|“||When something begins, you generally have no idea how it’s going to end. The house you’re going to sell becomes your home, the roommates you were forced to take in become your family and the one night stand you were determined to forget becomes the love of your life. We spend our whole lives worrying about the future, planning for the future, trying to predict the future, as if figuring it out will somehow cushion the blow. But the future is always changing. The future is the home of our deepest fears and wildest hopes. But one thing is certain when it finally reveals itself. The future is never the way we imagined it.||”|
- 1 Short Summary
- 2 Full Summary
- 3 Cast
- 4 Medical Notes
- 5 Music
- 6 Notes and Trivia
- 7 Gallery
- 8 Quotes
- 9 See Also
Izzie spends some time with a fellow cancer patient while contemplating whether or not to undergo a risky surgery, as Mark is ready to take his relationship with Lexie to the next level and a patient makes Owen reassess his place at Seattle Grace.
Meredith wakes up the morning after what was supposed to be their wedding day. Derek is lying next to her. He has been thinking all night on how to remove the tumor from Izzie's brain. He's smiling because he figured out how to do it. Once Izzie is cured, they'll go to the Bahamas and get married on the beach.
Izzie and Alex are walking through the hallways. She's having a good day, which is good because this is their honeymoon. She's taking him to her patient friends. She walks in the room and yells that she's a bride. Everyone applauds. Izzie introduces everyone. Alison asks to turn around so they can see his butt. Alex refuses, but Izzie manages to make him do it. Quality booty, according to Alison. She congratulates her.
Owen talks to Cristina about the shrink session this morning. She asks if they talked about his mom. Cristina wants him to go see her, as she still believes he's in Iraq. He's been planning to go see her, but still doesn't know when. Cristina walks away. George comes over, asking if he's not on trauma today. Owen asks him to follow him.
They enter an exam room. The patient is a soldier too and has been referred to Owen by his CO. Callie has already been looking at the patient's scans. Callie can't see anything functionally wrong with the leg, but the patient insists he cannot move without experiencing serious pain. He's tried everything so far. Callie suggests pain management, but there's nothing she can do surgically. There is, he says. She could cut it off and replace it with a prosthetic, so he can go back to Iraq.
Callie leaves the room with Owen following her. He doesn't think it's an unreasonable request. Callie thinks cutting off a healthy limb is dismemberment. Owen defends the patient, who has been lieutenant since he was 19 and has planned to stay in the army for the rest of his life. Callie questions if they'll take him back with a prosthetic. There have been cases like that, although Owen is not sure the amputation was voluntary in those cases. Owen doesn't want to send this patient away, as his CO referred him to Owen. George proposes another scan and an epidural for the pain, to which Callie agrees. She does say that she's not going to cut off a healthy leg.
Arizona meets Bailey and asks if she's busy today. Depends on Arizona, maybe she has more dying children Bailey can get overly emotionally detached on. Arizona asks her to scrub in on an 8-year-old with a neuroblastoma. She's confident he's going to live, so she can feel the joy. Richard interrupts and asks her to borrow her.
They walk down a stairs to the ORs and he asks her who Santa Claus is. She gives him a description of the typical Santa Claus image, but he says he is Santa Claus as he opens a door, revealing a Da Vinci Surgical System. Bailey cannot believe her eyes. He allows her to try it out.
Mark goes to talk to Lexie. With Meredith and Derek getting married soon, they have to move out of the attic. He wants to start looking for a condo. Derek is listening from a distance. Lexie says it would be great if he finally had a place of his own. He was actually thinking she could come with him. Absolutely, she would love to see. She says she's happy for him as she leaves with her charts. Derek hums and Mark asks how much he's heard. Derek says he was there for both him asking her to move in with him and her shutting him down. He finds it's too early for the two of them to move in together and says Mark just wants to do what Derek does. Mark claims he's thinking about his own future as life is short, setting Izzie as an example. Derek says he has a plan for Stevens.
Dr. Rebecca Swender asks Derek if he wants to remove her hippocampus. He's done the surgery before, but there's a risk she might lose her memory. It's unlikely, but it might. Dr. Swender points out she may not be able to practice medicine anymore and offers not to have the surgery and shrink the tumor with IL-2, if the tumor doesn't kill her first. There will be a test prior to the surgery to see how much her memory would be affected. As Derek and Rebecca start bickering, Izzie closes her eyes and envisions herself and Denny lying on a beach.
