I Will Follow You Into the Dark

"Every surgeon I know has a shadow. A dark cloud of fear and that follows even the best of us into the OR. We pretend the shadow isn’t there hoping that if we save more lives, master harder techniques, run faster and farther it will get tired and give up the chase but like they say... you can’t outrun your shadow. Every surgeon has a shadow. And the only way to get rid of a shadow is to turn off the lights, to stop running from the darkness and face what you fear, head on."

- Meredith Grey

 is the seventeenth episode of the fifth season and the 95th overall episode of Grey's Anatomy.

Short Summary
After learning at a deposition that more of his patients have died than survived, Derek leaves both the hospital and the house, even as Meredith refuses to give up on him. Meanwhile Bailey and the Chief continue to bicker over her peds fellowship until his wife, Adele, is called in, thoroughly annoyed at the both of them. The interns make a disturbing breakthrough on "Patient X," unaware that the charts they're looking at are actually Izzie's, prompting Izzie to confide in the most unlikely of people.

Full Summary
Shepherd appears depressed, bruised and eating cereal on the residents' couch. Meredith, Karev, Stevens and Lexie watch him and talk about him.

Yang finds Hunt sleeping on a gurney. When she tries to wake him, he was surprised and pushes her hard against a cupboard. He apologizes. He has a trauma case, a teenager trampled on a football field.

Torres is checking Sloan's fingers and tells him they are still swollen. She hides behind him when she sees Robbins walk past. Asks him not to judge.

Stevens tells Karev that he has a bright future in surgery and she looks forward to seeing him in 50 years' time, a successful surgeon. The interns come up to her and tell her they have ideas about 'Patient X'. She leaves with them. Karev, O'Malley, Yang and Meredith wonder when Stevens was last in surgery.

Webber asks Meredith if Shepherd is coming in. In the meantime, he ignores Bailey then pointedly asks why she isn't at pediatrics.

Bailey and Yang sees their patients - three siblings: Tricia, Meg and Mike Shelley. They all have the CDH1 gene, which gives them a 3 in 4 chance of getting stomach cancer. Almost everyone else in their family are dead from stomach cancer. They are at Seattle Grace to get their stomachs taken out.

Hunt and Karev's trauma patient, Beth, is seizing but they don't know why. Lorezopam did not work but Hunt is concerned that electroshock could kill her. He makes a call and tries it any way. It works - the seizures stop and she wakes up asking if she had another seizures, wondering why considering she took her medication. She is concerned that the 'seizure patrol' will kill her. They show up angry: two other band members who have been given responsibility to drop their instruments and assist Beth when she has a seizure.

The interns go through their thoughts on Patient X to Stevens. Lexie has good ideas. They ask for further testing.

The Shelleys are going through the risks of propylactic gastrectomy (preventative removal of the stomach) with Yang. They are surprised by the serious side effects and risks and Yang tells them it is a serious procedure. Mike does not want to do it, it was all the oldest sibling Trish' idea. Meg wants more time to think about it.

Webber is looking at the OR board and is rearranging procedures, wonders where Shepherd is. Sloan tells him he can't operate yet. Dr Nelson tells him he can do Shepherd's craniotomy. Nelson has been at Seattle Grey for 10 years - he was interim head of neurosurgery before Shepherd arrives - but Sloan does not recognize him or recalls having met him three times.

Karev kicks out the complaining seizure patrol from Beth's room. He has a chat with Beth and makes fun of her for wanting to be a band geek even though she gets seizures. She asks what he was in high school and he said a wrestler. She asks what he would do if he has seizures while operating.

Torres fixes Sloan's fingers by injecting corticosteroid. Tells him that would allow him to operate but he will be in a lot of pain afterwards. Sloan asks about Dr Nelson and Torres calls him 'shadow Shepherd'. A solid surgeon in his own right but always plays second fiddle to the much more illustrious Shepherd.

Meredith finds Shepherd in a dark room with stacks of files. He shows her that the stack of files on patients who died is bigger than those who survived - he has 'killed more patients than he has saved'. Webber finds Shepherd and tells him that he needs him to operate but Shepherd just walks out of the hospital.

Grey and Yang are bickering at lunch. Stevens tells them she can see them still bickering 50 years from now.

Karev is working on charts in Beth's room when he sees something odd in her monitor and she begin seizing again. He calls a code blue.

Bailey, Webber and Yang are operating on Trish to remove her stomach. Throughout it Bailey and Webber argue about the approach to take. Webber yells at Bailey to do it his way. Bailey finds something.

The interns decide that Patient X is fine. Stevens tells them she is not fine because she had hallucinations. They must be missng something.

