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Anesthesiology is a lot more challenging than it looks. Because it's mostly math. A patient's weight, their estimated blood volume, their lung function, all these variables have to be accounted for. It takes careful calculation to suspend a person between life and death. If one of those variables is off, you might wake up in the middle of your surgery. Or never wake up at all. If only less variables were as cut and dried as the rules of mathematics. If only there were clear answers, certainty, clarity, right or wrong. But all you can do is eliminate as many unknowns as possible. Then pick an answer and hope. Hope that at the end of the day, it's an answer you can live with.

Add It Up is the eighteenth episode of the fifteenth season and the 335th overall episode of Grey's Anatomy.

Short SummaryEdit

Maggie introduces mood rooms as an alternative approach to medicine. Alex and DeLuca butt heads over an 11-year-old patient who tries to sabotage her own surgery. Jackson and Richard deal with a gender non-binary patient. Meanwhile, Teddy has a pregnancy scare that brings Owen and Koracick to odds.

Full SummaryEdit

Maggie shows the interns her new way of quantifying the effect of environment on patient health: mood rooms. The first room is filled with plants. Plant life improves physical wellbeing. It decreases anxiety and blood pressure and increases attentiveness. The second room is meant to expose the body to high levels of blue light, which reduces systolic blood pressure. Finally, there's a game room. Bailey has discovered it already. She's playing Tetris.

Meredith runs into Andrew. He hasn't heard from his father. He leaves for rounds. Meredith discovers the plant room.

Owen finds Teddy and tells her he's coming to the birthing class with her. Richard is covering the ER. Once he's gone, Teddy tells Tom she should have told Owen that he was coming, too. Tom jokes they'll become besties. He leaves to put on his supportive boyfriend clothes. Teddy suddenly experiences pain and tells the baby to move off whatever organ she's on.

Alex tries to reach Jo, but she's not answering her phone. He then notices Meredith in the plant room. She's working on her ingestible diagnostic device research. She asks about Jo's trip to Pittsburgh, but he hasn't heard from her at all. Alex asks about DeLuca. Meredith admits they haven't talked since the blow-up with the dad. He's shutting her out.

Amelia and Maggie are taking in the blue light. Maggie notices Amelia's cheerful. She admits she had insanely good sex at the conference in San Diego. Link comes in to tell Maggie he e-mailed her some thoughts about the sternal reconstruction she consulted him about. It took him a while because he was away at a conference. Maggie puts two and two together. Once he's gone, Amelia tells Maggie it was a one time thing and quickly leaves.

Jackson and Richard are on the elevator to the helipad. Catherine's decided not to go back to work this week, but all she told Richard about it was "cancer card." They arrive. The first patient is Kari Donnelly, who complains about neck and back pain after a snowmobile collision. The second patient is Toby Donnelly, who suffered a deep soft tissue injury in the collision. Toby asks about their mother.

Alex paged Andrew, who's on his service. They have an 11-year-old kid with chronic pancreatitis. Today's the day for her total pancreatectomy. Andrew gets to deliver the good news.

The patient, Nora, is working on solving a math equation. Dahlia tries to help out since she dabbled in math before deciding on medicine. Nora tells her her solution is wrong. Alex and Andrew come in. Dahlia presents the case. Nora has been hospitalized for 6 months. The criteria for the surgery haven't aligned until now. Eileen, Nora's mother, cheers and tells her daughter she'll get to go back to school. Meanwhile, Nora herself asks how long she'll have to recover.

Casey finds Teddy in the blue room. She's in pain. She was hoping it's just stress and that the room might work, but it's starting to feel like her body's pushing out all of her organs. She asks Casey to page OB and Hunt.

Owen arrives at the birthing class and finds Tom's there. He wonders which pillow Teddy will want, but Owen tells him to go since he's Teddy's partner for the class. As the class starts, Owen receives a page about Teddy.

Carina has finished examining Teddy. She's not in labor but she has cervical insufficiency. Teddy decides to put herself in Trendelenburg. Carina urges her to stay calm. Owen enters.