He compliments her ring. Izzie says they're going to have beautiful kids. She wants four, two boys and two girls, one of which has to be a tomboy. She wants to have them close together, but that might be stupid. However, it would keep her busy if she's not able to practice medicine anymore. She wouldn't want to anymore, Denny says. Izzie asks why he keeps agreeing with everything she says. Because he is her. He's her tumor, she's talking to herself. At least until she has the surgery, if she has it.
Izzie, Alex, Cristina and Meredith are walking, weighing Izzie's options. She asks Alex to tell her what to do, as it's a husband's job to tell his wife what to do, but he claims it's his job to support her in what she wants to do. She doesn't know, which is why she's asking him. She wants to put it to a vote, but they don't agree. She begs them to decide for her. Alex says she can still think about it, but she doesn't have time.
The patient asks Owen if he'll be able to return to Iraq. George questions why he would want to cut off his leg to return to the war, asking him about his family. Charlie says he has family that doesn't get and know him, which is his biological family, and he has his guys in Iraq, whom he thinks off as his real family. They're always in things together, but here, he's alone. He has tried acting as a regular person here, but it doesn't work out for him.
Rebecca shows Cristina the scans of Alison Clark. Even after extensive surgeries and chemo, the mets came back. Now with IL-2 therapy, after three months, the mets are gone. Rebecca says that Izzie should give it a chance. As surgeons, they like to cut, but sometimes, there's a better way.
Bailey and Richard are operating with the Da Vinci system. Bailey has nicknamed the machine Leo, after Leonardo Da Vinci. It feels good operating with the machine, and Bailey starts making lightsaber noises, but she stops as Richard notices it. Richard tells her that a doctor at the Cleveland Clinic is doing single incision gallbladder removals through the belly button. They could try that on the next one. She's all in for that, and returns to her lightsaber noises.
Cristina has talked to Meredith about the IL-2. Meredith agrees it's impressive, but Izzie may not have 3 months. In fact, that tumor could start bleeding in 3 days, or 3 seconds. Meredith asks since when Cristina doesn't want to cut. Since it's not in the best interest of the patient, Cristina says. Meredith points out Derek is also trying to act in Izzie's best interest. Derek comes in, saying that they're ready for them in radiology for the memory test.
Izzie has to try to remember the series of images Meredith is going to show her when Derek puts the right side of her brain to sleep. Izzie exaggerates a little by searching for a specific race for the dog, the type of the plane and specific style of the house. Derek puts the right part of the her brain to sleep while Izzie keeps on whispering "dog, plane, house". As the part of the brain sleeps, Izzie can't answer Meredith's question of what she has seen. She can't even say what she sees on the cards as Meredith's shows them again. Meredith then asks Izzie what her name is, but Izzie can't even repeat Meredith after her. She doesn't even know who Alex Karev is. This is what Dr. Swender was afraid for.
After the test, Dr. Swender informs Izzie that the test impaired her memory to such a degree that she strongly recommends not to have the surgery. Derek says it was just the worst case scenario and has nothing to do with the surgery. Not operating is as risky as the surgery itself, if not more. The choice is up to her. Izzie asks Alex's opinion. Derek leaves them to think about it, but Alex has some more questions so he leaves the room. He tells her to think about what she wants for a second. Meredith closes the door and says Izzie is not having the surgery.
Alex asks Derek to talk to him as a friend and to tell him what to do. Derek can't do it. Alex asks what he would do if it were Meredith. Spending a few more months with her, knowing she was going to die, or spending the rest of his life with someone who looks like Meredith but isn't Meredith anymore. Izzie is the one good thing that happened to him, so he needs to know what he would do. He would ask her to have the surgery.
Back in Izzie's room, Meredith tells Izzie she didn't know the names of anyone she cares about. She couldn't even speak. The tumor is sitting right in the middle of everything what makes Izzie Izzie. During the test, she wasn't Izzie anymore. Meredith tells her about Alison's case, and advises her to go with the IL-2 treatment.
Izzie is talking to Alison, who also advises her not to have the surgery. Izzie tells her she's hallucinating all the time and has pretty long conversations with dead people. Izzie cannot imagine having a brain tumor and not allowing them to cut it out. Alison talks about her life before the cancer and how the surgeries did not work. She had given up hope, but now the IL-2 is working for her.
