02x05 - Bring the Pain



2x05: Bring The Pain

Original Airdate: 10/23/2005

Written by: Shonda Rhimes

Directed by: Mark Tinker

(Seattle Scenes)

(Izzie and Alex, outside of the house)

MVO: Pain comes in all forms.

Izzie (cold and sarcastic): I had a good time. Really. Thank you. It was the perfect evening. Best date ever. Whatever.

Alex: Izzie ...

Izzie: You know, I especially liked the part where you treated me like crap the entire night. That was fun.

Alex: I had a good time.

Izzie (confused): Really?

Alex: Yeah.

(They move into kiss)

MVO: The small twinge, a bit of soreness, the random pain. The normal pains we live with every day.

(Alex pulls away)

Alex: I gotta go.

(Izzie is left with a look that says unbelievable. Alex walks out the door)

Izzie (yells): Seriously? Seriously!?!?

(She slams the door shut)

MVO: Then there's the kind of pain you can't ignore.

(Izzie comes storming into George's bedroom. She flicks on the light switch)

Izzie (loud): Seriously?

(Izzie enters George's room waking him)

MVO: A level of pain so great that it blocks out everything else.

Izzie: Move over.

(He rolls over)

George (sleepily): I'm sleeping!

Izzie: Oh, shut it.

George (rubbing his eyes and still groggy): Shut ...

MVO: Makes the rest of the world fade away.

(Derek and Meredith, outside the house)

Meredith: I don't want to have this conversation again.

Derek: Meredith...

(Meredith opens the doors)

Meredith: You didn't sign the divorce papers. Fine. I get it. End of discussion.

(They both walk in)

Derek: Meredith.

Meredith (yells): What?!?

(He just stands there)

MVO: Until all we can think about is how much we hurt.

Derek: Oh ... I usually just say "Meredith" and then you yell at me. I haven't thought past that point. (Meredith looks pissed) I actually didn't have anything planned.

MVO: How we manage our pain is up to us.

(She hits him with her purse)

Derek: Hey. What is with that? Hey stop it. Ow.

Meredith (yells): Seriously?!?! Seriously?!?!

(Meredith goes into George's room)

Meredith (loud): Seriously!

(George rolls over)

George: This is a very small bed.

(George is lying on the bed between Meredith and Izzie)

Meredith: He's a brain surgeon.

Izzie: I look fantastic! I shaved my legs!

Meredith: He's a brain surgeon. How can he be so brainless?

(George sighs)

Izzie Hello? Seriously!

Meredith: Seriously!

(He pats both of their shoulders)

George: Shh. Sleep.

(The power goes out)

MVO: Pain. We anaesthetize...ride it out, embrace it, ignore it...

(Cristina enters in the pouring rain, soaked)

MVO: And for some of us, the best way to manage pain is to just push through it.

(Dr. Bailey is in the locker room doorway)

Bailey: You're dripping.

Cristina: I'm back. I just wanna make that clear. I'm back. I'm ready to work.

(Addison walks up)

Addison: Has any one seen Dr. Shepherd, this morning?

Bailey: His name is on the OR board. He should be here somewhere.

(Addison walks off)

Cristina: I'm good. I'm ready to scrub in. I'm 100% on top of my game.

Bailey: You just got discharged. Pace your self.

(Izzie looks at Alex)

Cristina: I'm paced. I'm paced.

Bailey: Mmm hmm. Rounds people.

(They start walking out. Alex stops Izzie.)

Alex: What? You're not talking to me anymore?

Izzie: Ok, what happened last night? What is going on with you?

Alex: I'm fine. What's your problem?

Izzie (huffs): Fine. You know what Alex? No, I'm not talking to you anymore.

(Izzie walks out.)

(Patients room)

Cristina: Dr. Bailey. Henry Lamott, age 42, is scheduled with Dr. Shepherd for a spinal implant...

(Mr. Lamott turns up the volume, there are women laughing and giggling)

Cristina: ...to control the pain of his herniated disc. Is allergic to all pain medication ...

(Everyone stares at the screen)

Cristina: Is that...?

Mrs. Lamott: p0rn.

Bailey: p0rn?

(She looks up at the TV)

Bailey: As in p0rn?!?!

Alex: All right. What are we watching?

Bailey: Karev! Go stand in the hall.

(Alex goes outside)

Bailey (distracted by the TV): Uh, Mr. & Mrs. Lamott, I'm sure you are really nice people, and what you do in the privacy of your own ... Look, we can't have p0rn in here. This is a hospital.

Henry: It's for my pain. My doc says it releases endorphins in the brain and helps keep my pain at a manageable level.

(Interns are amused)

George: Really?

Bailey: George! Hall!

(George walks out strangely)

Izzie (amused): What is this?

Mrs. Lamott: Nasty, Naughty Nurses ... um (she looks at the TV) 4.

(Meredith, Izzie and Cristina tilt their heads while looking at the screen)

Cristina: That does not look comfortable.

Meredith: Trust me. It's not.

(Cristina and Izzie both stare at Meredith)

Bailey: Get in the hall!

