Meredith: I hate you! And your cake.

Izzie: My cake is good. So, um, how hot is the s*x?

Meredith: Izzie.

Izzie: What? Come on, I'm not getting any. Help a girl out with a few details.

(Alex in locker room working out on rowing machine)

MVO: Maybe we like the pain.

(Jamie's room)

Jamie: Pooh.

George: How's she doing?

Derek: Good.

George: Good.

MVO: Maybe we're wired that way.

(Burke enters on call room, it is dark)

Burke: Cristina?

(He flips on the light to find the room empty.)

MVO: Because without it, I don't know...

(Cristina is in the bathroom looking at a pregnancy test)

MVO: ...maybe we just wouldn't feel real.

(It is positive)

(Meredith and Derek at her house, getting in bed)

Derek: You know, we could just...

Meredith: Sleep?

Derek: We could, yeah, if...if you want to.

Meredith: Yeah?

(They both crawl into bed)

MVO: What's that saying? "Why do I keep hitting myself with a hammer?"

Meredith: Oh, thank god.

MVO: "Because it feels so good when I stop."