Callie points out to Charlie that amputating the leg may not cure the pain. Even after the surgery, it'll be months before she can fit him for a prosthetic. She tries to downtalk a prosthetic and reminds him that the army may not take him back. She questions if he's sure about it. Charlie yells he's not willing at all to cut his leg off. He's not sure about it, but he is sure about the fact that he is in hell right now. He has lost everything he cared about for pain management that does not even work. She won't be able to scare him out of it, because he doesn't get scared after everything he's been through. "So are we going to do this or not?" he asks.
Dr. Webber informs Dr. Robbins that Bailey performed Seattle Grace's first single incision gallbladder removal. Bailey enthusiastically explains how the procedure goes. Dr. Webber suggest they do another one after lunch. Arizona says she'll be on her own then for the neuroblastoma, but she doesn't mind, as Bailey will have the rest of her life to do neuroblastomas. Arizona moves closer to Richard and tells him she's going to cry, but she wants him to ignore it. Crying is what happens when she's mad at someone with authority. As she starts crying, she says she has authority issues caused by her father, whom he reminds her of. She says it's wrong and mean to lure Bailey back to general surgery with a robot because she doesn't have a robot. All she has are little children, which is not as cool as a robot, but she promises she'll fight him and win. "You think you can fight me, and win?" Richard says. He laughs and walks away, as a crying Arizona yells that she has something he doesn't have: joy!
Alex enters Izzie's room, where Swender and Cristina are going over her IL-2 schedule. Alex thinks it's for after the surgery, so Izzie informs him she decided not to have the surgery. Swender and Yang leave. Alex closes the door and yells that she's having the surgery. Izzie asks what happened to it being her choice. That was when he thought she was going to make the right one, but now that she made the wrong one, she doesn't get to decide on her own anymore. It's his life with her on the stake now too. She'll be having the surgery, he yells.
Derek is yelling at Cristina for having talked Izzie out of a surgery she doesn't know anything about. Meredith comes in as Derek yells that Cristina crossed a line. Meredith says she's the one who crossed the line, so he should yell at her. Cristina says she'll go, unless he wanted to apologize, but she realizes this is not the moment and leaves. Meredith explains that she did it because she saw her mother disappear too, but Derek points out that Izzie doesn't have an untreatable brain condition. She made it personal and made up Izzie's mind as her friend. He orders her to go back as a resident and change Izzie's mind.
Owen takes Cristina into a supply closet for a quick consult. He knows why he hasn't gone to his mother yet: part of him is still in Iraq. He hasn't fulfilled his commitment to the army. He would still be there if his unit hadn't been destroyed. As long as his work there isn't done, he can't sleep at night, go to his mother or move forward with her. He has decided to go back. Cristina wants to leave as she can't say anything, but he wants her support. "You don't have it," she says and leaves.
Charlie approaches Callie and George to apologize. They say it's okay, but he says he gets that it's their job to put people back together instead of taking them apart. He understands it doesn't make sense for them he wants to go back to a place where people get hurt and die, but they're there because they want to help and save people, just like they do at the hospital. It's who he is, and he asks if they wouldn't do anything to be a doctor again if someone told them couldn't be one anymore.
Izzie is telling Alison about their fight, while they're not even married 24 hours yet. Alison jokes it makes for good make-up sex. Izzie doesn't want to hurt him, but Alison says he'll come around once the tumor's gone and she's back at work.
Meredith tells Cristina they have to go back to Izzie, but Cristina doesn't want to talk her into the surgery just because Derek is mad. Meredith says they have to, as they talked her out of it as her friends, not her doctors. Cristina thinks they just presented her options and let her decide, which is what doctors do. Meredith confesses she may have presented the options as "you're having the surgery over my dead body". This gives Derek the right to be mad. Cristina gets paged, swears and asks Meredith to come.
Izzie is giving Alison CPR. Cristina and Meredith rush in. Izzie asks where Swender is as Cristina takes over CPR and Meredith asks Izzie to sit down. Cristina keeps on performing CPR.