(Near the nurse's station)

Bailey: O'Malley, Karev, you're in the pit today. Stevens, there's a cardiac patient waiting up for you on 2. Yang, keep an eye on the Lamott's. I don't want any problems. Go.

(They all scurry off, except for Meredith.)

Bailey: Grey, your mother's being discharged this evening. You've made arrangements or do you need more time?

Meredith: The nursing home is coming at 8.

Bailey (starts walking off): All right then you're with Shepherd, Derek Shepherd, today.

(Meredith moves to speak)

Bailey (smiling): Hey, life is short. Times are hard. The road is long with many a winding turn. (She is serious now) He asked for you. Take it up with him.

(E.R room. George enters with Alex. Policemen are standing outside)

George: Ok.

Doctor: Pete Willoughby, 25 year old, GSW to the chest. Immediate return of 860 CCs of blood from the chest.

Pete: Oh Man! This hurts.

Doctor: He's put out more than 200 CCs in the past hour.

Pete (in pain): They never tell you in the movies how much it hurts to get shot.

George: Push morphine, 2mg. Alex, is this my case.

Alex: Morphine, 5mg. You didn't even call him.

George: I don't have to call him. I was here first.

Alex: You got here first because I let you. ... Where's his chest films?

George: I got it. You always get the surgery. Today, I'm getting a surgery.

Doctor: Guys. Knock it off. He's one of Seattle's finest. You've got an entire police force watching you...

(Police are watching from a nearby window)

George: Page Dr. Burke. Let him know I'm bringing up a GSW.

Alex: No, that "we" are bringing up a GSW.

(Ellis Grey's room)

Richard: Looks like you'll be able to go home today, Ellis.

Ellis: But I still have patients to see.

Richard: No. No more patients. I'll be back to check on you later, ok?

(He hands the chart to the nurse and they start walking out)

Ellis: You should know I'm thinking of leaving Thatcher. (Richard stops) I should never have married him. I'll leave him. You leave Adele. (The nurse looks at Richard) And then when our residency is over we can both get jobs at the same hospital.

Richard: Why don't you get her meds ready for her discharge, nurse? (Nurse nods and leaves) Thank you.

(Richard sits by Ellis on her bed. He takes her hand.)

Richard: Ellis, that was a long time ago, remember? We had this discussion 21 years ago.

Ellis: Think about it Richard. We should make the break now. (Richard sighs) If we wait until residency is over, you'll be at one hospital, and I'll be at another. We could end up at opposite ends of the country. It'll be too late.

(Derek and Meredith run into each other in the hall)

Derek: Meredith.

Meredith: Your wife is looking for you.

Derek (sighs): Oh, my God, this is hard for me, Meredith.

Meredith: Well, let me make it easy then. I'm not gonna be that woman. The one who breaks up a marriage or begs you to want me. You can sign the papers or you cannot. The choice is yours. Either way, when it comes to this relationship, I'm out. (Derek looks at her) Now, where's this patient I'm supposed to be helping you with.

Derek (points behind him): Down there.

(Meredith starts walking that way. Derek follows)

(Izzie checking a patient's heart. The patient's husband is there as well)

Mr. Bradley: You shouldn't have tried to walk the dog in the rain.

Mrs. Bradley: Oh, Lou, it wasn't the rain. I just passed out.

Izzie: Actually, Mrs. Bradley ...

Mrs. Bradley: Verna.

Izzie: Verna. You presented with lateral ST elevations and reciprocal inferior changes consistent with an MI. A heart attack.

Lou: Oh, my God!

Verna: Lou, don't worry. I've had these little chest pains before and it turned out to be nothing. This is nothing. (Lou kisses his wife on the cheek) Lou, not in front of the doctor.

(Derek and Meredith in a woman's room.)

Anna: I've had a twinge in my back for a little while. I thought it would go away, but then last night my legs went numb. And this morning my back ...the pain is just too much.

Derek: Miss Chue, we're going to put you on a PCA pump, give you some morphine which should help control the pain.

Anna: Thank you.

Derek: Ok. But there's a greater problem here. I've just taken a look at your MRI...

(Anna's parents enter)

Mr. Chue: Anna! Why didn't you call us before coming down here?

Anna: I'm sorry. (To Derek and Meredith) These are my parents.

Derek: Hi.

Mr. Chue: What's going on?

Derek: I was just about to explain that Anna's MRI has shown that she has myxopapillary ependymoma. It's a tumor in her spinal canal. But the good news is that we can operate. You have a 95% chance of fully recovering if we get you into surgery as soon as possible. We can't wait another moment. With a tumor this aggressive even waiting another day puts you at risk of permanent paralysis.

Anna (looks to her dad): Father?

Mr. Chue (shakes his head): No. No surgery.

Derek: Mr. Chue, without surgery Anna will be paralyzed, probably within the next 24 hours.

Mr. Chue: There will be no surgery today. We're taking her home.

Meredith: Anna needs the surgery.

Mr. Chue: And she can have it at another time.

Derek: Look Mr. Chue...

