Before and After

"Every patient’s story starts the same way. It starts with them being fine, it starts in the before. They cling to this moment, this memory of being fine, this before, as though talking about it may somehow bring it back. But what they don’t realise is that they’re talking about it to us, their doctors and that means there’s no going back. By the time they see us, they’re already in the after. And while every patient’s story starts the same way, how the story ends depends on us, on how well we diagnose and treat. We know the story hinges on us and we all want to be the hero."

- Meredith Grey

 is the fifteenth episode of the fifth season and the 93rd overall episode of Grey's Anatomy.

Short Summary
Addison needs Derek to operate on Archer, but after consultation, Derek cannot do it. Following a push from Sam, Derek changes his mind, even going as far as calling Archer a coward to let him do it. Cristina finds out Owen was previously engaged, and finds out more about Owen's past. Izzie arranges a game for the interns, in an attempt to remind them how much they enjoy medicine. thumb|300px|right

Full Summary
We opened on Addison bringing her brother to Seattle Grace Hospital, with her friend Naomi in town. Meanwhile, Izzie was working on some kind of glitter-based craft project to remind her interns about why they wanted to become doctors. She had trouble finding the scissors, which were on the table in front of her. Addison started second-guessing the way Derek wanted to treat her brother, but Derek was right. Addison's brother went into arrest and Derek pounded on his chest to revive him.

An intern asked the chief about a patient "with worms in his brain." None of the interns knew the medical term for "worms in the brain." Meanwhile, Izzie excitedly handed out her envelopes to her interns to play their first game of the day. The chief told Meredith about Addison being in the hospital because her brother had parasites in his brain. "Addison's brother has neurocysticercosis?" she asked.

"See," the chief shouted to the interns. "That's what I'm talkin' about!"

Derek said Addison's brother hated him and picked sides in the marriage. Then it was revealed that Archer and Naomi were dating. Derek and Naomi wondered what happened to their lives after they'd all been so in love. She reminded Derek that he wrote Addison a song. He told her to forget about the song.

Jen and Rob, the pregnant woman (played by Jennifer Westfeldt) and her husband who she accidentally ran over with the car, were still in the hospital. Jen kept Rob awake all night, worried her aneurysm was going to explode. Alex came in and told Jen that Derek got pulled on to another case and her aneurysm might have to wait.

Cristina and the chief saw a new patient, an older man (played by Sam Anderson, who plays Bernard on "Lost") who'd randomly passed out. He had a hernia, but that didn't seem to be the source. His daughter was there with him. When she walked out of the room, he spilled to the doctors that he had colorectal cancer and has had three polyps removed recently. He didn't want to tell his daughter. Dr. Hunt walked in and knew the man's medical history.

"You waited until she left to come in and say hello," the man said. "It's just like you to face things like a man."

The older told Hunt he lost any right to say anything about his daughter after he broke off their engagement in a two-line e-mail. Cristina looked stunned.

Naomi, Addison and Archer were singing Derek's love song while Meredith was in the room. Things were light until Derek came in and said surgery was not an option. He said he couldn't navigate through the mess in Archer's brain without rupturing a cyst in his ventricle. Archer realized that meant he was going to die.

Izzie ran her interns through their first test, draping dummy patients for the surgery noted in their envelopes. Sadie looked confused and draped her dummy incorrectly.

Derek told Addison "there's just no way." Addison started telling Derek she'd put him in a tiny box, and now she had to let him out so he could save her brother. "I need you to be a god," she said. "Just today. Be a god."

Sam, Naomi's ex-husband, showed up. "Even I don't know why I'm here," he told Bailey. (Ratings, man!). Bailey pointed him to the right place to see Archer.

Cristina and Meredith talked about what they didn't know about each other's boyfriends -- Derek used to play guitar and sing, and Hunt used to be engaged.

