06x15 - The Time Warp

[bunniefuu]

I've seen a lot of surgery residents come and go in my time.

And they're all addicted to surgery.

It comes before food, before sleep, it becomes the most important thing.

What?

Nothing.

Well, go away!

You look nice.

Go away.

The only thing.

What they don't know is that living on that high ... Can eat them alive.

I can't do it.

Of course you can.

Oh, my God. I'm gonna hurl again.

Okay, please don't, 'cause I just got the last of the puke out of your hair.

Why do I have to do this? I'm not a public speaker.

It's not my thing. God, I hate Derek Shepherd.

All you have to do is talk about being a great surgeon.

To a giant room full of people ... from a giant stage.

Oh, God. With a microphone.

Some make it through.

They come out on the other side.

They survive with their sanity intact.

They become ... better doctors and stronger people.

I didn't.

I broke.

I didn't k*ll anybody.

And I give thanks for that every day.

But I hurt people, and scared the hell out of myself.

I am 45 days sober today.

I am Richard, and I am a grateful and recovering alcoholic.

I was told if I went to rehab, my job would be waiting for me. Pending board approval.

I'm sorry, Richard.

You know, maybe they'll reassess in a few months.

I've been authorized to offer you a position as an attending general surgeon.

You want me to come work under you?

Yes, that's the stipulation.

Thanks for the offer, but, no.

I'll figure something else out.

Richard, it's lecture day, and I have an open spot.

Lecture day? You brought that back?

Look, I understand if you don't want to come back.

But if you're really gonna leave this place, don't leave it the way you did. Give one last lecture.

Good morning.

Good morning.

Good morning, everybody.

Good morning.

I'm excited.

Are you excited?

This is a, uh, teaching hospital.

We learn a lot by doing.

We can also learn ... we should also learn ... from other people's experiences.

Their losses will save you losses.

Their mistakes will save you mistakes.

Their victories will inspire yours.

Let's pay close attention. This is gonna be good.

Dr. Miranda Bailey.

Whoo!

Good morning, everyone.

Good morning.

Ow.

Morning, Dr. Yang.

What the ... If I have to stand here, you have to listen.

Eyes forward.

Answer a question right, you get a chocolate.

Doze off, you get beaned in the face ask Dr. Yang. My aim is exceptional.

2003 ... I'm three days into my intern year.

Anyone?

Alicia Tatum, status post-ophorectomy three months ago, now presents with fever and nonfocal abdominal pain.

Okay. What does her workup show?

Multiple stones and wall thickening.

Excu ... excuse me?

Multiple gallbladder stones and wall thickening.

Would you recommend we do it open or laparoscopically?

Laparoscopically.

Uh, who said that?

Who-who said that?

Uh ... Sir.

Mm.

You've, uh, had a pretty rough go of it, huh?

Nothing helps the pain

I've seen more doctors than I can count.

Hopefully we'll be the last ... eight.

We're gonna get to the bottom of this, okay?

Let's prep her for surgery.

You.

Uh, uh, Mandy.

Mandy? That's what you're going with?

Boy, your parents really wanted you to work for it, huh?

Draw some blood and take her for her pre-op x-ray.

Uh, uh, well, I was wondering

Blood draw is too much for you?

No. I can draw blood. I ... I ... I just wanted ... you don't have wants or needs.

You're an intern ... the bottom of the surgical food chain.

I am a resident.

I've been here three years. You've been here three days.

Do the math. Draw her blood.

Is she shaking?

Hmm?

She's definitely shaking.

Okay. Oh, she's doing her pee dance.

She does that when she has to pee.

Okay, well, is she gonna pee right now?

Oh. No, no, no.

That's not the right ... Um ... Okay.

Beautiful.

Um ... "In my third year as a resident, I was ... Can't hear you! Speak louder, please!

"In my third year as a resident, I ... was presented with a patient named Sunder ..."

Atluri, a 28-year-old grad ..."

"Student from India."

Uh, hey. I'm from ortho. I was paged.

You were paged by me. Alex Karev.

You have to put me on this case.

Um, here's a news flash, overly enthusiastic intern guy.

I don't have to do anything.

Oh, come on.

You seem like a cool person.

You don't know me.

Well, you look like a cool person.

I need some cool cases.