Mr. Chue (interrupts): We are taking our daughter home.

(Derek looks at him and then Anna)

Derek: Anna, you are over 18. You don't need your father's consent.

(Anna looks at her father)

Anna: I am Hmong, and my father is the elder. He says I go home, I go home.

(Derek stares hard at Anna's father)

(Derek and Meredith walking up an empty stair way)

Derek: Hmong? Let's find out what that means. Contact Social Services, see if we can get anyone down here, and talk to them.

Meredith: Do I continue to process her discharge?

Derek: Yeah we have to. It's insane, but we have to. It reminds of this case I had in New York one time and this woman came to the office and...

(They stop at then end of a stairway.)

Meredith (interrupts): Look, do you need me for anything else work related?

(Derek checks to see if anyone is in the stairway)

Derek: Look. I was married for 11 years. Addison is my family. That is 11 Thanksgivings, 11 birthdays and 11 Christmases. And in one day, I'm supposed to sign a piece of paper and end my family? A person doesn't do that. Not without a little hesitation. I'm entitled to a little uncertainty here! At least a moment to understand the magnitude to what it means to cut somebody out of my life. I'm entitled to a least one moment (some one enters the stair way. He speaks quieter) of painful doubt. And a little understanding from you would be nice.

(He storms off. Meredith just looks annoyed)

(Dr. Burke runs into Addison in the hall)

Burke: Dr. Shepherd. Still here, I see.

Addison: I couldn't leave you. Have you seen the other Dr. Shepherd?

Burke: I'll tell him you're looking for him.

(Burke keeps walking and Cristina walks up)

Cristina: So, um, thanks for, you know, being there.

Burke: No thanks needed.

Cristina: Ok.

Burke: So where are we?

Cristina: Uh the north-east corner of a hospital.

(Dr. Burke glares at her)

Cristina: Oh, I'm, I'm getting back on my feet.

Burke: Fine.

Cristina: That doesn't mean that...

Burke (interrupts): Cristina.

Cristina: It's my first day back, I've, I've got...

Burke (interrupts): I'm not waiting forever.

(Burke enters the elevator as Bailey walks out)

Burke: Karev & O'Malley are bringing up a GSW. Wanna scrub in?

Bailey: No can do. No extra work. I'm trying to get out of here at a decent hour tonight.

Burke: What, you got a date?

Bailey: Yes. Yes I do. A handsome man is whisking me away to a love nest for the weekend.

(Alex and George are wheeling Pete through the hall)

Alex: You got shot in the line of duty?

Pete (has difficulty speaking): First month on the job. Can you believe my luck? A guy pulls a gun and I freeze up. The rookie let himself get shot. I'm never gonna live this down.

George: Sure, you will.

Pete: You think?

George: Absolutely.

(Izzie runs up to Bailey)

Izzie: Hey, I got Verna Bradley's tests back. I don't think she had a heart attack.

Bailey: Yeah but look at the changes in her EKG. She had something.

Izzie: Yeah but her serial enzymes and her dobutamine stress echo came back negative. I actually think she's fine.

Bailey: Get a cardiac cath. Izzie, be thorough.

(Dr. Bailey walks off)

Izzie: I am thorough.

(George, Alex and Pete riding in the elevator)

Alex: So, dude, what's the deal with Izzie?

George: She shaved her legs for you.

Alex: And?

George: And you didn't even kiss her goodnight.

Pete: She shaved her legs for you and you didn't follow through?

Alex: Hey, I follow through. I always follow through.

George (half laughs): You didn't last night.

Alex: Mind your own business.

George: Mind... (George takes a breath) She had expectations. Women have expectations. And you didn't meet them. Hey, I live with these women and every time you guys don't meet their expectations, I have to hear about it. I didn't get any sleep last night. So you know it is my business.

(The elevator goes black and stops)

Alex: Dude, we're not moving.

George (sarcastic): Really! You think?

(Meredith, Cristina and Izzie are standing in the hall when the lights flicker. Cristina is in obvious pain)

Meredith: You know how long the surgical scar takes to heal. You must be in pain. You should take something.

Cristina: Drugs are for babies.

Izzie: I hate Alex.

Cristina (looks at Izzie): The non sequitur award goes to...

Izzie: I'm sorry. I hate Alex.

Meredith: I broke up with Derek.

Cristina: Burke wants to have a relationship.

Izzie: Boys are stupid.

(Izzie & Meredith walk off)

Cristina: Yep.

(The elevator is still not moving. Alex is trying to pry it open)

George: "If elevator should stop, do not become alarmed." "Press the button marked alarm to summon the assistance." (He pushes the button repeatedly) They don't want us to be alarmed then why call the button "alarm"?

Alex: That didn't work the last 5 times you did it. Get it through your head we've lost power. We're stuck here.

(Pete moans. George and Alex check him)

George: You ok? (George checks the BP monitor. Alex takes his pulse) His pressure is falling. (He whispers to Alex) Alex, there's a lot more asbestosis in the pleura back. We need to get him to the OR.

