The Face of Change

"Change is a funny thing and not everyone can handle it. It can sneak up on you. Things aren't what they used to be. Your whole world has transformed. You realize the ground beneath you has shifted. Things are uncertain and there's no turning back. The world around you is different now, unrecognizable, and there's nothing you can do about it. You're stuck. Your future is staring you in the face and you’re not sure you like what you see. Like I said, I'm not big into change."

- Alex Karev

The Face of Change is the fourteenth episode of the ninth season and the 186th overall episode of Grey's Anatomy.

Short Summary
Competition heats up as several of the doctors fight to become the new face of Seattle Grace; April brings in an emergency case, and Jackson and Alex work with a transgender teen couple. Meanwhile, the hospital implements new policies which test the patience of the staff.

Full Summary
Episode in detail.

Alex is posing for pictures and Cahill is lobbying for him as a possible "brand ambassador." Back at his house, he and Jo are both grossed out by Jackson and Stephanie making out on the couch. They also find themselves under Cristina's room and Hunt is visiting, which makes for more sex sounds. Alex and Jo start making wild wolf sounds to make their own noise.

The next day, Cristina gives Alex a hard time about Jo, saying they're one drink away from hooking up. Jo is also claiming she doesn't like Alex "like that" when the other interns give her a hard time. Alex denies it and turns it back on them, saying at least he isn't screwing his ex or "taking advantage of some intern on someone else's couch" (like Jackson). April walks in at this point. She wonders "what ever happened to good, old-fashioned romance." When no one responds  other than Meredith point out the fact that April's holding three burritos in her hand April leaves.

She's sitting outside in the ambulance with her new beau, whose EMT partner is eating her burrito outside in the cold. April complains that the night shift is boring with no incoming traumas. Now that the hospital's ER is closed, there's not much to do. Her guy gets an emergency call and invites her to come along.

A PR rep is shadowing Alex and taking pictures of him. Stephanie brings Alex to a new patient, Maya, a 13-week-old girl who was born with her intestines outside of her body. Alex says "today is the day" they're going to be able to close her up. The girl's mother hugs Alex and the PR rep starts snapping pictures. Alex is annoyed and says the next patients he's going to see are verbs sensitive. He opens the door and sees Jackson with a transgendered couple, and a photographer snapping pictures of the whole group. Jackson says it's part of "the whole brand ambassador thing," and seems to be embracing it much more than Alex.

Alex and Jackson argue about it a little and turn to the patients. Bryan and Jess talk about how they first met. Bryan was a girl and Jess was a boy. The doctors are removing Bryan's breasts. Jackson mentions that he'll be "taking the lead" on the surgery for the benefit of the PR folks. Stephanie and Jo are each supporting their guys in this thing.

Meredith is frustrated with the new electronic patient filing system, which keeps deleting her patients. Cahill brings a tour around and talks about how efficient the system is, and Meredith loudly and sarcastically says it would "be more efficient if it didn't keep deleting my patients." Callie overhears this and tells Derek, Webber, Hunt and Bailey about how Cahill told her to avoid mentioning her research, but more about her sports medicine. Bailey chimes in about how "maybe we'll be happy." She goes on to mention the benefits packages that might be available to those keeping their jobs. Callie says "we have to do something," to which Bailey responds, "You've done plenty." Derek suggest that "those of from the plane should keep our heads down for a while."

Alex is telling her PR rep about his African orphans program. Bryan's father is yelling at Jess in the hallway about Bryan's gender reassignment when Alex shows up. Bryan's father then shoves Alex against the wall and shouts, "Are you the one who wants to hack my little girl into pieces?"

Callie looks up Pegasus Horizons, the company that's looking to buy the hospital and owns apparently half the hospitals in the country  including Portland General, which was bought the year before. The website has no information about health care. Arizona tells Callie to cool her heels because "there's nothing we can do about it." Callie tells Webber that she isn't one to cool her heels and he suggests a road trip.

Bryan's father apologizes, saying he learned about the surgery the night before in an email. He had no idea about any of it. Alex tells the security guards they can leave. He sits down and talks to Bryan's father about how big of a change a surgery like this can be. Bryan shows up and asks his father what he's doing there.

Webber and Callie show up at Portland General and Callie gives a fake name, "Calliope Plantain." Webber takes her lead and says he's her husband, "Julio Plantain." Callie says "Julio" has chest pain.

Jackson is running a clinic for the interns about a technique. Jo asks Jackson mocking questions about plastic surgery while Stephanie makes a show of asking him about all the life-changing surgeries he's done.

April calls Jackson from the field, where she's with a kid who was in a hit and run. She says the next available ER is an hour away, and the kid will die en route if they go that far.

"Are you asking what I think you're asking?" Jackson says.

