If/Then

"The baby you have is the baby you were destined to have. It was meant to be. That's what all the adoption people tell you, anyway. I'd like to think it's true. But everything else in the world seems so completely random. What if, one little thing, I said, or did could have made it all fall apart? What if I'd chosen another life for myself, or another person? We might have never found each other. What if I'd been raised differently? What if my mother had never been sick? What if I'd actually had a good father? What if? What if?...What..if? Your life is a gift. Accept it. No matter how screwed up or painful it seems to be. Some things are going to work out as if they were destined to happen. As if they were just meant to be."

- Meredith Grey

 is the thirteenth episode of the eighth season and the 161st overall episode of Grey's Anatomy.

Short Summary
As Meredith puts Zola to bed and falls asleep, she begins to wonder -- what if her mother had never had Alzheimer's and she'd had loving, supportive parents? The reverberations of a happy Meredith Grey change the world of Seattle Grace as we know it. What if she had never met Derek in that bar and he had never separated from Addison? What if Callie and Owen had become a couple long before she met Arizona? And what if Bailey never evolved from the meek intern she once was?

Full Summary
At night, Meredith is walking around in the living room with Zola. Her voice over talks about how some things are supposed to happen, while others can be changed by doing one little thing differently.

Cristina and Owen are lying in bed, both awake, backs turned towards each other.

Richard finds a completely lost Adele in the kitchen. He takes her back to bed.

Callie and Arizona are sleeping in peace.

Meredith puts Zola back in her box, after which she crawls back into bed. She falls asleep wondering what her life would've looked like if she was raised differently, if her mother never would've gotten sick and if she'd have had a good father. That questions is answered.

Meredith is woken up by the voice of her mother. She gets dressed and walks down to the kitchen, where her mother is dressed and ready to go to work. She asks if Meredith rides with her, or with her father. Meredith decides she'll go with her dad. "Who's coming with me?" Richard asks as he enters the kitchen. He kisses his daughter on the forehead while Ellis warns them both not to be late, as it sets a bad example. Richard gives her a kiss.

The starts at Seattle Grace Hospital. The attendings, including a pregnant Addison and a very The Time Warp-like Bailey, gather in Ellis Grey's (the Chief of Staff) office for the morning meeting. Callie arrives with three children in the waiting room next to it. Owen comes out of the office to greet his kids and his wife. Callie had no other option, as the daycare hasn't opened yet. They enter the office together.

Bailey's eyes get big as Ellis Grey enters as she well. She immediately starts by saying that she has looked at Seattle Press' numbers, and that she thinks they can absorb them, like they did with Mercy West. That way, each department can have new residents and equipment. Addison interrupts to congratulate her on her third Harper Avery Award, which she received for having developed her own whipple technique. The others applaud and compliment her. Ellis says there will be some press today and then starts asking each department head for their plans. Owen, as Head of Trauma, replies first. Then Derek, who only has one surgery planned. Ellis reminds them all that if they're not innovating, they need to generate. Surprisingly, Callie is now Head of Cardio, and she tells that Yang will be doing a solo thoracic aortic aneurysm. She and Arizona then disagree over another patient's course of treatment. Ellis sides with Torres, as she came up with an innovative fix. She tells Derek that that is what she wants. General, Dr. Bailey, will be doing an extended whipple. Meanwhile, Owen and Callie's daughter is pressing her face against the window. Owen walks out of the room. After a short patient history, Ellis says she'll take over Bailey's case. While Addison does the neonatal update, Richard calmly tells Bailey that what Ellis just did is not a reflection on her. She probably just wants a surgery to take her mind off the Harper Avery stuff. Bailey does her best to withhold her tears. Ellis thanks them all.

Meredith shows April her engagement ring, which she got last night. She knows it is hard for April, but she assures her she will find someone. And Charles is really into her. Jackson smiles as he hears this. April knows this and starts to say something about Charles, but stops as he walks in and greets her. April asks Meredith if she told anyone else. Beside her parents, but she hadn't because April is her person. April says they're gonna be the next Shepherds. "Screw that, we're going to be the next Webbers," Meredith smilingly says. Meredith then starts telling the proposal story, but is interrupted by Cristina entering the locker room. She has bangs and is disliked by everyone in the room. The disliking is mutual. A cheerful, nerdy dressed Alex comes in. He's Chief Resident and tries to motivate them all. When Meredith hears about Yang's solo surgery, she figures out she'll be doing Torres' post-ops then. April is on Addison's service, while Charles is on Derek's. He proposes they could be the next Shepherds, but April declines the offer.