Pete: Ok, you're whispering. Don't whisper. I mean, I don't wanna complain here, but I got a bullet in my chest and whispering isn't a sign I'm gonna be A-OK, you know?

(Alex tries the emergency elevator phone)

Alex: Damn it. It's out.

Pete: It's bad. It's bad, right?

George: Someone is gonna get us out of here. Don't worry.

(Mr. Lamott's room)

Cristina: How we doing?

Henry: Oh, can you move me to another room? The lights and the TV went out.

Cristina: Ah. Power outage in the east wing. They'll have it back on soon. You're not a critical patient. You'll be fine here.

Henry: Oh, god! What am I gonna do?

Cristina: You mean...

Henry: Without my p0rn!

Cristina: Read a book. Talk to your wife.

Henry: No. School closed early because of the storm. She had to pick up the kids. She won't be back until after dinner.

Cristina: Well, I'm sure you can find some normal way of amusing yourself.

(She starts walking out.)

Henry: No, I need my p0rn!

Cristina (dismissively): Yeah.

(She leaves)

(Addison and Richard walking through a dark hall)

Addison: Lightning hit a sub station. We're running on back up generators. One of them is down. (Richard puts his hands on his hips annoyed) Richard, breathe.

Richard (frustrated): The only direct means of transporting from the ER to the OR isn't working. Don't tell me to breathe. I'll breathe if I wanna breathe.

(He walks off. Addison holds up her hands in defense and walks after him.)

(Bailey and Burke watching some men pry open an elevator)

Man: Cars caught between floors.

(Richard & Addison walk up to them)

Richard: How bad is it?

Burke: Two interns and a GSW to the chest.

(Richard closes his eyes and puts his hand to his forehead)

Addison: Good air in, (breathes in) bad air out.

(Richard gives her a look)

Richard: Come on people get those doors open.

(The doors partially open to reveal Alex and George inside with Pete)

Guard: It's jammed. It won't open any more.

Bailey: Move. Move.

Guard: This is wide as wide as it goes.

(Bailey looks)

Bailey (accusingly): What...What did you two do?

Alex & George: Nothing!

(She gets up. Dr. Burke takes her place and peers in)

Burke: How's the patient?

George: He's not looking so good.

(Anna's room)

Anna: Why do the lights keep flickering?

Meredith: Something about a backup generator. This pump will provide you with a morphine drip and should stop your pain.

Anna: I, I told you, I don't need it. I'm going home.

Meredith: You realize you'll have to sign an AMA form stating that you're leaving against medical advice.

Anna (nods): Fine.

Meredith: I know this is new and confusing. ... I called a social worker and she's willing to come down and talk to you...

Anna (interrupts): Spare me your white-girl, cultural divide love. I grew up from the street down here. I play in a band. I went to U-Dub. I get it. My father doesn't. He says no, it's no.

Meredith: We're talking about your ability to ever walk again.

Anna: That's what you're talking about. I'm talking about my family. Have you ever even heard of the Hmong people? Our religion has got rules that are way old and way set in stone and way spiritual and you don't mess with them. (sighs) You don't anger the ancestors. (She makes a face) Even if you pierce your tongue and play in a band.

Meredith: What are the rules exactly?

(Bailey is walking down a dark hall with a nurse.)

Bailey: All I.C.U. patients are going to the south wing. All telemetry and step-down patients north wing.

(Derek comes up to them. Nurse nods and walks off)

Derek: You paged me?

Bailey: p0rn! As pain management?

Derek (grinning): You met Henry. Yeah, there's a lot of different theories on how to treat pain.

Bailey: p0rn! As pain management?

Derek: Look. It's possible that pornography like art and music can stimulate the brain to produce endorphins that minimize pain.

Bailey: p0rn! As pain management?

Derek: I didn't prescribe it. It wasn't me. Take it up with the treating physician.

Bailey: If that man turns out to be some sort of s*x weirdo it's on you. That's all I'm saying. ... Oh, and you're wife's looking for you.

(She walks off)

Derek: I know.

(Meredith comes up to Derek. They start walking down the hall together)

Meredith: Derek.

Derek: Yes?

Meredith: You need to talk to Anna's father. I'd do it myself but I guess having testicles is a requirement.

Derek (sighs): What happened to social services?

Meredith: According to Anna they can't help us. Apparently Anna's father believes she's missing something that she needs for surgery.

Derek: Missing something? Missing what?

Meredith: One of her souls. (He looks at her) We don't need a social worker. We need a shaman.

Derek: A shaman.

(Verna's room)

Izzie: Cardio tells me that your cath went just fine.

Verna: Is that much bruising normal?

Izzie: Your one looks good Mrs. Bradley and so do the results on your cath. You don't have any blockage in your arteries.

Lou: Which means?

Izzie: You definitely did not have a heart attack.

(Both Lou & Verna sigh in relief and joy)

Verna: So I can go home?

Izzie: Not yet. Your EKG shows significant changes. And I'm gonna find out why before you leave the hospital.

(Stuck elevator)

Alex: Hey what are you doing?

