02x11 - Owner of a Lonely Heart

GREY'S ANATOMY

2x11: Owner of a Lonely Heart

Original Airdate: 12/4/2005

Written by: Mark Wilding

Directed by: Daniel Minahan

(Seattle Scenes)

(SGH Courtyard)

MVO: Forty years ago, The Beatles asked the world a simple question. They wanted to know where all the lonely people came from. My latest theory is that a great many of the lonely people come from hospitals. More precisely the surgical wings of hospitals.

(NICU Ward)

(Izzie, George, Cristina & Meredith are all in a room either standing over or sitting in front their respective quints who are in incubators. The babies are very tiny)

George: I have the best quint. Lucy, she just smiled at me.

Izzie: She's nine hours old, George.

George: I'm saying there are 5 babies here and clearly mine is the advanced one

Meredith: Charlotte's smart. She's got wrinkles on her forehead, very serious.

Izzie: Okay, A. This is not a competition and B. my quint kicks your quints' asses. Emily is strong, she won't let go of my finger.

Cristina: Ah, hey! Julie has her organs on the outside of her body and she's still alive thank you.

(Alex walks into the room)

Alex: Kate's the best one. (Izzie doesn't turn around to face him) Izzie.

Izzie: Leave.

Alex: Can we please just talk?

Izzie: You're too busy screwing nurses to talk. Just get out.

Alex: Can someone make sure that Kate's vitals remain stable?

Meredith: I will.

(Alex leaves)

Izzie: He's unbelievable! I am so glad I never slept with him which is his loss because I'm really good in bed. Mind blowing. Mind blowingly good in bed.

Cristina: Are you trying to seduce us?

Izzie (disdain in her voice): And then he sleeps with Olivia instead of me. Olivia.

George: Hey, I slept with Olivia.

Izzie: Yeah well then you both have bad taste.

George: You know you can't say that you weren't warned. Alex has always been Alex.

Meredith: You dodged a bullet, Iz, you're better off without him.

Cristina: Why are you even surprised? Sleep with a snake, you get bit.

Izzie (upset): Thanks, guys. For the support.

(Dr. Bailey enters the room)

Bailey: Who's on call tonight?

Izzie: I am.

Bailey: All right, the rest of you go home. Sleep. All 5 quints are still alive. It's a good day.

MVO: As surgeons we ignore our own needs so we can meet our patients' needs.

(Izzie watches as they all leave the room)

(Meredith's house)

(Meredith is lying in bed by herself awake)

MVO: We ignore our friends and families so we can save other people's friends and families.

(George is lying awake in bed by himself)

MVO: Which means that at the end of the day all we really have is ourselves.

(Quints room)

(Izzie is resting her head in the babies room looking sad)

MVO: And nothing in this world can make you feel more alone than that.

(Burke's apartment)

(Burke is sitting at the dining table reading a paper with breakfast prepared laid out before him. Cristina comes rushing in from the bedroom getting dressed)

Burke: I made breakfast.

Cristina: I don't, I don't have time for breakfast. I've gotta round before everyone else does if I want to get the good cases, you know that.

(She puts on her coat and grabs her bag)

Burke: Right. Well, coffee?

(He holds up a mug of coffee for her to sit and have with him)

(Cristina misunderstands and takes the cup from him, puts it into a flask to takeaway with her and puts the mug in the sink. Burke looks confused. Cristina leaves)

Burke: Bye!

(SGH Hallway)

(George and Meredith are holding cups of takeaway coffee walking down the hallway)

George: So I was thinking uh we could ah, I mean you could ah maybe ah go Joe's later, to talk by ourselves ...

Meredith (interrupts teasing): Somewhere new? Somewhere to be ... (she stops and tells George to shh when she sees Addison and Derek arguing in front of them a few feet away)

Addison: Cause you live in a glorified camper!

Derek: 40 acres of some of the most beautiful land in Seattle!

Addison: I did not give up a Central Park brownstone to come live in the forest!

Derek: Addie, our house in the Hamptons had trees. You didn't mind those trees, did you?

Addison: They were the Hamptons.

Derek: Why are you pointing at me like that?

Addison: Don't ...

(Their argument trails off as Meredith and George stop walking behind them. Meredith turns back to George)

Meredith: I'm sorry, what were you saying?

(George looks at her and then back down the hall)

George: Oh, nothing.

(George and Meredith are entering the staff locker room. Cristina is standing there eating chips out of a bag. Izzie is sitting against the lockers fast asleep)

Cristina: Oh, does anyone have any decent food?

George: You really should eat breakfast.

Cristina: God, you sound like Burke. You know sometimes I think we would be better off with dogs.

Meredith: Preaching to the choir! I'm over men.

George: Real nice. You know a dog is not a replacement for a human being.

(Alex wanders past them)

Alex (gestures to Izzie): You guys better wake her. If Bailey catches her sleeping, she's dead.

Cristina: Izzie. (she kicks Izzie) Izzie.

Izzie (angry): Damn it, what?

Cristina (to George): Hell hath no fury like a girl whose non-boyfriend screws a nurse.

Izzie: Bitch.

Cristina (nods): I like you bitter and pissed off. You're almost like a normal person now.

(Bailey, Izzie, Meredith & Alex are entering a patient's room. George is already in there. Patient name is Carl Murphy who has enormous swelling, pooling of blood at his nose and finger)

Bailey: Okay, what do we got?

George: Ah, Karl Murphy. 52. Multiple skin melanomas. Under went reconstructive surgery to his nose, right ear, as well as skin graft to the left index finger.

Bailey: How's the capillary refill?

George: Slow. About 4 seconds.

Bailey: Ah what do you recommend to get that blood moving Dr. O'Malley?

George: At this stage our best options are probably a bio-therapeutic agent.

Karl: What, what is that?

George: We put leeches on your face.

Karl (smiles): Leeches? You don't say.

Bailey: They secrete blood thinners to help break up pooled blood so it can help be evacuated. Sorta like a, a big drain. Look if this makes you uncomfortable ...