Everyone walks out, except Meredith. She stays behind and starts kissing Alex passionately. They had a rule about kissing in the hospital, but the ring just makes her look extra good. Her mother loved the engagement, as she adores him. Alex says that took her a while, but Meredith says she knows he was a jerk before he met her. Ellis didn't know there was a good guy in there, but Meredith did. She loves the engagement, and him as well. They continue kissing.

After the meeting, Owen takes the kids to daycare. Addison joins Callie and comments he's good with the kids. She asks how he's doing. He's better and she thinks they're past it. That's great, Addison says, because she heard it can be a hard road coming back. None of them knows what he went through out there, but Callie says he does Skype with some of his old buddies that are still in Iraq and this guy, Teddy, seems to be helping him through it. And he hasn't had another episode since that one. So anyway, he's good, and they're good now. Addison says she doesn't know how she does it with the kids, but Callie gestures at her belly and says she'll find out soon enough. Callie says she and Derek will be fine, as they're perfect together. As she walks away, Addison smile fades.

Richard tells Derek that all Ellis is saying is that she wants him to use his full potential. They arrive at the elevator, where Richard greets his daughter. Richard asks about a clinical trial, but Derek says he has no time for that as his baby is coming. Richard thinks it'll do him good. He leaves, leaving Meredith and Derek alone together. Meredith enthusiastically greets him, but barely gets response. As she begins to try to start a conversation, he walks away. "What an ass," she says.

In the ER, Jackson and Owen take on a junkie's case. Paramedic Nicole brings in the girl, who has tattoos and piercings all over her body. They found her in the street and presume an overdose. The girl is shaking. Just as they want to lift her off the gurney into a hospital bed, she goes into d-fib. They shock her, which normalizes her heart rate. Owen says the girl is all Jackson's. Jackson orders labs and turns the girl's head, revealing it's Lexie.

Meredith joins a group of journalists listening to Ellis offering them to come up to the gallery during her surgery and take a few shots of the technique in action. As the journalists disperse, Meredith compliments her mother and asks if she can scrub in, as she'd love to see the procedure first hand. Ellis asks why, as Meredith's focus is cardio. Scrubbing in on her mother's whipple won't get her a cardio fellowship next year. Ellis blamingly brings up Yang's solo surgery. Meredith says that that came in last night, when she wasn't there. Ellis says that is because she was too busy getting engaged and says that that is over now and asks if she wants to do the surgery, Ellis can ask Dr. Torres to give it to her. Meredith declines the offer, as she can get it herself. "There you go," Ellis says.

Alex meets Bailey. He's stoped for their whipple today. Bailey silently objects. Alex tells her to speak up, just like Ellis did earlier that morning. Bailey says they're not doing a whipple today, as she had it taken from her. Alex tells "Mandy" that they had talked about this. She can't let people walk all over her, she has to stand up for herself. Not if it's Ellis Grey, Bailey says. Alex gets excited, as watching Ellis Grey operate is great. He says they need to get in on the surgery. "We create our own destiny," he says. He rushes off and urges her to follow him.

Lexie wakes up. Jackson greats her and says she's finally stable now. He asks for her name, or anything, so they don't mix up her pee with somebody else's. "You got my pee?" she asks. "Yeah, you were kinda giving it away for a while there," he replies. Lucille Ball, Lexie says, making him smile. He comments she's funny, which is how she makes her living. He says they're gonna get her worked up and send her on her way. She asks him where she is. She smiles and sighs as she hears the hospital's name.

April is delivering a baby and tells the mother, Theresa, not to push. Addison comes in and asks April what's going on. Addison feels around and asks April to order a 3D-ultrasound and prepare an OR for a crash C-section stat. She also needs to have her husband paged.

Callie rushes into her patient's room. Arizona tells her the kid detached the connector to the artificial lung, so she had to clamp off the cannula to stop the bleeding. She told Callie this was a bad idea. Callie wants to book an OR to reconnect the device, but Arizona says it's too dangerous, he needs to go back on ECMO. The kid's mother asks if he's worse now that it's not working, but Callie watches the monitor and asks Arizona to stop. His sats are higher than they've ever been. She asks the kid if it's hard to breathe, but it's not. Arizona tests his breathing with a breathing device. He's breathing better than he ever has done before. From the sound of his lungs, it may look like a transplant is not necessary anymore after all. They mother is thrilled and hugs Callie, saying she loves her. "I think I do too," a smiling Arizona says, hugging her as well.

Bailey tells her patient and his wife that the Chief of Staff took over the surgery. They don't understand why. Alex steps in and tells them to think of it as a huge upgrade. They've just been handed the keys to a Jaguar, while they'd been driving a civic. Ellis walks in and introduces herself. She explains the procedure quickly. She gives them consent forms and gives them no time to ask questions or whatsoever. Before Ellis leaves, Alex asks her if he can scrub in. Of course, she'd love to have him. "See, you have to speak up for yourself," Alex says to Bailey, after which he leaves. Barry, the patient, asks if Bailey can explain what that woman just said. However, Bailey has noticed something in the chart and wanders off.