Pete (delirious): I have to get home.

Alex: Pete, you're in the hospital.

Pete (delirious): Need to get home. (George and Alex restrain him) No. Need to get home.

(Dr. Burke peers in through the small opening)

Burke: What's his blood pressure?

George: It's not reading. He's too agitated.

Burke: How's his pulse?

Alex: Thready but it's still there.

Burke: Do you have any instruments?

Alex: Uh, just a code box and some gloves.

Burke (annoyed): You didn't bring an open chest tray?

Alex: No we thought ...

Burke (interrupts angry): You don't have time for excuses. O'Malley, blood pressure.

George: I've taken it 3 times.

Burke: And?

George: I can't hear systolic over 50.

(Pete is really pale and wheezing)

George: He's gonna die.

(George & Alex look at each other. Burke makes a decision)

Burke: Intubate him. I'll be right back.

George: Wait. Where are you going?

Burke: To get an instrument tray. You guys are going to have to open up his chest.

(George and Alex look at each other. Dr. Burke stands up. Dr. Bailey is there standing next to him)

Bailey: Are you sure about that?

Burke: No.

(He runs off down the hall)

(George and Alex are intubating Pete)

George: When's Burke coming back? (whispers) Is Dr. Burke coming back? ... Alex?

Alex: Oh, would you shut up.

(Outside of SGH)

Derek: Mr. Chue! You wanna take Anna home for a healing ritual?

Mr. Chue: When sickness comes, it means one of her souls is missing. Anna needs every soul intact before she has surgery. She needs a shaman.

Derek: Well, you could of, told me that.

Mr. Chue: Why? So you coulc call me a fool.

Derek: I respect that you have traditions that I can't understand. But you're standing beside me in a $3000 dollar suit, so I also know that you respect the fact that I'm telling you Anna needs a surgery in the next 24 hours if she's going to continue to walk. She can't leave this hospital.

Mr. Chue: She can't undergo surgery without her soul. She'd die.

Derek: All right then. We're just gonna have to get a shaman. Today, in the hospital.

Mr. Chue (mildly amused): Shaman's aren't listed in the yellow pages. Our shaman is 500 miles from here. You are an arrogant man.

Derek: No. I'm just a guy with access to a helicopter.

(Mr. Chue smiles, takes out another cigar and hands it to Derek)

Derek: Thank you.

Mr. Chue: Finding her soul won't be easy.

Derek: It never is.

(He walks off)

(Richard & Bailey are walking down a hallway)

Richard: This is incogitable. There's not enough power to move those elevators?

Bailey: They're doing what they can to replace the back up generator now. Fire department is standing by.

Richard: All critical patients?

Bailey: Moved to the south wing.

Richard: Incoming trauma?

Bailey: Re-routed to Mercy West.

Richard (angry): Look that back-up generator should've been replaced last year.

Bailey: Yes, sir.

Richard (angry): Why didn't it happen?

Bailey: Chief, you ... eh ... have to ... ask maintenance, I wouldn't...know

Richard (interrupts): Dr. Bailey, you know everything. Tell me whose butt to kick.

Bailey: That would be your butt Chief. You didn't authorize the replacement generator, saved the money for the new MRI machine. (Richard looks at her) Um I need to get on back down to the ...

(She gestures to the elevator and walks off. Richard is left smiling sheepish)

(Burke comes back to the elevator)

Burke: Hey! This isn't gonna be too sterile but we can still try. Prep and drape the patient.

(Hands them the things they will need)[/i])

(Nurse's station)

Izzie (to nurse): Hey, can you get me copies of all of Verna Bradley's medical records and page me. I'll be on the OR floor.

(Cristina looks at her. Izzie starts walking off upstairs quickly)

Cristina: Hey ... wait ... where (Meredith is coming down the stairs hurrying) where are you 2 going so fast?

Izzie: Burke is talking George & Alex through heart surgery in the elevator.

(She heads up the stairs. Meredith is already half way down the hall)

Meredith: Shepherd is setting up a shaman healing ritual.

Izzie (from up on the next floor): Rock on!

Cristina (to Herself annoyed): I have p0rn guy!

(Mr. Lamott's room)

Mr. Lamott: Help please. ... Oh.

Cristina: Mr. Lamott. What's wrong?

(She picks up his chart and reads it. Mr. Lamott groans in pain)

Cristina: Pressure's elevated. Pulse is racing (in shock) You're really in pain!

Mr. Lamott: Whatcha think?

Cristina (still stunned): Are you telling me the p0rn actually sedated you?

Mr. Lamott: Oh, what did you think I'm some kinda pervert watching that stuff in front of you?

Cristina: Well ... yes.

(Mr. Lamott gives her a look)

Cristina: Oh, okay, okay. (she grabs his chart) Uh ... you're allergic to most narcotics and NSAIDs. I, I suppose uh we could try droperidol and dihydroemetine.

Mr. Lamott (in pain): No. That put me into a coma last year.

Cristina: Well, ah um I can get anesthesiologist down here. (She shakes her head) Oh no but with your surgery tomorrow I don't think he'll give you an epidural block.

