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Gunpowder and Lead

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“ Throughout history, traumatic experiences have caused physiological responses long after the events themselves have passed. Racing heart, pupil dilation, nightmares, panic attacks. Mesopotamian soldiers depicted these symptoms on cuneiform tablets over 3,000 years ago. Yet, post-traumatic stress disorder wasn't introduced as a diagnosable mental health condition until 1980. It's a lesson we learn in medicine time and time again: just because we don't have the words, doesn't mean the symptoms aren't real. Traumatic events are turning points. There's a before and an after. Sometimes, it's hard to remember who you were before. And it's even harder to figure out who you are after. But if you look for your people and hold them close, you will find your way again. ”

Gunpowder and Lead is the sixteenth episode of the nineteenth season and the 416th overall episode of Grey's Anatomy.

Short Summary[]

Amelia takes her personal problems out on her work colleagues, and the threats against Bailey come to a terrifying head. Lucas and Jules make a risky decision on a patient, and Mika struggles with burnout.

Full Summary[]

Winston works out at home.

Mika does exercises to fight her exhaustion. She came home at 3 AM after her shift at the bar. Lucas comes rushing down the stairs with clip-on ties with stethoscopes and diplomas on them, courtesy of his father to celebrate his achievements. Simone refuses to let him wear one of those at her wedding. Simone decides to take him shopping. The three of them leave for work.

Benson comes across Jules at the coffee cart outside and invites her to a new bar in his neighborhood. She comments it sounds like a date and declines.

As they arrive at work, Link and Scout show Jo and Luna that they have been learning the alphabet in ASL. Jo is upset because she needs more time to process.

Ben is at the hospital to sit by the side of a man he saved in a fire. Bailey offers to sit with him but he knows she has her own stuff. Bailey says they'll make it through this. Bailey then sees Addison in the NICU and goes to see her. Addison says she had to restock the PRT and she wanted to say hi to Bailey and Connor Marwood. Tia is doing better every day.

Levi has just cleared Matt's C-spine as Jules and Lucas come in. He injured his neck after taking a hit from a foam sword, a LARPing accident. If the CT is negative, they need to observe Matt to make sure the swelling in his trachea doesn't compromise his airway. Levi leaves and Matt asks the interns if he can go, too. He needs to get back to the park before sunset to usurp the game master. Lucas clarifies that his leaving could lead to actual death. Matt might be willing to risk it depending on the likelihood of his losing his airway. Lucas understands it's about a girl. Matt confirms it's about Princess Astrid of Dungeness. He has loved her for six years and today, he shall declare it.

Richard and Mika meet Russell Porter, who came in for a diagnostic colonoscopy. Russell is very nervous. Suddenly, he asks where he is and he doesn't recognize his wife. Richard orders a head CT.

Benson is taking Jonathan Cook's history. He says he's nauseous and is experiencing severe pain on his right side. He thinks it's kidney stones and says his kidneys have always been an issue. His right one was removed. Benson points out that's where his pain is. Jonathan corrects himself and says he mixed it up. Jonathan asks if Bailey is working today since he read she was the best for kidney issues. Benson will put in a page and get urine samples and X-rays.

Richard finds Mika doing jumping jacks as she awaits Russell's scan. Russell's bloodwork, including a tox screen, came back negative safe for anemia. Russell's wife Grace told Richard that he's been experiencing some mild brain fog lately, which she attributed to stress at work. The head CT is negative but the accompanying X-rays show bullets in his thoracic spine. Russell got shot 11 years ago at the grocery store. Mika lists Russell's symptoms: anemia, fatigue, weight loss, and now confusion. Mika will test Russell's lead levels.

As Bailey and Addison discuss Connor's progress, Bailey gets another anonymous call. Addison understands how the relentless harassing is causing her stress. Bailey hopes those lunatics move on before she has a second heart attack. Addison didn't even know about the first. Bailey says coming to see Connor helps. She's also glad Addison is here.

