|“||Ask most surgeons why they became surgeons and they usually tell you the same thing. It was for the high, the rush, the thrill that comes from cutting someone open and saving their life. For me it was different, maybe it was because I grew up in a house with four sisters. No, definitely because I grew up in a house with four sisters because it was the quiet that drew me to surgery. The operating room is a quiet place. Peaceful. It has to be in order for us to stay alert, anticipate complications. When you stand in the OR, your patient open on the table, all the worlds noise, all the worry that it brings disappears. A calm settles over you, time passing without thought. For that moment, you feel completely at peace. Ask most surgeons why they became surgeons and they usually tell you the same thing. The high, the rush, the thrill of the cut. For me it was the quiet. Peace isn’t a permanent state. It exists in moments. Fleeting. Gone before we even knew it was there. We can experience it at any time, in a stranger’s act of kindness, a task that requires complete focus or simply the comfort of an old routine. Everyday we all experience these moments of peace. The trick is to know when they’re happening so that we can embrace them, live in them. And finally let them go.||”|
When Isaac, the hospital lab tech, has an inoperable tumor wrapped around his spinal cord, he turns to Dr. Derek Shepherd to do the impossible, and Derek tests the Chief's authority when Richard objects to moving forward with the risky surgery.
Derek is getting ready for work while his voice over talks about why he became a doctor. Growing up in a house with four sisters, it was the quiet that drew him to surgery. He kisses Meredith, who's still in bed, and tells her to take care of herself.
Derek walks next to Cristina at the hospital. He heard she's a bit merger depressed, which is why he put her on his service. She needs a God, and he is a neuro God. She's not excited about his specialty, though a temporal lobectomy. They arrive at a gathering of personnel. Richard is giving a speech. Bailey informs Derek the Chief implemented a computer model to schedule their surgeries. Richard says he enlisted Mark to do a trial run for the last month. At first, Mark was against it, he says, but now he's a convert. Derek steps up and asks the other personnel if they haven't had enough change already. Change is good, Richard objects, so they better embrace it. While everyone disperses, Bailey tells Derek that he and Richard need to stop bickering, as it's unattractive.
Reed is stretching in the residents' lounge. Alex forces her to step aside. Cristina comes in and says Swender's office called her to inform her that Izzie's not called back to confirm her IL-2 appointment this week. Alex kind of doesn't care; she's crappy wife, but he's sure she'll show up as she's not an idiot. Cristina says the appointment is Thursday at 10, just so he knows. Reed tells him that being ditched by cancer wife doesn't change anything; she still thinks he's a douche.
Derek is staring at scans. Isaac, a lab tech who appears to be close to Derek, comes over with scans for a consult. It's an enormous spinal cord tumor that's worked its way all up the spine and has taken over the blood supply. Basically, the perfect tumor. Isaac informs him the patient still has leg function, which surprises Derek. With a tumor like that, the patient should be dead, or at least paralyzed. Derek would love to operate, but he'd have to cut the cord to remove the tumor, so he can't do it. He finally asks Isaac who's the doctor on the case. "You," Isaac replies. Derek can't follow. Isaac explains these scans are his and he wants Derek to try to remove the tumor.
Isaac says he ran an MRI on himself when the pain started to interfere with his work. He's been to every doctor, and each one of them was defeated when they saw the tumor. Derek, however, was inspired. Isaac took a job at this hospital just so he could meet Derek. He's looked up statistics and he knows Derek's the neurosurgeon who takes the most risks. Derek wishes he could operate, but he thinks Isaac will die. Isaac convinces him to take the scans and think over the matter. Cristina comes in to talk to Derek about a shunt, but when she sees the tumor, she says to screw the shunt and operate on the tumor.
Mark has joined Cristina and Derek, who is doubting if he should operate or not. He's taking a look at the tumor. Callie comes in; she's heard about Isaac. Cristina shows her the "awesome" tumor. Awesome in a bad way, Callie says. She can't believe he's actually thinking about taking out the tumor. Cristina says he should, as he's Shepherd. Arizona comes in too, having heard about Isaac, who helped her earlier this month. Mark doesn't know who Isaac is. Lexie comes in and tells them about a similar case she's read about, but the patient died, which is why the surgery only took 17 hours. Owen comes in too. Cristina wants them to all forget it's Isaac and just focus on the tumor, which may not even be inoperable. New scans appear on the screen. The tumor's even grown more. Richard walks in as they discuss the case and tells them to return to their own patients.
