Save Me/Transcript

1x08: Save Me

Original Airdate: 5/15/2005

Written by: Mimi Schmir

Directed by: Sarah Pia Anderson

(Seattle Scenes)

MVO: You know how when you were a kid and you believed in fairy tales?

(Derek is at Meredith's, applying deodorant; she is just looking at him)

MVO: That fantasy of what your life would be. White dress, Prince Charming, Who'd carry you away to a castle on a hill. You'd lie in bed at night and close your eyes, and you had complete and utter faith.

(Izzie is in the kitchen, a sink full of dirty dishes, and cupcakes everywhere. George is there eating cupcakes.)

Izzie: Eight hours, 16 ounces of chocolate, and 32 cupcakes, and they still don't taste right.

George: (With mouthful) No, these are good. Martha Stewart would be proud.

Izzie: Yeah, look where it got her.

MVO: Santa Claus, the Tooth Fairy, Prince Charming, they were so close, you could taste them.

Izzie: There's something missing, some specific ingredient. Why can't I remember?

MVO: But eventually, you grow up. One day you open your eyes, and the fairy tale disappears.

George: Look, just call her. Call your mother and ask.

MVO: Most people turn to the things and people they can trust.

Izzie: I don't want to call my mother.

(Meredith and Derek still getting ready. Derek is brushing his teeth. )

Meredith: So let's go sleep at your house tonight.

Derek: What?

Meredith: I mean, why are we always sleeping at my house? Do you even have one?

Derek: One what?

Meredith: A house. With a closet. With your stuff in it. Your personal stuff. Do you even have one of those?

Derek: Mmm.

(Derek and Meredith enter the kitchen)

Derek: Good morning.

George: Hey. You guys want a cupcake?

Derek: Oh, no.

George: Izzie made them.

Derek: You know, I like it here. You said so yourself, you liked having your things around, sleeping in your own bed.

(Derek is getting cereal and a bowl out)

George: You're like a health nut, aren't ya? You eat muesli every morning.

Derek: No, I don't.

Izzie: Ok, the muesli thing, you do. The last seven days, at least.

Derek: Oh, come on. I haven't been here for a whole week. Have I?

Meredith: See? Even they thing it's weird.

MVO: But the thing is, it's hard to let go of that fairy tale entirely. Cause almost everyone still has that smallest bit of hope, of faith, that one day they'll open their eyes and it will all come true.

(Derek and Meredith smile at each other)

(Seattle Scenes)

(Cristina in an office)

Woman: So I've checked the schedule.

Cristina: I start ENT on the 9th. It's a light rotation. Can you get me in then?

Woman: Oh, I'm afraid not. We have openings on the 16th. There are other options besides termination, you know? Adoption, keeping the baby. You think it over. Call me back. I'm here...

Cristina: Put me down for the 16th. I'll confirm after I rearrange my schedule.

Woman: I know this is a difficult decision.

Cristina: You know the talking part?

Woman: Mm.

Cristina: I'm not interested.

(Alex examining a female patient)

Alex: So, Devo, you just had a root canal, correct?

Devo: Yeah. I couldn't stop bleeding after, literally. Now I'm stuck with you guys.

(Burke enters)

Burke: Give me the bullet.

Alex: 17-year-old female hospitalized for excessive bleeding, status post root canal. Also had a significant new heart murmur associated with fever. Now afebrile on antibiotics.

Devo: If I'm gonna die, can you page my mom and dad?

Burke: You're not dying. Where are your parents?

Devo: In the cafeteria. My freak father likes hospital food.

Burke: You're in excellent hands here. Dr. Karev is gonna run some labs. And I'll see you with your parents in a little while. Add a bleeding time to the coags.

(Burke leaves)

Alex: So, what kind of name is Devo, anyway?

Devo: 80's rocker. My parents did too much blow. I call myself Esther.

Alex: Nice skirt. What are you, Amish?

Devo: Get a life. Haven't you ever seen an Orthodox Jew?

(Meredith and Cristina examining x-rays)

Cristina: This guy belongs in Psych. What are you doing turfing him here?

Psych Doctor: He's my gift to you. Had a seizure two days ago and another one this morning.

Meredith: What are you talking about? It says right here, "He talks to dead people, his family things he's dangerous. They had him committed." That's Psych, not Neuro.

Cristina: Man, didn't you go to med school?