Richard introduces Russell and Grace to Owen and explains that all of his symptoms are caused by lead poisoning from the bullets. Russell says his surgeon told him it was riskier to take them out than to leave them in. Owen confirms that is usually the case because of scar tissue forming around the bullets that prevents the leakage of lead but in this case, the best course of actions appears to be to remove them. Once the bullets are removed, his lead levels will drop and his symptoms will gradually improve. Owen relates to his experience as a shooting survivor. It is a lifelong struggle but relieving some physical pain may also help relieve some of his mental struggles.

Mika knocks on the door of Amelia's apartment. She was sent by Richard and Owen to get her for a consult. Amelia gets up off the couch once Mika tells her she really has to pee. After Amelia has opened the door, Mika says it was a false alarm. Owen told her that Amelia is the only one who can help on the case. Amelia says she'll drive herself and shuts the door in Mika's face.

Levi checks on Jo, who talks about waiting on Luna's test results. She has all these decisions to make for Luna's future and she doesn't know how to make the right one. Levi assures her that she's a great mother. He makes her laugh by signing "butt".

Amelia runs into Addison. She thinks Meredith sent her to check on her. Addison's actually worried about Bailey but tells Amelia to spill. Amelia says her sisters moved and Kai left her so she feels abandoned. Amelia walks off for her consult.

She arrives in the imaging suite, where Owen, Winston, and Simone are planning a non-anatomical resection for the bullet fragments in the lung. Amelia comments on them starting without her. Mika arrives late. Amelia picks a fight with Winston over his using the words "assuming you can remove the bullet from the spine." Owen shuts her down. Winston says the plan is to flip the patient after Amelia has removed the bullet from the spine. Amelia is not a fan of Winston being in charge but she'll follow his plan. Once she's gone, Owen assures Winston that that was not about him.

Matt assures Jules and Lucas that he's feeling fine. He wants to take off but the doctors tell him he's not out of the woods yet. Matt doesn't want to wait another week to tell Astrid, whose real name he doesn't even know, but he knows all about her. Jules tells Matt he's not thinking clearly. Lucas thinks the whole ordeal may be causing him to think straight for the first time in years. Jules makes him get back into bed. She prefers to tell sad men the whole truth and takes Matt's shoes, which he can get back once she discharges him.

Benson walks Bailey to Jonathan, whose urine analysis and X-ray are negative. Since Benson knows all the next steps to definitively rule out stones, Bailey wonders why he paged her. Benson says he asked for her and informs her that the patient supposedly only has one kidney, even though he got the sides mixed up and doesn't have any surgical scars. Bailey introduces herself to Jonathan, who has been looking forward to meeting her. As Benson performs an ultrasound, Jonathan asks about her kids and her new place. He threatens Pruitt. Bailey says the ultrasound is negative and orders Benson to discharge Jonathan. She backs away as Jonathan jumps out of the bed, calling her a baby killer. He runs after Bailey until Benson tackles him and pins him to the ground.

Winston cautiously joins Amelia in the scrub room. He thought they got along well. Amelia says he let Maggie, one of the few people who cares about her, move to Chicago. He let his ego destroy what was once true love. Winston says that is an oversimplification. Amelia says Maggie will continue to rise and he will always be in her shadow. She may forgive his smallness, because she is great like that, but Amelia won't. Winston leaves while Amelia start to scrub.

Jonathan has been restrained in a trauma room, where Link is examining him. Outside the room, Benson checks with Teddy if his attack will go in his record. She makes it clear that the official story is that the patient fell while attacking Bailey, so Benson had nothing to do with it. Benson thanks her. Ben arrives but Teddy stops him from entering the room. She directs him and his manic energy to go and thank Benson.

In the OR, Amelia instructs Mika to better retract. She asks for another retractor but drops it. Amelia then throws her out of the OR and off her service. Owen thinks she is overreacting since they can easily replace the retractor but Amelia insists that Mika is no longer welcome on her service.