Derek walks into Isaac in a hallway and tells him he's not decided yet. He enters an X-ray viewing room, where Bailey's looking at the tumor scans. He asks her advice. She notices the tumor is dangerous, complicated and smart. This is the reason she got into medicine. Successfully taking out this tumor is something he could hang his head on for the rest of his career. He could retire on this tumor, she says.
Richard tells him not to try, as the tumor is a beast. A malpractice suit waiting to happen, even if the insurance is wanting to cover it. Derek mentions it's an employee's tumor, but Richard objects that their pro bono budget is not big enough to cover every employee with a serious medical issue. They're not a charity. Derek asks him what happened to him. There's been a time where Richard would've convinced him to try the surgery, and now his first instinct is no. Richard says he said no as the Chief of Surgery. As for his medical opinion, it's still no. There is such thing as an inoperable tumor and he's convinced this tumor is that. Richard won't allow the surgery.
At home, Derek tells Meredith he scheduled the surgery. He's going to take out the tumor.
Derek has gathered the residents in a skills lab to teach them about microsurgery. For this surgery, he needs residents who are naturals at microsurgery. He's set up a test for all of them. They need to guide a marker through a hole in a cup and draw a dot on a dollar while looking through a surgical microscope. The one whose dot is closest to the President's nose and doesn't hit the side of the cup wins. Steve goes first, but he fails. So does Reed and the following residents. Cristina is waiting her turn, confident she's a natural at microsurgery, while commenting on the others' attempts. Each resident disappoints Derek, until Jackson. He pulls it off correctly. Lastly, Cristina tries, but she fails too, which shocks her deeply. Derek tells Jackson he gets to scrub in.
Mark's heard on the surgical floor that Derek's gone rogue, scheduling a surgery against the Chief's will. Callie and Arizona come over too. Arizona thinks the Chief will freak when he finds out, but Derek says a computer schedule is saying he's doing craniotomies all day, so the Chief is not gonna find out. Arizona hushes him because she can't keep secrets from the Chief. Callie comments he's badass and disappears with Arizona. Lexie comes over, asking him why he's paged every resident to the skills lab but her. He didn't page her because he has another job for her. He needs somebody in the OR to remind him to take breaks, bend his legs, drink water. He'll be her patient, essentially. That is if Mark is okay to let her off his service. Mark happily does.
Lexie meets Jackson at the vending machines. She comments he must be nervous for the surgery too, but he asks why she should be nervous as Derek didn't even let her compete. Because he needs her to maintain his care while they're in the OR, Lexie reminds him. Instead of being his doctor, it sounds more like she's his bitch. Lexie tells him that he's gonna need to take breaks too and when he does, she'll be there to take over. He claims he doesn't take breaks. He's managed to do it before by not taking fluids long before the surgery. He wishes her a lot of fun playing nurse. As he walks off, a diaper in a supply rack catches Lexie's eye.
Cristina is on the phone with Meredith, talking about Izzie. She hangs up when she spots Lexie in the residents' lounge with the diaper. Lexie explains it's for the surgery. Cristina thinks it's a genius idea. It's the definition of hardcore. She'll guard the door so Lexie can put it on.
Jackson, Lexie, and Derek are wheeling Isaac to the OR. Lexie's diaper is visible and Jackson notices it. As they're about to pass by Richard, Derek warns them to keep their mouths shut, or they'll be fired. Richard says he was describing their new scheduling system to a few board members. He peeks onto the schedule and says Derek's patient must be Mrs. Taylor, who's undergoing a craniotomy. Derek says it's clearly Mr. Taylor, and that they should be going now. They continue their way to the OR.
Isaac is about to be put under. Derek tells him that if he gets in there and finds it's too complicated, the responsible thing is to close him back up. Isaac doesn't want him to close back up. He can cut his cord if he must. He survived a war and the deaths of his family. He's survived the loss of his country. He survived, and he will survive the loss of his legs if he has too. But Isaac wants him to know that there's always a way to survive. In the face of the impossible, they get inspired. Today, if he becomes frightened, he should become inspired instead. Now he's ready to be put asleep.