Lexie told Sloan she wasn't going to do dirty public flirting with him unless he agreed to go public with their relationship. She had to ask Sloan for his "symptoms" as part of Izzie's big challenge. He told eventually her what he was supposed to say and she guessed his symptoms correctly, just as Sadie walked up. George gave Sadie a new set of symptoms because she'd overheard Lexie's answer.

Hunt wanted Cristina to ask her questions about the engagement thing. An intern came and asked Cristina for her symptoms (for Izzie's thing) and she told him. Then she moved on. That's when Owen's ex-fiancee saw him. She didn't even know he was back from Iraq. She told him she'd prayed for him every night and hugged him. She said she'd spoken with his mother and she didn't mention he was back. Hunt let her go and walked away without say anything.

Addison was in the chapel and Naomi, Sam, the chief, Bailey and Callie were wondering what she was doing. She was trying to pray, but she didn't know how. She said she could use some help, but she had no clout with God. Callie got on her knees and prayed to God for guidance about having kissed Arizona, who's perky but hot.

Sam found Derek and said he was in a midlife crisis. Sam said he met Meredith and Derek said "she's not a midlife crisis -- she's the real thing." Sam told Derek that Addison was praying and Derek said she's waiting for a miracle. He said the surgery was way too complicated because Archer had eight cysts in his brain. Sam suggested he break it down and explain how he would remove one of them at a time.

The interns were practicing on Jen and Rob, who needed a distraction. Jen asked what the prize was for the interns and Izzie realized she needed to figure out a prize. Sadie, meanwhile, was missing Jen's baby's heartbeat but Alex told her she had the ultrasound wand in the wrong place.

Hunt tried to tell Cristina he's "not as much of an ass as you think I am." She asked him if his mother knew he was back.

Derek started explaining to Archer how he was going to precisely remove the cysts from his brain and Archer said it was impossible. Derek called him a coward. He said he was a "coward, by trade," because Archer is a neurologist and they just hand off their patients to neurosurgeons who assume the real responsibility. Derek said he could bear the responsibility. "The question is, can you?"

As doctors gathered in the gallery to watch Archer's surgery, Sam noticed Bailey filling out a pediatrics surgery fellowship application. He said she didn't seem like a peds surgeon because she doesn't smile. She said she does. Sloan noticed, too, and seemed surprised. Bailey saw Sam take a puff from an inhaler because he has asthma. She asked another doctor to refill the inhaler for Sam.

Derek started the surgery, making Addison smile when he said his signature starting line, "It's a beautiful day to save lives."

Hunt was telling his ex-fiancee's father that he should tell his daughter about his cancer. He refused, then started coughing up blood. His daughter saw this and asked what happened. Hunt said it was "a complication" and said he was going to need surgery. "A complication from what?" she asked. Hunt said he would be OK.

In surgery, Derek deflated a cyst, removed it and dropped it into a petrie dish, where a work wriggled out of it. "One at a time," Derek said to himself.

Jen (of Jen and Rob) was starting to panic about not getting her surgery, so Alex set her up with a clear ultrasound look at her unborn child and told her to use that to hang on.

Cristina told Hunt that his ex needed to know about her father's cancer. They couldn't protect until it was over.

In surgery, Derek had seven of the eight worms out of Archer's brain, but wouldn't ya know it -- the eighth one broke loose inside the brain and Derek has just a couple of minutes to find it. He needed two minutes, maybe three.

The clocked flashed 2:22 and Derek caught the eighth worm and scooped it out.

Izzie asked the chief for a prize for the winning intern and he waited until the interns raced to the finish line. Lexie won and the chief said she could scrub in on Derek's craniotomy and "hold the Doomsday Sucker." While setting up the "finish line" with a roll of Scotch tape, Izzie missed the roll when Alex tried to hand it to her (that's probably going to be important).

Hunt's ex said he didn't look like himself. He looked "hard." She said she deserved more than two lines in an e-mail. Hunt told her about her dad. He said her dad was trying to spare her "any more pain."