Psych Doctor: Yes, and unlike the correspondence school you attended...

Cristina: Oh, that would be Stanford, right?

Psych Doctor: I learned not to jump to conclusions. Sorry, ladies. We can't take him back until he's cleared.

Cristina: So, you're dumping him on us?

Psych Doctor: He thinks his seizures are visions.

Patient: Hello! They're not seizures. I'm psychic.

Cristina: Of course you are, and I'm a chicken. (To Psych Doctor) Hey, genius.

Meredith: Ok, Mr. Duff. We're gonna start our workup now.

Mr. Duff: Work me up, work me down, I'm telling you it's a waste of time.

Cristina: Ok, well, humor us. Can you grip my fingers, please?

(He appears to go into a trance.)

Meredith: Cristina.

Cristina: Mr. Duff?

Meredith: Mr. Duff, are you ok?

Mr. Duff: Someone...

Meredith: Someone what?

Mr. Duff: Someone's gonna check out. Bye-bye.

Cristina: Oh, man, he's nuts.

Mr. Duff: I'm dizzy, not deaf, lady. And I'm telling you, someone on the fourth floor is gonna die.

Man on PA System: Code blue, fourth floor. Code blue, fourth floor.

(Code team goes running by in the hallway)

(Meredith and Cristina leave looking bewildered.)

(Seattle Scenes)

(Outside of SGH)

(Cristina walking through the hallway, still looking ill.)

George: Fourth floor, dead guy. The psychic predicted the fourth floor dead guy.

Cristina: I need someone to cover me on the 16th. You in?

(Meredith and Derek walk by)

George: I'm thinking about letting my hair grow. And maybe I won't shave. Go for the stubble effect. What do you think?

Cristina: The 16th, George. Can you cover me or not?

George: Uh, yeah. I guess. Why?

Cristina: It's none of your business.

George: Thank you would be nice.

(Cut to Meredith and Derek still walking through the halls)

Meredith: It's just that I hardly know anything about you.

Derek: You know I'm from New York. You know I like ferry boats.

Meredith: Enough with the ferry boats. What about your friends?

Derek: I'm a surgeon. I don't have friends.

Meredith: Everybody has friends. I mean, who do you hang out with? What do you do on your days off? These are important questions.

Derek: Ah, important for who?

Meredith: We're having sex every night. I think I deserve details.

Derek: You have more details than most.

Meredith: See, this is going somewhere weird. I want facts, and until I get them, my pants are staying on.

Derek: Or you could just roll with it. Be flexible. See what happens.

Meredith: I'm not flexible.

Derek: (Laughing) There I disagree. Hmm. I've got to go. We'll find these things out. That's the fun part. You know? That's the gravy.

Meredith: That is what I'm talking about. I don't want to be your gravy.

(Burke and Alex in the waiting area talking with Devo's parents.)

Burke: Your daughter needs a valve replacement. Tests are indicative of Von Willebrand's disease, which explains excessive bleeding after the root canal.

Man: And that means?

Alex: Devo can't take the blood thinners necessary to maintain a mechanical heart valve.

Burke: We're suggesting a porcine valve instead.

Man: Porcine? As in pig?

Burke: It's the standard of care for someone in this situation.

Man: Pig, huh?

Alex: It's the other white meat.

Woman: I don't care what you have to do. Save my daughter's life.

(Bailey performing surgery on a woman in the OR)

Bailey: I'm removing the lump now.

Woman: Someone said you guys have a psychic running around here. Is that true?

Bailey: I did not even hear you say that.

Woman: Predicted someone would die on the fourth floor.

Izzie: ICU's on the fourth floor. People die all the time.

Bailey: Ok. We're finishing up here, Mrs. Glass. We'll take this down to Path and get the results of the frozen-section biopsy and see you in a few hours.

Izzie: Seriously, the guy is just playing mind games. I can see further into the future than he can.

Bailey: Why do you even care about this, Stevens?

Izzie: I don't.

(Derek examining patient in the ER)

Derek: Ok, Mr. Walker. Does that hurt?

Mr. Walker: I can't feel anything until you get to my thigh.

Derek: Try wiggling your toes.

(Toes do not move)

Mr. Walker: Are they moving?

Derek: No.

Mr. Walker: Damn. I could about ten minutes ago.

Derek: Well, your spine x-rays look clear. You fell rock climbing?