Cristina wakes up Lexie by shining a flashlight into her eyes. She tells Lexie her heart stopped again. Because of all the cocaine she's enjoyed, she needs a surgical implant. Cristina gives her an informative brochure in case she has any questions about the surgery. Cristina walks away. Jackson asks if there's anyone he can call. Lexie replies her parents are dead. Her mother died of a stomach thing and her father killed himself. Lexie smiles and says she does have a half-sister, who works as a doctor at this hospital. Jackson asks her who it is, but Lexie says her sister doesn't know her, and she wouldn't want to.

Charles and Derek walk into Addison's OR, responding to her page. They look at the ultrasound. "That is a massive tumor!" Charles remarks, not aware that the mother is still awake. Addison explains to her what's going on and April says that the Shepherd's are the best team she could ever have. Addison delivers the baby and Derek immediately starts taking care of her.

Looking at the scans, Addison and Derek start fighting. They'll need to operate simultaneously, and it'll take all day. Addison apologizes, knowing he didn't plan to spend all day with his wife. He says he'll see her in the OR. "It's a beautiful day to save lives!" she yells after him.

Meredith meets Richard in the scrub room and tells him she needs to steal a surgery from Cristina Yang. Yang is always stealing surgeries, he justifies. "Girl gives me the creeps," he says. Meredith says Ellis is operating, but that she doesn't want her to be in there. Richard reminds off her of when she learned to ride a bike. After an accident, it was her mother who made her get back on her bike. And then she learned to ride a bike. Ellis just wants her to succeed. Richard offers her to scrub in on his surgery, but they agree she probably shouldn't. She lies her head on his shoulder.

April, Jackson, Alex, and Meredith are watching Cristina stitching a banana in the cafeteria. Cristina has already done two solo thoracic aortic aneurysm surgeries. Jackson asks if she ever eats with anyone, ever. No, April says, because that's what happens when you screw an attending. Jackson makes a virgin joke about April, but Meredith comes up for her person. Meredith reveals that Burke had to leave the state after his sexual encounter with Yang. Alex says Yang is so crazy she'll probably go 'full-on Izzie' and shoot up the hospital one day. Meredith and Alex tell Jackson Izzie was a crazy girl in their class, who was sleeping with a patient, and then she stole a transplant heart for him. Until Meredith turned her in to her mother and got her fired. April comments Meredith is brave. Alex kisses his fiancée as Jackson asks how many people washed out of their year. After Izzie, there's O'Malley, who failed his intern exam and was never seen again after. Meredith gets up to go and steal Cristina's surgery.

At another table, Miranda is explaining to Callie that Ellis' plan won't work, as she will try to use the iliac veins, but they won't be useful due to the patient's extended thrombosis. Callie isn't paying attention; she's watching Arizona talk to Dr. Atterman, some ortho surgeon. Callie states that she wanted to go into ortho, but she didn't because Ellis told her she was good for cardio. Meredith comes over and she asks if she can do the thoracic aortic aneurysm surgery, as Yang has already done two, while she has only done one, so it's only fair. Callie says she knows what her residents need, and thus refusing. Meredith comments that her mother suggested she ask her, which makes Callie change her mind. She proposes she and Yang split it, so she and Yang can do it together. Meredith thanks her and walks away. "Whatevery Ellis Grey wants," Bailey says, to which Callie agrees. Bailey says Yang won't like it, but it's better than kicking her off the case. "Bitch scares me," Callie says looking at Yang.

Jackson finds Lexie packing up her stuff and says 'Lucy's got some splainin to do'. She says she's just going. He objects, as she'll die if she doesn't have this procedure. He knows it's scary, but she knows what's going to happen. She cites the brochure, using her photographic memory. He's impressed and comments she should go to med school. He says she should see all of this as a second chance. She's smart, beautiful and sharp, and she can turn things around. He brings up her sister and says she can have a whole new family. "Let's start by fixing your heart," he concludes. She starts crying and hugs him.

Cristina is eating a banana and then sees Meredith's name has been added to her surgery on the surgery board.

She enters Alex's office to ask what Meredith Webber is doing on her aortic aneurysm, only to find April and Alex making out. She smiles as the two start panicking, and closes the door.

Alex is putting his shirt back on as he races after Cristina. He tells her that she can't tell anyone. Cristina comments that surgery is hers and he can't just throw his girlfriend on it. Alex says he'll make sure Cristina never sees the inside of the OR again if she tells anyone. Cristina simply states he needs to get Meredith's name off the board. Alex says he didn't change the board, Torres did. "Where's Torres, then?" Cristina asks.