Karl (interrupts): No, no, no. I've been a hiker for forty years. Almost forty years now and Mother Nature hasn't come up with anything yet that I haven't found reason to love.

Bailey (smiles): You're a big outdoorsman?

Karl: How do you think I got all these melanomas in the first place?

(Bailey is with her group in an open ward. She pulls open the curtains and sees Derek standing over Mr. Martin unconscious taking some notes)

Bailey: Oh Dr. Shepherd, you're in early if you'd like us to come back?

Derek: No go ahead.

Meredith: Robert Martin. 45. Collapsed and hit his head which caused a small subdural hemorrhage.

Derek (he looks pointedly at Alex): That was the problem.

Meredith: Mr. Martin was found to have a Rathke's Cleft Cyst on his pituitary and surgery was postponed when ...

(she trails off)

Alex: When I told a nurse ...

Izzie (interrupts): Olivia.

Alex: When I told a nurse to administer an incorrect dosage of hypertonic saline.

Derek (angry): Essentially dehydrating Mr. Martin's brain.

Alex: He still has chance he could wake up and be fine.

(Derek gives him a look and starts moving to walk off. Alex stops him. The others listen to their convo quietly as they try to speak privately)

Derek (scoffs): There is a chance.

Alex: I know I screwed up, just put me back on this case please.

Derek: There's not much of a case left here Dr. Karev. You saw to that. You want back on, be my guest.

(They all leave except for Alex who stands close over Mr. Martin)

(In the Quints' room Dorie and Tom are standing looking at their baby girls. Addison is checking one of them. Bailey and her interns come in, including Alex)

Addison: Oh good here you are. Mom and Dad are anxious for an update. Dr. Yang?

(Tom helps Dorie back into her wheelchair)

Cristina: Ah we've done the initial surgery on Julie's omphalocele. A primary closure was attempted but there was pulmonary comprise, so we couldn't continue...

Bailey (interrupts): Yang, how about we do this in plain English?

Cristina: Oh, um we operated on Julie's external sac of organs and we pushed in as much of the bowel we could and we think we can push in the rest with a second operation.

(Tom nods but Dorie sighs)

Dorie: She has to have a second operation?

Cristina: Yeah. (Dr. Bailey nudges her) Uh well not for a few days.

Addison: Dr. O'Malley.

George: We put in Lucy's brain shunt in yesterday and she's doing very well, but we just have to keep monitoring her to make sure the spinal fluid doesn't back up.

(Addison nods)

Addison: Stevens.

Izzie: Dr. Burke used a catheter to open Emily's atrial septum last night. Today we're going to go in and try to reconstruct the left chamber of her heart. We're very hopeful.

Addison: Dr. Grey.

Meredith: Charlotte's lungs were a little more underdeveloped than the rest of the quints so we put a special mask on her to help her breathe and we're monitoring her closely.

Addison : And that just leaves Kate.

Alex: She seems to be pretty healthy. No major issues have been identified but we're going to keep her in the isolette till she makes it to 4 pounds.

Tom: You hear that honey? Kate's doing really well.

(Dorie looks despondent)

Dorie: I'll be in my room.

(She is wheeled out of the room by a nurse)

Tom: Dr. Shepherd?

Addison: It's alright Tom. She's just had 5 babies. Her hormones are all over the place. Just give her some time. She'll come around ...

(Their conversation dies off as they make their way out of the room. Izzie looks on sad)

(Bailey and her interns are walking up stairs in the hospital)

Bailey: Grey, keep an eye on the mother of the quints. Make sure her hormones don't get the best of her.

Izzie: But I can look after Dorie.

Bailey: No you have ah Emily's heart surgery with Dr. Burke.

Izzie: But I have a relationship with the mother.

Bailey: Why are you arguing with me?

Izzie: Because I don't understand why I'm being pushed off of the case!

(Bailey stops walking and turns around to face Izzie)

Bailey: Hey, Hey Stevens! I don't know what you're so angry about but I don't care. You better keep it to yourself. (the others watch quietly) On top of every other patient we have under our care, we've got quints to worry about, understood?

Izzie (nods): Yeah.

Bailey: Look these are preemie's people, they were supposed to have spent another 8 weeks in the womb. Just like interns, they're not ready for the real world. (her beeper goes) Oh, it's the pit. Yang, come with me.

(Bailey heads back down the stairs with Cristina and the others head off in different directions)

(Bailey and Cristina are standing outside an ambulance in front of the E.R part of the hospital. The paramedic Jill walks out to meet them)

Jill: Constance Ferguson. 40. Inmate at Henderson. (she opens the back doors to ambulance) Swallowed a razor blade.

Cristina: Attempted suicide?

Bailey: Attempted field trip. Worked too.

(Some ER doctors and Jill pull out a gurney with Constance � played by Rosanna Arquette, screaming with joy)

Cristina (to Dr. Bailey): What do you mean field trip?

Bailey: It says on her chart she's was in solitary. This is her way out.

Cristina: Oh is she crazy?

(They start wheeling Constance into the hospital)

Jill (sarcastic): If you call a murder crazy.

Constance: Yeah, baby that's what I'm talking about!

(Constance is lying in a hospital bed chained by handcuffs. Two policewomen are sitting outside the room. Bailey & Cristina are in the room with Constance)

Bailey: Ms. Ferguson, are you experiencing any discomfort?

Constance: You mean apart from these snazzy handcuffs you got pinching my wrists?

Bailey (gives Cristina a look): Did you at least put tape on the blade?

Constance: I'm not an idiot.

Bailey: You swallowed a razor blade.

(Constance raises her eyebrows at her)

Bailey: So you're not going to tell me what it hurts?

Constance: What and shorten my vacation? (to Cristina) Hey since you're just standing around why don't you get me some chocolate pudding? Make the blade go down smoother.

(Bailey hands the chart over to Cristina)

Bailey: Yang, get an x-ray. Make it portable. Prisoners so we have to minimize flight risk.

