Grey's Anatomy Universe Wiki
Grey's Anatomy Universe Wiki

Surgeons are all messed up. We're butchers. Messed up, knife-happy butchers. We cut people up, we move on. Patients die on our watch, we move on. We cause trauma, we suffer trauma. We don't have time to worry about all the blood and death and crap it really makes us feel. Doesn't matter how tough we are, trauma always leaves a scar. It follows us home. It changes our lives. Trauma messes everybody up, but maybe that's the point. All the pain and the fear and the crap. Maybe going through all of that is what keeps us moving forward. It's what pushes us. Maybe we have to get a little messed up before we can step up.

Elevator Love Letter is the nineteenth episode of the fifth season and the 97th overall episode of Grey's Anatomy.

Short Summary[]

The pressure is on for Derek as his first surgery back is part of Izzie's treatment, while Alex and George individually try to cope with their feelings for Izzie, as her boyfriend and her best friend, and her diagnosis. Izzie knits, as is alone for the day because nobody comes to visit her. Owen's PTSD hurts Cristina again, this time more violently to the concern of Callie and Meredith. Mark, Karev and Lexie try to keep a patient alive although her family are fed up of her being "almost dead" every month. Derek and Meredith get a happy ending as Cristina loses her own happy ending.

Full Summary[]

Alex is pacing outside Izzie's room. Izzie herself is fast asleep. A nurse asks him if he would like to have cot set up for him in her room, but he says no. He's a doctor here. He returns to pacing.

Arizona and Callie are dancing at Callie's place.

Cristina has fallen asleep to a surgical video. Owen shuts off the light, covers her with a blanket, and stares at the fan on the ceiling. Owen's eyes close.

The next moment, he's on top of Cristina, choking her. Cristina is gasping for air and tries to break free. Callie is alarmed by the noise and comes in to check. Cristina then manages to break free and flees into the bathroom. Owen comes to his senses.

Meredith's phone rings. It's Callie calling her to tell what happened.

Cristina lets Meredith into the bathroom. Meredith sees her neck and says she'll kill Owen, but Cristina says she's fine and that it was just a nightmare. Owen knocks, wanting to know if she's all right. Cristina opens the door. Owen says he's sorry. He doesn't know what happened. Cristina tells him to look at her and assures him she's okay. She holds him as he cries and keeps repeating it's okay.

Meredith's having breakfast as Derek enters the kitchen. He sits down with her and gives her the ring. She says not like this. Today is about Izzie and his gift to save her. He can do it. Derek decides to go take a shower.

Cristina is wearing a turtleneck under her scrubs to hide her bruised neck. Meredith says this is not okay, and neither is Owen. Alex asks Meredith if Derek is okay to be back. Today is not just any patient, it's Izzie. Meredith says he's fine.

Callie sees Derek, Richard, Alex, Cristina, and Meredith walk by. George comes over and she's surprised he's not going to the big presentation with Izzie. George says he was the very last to know about Izzie. He wants to work and asks Callie if she has room on her service. She does. George takes a chart from her and walks off.

As doctors enter Izzie's room, Bailey tells Meredith, Alex, and Cristina that if they enter Izzie's room, they are her friends, not her doctors. She needs people to hold her hand as she's got enough doctors. They enter the room where Izzie stops knitting. Bailey tells Izzie they have a lot of surgeries and procedures lined up for the coming weeks. One of those surgeries will be removing mets from her liver. Also, Dr. Parker from OB will harvest healthy eggs before she undergoes any radiation so she has the option of having babies for later. Derek says their primary concern for today is the mets on her temporal lobe. Derek is surprised they didn't catch it sooner as it can cause intense hallucinations. Dr. Swender asks if they're done. She tells Izzie that there will be lots of surgeries even for the mets they already know about. Swender will administer chemo, radiation, and immunotherapy. The treatment will be aggressive and harsh, so Izzie should prepare herself. Swender will be overseeing every procedure Izzie has. She welcomes everyone to the cancer wing. The doctors leave. Izzie tells her friends to go save lives now. They leave for rounds, leaving her alone in her room, knitting.