In surgery, Addison tells Derek he needs to have lunch with the president of the Bryson school tomorrow. He asks why they're talking about it now, so she tells him it's because he's never home. He always sleeps in that trailer, planning that house he'll never actually build. The patient deteriorates. Derek thinks Addison made a mistake, but she didn't. She tells him to concentrate on what he's doing.

Ellis is in the OR, preparing. Alex is scrubbing in and Bailey finds him. She tells him the iliac veins may not be suitable for grafting and asks him to tell Ellis. He asks why she didn't tell her, and refuses to do it himself as it's her patient and he doesn't want to tell Ellis that she's wrong. Bailey does say that Ellis read the chart, which convinces Alex that she knows what she's doing. Bailey asks him to tell her anyway, but he doesn't listen as he enters the OR.

Cristina is on her way to Owen. Jackson is following her and asks when she's going to do Lucille's AICD. She says that she is not, because she has surgery. He'll have to do it, but he refuses because she did the consult. Yang asks Owen where his wife is, but Jackson interrupts her and tells her about Lucille. Owen orders her to do it, as she was the consult. Cristina keeps on saying she won't give up her surgery, making him burst out and smash a window as he tells her to back off. The whole ER looks at him, shocked. He flees into a trauma room.

Cristina follows him and grabs some bandages for his hand. He won't need stitches this time. Cristina thought his PTSD was supposed to be getting better. He asks why she keeps helping him instead of reporting him. They share a look until she says she does so because she's a doctor. He asks her not to tell Callie. She leaves for surgery.

In the OR, with journalists watching from the gallery, Ellis asks Alex where the wedding will be. He and Meredith thought about Hawaii, but Ellis doesn't feel like going to a destination wedding. She runs a hospital, so she can't just dash off. She says she'll book the rainier club, as it's gorgeous. He says it's great as Ellis discovers the iliac veins are completely thrombosed and thus completely unusable. She asks if he knew about this. He lies and says no. The reporters are taking pictures. Change of plans: they'll use the renal vein instead. Ellis is furious and asks to have Bailey paged stat.

While Callie reads a magazine, Cristina and Meredith are fighting over the course of treatment. The patient is already sedated. Callie suggest they had thought of a surgical plan before the actual surgery, but Cristina says she didn't know that Meredith would be in there with her. Callie warns them not to make her come and do it. They both ask for the 10-blade.

Owen finds Avery, who backs away as Owen approaches. He's on his way to reserve an OR to put a pacemaker into Lexie's heart. Owen tells him someone made off with an armload of drugs from the dispensary, with his ID card. Jackson now notices his ID card is gone and he rushes over to Lexie's bed and notices that she's gone.

Ellis asks Bailey if she knew the patient had thrombosis. Looking at Alex, Bailey says she did. Ellis looked at the patient's chart, but asks why the fact that his thrombosis wasn't in there. Bailey says it's because had chosen to use the jugular vein. The information was in the medical records though. Ellis says she had to use the jugular eventually, because the patient had been under far longer than optimal. "That's why I picked the jugular," Bailey comes to her own defense, making Ellis even more furious. Alex is ready for the graft, but accidentally knicks the carotid artery. Ellis looks up at the gallery and snaps that them people are trying to kill her.

Addison and Derek are scrubbing out. She wants to know what she has to tell the mother, but he snaps he will go and talk to her himself. She brings up the preschool again, but he dodges and says he'll stay late to look into this clinical trial. One more reason for him to stay out of the house, she says. Addison hopes things will change when the baby comes, but he says nothing's going to change. She asks if he even wanted a baby. He does. She specifies she's talking about this baby, with her. Charles and the other staff is watching them from the OR. She asks him if he loves her. He looks down and says of course. "Can you say it without looking at the floor?" she asks. He can't.

Callie says there are only three minutes of circulatory arrest left. If more, the organs will starts dying. Cristina blames Meredith for having taken too long. They're done, the patient can get back on bypass. Meredith however says not as there's a leak. Cristina opts to find it and throw in a stitch, but Meredith wants to do an internal graft. Callie sides with Meredith and asks Cristina to move her hands. Cristina does so, but immediately goes back in when Meredith is struggling with the instruments for a second. She found the look and asks 5-0 Prolene.

Derek asks Ellis if she has seen his wife. As a matter of fact, she has. She just threatened to quit. She asks him to wash his dirty laundry at home, not in her OR. He says there are two sides to every story, but she's not interested in his side. Richard and she had very high hopes for him, but he's a disappointment. He doesn't publish, doesn't teach, and he has a terrible attitude. His nickname is not very flattering either. She tells him to get it together, because if it comes down to a choice between him and her, he needs to be very clear on who she'll choose, implying she'd choose Addison.