Cristina: Wh, what, okay, okay but I'm supposed to check on Julie. I thought you said we were supposed to keep a close eye on the quints.

Bailey: Julie is my quint too. I got that covered, you do this.

Cristina: Are you sure you can't do it?

Bailey: I can! I choose not to!

(Dr. Bailey leaves the room)

Constance: Come on baby. I'm not gonna hurt you. I only murdered three people and none of them were doctors.

(George is entering Mr. Murphy's room. There's a jar of leeches on the table at the end of the bed. Nurse Olivia is already in there trying to put a leech on Mr. Murphy's nose)

George: Olivia.

Olivia: Dr. O'Malley.

George: How are the leeches doing?

Olivia: They're not. Still can't get them to bite.

Carl: All this blood. Think it'd be a no-brainer for a leech.

George: Sometimes they get a little anxious, bright lights (he switches off the bed side light) thunderstorms ...

Olivia (drops the leech): Ooh!

George: Nervous handlers.

Olivia (to Mr. Murphy): I'm sorry. I should be better at this. (Mr. Murphy smiles as if to say its okay) I still get a little squeamish around leeches.

George: Huh, that's not what I've heard.

(Olivia gives George a look)

Olivia: Dr. O'Malley can take over from here.

(Olivia leaves the room and George moves to where she was standing to put on the leeches)

Carl: Whoa, whoa, whoa, what was that all about?

George: Nothing. (He picks up a leech) Okay. (He gets it to bite) There we are. He's in.

(Izzie is standing by herself in an elevator looking stone-faced, arms crossed in front of her as the doors open. Olivia gets on the elevator and breathes out deeply to herself. The doors of the lift close)

Olivia: I had no idea that you and Alex were a couple. It's just ... I was having a bad day and it was good to have someone. (The elevator dings past a floor) To talk to I mean. Not good to ... Alex really is good. (She nods) I mean he's good in the way he's a good person good. Not the other kind of good. (The elevator dings past another floor) You know good in bed, good. ... Which he is as I'm sure you know, but ...

(The elevator dings open at a floor and Izzie gets off still stone faced and not saying anything)

Olivia: Oh ok. Well bye.

(Meredith is sitting at Charlotte's incubator checking on her in the quints' room. A nurse is there with her at Lucy's incubator. Derek walks in towards Lucy's incubator)

Derek: Any temperature spikes?

Nurse: No, no fever. Vitals are stable.

Derek: Good, that's very good. Go ahead, after you. Thanks.

Nurse: Thanks.

(The nurse leaves and Derek checks Lucy's chart. George is comes to the door and stops himself from walking in when he sees Meredith in there with Derek and stays outside and watches)

Meredith: So, you're giving up the trailer?

Derek: I'm not giving up the trailer. Is Addison telling people that I'm giving up the trailer?

Meredith: It's just funny, I just never would have pegged for that guy.

Derek: What guy?

Meredith: You know the marble bath, private pool, gated community guy.

Derek: Don't peg me. I'm not peggable.

Meredith (smiles): You're pegged. Deal with it.

(All of sudden Charlotte's heart monitor starts beeping rapidly. The nurse comes rushing in and Meredith stands up quickly and Derek rushes over. George enters the room. The nurse opens up the incubator)

Nurse: BP's low. She's tachycardic.

Derek: Sats?

Nurse: Dropping on high flow O2.

(Meredith is checking Charlotte with a stethoscope while the nurse uses a manual respirator pump on Charlotte)

Meredith: No breathing signs on the right side.

Derek: Her lung has collapsed.

George: Should I call the other Dr. Shepherd?

Derek: No time. (to Meredith. He holds up a thin tube) Here stick this between her 2nd and 3rd rib. Do not go too deep. You're gonna hear a small gush of air.

(Meredith takes the tube and does it. A small gush of air is released and the heart monitor stops beeping rapidly)

Meredith: I heard it.

(Derek sticks in his stethoscope from the other side to check Charlotte's breathing)

Derek: Nice job.

Meredith: Thank you.

Derek: I'm not giving up the trailer.

Meredith (smiles): Whatever you say, Dr. Shepherd.

(George stands and just watches)

(Dorie's patient room. Dorie is sitting on her bed with Tom standing near her. Meredith is there talking to them. Dorie has her back to Meredith)

Tom: Her lung collapsed?

Meredith: And I know it sounds scary but it's really not that uncommon in a preemie this size. So we've inserted a tube into Charlotte's chest and that will help her breathe until her lung can stay up on its own. (She looks at Dorie) Mrs. Russell? (Tom's phone rings and he checks it) She really is doing fine now.

Tom: That's me, I gotta go. My mom can only handle the triplets for half a day. She's 74, so...

Meredith: Mmm.

Tom (to Dorie): I'll call you as soon as I get home, ok? (Dorie nods) I love you.

(She smiles half heartedly as he kisses her forehead. Tom moves to leave the room but stops to talk to Meredith)

Tom: Could you?

Meredith: I'll keep an eye on her.

Tom: Thank you.

Meredith: Ok.

(Tom leaves and Meredith walks over to stand in front of Dorie)

Meredith: Dorie, this isn't your fault. You can't blame yourself for this.

Dorie: I've got one baby who can barely breathe and one with half a heart. Two of the others are ... (she sighs while Meredith looks at her sadly) If I'd have listened to the doctors I could've had 3 healthy girls instead of 4 who might not live until tomorrow. It was my decision. Tom agreed with the doctors. So really Dr. Grey, who else should I blame?

(Meredith is silent unsure how to respond)

(Dr. Burke and Izzie are in the scrub room adjacent to the OR getting prepped for Emily's heart surgery)

Izzie: First step in the Norwood is the cardio pulmonary bypass.

Burke: With HLHS what else do you get besides hyperplasia of the ventricle?

Izzie: Stenosis or atresia of the mitral and aortic valves.

Burke: Why are using the RV-PA conduit instead of the modified Blalock-Taussig shunt?

Izzie: It limits diastolic run off.

Burke: Well you've done your homework.

