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Before and After

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“ Every patient's story starts the same way. It starts with them being fine, it starts in the before. They cling to this moment, this memory of being fine, this before, as though talking about it may somehow bring it back. But what they don't realize is that they're talking about it to us, their doctors and that means there's no going back. By the time they see us, they’re already in the after. And while every patient's story starts the same way, how the story ends depends on us, on how well we diagnose and treat. We know the story hinges on us and we all want to be the hero. ”

Before and After is the fifteenth episode of the fifth season and the 93rd overall episode of Grey's Anatomy.

Short Summary[]

Addison needs Derek to operate on Archer, but after consultation, Derek cannot do it. Following a push from Sam, Derek changes his mind, even going as far as calling Archer a coward to let him do it. Cristina finds out Owen was previously engaged, and finds out more about Owen's past. Izzie arranges a game for the interns, in an attempt to remind them how much they enjoy medicine.

Full Summary[]

An ambulance arrives in the ambulance bay, where Derek and Richard are waiting. Addison gets out of the ambulance, followed by Naomi. Addison hugs Richard while Naomi hugs Derek. While Addison hugs Derek, Archer is unloaded from the ambulance. Addison tells Derek he was fine. They go inside.

Izzie is in the kitchen, using paper, glue, and glitter. The interns are broken and their punishment makes them hate medicine, so she's going to remind them it's not something to hate. Alex asks if this is a Denny thing. Izzie says it's about the interns. They're not losers. They need to have some fun and so does she. She asks where the scissors are. Alex says they're right in front of her. She holds up a glittery card and says it's going to be great.

While Richard and Derek are examining Archer. Naomi and Addison inform them about the parasite. Archer has a reaction to the meds so Derek asks to take him off the drip. Addison says that if he seizes again, Archer might have permanent brain damage. Derek says they'll have to hope it won't happen then. Addison doesn't like that. A nurse delivers the other med. Archer goes into V-fib. Derek slams onto his chest. Archer opens his eyes and gasps.

The interns heard about the guy with worms in his brain. No one knows the medical term. Richard tells them that Izzie requested them for a special project. Izzie tells them to all take an envelope, which they'll need for their first game. She says they'll have a lot of fun today.

Richard tells Alex, Cristina, Meredith, and George that he'll give them their assignments since Bailey's with Addison. He informs them that Addison's brother was admitted with parasites in his brain.

Derek's checking on Archer. Bailey cleared her schedule to be with Addison. Addison introduces her to Naomi. Derek comes out and tells them that Archer hates him. Derek wonders why Archer's girlfriend is not here, as he had a seizure during sex. Naomi says she is here. Addison enters Archer's room. Naomi doesn't know what she and Archer are. Derek asks about Sam. Naomi says he's good. Naomi asks about Meredith. She's good, too. Naomi says they're talking about his girlfriend. Everyone got divorced. She remembers the song Derek wrote for Addison. It made her think they were gonna last forever. Naomi says Sam misses him.

Callie is checking up on Rob. He didn't sleep well. Jen says that is her fault. She kept him because she was afraid her aneurysm was going to explode. Alex comes and says Derek and Meredith got pulled into an emergency surgery, so her aneurysm will have to wait. Jen and Rob tell Alex what happened. Jen wants Derek to operate on her sooner than later. Alex tells Callie that Addison's brother is the emergency.

Richard and Cristina are checking up on their patient. The man's daughter is worried. Beth, the daughter, says her father hates being helped. She asks her father to call her when she needs him and leaves. Once she's gone, he tells the doctors he has colorectal cancer. He's had polyps removed and had some radiation. He doesn't want his daughter to know. Richard asks Michael where he's been treated. Owen comes in and names the hospital. He then greets Michael, who says it's typical he waited until Beth's gone. Owen says Michael should tell her daughter, but Michael says he's not one to talk, as he broke off his engagement to Beth in a 2-line e-mail. Cristina is surprised.

Naomi and Archer are singing Derek's song as Meredith is in the room. Mark comes in, recognizing the song. Meredith's not bothered by the song, commenting it sounds fine. Archer's not looking forward to the surgery that Derek has to perform to remove the parasites. Derek comes in and says surgery is not an option. The single cyst from the previous scan has multiplied by eight. He can't navigate through that mess without rupturing one. That means Archer's going to die.