Charles comes into the locker room and tells Meredith and Alex they do not want to be the next Shepherds. However, they're all too busy listening to Meredith's story of Cristina sticking her hands back into the patient. Cristina comes in and says her patient is awake and doing great. Jackson says that's great, cause OD girl bolted. Meredith and Cristina start arguing and Cristina says Callie only sided with her because she is the Chief's little girl; Torres is a pathetic lackey. Meredith brings up Burke. "Good one", Cristina says. "However, if she wants to get personal, why doesn't she ask what Prince Charming and Virgin Mary like to do in his office?". Alex starts to deny, but April starts crying and apologizing. Meredith rushes off. "Just shoot me now!" a disgusted Charles says.

Arizona tells Callie their patient is doing great. He can go home by the end of the week and has been taken off the transplant list. They shake hands over Callie's amazing work and Arizona calls her amazing. They agree they should get drinks sometime to celebrate. They share an intense look as Callie's daughter comes running over. Callie is then forced to leave with her kids, but they agree to have drinks sometime.

Richard is comforting his crying daughter and asks her what happened. She can't talk about it. Ellis comes in, saying that she's heard what happened. Ellis says she should be upset and humiliated. She says Meredith can't let anyone show her up in her OR, ever, revealing that she's unaware of the real reason why Meredith is crying. Meredith says she shouldn't have been in that OR, as she wasn't prepared. Ellis asks why she went in. Meredith says it's because Ellis pushed her. Meredith says Ellis is not mad because Meredith embarassed herself, but because she embarassed her. Ellis closes the door after Meredith leaves. As Richard asks what's wrong with her, Ellis tells her she wants him to fire Bailey, tonight, as she made a complete fool of her. She looked like a total failure. She starts crying too because she was humiliated in front of all those people. Richard comforts her and tells her she can't control everything, even though she wants to. Ellis asks if Meredith is all right and admits she doesn't know how to talk to her, so she asks him to do it. Ellis admits she's horrible with her, but she just wanted her to do the best she could. Richard knows. She thanks him and he continues to comfort her.

Owen finds Cristina and thanks her for today. She tells him to tell his wife and get some help. Owen says she'll leave and take the kids with her, as she's afraid he'll hurt one of them. "Aren't you?" she asks as Callie and the kids come over. Callie asks Owen about his hand. He lies and says that a junkie patient knocked him into a tray of instruments. Callie says they should get home so she can take a look at it.

In the ER, Mark comes in carrying Lexie. She was lying in the street and he almost ran her over.

Mark is performing CPR. Cristina and Jackson have stepped in too. They manage to revive her. Mark asks nurse Ruth where he can find Dr. Shepherd. "Which one?" she asks.

Richard finds Meredith, who tells him he doesn't need to come cleaning up after her mother again. He does it every time, and it's beneath him and pointless. Meredith finally figured out why she can't do anything right for her mother. She wants everyone around her to be ordinary, so she can be extraordinary. She wants everyone around her small, and that's what she's done to him. Meredith is not planning on letting her mother do it to her too.

Derek finds a crying Addison in a lounge. He doesn't know what's wrong with him. All he knows is that the baby's coming and that he wants it. It may change things. She'll get happier. They'll take it one step at a time so they can make it work. Addison then reveals it's not his baby. Mark comes out of the bathroom, shirtless. He's washed the junkie blood off of it. "This is awkward," he says. Derek shakes his head.

Meredith sees how Cristina and Jackson are trying to revive Lexie again. She steps in and proposes they crack her chest. Cristina says it's not indicated as she OD'd, but Meredith says she's going to anyway, so there's nothing to lose. She asks for a chest tray. Cristina steps in and they crack her chest together.

Bailey gets on an elevator. Alex is in the corner, crying. He says he screwed up. He had a good thing, he had a chance to be better and he screwed it up like he does every time. "I just lost my job. Do you see me crying?" she asks, finally having found her strength and being shy anymore. She has no idea what to do next, but she's not hiding whimpering about it. Now she asks him what they say. "We create our own destiny," they say together. That's exactly what she's going to do, and he should do too.

Jackson tells Meredith and Cristina they lost the patient, but they tell him to shut up and refuse to give up. They manage to get the girl back.

Later that evening, Meredith and Cristina are drinking tequila at Joe's. Cristina says they don't have to do that where she says someting, and then Meredith says something, and then someone cries, and there's a moment or whater. Meredith happily agrees. It's just that nothing is turning as Meredith thought it would. She doesn't even recognize her own life. Cristina knows what she means. Cristina then says she should go and have some sleep. She suggests Meredith do the same, as she looks like crap. "I look better than you!" Meredith says, but Cristina replies that that's not possible. She leaves. Derek is sitting at the bar as well and asks her what his nickname is. McDreary, she replies. He laughs and agrees that that's his life. She proposes that tonight, he's just a guy in a bar. Then she's just a girl in the bar, he says. She is, and she drinks tequila. He smiles and orders another tequila for her. They cheer.