Mr. Walker: In Snohomish. Just a small drop. I was belayed. My wife and boys are on the way. What's wrong with me, anyway?

Derek: Hold your legs up

(Lifts the mans legs, lets go and they drop)

Mr. Walker: Should I be scared now?

Derek: Just try and relax. Nurse, I need a stat MRI. Send an intern with him. Make it Meredith Grey.

Nurse: Mm-hmm.

(George and Alex in an exam room with a patient, Burke is walking by)

Alex: Ew. Thick, short neck. That isn't good. It's hard to intubate. You want me to do that?

George: He's my patient. I'm fine. I just can't see anything yet. Suction.

Alex: Don't break any teeth.

George: I know that...don't you think I know that?

Alex: Pulse ox down 87 percent.

George: Bag him.

Alex: Are you sure you don't want me to do that?

George: No, damn it! Tube. (Puts tube in forcefully) There. Huh. Got it.

(Alex listens to the lungs)

Alex: It's in the esophagus. Don't you know an esophagus from a trachea?

George: Damn it. Anatomy is all messed up in here.

(Burke enters)

Burke: Are you trying to kill this patient, O'Malley? Maybe we should send you back to practice on mannequins.

George: No, it's just I haven't done his much. But when I have, it's...it's been good. It's just I-I haven't...

Burke: Let's review the concepts. Never take your eyes away. Always, always know you can follow through.

Alex: Don't ever follow through on one of my patients, O'Malley.

(Alex and Burke leave, George looks frustrated.)

(Cristina is in the Mr. Duff's room)

Mr. Duff: A little Botox would do wonders on those frown lines.

Cristina: Ok. Shut up.

Mr. Duff: Are you allowed to talk to me like that? (Cristina hisses at him) God, you're hot...in a Mrs. Livingston kind of way.

Cristina: See here? (Shows him papers) These are spikes in your temporal lobe. It means you have epilepsy. Not visions. Seizures.

Mr. Duff: You think I'm epileptic? That is no not right.

Cristina: I'm gonna order an MRI so I can take a closer look at your brain.

Mr. Duff: Yeah, there's no way... (Starts having a "vision")

Cristina: Mr. Duff? Mr. Duff, can you see me? Can you hear me? Stay with me.

Mr. Duff: I wouldn't have picked you for the mommy track, Nurse Betty.

(Cristina stares at him)

Mr. Duff: See? I told you I know things. This pregnancy thing, you can't run away from it.

(Cristina leaves quickly and takes the elevator to the lounge where Bailey and Izzie are.)

Cristina: Dr. Bailey, I want off the psychic case. I'll take whatever you got. Can I switch?

Bailey: Ask nicely.

Cristina: Uh, well, this is me doing nicely.

(Bailey stops what she is doing and glares at Cristina)

Izzie: Look, I know the type. These guys just want everybody to think they're a slideshow. Let me take him.

Bailey: I don't do switches.

Cristina: I'll do your post-op notes for a month.

Bailey: Fine. I can accept that. Izzie, you get Psych guy. Yang. This is your lucky day. You get to be with me on the breast cancer. And there's spotting. So you'll need to do a pelvic. She's pregnant.

(Meredith and Derek looking at Mr. Walker's scans)

Meredith: See, this. The guy's films are clear. There's no reason I can see for his creeping paralysis.

Derek: It's just so surprising. I expected an intrusion into the spinal space or bony spur in the nucleus pulposus.

Meredith: Well, you were wrong. You don't always get what you expect, do you?

Derek: What is your problem?

Meredith: Give me something to go on. Anything. What are your grandparents' names?

Derek: I don't have grandparents.

Meredith: Whered you grow up? What's your favorite flavor of ice cream? Where'd you spend your summer vacations?

Derek: Lighten up. It'll be good for your blood pressure. (Leaves the room)

Meredith: Oh, don't you tell me to lighten up. I'll lighten up when I...feel light.

(Cristina and Bailey in the breast cancer patient's room, talking with her and her husband)

Husband: Don't we have treatment options? I-I mean, aren't there always alternatives?

Cristina: With this stage of invasive carcinoma, surgery, chemo, radiation and drug therapy are your only options.

Woman: Can I wait until the end of my pregnancy?

Cristina: The pregnancy hormones will likely speed the growth of the cancer.

Husband: And the baby? Cristina: Oh, none of these courses of treatment will allow the baby to survive.

