Almost Grown

"They train doctors slowly. They watch us practice on frogs and pigs and dead people and then live people. They grill us relentlessly. They raise us like children and eventually they take a cold hard boot and kick us out of the nest. We all want to grow up. We're desperate to get there. Grab all the opportunities we can to live. We're so busy trying to get out of that nest, we don't think about the fact that it's going to be cold out there. Really freaking cold. Because growing up sometimes means leaving people behind. And by the time we stand on our own two feet, we're standing there alone."

- Meredith Grey

As part of their training, the Chief puts Seattle Grace’s residents — including Meredith, Cristina, April and Jackson — in charge; meanwhile, Derek, Callie, Owen and the other attending surgeons compete for a million-dollar grant.

Full Summary
The chief tells all the doctors he has "great faith" in all of them. He's giving the attendings some time to work on a special project while he's making the residents attendings. Lexie doesn't get the attending navy blue scrubs, though, and the chief tells her it's because she's not a fourth-year resident.

Cristina stares blankly at her new scrubs. Meredth assures her they're probably "basically just playing dress-up."

The real attendings have been giving a chance to pitch the chief ideas on how they would use the hospital's $1 million surplus, which is why they need time away from babysitting residents.

Alex gets a breast-reduction case from Sloan. It's a teenage boy who is skinny and has significant breasts.

Meredith and Avery get a case of an older woman who needs a shunt in her head to relieve pressure around her brain. Her partner, a school teacher, doesn't want them to be "learning on the job." Derek tells them he wants to see them practice the procedure before decide who will do it.

Callie continues trying to play head games with the other attendings. She's already told Teddy that the chief would be hard on her pitch (and that it needs a table of contents), and now she's telling Arizona not to be afraid of the chief, who she finds intimidating. She's also telling Sloan he can't count on his good looks and charm, which he says, "always works."

April and Cristina have a case of a 57-year-old man, Mr. Henley, who needs new lungs. He says he's needed them for years, but didn't receive them earlier because he was perceived to have been too healthy at the time. Teddy watches Cristina's reaction. Cristina has no answers when Teddy asks her opinion on the case. Teddy tells Cristina she's at a crossroads, "Where you either get in the game, or I tell Richard it's time to send you home."

Later, Teddy makes her pitch: Making Seattle Grace the hospital that eliminated heart surgery. She wants to use stem-cells to re-grow heart patients' damaged hearts. She eventually puts her notes aside, then starts to say he can't give the money to neuro, and proceeds to go off on Derek, who once tried to get her fired. She realizes she's holding a grudge and should have stuck to her notes.

Avery gets frustrated while practicing for Derek's procedure. He must be able to drill into an egg shell without breaking the membrane. Meredith encourages Cristina.

The mom of the teenager stops Alex from going through with the breast reduction. She says his father has the same chest and no one thinks he's a woman. The kid confides in Alex that he wants to be "normal."

Mr. Henley wants to know Cristina's opinion on whether he'll pass the panels for the lung transplant. He says she has a "sourpuss" on her face. She continues being pretty short with him.

Sloan is upset that Alex can't seem to handle the teenage boy's procedure. Lexie treats -- or tries to treat -- woman with a broken leg. The woman thinks Lexie is too frazzled to know what's going on with her case, and Lexie proceeds to recite from memory the woman's entire chart, including previous procedures and medications, allergies, and anything else you'd want to know. "I'm busy, but I can handle it," Lexie says.

Hunt makes his case to the chief that everyone in the hospital needs trauma training. He says that Dr. Percy wouldn't have died in the shooting if Bailey had been trained to handle such a trauma. She couldn't get to an O.R. and she watched him die in her arms. "I can't face that ever again," Hunt tells the chief. "Can you?"

Sloan gives his pitch next, saying he wants Seattle Grace to be the place for serious burn victims. He'd also like to make them a "real nationally renowned center for cosmetic reconstructive surgery. The chief questions the two sub-specialities, but Sloan says the cosmetic center revenue would support the burn unit. The chief says it's ambitious and a "tremendous amount of work." Sloan leans in and says he's not seeing or hooking up with anyone, so he's got plenty of ambition. The chief tells him to leave.

The teenager's mom refuses to speak with Alex about her son's surgery. April tells Cristina their patient's situation is urgent and Cristina continues to say she doesn't know. Cristina starts to hear nothing, and hands the paper back to April. Cristina doesn't seem to care, and April doesn't get it.

At lunch, everyone makes fun of Sloan for his flop with the chief. Alex walks by and says the boy's mom won't talk to him. Callie continues to play mind games, handing Arizona a packet of tissues "just in case" she cries when talking to the chief.

In the lab, Meredith realizes Avery was playing her when they compete in the egg carving contest. Meredith is proud when she carves her initials into the egg shell without breaking it, but Avery carved his whole name into it, and wins. Derek tells Meredith she was over-confident.

Arizona talks with the chief about using the money in pediatrics. He admits he thought she was going to cry. She starts to stammer and says the crying thing is behind her. He says nothing while she continues talking, eventually going into a mild rage. But she doesn't cry.

Hunt tries to talk to Cristina, and attempts to make her laugh by saying they should go outside so she can kick his ass. It works a bit. He tells her they'll go home together at the end of the day, good or bad.

Alex confronts the teenager's mom, saying her kid doesn't need to be subjected to the the psychological crap that comes with having breasts in high school.

Lexie's knee surgery patient says she has a headache and now can't see. Lexie says she doesn't know yet what's going on, but she's going to be page for a neuro consult. Lexie leaves the room looking a bit concerned.