Outside Izzie's room, Derek tells Alex it seems like the tumor hasn't grown since her last scans. Derek asks if he has any concerns. Alex wants him to keep Izzie's frontal lobe in her skull. Derek enters Izzie's room to talk about the surgery. Bailey asks Alex if he's coming, but he says he has to go as he's on an old lady.

Jackie introduces Mark to her brothers Luke and Tobin, who flew in this morning. Their aunt Joyce is very sick. Mark says it's time to say goodbye. Tobin wants to know what time frame they're talking about. She probably won't make it another day. Tobin has a flight to catch in the morning and he can't change it when it's past noon. Luke has to catch a plane tonight. Mark, Lexie, and Alex seem to find them a bit insensitive.

Cristina is walking with Swender, who's doubting about Derek. Swender reviews Izzie's labs and decides to go for IL-2. It's about as bad as it gets. Cristina doesn't want her to tell Izzie now as studies have shown telling patients bad news before surgery drastically increases their chance of complications. Swender says the news remains the same, whenever delivered, and she has time now. Cristina says she believes Izzie is down in radiology, so Swender has to wait an hour.

Richard paged Alex to talk about Izzie's eggs. Frozen eggs have a better survival rate when they're fertilized. It's a lot to digest so Alex can think about it. Alex asks for the cup.

Callie asks Meredith if Cristina is okay. Meredith says she says she is, but she doesn't believe her. Owen comes over, but Meredith blocks him from going over to Cristina.

Owen and Derek are on the helipad, where a helicopter brings in a patient with a massive head trauma following a motorcycle accident. Owen tells Derek it's good to have him back. Owen appears to be hypnotized by the rotor blades. It takes some time before Derek can get through to him. The patient's DOA.

Alex is staring at the cup in an on-call room. He gets paged.

Cristina is complaining about Swender having no vision. Meredith tells her Owen obviously has issues, but that doesn't mean Cristina has to stand by him. Cristina says it's like if he lost a leg or had a heart attack. She can't walk away just because he has war wounds. It's not as bad as Meredith thinks it is.

Alex and Lexie are shocking Joyce, successfully reviving her. Jackie and her brothers are disappointed. Alex calls them vultures. Tobin explains Joyce had one month to live, three years ago. They were crushed and they stayed with her for weeks and said their goodbyes, and then she stabilized. Ever since, Joyce has been in and out of the hospital every month. They always jump on planes and say their goodbyes again. Each time, Joyce winds up getting better. Everyone is ready for her to move on.

Derek and Owen are sitting in the ambulance bay. Derek tells him researchers are close to understanding the physical side of the psychological trauma that is PTSD. Owen asks what Meredith told him about last night. Derek says PTSD can be healed. Owen says he came back in one piece. Lots of guys came back with real injuries. Derek says he can help, but Owen says he's not the one who needs help here. He's not the one who took out half a woman's brain. He suggests Derek look in the mirror. Owen goes back inside.

Richard is outside the on-call room to check how Alex is doing. Alex would be better if he weren't out there listening. Richard apologizes. Meredith comes in and says she came in case Alex needed to talk. Alex says talking won't help. A cup with his swimmers won't make everything okay. Alex wonders if they'll even get a chance to use the frozen embryos. He wonders if Izzie will survive. Izzie told him she was seeing a ghost, but he's so used to crazy women in his life that he didn't think about it. This isn't how it's supposed to happen, how he wanted to do this. 

Cristina enters the vent room, but Owen's already in there. She says she hasn't seen him all day. He wonders what if he hadn't woken up. He has no memory of what happened. He would never hurt her, but he did. He doesn't understand how his hands could have been capable. Cristina tells him not to blame himself for something that's out of his control. Owen says they have to stop seeing each other. Cristina knows her limits. She'll decide what she can handle. She sees the scratches on his neck and leaves the room.

