Bad Blood

"We've all heard the buzz words, streamline, optimize, integrate, adapt. Everyday someone comes up with a new strategy or tool or technology to increase our efficiency. The idea is to make our lives easier but the question is, does it?" "To really be efficient, you have to eliminate what doesn’t work. You have to figure out what is important and hold on tight to the things that matter most."

- Meredith Grey

Bad Blood is the thirteenth episode of the ninth season and the 185th overall episode of Grey's Anatomy .

Short Summary
As Derek and April work around the clock to find a solution for the hospital, Cristina struggles to respect the wishes of a family whose son is dying. Meanwhile, Arizona empathizes with a teenager who faces problems similar to her own.

Full Summary
Meredith and Cristina are in the CCU, watching a newly installed camera. Cristina says the new cameras are all over the CCU and will be soon be installed in the ORs and even on-call rooms. She believes they're being spied on when suddenly a voice greets her. Cristina feels uncomfortable as he knows her name, covers up her name tag and leaves.

In an OR, Cahill explains the cameras are there to supplement the doctors. Behind the camera, there's a remote physician, an extra set of eyes, to help reduce mistakes, improve patient care and maximize physician hours. All surgeons seem to be uncomfortable with the changes Cahill made. Cahill also adds that the ORs now are organized with maximum efficiency, specifically for OR turnover. Callie and Arizona came in late and Callie asks what they've missed. Richard says "ORs are sloppy". "There are doctors in the ceilings", Bailey says. Callie and Arizona start a little fight over their efficiency, when Cahill says that you need to most efficient approach when every second counts, to which Callie agrees.

Outside the OR, Jo tells the other interns that Cahill's talking about hospital procedures. Jo thinks that they'll be fired, because they weren't invited. The others don't believe her, but when Jo shows them the nurses are stockpiling, they show a little more belief. Inside the OR, Cahill finishes with saying she'd like to see the time in between surgeries cut in half. The doctors leave. Cristina says that the new OR arrangements and the closing of the ER will lead to them having no patients, and that Owen said to her he's not doing anything about it until it actually happens. Meredith says the ER won't close, as Derek spent the night with Kepner to come up with a plan to prevent it from closing.

In a conference room, April and Derek go over their plan one more time. Derek says the departments of the hospital will be mad about the cuts they are planning to make, but that they will definitely keep the ER open. When checking if there's a reply on their email, Derek notices April used "PROPOSED BUDGET CUTS" as subject line. He says no one will open the email, so they'll have to pitch their plan in person. They come to the conclusion that they both have to brush their teeth first.

Cahill brought all the general surgeons together in the skills lab to have Dr. Darryl Nesbaum teach them a standard technique for a hernia repair. Bailey starts clapping enthusiastically. "When did you end becoming a kiss ass?", Webber asks her. Bailey explains that every other hospital where Cahill maximized the efficiency, ended up by cutting their staff by 30%. Therefor, she says she'd do anything to keep her job. Meredith says she's pretty sure she gets to keep her job, because they "can't fire the pregnant lady". Bailey starts cheering when Nesbaum finishes his introduction.

Outside a patient's room in peds, Callie comes over and asks Arizona and Alex if the patient has moved yet. Arizona and Alex make comments on how mean the kid is, but Callie says it's normal because the patient is 13 years old and had a double hip replacement. When Callie notices Arizona doesn't really dare to make the patient stand up, Callie sends in Karev.

Cahill approaches Owen, asking him about the people who came to measure the ER space. Owen told them to get lost because they were in the way while doctors were treating patients on the ER's last day. They both step into an elevator to the helipad. Cahill says it's not clear yet what they will replace the ER with. He thinks the ER is the way for them to get the closest to the injury and thereby help the people that need it. The elevator arrives at the roof, and the paramedics enter the elevator with their patient, who had a severe accident with his chainsaw. Suddenly, the carotid artery of the patient blows, but Cahill quickly applies pressure with both of her hands. She looks at Owen and says she "was closest".

In the OR, Cahill is still applying pressure to the carotid artery. Owen is getting to ready to perform surgery and tells a nurse to page plastics for the sliced of nose of his patient. Cahill ensures Owen she doesn't need to be replaced, as this would enlarge the chance of the patient stroking out.

April and Derek are talking about how they'll approach Dr. Russell, when Derek is paged to Owen's OR. April has to start talking to Russell alone, but Derek calms her down, saying she can do it.