Main Cast

 * Ellen Pompeo as Dr. Meredith Grey
 * Sandra Oh as Dr. Cristina Yang
 * Justin Chambers as Dr. Alex Karev
 * Chandra Wilson as Dr. Miranda Bailey
 * James Pickens, Jr. as Dr. Richard Webber
 * Sara Ramírez as Dr. Callie Torres
 * Eric Dane as Dr. Mark Sloan
 * Chyler Leigh as Dr. Lexie Grey
 * Kevin McKidd as Dr. Owen Hunt
 * Jessica Capshaw as Dr. Arizona Robbins
 * Kim Raver as Dr. Teddy Altman (credit only)
 * Sarah Drew as Dr. April Kepner
 * Jesse Williams as Dr. Jackson Avery
 * Patrick Dempsey as Dr. Derek Shepherd

Special Guest Star

 * Kate Walsh as Dr. Addison Montgomery-Shepherd

Guest Stars

 * Loretta Devine as Adele Webber
 * Robert Baker as Dr. Charles Percy
 * Kate Burton as Ellis Grey

Co-Starring

 * Kevin Brief as Barry
 * Marilyn McIntyre as Jill
 * Nicole DuPort as Theresa
 * Sonya Leslie as Rita
 * Nicole Cummins as Paramedic
 * Teresa Huang as Nurse
 * Kayla Madison as Allegra
 * Bryson Thomas as Riley

Uncredited

 * Ray Singh as Nurse Howard

Owen's Patient

 * Diagnosis:
 * MVC injuries


 * Doctors:
 * Owen Hunt (trauma surgeon)


 * Treatment:
 * Abdominal closure

Owen told Ellis that he was doing an abdominal closure on an MVC patient.

Neuro Patient

 * Diagnosis:


 * Doctors:
 * Derek Shepherd (neurosurgeon)


 * Treatment:
 * Lamenectomy

Derek was scheduled for a lamenectomy.

Cardio Patient

 * Diagnosis:
 * Thoracic aortic aneurysm


 * Doctors:
 * Callie Torres (cardiothoracic surgeon)
 * Cristina Yang (surgical resident)
 * Meredith Webber (surgical resident)


 * Treatment:
 * Direct approach

Cristina was supposed to do a solo thoracic aortic aneurysm, but Callie made her let Meredith scrub in. Rather than doing a safer TEVAR, Cristina planned for a direct approach, which she said was cooler. In surgery, the patient developed a leak. Meredith wanted to use a graft, but Cristina said she could find it and put a stitch in it. Callie told her to let Meredith do it her way, but Cristina did it her way. The patient was awake and doing well post-op.

Riley

 * Diagnosis:


 * Doctors:
 * Arizona Robbins (pediatric surgeon)
 * Callie Torres (cardiothoracic surgeon)


 * Treatment:
 * Artificial lung

Riley was on an artificial lung while he was waiting for a transplant. He detached the cannula and they were ready to rush him back into surgery to replace the lead, but when Arizona tested him, his lung function improved to the point where they suspected he wouldn't need a lung transplant. He was breathing unassisted and his stats were great, so they removed him from the transplant list.

Barry Taylor

 * Diagnosis:
 * Pancreatic cancer
 * Deep vein thrombosis


 * Doctors:
 * Miranda Bailey (general surgeon)
 * Ellis Grey (general surgeon)
 * Alex Karev (surgical resident)


 * Treatment:
 * Extended whipple

Barry, 47, had advanced pancreatic cancer. Bailey planned to perform an extended whipple, but Ellis took over the case from her. She planned to use her new technique, but didn't read the chart that said that Barry had deep vein thrombosis, meaning she couldn't use that technique, which involved grafting the iliac vein instead of the jugular. She found this out on her own and was enraged at Bailey. Alex then nicked the carotid, which made the situation even worse. Despite this, they were able to save the patient and finish the surgery.

Addison's Patients

 * Diagnosis:
 * Pyloric stenosis


 * Doctors:
 * Addison Forbes Montgomery (neonatal surgeon)


 * Treatment:

Addison had two patients with pyloric stenosis.