Bailey: Mr. and Mrs. Glass, I understand how difficult this is.

Mrs. Glass: No disrespect, but like hell, you do.

Bailey: You're going to have to make a decision as to how you want to proceed.

Mrs. Glass: You mean my baby's life or my own? Bailey: Yes. (They are shaken) We'll have to evacuate the fetus.

(Derek is speaking with Mr. Walker, Meredith enters)

Derek: Any changes, Mr. Walker?

Mr. Walker: I can't move my legs at all now.

Mrs. Walker: He said he was moving his legs when he came in. What's wrong with him?

Derek: I don't know. The paralysis is moving very quickly and there was nothing in the MRI to explain it.

Meredith: Has Tommy been under any stress lately?

Mr. Walker: You know what's making me stressed? Is being in here and not being able to move.

Derek: Dr. Grey.

Meredith: Emotional trauma can be converted into something physical, right?

Derek: Yes, it's possible.

Meredith: Like hysterical numbness or paralysis. Maybe there is no physiological reason, and he's just having a conversion reaction.

Derek: You think it's psychosomatic?

(Curtain behind them flies open)

Mr. Duff: It is not in your head, man. I believe you.

Izzie: Mr. Duff, please.

Derek: Who was that?

Meredith: Psych sent him down. He has visions.

Mr. Walker: Is that it? Am I crazy?

Derek: No. No. I'm gonna order a higher-level MRI. We're gonna figure this out.

(Devo's room)

Devo: You know how important this is to me!

Mother: This is about saving your life, sweetie.

Devo: And you're not respecting it, or me. You're letting them put a pig, a freaking non-kosher, traif mammal, into my chest, into my heart! The very essence of my being!

Alex: It's a porcine valve, actually.

Devo: I don't care what the hell it is. If you give me a pig part, I might as well be dead.

Father: I told you this whole Orthodox thing was a mistake. What was so wrong with being plain old Reform like everyone else we know?

Devo: You guys don't even light candles Friday nights. You don't even know all the Passover plagues.

Alex: Boils, vermin, pestilence. Even I know that.

Burke: Miss Friedman, I appreciate your extreme religious convictions.

Alex: Fire, hail...

Burke: But, simply put, without this procedure, you will die.

Devo: You're hotshot doctors. You'll come up with something else. As long as it doesn't answer to Wilbur and say "oink," I don't care what it is.

(Izzie loading Mr. Duff into the MRI machine)

Mr. Duff: Your nostrils are flaring.

Izzie: They are not.

Mr. Duff: You're into me. I can tell. "Dr. Small and Angry" was a hot appetizer but you, doc, are a smorgasbord of lust.

Izzie: Mr. Duff, you're pressing your luck.

Mr. Duff: Would you press it for me?

Izzie: I hope you're not claustrophobic. You're staring at me. Stop it.

Mr. Duff: I'm looking at you, sweetheart, but it's the strangest thing. I'm hungry for a chocolate cupcake.

Izzie: What did you say?

Mr. Duff: A chocolate cupcake. Maybe one of those fudgey things with the white squiggle on the frosting. Could you oblige?

Izzie: What, do I still have some chocolate on my face or in my hair or something?

Mr. Duff: What are you talking about?

Izzie: You. I know the drill, so keep it up. Next you'll be reading my cards, telling me my dead uncle is in the room.

Mr. Duff: Is he?

Izzie: I don't have a dead uncle. I'm watching you.

(Cristina is at a desk, smell her sandwich and drops it, Meredith and Izzie are there, George and Alex enter)

George: If that's turkey, can I have some?

Cristina: It's soggy.

Alex: If it'll kill you. Solve everything.

George: I coulda gotten that intubation. I am good at intubations.

Meredith: (Taking a bite of the sandwich) Why does everything in a hospital smell like a hospital?

Izzie: Don't be so hard on yourself, George. Everybody makes mistakes.

George: You know, I'm good at a lot of things.

Cristina: You know what, I'm gonna tell you something. Hey, George. You need to get laid. See that nurse over there? (Points to a red headed nurse) She's single. She's got red hair. Go ask her out.

George: In care you forgot, I intubated an esophagus.

Alex: Dude, you're tweaking. Maybe you should go see that psychic. (Alex leaves)

Izzie: Mr. Duff is not a psychic!