Amelia finds Link and tells him that Maggie knows because he mentioned San Diego. She re-iterates that it was a one-time thing. It was just pain management. To be safe, they should steer clear of each other. She really likes his pheromones. He promises he'll stay away from her, but that plans is thwarted when they find out Richard paged them both to the trauma room for Kari. He leaves them to deal with her and goes to help Jackson. Kari says Toby told her not to drive too fast, but she figured that's what snowmobiles are for. Link studies her X-rays and diagnoses fractures in C4 and C5. They won't know how bad it is until they have a scan. Link and Amelia simultaneously order an MRI.

Richard joins Taryn and Jackson at Toby's bed. The blood flow to her arm is compromised. Toby asks about their mother. Richard says they'll know more soon and uses the ultrasound to scan for more injuries in Toby's abdomen. Toby says the snowmobile was their mother's way of pushing them past their fears. They admit it was fine until they flipped. Richard orders a CT angio to determine the location of "her" vascular injuries. Toby corrects him. They are gender non-binary. Their pronouns are they/them. Richard can't quite follow.

Dahlia paged Casey to read math problems for her and Nora to solve. Nora beats Dahlia. Andrew wants to prep Nora for surgery, but Nora asks for one more question. Alex comes in with bad news: her blood glucose has suddenly risen, meaning they'll have to postpone the surgery and start an insulin drip. Nora herself doesn't seem too concerned and tells Dahlia the answer to Casey's last question.

Alex tells Andrew he's sorry that the surgery's off. Andrew says he should be sorry for Nora. He suspects Meredith asked Alex to cheer him up. He doesn't need any favors.

Amelia and Link are waiting for Kari's scans to come up. There's a bulging disc at C5 and a total obliteration of the CSF space at L4. She could end up paraplegic. Link doesn't want to handle this case on his own.

Bailey's still playing Tetris but she refuses to let Maggie measure her BP. Maggie's distracting her makes her lose a few points short of breaking her own high score. Dahlia comes in to ask if she can borrow Levi. Her patient is a math whizz and she needs backup. Maggie and Bailey ask how good at math they're talking about.

Maggie, Bailey, Levi, and Dahlia have teamed up. They make their way to Nora's room.

Teddy has never been called insufficient. Carina agrees with Teddy's self-prescribed treatment. The Trendelenburg appears to be working. Owen asks what he can do. Carina tells him to keep Teddy and the baby calm by talking to them. Carina leaves and Owen starts talking to the baby with a baby voice. Teddy can't bear hearing it. Owen changes his voice but that too freaks her out.

Casey is reading more math problems. Nora still beats all the doctors. She thinks they are letting her win, but Bailey says that is not something she does. Dahlia wants to quit, but Nora tells her not to give up. She's on her team now. As Nora and the doctors work on the next question, Dahlia finds an empty juice box hidden under Nora's pillow.

Taryn's helping Toby get comfortable for their MRI. In the booth, Jackson checks with Richard if he's keeping something from him about Catherine. Richard assures him he's not. Jackson is concerned for his mother. Taryn comes in. Richard brings up the pronouns. He says it's complicated. Jackson points out you also use "their" when you find something from someone whose gender you don't know. Richard maintains it's grammatically incorrect. Taryn says that's wrong. It's ungrammatical. Toby's scans come up. There's an obstruction of blood flow in Toby's middle brachial artery. Richard says they need to get "her" up to the OR. Jackson points out his mistake.

Link and Amelia are examining Kari. They tell her she suffered a severe injury to her lower spine. They need to get in there to decompress the nerves before she's paralyzed from the waist down. Kari breaks down. She can't do a wheelchair. Amelia promises they'll do everything she can.

Alex finds Meredith and tells her her boyfriend's being a jerk while he was trying to do him a favor. Meredith's staying out of his life for now. Andrew comes in. Meredith suggests a coffee break, but Andrew was looking for Alex. He shows Alex what Dahlia found and says it looks like Nora's sabotaging her own surgery.

Eileen demands to know why Nora sabotaged her surgery. Nora doesn't want to go back to school. It's all cliques and stupid girls and stupid boys who get mad when she beats them at math. She has no friends. Lauren found other kids to sit with at lunch because Nora's out sick all the time. She has friends in the hospital, so she wants to stay here. Alex says they'll run her labs again after the insulin drip has finished. Nora will just drink more juice. She does not want the surgery and it's her body. Eileen's not sure what to do here.