Dr. Darryl Nesbaum finished explaining everything about his hernia repair technique, when Dr. Webber asks him if he can keep using his own technique. Nesbaum says he can't, because the hospital needs to standardize the way to approach hernias. Nesbaum suggest to organize a little competition. The first surgeon who performs his technique 20 times in the skills lab, will win a sweater from the hospital, which is not cheap, according to Meredith. Bailey starts the competition with quoting the Hunger Games.

Alex tries to convince the patient to stand up. However, the patient doesn't care if her hips heal right or not, because her career in gymnastics, which meant everything to her, is already over. She manages to talk Alex out of her room.

In the CCU, intern Leah comes to Cristina to tell her that Dr. Richardson, the remote physician, doesn't agree with Cristina's plan. Leah says she tries to ignore it, but it's upsetting the patient. Cristina walks into an empty room in the CCU to tell Dr. Richardson not to question her medical decisions and only be there as an extra set of eyes. Cristina starts insulting him, when Leah comes to get her for a possible cardiac trauma coming into the ER.

April approaches Dr. Russell with her plan, but he thinks the only way for the hospital to become better is to be innovative, and not budget cuts. He walks away with further listening.

After checking for possible bleeds, Cahill says she can put in a shunt. Cahill says she having fun, when Derek walks in. "So instead of telling them how to do our jobs, now you're just doing them", Derek says. Owen says Cahill saved the patient's life. Derek says that the patient would've died tomorrow if his chainsaw wouldn't have slipped today.

Paramedic Nicole comes into the ER with the cardiac trauma. While treating the patient and asking his friend some questions, someone finds the patient's medical ID. He turns out to be a Jehovah's witness, meaning they can't give him any blood. Cristina and Leah move to the OR, to do a bloodless repair of the aortic transection.

Alex tells Callie and Arizona that the girl is really dark and that she turned him into a suicide risk. Callie decides to go in and move her herself. Arizona wishes her good luck with her bad cop attitude.

Right before cutting into the patient, Cristina realizes this will cause him to loose too much blood. She tells everyone in the OR to get it ready for an endovascular repair.

In the skills lab, Nesbaum compliments Meredith. Richard on the other hand isn't doing well, suggesting he should stick to his own technique. Bailey finishes her first hernia repair, but Nesbaum tells her to pay more attention to details, like Meredith, who starts gloating.

Leah comes to the patient's friend to inform him on her patient's condition and asks him if his friend's family has arrived. She sees the family members, who are all praying. Before she can go over to them, the friend tells her that he doubts his friend really is religious, as he never told him about it. The friend has to go, but asks her to call him when something happens.

Cahill and Hunt are still operating. Jackson comes in, criticizing Cahill's recent changes in the OR, as he doesn't realize she's in there. His intern Stephanie does though, and tries to get him to stop. Jackson thinks that Cahill shouldn't tell them anything about the OR when she hasn't been in the OR for years. "Until today", she says. Jackson quickly leaves, saying he can take care of the nose post-op. Owen apologizes, but Cahill says it's fine, as she knows she actually saves the hospital.

In the CCU, Leah suggest Cristina gives the patient blood, following the patient's friend's doubts. Cristina refuses to give him blood. They leave to talk to the family. Dr. Richardson wishes them good luck.

Callie is trying to get Simmi, the double hip replacement patient, out of the bed. Callie says she otherwise has to discharge her for acting against medical advice, and then Simmi will probably never walk again. Simmi starts talking about how everything is out of Callie's control, making Callie doubt.

In the skills lab, Bailey finally has the technique down, when Meredith leaves, touching her belly like something's wrong with her baby. Bailey goes after her. In the hallway, Meredith tells her something's wrong, as there's a flutter. Bailey touches Meredith's belly and comforts Meredith, saying it's a good thing: the baby is kicking.

Talking to the family of her patient, Cristina says the patient lost more than half of his blood volume and that he may not have enough time to make new blood cells. Cristina tells them blood transfusions would really help, but the family doesn't allow it. Cristina makes it clear to the parents that it's very likely their son will die when his organs starts shutting down without blood. The parents still don't agree, and they say they'll continue praying for a miracle.

April tells Derek everyone shut her down. Derek rushes off to talk to the Chief of Dermatology, and right before April's eyes, Derek manages to make him agree to the plan.

Meredith comes to the CCU to tell Cristina the baby kicked, and Cristina says she hates her intern and she should maybe kick her. Secretly, Leah sneaks into the Jehovah's witness's room to give him blood, only to be stopped by the remote physician. Later on, Cristina is ranting to Leah about her actions and throwing her off of her service. When Leah leaves, Cristina and Dr. Richardson agree that the patient is circling the drain.

In the OR, the surgery turns out to have worked. Owen and Cahill are relieved. Cahill agrees to finish up together with Owen, and later tell the family.