Ever since the elevator thing and heart guy, it's just ... Wait, that was you?

You're the heart-in-the-elevator guy?

Sure. Let's go with that.

You're not at all how I pictured you.

What's that supposed to mean?

I heard the story ... the heart in the elevator.

It was basically "Rudy," you know-dorky guy makes good.

But you're not dorky. You're hot.

Maybe I was dorky before I saved the cop in the elevator.

Maybe my unbelievable skill under pressure transformed me completely.

Did it?

Does that turn you on?

No. But this does.

The chief.

Um ... good ... good morning.

Once up on a time ... long before I was chief of surgery, even before I was an attending, I was a resident right here at Seattle grace, just like you.

You learn from everything in your residency ... the patients, the nurses, the attendings.

But you don't realize how much you learn from each other.

1982 ... you were all in diapers.

Give me the chart on

23-14. - Yes, doctor.

So, Dr. Russell, I hear you sh*t a 74 last week.

You should come to my club when you have a day off. Here you go.

I used to play out there with your father.

We'll see if you measure up.

Oh, I'd love to, sir.

We get any path back yet?

Nothing's grown out of the cultures.

I checked them this morning, sir. I went to the lab myself.

So, Dr. Russell, is he still febrile?

Where is it?

Where's that damn crash cart?

I was checking his wound when he went into SVT

with respiratory distress. I can cardiovert him out of it. Charge the paddles to 100.

Charge paddles? What the hell is going on here?

He's here for a hernia surgery. What's happening?

Look, this is no job for a nurse.

I'll take it from here.

You know very well I am not a nurse.

Back off.

Clear.

Dr. Ellis Grey ... and my colleague on this case ... a case that changed my life.

Look around.

The biggest influences in your life are sitting next to you right now.

This is gonna get more interesting.

Yeah.

The late Dr. Ellis Grey was known as a groundbreaker, a lion.

She was the best this hospital or most hospitals had ever seen.

But back then, she was known as "sugar"

or "nurse"

or nothing at all.

And he's getting sicker a instead of better.

You people better figure out why, and fast.

Guess it's just you and me, kid.

Surprise, surprise.

Oh, crap.

Oh, come on.

Oh, come on. Come on.

Hmm!

Come on, come on, come on.

Just talk.

Hmm?

Just ... tell us what happened.

Okay.

Um ... There was, uh, this patient.

He wanted to get his clubfoot fixed.

But I had a different idea.

You told him he could walk?

Yes. I was in the Peace Corps.

I've seen polio. I've studied the procedures.

You're privileged.

Sir?

Your application. I remember it.

I'm saying, you grew up privileged, and that privilege made you arrogant.

And arrogance in an un Season ed surgeon is a very dangerous thing.

Sir, I didn't make this promise lightly.

I can do this.

Did you promise him you'll try or did you promise him he'll walk?

Arrogant.

All right, Dr. Torres.

You'll live and die on this.

This is your career at Seattle Grace.

He's such an ass.

Dr. Gracie didn't like your infectious process idea, but I think that's what it's gotta be, right?

Gracie wouldn't know his ass from his finger.

Is "ass" the word of the day?

There was mild hemolysis on his CBC.

Anemia? Rhabdo?

Was there any hematuria?

No, but there was some yeast in his urine.

A contaminant.

Maybe the hemolysis was just a bad blood draw.

Every day?

That doesn't seem right.

This hemolysis thing is a red herring.

I feel it in my bones that we're going down the wrong road.

Yeah, you're right. I

feel it in my bones, too.

Get your mind out of the gutter.

How can I do that when I'm tearing your clothes off?

Oh. Think of the possibilities for post-op fever ... wind, wound, water.

Water.

The yeast.

I think I got it.

Single most important step ... In the treatment process ... Anyone?

Physical exam.

No. No chocolate for you.

Lab and radiology evaluation.

Uh, oh, come on, people. Now you're embarrassing me.

Patient history.

Thank you. Catch.

There isn't much inflammation, but there are a lot of gallstones.

Dr. Baylow, what causes gallstones?

High fat diets are a huge contributor.

Yes, fatty foods and?

Uh, she's vegan.

Who's talking?

I'm sorry, sir.

Keep it down or get out of the O.R.

She's vegan.

She is?