Meg and Mike find out that their sister Trish did have stomach cancer. She just had a colonoscopy last month but it is an aggressive cancer. The stomach removal saved her life. Meg tells Mike that Trish is the only responsible family member they have left. She wants the surgery right now.

Karev tells Robbins and Hunt that he saw abnormal heart activity on Beth's monitor before her seizure starts. He thinks she actually has a heart abnormality and they need to open her up. Robbins tells him that if he is wrong the procedure can kill her - thay can't just tell Beth's parents that she has been misdiagnosed and mistreated for epilepsy all this time. Karev insists he is not wrong. Hunt says that then it is Karev's call.

Stevens and O'Malley are talking. He tells her that the other residents think she's being like him by not going after surgeries. She tells him that she would be proud to be the new O'Malley - he reads more journals and research and spend more time in the skills lab than anyone else. He never stops aiming to be a better doctor.

Lexie finds Stevens and tells her that because Patient X has swollen lymph nodes, ruling out a brain malignancy based on the CT scan was a mistake. She wants to order an MRI with contrast and maybe biopsy a lymph node. Whatever is wrong with Patient X must already be in her brain.

Robbins, Hunt and Karev are in the operating room for Beth. Robbins asks Karev again if he is sure. He is. She gives him the paddles and tells him he is on the crash cart. If he is wrong he should get ready to use it.

Post-surgery for Meg Shelley - they found no cancer. She tells Mike that the wound hurts a little but otherwise she is fine. Trish asks Mike if he remembers how much pain their mother was in during her final days. He was only 2 when she died so he doesn't remember and he does not get scared by every stomach pain, he only knows what Trish has told him. He still doesn't want the surgery.

In Beth's operating room, there is no arrythmia - Karev may be wrong. But then it shows up. He holds up the shock paddles but Hunt tells him to hold on. She is coming up. Robbins diagnoses her with ARVC - her blocked right ventricle is causing the arrythmia and when her brain does not get enough oxygen it causes the seizure. Karev is right - Hunt tells him he just saved the girl's life. Karev doesn't respond - he is frozen with his hands still holding the crash paddles, shaking. Hunt calms him down and he drops the paddles.

Sloan tells Webber that his surgery went well. Webber barely acknowledges this - he is still looking for Shepherd. Nelson is there and looks sad. Sloan understand now.

Bailey comes up to Webber and tells him that yelling at her in front of her residents is no OK. He walks away. She tells him that is not mature.

The interns tell Stevens that they have a diagnosis. Patient X has enlarged lymph nodes and a suspicious mole that had been biopsied. A brain MRI shows mets. Patient X has metastaic melanoma with mets to her skin, liver and brain. With chemo and radiation her prognosis is only a few months. The interns are being insensitive, unaware that Patient X is Izzie. One says that with a 5% survival rate the girl is pretty much toast. Having successfully diagnosed the patient, they asked for a prize like in the last diagnostic quiz. Stevens gets angry and tells them that the prize is that they were doctors today - they did something right and did not screw up.

Adele shows up at the hospital and gets Bailey and Chief Webber.

Karev tells Beth that they have implanted her with a pacemaker. She still has a serious heart condition but with it in she won't have seizures anymore. She can't believe she was saved by a wrestler. The seizure patrol return and tell Beth that she should pick a less physical activity - not be in the band. Karev tells them that Beth won't have seizures anymore - he removed her 'epileptic bone'. He then tells them they are all band geeks.

Adele tells Webber to start acting like the chief of a hospital and apologize to Bailey. As she leaves, she also tells Bailey that she is also immature for telling on a man to his wife.

Trish is watching her siblings, accompanied by Meredith. She tells Meredith that Mike will get the surgery eventually - she will keep pestering him until he does. She tells Meredith that you don't leave the people you love alone.

Lexie finds Izzie and thanks her - she learned a lot from diagnosing an actual patient. Stevens asks her what she would say. When she is not sure Izzie says she should say you have a choice - run away or face the disease. Surround yourself with people you love because this will be the fight of your life and you will need all the help you can get. At 5% the odds are not great but Lexie says screw the odds. The odds mean crap. Her mum died of the hiccups - which should have a 100% survival rate. People should stay and fight.

Hunt and Robbins tell Karev that he was impressive and Hunt will tell the Chief so. Robbins says that if he gets his attitude in check he can be the future of this hospital - the resident to watch.

He excitedly tells Stevens this. He tells her to stop screwing around with the Patient X stuff and get on to real patients and surgeries because he doesn't want to be the future of the hospital without her. She kisses him but after he leaves she stops smiling.