Outside, Stephanie says she is pretty sure the hospital won't fire them, as they are the future doctors of the hospital. Leah gets a page and leaves, because her patient is coding. Suddenly, Callie appears, laughing. She is still depressive due to Simmi's speech and tells them the future is out of their control.

Derek talks to Jeff Russell about their budget plan. Russell says Derek's parking space may open his heart to Derek's case. Derek then asks Jeff about his sister, whose aneurysm he once clipped. Russell then agrees, but only if he gets the parking space.

In the surgical skills lab, Bailey is on a roll. Webber calls over Nesbaum to give him a look at his hernia repair technique. When Nesbaum says every patient needs to get the same standard care, Richard asks how good that care can be when you see 50 patients a day. Nesbaum then starts screaming that it's not about the patients, prompting everyone to stop for a second and look at each other.

In the CCU, Cristina is doing everything she can to resuscitate her patient, with Leah watching her. When Cristina calls time of death, everyone leaves and Leah comes in, saying he didn't have to die. Cristina leaves to go tell the parents. "The show's over, Bob, you can change the channel", she says to the camera.

Arizona meets Callie and Alex in front of Simmi's room, only to discover she still hasn't moved yet. She enters the room, saying it's hard, but that Simmi wants it. Simmi says that Arizona doesn't know what she wants. Arizona then shows her her prosthetic leg. When Simmi calls her cripple, Arizona gets angry and tells her she can act the way she wants, but that she cannot take others down with her. She then tells her to treat people with respect and that she has to start with herself. She tells Simmi she has to stand up, or that she'll drag her out of bed. Simmi then gets out of bed, and Callie and Alex, who have been watching them, come in to help her taking her first few steps.

Owen and Alana Cahill are in their patient's room, telling the family the surgery went well. The patient's wife hugs Alana.

Drs. Webber, Bailey and Nesbaum are in the elevator together. Bailey is wearing the hospital sweater. Nesbaum says change is hard, but that they'll come around. He also says the sweater looks good on Bailey. "It's itchy", she says, when leaving the elevator with Richard.

Alana says again to Owen she had a nice day, when Derek and April come over with their budget cut plan. Cahill says they misunderstood, as no budget cutting or shuffling will save the ER or the hospital for that matter. Derek than realizes Alana is making the hospital presentable for a buyer, which is the only way to save SGMWH.

Owen turns off the lights in the empy ER and leaves. The ER doors automatically close and Owen turns around, looking at the paper on the doors, saying the SGMWH emergency department is closed. Cristina is sitting outside on a bench, and asks him what he's going to do. "Right now, I'm going to drink... a lot", he says. They leave together.

In their bedroom, Derek's hand is on Meredith's belly, feeling the baby kick.

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
 * Kevin McKidd as Dr. Owen Hunt
 * Jessica Capshaw as Dr. Arizona Robbins
 * Sarah Drew as Dr. April Kepner
 * Jesse Williams as Dr. Jackson Avery
 * Patrick Dempsey as Dr. Derek Shepherd

Guest Stars

 * Constance Zimmer as Dr. Alana Cahill
 * Andy Milder as Dr. Darryl Nessbaum
 * Camilla Luddington as Dr. Jo Wilson
 * Gaius Charles as Dr. Shane Ross
 * Jerrika Hinton as Dr. Stephanie Edwards
 * Tessa Ferrer as Dr. Leah Murphy
 * Cullen Douglas as Dr. Bob Richardson
 * Dominic Hoffman as Dr. Jeff Russell
 * Lexi DiBendedetto as Simmi Johnson

Co-Starring

 * David Goryl as Ron Campion
 * Helen Eigenberg as Lillian Campion
 * Michael James Olsen as Brock
 * Kovar McClure as Dr. Tim Redmond
 * Nicole Cummins as Paramedic Nicole
 * Arlene Santana as CCU Nurse
 * Molly Schreiber as Flight Nurse
 * Vivian Kerr as Logger's Wife
 * Ursula Burton as O.R. Nurse

Notes and Trivia

 * This episode's title originated from the song Bad Blood, originally sung by Black Rebel Motorcycle Club.
 * This episode scored 8.93 million viewers.
 * Cullen Douglas previously appeared in Kung Fu Fighting as a different character. Different from that episode, this time only his voice is on the show.

Quotes

 * Bailey: Tributes, may the odds be ever in your favor.


 * Meredith: I would be happy to give you some pointers if you'd like.


 * Bailey: That bun in the oven may give you job security, Meredith Grey, but it does not make you immune for a smack in the mouth.