In surgery, Derek tells Avery that as soon as he cuts into the woman's skull, he's on his own. Meredith watches, but when Lexie's pages come though Derek tells Meredith to go do the consult.

April is worried that she's not good at cardio and will humiliate everyone when she gives her recommendation on Mr. Henley's lung transplant. Cristina finally says that Teddy could have convened a panel the previous day if she thought he was a candidate for a transplant, so she clearly doesn't. April is happy, until Cristina says, "Everyone will be fine except for Roy ... who will be dead."

Meredith shows up for Lexie and realizes that the patient got a brain bleed. She assures Lexie that she did everything right, but the only thing she's doing wrong now is standing around talking about it when they should be getting the patient into an O.R. They both realize Meredith is sounding like a real attending.

Back in surgery, Avery messes up and the woman's head starts bleeding.

Callie talks to the chief about why the future of ortho is in xenografting. He says he was hoping for something more "inspirational." He starts to talk about Arizona's idea, and Callie blows it off, saying Arizona's nicer than her and is even a better lesbian than her. The chief leaves.

Cristina works on Mr. Henley, who asks if she's "one of those, what do you call 'em, when someone's really smart, like a genius, but they're a little different. Like, they don't know how to talk to people?"

"Are you asking me if I'm autistic?" Cristina replies.

"That's the word," Mr. Henley says. She lays him back down and says nothing. He tells her she's "a tough nut to crack" and reminds him of her daughter, who is not coming to see him. He says he went through a messy divorce and his daughter sided with her mom.

"I hate it, but I get it," he says. "Life goes on. So it's just and me, sourpuss."

April hears most of this and comes in to tell Cristina the panel is gathering. Mr. Henley coughs and looks Cristina in the eye and asks if the panel is going to go his way.

"They don't just send people home to die," he says. "I want to live."

Derek, frustrated with Avery's mistake, tells Meredith over a walkie-talkie that she's going to have to do the brain bleed surgery herself because he can't leave. She cuts.

Alex prepares to do the breast reduction as Sloan and Arizona watch. In another room, Lexie is in awe of Meredith's mad skills. Alex seems to have completed the surgery well as Arizona nods while she watches. Mr. Henley sits alone in his room. Derek makes it into Meredith's room and she tells him she's got it after Lexie made a good call. He looks at her work and says, "Yes, you do."

Derek talks to the chief about working on a clinical surgical trial to cure Alzheimer's. He tells the chief about how he just watched Meredith do a great job in solo surgery, and he's worried that she might have Alzheimer's like her mother did. He says he worries about it every time she can't find her keys or forgets simple things. He says that when he's done with the million dollars, "investors are going to throw money my way for the same reason I am going to throw everything I've got at this trial -- because their dad has it, or their wife.

"Breakthroughs don't happen because of the medicine," he says. "Real breakthroughs happen because someone is scared to death to stop trying."

Alex tells his patient he doesn't have boobs, as his mother cries.

April speaks at Mr. Henley's transplant panel. She gets a bit nervous when the chief walks in. Cristina is watching from the back of the room. April starts listing the reasons why he is not a good candidate for a transplant. The chief asks why she convened the panel if she didn't think he was a candidate. She stumbles and he presses her more.

April goes on to say the man has no support system and Cristina mutters, "That's not a reason." Teddy turns and asks if she doesn't think having a support system is an important factor and Cristina says, "It's one factor."

Cristina starts to talk about Mr. Henley, saying he's "borderline." She says he has the will to fight, and that if he gets the lungs, it won't be a waste because he will live.

"I know it," she says.

Avery is nervous about telling his patient he messed up. Derek says it doesn't matter. Their job now is to smile and say the surgery went well, which it did.

April asks Cristina why she turned on her in the panel, and Cristina says she didn't know what else to say. Cristina then apologizes to Teddy because she disagreed with her decision. Teddy says the right decision is simply making a decision and standing behind it, which Cristina did. And the panel agreed to put Mr. Henley on the list.

Bailey gives the chief a list of big equipment that is broken, which upsets him. He says the goal was to inspire big ideas. Bailey says she could do a big tap dance about how she's "going to change the face of medicine with a million dollars, but you can't do anything with $1 million."

She says she's being realistic. "We need to fix the medicine we already have," she tells him. She then adds that it's a silly exercise because doesn't even have $1 million.

He says things might be a little different around here in the next few weeks.

The chief congratulates Hunt and everyone looks at him with a little bit of skepticism, especially Derek.

Meredith has trouble finding her keys when she and Derek get home -- they're in her hand. He smiles for a second, then looks troubled.

Music
This episode's title originated from the song , originally sung by  Chuck Berry.
 * "On The Sly" - The Bamboos
 * "You Always Make Me Smile" - Kyle Andrews
 * "Look Alive" - Wait.Think.Fast.
 * "Head On Your Heart" - Mat Kearney

Quotes

 * 3 quotes from the episode.

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 Ramirez as Dr. Calliope 'Callie' Torres
 * Eric Dane as Dr. Mark Sloan
 * Chyler Leigh as Dr. Alexandra 'Lexie' Grey
 * Kevin McKidd as Dr. Owen Hunt
 * Jessica Capshaw as Dr. Arizona Robbins
 * Kim Raver as Dr. Teddy Altman
 * Sarah Drew as Dr. April Kepner
 * Jesse Williams as Dr. Jackson Avery
 * Patrick Dempsey as Dr. Derek Shepherd

Guest stars

 * Ron Perkins as Roy
 * Candice Patton as Meg Waylon
 * Randee Heller as Joanne
 * Deborah Strang as Ellie Ratigan
 * Charlie Koznick as Trey
 * Susan Slome as Mindy Gruberman
 * Jarrod Bailey as Seth Gruberman