Izzie: I was on call last night. I study when I'm on call.

Burke (chuckles): Well, no matter the books say, I guarantee you; you've never seen a heart this small.

(Izzie notices Alex standing outside in the hallway)

Izzie (mutters to herself): Bet you I have.

(Bailey is checking on Julie in the quints' room)

Bailey: How you doing you? You know I'm having a baby too. (she puts on a baby voice) Yes I am. A little boy. Maybe you can meet him someday. How does that sound? Does that sound good?

(Cristina is standing the room quietly. She lets out a little hem hem and Bailey turns around to see her. Bailey closes the incubator and clears her throat talking normally now)

Bailey: Pregnancy has not made me soft. I haven't got soft. I don't do soft.

Cristina: Of course not. You were just talking to a patient.

(She walks up to Bailey with some x-ray films)

Bailey: What's this?

Cristina: The inmate's x-rays.

(Bailey takes the film to hold up and look at)

Bailey: Uh! That foolish, foolish, woman! She swallowed 4 razor blades!

Cristina: Mm-hmm.

(Constance is sitting agitated in her room by herself. She notices nurse standing outside)

Constance: Hey! Hey you! Hey nurse!

(The nurse walks in)

Nurse: Would you keep it down please?

Constance: I'm starving.

Nurse: You're NPO. No food allowed.

(Constance looks at the television program playing in her room)

Constance : Come on April baby don't go for him. He's such an idiot. (the nurse stares at her and she turns her gaze back at her) I didn't come here to starve to death. I want mint chocolate chip ice-cream! Mint, okay? Not rocky road! You better not get me that rocky road! It sucks!

(Bailey and Cristina enter the room)

Constance: Oh thank god, mama bear help me out here ok? I'm starving.

Bailey: Don't give her anything.

(The nurse leaves)

Constance: See right there you're in official violation of the 8th amendment.

Cristina: Uh you can't eat anything because you're about to undergo major surgery.

Constance: What? (to Bailey) What's she talking about?

Bailey: You're at risk for a perforated intestine and half a dozen kinds of infection. We need to operate right away.

Constance (scoffs): I don't need an operation. I taped up the blade like I always do. It passes the next day. What's the big deal?

Cristina: You swallowed 4 blades this time. That's the big deal.

Constance (shrugs): I Thought it'd buy me an extra day. Does this operation have a nice long recovery time?

(Bailey shakes her head less than impressed)

Cristina: You realize this is major surgery? It's dangerous and you could die.

(Constance is silent and just stares at her)

Constance: Mint chocolate chip. I want at least a gallon once you ghouls are done splitting me open.

(Bailey and Cristina leave)


(Dorie and Meredith are outside the quints' room. A nurse and doctor are in there already. Meredith is helping put a gown on Dorie)

Dorie: What exactly is it that we're doing?

Meredith: We're visiting. We throw all this medical talk at you and outlined all these worse case scenarios which has probably scared you half to death. One thing we haven't done is actually given you a chance to be with your daughters.

(She wheels Dorie into the room. The two people in the room leave)

Dorie: How's that gonna help? If I've learned anything in these last few days is that I need to face reality.

(Meredith wheels her next to an incubator)

Meredith: Here's Kate. You can reach in and touch her if you like.

Dorie: I would like to very much.

(Dorie reaches in tentatively and strokes Kate's fingers. All of a sudden a heart monitor starts beeping rapidly. The nurse from earlier enters)

Nurse: Dr. Grey, Charlotte's not breathing!

(Meredith and the nurse rush over to Charlotte's incubator. The nurse opens the incubator and Meredith gets out her stethoscope to check Charlotte)

Meredith: Page Addison Shepherd. She's in the OR

(Dorie watches anxiously from her wheelchair)

(Addison, Burke & Izzie are operating on Emily in the OR. Various other doctor's and scrub nurse's are there)

Addison: We didn't see this on the echo.

Burke: You can never get an exact measurement.

Izzie: What?

Burke (sighs): The baby's aorta is narrower than we thought. The diameter is only a millimeter. Just not getting enough blood flow.

Addison: Damn.

Burke (to Addison): I wanted you to see this before I started closing up.

(Addison nods)

Izzie: You're closing up? You didn't do anything.

Addison: Dr. Stevens.

Izzie: No! We barely started!

Addison: Dr. Burke has done as much as he can do for now. So unless you know how to do a 1st stage Norwood, he's gonna close this baby's chest.

(Addison's pager goes off. She looks at and leaves)

(Izzie sighs shaking her head)

Burke: You ok?

Izzie: I'm fine. May I go?

Burke: Yes.

(Izzie moves away from the surgery)

(Addison enters the quints' room hurriedly)

Addison: What happened?

Meredith: She had an apneic episode. She's still not breathing on her own.

(Dorie looks startled at this.)

Addison: Let's intubate and give her surfactant. Push 0.1 atropine and 3mg of ketamine.

(They all start moving quickly to intubate Charlotte)

Nurse: Meds are in.

Addison : Tube. (They continue fixing the intubation) Okay, place the CO2 detector.

Meredith: She was doing fine with the chest tube.

Addison: That's the thing with RDS cases. (She gets her stethoscope to check the baby) We think the baby's getting better. They slip right back. Breath sounds equal. Good.

(Meredith looks up suddenly)

Meredith: Mrs. Russell.

(She looks over to the spot where Mrs. Russell was before but there's only an empty wheelchair there)

(In an OR Bailey and Cristina are operating on Constance. Bailey pulls out a razor blade. Bailey sighs)

Cristina: Unbelievable. Who would do this to themselves?

Bailey: The woman wasn't just in prison Yang. (She puts the blade in a dish held out by a scrub nurse) She was in solitary.

Cristina: Well, she's seriously deranged.

Bailey: You try spending a month, locked in a room with no windows, no one to talk to, 23 hours a day. (She pulls out another blade and discards it) See how deranged she is then.

Cristina: Dr. Bailey, she's a murderer.