Izzie has gathered all the interns. In their envelopes is the name of a surgery. Their task is to drape their dummy patient accordingly. They all open their envelopes after she counts down and get to work. Izzie tries some trash talk to lighten the mood. Lexie finishes up. She's done well, so George gives her her next envelope. Sadie's done, too, but it's all wrong. She has to start over.

Addison finds Derek. He tells her there's no way. Addison says she put Derek in a tiny box after the divorce. She made him petty so that he could fit into the box. It helped her to get out of bed in the morning. Now, she has to take him out of the box because she has to believe he can save her brother. For today, he has to be a God.

Sam's at the nurses station, wanting information on Archer. Bailey overhears him talking and asks Sam what his relationship to Addison is. Sam introduces himself as Naomi's ex-husband. Sam doesn't know why he's here. She directs him to Archer's room. She tells him it looks like a difficult case.

Meredith tells Cristina that Archer's problem is probably inoperable. She tells Cristina about the song. Cristina tells her about Owen's ex-fiancée. Meredith tells Cristina to ask Owen if he plays the guitar, like Derek.

Lexie's next task is to ask Sloan for his symptoms and diagnose him. Mark flirts with her, but she says she doesn't do dirty flirting with him anymore. He reads his symptoms from Izzie's card. She loudly diagnoses anaphylactic shock as Sadie walks over. George says it's foul play as she heard Lexie's answer. She should keep some distance.

Owen knows Cristina has questions. Ryan comes over to ask Cristina about her symptoms. Cristina gives him the symptoms. He correctly diagnoses testicular cancer. Cristina ignores Owen and asks if Michael's in CT. Beth comes over, saying she wasn't doing any good at school, so she came back. She then sees Owen. She doesn't understand what he's doing here. He says he works here. She didn't even know he got back. She just saw his mother and even she doesn't know. Beth's been praying for him every night. She hugs him as Cristina watches. Owen pulls her off and walks away.

Bailey, Sam, Callie, Naomi, and Richard are watching Addison in the chapel. They can't believe she's praying. Addison can hear them. She is trying to pray, but she doesn't know how as she's a W.A.S.P. Callie joins her. Addison says God doesn't even know who she is, which sucks, because she could use some help. Callie shows her how to pray. She needs God's guidance. She kissed a female peds surgeon. She is perky and has a butterfly scrub cap. She's also really hot, so she wants help to get over the butterflies. Callie tells Addison she saves babies, so God knows who she is. Addison asks if she really believes. Callie says sometimes.

Derek's still watching Archer's scans. Sam comes in and tells him Addison's praying. He says she's in a midlife crisis. He also met Meredith. Derek says she's not his midlife crisis. She's a real thing. Sam is happy for him. Derek says he should have stayed in touch. Sam understands, as they all moved on. Derek says Addison is expecting a miracle, and he can't give her one. Sam says he may be too close to it. He asks how Derek would remove just one.

Sadie is checking up on Jen and Rob, with Alex, Izzie, and George watching. Jen and Rob wonder what the prize is for winning the contest. Izzie doesn't have one yet. Meredith comes in and Alex tells her what's going on. Jen asks if it's time for her surgery. Meredith says not yet, but it could be any time now. Sadie is doing an ultrasound on Jen, but she can't find the baby. Alex directs Sadie towards the baby's heart, as she was on the baby's ass. As they hear the heart, Izzie claps.

While's Michael's having scans taken, Owen tells Cristina he's not as big of an ass as he seems right now. Cristina asks if his mother knows he's back. She doesn't. 

Derek tells Archer he needs to deflate each cyst and then remove them one by one. Archer says they'll rupture. Derek will pull them up to the edge of the port with forceps and suction out the fluid. The suction would have to be really precise, but he thinks he can do it. Archer doesn't want to go down fighting. Derek calls him a coward, which is what neurologists are. They refer their patients to neurosurgeons and blame them if something happens, unable to handle the responsibility. Derek can handle the responsibility. The question is, can Archer?