Outside the room, Eileen questions how she did not know about Nora's school. Alex says kids keep secrets at a certain age. It's not on her. Eileen says she called Lauren a bitch once to Nora. Maybe that's why she stopped talking to her. Eileen is not sure what to do. Andrew says she has to convince Nora to get the surgery. Every kid hates school at some point, but Andrew doesn't want to see Nora die over it. Eileen says she's not dying. Andrew says it hurts Nora every time her pancreas flares up, so she should get the help that she needs. Alex orders Andrew to walk away.

Teddy says talking to the baby makes her feel shy. Owen turns around, but it doesn't help. Teddy says she's already failing as a mom. She probably did something that caused the baby to want to come out early. Owen leaves and comes back in with a gurney. He lies down in Trendelenburg next to her to show her she's not alone.

In surgery, the surgeons are repairing Toby's vessel. Richard is using correct pronouns now, but he comments it sounds unnatural to his ear. He recalls he had to fire the best mechanic because he kept calling him Ricky. Taryn says an annoying nickname isn't the same as misgendering. Richard admits he's trying to keep up with the world but their attitude is not helping. Jackson once broke up with a girlfriend who called him Jackie.

Dahlia finds Alex to tell him that Nora's numbers are back to what they were this morning. They walk up to Nora's room and find Andrew talking to Nora. He tells her that he was bullied in school. It was tough, but he got through it. And Nora's way cooler than he was. He shows her a picture of him as a kid. He assures her she'll get through it and make new friends. Andrew sees Alex, who does not look amused.

Link compliments Amelia's work. They need to work carefully so Kari can do the triathlon with Toby. They remove the bone fragments and run the potentials again. All signals are looking good. Amelia's glad. They can reposition Kari for the C5 repair.

Alex takes out Nora's pancreas. There's some necrosis, but Dahlia thinks they'll manage to find some healthy islet cells. Dahlia says kids are mean. She was bullied, too, because she was the only non-Mormon. Alex says he was fat. Levi was himself, which was hard, too. Andrew comes in and asks why no one told him they were starting. Alex says he's off the case. Andrew says he's the reason Nora consented. Alex reminds him he had told him to stay away from her.

Link and Amelia are working in C5. Link doesn't get how she can do neurosurgery. It's life or death all the time. Adrenalin is the only high she lets herself have. They are warned that the signals to all four extremities are gone. They have no idea why.

Teddy tells Owen he looks like he's about to throw up. He doesn't have to suffer with her. He says he does. They are in this together. He knows she's scared. She says he knows what to do since he has Leo. Owen admits he still screws up sometimes. All they can do is their best. Owen tells the baby that her mother is the best. She's kind, hilarious, and strong. She is loyal and fierce. She'd lie upside down for weeks if necessary. That's why they don't have to worry. Teddy's got this. Tom comes in. Teddy assures him they are all safe. She didn't want to worry him. Owen leaves to get some coffee. Tom follows him outside.

Tom asks Owen if he would have told him had Teddy been in labor. Owen says that doesn't matter. Tom knows Owen doesn't like him, but he advises to rethink his decision if he were to plan to make a move on Teddy, the woman he has hurt and abandoned over and over again. Tom won't lie down and walk away. He'll fight for her. Owen tells him he knows nothing about his history with Teddy. Tom knows he chose Amelia over her more than once. Tom loves Teddy and only her. She deserves to be with someone for whom she's the first and only choice.

Link, Amelia, and Jackson update Toby about their mother's spinal injuries. Her cord swelled in surgery. She is paralyzed from the neck down. Link says Kari will need a lot of help. Toby can't do this. Their mother is the one with all the answers. Jackson knows that type of mother really well. He's learned that it's now, when she's the one who's hurt, that you realize your mother has given you everything you need to help her. Their mother showed them how to help her, so Toby can't let her down. Toby wants to be there when she wakes up.

Alex again tries to roach Jo, but she's still not answering. Andrew comes up and calls out Alex for being unprofessional. Alex says it was him who was unprofessional. That talk he had with Nora should have been the first thing he did. Alex knows like no other what a number parents can do on their kids, but Andrew let it interfere with his job today and also his relationship. When people reach out a hand, you don't bite it, because it stops them from reaching out.