Bailey: I didn't say she wasn't. (She pulls out another blade and counts them) 1, 2, 3. I said try to having no one to make your snarky comments to for a solid month. My guess is (she pulls out another blade) you'd swallow the entire razor.

(George is entering Mr. Murphy's room)

George: How are they treating you Mr. Murphy?

Karl: Oh, I've done worse for company.

George (checks the leech on Mr. Murphy's finger): Oh they're definitely filling up. Tissue is getting nice and pink.

Karl: Did you make up with that cute little girlfriend of yours yet?

George: Olivia is hardly my girlfriend.

(He moves to check the leech on Mr. Murphy's ear but it falls off. He picks it up)

Karl (looks at the giant leech in George's hand): Is she ok?

George: She?

Karl (he nods at the leech): Isabella. (George looks down dumbfounded) This one here on my finger, that's Darcy. And that little guy on my nose, named O'Malley. (He chuckles. George half smiles still a little creeped out) That's right. I named him after you. You're the one that got him to bite.

George: Isabella's fine. She's just full.

Karl: Oh. (George moves to dispose Isabella) Wait. What are you going to do with her?

George: She's done her job. We don't really have any more use for her except as medical waste.

Karl: No. I'd like to keep her. If I could.

(George just stands there and stares at him)

(George is rummaging through the Medical supply stands of the hospital in a hallway)

George (to himself): Crazy nature man. You want to take a leech home as a pet. That's fine with me.

(Olivia walks up to him)

Olivia: You had no right to speak to me that way in front of a patient.

George: Yeah, well you hurt my friend.

Olivia: I had no idea Alex was seeing Izzie. That's not what you're upset about.

George: You have no idea why I'm upset. Besides you know what I don't understand is why Alex? (he turns to face her) And why again?

Olivia (nods and shrugs): People get lonely, George.

(Meredith is on the phone at the nurse's station outside Dorie's room. She is watching Dorie from there)

Meredith: Hi, Mr. Russell. It's Meredith Grey calling. I was wondering if there was any chance maybe you could bring your boys by to visit there mom. I think she could use the company. (Dorie looks despondent) Oh the flu. No definitely don't bring them. Thank you. You too.

(Alex is sitting taking notes and looking through text books sitting in front of his quint, Kate in the quints' room. No one else is in there. Meredith walks in and then walks up to him)

Meredith: You've been lying low.

Alex: Well nobody's talking to me so it makes it kind of easy, right?

Meredith (pulls up a chair and sits next to him): I'm talking to you. In short mono-syllabic sentences laced with disdain and contempt.

Alex: So what according to girl rules, now you all have to hate me?

Meredith: I don't hate you. If my mother hadn't gotten Alzheimer's I'd probably be you.

Alex: Well, really?

Meredith: Really. Before she got sick, I mean, I'd finished college but I was partying way too much and staying out way too late to keep a job. I was the one at family reunions everybody was embarrassed to talk about.

Alex: So that's what you think of me?

Meredith: Are you ok?

Alex: I almost killed a guy yesterday.

Meredith: Mr. Martin?

Alex: So I'm just trying to find anything I can to help him.

(Meredith grabs a textbook from him)

Meredith: Ok, well what are we looking for?

Alex: Ah anything on central pontine myelinolysis.

(They start looking through the books. Just then Izzie walks in straight past them to check on her quint. They look up at her. She turns around slowly and gives Meredith a look as if to say how could you do this)

Izzie (shakes her head): Unbelievable.

(Izzie leaves the room)

Meredith: Izzie.

(Alex half chuckles at the situation of it all. Meredith sighs and gives Alex the book back. Alex sighs as well looking low. Meredith gets up to chase Izzie)

Meredith: Izzie, come on.

(Meredith is following Izzie down the hallway adjacent to the quints room)

Izzie (angry): Come on, Come on? You're fraternizing with the enemy and you tell me to come on?

Meredith: Alex and I are sort of friends.

(Izzie stops walking and faces her)

Izzie (angry): Since when? Since when are you and Alex friends? You tell me to cut my losses. That I'm better off without him and as soon as I turn my back ...

(She turns around and starts walking again with Meredith following)

Meredith: Izzie, you're making way too big a deal out of it.

(She stops again and turns to face Meredith)

Izzie (angry): Right of course, because I'm the unreasonable one. You know what Meredith do whatever you want. Sleep with the guy for all I care.

(She turns around again, walking off)

Meredith: Well obviously I'm not going to sleep with him Izzie.

Izzie (angry): Why not you slept with everyone else?

(Meredith stops walking after her instantly and gets a look on her face and turns around and heads back down the way she came)

(Cristina is talking to Constance after the surgery)

Cristina: Your surgery went smoothly. You'll have some abdominal pain for a day or two.

Constance: Just a day or two?

Cristina: We'll watch you until your bowels start moving again. The average is about 36 hours.

Constance: 36? 4 razor blades and that's all you can give me? Come on sugar plum I thought we were having fun.

(Cristina makes to leave the room at this)

Constance: Don't' leave.

(Cristina turns around)

Cristina: What?

Constance: Just maybe a little conversation? They got me here in all by myself. I thought I'd have a roommate. Somebody to talk to.

Cristina: Ok. (She walks up to Constance's bed side) Why'd you kill 3 people?

Constance (sarcastic): Start off with a little small talk why don't you? (Cristina makes to leave. Constance speaks quietly) I was high. On meth. ... And I had this boyfriend who had this robbery all planned out. He said that he would leave me if I didn't help him. Things got out of control. (She sighs) He was gonna leave me. (She nods) He was all I had. I would've been all alone.

Cristina: Clearly being alone has its benefits.

(Cristina shakes her head slightly and leaves. Constance just rests her head against the pillow sad)

(George is smiling entering Mr. Murphy's room, he stops when he sees Olivia standing there. There are few giant leeches in little jars at the bed table with name tags on them. George walks up to the opposite side of the bed, facing Olivia. Mr. Murphy watches with interest)

George: You paged me?

Olivia: Another leech fell off and I can't get the new one to bite. I'm sorry they just really freak me out.