Addison, Bailey, and Naomi are in the gallery. Down in the OR, Archer's been put under. Sam sits down and sees Bailey's filing documents for a peds surgery fellowship. Sam says she doesn't seem like a peds surgeon because she doesn't smile. Bailey says she's capable of smiling. Mark sees Bailey's documents and he's surprised too. Bailey tells them she has a child. She's going to be an excellent peds surgeon. Sam says she's going to need to keep that temper in check. Mark says it's weird to see Archer on the table. Sam uses his inhaler, which is almost empty. Bailey gives it to a resident and tells him to go refill it. Addison is waiting for Derek to say it. Derek looks up and says it's a beautiful day to save lives. Addison's relieved.

Michael tells his doctors that Beth can't handle bad news. Owen used to know that about her. Owen says she'll find out eventually. Michael starts coughing up blood and Cristina and Beth enter the room. Owen tells Beth it's a complication, but he needs surgery. He promises to keep her updated.

Derek has reached the cysts. He secures the first one and suctions out the fluid. Meredith puts the cysts in a petri dish and the parasite crawls out. Derek looks at Addison and moves on to the next.

Addison needs to be distracted. Callie says Mark is good at talking about himself. He talks about an endoscopy technique he developed, but Callie says he met someone. 

Rob's eating, but Jen can't eat since she may have surgery soon. Jen wants her surgery now. Alex yells to stop. She has to settle down or her blood pressure might go up, which is bad for the baby. Alex shows her their son's face with an ultrasound. She has to hold on to that.

In the OR, Cristina sees a tumor. Richard says Michael needs more aggressive treatment. He'll have to tell his daughter. Owen says he won't. Michael's been shielding Beth ever since her mother died. Cristina says that way, Beth will only find out when it's almost over. She deserves more than that, Cristina says.

As Derek's moving the last cyst, it ruptures too early. The parasite gets away. Archer becomes asystolic and the nurse starts the code clock. Meredith gets ready for the crash cart, but Derek says he has 2 to 3 minutes to find the parasite.

Addison and Naomi are watching as Archer's been down 2 minutes and 20 seconds. Derek finds the parasite, but as he grabs it with the scope, it starts to tear apart. Luckily, that's resolved by rotating the scope. He pulls out the parasite. Archer's heart rate goes back up. Derek thanks everyone.

Richard joins Alex, Izzie, and George at a nurses station. It can be any minute now. Izzie is still looking for a prize, but not too big since they still are punished. George says the interns are coming up from their last diagnosis. Alex grabs the tape to make a finish line. As he wants to hand over to Izzie, she reaches a few inches below the tape at first. She then grabs it and makes the finish line. Ryan, Lexie, and Steve come running from the other end of the hall. It's a three-way tie, but Lexie is the only one who has the right final diagnosis. Izzie cheers and Richard tells her the prize is scrubbing in on Derek's craniotomy for the doomsday sucker.

Owen finds Beth in the waiting room and tells her they removed the diseased parts of Michael's bowel. He's in recovery and she can go see him in about an hour. Beth tells Owen he doesn't even look like himself. He looks hard. She knows it wasn't easy over there and he can't just come back and be normal right away, but two lines in an e-mail? She deserves more than that. Owen tells her about her dad's cancer. He didn't tell her because he didn't want to burden her. He wants to shield her from pain.

Meredith and Cristina watch Derek, Addison, Naomi, Sam, and Mark laugh. It freaks Meredith out a little bit that Derek was this whole other person, like she doesn't know him. Cristina also doesn't know Owen. They don't know them.

George finds Sadie and says he's happy to help her. He knows how easy it is to get behind. She says she doesn't need a tutor. He says that at this point in her training, she should be able to hear symptoms and decide if the patient needs surgery. He wonders if she can do that, because they think she can, so she'll be in situations where she has to. Sadie walks off and George yells after her that she could hurt someone.

Owen takes Cristina into an on-call room. He says he calls his mother once a week, but he hasn't told her she's back. He can't bear the thought that the son she sent off to war is gone. If he went to see her, she'd be so sad and she'd look at him the same way Beth does, like he's not there. The only time he doesn't feel like a ghost is when Cristina looks at him. She sees him. This is him. He asks her to please see him. Cristina looks at him.