Y ... yeah. She, uh, has had severe reflux most of her life, until she discovered when she was 15

that a vegan diet helped her ex-boyfriend, who broke up with her after her last surgery, was a vegan chef.

Well, that's quite a history you have there, doctor.

Dr. Baylow, your intern's doing a hell of a job.

Listen you little moppet.

You hang me out to dry like that in front of the chief again, and I will end you ... your career, your future, your life.

Do we understand each other?

If it were up to me, you'd be doing scut until your hair turns gray.

Oh, wait a minute. It is up to me.

We're not allowed to b*at you with sticks.

So we punish you with scut.

We do it today, and they did it back in my day.

Dr. Grey and I did mountains of scut.

Mm-hmm.

Testing tissue samples was boring.

But it's how we found out our patient had a fungus called cryptococcus.

Have you traveled recently to a tropical country, like Taiwan or Argentina?

No. I've never even en out of this country?

Do you live near a bird aviary or are you around a lot of pigeons?

No.

What kind of questions are these?

We asked his girlfriend to step out ... Because we knew we were gonna have to ask some pretty uncomfortable questions.

We suspected he might have GRID.

Does anyone know what GRID is?

AIDS.

That's right.

But in 1982, it was known as ... Gay-related immune deficiency?

You think I have sex with men?

Are you out of your minds? What kind of doctors are you?

Sir, sir ... You're sick!

Sir, just calm down. We're not passing any judgment.

They're just standard questions.

Get this thing out of my arm!

Sir, get back into bed. You still need the antibiotics.

I'll get the antibiotics elsewhere, from real doctors.

I did not come here e insulted!

And don't think I won't talk to your superiors about this.

This was early 1982.

We hadn't seen a case in Washington state, ever.

San Francisco only had five cases.

We didn't know what it was, and because it was isolated to the gay community, the government wasn't funding research.

Does anyone know when the HIV retrovirus was finally discovered?

Uh, 1983, but there wasn't a test for it until '85.

That's right. It was so new that even our attending didn't know how to handle it.

GRID?

You accused a patient in my hospital of having a disease that hasn't even been proven to exist?

What were you thinking? That patient wasn't even a gay.

He's threatening to sue us for slander. Good job.

You're on probation.

Both of you.

Patient's getting harder to ventilate.

Did you hear me?

I heard you. Shush.

Did you shush me?

Don't shush me.

You need to start to wrap up.

Wrap up? I just got started.

We've been working for eight hours.

Because I'm trying to be meticulous, make sure I'm getting a good compression.

I think it's gonna work. I'm pretty sure.

He's got pericarditis and lung disease.

He's getting unstable.

Dude, do you want him to walk or do you want him to keep breathing?

Successes or failures ... Which teaches you more?

Failures.

Yeah, but that was a gimmie. Don't get too cocky.

The patient was discharged, and a month later, she was back in the E. R. in the middle of the night.

She had right lower quadrant pain, fever, vomiting ... symptoms consistent with?

Appendicitis.

Aha. You get a chocolate, 'cause that's what I thought.

But don't eat it yet. Pay attention.

I diagnosed Alicia with appendicitis.

And Dr. Webber decided that that appy was going to be my first solo surgery.

Mobilize the cecum.

There you go.

Not bad, Dr. Bailey.

Thank you, sir.

I'm glad you decided to come to Seattle Grace.

You were a strong applicant.

People are excited to have you here.

Surgery's a shark t*nk.

Sharks have teeth.

Make sure you're a shark, too, and not a minnow.

S ... sir, are you referring to my height?

No, I'm not. God made you short.

Who made you quiet?

Um ... That, unfortunately, is a perfectly healthy appendix.

What?

No infection, no inflammation.

The whole lower right quadrant looks good.

Sir, I'm ... I'm s ... I'm so sorry.

Shake it off. You know, if you never get a negative appy, that means you're not doing enough appys.

That's just part of the process.

All right, let's take it out, and we'll get ready to close.

I didn't want to close, but ... we had to.

So ... we took the ... patient to surgery again, and ... Wait, no.

Hang on.

You were there. Help her.

That's when we saw the dude do the thing with his foot.

You know ... The surgery was more difficult than I anticipated.

Uh, I ... I was able to do the tendon release.