Izzie uses Bailey to measure the scarf she's knitting. Bailey thinks it's for Alex and says she hasn't seem him much today. Izzie says he's working like everybody else. She told them to do that. Bailey says she has a colectomy this afternoon. She asks what Izzie would do to divide the cecum. Bailey has decided not to let Izzie fall behind as she'll need to know how to do this a year from now. She really believes Izzie will be around then.

Derek's in the OR by himself, talking himself through the procedure. He's breathing heavily and staring at his hands, then decides to start over.

Richard's eating lunch in a conference room as Alex delivers the filled cup. Richard tells him to go talk to Izzie as they're basically conceiving a child today. Alex says he has done his part and leaves. Richard moves the cup away from his food.

The residents sit down in the cafeteria. Nobody knows how Izzie is doing, not even Alex.

Izzie's in her room by herself as Bailey comes in. She notices Izzie has finished the scarf. She asks if no one came up to visit. Izzie understands and she says Bailey doesn't need to keep checking on her. Bailey says she has to be there to start Izzie on her meds before the surgery. She talks about her colectomy. She found a mass inside the patient and talks about how they resected it.

In the chapel, Callie tells Arizona she wished Izzie dead for weeks. And now, it's happening. She wonders what kind of person would wish for this to happen. Arizona asks if she's praying for Izzie to die right now. Callie says no. She's praying for Izzie to live.

Joyce is coding again. Alex asks her nephews and niece to wait outside. He shocks Joyce and asks her not to give her family the satisfaction. He shocks her again, which revives her. Joyce opens her eyes and Alex introduces himself. He tells her she worked hard today. Joyce says her family is impatient. It's been a long time, but they always come. They are her people. People keep you going. People are better than no people.

Derek is scrubbing in with Richard by his side. Meredith comes in to give Derek his ferry boat scrub cap.

Derek follows Meredith out to the hallway. He needs her to say yes now, so it's regardless of the outcome of the surgery. She says she can't, not if agreeing to marry him will make it okay for Izzie to die. She loves him and he can do this. She knows he can.

Alex rushes into Izzie's room, but she's gone.

Izzie's on the table in Derek's OR. Izzie looks at him as he enters. He tells her he'll see her soon. She hopes so. Bailey knows so. Izzie tells Bailey the scarf is for her, in case anything goes wrong. Derek says it's a beautiful night to save lives. Bailey then puts Izzie under.

George is smashing a cast with a hammer. Callie doesn't get why he's not with Izzie, but he doesn't want to talk about it. He asked Izzie hundreds of time what was wrong and she ignored him, and when she actually needed help, she turned to Cristina, of all people. Callie says there's also the fact that his best friend might die on him. Callie takes the hammer from his hands. She says they're going to wait for Izzie, and he owes her this, because she wished Izzie dead because he slept with her. Callie knows him and she knows that he cares if Izzie lives or dies.

Meredith informs Alex and Cristina that the surgery has started. Intern Steve comes over and asks if the surgery has started. Meredith wants the interns to go, but Alex says they can stay as people are better than no people.

In the OR, Derek is ready to buzz the superficial temporal artery. He's going for tenting sutures. Bailey says he can take his time. Everyone here is on his side. Swender asks if they're gonna hold with all the friable scar tissue. Bailey trusts him as she saw him do it with even more friable tissue.

Lexie is shocking Joyce, but it's unsuccessful this time. Joyce is gone. Jackie thanks her. Suddenly, Joyce heart starts beating again. The family rolls their eyes and says it's never going to end. Lexie listens with her stethoscope and says it's just Joyce's pacemaker. She's really gone. However, Lexie has to get her superior as she's not authorized to call time of death in this situation.

Callie and George joins the others who are waiting for Izzie. Meredith once again says the choking is unacceptable, but Cristina bounces back that she's had a ring thrown in her face.

Mark shuts the pacemaker down and calls time of death. Lexie tells Jackie, Tobin, and Luke they can now leave and catch their plane. They actually want to stay a little while longer. They all start crying.

Richard asks the waiting doctors what they're doing. Alex says they're waiting for Izzie. Richard says he's scared, too.