George: I'm a surgeon Olivia.

Olivia: You're an intern George.

(George grabs the container with the leeches roughly and starts getting out one)

Karl: You know what time it is? ... Time for you two kids to kiss and make up. That's what time it is.

George: Mr. Murphy, we are not a couple.

Karl: Oh you can't pull much over on me. And I say there's something between you two.

Olivia: You're right Mr. Murphy. There was.

George (looks up shocked): Olivia. This isn't the time and this really isn't the place.

Olivia: He broke up with me for this girl who doesn't even know he's alive.

George: She does so know I'm alive.

Olivia: Listen to me George. You, Meredith Grey, never gonna happen.

George (dazed): Wh, why, why, why would you even think it's Meredith?

Olivia: Anyone who's playing the slightest bit of attention knows how you feel about Meredith! Except Meredith! Which should tell you something shouldn't it! (She puts down the patient file she was holding) Sorry Mr. Murphy.

(She leaves the room quickly. George looks back at Mr. Murphy)

George: She gave me syphilis.

(Addison is sitting in chair in Richard's office facing Richard who's sitting at his desk)

Addison: Remember what you did to me? When I was an intern?

Richard: How could I forget? You didn't speak to me for almost a year. (Addison is silent looking away) But you learned.

Addison: Yeah well I think I gotta do that to Izzie Stevens.

Richard (half nods): Well she's smart, hard working. (he gives Addison a look) Gets a little too involved with her patients. A lot like you.

Addison (stands up): I know. It took me a long time to recover from that Richard.

Richard: But it made you a better surgeon Addison. (Addison nods) The question is, is she talented enough a surgeon to make the lesson worth it?

Addison: She's the best I've seen in years. I was hoping that we could ...

Richard (interrupts): You're not here to make friends Addison. You're here to make better surgeons. ( Addison nods looking down) Being a teacher can be a lonely business.

(She nods again and walks out)

(Izzie, George and Cristina are sitting at a table in the outdoor section of the cafeteria eating dinner)

Izzie: I'm telling you Meredith was all over him!

Cristina: Seriously? She was all over him? (She looks at George) What like a, mounting him? With all the babies watching? Seriously?

(Izzie rolls her eyes)

Izzie: Well she would've been if I hadn't interrupted.

George: She was talking to him.

Izzie: You don't talk to bastards that cheat on their girlfriends George! That's the rule!

George: You weren't officially his girlfriend.

Izzie: That's not the point.

George: It is kinda the point. You don't see me getting all emotion over people I'm not dating.

Izzie (raises her eyebrows and gives George a look): Really? You wanna go there?

(There's a short silence)

George (realization dawning): No.

Izzie: I'm having a moment here! Don't mess with me!

Cristina: You're not gonna have a nervous breakdown and kill yourself are you?

Izzie: No.

Cristina: So there's no chance you'll kill us? (She gestures to herself and George)

(Izzie gets up and walks off in a huff)

George: Oh that was wrong on so many levels.

Cristina (chuckles): So good.

George (smiles): Yeah, that was ... that was good.

(Cristina starts laughing)

Cristina: It was good. It was good.

(Meredith is standing in the quints' room over Charlotte's incubator looking at an x-ray film)

Meredith: Your lungs are not good. (she puts down the film) I know we got you out of there a little earlier than you would've wanted. We have to find something to help you. So if you have any ideas Charlotte...

(She looks up and sees outside in the hallway Addison giving Dorie some news. Dorie breaks down crying holding her head in her hands)

(Izzie is filling in a patient's chart at a nurse's station. Addison walks up to her dressed to go home)

Addison: Dr. Stevens.

Izzie: Ah Dr. Shepherd, is there something you need?

Addison: Yes, Dr. Burke and I have reassessed. We think that there's a chance with the Norwood if Emily can make it through the next 10 hours. Would you look after her for the night?

Izzie: I was on call last night. (Addison just looks at her) But I mean yeah, of course.

Addison: Good, good. I've left a list of meds and ah you're familiar with pediatric life support?

Izzie: Got myself certified as soon as I got in the program.

Addison: Ok then.

(She moves to walk off)

Izzie: Is there anything else I should know to look out for her?

Addison: No that should do it.

Izzie: Uh should I notify Mrs. Russell about the...

Addison (interrupts): No! I've done that. Dr. Stevens this baby is your responsibility. She better be alive when I get back in the morning.

Izzie: Ok.

(Addison walks away looking a bit unsure about the thing she is doing)

(Derek is dressed to go home at the front entrance of the hospital walking to the entrance doors. Alex comes running after him with pages of notes)

Alex: Dr. Shepherd I found these studies of the use aggressive plasmapheresis. I think these could work on Mr. Martin.

Derek: Those are all isolated cases.

Alex (sighs): Well, still the studies have resulted in approved clinical symptoms.

Derek: No, no. No trial studies have been done. There's nothing you can do.

Alex: Okay what about thyrotropin?

Derek: No. No.

Alex: European studies ...

Derek (interrupts): Karev it's over! It's done. You screwed up. Mr. Martin's fried. You fried his brain. He wakes up; you put him in a wheelchair. He dies, you killed him. ... Deal with it.

(He walks out of the hospital)

(Izzie is in the quints room injecting a drug into Emily's IV. A nurse comes in with Emily's chart)

Nurse: Dr. Stevens, baby's VO2 is still 40% after transfusion.

Izzie (nods): How's her BP doing?

Nurse: Still low. Last systolic was 52.

Izzie: Okay I'm gonna push 30ccs of NS manually.

(She injects the NS and the baby's BP starts rising on the heart monitor)

Nurse: Nice start. Pressure's 65.

(Izzie sighs and sits down in front of the incubator. The nurse leaves. Meredith walks in and stands in front of the incubator next to Izzie. She turns to talk to her)

Meredith: Hey Iz.

Izzie: Ok, really? You think I'm talking to you?

Meredith: Well I just wanted to say I'm sorry.

Izzie: What are you sorry for?

