Piece of My Heart

"Great surgeons aren't made, they're born. It takes gestation, incubation, sacrifice. A lot of sacrifice. But after all the blood and guts and gooey stuff is washed away that surgeon you've become - totally worth it. Giving birth may be all intense and magical and stuff, but the act itself is not exactly pleasant. But it's also a beginning of something incredible, something new, something unpredictable, something true, something worth loving, something worth missing, something that will change your life forever."

- Meredith Grey

Piece of My Heart is the thirteenth episode of the fourth season and the 74th overall episode of Grey's Anatomy.

Short Summary
Addison returns to Seattle Grace for a surgery and discovers a lot has changed since she departed for her new life in L.A. Derek and Meredith's clinic trial has an uneasy start and Callie becomes defensive when Addison suggests there may be more than friendship between her and Erica.

Full Summary


Addison Forbes Montgomery returns to Seattle Grace and is greeted by Bailey and then Webber but she insists that she is not back.

Addison greets Alex outside an elevator and he tells her he'll be a resident on the case but he lets her leave when he sees Ava who quickly blurts out that she is pregnant. He brusquely asks her if she is keeping it or getting an abortion, and leaves to attend to the ectopia cordis baby. Meanwhile, the baby’s father is extremely optimistic and reassures his wife that the baby is protected by their love. This gets on Alex’s nerves, causing him to tell the father off for not preparing for any contingencies. The father tells him that he is not stupid, but that it is also good to always have hope.

Erica continues to be extremely hard on Cristina. Callie advises Cristina to tell Erica how she feels. But after a failed attempt to ‘talk girl’ with the other residents, Cristina threatens Callie with eviction unless Callie gets her in on Erica’s ectopia cordis surgery.

Izzie bumps into Rebecca at the clinic, and takes a blood sample for testing. Alex later tells Rebecca that he is not good father material and she does not want him for a situation like this. However when the baby’s surgery is a success, Alex reconsiders his relationship with Rebecca.

After the surgery, Addison realizes that Bailey seems sad even though it was a success. Bailey confesses that her husband has moved out and she wishes that Addison would go back to Los Angeles so that the opportunity to talk about her problems would go away, and she will not have to fall apart. The Chief tries to get Addison back to Seattle Grace, but she tells him that she only returned to see if it was right to leave.

Meredith and Derek admit Philip, the brain tumor patient that was mauled by a bear, into their clinical trial. Derek warns Meredith not to get too emotionally attached to the case. Philip’s brain tumor has caused to him to act aggressively and erratically, including finding a new husband for his wife, Jennifer. Meredith reassures Jennifer that it is just the tumor talking. The doctors plan to inject a live virus into the tumor to reduce it from within, but this procedure is still untested on humans. After Philip suddenly loses his sight, Derek decides to move up his surgery.

Philip confesses to Derek that the only reason he keeps trying to propose to Jennifer relationships up with other men is because he wants her to be stable and opportunistic after his impending death. Derek gets Philip to tell what he told him to Jennifer before he goes into surgery. Despite their best efforts, Philip dies on the table. Both Meredith and Derek confess to each other that they got their hopes up, and agreed that it was a pleasure working together.

Meanwhile, Izzie has been hiding in the free clinic and is struggling to keep her rebelling interns under her control. It turns out George is very popular among the interns, and Izzie feels jealous and left out. When she finds out that George is going to a dart tournament at Joe’s with the other interns, George is forced to invite her along. Lexie informs George that the other interns will drop out of the tournament if Izzie comes, because no one wants to get drunk with their boss.

Izzie meets a couple, who come in for a pregnancy test. The test results confirm the pregnancy, but the woman is insistent on getting an abortion immediately because she is HIV positive and does not want to pass the virus to her baby. Izzie tries to get Addison to talk to the couple, but Addison uses her new "Zen" outlook on life to convince Izzie to tell the couple herself. Izzie tells the couple that they still have a chance at procuring a healthy child, which pleases the husband. However, his wife is furious and becomes disgruntled that Izzie did not schedule the abortion as requested. The wife demands to be seen by another less intrusive doctor.

George tells Izzie that she cannot play darts with the other interns because she is seen as an authority figure. This causes Izzie to realize that she has been shirking her responsibilities. Firmly gathering her interns, she goes back to the couple and apologizes for being ineffectual and unclear. She informs them that there is a 98% chance that their baby would be born healthy if the proper medication and care are taken. This causes the mother to reconsider her earlier decision.