But your lungs and heart weren't able to withstand any more time under anesthesia.

So I couldn't do any more than that.

I understand.

When do we start again?

Sunder, I'm saying, I ... I think we don't.

Well ... Now I don't understand.

Look at this.

Look at my foot.

Watch it.

You did that for me.

Since I was 7, I have never been able to do that.

I've always been different.

I've always been stared at.

I want to walk.

I want to stand straight up.

I believe you can do the rest.

Please.

Please try.

No surgeon likes giving up on a patient.

Dr. Grey and I liked it even less than most.

But when a patient refuses treatment, you're done.

I mean, we were done.

Well, that's what we thought anyhow.

I put in the NG tube, doctor.

Okay.

Dr. Grey, looking beautiful as usual.

Flattery will get you to an on-call room in five minutes or less.

You're on.

Mommy! Mommy! Look!

That's supposed to be for her birthday.

She was crying. She misses you.

And I got desperate.

Richard.

Thatcher, how are you?

I only have a few seconds. Show me your doll.

Dr. Grey, Dr. Webber, stat to emergency.

I gotta go, Thatch.

Mommy, don't go!

Take her.

Thatcher, I have to go. Meredith.

Mommy, no.

Mommy.

Don't go.

Dr. Grey, Dr. Webber, stat to the ER.

Kaposi's sarcoma.

Your GRID patient from a few months back.

Handle it.

I'm sorry I ... You were right.

You were right about everything.

Please ... Help me.

A healthy appendix ... the third surgery for this patient with unrelenting abdominal pain, fatigue and muscle pain.

Now what?

Test for zebras. Um, uncommon diseases.

Okay.

Do an ANA for lupus.

Lupus. Yeah.

Whoa, what about lead? You test for lead?

Good, good. See?

Sometimes I ... it's not easy.

Sometimes you have to be your patient's advocate and push to get things done.

Excuse me, uh, Dr. Baylow.

Alicia Tatum is being discharged with nothing but a note for a psych consult?

She's sniffing around for pain meds.

She's depressed, is her problem.

Well, yeah.

Months of severe, untreated pain can be depressing.

Okay, smarty pants.

I just thought maybe we could test for lupus or, um, lead poisoning or look, even hemochromatosis ... we are not ordering thousands of dollars in tests for something that can be cured with a big dose of prozac.

But ... What are we doing with Alicia Tatum?

We're turfing her to psych for depression.

Well, we cut her open three times and didn't cure her pain.

Wouldn't you be depressed?

Of course.

B ... before she goes, I

thought we could test for lupus or lead poisoning or maybe hemochromatosis.

Hemochromatosis. Now you're thinking.

Good work.

Oh, my God. I think that's an intussusception.

I've never seen one before in an adult.

Well, I suppose we'd handle it the same way as with a kid, right?

Dr. Gracie, what would you do in this situation?

Quite frankly, nothing. I wouldn't operate.

This patient a lost cause. He's grot GRID.

It's called AIDS now.

AIDS.

No one knows what's causing it or how it spreads.

You want me to potentially risk the health of my staff, my own life, for a guy with a death sentence?

No, I'm not doing it.

And I recommend you don't do it either.

We took an oath. We're supposed to be healers.

Ten years ago, you wouldn't even have been allowed in this program.

Don't you dare tell me what kind of oath we take.

We'd hit a wall.

And, um ... we planned a number of procedures.

But, um ... Uh, but then ... then I gave you that rousing pep talk.

You know what? You totally did.

What if I had quit in the elevator?

What if I had frozen? I mean, I had every reason to freeze.

I'm an intern. I never had my hand on a heart before.

No reason for me to think

I'm not gonna do anything but k*ll that cop faster.

But you didn't.

No, I didn't.

I ... I cut him open, I

cross-clamped the aorta, I stuck my finger in the hole and I stopped the bleeding.

It was seamless. I was perfect.

So pretend there's a blackout and you're stuck in an elevator and your guy is bleeding out.

What are you gonna do? Are you gonna just quit?

What was the result?

Did she test positive for hemochromatosis?

Nope.

Uh, what about lime disease?

Lime disease-negative.

Celiac disease-negative.

Every test I could think of-negative.

So I did what I've told you all to do when you get stuck.

I went to the library and I hit the books.

I hit 'em hard.