Meredith lamented the fact that Derek seemed like he was a totally different person. Cristina said she felt like she didn't know Hunt. "We don't," she said.

George offered to help Sadie after noticing she was having trouble. She said she didn't need a tutor. He told her she needs to know how to diagnose patients during surgery. "Can you do that?" he asked. "Because they think you can, and they'll put you in situations where you have to." She walked away as George shouted, "Sadie, you could hurt someone."

Hunt confessed to Cristina that he calls his mother every week and says he's still in Iraq. He said his mom would look at him like he's not there -- the same way Beth looked at him. He said the only time he doesn't feel like a ghost is when Cristina "sees him." He said she's the only person who sees him.

Derek apologized to Jen for delaying her surgery. He wanted to do it the next morning but she begged him not to make her wait another night.

Addison introduced herself to "Little Grey" while she was talking to Sloan. Derek said he was going to do the craniotomy that night and told Lexie to meet him in the O.R. in preparation for holding the Doomsday Sucker. Addison started to talk about "Little Grey" and Sloan quickly changed the subject, mentioning that Derek was going to propose to Meredith.

Alex asked Izzie what was wrong. She said she was fine.

Sadie was talking to the chief and George told Meredith what it was about. Sadie quit and told Meredith she thought she'd pull her through. Meredith said they weren't 25, "sleeping our way through Europe every night." Sadie said this wasn't the Meredith she knew. Meredith said she was the same person, but this was where she wanted to be.

In surgery, Derek asked Lexie if the sucker was at the ready. She realized he was mocking her. "Only a little bit," he said. There was a mild complication and Lexie really did have to use the Doomsday Sucker, and it worked. Derek said he'd never mock an eager young intern again.

At Joe's bar, Sloan told Addison he was "an ass" for blurting the thing about Derek proposing to Meredith. "A little warning would have been nice," she said. She said she expected to feel something, but seeing her brother on the operating table changed her perspective. Derek arrived at Joe's and the old group of friends gave him a hard time about the song he wrote, singing it even through a bit of awkward silence where Addison looked at Derek, who looked at Sloan, who gave him a reassuring nod.

Cut to the hospital and Jen was in bed gasping for air. Alex called to someone to page Derek.

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
 * Kevin McKidd as Dr. Owen Hunt
 * Patrick Dempsey as Dr. Derek Shepherd

Special Guest Stars

 * Kate Walsh as Dr. Addison Montgomery
 * Audra McDonald as Dr. Naomi Bennett
 * Taye Diggs as Dr. Sam Bennett

Guest Stars

 * Grant Show as Dr. Archer Forbes Montgomery
 * Jennifer Westfeldt as Jen Harmon
 * Ben Shenkman as Rob Harmon
 * Laura Allen as Beth Whitman
 * Sam Anderson as Michael Whitman
 * Steven W. Bailey as Joe
 * Brandon Scott as Dr. Ryan Spalding
 * Melissa George as Dr. Sadie Harris

Credited

 * Mark Saul as Intern Steve
 * Gloria Garayua as Intern Graciella
 * Candice Afia as Intern Laura
 * Amrapali Ambegaokar as Intern Dani
 * Tymberlee Chanel as Intern Claire
 * Molly Kidder as Intern Megan
 * Winston Story as Intern Leo
 * Joseph Williamson as Intern Pierce
 * Kate Anthony as Nurse Kate

Notes and Trivia

 * This episode's title originated from the song Before & After, originally sung by Rush.
 * This episode scored 15.70 million viewers.
 * This is the second part of the Grey's Anatomy-Private Practice crossover.

Quotes

 * Callie: (to Addison) You're an amazing doctor, you save babies. God knows who you are.


 * Addison: (to Derek) I need you to be a God.


 * Richard: You get to scrub in on Shepherd's craniotomy and hold the doomsday sucker.
 * Lexie: Yes! What's the doomsday sucker?
 * Izzie: (to the Chief discretely) Doomsday sucker?
 * Richard: It's just a really bad sucker.