They've been in the OR for 1 hour and 13 minutes now. Derek is getting a first look at the tumor now. It's more intricate than the MRI showed. Derek starts thinking aloud, mumbling to himself. At first, Jackson and Lexie try to talk back, but they stop when they realize he's just talking to himself.
Owen sits down with Cristina in the gallery. He's sorry about the contest, which he heard about in the ER. Cristina doesn't want to talk about it. Watching Lexie wearing a diaper is punishment enough. Owen laughs at this, commenting that is a reason she should be glad she's not down there. But that is the reason she wants to be down there. She doesn't want to pee in a diaper, but she wants to have to pee in diaper. To be in a surgery so difficult and so long that her only option is to put on a diaper. She jumps up and questions if Derek is just gonna stare at it all day, as he hasn't made a single cut.
Derek is still talking to himself. Lexie thinks it's time for a break, as it's been 8 hours. He ignores her. Jackson says she can take a break if she needs one, but she says she doesn't. He starts teasing her about the diaper until Derek yells at them to shut up. He says he doesn't need a break but they can take one if they need to. Lexie runs out for a bathroom break as Bailey enters. She's sure this is a completely authorized surgery, but she wants him to know the Chief is scheduled to do a surgery across the hall shortly, so if he's planning on doing anything, he might want to do it soon. Derek thanks her.
Alex is on the phone with Swender's office, trying to convince them not to cancel Izzie's appointment. Reed comes over and says Shepherd's scheduled them to round on his patients. She proposes she take care of it on her own if he needs to take care of his Izzie stuff, but he thinks she's only proposing this so she can do a big neuro procedure in case something goes wrong. That makes her the douche. She says she at least tried be human, but now she says he can go ahead and throw away his marriage. He insists on rounding.
Mark, Callie, and Arizona have come together in front of Derek's OR. Mark says he told Derek not to try it. Arizona tells him not to be smug as it's one of their people's lives at stake. Callie says it must be depressing to stare at a spine for 10 hours, trying to figure out what to do. "What did you just say?" Richard asks. Callie takes back her words, so Richard asks Robbins.
Richard enters the OR. He asks if he's understanding correctly that Derek cancelled his patients to operate on the inoperable tumor. Richard reminds him that every second the patient's open on the table, the risk for infection increases, not to mention the thousands of dollars he's wasting standing there, doing nothing. So he demands that he closes Isaac up and relinquishes the OR. Derek agrees to close up.
Derek explains to Isaac that there was no way to take it out and he didn't want to cut Isaac's cord yet, as he's still walking. They can revisit the matter in a few months. Isaac understands he's tired, but he asks him to try again tomorrow. Derek says he can't try again. He can't fix this. Isaac tells him to go home and sleep on it. They'll talk more tomorrow.
Derek tells Meredith he just spent 10 hours in the OR, staring at the tumor without doing anything. He wants to hear about her day. She tells him about all things she did today, but they realize they both want to talk about the tumor. She admits she's a surgery junkie as he starts talking about the tumor. As it's too difficult to explain with words only, Derek pulls aside and takes a marker to draw the tumor on the wall, right under their marriage post-it.
The next morning. Derek is still talking about the tumor to Meredith. They still have not figured out a way to remove the tumor, but Meredith says that against all odds, Derek still didn't give up. There must be a reason why.
Derek is watching Isaac pray from outside the room.
Derek, Lexie, and Jackson are in a conference room with Richard. As the patient understands what it means to have his cord cut and as it's the only option to remove the tumor, Richard authorizes the surgery. Cutting the cord will only take an hour or two, Richard knows. He assigns Derek to OR 1, which Owen needs right after. He wishes him good luck. After Richard's left, Derek informs his residents they're not cutting the cord. The mistake he made yesterday is that he wanted a plan. Now, he figured he just has to pick a point and cut. Lexie reminds him of the risks, but Derek says Isaac wanted them to take the risks. It's their job to try. Derek says he'll see them in the OR and leaves. While Lexie thinks this is very bad, Jackson is impressed by how badass Derek is. Jackson wishes her good luck with "her patient". Lexie says she'll wear a diaper again today if helps get Shepherd through his surgery. Her diaper is hardcore and she's gonna wear it with pride. She'll pee in it, because she is a surgeon and this is America and she'll do what needs to be done. So he can kiss her hardcore, diaper-wearing ass.