Lexie Grey (Lucille Ball)

 * Diagnosis:
 * Cocaine overdose


 * Doctors:
 * Owen Hunt (trauma surgeon)
 * Jackson Avery (surgical resident)
 * Meredith Webber (surgical resident)
 * Cristina Yang (surgical resident)


 * Treatment:
 * Narcan

Lexie was brought in with a cocaine overdose. They'd tried narcan on the way to the hospital, but got no response. In the ER, they had to defibrillate her once and Owen told Jackson to take over. She used the alias Lucille Ball to avoid giving her real name. Because of the damage caused by the cocaine, Lexie needed an AICD pacemaker. Before she could have surgery, Lexie tried to leave the hospital. She stole Jackson's ID badge and used it to steal drugs out of the dispensary. Mark brought her back into the hospital after almost running her over with his car. in the ER, Cristina and Meredith cracked her chest and were able to get her heart beating again.

Theresa

 * Diagnosis:


 * Doctors:
 * Addison Forbes Montgomery (neonatal surgeon)
 * April Kepner (surgical resident)


 * Treatment:
 * C-section delivery

Theresa was giving birth when suddenly, progress stopped. Addison ordered a 3-D ultrasound and told April to prep for an emergency c-section delivery. They discovered that the baby had a massive tumor on her neck, which is why she hadn't been able to deliver the baby vaginally.

Theresa's Baby

 * Diagnosis:
 * Neck tumor


 * Doctors:
 * Derek Shepherd (neurosurgeon)
 * Addison Forbes Montgomery (neonatal surgeon)
 * Charles Percy (surgical resident)


 * Treatment:

Theresa's baby was delivered via emergency c-section. An ultrasound revealed a large tumor on her neck which was compressing her trachea. Addison and Derek operated to remove the tumor.

Richard's Patient

 * Diagnosis:


 * Doctors:
 * Richard Webber (general surgeon)


 * Treatment:
 * Proctocolectomy

Richard was scrubbing in for a proctocolectomy and invited Meredith to scrub in with him, but she declined.

Owen Hunt

 * Diagnosis:
 * Hand laceration


 * Doctors:
 * Cristina Yang (surgical resident)


 * Treatment:
 * Bandage

Owen cut his hand punching a window. Cristina cleaned the wound and put gauze over it, telling him he could finish taking care of it himself. She stated that it was not deep enough to need stitches.

Notes and Trivia

 * This episode's title originated from the song If/Then, originally sung by Ras Kass.
 * This episode scored 9.71 million viewers.
 * It is an alternate reality episode.
 * This episode marks the final appearance of Addison Forbes Montgomery on Grey's Anatomy.
 * Several songs in this episode were used in previous episodes:
 * Portions for Foxes - A Hard Day's Night
 * Ruby Blue - Make Me Lose Control
 * Girl, You Shout! - The Name of the Game
 * Fools in Love - Make Me Lose Control
 * Into the Fire - A Hard Day's Night
 * You Wouldn't Like Me - The First Cut Is the Deepest

Character changes:
 * Derek Shepherd is very sad and miserable and still married to Addison, never had a relationship with Meredith; his nickname is McDreary instead of McDreamy, and he's professionally stuck, unwilling to teach, publish, or be creative. He is also known as Bad Shepherd and is unaware of Mark and Addison's affair until the end of the episode.
 * Meredith Grey is a lot happier, has 2 loving parents, Richard and Ellis, adopted the surname Webber, is engaged to Alex, and hates Cristina as she follows cardiothoracic surgery, too. It is shown that she was very selective with the interns she was kind to, and may have been more of a teacher's pet as seen when she told her mother that Izzie cut Denny's LVAD wires.
 * Cristina Yang has straight hair and is very bitter towards the others, except Owen and helps him with his PTSD. Also, since Meredith and Derek never were in a relationship, she was the only intern sleeping with an attending, which makes the others very cruel towards her.
 * Alex Karev a lot nicer person, wears glasses, and is the current chief resident and is most likely pursuing general surgery as he and Bailey work very closely together. He proposed to Meredith and is very optimistic. He also had an affair with April Kepner -- Meredith's now best friend.
 * Ellis Grey does not have Alzheimer's, is together with Richard, and is a loving mother and also is the chief of surgery and chief of staff.
 * Richard Webber chose Ellis over Adele and became Meredith's father. His leader traits were overshadowed by Ellis'.
 * Addison Forbes Montgomery is still with Derek, though is pregnant with Mark's baby, and still works at Seattle Grace Hospital as both neonatal and OB/GYN-perinatal chief. She is known as Good Shepherd among the residents.
 * Owen Hunt married Callie, had 3 children with her, and still shows anger management issues due to postraumatic stress.
 * Callie Torres married Owen instead of Arizona, chose cardiothoracic surgery instead of orthopedic surgery as suggested by Ellis, and apparently never faced her lesbian self.
 * Arizona Robbins did not marry Callie and apparently barely knows her.
 * Miranda Bailey is still shy and has zero confidence in herself from not having Richard teach her. Alex is the one who reinforces her self-esteem every now and then. She also has her intern-year dreadlocks.
 * Lexie Grey is a drug addict with tattoos and never went into medical school. She stated that both Thatcher and Susan are dead. She knows about Meredith but has never met her.
 * Mark Sloan does not work at Seattle Grace.
 * April Kepner is Meredith's best friend, her person, and had a casual fling with Alex. Instead of focusing on neurosurgery or trauma surgery, April seems to be focused on OB/GYN and/or neonatal surgery.
 * Jackson Avery may not have followed plastic surgery as Mark doesn't work in the hospital. It is suggested he follows trauma surgery as a specialty.
 * Charles Percy was not shot and is alive and is in love with April.