Webber and Bailey talk. Bailey thinks Webber is disappointed everytime she does something he sees as 'soft - like have a baby, go on leave to be with her baby, decide to work with babies. She thinks he thinks that letting her do 'soft' things makes him 'soft' as well. She says that he probably should embrace it because surgeons are leaving left and right so he should be trying a different approach.

Yang tells Hunt that she can handle trauma. It will take more than a bad dream to scare her off.

Meredith is reading in the cafetaria. Webber comes up to her and asks for her help to bring Shepherd back to work. Meredith says that sometimes people just want to be left alone so Webber tells her that he had been planning to propose. He had been carryin around a ring - not a man who wants to be left alone.

Lexie tells Sloan that their relationship's survival rate may be low but they should still give it a try. As they leave together, Dr Nelson invites Sloan for a drink but he gets blown off.

Robbins and Torres ends up in the elevator together. Robbins tells Torres about having misjudhed Karev as well as the situation with Torres. She would like to take Torres out to dinner. Torres initially says her schedule is busy but as she is leaving the elevator asks, 'How about tomorrow?'

Stevens is looking into the residents' changing room - assessing the people. Says goodnight to fellow residents as they leave one by one. O'Malley tells her that he is still there for her and still cares but she tells him that she doesn't want to talk about it yet. Finally she goes over to Yang. She says that because Yang is a robot and doesn't like her very much, she would be able to handle the news. But she can't tell her there.

Meredith arrives at Shepherd's. He is hitting cans with a baseball bat outside his caravan. He tells her to go home. He is not hiding - he is done. He says that Meredith is broken and cannot be fixed - tells her to leave. When she tells him that she knows there is a ring he takes it out and hits it to the woods with his bat. He goes inside. She shouts at him and says that she is not bailing.

In the steampipe room, we see Stevens sharing her news with Yang.

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

Guest Stars

 * Jessica Capshaw as Dr. Arizona Robbins
 * Michael Rady as Mike Shelley
 * Wendy Hoopes as Tricia Shelley
 * Erin Cahill as Meg Shelley
 * Susane E. Lee as Beth
 * Brandon Scott as Dr. Ryan Spalding
 * Loretta Devine as Adele Webber

Co-Starring

 * Phil Abrams as Dr. John Nelson
 * B.K. Cannon as Girl Band Geek
 * Marcus McGee as Boy Band Geek
 * 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
 * Nicole Cummins as Paramedic

Shelly Siblings

 * Diagnosis: CDH1 gene, predisposed to Hereditary Diffuse Gastric Cancer
 * Doctors:
 * Miranda Bailey (general surgeon)
 * Richard Webber (general surgeon)
 * Cristina Yang (resident)
 * Treatment: Prophylactic gastrectomy

Beth

 * Diagnosis: Arrythmogenic right ventricular cardiomyopathy (ARVC) causing seizures from cerebral hypoxia, previously misdiagnosed as epilepsy not uncontrolled by treatment
 * Doctors:
 * Owen Hunt (trauma surgeon)
 * Arizona Robbins (pediatric surgeon)
 * Alex Karev (resident)
 * Treatment: Surgery to implant artificial cardiac pacemaker

Patient X (Izzie Stevens)

 * Diagnosis: Metastatic melanoma, with mets to the skin, liver, and brain
 * Doctors:
 * Izzie Stevens (resident)
 * Lexie Grey (intern)
 * Ryan Spalding (intern)
 * Pierce (intern)
 * Graciella Guzman (intern)
 * Megan Mostow (intern)
 * Steve Mostow (intern)
 * Treatment: chemotherapy, radiation and surgery (not yet decided)

Notes and Trivia
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 * This episode's title originated from the song, I Will Follow You into the Dark, which was originally sung by Death Cab for Cutie.
 * This episode scored 13.54 million viewers.
 * Michael Radey who played Mike Shelly would later go on to play a surgical resident in 'Emily Owens MD'

Quotes

 * Owen: (to Alex) You did a hell of a job today. The Chief is gonna hear about it.
 * Arizona: Pretty impressive for a resident. You fix that attitude of yours, you could be the future of this hospital. The one to watch. You go, Karev!


 * Meredith: How'd it go with the lawyers?
 * Derek: They told me my death rate. (looks at small pile of files) These are the people I saved. (looks at big pile of files) These are the people I killed.
 * Meredith: Okay. Well most of those people were terminal when they came to you. You were their last chance, and you take on impossible cases. Look at the clinical trial.
 * Derek: It's just so many people. More than Dahmer, Mason, and Bundy combined.
 * Meredith: You're not looking at the big picture.
 * Derek: (points to the big stack of files) This is the big picture.