Maggie's checking Meredith's BP. She appears to be stressed. Maggie then sees Meredith has a text from Andrew asking her to come over. Maggie asks if her heart's pounding. Meredith says she's not 13.

From outside the exam room, Owen watches Tom feed Teddy ice cream. Carina leaves the room and tells Owen everything's okay. Owen then walks off.

Jackson finds Maggie in the plant room. She's working on a complicated math problem. Jackson takes a look and immediately gives her the correct answer. Maggie hates him for it. They share a kiss.

Amelia's taking a moment in the blue room. Link comes in. She walks up to him and they hold hands. She locks the door and they start kissing.

Meredith shows up at Andrew's place. She's talking first. Sitting at work wondering if her boyfriend is avoiding her is not something she does. She's past that point in her life. He knows. He can't fix his father and he couldn't believe how much that hurt. He needed a minute to hurt and he didn't want to drag her down with him. Now, he just needs her. Meredith jokes she might need a minute now. They share a kiss and she sees he prepared dinner for them. They sit down and he pours her some wine.

Alex comes home. Jo is sleeping in bed. He kisses her on her forehead and tells her she missed her. As he goes into the bathroom, she opens her eyes and continues crying.

CastEdit

  • Meredith Grey
  • Alex Karev
  • Miranda Bailey
  • Richard Webber
  • Owen Hunt
  • Jackson Avery
  • Amelia Shepherd
  • Jo Karev
  • Maggie Pierce
  • Andrew DeLuca
  • Teddy Altman
  • Tom Koracick
  • Atticus Lincoln
  • Kari Donnelly
  • Levi Schmitt
  • Carina DeLuca
  • Eileen Hillridge
  • Taryn Helm
  • Dahlia Qadri
  • Casey Parker
  • Toby Donnelly
  • Nora Hillridge
  • Sherri
  • Flight Doc
  • Neurophysiologist
  • Dr. Knox

Main CastEdit

Guest StarsEdit

Co-StarringEdit

Medical NotesEdit

Kari DonnellyEdit

  • Diagnosis:
    • Fractures at C4 and C5
  • Treatment:
    • Surgery

Kari, 50, was in a snowmobile accident. She had neck and back pain and leg weakness. Her scans showed fractures at C4 and C5, so they ordered an MRI. Her MRI showed her condition was worse than they thought, with damage down to the lumbar spine. She was told about the risk and then taken into surgery to decompress the spine. The surgery was going well, but suddenly, there was no signal to any of her four limbs, which left her paralyzed from the neck down.

Toby DonnellyEdit

  • Diagnosis:
    • Soft tissue injury
  • Treatment:
    • Surgical repair

Toby, 22, had a deep soft tissue injury to their left upper arm after a snowmobile accident. They had arterial compromise in the arm. Richard did an ultrasound and ordered a CT angio to check for other internal injuries. The CT showed no flow in the mid-brachial artery, so they were taken into surgery. The surgery went well and they were stable and awake afterward.

Nora HillridgeEdit

  • Diagnosis:
    • Hereditary pancreatitis
  • Treatment:
    • Insulin
    • Pancreatectomy
    • Islet autotransplantation

Nora, 11, had chronic pancreatitis since she was five. Her numbers were finally stable enough to have her pancreatectomy and islet autotransplantation so she wouldn't develop diabetes. However, before her surgery, her blood glucose spiked with no explanation. They gave her insulin to bring it down and waited. It worked, but Dahlia discovered she'd used juice to bring her blood sugar up. She didn't want the surgery because she didn't want to go back to school. However, Andrew talked to her about his experience being bullied and convinced her to have the surgery, which went well.

Teddy AltmanEdit

  • Diagnosis:
    • Pregnancy
    • Cervical insufficiency
  • Treatment:
    • Trendelenburg

Teddy had serious pain and was worried about the baby. Carina diagnosed cervical insufficiency and put her in Trendelenburg. Carina checked on her every hour and told her that it seemed to be working.