Mr. Lamott (desperate): What am I gonna do?

Cristina (scratching her head): Uh hold on.


Alex: We're really going to do this.

(George just looks at him. Dr. Burke peering through puts through his hand to hand over a pair of scissors and a scalpel to Alex)

Burke: Take these.

(Alex just looks at them and remains standing still)

Burke: Karev, take the scalpel.

(Alex just stands frozen with a scared look on his face. He looks at George)

George: Alex. Come on. (He doesn't move) Alex!

(Dr. Burke looks at Alex confused. There's a huge crowd now outside the elevator. Lots of interns and doctors. Izzie & Dr. Bailey are 2 of them. Alex just looks away from the scalpel and scissors. George annoyed moves.)

George: Ventilate!

(Dr. Burke is looking at Alex now concerned. George moves to take the scalpel and scissors)

George: I got it.

(George gives Alex an angry look. Alex is just looking down petrified)

George (to Dr. Burke): What do I do?

Burke: Make a large anterior, lateral, mid-auxiliary incision in the 5th intercostal space.

George: How, how large?

(Alex is now holding a light for George as well as ventilating)

Burke: As long as possible. You need to get 2 hands in there. It needs to be long and deep. Use the scissors if you have to.

(Alex makes eye contact with Dr. Burke. Dr. Burke looks at him but then turns his attention to George)

George: Ok.

(He is about to cut when Dr. Burke startles him)

Burke: But, be sure you don't cut into the lobe of the heart.

George: Uh, how can I be sure of that?

Burke: You just have to be sure.

(George looks a little panicked)

George: We're not in Kansas anymore.

(He starts cutting into Pete's chest)

(Anna's room)

Derek: Your shaman's late.

Mr. Chue: My shaman is never late.

(Derek and Meredith smile half heartedly at each other)

(Crows outside the elevator)

Izzie: You guys see anything? Poor George, doesn't have the steadiest hands.

Bailey: Izzie.

Izzie: Yeah?

Bailey (speaks out each word distinctly): He can hear you.

(Dr. Burke is watching the operation)

Burke: O'Malley, how are you doing down there?

(Fire department arrives)

Bailey: Uh, fire department's here. They can get the doors open.

Burke: No. Nobody moves. Nobody works on the elevator. I have an open chest and a very nervous intern in there. Keep them back until I give the word.

(Dr. Bailey nods)

Burke: O'Malley.

George: I didn't cut the heart or the lungs. (Louder) Dr. Burke, I didn't cut the heart or the lungs!

Burke: Good, good. Good. Good, O'Malley. Really good. Now check for injuries and do a pericardiotomy.

George (concentrating on Pete): Uh I'll need some lap pads, forceps, Metzenbaums and Satinksy clamps.

Burke (nods smiling, quietly impressed): Yes, you will.

(Mr. Lamott's room)

Cristina: You tell anyone I did this for you, not only will I kill you; I will sell your body parts for cash.

(Mr. Lamott nods gratefully)

Cristina: Okay. So ... there were these women. ... Nurses. 3 nurses. And they were ... naughty. ... Really, really, naughty. ... They were 3 naughty nurses. Uh saucy even. They were saucy and, and bad and naughty. 3 saucy, naughty, bad nurses. They were taking a shower ... together. (Mr. Lamott starts to become less in pain) Soaping each other up. And then this doctor walks in and he sees these 3 naughty bad nurses with these great big ...

(Verna's room)

Izzie: Mrs. Bradley, do you realize you've been admitted to the hospital on this date for the past 7 years?

Lou: Oh, that can't be. I don't remember the date exactly but ...

Izzie (interrupts): I have the medical records. On this date for the past 7 years you have what looks like a heart attack.

Verna (smiling): No. No. I know I've had some scares but I, I don't...

Lou (interrupts): Every year on this date?

(Izzie nods)

Izzie: Is there some significance to this date for you personally?

Verna: No. Nothing.

Izzie: What we're you doing the first year? The first time you had a cardiac episode?

Verna: Oh, I couldn't remember back that far.

Lou: We were in the yard. I remember because our neighbor ... what was his name?

Verna (gets a look on her face): Ted.

Lou: That's right. He died ... of an aneurysm I think. And we watched as the funeral home people took him away and you had your first attack.

Izzie: And you were close to Ted?

Verna: No. Oh. (Looks at her husband) We barley knew Ted.

Lou: That was all very sad, but what does that have to with Verna's heart?

(Izzie looks at Verna. Verna looks away)


George: I've removed the small clot from the pericardium. No obvious cardiac injuries.

Burke: Any change in the vitals?

Alex: BP's still too low to register on the monitor.

Burke: We need to cross clamp the aorta.

(He grabs a clamp from a tray next to him and puts it through the opening. George moves to retrieve it)

Burke: Stick your hand in and bluntly dissect down until you feel 2 tube-like structures. The esophagus will be more medial and anterior.