(Meredith is silent and Izzie shakes her head)

Izzie: When Derek broke up with you I never once said you're better off without him. It's not supportive, it's condescending. I was there. All I ever am is there for you guys and the one time I need you ... Just go away Meredith.

(Meredith walks out)

(Constance's room where Constance is choking. A nurse is already there. Cristina runs in)

Nurse: She was fine. She just started seizing.

(Cristina grabs a hold of Constance and looks down her throat)

Cristina: She isn't seizing, she's choking.

(She gets out a paddle stick and sticks it in Constance mouth to hold down her tongue and see what she's taken. She manages to pull out a piece of bloody glass. She looks down and around and sees a smashed lamp)

Cristina: My god, she swallowed a light bulb.

(Constance starts choking even worse. Cristina and the nurse try to stick a tube down her throat)

(Constance is wearing a oxygen mask and her heart monitor is beeping rapidly. She is still choking)

Nurse: We're losing her.

Cristina: I can see that. Don't you think I can see that?

(Cristina is checking her breathing with a stethoscope)

Cristina: She needs an airway.

(They pull down her bed and a nurse hands Cristina a silver instrument)

Cristina: Ah she's clamped down. I can't intubate. (She calls out to the hall) We need some help in here!

Nurse: You want me to get paralytics to relax the muscles?

Cristina: Ah, no she'd be dead by then.

(She grabs a manual respirator pump)

Cristina: I need a scalpel for a crich.

Nurse: You done one?

Cristina: Of course not! Go!

(The nurse leaves. Burke walks in and checks Constance with his stethoscope)

Cristina: I was gonna do a crich.

Burke: How long has she been unconscious?

Cristina: She just went down.

Burke (to another nurse): Prep O.R 2 for an emergency throacotomy.

Nurse Right away.

Burke: Cristina, she'll be okay. Come on, Come on, come on.

(He gestures for them to follow and he leaves)

(A nurse runs into the quints' room with Izzie still there sitting in a rocking chair)

Nurse: She's coding.

Izzie: Again. Ok uh, uh turn up the epi drip.

(The nurse turns up the epi drip and Emily's BP rises again)

Izzie: Ok. Ok. Ok.

(She sits down at Emily's incubator and strokes her)

(Meredith is entering Dorie's room. Dorie looks like she's packing)

Meredith: Hey, Dorie. What are you doing?

Dorie: I'm packing.

Meredith: Dorie, you've just had major abdominal surgery. You're not in any shape ...

Dorie (interrupts): I'm going home Dr. Grey. I need to go home. I can't be here. I can't watch them die.

Meredith: They're not dying. They're trying to live. And you leaving them isn't going to help them.

Dorie: I have 3 boys who need me.

Meredith: Your daughters need you.

Dorie: Don't you understand that I can't do it? I can't do it! They're too sick. They're too hurt.

Meredith: Which is why they need their mother.

Dorie: If Emily dies ...

Meredith (interrupts): If Emily dies it will be horrible. But if Emily dies and you're not here ...

Dorie: I can't even hold them.

Meredith: But you can sit with them and talk to them and let them know they're not alone in this world. That's all they need. That's all that anybody ... (she trails off, a look of dawning comes across her face)

Dorie: What?

Meredith: I think I know how to help Charlotte.

(She leaves the room with Dorie looking after her)

(Meredith is in the quints' room disconnecting Kate from her incubator. Dorie is standing behind her in a pink gown looking over her shoulder. Izzie is also in there at Emily's incubator watching)

Meredith: I don't know why I didn't think of this sooner.

Dorie: What are you doing?

Meredith: It's called co-bedding. Hospitals sometimes do it with twins when one of them is sick.

Dorie: And the other one gets better?

Meredith: It helps.

Dorie: How?

Meredith (she removes Kate from the incubator): We don't really know. Sometimes babies get stressed in the ICUs from all the activity.

(She moves Kate into Charlotte's incubator where Dorie is standing)

Meredith: This way there's someone there to comfort them. To be there with them.

(She re-connects Kate's tubes while Dorie looks over her two babies)

(Karl's room. There are jars of several big leeches swimming around. None are on Mr. Murphy any more. George is there checking on him)

George: That's excellent blood flow in all three places. You're healing very nicely.

Karl: And I like my new nose.

(George picks up the patient chart and starts writing in it)

George (notices the wedding ring): Well I'm sure your wife will like it too. Not too sure about what she'll say about your new houseguests.

Karl: Oh I'm gonna let these guys go in the lake on my favorite hiking trail. Saved my face, least I can do for 'em. And I don't have a wife.

George: Oh, I'm sorry I thought your wedding ring.

Karl: No, I'm divorced. Just never took it off.

George: By the way, ah sorry you had to see that little scene earlier.

Karl: Oh you mean talking with the girl who isn't your girlfriend about the girl who'd you like to be your girlfriend.

George: Yeah. Did she, she shouldn't have said that stuff. Did she, she, is just very unprofessional.

Karl: Yeah. (he puts a hand on George's shoulder. George immediately stops writing) But is it true? (George just looks at him) Do you like this Meredith person?

George (discomfited): I don't think that's really any of your business. (Mr. Murphy gives him a look) She's ok. I like her ok. (Mr. Murphy just sits there) All right I love her.

Karl (chuckles): Oh come on don't be embarrassed. I loved my wife. But sometimes no matter how much you love someone they just can't love you back in the same way.

(He now places his hand over George's hand)

Karl: Believe me son. Living with a woman who can't love you back, way lonelier than being alone.

(Izzie is in the quints' room with the nurse. Emily is coding again)

Nurse: What do you wanna do?

Izzie: We can, we can put her on ECMO.

Nurse: Baby this size, you're risking intercranial hemorrhage.

Izzie: Uh, it she's already coded 3 times. You paged Dr. Shepherd?

Nurse: She called to say you have to handle this for yourself.

Izzie (frustrated): What? I, it's, I'm an intern!

Nurse: Dr. Stevens.

Izzie: Just give me a second.