 * Richard: Where the hell is Shepherd?!
 * Mark: Uh, you can't rely on Shepherd, sir, is there anything that I can do?
 * Richard: Well, my neuro surgeon's been missing for days, I still have no head of cardio, I've got general surgeons quitting on me left and right, surgeries piling up on me like dead fish, and no surgeons to do 'em.
 * Mark: Well, now would probably be a bad time to that my hand is still out of commission and I can't operate. ... You know what? Leave me on the board Chief, and I won't let you down.
 * Jim Nelson: I could do that craminotomy, Chief.
 * Richard: Uh, put Dr. Nelson on the cramiotomy. Apperciate it John. (walks off)
 * Jim Nelson: It.. It's Jim.
 * Mark: You must be new. Welcome to Seattle Grace.
 * Jim Nelson: I've been here for ten years. I was the interm Chief of Neuro until Shepherd and his red cape swooped in from New York.
 * Mark: Mark Sloan, Plastics.
 * Jim Nelson: We've met... three times.


 * Lexie: Yes, the odds are against us. I'm a one woman wrecking ball, all I do is break you. Your hand, your penis, your relationships, your life. I'd say our survival rate is about 3%. And that's...that's, that's bad. But, it's not nothing. And I don't think we should give up on this. At least not yet because... (Mark puts a finger to her lips to stop her) Okay.
 * Mark: You think you broke me, Little Grey? ... You're the one that put me back together. (Lexie smiles)


 * Lexie: I learned a lot today. Diagnosing a patient from beginning to end. So, thank you for teaching us.
 * Izzie: What would you say? To patient X. How would you... How would you break the news?
 * Lexie: Um, I would say that I was very sorry, and that there were support groups. Th... I ... I don't know. What do you say to somebody whose, whose gonna...
 * Izzie: You say, they have a choice. They can runaway and hide from it, or they can face it. You say they need to be around the people who love them, because it's gonna be the toughest fight of their life, and no one should have to do it alone. And then you give them the odds. And even though a 5% survival rate is bad, it's really bad. You say.... you say....
 * Lexie: Screw the odds! People die of the hiccups. My mother died of the hiccups. Survival rate for that is what... 100 percent? The odds are that she should be alive right now. The odds are... The odds mean crap! So people should face it and they should fight. ... Maybe not those words.
 * Izzie: No. Exactly those words. Thank you Dr. Grey.


 * Meredith: (about Derek) And he just walked out. Without saying a word, he just walked out!
 * Cristina: Hunt won't even look at me, since he went all "Apocalypse Now" on me this morning.
 * Meredith: He had to get all scalpel happy up in that patients brain, and now he can't face it!
 * Cristina: He thinks I'm what? This wilting flower? Well guess what, I'm the strong one.
 * Meredith: Oh my god! I'm the strong one.
 * Cristina: You see, if I had that stomach cancer gene, I would get that gastrorectomy no problem. I face things, I don't walk away.
 * Meredith: Derek walks away. Maybe walking away is the answer?
 * Cristina: See it's not emotional, it's science. You have a problem, don't ignore it.
 * Meredith: Well, sometimes if you have to pee and you ignore it, it does go away.
 * Izzie: (laughs) You guys are hilarious! I mean do you even know what she just said? Or what she just said? (Meredith and Cristina look at each other) I can totally see you guys in 50 years, at a nursing home, just talking at each other with your hearing aids off. (laughs) Hi-larious! Ah, I love lunch.


 * Richard: You told Adele on me?
 * Bailey: You stopped speaking to me, sir. That didn't exactly leave me many options. I'd like to know if you'd have reacted like this if I left general surgery for neuro or cardio?
 * Richard: I don't follow.
 * Bailey: Or is it because you regard peds as a soft specality? Is that what's bothering you?
 * Richard: Oh, that's ridiculous.
 * Bailey: Well, maybe, but it seems to me that every time I do something that you perceive as soft, like havin' a baby, takin' some time off to see my baby, specializing in babies, I'm dead to you. You wanna know what I think, sir?
 * Richard: Not particularly.
 * Bailey: I think that you're scared that you've gone soft. You blame this whole hospital's decline on it. And you wanna know what I think about that?
 * Richard: You're gonna tell me anyway.
 * Bailey: It's not doin' one bit of good. I mean, surgeons are still droppin' like dominoes around here. So, maybe it's time that you got in touch with your femnine side. Maybe you need a little soft.
 * Richard: ... You still shouldn't have ratted me out.
 * Bailey: Sorry.
 * Richard: Me, too.