I was raised to be polite, you know?

Don't raise your voice, have respect for people higher in the pecking order, be generous to those below ... I was not raised to be a shark.

Now does that make me a minnow?

Am I a minnow?

I ... I really don't know.

I'm a minnow.

Oh.

Not because of my height.

Because I'm a minnow on the inside.

That is a sad state of affairs, Joe.

Hell, we weren't noble.

We were just more arrogant than the rest and had more to prove.

Your C.T. showed that your bowel has twisted in on itself, probably because of kaposi's lesions in your abdomen.

It's a pretty rare problem, but we can take care of it with surgery.

Will Dr. Gracie be doing the surgery?

I'm afraid you're stuck with us.

He's scared, isn't he?

Just like them, outside.

I can see them ... pointing, mumbling, staring.

Screw them.

I don't blame them ... for being scared.

I'm scared, too.

I used to be scared that, um ... People would find out that I was gay and ... Now, um, I can't even hide it anymore.

I'm a ... I'm a leper ... An outcast ... an untouchable.

No one will look at me.

No one will touch me.

I want to hate everyone for treating me this way.

But how ... how can I hate them for being scared when I'm the one that's been living the lie?

This is your chance to change that.

Have this surgery, let us operate.

What's the point?

No one recovers from this.

No one lives.

For all you know, there could be a cure for this thing tomorrow or next week.

Let us operate.

We spent days trying to make things right, trying to figure out the best strategy.

So we, uh, we researched and, uh, practiced and practiced, and ... eventually, we were ready.

Okay, retract the rectus femoris.

What about the nerve?

B. P. just dropped and he's tachycardic.

Torsades on the monitor. Oh, my God. Pericardial tamponade?

Sounds like.

Damn it.

Okay, nobody panic. Page cardio.

Alex, we need to do a subxiphoid pericardiotomy to drain the blood that's squeezing the heart.

It's like a miniature version of what you did in the elevator. So get a scalpel.

What do you mean, you can't? You already did.

Take the scalpel.

I ... I can't.

The patient is crashing, Karev. Do the elevator thing.

I can't. I've never done this. It ... it w ... it wasn't me.

I'm not the heart-in-the-elevator guy. It was O'Malley.

Okay. Okay.

No, this is fine.

We're fine.

And you ... you're doing this.

But I haven't just because you haven't doesn't mean you can't.

Get it together and take the scalpel.

Okay.

Uh ... Make a 6-centimeter-long incision over the sci-phisternal junction.

Good.

We knew what we were doing was risky.

These days we know that AIDS transmission requires exchanges of bodily fluids.

But back then we had no idea.

Can you get it from casual contact, from the air, from surgery?

No idea.

Poor guy.

Living a lie for so long.

Yeah. Shame.

We're living a lie, too.

What?

We shouldn't be doing what we're doing. We have to stop.

No. We're not the lie.

Our marriages are the lie.

This? Us?

This is what's right.

We should leave them, Richard.

You leave Adele, and I'll leave Thatcher.

I can't. You have a daughter. I can't.

And neither can you.

You don't have to go in there. I can do this alone.

You have Meredith to think about.

You're just like the rest of them.

You have a different skin color, but turns out, you're just like them.

Ellis ... I gave birth to a child, Richard.

That makes me a mother. It doesn't make me inept.

It doesn't make me less of a woman.

It doesn't make me less of a surgeon.

No matter how much everyone wants it to.

All my research didn't help.

Dr. Baylow sent the patient home.

So I thought she'd won.

I thought, you know, maybe I wasn't cut out for this game.

But a couple of months later ... Alicia?

Oh, thank God. A familiar face.

What happened?

The pain got really bad.

They said maybe I have some sort of obstruction or something from the other surgeries.

They want to go back in and take another look.

Mandy ... I don't think I can take it anymore.

Please tell me this surgery's gonna help.

They're gonna find something, right?

Uh ... ju ... d ... don't touch her.

Uh, I know you're ... you're here to take her to the O.R. , but, uh, don't touch her.

So you canceled your resident's surgery?

Isn't that a little bold?

Well, she was worried out adhesions, right?

Give me candy.

No adhesions. No candy.

And it wasn't bold, Grey, it was stupid.

But in this case, it was also necessary.