Simone tells Grace that the bullet in the spine has been removed. They will start on his lung soon. Grace starts crying and says Russell never told her much about the shooting before. He didn't want to feel it but she knows that he felt it because after that day, he didn't want to have kids anymore. She tried talking about it so many times because she knew the trauma would damage his mental health. Yet, she never thought it would kill him slowly, physically. Simone says they're working to stop that from happening. Simone sits with her for a few minutes.

Addison meets Bailey outside and hands her hot chocolate for good juju. Bailey throws the cup away in frustration. Addison tells her to yell at her and pretend she's all of the people harassing her. Bailey can't believe they would hurt a 4-year-old girl in the name of life. She knows they don't care about making the world a better place. They should be ashamed. They are what is wrong in the world. Her mother always told her to kill with kindness but she wishes she could kill them with the truth. Addison suggests there is a way to do both.

Benson is bragging to Stella Owens about saving Bailey. From a distance, Jules scoffs at his behavior. Lucas points out she seems jealous and says it's not a character flaw to want to be with someone. They then notice that Matt is struggling to breathe. Lucas calls a code blue. Jules starts CPR while Lucas preps to intubate. There is too much swelling so he decides to do a crike himself rather than wait for Levi. Jules advises him to put a bag of saline under Matt's shoulder to make it easier, as she once saw Owen do it. Lucas checks if anyone has eyes on Levi yet and then makes the cut.

Amelia leaves the OR. Winston tells Owen that Amelia is mad at him over Maggie leaving. Owen says Amelia is hardly fair when she is angry. Winston checks if Simone knows the next steps. She does so he invites her to perform the next step as, unlike Maggie, he believes she is ready. She correctly positions the stapler and fires it. The edges start bleeding and Simone freezes. Owen invites Winston to take over but he tells him to back off. He encourages Simone, who throws in some quick stitches to stop the bleeding. Her sutures hold.

Levi confronts Lucas and Jules outside of Matt's room and refuses to say whether Matt is okay. They should have waited. If Matt doesn't make it, Lucas's career is over. Jules defends Lucas by saying that Matt didn't have two minutes to wait for Levi's arrival. Levi adds that paying off student debt is really hard without a medical license. He then reveals that Lucas performed the crike well. He's admitting Matt to the ICU now. Levi tells them to remember this fear so they'll wait next time. Lucas thanks Jules for backing him. She says they couldn't let him die without declaring his love to a fictional character. Lucas asks if she is anti-love. Jules says she went to med school in Colorado because she had a crush on a guy in O-chem and he was going there. Her parents encouraged her to follow him because they think love is the only thing in the world. Jules failed gross anatomy because she was at the guy's birthday party rather than studying for the final. The guy then called her Jane and made out with her best friend. Her grades recovered but because surgical internships are competitive, which is why she's in the program for rejects and losers. Lucas points out there is a difference between an obsessive crush and actual love. Jules says he sounds like her mother.

Teddy finds Owen in her office. Owen tells her he removed bullets from a mass shooting survivor's lung and spine today. While they were doing that, there were two more shootings. He doesn't recognize his country anymore. Weapons of war are in everyday spaces and there are active shooter drills in third grade. Shootings happen so frequently they no longer blink at them. Nothing changes and he feels hopeless. Teddy comforts Owen. Addison comes in with a polarizing idea.

Mika finds Amelia and apologizes again. Amelia says she lost focus while her hands were inside a man's back so she should be apologizing to the patient instead. You can't let yourself get distracted when people are depending on you. As Addison walks up, Amelia continues to scold Mika relentlessly as Mika stammers that she didn't drop the retractor in the surgical field. Amelia genuinely wonders what is wrong with her. Addison cuts in and tells Mika to go. She drags Amelia into a supply room and tells Richard, who walks by, that she'll find him later.

In the supply room, Addison checks if Amelia is high or using again. Amelia says she's not sleeping well but swears she's not using. Addison loves her enough to tell her to pull her head out of her self-absorbed ass and get to an AA meeting. The world is already on fire and they don't need Amelia lighting more fires. She has to figure out a way to be of service to this broken world rather than continue down this spiral that'll end with her back in rehab, if she's lucky. No one has abandoned her. She loves Amelia and everyone is barely surviving, and it has nothing to do with her. She loves Amelia and she needs to stop the spiral or find someone to help her do that if she can't do it on her own. She loves Amelia and she needs to get off the ride before it's too late.