Cristina meets Owen in front of the OR board. He's assigned her onto his surgery, a 12 hour surgery, 15 if things get bad. Cristina walks off happily as Derek comes over to ask Owen for a favour.
Lexie and Cristina are on their way to their ORs, both wearing diapers and smiling at each other. However, Owen walks up to them and informs Cristina that Derek needs their OR. Extremely disappointed, Cristina walks off.
As Derek is about to make the first cut, Mark walks in. He heard Derek needed support. It was Lexie's idea. She figured he needed people to talk to, experienced surgeons. Derek thanks her and starts. He makes the first cut. One vessel down, many more to go.
Reed and Alex are doing rounds. Reed notices that Alex checks his watch and asks him to speak with her. She tells him he needs to go, as he's checking his watch every 5 seconds and he's distracted. She'll finish up here. He objects, but she doesn't let go. He says Izzie doesn't want to see him, and that she even left him a note instead of telling him to his face. So he wants Reed to stop acting like she knows anything about his personal life and let him get back to his job. Reed says that's fine if he's sure about that, but he better be sure because right now, he is making a choice, not Izzie. He better be at peace with that. Alex thinks over what she just said and walks off.
In the OR, there's bleeding, which may mean Derek just paralyzed the patient. Cristina is sitting in the gallery, on the phone with Meredith, updating her on what's happening. Just when Derek wants to cut the cord, Mark informs him the amplitude's back up. They're relieved, as this means Isaac isn't paralyzed. Derek asks someone to take off his mask. Lexie quickly does, right before he throws up.
Mark tells Derek to take a breath and get back in there, but Lexie forces Derek to drink first.
Alex is waiting in the immunotherapy room, but Izzie is not there.
Owen walks into Richard, who thought Owen was supposed to be in OR 1. Owen says he swapped with Torres, who had an emergency laparotomy. "What am I doing?" Callie says as she comes over, having heard her name. Richard puzzles together Derek didn't cut the cord and walks off. Callie thinks Bailey will stop him at the door, but she's in the OR with Shepherd. Arizona is guarding the door now. Arizona body blocks Richard and refuses to move. She stands up to Richard, successfully. Callie comments she totally thought it was gonna end differently. "Yeah, more like that," Callie says as Arizona starts crying because of her authority issues.
Bailey is standing by the door on the inside of the OR, but she refuses to inform Derek on what happened as anything outside of the OR is none of his concern. She urges him to keep going.
Hours later, Derek swears as he can't figure out which one of the vessels feeds the cord and which one feeds the tumor, so he has to do a blind cut. If he cuts the wrong one, the cord strokes out. He decides to come back to this later, so finishing the entire surgery, only to have the possibility of cutting the wrong one in the end. Then it's all been for nothing.
After 21 hours of operating, there's less than 2 inches left, which means they still have four to five hours ahead. Suddenly Jackson swears. His hand is cramping, but it's absolutely necessary to keep his hand entirely still. Lexie reaches in and applies pressure on Jackson's hand to stop the spasm. Derek asks Jackson if he's had a drink today. Muscle spasms are a result of dehydration. Derek knows he didn't take any fluids so Lexie couldn't get her hands on the retractor. Jackson apologizes, but Derek tells him to step aside so Lexie can take over. They switch positions.
Five hours later, Derek is all done. Only the blind cut is what's left now. He asks the residents A or B, but they don't want to gamble. Sloan says it's his call.
Arizona, Callie, Cristina, and Owen are in the gallery, closely watching his every move and waiting for him to decide. Cristina is still on the phone with Meredith.
Derek takes a moment to decide and makes a cut.
Meredith is dying to find out if it's the right one, but Cristina doesn't reply.
Derek is sleeping next to Isaac's bed. Isaac's waken up and wiggles his toes and starts yammering. Derek wakes up too and asks what's up. Isaac is sad because he can move his toes, thinking Derek again didn't do anything. Derek informs him the tumor is gone. They saved the cord. The surgery was successful. Isaac is extremely relieved and can't believe he's going to be okay. He says Derek is a very good man.
Alex is still sitting in the immunotherapy room. Reed comes in and says Derek finished the surgery and that she finished rounds, so they're all good to go. A crying Alex says Izzie didn't show. He can't believe Izzie is being this stupid. She didn't show up for her IL-2, which saved her life. Reed doesn't seem to know if she should comfort Alex or not.