Derek finds some of the Sylvian vessels are wrapped around the tumor capsule. He asks for a Penfield four, which surprised Swender. Derek is sure of his choice and finds his confidence.

Bailey goes to tell the doctors that Derek managed to resect all of the tumor. Izzie's going to be in the PACU for an hour, but she'll be fine. Everyone is relieved. Bailey tells Izzie's friends that that is not thanks to them. She tells them to do better tomorrow.

Richard wonders why Derek and Meredith aren't celebrating. Derek says Meredith turned him down twice. Richard says Derek showed her his dark side, but Meredith never struck him as someone who's afraid of the dark. Derek doesn't know. Richard says it was Meredith's idea to ask Izzie about harvesting her eggs. That shows that she was confident that Derek would succeed. Meredith believes in him. Derek then starts shaving off his beard.

Alex enters Izzie's room. He's crying and tells her he's right here. He takes her hand. Bailey, wearing her scarf, passes by outside the room.

Cristina tells Owen that Izzie's surgery went well. He wishes things were different. So does she. He asks if he can hold her. She lets him and they kiss. They take off their shirts and lie down on a bed, and proceed to have sex.

Meredith is about to get on an elevator, but Richard rushes over and tells her she can't take that one. He blocks her until the doors close. She pushes the button again. The other elevator arrives. Its walls are full of scans and files. Derek welcomes her as she gets in. He shows her Katie Bryce's CT. That was their first surgery together. Another scan shows a patient whose cerebral cyst they removed. It was tough, but they did it. After that surgery, he kissed her in the stairwell. Another scan is from the time Bailey kicked Meredith out of the OR because she caught them in his car. Another scan is from the time she held a clamp for 7 hours and never flinched. That's when he knew she was going to be a great surgeon. Also there are Beth Monroe's scans, the first patient to survive their trial. Meredith talked him into operating on her. That's when he knew he needed her. He finally shows her Izzie's post-op head CT from today. Her brain is tumor-free. Derek says that's because of Meredith, as she got him into the OR. If there's a crisis, Meredith moves forward instead of freezing, and she gets everyone else to move forward, because she's seen and survived worse. She knows they'll survive, too. Being dark and twisty is a strength, not a flaw. It makes her who she is. He won't get down on one knee to ask her a question. He loves her and he wants to spend the rest of his life with her. She says she wants to spend the rest of hers with him. They kiss.

Owen and Cristina are lying in bed. She doesn't think she can handle this after all. She's sorry, but lying her in his arm, she's afraid to fall asleep.

Owen's in the MRI. He apologizes to Derek for what he said earlier. Derek says it's all forgotten. Owen thanks him for doing this. Derek activates the scanner.

At home, Cristina is staring at the fan. Meredith enters her bedroom and tells Cristina she's engaged. Cristina says she broke up with Owen. Meredith lies down next to her.

Alex lies down in bed with Izzie. She wakes up and he tells her he snooched into a cup for her today. She guesses she should thank him. Meanwhile, Alex's voice over says that maybe going through all the pain that comes with trauma is what keeps you moving forward. Maybe we have to get a little messed up before we can step up.


Main Cast[]

Guest Stars[]



  • Frances Bay as Joyce Wallington

Medical Notes[]

Izzie Stevens[]

  • Diagnosis:
    • Stage IV metastatic melanoma
    • Liver mets
    • Skin mets
    • Brain met
  • Treatment:
    • Liver met resections
    • Brain met resection
    • DTIC
    • High-dose IL-2

Izzie had been admitted to the hospital to start her cancer treatment. They planned to resect her liver mets and harvest eggs from her ovaries. Derek also wanted to address her brain mets. He eventually took her into surgery to remove them. The surgery went well and was successful.

Callie's Patients[]

  • Diagnosis:
  • Treatment:
    • Hip replacement
    • Tibia/fibula repair

Callie told George she had three hip replacements scheduled that day, plus a tib/fib repair.