Derek informs Jen he has her scheduled first thing for the morning. Jen uses his first name as she's starting to consider them friends. She begs him not to make her wait another night. Derek tells Rob she's good. Rob knows, he can't say no to her either.

Mark finds Lexie and congratulates her, without any innuendo. Lexie asks Mark what a doomsday sucker is. Addison comes over and introduces herself to Lexie. Derek introduces her to Little Grey. Derek tells Addison he'll meet them at Joe's later as he has a craniotomy. He tells Lexie to go to OR 2, where she'll get to hold the doomsday sucker. As Addison is about to bring up Mark and Lexie, Mark blurts out Derek's proposing to Meredith. Derek leaves for surgery.

Alex finds Izzie in the residents lounge and asks her what's going on with her. She says she's fine. She proved the interns aren't losers. She repeats she's fine.

George and Meredith are watching Sadie talk to the Chief in a conference room. George tells Meredith that Sadie knows nothing, so he told her to tell the Chief or he would do it. He wanted to let Meredith know since she's Sadie's friend, although he doesn't get how they ever were friends. Sadie comes out and says she quit. She'd rather be deemed a quitter than a cheater. Meredith asks if she cheated her way into the program. Sadie says she's not book smart. She thought Meredith could pull her through. Meredith says they're not 25 anymore, sleeping their way through Europe. Sadie says they could be, though. They could get on a plane tonight. Meredith says no. She has to work. Sadie says they sucked the life out of Meredith. Meredith says she wants to be here.

Derek's operating as Lexie is holding the sucker. She notices they're mocking her. Derek swears and tells Lexie to get in there now. She starts sucking out a lot of blood. Derek places some clips, which restores good blood flow. They did it. That will teach him to never mock an intern again.

While Sam and Naomi are at the bar, Mark and Addison are sitting by a table. He says he's an ass. Addison says a little warning would have been nice before he blurted out the news. She'd expect some sadness, but she's okay with it. Maybe it's seeing Archer in that OR. Maybe it changed her perspective. Mark understands she wishes she'd been the first one, though. Addison wonders what to call Lexie, as they called Meredith a twelve year old. Mark says she's a preschooler. Mark's decided to tell Derek. Derek comes in and they all cheer. Addison hugs Derek and tells him he was a God today. But now, he needs to go back in the box. She asks about his craniotomy. He says it was fun. He also went to check on Archer, who's doing good. Naomi, Sam, and Mark come over and start singing his song from the beginning. They can't remember the chorus. Addison and Derek help them, a little reluctantly. Derek jokes this is why he doesn't keep in touch.

Back at the hospital, Jen is gasping for air. Alex yells to page Shepherd.

Cast[]

Main Cast[]

Special Guest Stars[]

Guest Stars[]

Co-Starring[]

Medical Notes[]

Archer Montgomery[]

  • Diagnosis:
    • Seizure
    • Neurocysticercosis
  • Treatment:
    • Surgical extraction

Archer was brought to SGH from Los Angeles to see Derek. He had neurocysticercosis, worms in his brain. Derek came in with the results of his CT and said surgery was not an option because the single cyst on his previous MRI had become eight and they were clogging the third ventricle. He couldn't navigate it without rupturing a cyst. Sam challenged him to figure out how to remove just the first one. He took it one cyst at a time. He said he would control the rupture of each one to extract it. He removed seven cysts easily, but the eighth cyst ruptured while he was moving it. Archer went into asystole, but Derek delayed started compression to find the worm and remove it. He was able to do so and Archer was stable after surgery.

Jen Harmon[]

  • Diagnosis:
    • Pregnancy
    • Aneurysm
  • Treatment:
    • Craniotomy

Jen's surgery was pushed back due to Archer's arrival at the hospital. Jen panicked briefly when Sadie couldn't find her son's heartbeat, but it turned out that she was looking in the wrong place. When they finally took her into surgery, there were complications, but Derek was able to finish the surgery. However, Jen later became unstable.

Rob Harmon[]

  • Diagnosis:
  • Treatment:

Rob was still in the hospital after his shoulder surgery. Callie examined his shoulder.