Teddy has gathered the surgical staff in her office because they are all worried for Dr. Bailey. How doxing is not against the law is beyond her. She knows, however, it is easier to hurt someone you don't know. Benson hands out lists of the most frequent callers. She asks everyone to call these people and talk to them in a respectful way so maybe they'll think twice about picking up that phone again.

In the ER, Jules tells one of the callers that Bailey would like them to know she's praying for them, too. Lucas walks by as he tells someone that Bailey respects their beliefs. Levi tells another caller that he is a better surgeon because of dr. Bailey being his teacher.

In the ambulance bay, Carina, Vic, and Maya are making calls as well.

In her office, Teddy tells a caller their prayers have been received and they are praying for them as well. Owen tells a caller he knows they can understand that dr. Bailey wants to keep her family safe. Addison tells another caller that Bailey is an incredible person and friend.

Winston and Link pass each other as they make another call in support of Bailey. Simone and nurse Linda are on the phone at the nurses' station.

Ben checks in on Bailey, who says she's feeling a little bit better.

A woman arrives in the ICU and tells Jules she's looking for someone whose name she doesn't know. Jules asks if she is Princess Astrid. She is. She's delighted to hear that Matt talked about her. Jules tells her that Matt is sedated right now but she's sure he'll be happy to see her. She takes her to his room.

Richard and Owen inform Russell and Grace that they removed every last piece of bullet. Russell is so relieved to finally be rid of those bullets, which he didn't know he hated so much. He starts crying.

Jo receives a phone call about Luna's results. She rushes to find Link and informs him that Luna is okay. She doesn't have cancer. It's just isolated hearing loss. They can learn sign language and technology has come a long way. She apologizes for having been an ass. They hug.

In the locker room, Simone tells the others that she performed a stapler lung resection today. Lucas talks about his emergency crike. Simone is amazed but the full story will have to wait till later as she leaves to take a call from Trey. Once she is gone, Lucas tells Jules that he needs her to be Simone's maid of honor. She accepts only when he offers to do all of her scut until the wedding. She comments he must really love her. Lucas replies she sounds just like her mother and leaves. Benson walks by and leaves with Stella, whom he's taking to the new bar.

A distraught Mika sits down at Joe's bar. Taryn watches her for a moment.

Teddy packs up for the day as Winston comes in. He wanted to make sure he is being considered for Chief of Cardio. Teddy will take it into consideration. As Winston walks off, a fierce Taryn enters. She says that nobody stood up for her when she burned out so she is standing up for Yasuda. If she can't afford to pay off her student loans and also eat and live while learning to save lives, there is something wrong with the system. The fact that is has been broken for a long time is no excuse not to fix it. As Chief, it is Teddy's job to figure out how to support her interns rather than using and abusing them and then throwing them out with the trash. She storms off.

As he walks to his car, Richard is video chatting with Maggie, who informs him that the lab is incredible and the people are nice. Her apartment is amazing. Richard then spots Amelia and tells Maggie he has to go to be a friend to Amelia. Maggie thanks him for looking out for her. Richard walks up to Amelia and says he is also in an alcoholic, self-obsessive spiral about abandonment. He could really use a meeting. She hugs him.

Bailey is helping Addison to re-stock the PRT. She still can't believe Addison drove out all the way out here for one day. She then realizes Addison was doing a wellness check on her. Addison says she couldn't stay away while Bailey is going through hell. They're in this together. Addison then finds a note addressed to her in one of the supply boxes. It reads, "This should keep you in business for a while. Keep fighting. Yang." Both Addison and Bailey are moved by Cristina's gesture and proceed to load the supplies into the PRT.

Cast[]

Main Cast[]

Special Guest Star[]

Guest Stars[]

Co-Starring[]

Medical Notes[]

Connor Marwood[]

  • Diagnosis:
  • Treatment:
    • Mechanical ventilation

Connor was still in the NICU after his premature birth. Bailey told Addison he'd been off the oscillator for three days and they were minimizing his vent settings.