Addison is shocked to learn that Meredith and Derek have broken up, and that Callie is now divorced. When she notices how close Callie and Erica are, she asks Callie if she is involved in a relationship with Erica. This gets Callie very flustered. Later at Joe’s, Addison, Callie and Erica are having drinks together. Addison and Erica dismiss Mark’s attempts to get them to dance, but Callie decides to dance with him. Cristina approaches Erica and asks why she is so harsh on her. Erica tells her that she has talent and there is no need to constantly seek her approval. After Cristina leaves, Erica confesses that Cristina reminds her of herself. Meanwhile, Mark and Callie leave together as Erica watches on with a twinge of wistfulness. Before Addison leaves for Los Angeles, she vents her frustration to Meredith about Meredith and Derek's breakup and says she almost wants to kick Meredith, despite her new "Zen" outlook because she is letting Derek's soupy doe-eyed nurse rebound girl have the happy ending Meredith and Derek deserve.

Back at the hospital, Izzie receives Rebecca's test results and discovers that Rebecca is not pregnant; however, it seems as if Alex has decided that having the baby would be for the best and is seen caressing Rebecca's stomach.

Main Cast

 * Ellen Pompeo as Dr. Meredith Grey
 * Sandra Oh as Dr. Cristina Yang
 * Katherine Heigl as Dr. Izzie Stevens
 * Justin Chambers as Dr. Alex Karev
 * T.R. Knight as Dr. George O'Malley
 * 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
 * Brooke Smith as Dr. Erica Hahn
 * Patrick Dempsey as Dr. Derek Shepherd

Special Guest Star

 * Kate Walsh as Dr. Addison Montgomery

Guest Stars

 * Amy Madigan as Dr. Katharine Wyatt
 * Elizabeth Reaser as Rebecca Pope
 * Clea DuVall as Jennifer Robinson
 * Lauren Stamile as Nurse Rose
 * Kathleen Rose Perkins as Sarah
 * Ken Barnett as Freddie
 * Jason O'Mara as Phillip Robinson

Co-Starring

 * Sam Daly as Will
 * Meg Cionni as Nikki
 * John O'Brien as Lab Tech
 * Gloria Garayua as Intern Graziella
 * Tymberlee Chanel as Intern Claire
 * Winston Story as Intern Leo
 * Joy Osmanski as Intern Lucy
 * Molly Kidder as Intern Megan
 * Richard Keith as Intern Mitch

Medical Notes

 * Ectopia Cordis: when the heart is located abnormally - which can be outside of the body or in the abdomen. It's prevalence is estimated to be 7.9 per million live births, however this is usually a fatal problem (and usually has other associated abnormalities) and most do not survive past the newborn stage.
 * The patient Addison was called in to see had her child with the heart growing externally from the body. The surgical team also suspected a diaphragmatic hernia (organs in the chest cavity), which would not have been uncommon in these cases. Addison claims she worked on one of these cases 10 years ago - the baby squeezed its own heart in utero (in the uterus) and died.
 * Addison delivers the baby by casarean section, with the baby then being transferred to Erica, where she works to push the heart back into the thorax and it goes almost all the way in with no evidence of a hernia to complicate matters. Mark has already grown a flap of the baby's skin for closure, and does a one-stage closure to prevent any infection.

Notes and Trivia

 * This episode's title originated from the song Piece Of My Heart, originally sung by Erma Franklin.
 * This episode scored 15.31 million viewers.
 * This is Addison's first appearance since the season three finale Didn't We Almost Have It All? and her first return to Seattle Grace since she resigned in the Private Practice episode In Which We Meet Addison, a Nice Girl From Somewhere Else. It is believed a guest appearance was scheduled for Kate Walsh due to the fact that no more episodes of Private Practice's first season were made after the Writer's Guild Strike.

Quotes

 * Callie: Did anyone ever think you two were a couple?
 * Meredith: No because we screw boys like whores on tequila.
 * Cristina: And then we either try to marry them or drown ourselves.


 * (Derek is riding in the elevator with Meredith, Addison and Rose.)
 * Mark: (to Derek) Bet you're wishing you took the stairs right about now...


 * Meredith: Hey, you're leaving already?
 * Addison: I have a plane to catch... I walk on the beach now, I buy Aromatherapy candles, I'm very zen, but I want to kick your ass so badly right now it is killing me.
 * Meredith: Excuse me?
 * Addison: I'm talking about Derek. Derek Christopher Shepherd. Are you letting him get away? Because I swear to God Meredith, if you let him ride off into the sunset with that doe-eyed little thing...


 * Addison: Hey, look, I hugged you there! Did you see how I hugged you? You stole my husband from me and I hugged you! I've grown, I have, and I can be happy for the happy couple!


 * Addison: So, who's the new mystery woman that Derek's dating? Who is the unlucky McRebound? (laughs, while nobody answers) What? Is the whole Mc-thing over now? I'm sure thing haven't changed that much around here.
 * Miranda: Addison, the woman standing immediately to your right, the one handing you the surgical instruments.
 * Rose: Hey.
 * Addison: Hey!
 * Rose: Six dates, heavy petting, lots of tongue. Good guy.