Cristina: I am trying to help you. Go buy her a latte and freshen up your gonads, please. (Cristina leaves)

Izzie: Shut up.

George: It's not too late to call her. You know, moms like that, surprises on their birthdays. You know, it's very Hallmark. (George leaves, Izzie sits there shaking her head)

(Cristina in Mr. and Mrs. Glass' room)

Mrs. Glass: I'm 47, you know? I'm 47 and having a baby which is kind of a miracle and it kind of sucks, if you see what I mean. We'd actually given up on the whole kid thing about a year ago. You know, fertility treatments, acupuncture needles in my eyes. Well, not really, but it felt like it. I was like, "Screw this. I want my life back." Then one awesome night on the beach with a bottle of merlot...

Cristina: I should have these labs back in a couple hours.

Mrs. Glass: You get it, right? My hesitation? This isn't an easy decision, I mean. I'm having a baby.

Cristina: You have advanced-stage carcinoma. You're 47 years old, so statistically you have a good probability of survival. Forego treatment, chances are you won't see your baby go to kindergarten, so whose like are you interested in saving? Excuse me.

(Mr. Walker in the ER)

Mr. Walker: First my legs, then my stomach. God. Doc! Doc, my hands can't move.

Derek: Squeeze my fingers.

Mr. Walker: I can't.

Derek: Right here. No? Let me know if you feel this. (Pokes him with needle) How about that? Here? Anything here? Up here? Ok. Nothing on this side? All right. I'll be right back. Nurse, cancel the second MRI. Call down and prep OR stat.

Meredith: You're operating? On what? If there was something to fix, wouldn't we have seen it?

Derek: I think the MRI missed a clot somewhere in his upper spine. I'm gonna cut him open. I'm going in.

Meredith: What if you're wrong? Couldn't unnecessary spinal surgery do more damage?

Derek: If we wait any longer and this expands into his brain stem, we have a paralyzed man who can't breathe. I'm trusting my instincts. Sometimes you've got to take a chance to save a life.

(Seattle scenes)

(Alex in Devo's room)

Alex: Your mitral regurge is getting worse. The valves are leakier than ever.

Devo: Are you hitting on me?

Alex: If you want me to.

Devo: I hear they call you Dr. Evilspawn.

Alex: Well, only the people that like me.

Devo: I guess that explains the lack of faith thing.

Alex: You know, I kind of think of myself as a pagan, but, hey, that's just me.

Devo: You know what it's like being a teenager these days? My friends spend most of their time screwing around and getting wasted. At least I have God.

Alex: Well, so God wants you to die, huh?

Devo: He wants me to be passionate about what I believe in. You don't believe in anything.

Alex: Well, my mother used to pray to Saint Jude for me.

Devo: How appropriate. Patron saint of lost causes.

Alex: Mmm.

(Izzie walks up to Bailey in the hall)

Izzie: I did an angio on my Psych case. The MRI came out clean, but I saw a ditzel. There's something here.

Bailey: Yep, you're right. There's an AVM on his left temporal lobe.

Izzie: I'll schedule the OR for tonight then.

Bailey: Ohh, back up, girl.

Izzie: There's high risk of spontaneous hemorrhage.

Bailey: The attending has to see films. We need consent forms. Believe it or not, Stevens, we have to follow protocol. Take a breath.

Izzie: But if the AVM looks like it's gonna blow, we fix it, right?

Bailey: If the man needs to be fixed, we'll fix him in due time. Why are you moving so quickly? You get too involved with your patients, Izzie. Why do you make everything so personal?

Izzie: It's not personal. (Bailey glares at her) It's not.

(Mr. Walker in surgery)

Derek: We've got to save this cord. This guy's built like the Rock of Gibraltar.

Meredith: You want me to start?

Derek: No, I'm gonna to cut here from the base of the neck to the rib cage. I want you to hit the bleeders.

Meredith: I still don't think we should be doing this.

Derek: This guy has a spinal hematoma.

Meredith: We don't know that.

Derek: Which left untreated are almost always fatal.

Meredith: You're cutting blind. Whatever happened to being practical?

Derek: I need to see more here. Retractor.

Meredith: Wow. The spine.

Derek: There's no "wow" in "practical."

(Bailey and Cristina enter Mr. and Mrs. Glass' room)

Mr. Glass: We've decided to go ahead with the evacuation.

