The Heart of the Matter

"In life only one thing is certain, apart from death and taxes: No matter how hard you try, no matter how good your intentions, you are going to make mistakes. You are going to hurt people. You are going to get hurt. And if you ever want to recover, there's really only one thing you can say. Forgive and forget. That's what they say. It's good advice, but it's not very practical. When someone hurts us, we want to hurt them back. When someone wrongs us, we want to be right. Without forgiveness old scores are never settled. Old wounds never heal, and the most we can hope for is that one day we'll be lucky enough to forget."

- Meredith Grey

 is the fourth episode of the fourth season and the 65th overall episode of Grey's Anatomy.

Short Summary
Meredith and her intern lose a patient after they give her the wrong diagnosis, Callie confronts Izzie, and McDreamy bonds with the other Grey.

Full Summary
Adele is back. And not for personal reasons. The Chief's wife rushes their niece, Camille, to Seattle Grace, the hospital where she had her prom. She can't breathe and Izzie and Alex perform an emergency tracheotomy to keep her alive. It turns out Camille's cancer has spread all over, to her throat and beyond, and she doesn't want to continue fighting. She's too tired and wants to spend her last days at home with her friends.

Adele wants Richard to do everything he can to save Camille's life, but in the end, Richard gives her the options of treatment, but decides to honor his niece's wishes and discharge her. Adele says this is the one time she asked Richard to put his job first, and he didn't, not even to save his niece - the closest thing they have to their own daughter. It doesn't look good for the future prospects of Richard's marriage.

Miranda has a patient named Ruthie whose ankle is swollen and blue from a bad fall on the treadmill. Ruthie is osteoporotic, despite being only 28, because she's been working out while starving herself in order to lose 40 pounds. Callie tells Ruthie and her boyfriend that she can repair her leg, but she's going to be in a cast for a very long time.

They begin to argue when Ruthie starts to vomit up blood. The doctors then operate and find a bleeding ulcer. All the ibuprofen she's been taking to relieve her aches from working out too much made it much worse. Callie can't believe someone would willingly ruin their body, but Bailey says people are stupid and only want to be loved - that's they only reason why they do anything. Callie - who's had a brutal day (more on that in a few moments) - almost fights the boyfriend outside. Bailey intervenes.

After George's confession to Callie, she simply says she forgives him. He made a mistake, but they took vows, so she forgives him. It's over.

Hearing this, George frantically looks for Izzie, but Callie has found her first. She tells Izzie, “Cafeteria. Noon. You, me. Be there.” This makes Izzie fear she's going to get beaten up and all the other doctors excited there's going to be a fight. The only one not excited is, who after hearing she slept with George, is furious at Izzie. Maybe he still has feelings for her? Maybe he just can't believe he got rejected and George didn't?

In any case, everyone gathers around Izzie as she prepares for Callie to fight her in the lunchroom. Noon arrives, Callie finally approaches, and Izzie puts up her dukes. But Callie just wanted to talk, and is now much more humiliated by this debacle. Later, Izzie tries to apologize and Dr. Torres loses it, telling her “Don't you dare come to me for forgiveness, you traitorous bitch.” Yikes.

Izzie goes home and spends the night crying in bed. Alex, though, who is now living at the house remember, comes in with a box of tissues, and not so seriously tells her to keep it down. George finds Callie in the rain outside the hospital. He doesn't want her to just say that she forgives when she's angry. Callie breaks down and admits he's right - she furious and she doesn't forgive him.

Derek wants to take Meredith away to wine country for 48 hours of hot sex. She is so in, but has to get Alex to cover her shift and thus take Norman, the world's oldest intern, off his hands in the meantime. Problems happen immediately when Norman informs one of Mark's patients, Ms. Bitzer, that she's terminally ill and going to die. Only she isn't. He read the wrong chart.

Cristina, meanwhile, treats a high school football player who was paralyzed in a game. The boy's father is a crazy and pretty much berates his son for getting hurt. Derek drills holes into his head and stretches his body out so that the spinal cord can fit back in. Lexie, or simply 3 in Cristina's eyes, tries to assist, but Yang sternly corrects her every move.

Later, after some urging from Derek, Cristina becomes a better teacher to 3, helping her out in the boy's second operation. Derek and Lexie have now started to get to know each other, bonding over their common ground - Mer - which she's less than thrilled about. She gets mad at him for getting to know Lexie, but Derek says he talks to Lexie about things he can't talk to Meredith about. He also has canceled their weekend.

What things? How about how he wants to marry Meredith, have kids with her, settle down and grow old with her. As usual, Mer freezes up, but Derek, he says he understands why she can't or won't talk about it. He says that he knows she's not ready. He says he will wait for her, but ... even though he's waiting, if there's someone else who gives him what he wants before Meredith is ready, there are no guarantees.

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
 * Patrick Dempsey as Dr. Derek Shepherd

Guest Stars

 * Edward Herrmann as Dr. Norman Shales
 * Michael McGrady as Stanley Singer
 * Matt Lanter as Adam Singer
 * Maggie Siff as Ruthie Sales
 * Miriam Flynn as Gretchen Bitzer
 * Camille Winbush as Camille Travis
 * Ron Melendez as Will
 * Loretta Devine as Adele Webber

Co-Starring

 * Shelley Robertson as Arlene
 * Jeremy Rabb as ER Resident
 * Maile Flanagan as Lab Tech
 * Tymberlee Chanel as Intern Claire
 * Gloria Garayua as Intern Graziella
 * Richard Keith as Intern Mitch
 * Molly Kidder as Intern Megan
 * Joy Osmanski as Intern Lucy
 * Mark Saul as Intern Steve
 * Winston Story as Intern Leo
 * Cassandra Braden as Housekeeping Staffer
 * Nicole Cummins-Rubio as Paramedic

Quotes

 * Meredith: So, I got Alex to cover for me so I can leave right after I round on my patients... 48 uninterrupted hours!
 * Derek: Yeah, yeah, yeah... um... you know, maybe this is not a good weekend.
 * Meredith: What did Lexie say about me?
 * Derek: She didn't say anything. I did all the talking. Oh, don't blame her.
 * Meredith: So what, you're friends with my sister now? I mean, you talked to the other Grey about me?
 * Derek: You know what I talked about with the other Grey? All the things this Grey won't let me say.
 * Meredith: You can say anything to me.
 * Derek: I want to marry you. I want to have kids with you. I want to build us a house. I want to settle down and grow old with you. I want to die when I'm 110 years old, in your arms. I don't want 48 uninterrupted hours. I want a lifetime.
 * (Meredith steps back a little)
 * Derek: Mm. See what happens? I say things like that, and you fight the urge to run in the opposite direction. It's ok. I understand. I didn't, but now I do. I do. You're just getting started and I've been doing this for a long time. Deep down, you're still an intern, and you're not ready.
 * Meredith: I'm not ready right now. But things can stay the way they are, and I can get ready. I'll get ready.
 * Derek: Things can stay the way they are. We can still meet in the elevator, the on-call room, and maybe you'll get ready. And I'll wait. I'll wait until you're ready.
 * Meredith: Ok, then...
 * Derek: Yeah, but what if, what if while I'm waiting, I meet someone who is ready to give me what I want from you?
 * Meredith: What if you do?
 * Derek: I don't know...