Cristina is in the skills lab, still practicing on the microsurgery test. Owen comes in and instructs her on how she can pull it off successfully. So she does.
Richard is manually filling in the OR board. Derek comes over and says they can't keep doing this. He's tired of fighting Richard. He can put it behind them if Richard can do it too. Richard turns around. "You're fired," he says. Immediately. Derek tells Richard to go home and sleep on it. They'll talk more tomorrow.
Derek comes into the bedroom with champagne and two glasses. He crawls into bed with her. She's almost heard everything from Cristina, but she wants to hear his version too. She wants him to tell her everything, but Derek's fallen asleep. She opens the bottle and looks at the drawing on the wall in front of her.
- Ellen Pompeo as Dr. Meredith Grey
- Sandra Oh as Dr. Cristina Yang
- Katherine Heigl as Dr. Izzie Stevens (credit only)
- Justin Chambers as Dr. Alex Karev
- Chandra Wilson as Dr. Miranda Bailey
- James Pickens, Jr. as Dr. Richard Webber
- Sara Ramírez as Dr. Callie Torres
- Eric Dane as Dr. Mark Sloan
- Chyler Leigh as Dr. Lexie Grey
- Kevin McKidd as Dr. Owen Hunt
- Jessica Capshaw as Dr. Arizona Robbins
- Patrick Dempsey as Dr. Derek Shepherd
- Temporal lobectomy
Derek said he had a temporal lobectomy scheduled for that day.
- Reed Adamson (surgical resident)
Reed said she was in surgery all night sewing a hang-glider's intestines back together.
- Tumor resection
Isaac came to Derek to remove his spinal tumor. Derek said the only way to do it would be to cut the cord and paralyze the patient, but he agreed to do the surgery and said he'd attempt to do it without cutting the cord. When Derek took him in, he said to go ahead and cut the cord if he needed to. Over an hour into the surgery, Derek had opened the dura, but done nothing else. Eight hours in, he still hadn't made a cut. After ten hours, Richard made him stop and close. Derek said that the only way he saw to do it would mean cutting the cord, which he wouldn't do because Isaac still had leg function. Isaac told him he wanted him to proceed anyway. Derek drew a picture of the tumor on the wall in order to look for inspiration. He lied and told Richard that he'd cut the cord in order to get Isaac back into surgery. He said he just needed to pick a point and cut, which he did. He got to the end point and had to cut one of the two vessels, one of which fed the tumor and one of which fed the spinal cord. He just had to cut blindly. He did it and it was ultimately the correct choice. He woke up after the surgery and was able to move his toes. He initially thought Derek hadn't finished the surgery, but Derek told him he had and the tumor was gone.
- Arizona Robbins (pediatric surgeon)
Arizona said that Isaac had diagnosed an osteosarcoma for her a month prior.
- Retroperitoneal sarcoma
- Tumor resection
Owen invited Cristina to operated with him on a redo retroperitoneal sarcoma. The surgery was pushed back for Isaac's second surgery.
Derek's Other PatientEdit
- Alex Karev (surgical resident)
- Breathing treatment
Alex was rounding on Derek's cancelled craniotomies. One was wheezing, so Alex ordered a breathing treatment.
|"Moon and Moon"||Bat for Lashes||
Notes and TriviaEdit
- This episode's title originated from the song Give Peace a Chance, originally sung by John Lennon.
- This episode scored 13.74 million viewers.
- Just before Chief Webber fires Derek, we see him writing on the O.R Board. He was assigning Derek to a crainotomy on a John Doe.
- This is the first episode to be directed by Chandra Wilson, the actress who portrays Bailey.
- This episode is the first to feature a special opening title card, displaying the scan of Isaac's tumor in the background.
- Lexie: Hey, I wore a diaper yesterday, yes. And I will wear one today. If it helps get Dr. Shepherd through this surgery, I will wear a diaper, 'cause my diaper is awesome. My diaper is hardcore. You wish you had the balls to wear my diaper. I'm gonna wear it and I'm gonna wear it with pride. And if I have to pee in it, oh, I'll pee. Because I am surgeon. This is America, and I will do what needs to be done. So, you can kiss my hardcore, diaper-wearing ass.