Mrs. Glass: What the hell, right? Maybe this is how it's supposed to be.

Bailey: We need to start chemo right away then.

Cristina: We'll get everything ready.

(Bailey and Cristina leave the room)

Bailey: Have you even done a D and C before.

Cristina: We learned at school.

Bailey: Ok, uh, go ahead. I'll call an OB resident down to supervise. If she needs anything, page me.

(Alex and George in the research room, George slams a book shut and leans toward Alex)

Alex: You're using up my oxygen, O'Malley.

George: How does a pompous, cocky jackass like you always have women all over him?

Alex: Little blue love pills, lots of them.

George: Come on.

Alex: Float like a butterfly, sting like a bee. There it is, a bovine xenograft. (Jumps up shouting) O'Malley, you think too much. Can't you see it? You got to dance and jab. Dance and job. Like me. I am the Ali of this place.

(Alex enters Devo's room, she is praying in Hebrew)

Alex: Does the wall ever bow back?

Devo: It's called davening, smartass. This is me communing with God, and you're interrupting.

Alex: I've found a transplant option. At first, I thought maybe a cadaver, but they're really hard to find. And then I realized Dr. Burke can transplant a bovine mitral valve instead of the pig

(Burke enters just as Alex says this)

Father: She can get a cow valve?

Mother: Dr. Burke, why wasn't this mentioned before?

Burke: Dr. Karev.

Alex: The bovine valve has only been an option the last few years.

Burke: And it's a much more complicated procedure.

Alex: But the best part is it's actually superior to the pig. It lasts longer.

(Cut to Burke and Alex in the hallway)

Burke: What incredibly small fraction of your brain were you using in there?

Alex: What?

Burke: Correct me if I'm wrong, but did you not present an alternative procedure without consulting your attending first?

Alex: I thought you'd be...

Burke: What, impressed? That's just stupid.

Alex: I'm sorry...

Burke: We're finished here, Karev. You're off this case.

(Izzie enters Mr. Duff's room)

Izzie: You need to sign these consent forms so we can proceed with your surgery.

Mr. Duff: Sweetheart, I'm not signing anything unless it's got my name on it followed by a whole bunch of zeros.

Izzie: Look, the AVM is located in this crucial part of the brain. It's a tangle of blood vessels that could burst and affect your speech, among other things. So, we know your visions are actually seizures.

Mr. Duff: Do you?

Izzie: Do I what?

Mr. Duff: Know they're seizures.

Izzie: You're really good at reading people, aren't you? Telling them what they want to hear?

Mr. Duff: There's a really unfortunate alignment of Saturn in the house of Jupiter right now.

Izzie: Ok, I know what you're doing. You watch people, read their body language. You say "chocolate cupcakes," I lean towards you, so you think you're on the right track. Not only do you know you're having seizures, but you're milking it.

Mr. Duff: Hmm. Well, we'll just see about that, cricket.

Izzie: What? What did you just call me?

(Cristina enters Mr. and Mrs. Glass' room)

Cristina: I'm gonna do a quick pelvic exam. The OB resident should be down soon. It's a short procedure. Your husband can stay if he likes.

Mrs. Glass: We changed our minds.

Cristina: Excuse me?

Mr. Glass: We've decided to keep the baby.

Cristina: You have cancer.

Mrs. Glass: Can't you tell me I'll survive if I go through with this?

Cristina: Having the procedure does not necessarily improve the treatment outcome.

Mrs. Glass: You have quite the bedside manner. You know that, right? My mom died of breast cancer when she was in her 40's. I have that cancer gene. My chances are pretty much lose-lose, whichever way you look at it, except for the baby. We're keeping it.

Cristina: I'll call down a Psych consult.

Mrs. Glass: Don't bother. I am going to get fat and happy instead of skinny and bald. I am the end of it all...

Cristina: Look, if you want to live...

Mrs. Glass: Honey, that's what I'm doing.

(Cristina is sitting on bed in the on call room when Burke enters)

Cristina: Look, if you think you're gonna get any, think again. I'm not in the mood.

Burke: I'm not in the mood, either.

Cristina: Good. (Pause) What do you want?

Burke: Nothing. I just haven't seen you all day.

Cristina: So I'm working.

Burke: I've never done a bovine replacement before. I don't know what I'm doing.

Cristina: Look it up, research it and get someone to assist you.

Burke: It's not that easy.