MusicEdit

Song Performer Scene
"Good to Go" Lònis (feat. Daphne Willis)
  • Maggie shows the interns her mood rooms.
  • They find Bailey playing Tetris in the game room.
"Do Your Worst" Rival Sons
  • Bailey, Maggie, Dahlia, and Levi walk to Nora's room.
  • Levi and Maggie high five.
"Run to You" Ocie Elliott
  • The doctors tell Toby that their mother is paraplegic. Jackson convinces them they have the strength to support her.
  • Alex tries to reach Jo again. He tells Andrew he was unprofessional and tells him not to let his father's problems affect his life.
  • Maggie checks Meredith's numbers.
"When You Were Young" (originally by The Killers) Benjamin Francis Leftwich
  • Jackson and Maggie kiss in the plant room.
  • Link and Amelia kiss in the blue room.
  • Meredith and Andrew talk things out.
  • Jo pretends to be asleep and continues crying when Alex is gone.

Notes and TriviaEdit

Grey's Anatomy 15x18 Promo "Add It Up" (HD) Season 15 Episode 18 Promo

Grey's Anatomy 15x18 Promo "Add It Up" (HD) Season 15 Episode 18 Promo

  • This episode's title originated from the song Add It Up, originally sung by Violent Femmes.
  • This episode scored 7.00 million viewers.
  • Goof: While in the game room, Bailey supposedly loses right before beating her own high score, but the screen actually says she set a new high score.

GalleryEdit

Episode StillsEdit

QuotesEdit

Owen: Hey. Your mom she's better than the best. She's incredibly kind and hilarious, and she's so strong. I remember I saw her do a thoracotomy in a helicopter that had no doors, and that patient lived, yeah.
Teddy: Yeah.
Owen: She listens to Duran Duran way too loud and she can take down an entire pizza on her own, which I find insanely charming. She is loyal, and she is fierce, and she would lay upside-down for weeks if you needed her to. You'll never turn around and not have her standing right behind you, holding you up, okay? So, little one, you do not have to worry. Your mom has got this.

Richard: You know, I had a mechanic who called me Ricky no matter how many times I corrected him. Best mechanic I ever had. I fired him.
Jackson: You fired a guy 'cause he called you Ricky?
Richard: I'm not a Ricky.
Taryn: That's kind of a false equivalent. Comparing an annoying nickname to misgendering...
Richard: I'm just saying that I understand what it's like when you're called something you aren't. I've been called a lot worse than Ricky. It's just that the world moves fast, and I'm trying to keep up, and I'm trying to adjust, and your attitude is not helping the process.

Tom: So I'm curious. Uh, if Teddy had been in actual labor, would you have told me then? Or would you still have let me stay in that class?
Owen: She wasn't in labor, so what does it matter?
Tom: Okay. Here we go. I know you don't like me. Trust me, I'm not losing sleep over it, but if you plan to make a play here? If you're gonna show up with a ring and take advantage of the very old pain and vulnerability of a woman you have over and over again hurt and abandoned, please rethink that. Because I will not lie down, and I will not walk away. I'll fight for her. And that'll bring on a whole lot of drama and pain for the woman you claim you just want to be happy.
Owen: You don't know anything about my history with Teddy.
Tom: Your history with Teddy...
Owen: Yeah.
Tom: ...is you chose Amelia. More than once. My history is, I love Teddy. I mean, I'm in love with her. And only her. And she deserves to be with someone for whom she is the first and the only choice.

Andrew: Look, I'm not some intern you can kick around anymore, all right? What you did today was unprofessional.
Alex: No, what you did today was unprofessional. The way you helped out Nora that should have been the first thing you did. But you're too pissed at the world about your dad. And believe me, I know what a number our parents can do on us. But you let it mess with your job today. And with my patient's really excellent mom. And it's messing with your relationship.
Andrew: My relationship? What does it have to do with that?
Alex: No, don't let it. Just don't. When people reach out a hand, you don't bite it. I did it for years. The only thing it gets you is they stop reaching out.

Meredith: I'm talking first because I don't do sitting at work wondering whether my boyfriend is avoiding me or being weird to me. It's just... I'm past that point in my life. I'm not interested in it. I have no time for it.
Andrew: I know. I ran out of minutes.
Meredith: What?
Andrew: The thing with my dad. I can't fix him, I can't help him, and I couldn't believe how much that hurt. And I needed a minute to be hurt. I didn't want to drag you down with me. I needed a minute, all right? But now, now I just need you.

See AlsoEdit

A complete overview of this episode's crew can be found here.

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