- Bailey: You two need to stop bickering, it's unattractive.
- Derek: You need God. Neuro God, right here.
- Cristina: Godly? Your entire day consists of putting shunts in people.
- Cristina: (to Lexie) Hey, you know what, don't try to Lexipedia your way on this. This is my tumor.
- Bailey: Everyone had said you found the great white of tumors, but I just had to see if for myself.
- Derek: And now that you have?
- Bailey: You want my fellow attending answer or my fellow surgeon?
- Derek: Fellow surgeon.
- Bailey: This tumor is dangerous, complicated and smart, beautiful. This tumor is the reason why I got into medicine in the first place. To successfully take out this tumor would be an achievement you hang your hat on for the rest of your career. You could retire on this tumor.
- Derek: Isaac, if I get in there and it looks too dangerous to remove, the responsible thing to do is close you back up.
- Isaac: No, don't close me up. If you get in and it's too complicated, cut the cord. Paralyze me if you must. I survived a war did you know that? I survived a war where they put bodies in to mass graves where there was once a playground. I survived the death of my family, my parents, my brothers and sisters. Then I survived the death of my wife and child when they starved to death in a refugee camp. I survived the loss of my country, of hearing my mother tongue spoken, of knowing what it feels like to have a place to call home. I survived. And I will survive the loss of my legs. If I have to, I'll survive it. Okay? But Derek, there is always a way when things look like there's no way. There's a way to do the impossible, to survive the in survivable. There's always a way. And you, you and I have this in common. We're inspired. In the face of the impossible, we're inspired. So if I can offer one piece of advice to the world's foremost neurosurgeon. Today, if you become frightened instead become inspired. Okay, I'm ready now. Put me to sleep.
- Cristina: (about the surgery) No, that is the reason I wanna be down there. Lexie gets to pee in a diaper and I don't.
- Owen:You want to pee in a diaper?
- Cristina: Oh, God. No. I want to have to pee in a diaper. To be in surgery so difficult and so long that my only option is to put on a diaper and pee in it.
- Meredith: I admit it. I'm a surgery junkie.
- (When the Chief finds out that Derek is performing the spinal surgery on Isaac and Arizona is blocking the door so he can't come in to the operating room.)
- Arizona: (standing in front of the door) No, no, whoa, whoa, whoa!
- Richard: Move!
- Arizona: No!
- Richard: Dr. Robbins!
- Arizona: I said no. Dr. Shepherd is operating on the inside of a man's spinal cord right now. Even the most minor disturbance could cause him to make a mistake on that patient- a patient who happens to work here, and whose life I personally would like to see Dr. Shepherd save. So no... you don't get to go in there and be a bully. Not today, Chief, not on my watch.
- (The Chief turns and walks away; Arizona is in tears)
- Callie: Okay, I totally thought that was gonna end different. (Arizona starts sobbing on her shoulder) Yeah, more like that.
- Cristina: (to Owen) Look at your hands, they're hams. Mine are tiny little geniuses.
- Derek: We can't keep doing this, Richard. I'm tired of fighting you. Let's just put this behind us and move on. I can, if you can.
- Richard: You're fired. Immediately. Get the hell outta my hospital.
- Derek: Go home. Sleep on it. We'll talk more tomorrow.
A complete overview of this episode's crew can be found here.
The Grey Matter blog post on this episode can be found here.
|Grey's Anatomy Season 6|
|#01||"Good Mourning"||#09||"New History"||#17||"Push"|
|#02||"Goodbye"||#10||"Holidaze"||#18||"Suicide is Painless"|
|#03||"I Always Feel Like Somebody's Watchin' Me"||#11||"Blink"||#19||"Sympathy for the Parents"|
|#04||"Tainted Obligation"||#12||"I Like You So Much Better When You're Naked"||#20||"Hook, Line and Sinner"|
|#05||"Invasion"||#13||"State of Love and Trust"||#21||"How Insensitive"|
|#06||"I Saw What I Saw"||#14||"Valentine's Day Massacre"||#22||"Shiny Happy People"|
|#07||"Give Peace a Chance"||#15||"The Time Warp"||#23||"Sanctuary"|
|#08||"Invest in Love"||#16||"Perfect Little Accident"||#24||"Death and All His Friends"|
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