Joyce Wallington[]

  • Diagnosis:
  • Treatment:

Joyce's family was told she had less than 24 hours to live. She'd had surgery and was not doing well. She coded several times and was brought back before finally dying.

ER Patient[]

  • Diagnosis:
  • Treatment:

Owen and Derek waited on the roof together for a patient with head trauma. The patient was DOA.

Bailey's Patient[]

  • Diagnosis:
    • Tumor
  • Treatment:
    • Colectomy
    • Tumor resection

Bailey told Izzie she was doing a colectomy that afternoon and asked her questions about it. She later came back to tell Izzie that the surgery went well. She said that she found a tumor during the surgery which she resected.

Owen Hunt[]

  • Diagnosis:
    • PTSD
  • Treatment:

Owen had Derek do an MRI after Cristina told him she was afraid to fall asleep with him there because Derek had mentioned that you could see the changes in brains with PTSD.


Song Performer Scene
"Little Pieces" Gomez
  • Alex paces outside Izzie's room.
  • Callie and Arizona dance it out together.
  • Owen and Cristina go to sleep after watching a surgical video. Owen stares at the ceiling fan.
"The Weight of Us" Sanders Bohlke
  • Alex tells Meredith this is not how he and Izzie were supposed to make a baby.
  • Cristina and Owen talk in the vent room. She assures him she knows her own limits.
  • Bailey checks up on Izzie, who's knitting a scarf.
"That Home" The Cinematic Orchestra
  • Alex goes to Izzie's room and she is not there.
  • Izzie is in the O.R. with Derek and Miranda. She tells the scarf is for Miranda. Derek says it is a beautiful night to save lives.
"Rise Up" Ben Lee
  • Aunt Joyce finally dies and her family decides to stay a little while longer to say goodbye for real.
  • The residents and interns are waiting for Izzie, and Richard admits he's scared, too.
  • In the OR, Derek finds his confidence back.
  • Bailey tells the waiting doctors that Izzie is fine. She tells Izzie's friends to do better tomorrow.
"With the Notes in My Ears" Peter Broderick
  • Derek shaves off his beard.
  • Alex tells Izzie he's here for her. Bailey, wearing her scarf, watches from outside the room.
  • Cristina and Owen have sex in an on-call room.
"We Do What We Want To" O+S
  • Derek shows Meredith the scans in the elevator and proposes to her in the elevator.
  • She accepts his proposal.
  • Cristina admits she can't handle this thing with Owen after all as she's scared to lie in his arms.
  • Owen finally accepts Derek's help and gets in the scanner.
  • Meredith tells Cristina she's engaged, and Cristina tells her she broke up with Owen.
  • Alex lies down with Izzie and tells her about the cup. 

Notes and Trivia[]


Grey's Anatomy 5x19 Promo

  • This episode's title originated from the song Elevator Love Letter, originally sung by the Canadian band, Stars.
  • This episode scored 16.10 million viewers.
  • Goof: When Meredith is leaning on the OR Board while Izzie's in surgery, Izzie's birthday is written down as 06/23/81. Previous episodes indicate the episode takes place in 2009, which would make Izzie almost 28 years old. However, earlier in An Honest Mistake, she was stated to be 29.
  • While the Chief is eating, Alex hands him a cup of his sperm. After Alex leaves, a disgusted Chief moves the cup away from him with his fork. This is illogical as he uses the same fork to eat.
  • There's a deleted scene of this episode in which Alex, Meredith, George, Cristina, Callie and Lexie are waiting in Izzie's room for her to wake up. While they are waiting, Bailey walks by, wearing the scarf that Izzie made her.
  • Sara Ramírez and Jessica Capshaw were listening to "Single Ladies" by Beyoncé when they filmed the dancing scene.


Episode Stills[]


Richard: (knocking) Karev? Just checking in. Seeing how you're coming– ah, just seeing how you're doing.
Alex: I'd be doing a lot better if you weren't on the other side of the door listening.
Richard: Right, right. Sorry.
Meredith: (knocking)
Alex: I said go away.
Meredith: (entering anyways) You left the door unlocked. That's bold.

