Change of Heart

"Over the past twenty years, one of the most valuable tools a doctor has is the algorithm. Your patient's main complaint goes into a box and then the formula helps you to decide what to do next. But what happens when the problem doesn't fit into a box? Well, you're suddenly on your own. Unexpectedly, with about a thousand paths to choose from. So what do you do? How do you decide when you're left in the dark? How do you make sure you're not making the worst mistake of someone's life? You close your eyes. You block out everyone and everything around you and you pray that the voice inside you is right. Because once you've decided, you can't ever go back."

- Meredith Grey

 is the 21st episode of the tenth season and the 217th overall episode of Grey's Anatomy.

Short Summary
Jackson is given the daunting task of delivering disappointing news to the doctors. Meanwhile, Derek's sister Amelia drops by for a surprise visit, Richard surprises Catherine in Boston and when Bailey gets frustrated by the slow pace of her research, she makes a risky decision.

Full Summary
At the airport of Boston, Meredith and Owen are sitting in their seat on the plane. Cristina's seat is empty. They're both on the phone. Meredith tells Derek Cristina was supposed to fly out with them and that she didn't show. Owen tells Meredith Cristina's phone is still off. Meredith tells Derek that Cristina only said that that's how it goes after the award ceremony. And that the winner's speech was a 20 minute ode to himself. The flight attendant tells Meredith they're shutting the doors, but Owen says it'll only take a minute. Meredith keeps on dishing the winner's research and the flight attendant tells her she has to put her phone away. "I heard you," Meredith says and she tells Derek she'll call him later.

At the dreamhouse, Derek tells his kids that their mother hung up on them. He asks Zola to put her shoes on. Suddenly, someone knocks on the door. Derek opens and Amelia walks in. She knows she should've called, but she knows he would have said no if she would have. She can't believe how grown up Zola has gotten and she's delighted to see her nephew for the first time. "Hello to you too," Derek says. He hasn't spoken to her in two months. Amelia says a thing happened. James proposed to her. She shows him the ring and he reacts happily surprised. He congratulates her and she says she freaked. "I'm sure you did," he says. She clarifies she didn't leave-the-country-freaked, but she realized there's the possibility she may be facing a different kind of life, the kind that he and Meredith have. So she thought she'd come over and visit to see what it's like and get unfreaked. Hopefully. She thinks he's mad, but he is in fact happy. He tells his kids that auntie Amelia will play with them while he goes to work. He hands over Bailey to Amelia, who realizes he's really not mad. He tells her Bailey's feeding schedule is up on the refridgerator and that Zola likes to stick stuff up her nose, so she'll have to keep an eye on that. He smilingly tells her he'll see her later and leaves her with the kids.

In their bedroom, Callie and Arizona are planning the pregnancy. They want to do the insemination in May, so the baby will be born in February. April comes in to borrow some toothpaste. Callie plans to take off the spring with a recover nurse and then Arizona can take off the summer. Arizona agrees, saying that that works if she puts Alex in charge of peds. April comes out of their bathroom and asks if they're sure about that, because then Alex will be in charge of the new interns. She proposes to postpone the insemination, but Callie tells her to get out of her vagina. "Right," April says and she leaves. Callie says these two nights with April feel like 10.

Alex and Jo are naked and kissing. She says there are pre-rounds to get to, but he ignores this. They kiss, but she knows he has to work too and realizes he's avoiding something. He got a really good offer from Lebackes to work at his private practice. She thinks it's great, so she questions why he doesn't look like it's great. He's supposed to give them an answer by the end of the day and he doesn't know how to tell Robbins, who'll be pissed. Jo tells him to be pleasant, confident, and firm. He has to smile and tell her how excited he is about this great, new opportunity. If she starts making her scary, angry face, he has to distract her with a compliment. She gets out of bed with the blanket wrapped around her body and he asks if the compliment thing works. She nods and he replies she looks sexy. She drops the blanket and says it's doesn't work on her as she disappears into the bathroom with a cheeky smile. He follows her.

Shane is presenting Francesca McNeil's case. She's had an LVAD, but there's no damage repair. Luckily, Jeff Russell informs them that a donor heart has become available. Jon doesn't remember who Jeff is again, and Arizona explains he's the head of cardiothoracic surgery and that he'll be performing the transplant since Dr. Yang is not back yet. Jon questions how they can know if Jeff is as good as Yang. Russell replies he's an attending while she's a fellow, so he is as good. Alex comes in and assures the parents that he and Arizona will be in the OR all the time, so she's in good hands. Sabine asks about Link, who's lying in the same room. Leah just finished her exam and tells them that his heart pump is working good. Ivy is having a video conversation with Link and says it's good that he's getting better. Link asks the doctors when Ivy can come back into their room. Arizona watches Ivy, who's lying in the room next door, and explains that she's still sick so she'll need to stay in a seperate room for a little bit longer. Arizona tells the parents that Ivy is still in rejection and that she's still on the UNOS transplant list. She assures them they're watching Ivy very closely.