Matt Ortega[]

  • Diagnosis:
    • Tracheal trauma
  • Treatment:
    • Cricothyrotomy

Matt was stabbed with a foam sword while LARPing. The sword damaged his trachea, so Levi ordered a CT. He told the interns that if the CT was negative, they should keep him for observation and make sure the swelling didn't compromise his breathing. He tried to leave because he had an event he wanted to get to, but they made him stay. Later, he lost his airway, forcing them to crike him in his room. Levi then admitted him to the ICU.

Russell Porter[]

  • Diagnosis:
    • Lead poisoning
  • Treatment:
    • Surgical extraction

Russell, 31, was in the hospital for a colonoscopy after unexplained weight loss and anemia along with a family history of colon cancer. Before they could take him for that, Russell suddenly got confused and panicked. Richard ordered a CT and a neuro consult. The lab work showed only anemia and minor renal impairment, but the CT showed that he had three bullets in his thorax. He said he'd been in a grocery store shooting eleven years prior. Richard realized he had lead poisoning from the bullets and that was the cause of his symptoms. Lab work confirmed this diagnosis. He'd been told it was riskier to take the bullets out, but Owen said the scar tissue that normally would have protected him hadn't formed, so they needed to come out. He was told after the bullets were removed, his lead levels would drop and his symptoms would fade, but it would take a while. They made a surgical plan to remove the bullet from his spine first and then flip him and remove the other two. The surgery was successful and Russell was stable and awake afterward.

Jonathan Cook[]

  • Diagnosis:
  • Treatment:

A patient came into the ER complaining of pain in his kidney area. He said he'd had his right kidney removed and suspected he had kidney stones, though he was holding his right side. When Benson questioned that, he corrected that it was his left kidney that had been removed. He asked for Bailey to treat him as he'd read she was the best in the hospital for kidney problems. The urinalysis and x-ray were negative and also showed that he had both his kidneys. He also had no surgical scars. Bailey came to consult on his case and quickly realized he had faked his symptoms to get to her so he could attack her. After Benson tackled him, he was restrained and examined by Link.

Luna Wilson[]

  • Diagnosis:
    • Hearing loss
  • Doctors:
  • Treatment:

Luna's test results came back and Jo learned that Luna had no tumors or cancer and her only issue was her hearing loss.

Music[]

Song Performer Scene
"That Fire" The Dane feat. Dawdy
  • Winston works out.
  • The interns get ready for work.
  • Simone tells Lucas they'll have to go shopping.
  • Benson asks Jules to go out with him, not on a date.
  • Link and Jo bring their kids to work.
"Right Here, Right Now" Judith Hill & GHARP
  • Bailey's people make calls on her behalf.
  • Ben comforts Bailey.
"How" Marcus Mumford (feat. Brandi Carlile)
  • Jules shows Greta to Matt's room.
  • Owen tells Russell and his wife the bullets are gone.
  • He gets emotional.
  • Jo gets Luna's results.
  • She runs to Link and tells him Luna's okay.
"Exhale You" biz colletti
  • Jules watches Benson and Stella leave.
  • Taryn watches Mika at the bar.
  • Winston puts his hat in for head of cardio.
  • Taryn tells Teddy that Mika's burning out.
  • Richard talks to Maggie, then checks on Amelia.
  • Bailey helps Addison load supplies from Cristina.

Notes and Trivia[]

  • This episode's title originated from the song Gunpowder and Lead, originally sung by Miranda Lambert.
  • This episode scored 3.35 million viewers.[1]
  • This episode features the 100th appearance of Barrett Doss as Victoria Hughes.
  • Kelly McCreary appears in this episode and retains her credit as series regular, while the previous episode was widely announced to be her final appearance as a series regular with only guest appearances scheduled later in the season.

Gallery[]

Episode Stills[]

Behind the Scenes[]

Quotes[]

See Also[]

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


References[]

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