Missing characters:


 * Teddy Altman is still in Iraq.
 * George O'Malley ran away after failing intern exam; it's assumed that he is alive.
 * Izzie Stevens was fired for cutting Denny's LVAD wire after Meredith told her mother.
 * Reed Adamson was possibly fired during the merger and it is to assumed she was never shot and is still alive.
 * Preston Burke left Washington State after his relationship with Cristina, reason unknown.
 * Neither Zola Grey Shepherd nor Sofia Robbin Sloan Torres exists in this reality.
 * Erica Hahn is not mentioned.

Hospital changes: Glitches:
 * Rather than merging, Seattle Grace Hospital merely absorbed Mercy West Medical Center, and Ellis planned on absorbing Seattle Presbyterian Hospital, as well.
 * Instead of the blue color scheme, the surgical staff wears a gray color scheme, with light gray for the surgical residents, and dark gray for surgical attendings.
 * Scrub caps are no longer personalized; instead they match the color of the surgical gown, which is purple.
 * Scrub shirts worn by men are of a v-neck style, while the women wear an a-neck style.
 * Surgical masks are no longer tied behind the head; instead, they loop behind the ears, similar to the surgical masks at St. Ambrose Hospital.
 * Department chiefs and/or senior attendings do not wear scrubs when outside the OR; instead they wear dress clothes with their lab coat.
 * SGH's insignia is more intricate, adding a shield, stepped-formatting with the font, and laurels.
 * The explanation given for Callie being a cardiothoracic surgeon instead of an orthopedic surgeon is that Ellis urged her to pursue a career in cardio. However, Ellis shouldn't have been able to have that influence on her, as Callie started an ortho residency right after medical school, so she already chose a specialty before having encountered Ellis.

Quotes

 * Meredith: We'd all be working under Preston Burke right now, but you screwed us out of that opportunity. Literally! What exactly did you do to him, because he left the state to get away from you!
 * Cristina: Good one. If you wanna get personal, why don't you ask Prince Charming what he and the Virgin Mary like to do in his office?


 * Owen: Yang! Thanks for today.
 * Cristina: Tell your wife. Get some help.
 * Owen: She'll leave. And I'll lose my kids. She's afraid I'm gonna hurt one of them.
 * Cristina: Aren't you?


 * Charles: Shoot me now.


 * Meredith: So how about tonight, you're not McDreary? You're just a guy in a bar.
 * Derek: And you're just a girl in a bar?
 * Meredith: I am. And I drink tequila.


 * Jackson: Lucy... you got some splainin' to do!


 * Richard: Meredith!
 * Meredith: No, Dad. Don't come and clean up after her again. You do it every time and it's beneath you and it's pointless. I can't do anything right for her.
 * Richard: Your mother doesn't...
 * Meredith: And I finally figured out why. She wants everyone around her to be ordinary, so she can be extraordinary. She wants everyone around her small!
 * Richard: Oh, you stop it!
 * Meredith: And that's what she's done to you. She has made you small, and I'm not gonna let her do it to me.


 * Derek: I... I don't know what's wrong with me. All I know is that the baby's coming, and I want it. It may change things. You'll get happier. We'll just take it one step at a time. I wanna make it work.
 * Addison: It isn't your baby.
 * Mark: (leaving the bathroom) It's stupid, I know, but it's a brand new shirt and I almost got junkie blood all over it. Oh... This is awkward.


 * Miranda: Are you crying?
 * Alex: I screwed up. I... I had a good thing. She was a good person, but... I had a chance to make it better. I had a chance to make it better, and I screwed it up like I do every freaking time! What the hell is wrong with me?
 * Miranda: I just lost my job. Do you see me crying? I have no earthly idea what to do next, but am I hiding in an elevator, whimpering about it?
 * Alex: No.
 * Miranda: No. Because what do we say, Alex? What do we say?
 * Alex: We create our own destiny
 * Miranda: ...own destiny, uhu. And that's exactly what I'm going to do. You should too.