"If I am, will you do it?" April replies.

Hunt is now leading the tour for the buyers when Jackson pulls him aside and tells him about the hit-and-run case. Cahill hears this and says, "absolutely not." Hunt agrees and says the protocol dictates the kid has to go to the closest trauma center. Jackson turns to Jo and Stephanie and asks them both if he can trust them.

Back in Portland, Callie and Webber are experiencing the retail-like "customer service"-oriented treatment at Portland General. Callie intentionally tries to challenge the doctor's questioning. The doctor's tablet freezes and he has to start all over.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Jackson and Jo roll a gurney into the darkened ER. He tells her to lock the door and reminds that "no one can know about this  no one comes in, do you understand?"

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Jo is guarding the door and won't let Meredith in. Jackson opens the door and tells her that he paged Meredith.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Bryan explains to his father that "this is me," even though the father thinks Bryan is making a huge decision to change his sex. Jess chimes in and says that "Bryan is dying inside," but his father starts shouting again. Bryan tells him to get out, and Alex says, "You heard him." The father leaves.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Cristina and more interns are involved in Jackson's secret project now. April rolls up in the ambulance but the doors are locked shut and won't open. Alex shows up and helps pry the door open. It takes virtually all of them to pull the doors open, but they do it.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">The doctors are all working on the kid. There are supplies missing and everyone scrambles to find the things they need. Shane is standing lookout and shouts, "Incoming!" The doctors shut all the lights off and wait for a clear sign from Shane. He gives it and they turn the lights back on. Stephanie is buying time for Jackson and Alex, whose PR reps are wondering where they are, saying that Jackson likes to take power naps before a big surgery and Alex is at a dentist appointment.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">April's EMT guy's partner is annoyed, saying, "If this kid dies because you brought 'red' along on some lame idea of a date"

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Jackson is surprised to hear the ride-along was a date, but they all keep working. April doesn't respond to this. They need to do a calculation to determine how much medication to give the kid, and Jo does it all out loud to everyone's surprise. Jackson realizes they don't have meds or access to them because they don't have the codes. Derek shows up and says he has the codes, "tell me what he needs."

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Callie and Webber are leaving, wandering around the Portland hospital. They decide to get coffees because that helps you look like you belong. They stand near a group of doctors and Webber finally introduces himself with his real name, and Callie with hers, but says they're with Pegasus and wanted to see if the doctors have any concerns.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">"Really?" a couple of the doctors say, smiling.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Derek is getting meds when the Pegasus tour group comes around. Derek tells Jo to get over to the ER, then he distracts the tour group by offering to show them a real brain up close.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Jackson notes that Bryan's surgery is happening in 20 minutes and Cahill will know something's amiss if he and Alex don't show. Jo shows up and tells the doctors they have to move the kid because Cahill is on her way there. Alex says, "I'm staying."

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Cahill tells Derek they're on a tight schedule and need to get down to the hernia clinic immediately. Derek steps into the elevator and offers to go with them.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">The doctors start to prepare to move the kid, but he starts to code and they need to scramble. The tour group, meanwhile, is getting closer and Cahill is explaining that hernias are "one of the most common medical procedures and, as it turns out, one of the most lucrative."

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">The doctors are scrambling and Jo shouts that they have to move because Cahill is almost there. Derek tries to distract Cahill again at the last second, but she blows right by him. She opens the door and the doctors and the hit-and-run patient are all gone  to Derek's surprise.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Back in Portland, the doctor's tell Webber and Callie that they "have no say in anything  at all." They're venting about how it seems, at times, "like the walls have ears." Another doctor joins the group and recognizes Callie's name. He's an ortho, too, and knows her work. He's surprised she went to work for Pegasus.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Stephanie is stalling now before Bryan's surgery, and Alex and Jackson finally arrive.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Cahill is answering questions from the Pegasus group about the hernia center, which is where the ER used to be. She looks down and notices some drops of fresh blood on the floor and kindly asks Derek to take over the tour before she leaves.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">In Portland, the ortho tells Callie and Webber about how he's "the face of Portland General" and doesn't get to do much real medicine anymore. He asks them if there's an opening at Seattle Grace.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Jackson and Alex tell each other they hope the other gets the "brand ambassador" role. Cahill walks in on Jackson and Alex's surgery and asks who they're operating on.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">"My transgender patient, why?" Jackson says. Cahill leaves. Hunt, who is with her, asks, "What did you do?" No one responds.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">The other doctors are working on the hit-and-run kid when Cahill comes in and asks where the patient came from. Cahill threatens to look it up herself and Meredith jumps up to offer to look it up. Meredith gets out her handy tablet and "accidentally" deletes the patient file, giving Cahill an "oh, darn" kind of look through her surgical mask while lamenting the fact that this keeps happening with the new system.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Alex and Jackson show up to see all the doctors sitting in a hallway outside the room where Cahill and Hunt are questioning each doctor and the interns individually. Alex decides to barge in as Heather is being questioned and explains that "a kid was dying and we kept him alive."