(George sticks his hands in the open chest)

George: Ah I feel one tube that is easily collapsible and the other is more muscular, spongy. I can ah feel the spine just underneath it.

Burke: Yes, you're touching the aorta.

George (to Alex): I'm touching the aorta.

Burke: Wrap the index finger of your left hand around it and apply a Satinsky clamp with your right hand.

(George puts in the clamp)

George: Got it. ... Wait I...I think I can localize the bleeding. I think it's coming from the inferior vena cava.

Burke: Can you find the lesion?

George: Yeah. Yeah. I think I can feel ah (he fiddles around) ... it's too far in to repair.

Burke: How big is it?

George: Small, maybe. Maybe smaller than a dime.

Burke: Ok, O'Malley. I want you to take your finger and plug the hole.

(George puts his hand in)

George: I think I can feel his heart... starting to fill more. It's beating a little stronger.

Burke: Excellent. Keep your finger there.

George: Ok, now what?

Burke: That's it.

George: That's it? (Dr. Burke turns over to lie on his back in relief) I just stand here with my finger plugging the hole?

Burke: Until we can get you out of that elevator and into the OR.

(George and Alex look at each other)

Burke: Dr. Bailey, tell the fire department to get my guys out of there.

Bailey: Will do. (To fire department) Ok, we're ready.

Burke (rolls back over and peers in): O'Malley.

George: Yes sir?

Burke: You just flew solo.

George: Thank you sir.

(Seattle Scenes)

(Anna's room)

Meredith: Ok, Anna. We're going to shut off the PCA pump now which means you'll be in a lot of pain for the duration of the ...

Anna (interrupts): the healing ritual.

Meredith: Are you ok with that?

Anna: Yeah. I can't find my soul if I'm medicated. No pain, no gain right?

Meredith: Well, it's not just for your father. You believe it too, right?

Anna: I know it sounds like a load of crap but ... watch the ritual. You'll see.

Meredith: See what?

Anna: The moment it happens.

(Meredith nods)

(The shaman comes to the doorway with Anna's family.)

Anna: I'm ready.

(Mr. Lamott's room)

Cristina: "Oh, yes I'm so very, very naughty," Bianca said as she dropped her stethoscope.

(Dr. Bailey is walking by the room and pokes her head in. Cristina doesn't see)

Cristina: Me too said Crystal as she snapped on her surgical glove.

(Dr. Bailey looks aghast)

Cristina: And then there was Marta...

(She stops when she sees Dr. Bailey looking at her demandingly. Cristina shrugs and gestures look at him, he's sedated. Dr. Bailey looks annoyed but walks off)

Cristina: Where was I?

Henry: Marta.

Cristina: Oh yes Marta was the naughtiest nurse of all because she knew how ...

(She stops when the lights and television come back on)

CRISTINA: Oh, thank god.

(Anna's room where the healing ritual is taking place)

Derek: How long do you think it takes to retrieve a lost soul?

Meredith: I don't know.

(Elevator, Izzie is looking in)

Izzie (smiling): Way to go George!

George: I have my finger in a heart.

Izzie: Very cool. (She stops smiling when she makes eye contact with Alex who looks upset)

(Ellis's room)

(Verna's room)

Izzie: You have stress cardiomyopathy.

Verna: Cardiomyopathy? What does... can you tell me what that is?

Izzie: It's Ted.

Verna: Ted?

Izzie: Ted. Not just the neighbor you barely knew, was he?

Verna (trying to not get emotional): I don't know what you're talking about.

Izzie: Cause every year on the day he died, you get a rush of adrenaline caused by stress. Your pressure rises. You have chest pains. And you end up here.

Verna: 27 years. I loved the man next door, and he loved me. I know how this is gonna sound but Ted was my soul mate. And then he just died!

Izzie (quietly): Its grief. Your heart stops because you're grieving for Ted.

Verna (teary): So ... what do I do next? ... I mean how do you treat it?

Izzie: I wish I knew.

(George talking with the police being congratulated. Alex just walks away)

(Derek and Meredith watching the healing ritual)

(Richard enters Ellis's room)

Ellis: I told Thatch I'm leaving him.

Richard: You left Thatcher, Ellis. But I couldn't bring myself to leave Adele. Do you remember?

Ellis: Painted horses.

Richard: Yes. We were on the carousel in the park. It was raining.

Ellis: I have an offer from Boston General.

Richard: You took it to get away. We swore to never to talk again about what we had together. It was gonna always be our secret.

Ellis: Richard.

Richard: Yes, Ellis?

Ellis: Carousels give me the creeps.

(Mr. Lamott's room)

Cristina: How do you put up with it? ... I mean 'Nasty Naughty Nurses 4' and I'm assuming 1, 2 & 3.

Mrs. Lamott: He's my Henry.

Cristina: I know, but don't you find him misogynistic and degrading and kind of ... (she sighs) 24 hours a day of p0rn. Seriously that's your life?

Mrs. Lamott: I'm grateful for it. It takes away his pain. You see the thing is ... Henry ... Henry takes away my pain.