All doctors leave the room. Russell asks Arizona to page him when the heart is a go, and he leaves. Shane asks about Dr. Yang. Arizona hasn't heard anything from her. Shane asks if anyone has heard from her. Arizona dodges the question and simply tells him to make sure Franky is ready and prepped. He and Leah leave. Arizona asks Alex why he's hovering and what's wrong with his face, as he's smiling weirdly. He compliments her hair and she immediately knows he has something to tell her.

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
 * Camilla Luddington as Dr. Jo Wilson
 * Gaius Charles as Dr. Shane Ross
 * Jerrika Hinton as Dr. Stephanie Edwards
 * Tessa Ferrer as Dr. Leah Murphy
 * Patrick Dempsey as Dr. Derek Shepherd

Guest Stars

 * Debbie Allen as Dr. Catherine Avery
 * Caterina Scorsone as Dr. Amelia Shepherd
 * Dominic Hoffman as Dr. Jeff Russell
 * Mark Adair-Rios as David Morris
 * Rebecca Field as Sabine McNeil
 * Bresha Webb as Teresa Morris
 * Billy Malone as Jon McNeil

Co-Starring

 * Chad Addison as Sam Roane
 * Danny Nero as Anesthesiologist
 * Nadine Griffith as Circulating Nurse
 * JoAnna Rhambo as CCU Nurse
 * Lori Dean as OR Nurse
 * Angela Landis as Flight Attendant
 * Harley Graham as Francesca McNeil
 * Jadin Gould as Ivy McNeil
 * Thomas Barbusca as Link McNeil
 * Armani Jackson as Braden Morris

Francesca McNeil

 * Diagnosis:
 * End-stage heart failure


 * Doctors:
 * Arizona Robbins (pediatric surgeon)
 * Jeff Russell (cardiothoracic surgeon)
 * Cristina Yang (cardiothoracic surgeon)
 * Alex Karev (pediatric surgeon)
 * Shane Ross (surgical resident)
 * Leah Murphy (surgical resident)


 * Treatment:
 * Heart Transplant
 * Total artificial heart

Two days after her LVAD was inserted, Frankie's heart was still heavily damaged. However, a heart was available for transplant and was brought to GSM for Frankie. However, the heart was damaged during retrieval, so they weren't able to close her. Another heart became available, but while Alex and Arizona went to retrieve it, Frankie's sister, Ivy, declined, bumping her status up. Cristina made the decision to give the second heart to Ivy and attempt a total artificial heart on Frankie. That procedure failed and Frankie was pronounced dead in the OR.

Lincoln McNeil

 * Diagnosis:
 * End-stage heart failure


 * Doctors:
 * Arizona Robbins (pediatric surgeon)
 * Leah Murphy (surgical resident)


 * Treatment:
 * Drug-eluting heart pump

Link was doing well, with good breath sounds and his echo was clear. His heart pump was working exactly as it was meant to.

Ivy McNeil

 * Diagnosis:
 * Donor heart rejection
 * Global systolic dysfunction


 * Doctors:
 * Cristina Yang (cardiothoracic surgeon)
 * Arizona Robbins (pediatric surgeon)
 * Alex Karev (pediatric surgeon)
 * Jeff Russell (cardiothoracic surgeon)


 * Treatment:
 * Anti-rejection meds
 * Intubation
 * Etomidate
 * Heart Transplant

Ivy was still in full rejection. While her sister was in surgery to receive a heart transplant, Ivy declined rapidly. Her status was moved up. So when the replacement heart for Frankie was retrieved, it was redirected to Ivy. The transplant was performed successfully.

Braden Morris

 * Diagnosis:
 * Viral infection


 * Doctors:
 * Miranda Bailey (general surgeon)
 * Stephanie Edwards (surgical resident)


 * Treatment:

After receiving chemo to kill off the enzyme-deficient cells, Braden came down with a viral infection, causing his parents to question whether or not they should continue with the gene therapy treatment. After a conversation with Sabine McNeil, Teresa withdrew consent for the gene therapy.

Sam Roane

 * Diagnosis:
 * Blunt Trauma
 * Deformity to the right lower extremity
 * Compartment Syndrome


 * Doctors:
 * Callie Torres (orthopedic surgeon)
 * April Kepner (trauma surgeon)
 * Owen Hunt (trauma surgeon)
 * Jo Wilson (surgical resident)


 * Treatment:
 * Splinting
 * External fixation

Same Roane, 23, was attempting to walk across the country, ocean to ocean, when he was hit by a pickup truck. His leg was severely broken, severing his femoral artery. He was taken from the ER into surgery where an external fixator was placed while his other injuries were repaired.

Meredith and Derek's Patient

 * Diagnosis:
 * Spinal Schwannoma


 * Doctors:
 * Derek Shepherd (neurosurgeon)
 * Meredith Grey (general surgeon)


 * Treatment:

Derek and Meredith scrubbed in together to remove a spinal schwannoma.

Notes and Trivia

 * This episode's title originated from the song , originally sung by Cyndi Lauper.
 * According to the promo, this episode is the beginning of the farewell to Cristina Yang.
 * This episode scored 7.99 million viewers.
 * This episode marks the first time since Have You Seen Me Lately? that a character from Private Practice crosses over to Grey's Anatomy.

Quotes
JacksonCan we please just take a break from our hypothetical children?

April No we can't! Because Their not hypothetical anymore. Jackson I'm Pregnant.