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Cahill asks who else was involved and Jackson jumps in to say he, too, was involved. He says it was his call, and he and Alex agree that saving the kid's life was all that mattered. Hunt tells them both to leave. Cahill asks if they're going to be disciplined.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Derek shows up asking why he was paged. Cahill says that if she's going to do her job, she can't be dealing with an "uprising," especially when Derek helps them. Hunt is confused and Cahill notes that it was Derek's code that accessed the medication case. Hunt asks if this is true, but Derek doesn't respond to him directly. Cahill tells Derek this "stunt" would have cost the hospital dearly if the kid had died on their watch. She says Pegasus would have backed out "and without them, you're done." She says she can't help if Derek and others are "undermining" her at every turn.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Jess waits for word about Bryan. The surgery went well and Bryan will be in recovery soon. Bryan's father steps out from around the corner and looks tearful but relieved. He just wanted to know Bryan was OK, and apologizes before starting to leave. Jess tells him that she sent the email the night before and Bryan wasn't going to tell his father about the surgery. Jess tells Bryan's father that he talks about him a lot, admires him and wants to grow up and be like him. Jess tells Bryan's father that "it's hard being like us, trying to fit into this mold that doesn't fit." Bryan's father asks if they're OK on rent. He hands over some money and turns to leave.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">"You don't want to be there when he wakes up?" Jess asks. Bryan's father slightly shakes his head and walks away.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Meredith sees Alex and suggest that maybe he and Jo "should be" a thing, because Jo "kinda kicked ass today." Jo then shows up and pulls him aside to show him something.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Webber and Callie sit outside Seattle Grace. Webber says it's funny how you don't really appreciate something until you're about to lose it. Callie tells him they "can still fight this." Webber says maybe she can, but he has an early retirement package waiting and he might take it. Callie says nothing. Webber gets out of the car and gives her a smile.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">April is leaving the hospital and sees Matthew, the EMT, outside. She tells him the kid made it through surgery well. Matthew stammers before finally saying what he wants to say. He tells her she's the "strongest, most fearless, beautiful woman" he's ever met. He tells her he likes her. She kisses him. Jackson, walking out with Stephanie, sees this and they keep walking.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Jo takes Alex into a supply closet and unveils a box of donuts that she stole from the nurses. She says they won't eat them because they're all sugary. They start to eat the donuts together and Alex begins to look at Jo a little differently.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Hunt finds Cristina in an on-call room and tells her, "You guys are killing me." She says it was the right thing to do, and Hunt says, "Yeah, but you're still killing me." They start to make out. Cristina's phone buzzes but she doesn't answer.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Meredith is getting no answer from Cristina. Callie is on the roof with Meredith, Derek and Arizona. She says they can't just keep their heads down and lay low. They have a responsibility. She proposes that they buy the hospital themselves. The rest of the group is stunned.

<span style="color:rgb(51,51,51);font-family:Arial,Helvetica,sans-serif;font-size:13px;line-height:17.030000686645508px;">Inside the hospital, Webber steps into an elevator. When the doors close, he's looking at a massive photo of Derek, who is apparently now the "brand ambassador."

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
 * Patrick Dempsey as Dr. Derek Shepherd

Guest Stars

 * Constance Zimmer as Dr. Alana Cahill
 * Camilla Luddington as Dr. Jo Wilson
 * Gaius Charles as Dr. Shane Ross
 * Tina Majorino as Dr. Heather Brooks
 * Jerrika Hinton as Dr. Stephanie Edwards
 * Justin Bruening as Paramedic Matthew
 * Rachel Broshanan as Brian Weston
 * Matt Pascua as Jess
 * Brett Rickaby as Mr. Weston
 * Nazanin Boniadi as Amrita
 * Rob Brownstein as Larry
 * Gerald Downey as Dr. Kenton Giles

Co-Starring

 * Nicole Cummins as Paramedic Nicole
 * John Duerler as Grant
 * Paull Walia as Dr. Kan Mattoo
 * Jeremy Cohenour as Dr. Boyd
 * Brandon Ford Green as Dr. Allen
 * Yvette Saunders as Dr. Collier
 * Maggie Henry as Olivia Noel
 * Renee Pezzotta as ER Nurse
 * Stephanie Maura Sanchez as Admitting Nurse

Notes and Trivia

 * This episode's title originated from the song The Face of Change, originally sung by INXS.
 * This episode scored 8.91 million viewers.
 * The song that played in the promo for this episode is "Crash" by Sum 41.