Cristina: This is a problem that has a solution, Burke. There are a lot of problems that don't.

(Mr. Walker's OR)

Meredith: Third thoracic laminae. Nothing. I think I see the dura pulsating here.

Derek: No, it's not. Keep looking.

Meredith: We have been at this for four hours. Maybe he just injured his spinal cord and there's nothing to fix.

Derek: Grey, when you read your books, make sure you reference them correctly. Progressive paralysis implies a pressure lesion.

Meredith: My books got me here...

Doctor: Pressure's up to 180/111. The pulse is in the 40s.

Meredith: What is it?

Doctor: I'm pushing 70 milligrams Diazoxide.

Derek: Ok. Autonomic dysreflexia.

Meredith: Damage to the sympathetic nervous system?

Derek: BP and the heart rate are unstable.

Meredith: We're in trouble, aren't we?

Derek: We've got to find the clot.

Meredith: I can see the cord below the dura. Is he gonna stroke out?

Derek: Focus, Grey. We're gonna find the clot. It's there. Cleanup, please.

Doctor: BP's still up. Heart rate's at 44.

Derek: Get on those bleeders. Keep looking, Dr. Grey.

(George walking through the hall when he is stopped by Olivia)

Olivia: Dr. O'Malley? Our patient's pulse ox is dropping. She's agonal. She needs to be intubated.

George: Isn't there anyone else who can do this?

Olivia: You're standing right here. I could try and find someone.

George: No, that's...I got it.

Olivia: Sats down to 86 percent.

George: Cric pressure, please.

(Burke walks by in the hall)

George: Ok. I see cords. Tube. Hurry. Check for breath sounds.

Olivia: Clear and equal. CO2 detector mellow yellow. Smooth moves, doctor.

George: Kicked ass.

(Olivia and George smile and laugh, obviously sharing a moment.)

(Burke in the stairwell, runs into Alex)

Burke: Oh, Dr. Karev. How long would it take to get a cow valve?

Alex: Oh, about 60 minutes by messenger.

Burke: You're scrubbing in.

Alex: Thank you very much, sir.

Burke: This doesn't get you any points, Karev. I'm the only one with points around here, ok? Oh, by the way. Devo wants a rabbi to bless her before surgery.

Alex: Seriously?

Burke: You came up with the cow, you can find that girl a rabbi.

(Mr. Walker's OR)

Meredith: What is it?

Derek: See for yourself. The second thoracic vertebrae.

Meredith: Oh, my God. I see it. It really is there.

Derek: Of course it is. Let's suction and pack this baby, shall we?

(Scrub room outside Mr. Walker's OR)

Meredith: You were right. Is he gonna be ok?

Derek: I think so.

Meredith: But you don't know that.

Derek: I know we stopped the paralysis from advancing.

Meredith: But, you don't know if the paralysis he already has will be permanent.

Derek: No.

Meredith: You know, you keep taking everything on faith. How do you know what's real and what's not?

Derek: You just do. You know some people would call this a relationship. The kind where you exchange keys, leave your toothbrush over.

Meredith: Who? Who would call it that?

Derek: Me. I would.

Meredith: And I'm supposed to believe you?

Derek: Uh-huh.

Meredith: Show me something. Give me a reason to believe.

(He walks away)

(Cristina enters Mr. Glass' room)

Cristina: I have your discharge papers.

Mrs. Glass: Oh, you're not happy with me, are you?

Cristina: I'm your doctor. It's not my place to be happy.

Mrs. Glass: My husband and child are going to be together long after I'm gone. We've talked about it. It's our decision, and that's ok.

Cristina: So why do you need my approval?

Mrs. Glass: I just want you to understand.

Cristina: Well, I don't.

(Izzie enters Mr. Duff's room)

Izzie: I brought the consent forms again. You really need to sign them. Your surgeon scheduled the OR. Mr. Duff, are you all right? Are you having another seizure?

Mr. Duff: Yeah, yeah. I think maybe I am.

Izzie: What is it?

Mr. Duff: It's me. I think it's about to be over.

Izzie: We know what we're doing, Mr. Duff. You saw the angio results. We're catching the AVM just in time. You don't need to be nervous. You're not gonna die.

Mr. Duff: I'm not talking about dying. My whole life has been about what I see and about believing in myself, whatever people think. And you're telling me there's a very good chance that will go away.