(Cristina looks likes she understands)

(Healing ritual, Anna and Meredith nod at each other)

(Derek and Meredith in Anna's surgery. Derek looks up to the gallery to see Addison watching, smiling. Meredith notices.)

(Scrub room after the surgery)

Meredith: I lied. I'm not out ... of this relationship. I'm in. I'm so in, it's humiliating because here I am begging...

Derek (interrupts quietly): Meredith.

Meredith: Shut up. You say Meredith and I yell, remember?

Derek: Yeah.

(Derek leans against the sink listening)

Meredith: Ok, here it is. Your choice. It's simple. (She starts getting teary and emotional) Her or me. And I'm sure she's really great. But, Derek... I love you... in a really, really big ... "pretend to like your taste in music, let you eat the last piece of cheesecake, hold a radio over my head outside your window"...unfortunate way that makes me hate you, love you. So pick me. Choose me. Love me.

(Derek looks at her lovingly. He moves in to touch her. Meredith pulls away)

Meredith: I'll be at Joe's tonight. So if you do decide to sign the papers, meet me there.

(Meredith walks out. Derek looks distressed and sighs)

(Seattle Scenes)


(Ellis's room)

Richard: Goodbye, Ellis.

(Ellis doesn't look at him. Meredith walks up to Ellis)

Meredith: I am gonna come see you tomorrow, okay?

(She moves to step back but Ellis grabs her arm)

Ellis: He doesn't love her. He can't. But he'll stay with her anyway. She's his wife.

Meredith: Mom? (Ellis looks like she recognizes Meredith as she is today). Mommy.

Ellis: Meredith. (Meredith crouches down. Ellis places cups Meredith's cheek with her hand). You grew up.

Meredith: I did.

Ellis: Hmm. It's a shame. It's awful being a grown-up. But the carousel never stops turning. You can't get off.

Meredith: Ok.

(She stands up and a person wheels Ellis out. She and Richard just stand there)

(Joe's bar, Meredith is doing tequila shots)

Meredith: You think he'll show?

Joe: He'll show.

(The door opens. Meredith turns to the door hopefully but it's George walking in)

George: Hey!

(Derek in the waiting room of SGH, Bailey walks by all dressed up)

Bailey: How's your patient? The one who got her soul back?

Derek: She's gonna be fine.

(A man knocks on the window from outside the hospital. Dr. Bailey sees, smiles and waves)

Bailey: Gotta go.

Derek: Look at you. You're like a girl. (she gives Derek a look) Is that your date?

Bailey: That's my husband.

Derek: You're married?

Bailey: 10 years today.

Derek (shocked and smiling): How come I didn't know you were married?

Bailey: You never asked. (He half nods) You haven't signed those divorce papers yet, have you?

(He shakes his head no. She shakes her head as well)

Derek: Bailey. Tell me what to do.

(They both chuckle)

Derek: God, why does this have to be so hard?

Bailey: It's not hard. It's painful but it's not hard. You know what to do already. If you didn't you wouldn't be in this much pain.

(She walks outside and meets her husband. They hug and kiss. Derek watches)

MVO: Pain. You just have to ride it out. Hope it goes away on its own. Hope the wound that caused it heals.

(Cristina enters the on-call room)

Cristina: So here's where we are. I work too much. I'm competitive. I'm always right. And I snore.

(Dr. Burke looks confused)

Burke: What?

Cristina: I'm trying here.

(Dr. Burke still looks slightly confused)

Burke: Ohhhhh. Oh. ... (Realization dawns) Oh! Oh.

Cristina: Yeah. (She smiles)

Burke: So?

Cristina: Okay. We're a couple. Whatever. Don't make a big deal about it.

(She walks to the door. But then walks back quickly, jumps and kisses Burke. She walks back and out of the room)

(Derek is still sitting in the hospital)

MVO: There are no solutions. No easy answers. You just breathe deep and wait for it to subside.

(Meredith is still waiting)

Meredith (sighs): He's not coming. (Izzie looks sad for her) You don't think he's coming.

Izzie: He might come.

Cristina: Yeah. You never know.

George (to Meredith): He's definitely coming.

(Izzie kicks George)

George (to Izzie & Cristina): Ow. What? Do you want her doing tequila shots all night? I'll be the one cleaning up the vomit. (they look at him. He looks at Cristina) Besides, I touched a heart today. Porny.

(The bell on the door goes off again. They turn to look. It's just a couple entering the bar)

MVO: Most of the time pain can be managed.

Meredith (to Joe): Pour me another one.

MVO: But sometimes, the pain gets to you when you least expect it.

Joe: I'm telling you. Any second.

(Derek is still sitting in the hospital)

MVO: Hit's way below the belt and doesn't let up.

(Addison walks up to him)

Addison: I have been looking ... everywhere for you.

Derek: Well ... you found me.

Addison: So? You gonna sign those divorce papers or not?

(Derek just looks at her)

(Meredith is at the bar, taking tequila shot after tequila shot)

MVO: Pain. You just have to fight through because the truth is you can't out run it. And life always make more.

(Meredith sits at the bar, very sad)