Where do you get off canceling my surgery?

When I paged you ... You work for me. Got that?

You listen to what I have to say.

Are you at all familiar with what surgeons do, Dr. Bailey?

We cut.

Yeah, rebook Ms. Tatum for surgery.

No, D ... Dr. Baylow, you wanted to go in and explore her obstruction.

She doesn't have any signs of adhesions.

Look, just because she's had previous surgeries doesn't mean that you shouldn't actually look for another cause.

She has a pseudo-obstruction that could be resolved with an N. G. tube.

And if you'd looked further and I ... I don't know, talked to your patient, you would've discovered that along with abdominal pain, she also had, uh, weakness, palpitations, numbness, uh, skin changes and her urine is intermittently dark.

Ringing any bells yet?

Your patient, who's been sliced nine ways to Sunday, has porphyria.

If you had diagnosed it earlier, she could've avoided getting her ovaries taken out and her gallbladder and ... Yes, yes, I took out her appendix, and I, too, am at fault for not looking at the whole person.

But you know the difference between you and me?

I learned something from it.

I learned when not to cut.

I learned to listen to my patient.

How could you have not learned in three years what took me three months to learn?

Dr. Bailey.

And the reason I had her chart was because you ignored my pages and she needs to get started on hemin right away.

Was because you put it in her I. V.

You give it to her daily for four days ... Dr. Bailey.

The patient gets better.

The patient doesn't get prodded, probed, scoped or cut open like a Thanksgiving Turkey you supercilious fool!

Dr. Bailey. My office.

Now.

We did a series of shorter surgeries so his lungs and heart could withstand the anesthesia.

It was grueling for the patient, but worth it in the end.

Show 'em the x-rays.

Oh, yeah. So cool.

Okay, um ... these are the before.

And these are the after.

Wow. Yeah.

Um ... Yeah, it was ... it was amazing.

I mean, after the final surgery, we were just ... and, uh, we celebrated that night.

Man, did we ever celebrate.

Mm. Wait.

Cone of silence.

Yeah, yeah, yeah. Whatever.

I knew I was in big trouble.

Now it is my job to make sure that my residents are supported and treated with respect.

Of course, and I'm so sorry ... You have said enough for one day. Sorry.

It's my job.

So we are gonna sit here with you wearing that terrified look on your face for a respectable amount of time so that Dr. Baylow and her friends can assume you are having your behind handed to you on a platter.

You're gonna make a hell of a surgeon, Dr. Bailey.

Lose the smile.

Well, the patient survived the surgery.

But eight months later, he came back with PCP pneumonia.

He d*ed a week later.

Dr. Grey and I ... Well, um ... I won't speak for her.

But I lost the sense that I was a superhero.

And I really started to think of how dangerous it all was.

It changes you ... this work.

Your patients, your colleagues ... you change each other.

You don't ever think you'll lose your way.

But what happens in this hospital ... just remember why you came here.

You said it the day you graduated from med school.

You took the physician's oath.

Remember it.

Tape it to your locker, to your bathroom mirror ... 'Cause it is too easy to lose your way.

I solemnly pledge to consecrate my life to the service of humanity.

I will give to my teachers ... the respect and gratitude that is their due.

I will practice my profession with conscience and dignity.

The health of my patients will be my number one consideration.

I will respect the secrets that are confided in me, even after my patient has die, I will maintain, by all the means in my power. .

the honor and the noble traditions of the medical profession.

My colleagues will be my sisters and brothers.

I will not permit considerations of age, disease or disability ... creed ... ethnic origin ... gender ... race ... political affiliation ... nationality ... sexual orientation ... social standing ... or any other factor to intervene between my duty ... and my patient.

I will maintain the utmost respect for human life.

I will not use my medical knowledge to violate human rights and civil liberties, even under thr*at.

I make these promises solemnly ... freely ... and upon my honor.

The job offer still stands. Think about it.

Let me know.

We'll see.

To Philip.

May he rest in peace.

You can't toast a dead Irishman with a soda pop, Richard.

Get this man a vodka, Frankie.

Oh, yeah. Coming right up.

You know I can't stand the taste of that stuff.

It's time to learn.

You're a grown-up, Richard.

It's time to act like it.

I can't leave her, Ellis.

I can't.

We'll see.