Izzie: Look, you're a healthy guy. You're gonna live a long, full life. And if you're psychic visions are real, you've got to believe you'll have them when you come out.

(She hands him the paper, which he signs)

(Devo's OR, she is being blessed by the Rabbi)

(Burke is standing next to a TV monitor)

Burke: This is Dr. Chesney from the Cleveland Clinic. He's an expert on bovine valve replacement surgery. He will be assisting via satellite.

Dr. Chesney: Thank you, doctor. After the sternotomy and connection to bypass, we're going to do a transverse left atriotomy to expose the valve.

(Interns are in the deserted hallway)

Meredith: I tried to talk Shepherd out of that clot surgery. What is wrong with me?

Alex: Basically, you tried to kill the guy.

Cristina: Basically, you're an ass.

Alex: Come on. You know you want it. Come to papi, baby.

(George enters)

George: This, uh, is George. (Points at his name tag) George has a hot date.

Meredith: Oh, that's great, George.

George: Yeah.

Alex: Left pocket of my lab coat, Georgie. (Gets up to leave) No glove, no love.

(George grabs Alex's arm as he is leaving and takes a condom from his pocket)

Izzie: My psychic had his surgery.

George: Yeah?

Izzie: I wonder what happened with his...gift.

Cristina: Come on. We all know he's crazy.

Meredith: Thought you said you didn't believe in that stuff.

Izzie: I grew up in a trailer park. I waited tables, which was supposed to put me through college, but my mother was always calling these psychics all the time. And the bills started piling up, so I had to use my money to pay them. When I turned 18, I left and never went back. But this guy has been saying things to me, things he couldn't possibly know anything about. So I just wonder.

(Meredith is examining Mr. Walker)

Meredith: Do you have sensation anywhere else?

Mr. Walker: Some feeling in my stomach and feet, I guess.

Meredith: Bladder and bowels?

Mr. Walker: Not so good still.

Mrs. Walker: He said the pressure stockings help relieve clots and bedsores?

Meredith: They do.

Mr. Walker: I wanted to thank you for everything. Believing in me, that I wasn't making it up.

Meredith: Well, I'll come back tomorrow, then.

Mr. Walker: Hey, I wanted to show you something. I wasn't sure it would last but now look. (He moves his finger) I know it's hardly anything, but...

Meredith: No, it's something. It's something really big.

MVO: At the end of the day, faith is a funny thing.

(Izzie in the elevator with Mr. Duff)

MVO: It turns up when you don't really expect it.

Izzie: Mr. Duff, you're still with us.

Mr. Duff: For your recipe...one tablespoon coconut extract.

MVO: It's like one day you realize that the fairy tale may be slightly different than you dreamed.

(Meredith and Derek outside getting into his car)

Meredith: Where are we going?

Derek: Trust me.

(George and Olivia leaving together)

MVO: The castle, well...it may not be a castle.

(Cristina watches Mr. and Mrs. Glass leave)

(Alex in Devo's room)

Devo: Does it beat or moo?

MVO: And it's not so important that it's happy ever after.

(Burke is watching from outside the door)

MVO: Just that it's happy right now.

(Izzie pulls cupcakes from the oven, screws the lid on the coconut extract, eats one and picks up the phone)

Izzie: Mom. It's me. Cricket.

MVO: See, once in a while, once in a blue moon, people will surprise you.

Izzie: I'm good. I've been thinking about you a lot too.

(Meredith and Derek outside, it is dark, they are walking)

Meredith: Where are we?

Derek: Shh, shh. I'm gonna tell you. All right. My mother's maiden name, Maloney. I have four sisters. I have, uh, nine nieces. Five nephews. I like coffee ice cream, single-malt scotch, occasionally a good cigar. I like to fly fish. And I cheat when I do the crossword puzzle on Sunday. And I never dance in public. Um, favorite novel, The Sun Also Rises. Favorite band, The Clash. My favorite color is blue. I don't like light blue, indigo. The scar right here on my forehead, that's why I don't ride motorcycles anymore. And I live in that trailer. All this land is mine. I have no idea what I'm gonna do with it. So that's it. That's all you've earned for now. The rest you're just...just gonna have to take on faith.

(Meredith takes a few steps toward the trailer)

MVO: And once in a while...people may even take your breath away.

(Meredith reaches her hand out for him and they walk into the trailer)