Alex: You think talking will help? You think a dixie cup of my swimmers will make everything okay? It's crap. This is crap! You just cant go messing with peoples heads like that! Even if she freezes the embryos you think, you think we'll get a chance to use them?! You think she'll still be here? You think she'll survive all this?! You think... I think.. She told me, she told me she was seeing a ghost, okay? And I'm so used to all the crazy chicks in my life that I didn't even... I'm a doctor. A doctor! And I didn't even think to... And now she's... This is wrong. This isn't how it's supposed to happen.
Meredith: I know.
Alex: It's crap.
Meredith: I know.
Alex: I hate this.
Meredith: I know.
Alex: This isn't... This isn't how we were... This isn't how I want to do this. This isn't how Izzie and I were supposed to make a baby.

Richard: Wait. Um. Wait. No. You can’t take that one.
Meredith: Why not?
Richard: I said don't take it.
Meredith: I will take the elevator I want to take.
(The Chief blocks the elevator doors. They close and Meredith presses the button for a new elevator. The other elevator doors open.)
Richard: Well go on.
Derek: Hey! Come on in. This is a CT of Katie Bryce. 15 year old female severed aneurysm.
Meredith: From a fall during rhythmic gymnastics, I remember.
Derek: It was the first surgery we ever scrubbed in together on right? Our first save. Right here is a cerebral cyst. Tough save, but we did it. I kissed you in the stairwell after the surgery. And this right here is where Dr. Bailey kicked you out of the surgery because she caught us in your driveway in my car. And right here, this was a 7 hour craniotomy and you held the clamp the entire time, never flinched. That’s when I knew you were going to be an incredible surgeon. Beth Monroe, made our clinical trial a success by surviving. You talked me into putting her under. That’s when I knew I needed you. And this is today. The post op head CT of Izzie Stevens. See that, right there? Tumor free. Because of you. You got me into the OR. If there’s a crisis you don’t freeze. You move forward. You get the rest of us to move forward. Because you’ve seen worse. You’ve survived worse. And you know we’ll survive too. You say you’re dark and twisty. It’s not a flaw. It’s a strength. It makes you who you are. I’m not going to get down on one knee. I’m not going to ask a question. I love you Meredith Grey. And I want to spend the rest of my life with you.
Meredith: And I want to spend the rest of my life with you.

Derek: You know, they're doing tests That show altered brain anatomy in patients with PTSD. They're actually getting close to understanding the physical side of the psychological trauma. It's amazing what you can see with an MRI.
Owen: What did Meredith tell you about last night? What did she say?
Derek: Post-traumatic stress is a real injury, Owen. It can be healed. There are resources. Vet centers, therapy... You shouldn't try and handle this on your own.
Owen: I came back in one piece. I have both arms, both legs. Lots of guys came back with real injuries. If the worst I have is a couple nightmares or freezing for a moment...
Derek: Is that what happened last night? You had a freezing moment? If you want, I can help.
Owen: Oh, yeah? I'm not the one who needs help around here. I'm not the one who cut out half a woman's brain, then ran off to hide. I'm not the one who half this hospital is talking about behind their back. So maybe you should spend a little less time worrying about me, and, you know, just take a look in the mirror, all right?

Cristina: I don't think... I can't handle it after all.
Owen: What? What do you mean?
Cristina: I'm sorry. I'm so, so sorry. But I'm lying here in your arms and I'm afraid to fall asleep.

Richard: Shouldn't you and Meredith be out celebrating or something?
Derek: She turned me down, twice. She says she understands. She forgives me for what happened in the woods, but...
Richard: So you showed her your dark side? Meredith never struck me as a woman who was afraid of the dark.
Derek: I don't know.
Richard: Do you know it was Meredith's idea to ask Izzie if she wanted to harvest her eggs, so Izzie could have a chance at the future she wanted? The future, Derek. She was confident you'd succeed today. Meredith believes in you.

See Also[]

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

The Grey Matter blog post on this episode can be found here.