Michael Whitman[]

  • Diagnosis:
    • Inguinal hernia
    • Obstruction
    • Colorectal cancer
    • Dead bowel
  • Treatment:
    • Surgery
    • Bowel resection

Michael was in the hospital after passing out during dinner with his daughter. He also had an inguinal hernia, but that did not cause the obstruction. After sending his daughter out of the room, he told the doctors he had colorectal cancer. He'd had five polyps removed in three years and radiation. They sent him for a CT with contract. After CT, he started coughing up blood, so he was taken to surgery. In surgery, they found a tumor. They said he'd need more aggressive surgery. They removed a portion of his bowel that was dead.

Music[]

Song Performer Scene
"Emily" Keri Noble
  • Addison, Naomi, and Archer arrive at SGH, where Richard and Derek are waiting for them.
  • Izzie has come up with a plan to remind the interns that they love medicine.
"Gather to the Chapel" Liam Finn
  • Addison is trying to pray in the chapel.
  • Callie joins her and shows her how to pray by asking God to help her get over the butterflies on the scrub cap of the peds surgeon she kissed.
"Roll It" Shontelle
  • Alex, George, Richard, and Izzie are waiting for the interns.
  • They improvise a finish line as Lexie, Steve, and Ryan come running over.
  • Lexie is the only who figured out the final diagnosis, so she gets to hold the "doomsday sucker".
"Winter Song" Sara Bareilles and Ingrid Michaelson
  • Meredith and Cristina watching Derek, Mark, Addison and their friends. 
  • George offers help for Sadie as he's noticed she's way behind, but she declines.
  • Owen tells Cristina that he calls his mother once a week but hasn't told he's back because he's different now. Cristina is the only one who sees him for who he is now. He asks her to see him.
"Happy Ending" Slow Runner
  • Sam, Naomi, Mark, and Addison hang out at Joe's bar and Addison tells Mark she's fine with Derek having someone else now. Mark has decided to tell Derek about Lexie soon.
  • Derek comes in and Addison tells him he was a God today, but he needs to go back in the box.

Notes and Trivia[]

Grey's_Anatomy_5x15_Promo

Grey's Anatomy 5x15 Promo

  • This episode's title originated from the song Before & After, originally sung by Rush.
  • This episode scored 15.70 million viewers.[1]
  • This is the second part of the Grey's Anatomy-Private Practice crossover. The first part is the Private Practice episode Acceptance.
  • This episode marks the last appearance of Melissa George as Sadie Harris.

Gallery[]

Episode Stills[]

Quotes[]

Callie: (to Addison) You're an amazing doctor, you save babies. God knows who you are.
Addison: (to Derek) I need you to be a God.
Richard: You get to scrub in on Shepherd's craniotomy and hold the doomsday sucker.
Lexie: Yes! What's the doomsday sucker?
Izzie: (to the Chief discretely) Doomsday sucker?
Richard: It's just a really big sucker.
Sadie: You know, they've sucked the life right out of you. The Meredith I used to know...
Meredith: Is right here. I'm here. I just don't wanna sleep my way through Europe anymore. I wanna be here.
Meredith: What's wrong with her?
Cristina: Well, she calls her Dad "Daddy."
Meredith: No. What's wrong with her? Why is she in the hospital?
Owen: I call her, all right. I call my mother, once a week. I haven't told her I'm back, she thinks I'm calling from... I keep the conversation short because I can't bear for her to know that the son she sent off to war is gone. He's gone. And if I just got in my car and drove the six miles to see her, she'd be so sad. And she would look at me in the same way Beth does now. Like I'm not there. The only time I don't feel like a ghost is when you look at me, because when you look at me, you see me. You see me. This is me. This is me. Please, Cristina, see me. See me.
Callie: Dear God, I need your guidance. I kissed a peds surgeon.
Addison: You kissed a peds surgeon?
Callie: I never thought I'd end up with a woman, God, I mean not until lately, but that's not the problem. The problem is the peds thing. She's perky and has butterflies on her scrub cap, but she's also hot. Really hot. So, help me get over the butterflies. Amen.


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.

References[]

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