Nurse: You don't have a second.

Izzie: Okay, um ECMO is too dangerous; we just have to keep her going on epi.

Nurse: Too much epi and you'll stop her circulation. There's no point in keeping her heart rate if she doesn't have functioning arms or legs in the morning.

Izzie (angry): Yeah, I know that! (She pauses more calm) I'm sorry. It's just, we just going to have keep pushing epi. It's our best option. We'll just have to fina middle ground. (Izzie takes over for the nurse with the manual respirator)

Izzie (to Emily): You can do this.

(Sunrise)

(SGH Hallway)

(Meredith is standing on the mezzanine balcony hallway looking through the large window/wall at the sunrise. Derek walks up and stands next to her)

Meredith: I can't believe you would consider moving out of your trailer. The view alone.

(Derek nods)

Derek: See the mist rise off the lake.

Meredith: Yeah.

Derek: Yeah. (silence) I'm not moving.

(Meredith nods)

Meredith: You're still you?

Derek: I'm still me.

Meredith: Good.

(George is watching them from a distance in the outdoor caf�)

(Izzie is fast asleep in front of Emily's incubator, except Emily is no longer there. The nurse from last night is checking on the other babies. Izzie wakes up)

Izzie: Where's Emily?

Nurse: They took her away.

Izzie: Where? Why didn't you wake me?

Nurse: Dr. Shepherd told us not to.

Izzie: What? (she huffs) Where's the baby?

Nurse: Dr. Stevens, she died half an hour ago.

(Izzie looks horrified)

(Seattle Scenes)

(SGH)

(Izzie is standing watching Dorie holding one of her quints in her own room. Addison is there and sees Izzie. She walks out and pulls Izzie to follow her down the hall away from the room. They stop walking and Addison turns to face her. Izzie looks distraught)

Addison: It wasn't your fault.

Izzie: You put me in charge. I fell asleep. I killed that baby.

Addison: No, you didn't. She was going to die anyway. She had a restricted atrial septum and virtually no aorta. As soon as Dr. Burke opened up her chest we knew she didn't have a chance.

Izzie (shakes her head, upset): I don't get it. You order me to stay the night to take care of her. I worked my ass off doing CPR, pumping her full of every drug on the planet and, and ... I mean god do you have any idea how scared I was? It was all for nothing!?!

Addison: Hardly. If the situation ever comes up again I know you'll be able to handle the pressure.

Izzie (angry): You lied to me!

Addison: You have to learn distances, Stevens. You'll be a better doctor for it.

Izzie (disbelievingly): A better, a better doctor?

(She shakes her head angrily at Addison and walks away. Addison looks unhappy after her and sighs)

(Bailey is entering the quints' room. Meredith is in there already looking over Charlotte and Kate's incubator. There are various other nurses in there as well. Bailey walks up to Meredith)

Bailey: Heard you worked a miracle last night.

Meredith: She came around so fast I thought the equipment was malfunctioning. Her sats are completely stable.

Bailey: She's gonna make it. (she looks at the two quints) Go home Grey. You've earned it. And Grey, way to go.

(She leaves)

Meredith (to the two quints): Did you hear that? Way to go.

(Izzie is sitting despondently in the staff locker room dressed to go home. Her hair is all wet from a shower. George walks in with Cristina and Meredith close behind. Meredith is the only other dressed to go home. Cristina and George sit on either side of Izzie. Meredith stands in front of her.)

Izzie: My baby died.

George: We know.

Izzie: She just ... died.

(They're all silent)

Meredith: I have an idea.

(Izzie looks up at her and Meredith holds out her hand. Izzie takes it and they walk out)

(Alex is sitting in a chair watching over Mr. Martin who's still unconscious. Derek walks by and sees Alex there. He looks at him thoughtful)

Derek: First person I killed, I was a second year resident. James Hanson. You should go home Alex, there's nothing you can do here.

Alex: Nobody should die alone.

(Derek nods and leaves)

MVO: 400 years ago another well known English guy had an opinion about being alone. John Donne. He thought we were never alone.

(Cristina is standing in Constance's patient room at her bedside. Constance is hooked up to a lot more monitors. The 2 cops are standing inside at the door way)

MVO: Of course it was fancier when he said it.

Cristina: Don't, don't try and talk. Your windpipe was perforated. Dr. Burke repaired it and you should be fine. ( Constance reaches out to take Cristina's hand but Cristina backs away) Uh we'll keep you here at least 10 days for observation. Make sure there's no infection. (She moves to walk off but then turns back quickly) Maybe just to be on the safe side we'll make it 2 weeks.

(Constance smiles thankfully at Cristina. Cristina smiles and leaves the room)

MVO: No man is an island entire unto himself.

(Meredith and Izzie are walking past a long fence in kinda of an industrial place. They stop suddenly and bend close to the fence)

Meredith: Oh. That's him.

Izzie (smiling): Yeah that's him.

(Derek is sitting in an empty gallery overlooking an empty OR. He's writing notes in a patient chart. Addison walks in and sits next to him)

Addison: I'm lonely, Derek.

(He puts the chart away and they look at each other)

MVO: Boil down that island talk and he just meant that all anyone needs is someone to step in.

(In Burke's apartment, Dr. Burke is sitting eating breakfast. Cristina walks in and stands in front of him for a few seconds before deciding to sit down as well. She takes a slice of his toast and takes a bite of it. He looks at her and then smiles down into his plate)

MVO: And let us know we're not alone.

(Izzie and Meredith are in the townhouse living room holding up a blue soft toy playing keepings off with a dog. They're laughing and having a blast)

Izzie: Get it. Good boy! Good boy Doc!

Meredith: Ok!

MVO: And who's to say that someone can't have 4 legs. Someone to play with or run around with.

(George walks in to the nearby hallway dumbfounded by the presence of the dog. Izzie throws the blue bear into his hands. The dog runs barking at George who runs off. Izzie and Meredith laugh)

(Kate & Charlotte are lying asleep in their incubator)

MVO: Or just hang out.