George, Callie and Owen are operating on Charlie. Everything is ready for Callie to cut off the leg, but she wants someone to remind her why she's doing this again. Owen says she doesn't know what'll happen to Charlie, how many battles he'll win or lives he'll save, but if Callie doesn't do this, he'll never get to try. "We're not doing harm, we're not hurting him, we're saving him," Owen convinces her. George says they're doing what he wants. Callie moves closer with the bonesaw and starts cutting.
Cristina and Swender are in the OR with Alison. They're looking for a bowel perforation, but Cristina cannot find it. "So much for IL-2," Cristina says. Swender reminds her that there is no cure for cancer. It's just the two of them, right here, fighting this thing as aggressively as they know how. Sometimes, that means pumping toxins into the patient to kill the cancer and yes, sometimes, not very often, but sometimes these toxins kill the patient as well. Alison only had three months to live when she came to see Swender, who gave her two years. Swender is thereby not about to give up on Alison or IL-2 any time soon. "And neither are you," she tells Cristina.
Mark tells Lexie he wasn't asking her to come see the condo, he was asking her to move in with him if she wants. She does, not right away, but like "10 years" she says, as he says "a year". Lexie explains she'll be a resident for 6 more years before she gets her practice up and running, so she suggest 7 years. He proposes 5, but she says she'll still be a resident. Mark names some other residents that are happily married or soon-to-be married. She wants to know if he's asking her to marry him, which is not the case. They feel awkward and agree they shouldn't be having this conversation.
Richard compliments Bailey's work today. He looks at Arizona and smiles. Arizona walks up to Bailey, who asks her about the neuroblastoma. He made it, everything went well. She wanted Bailey to be there, because the kids you can save almost make up for the ones that you can't. She's going to monitor her patient now and tell the parents the good news. She offers Bailey to stop by and witness the joy. Bailey agrees, and Arizona walks back to Richard, smiles back at him and leaves.
Izzie goes to the ICU where she watches Alison in her bed. Swender is explaining to Alison's family that they couldn't finish the surgery. Alison can't breathe on her own now, so she is on a ventilator. If Alison stabilizes, they will be able to finish the surgery. The family thinks she'll be able to breathe on her own again after the surgery, but Cristina explains that her brain didn't get enough oxygen when Alison's heart stopped during surgery. It's unlikely Alison will ever be able to breathe on her own again. Alison's mother breaks down as Izzie watches Alison.
Izzie is lying on the beach again with Denny, watching the sky.
George wakes her up from her daydream. She paged him and he wants to know if she's okay. She's not and asks him to tell her what to do, because she feels like she's going to die either way. He says she knows what to do, but she's just scared to do it. She has already made the decision, she made it the second she decided to fight this thing. He asks her to look where she started and to where she is now. She's this incredible teacher and surgeon. She's a doer. She cries and he comforts her. "You know exactly what you have to do," he says.
Izzie and Meredith meet Derek in a conference room. She says he can do the surgery, but she doesn't want to end up a vegetable. She wants the surgery right now, but if something goes wrong, she doesn't want to end up on a ventilator. She's signing a DNR.
Izzie is being wheeled into surgery. Alex reminds her of Denny's DNR and how crazy she went. He is ready to go crazy and wreck his career for her. He asks to stop for a moment and says she does not get to quit on him. He begs her to tear up the DNR. Izzie tells him what kind of hallucination she is seeing right now. She doesn't want to live like this. She doesn't want extraordinary measures to keep her alive in case anything goes wrong. She explained she went crazy with Denny's DNR because she didn't understand, but now she does. She wants him to understand and not go crazy and have a brilliant career. She hopes she gets to be there for that, but if not, she wants to go to the other side. Whatever there is on that side, it must be better than hospital beds and tubes down her throat. "If it comes down to it, just let me go," she begs him. He is crying and she asks him to kiss her, which he does. Izzie is then wheeled into the OR.
Watching Izzie being wheeled away, Meredith confesses to Derek that she always thought she would be the one who'd get Alzheimer's and forget everyone. She proposes to go to city hall tomorrow, as she doesn't want to spend another day not being married to him. He agrees and kisses her.
Owen meets Cristina on a bench outside the hospital. He sits down with her and she says it doesn't matter how good you are or how hard you work, but your patients are still gonna die. You can always get hit by a car or have another accident. There's nothing you can do about that. She doesn't want him to die.
Bailey meets a depressed Swender and Callie in the doctors lounge. She asks if they're okay. Callie confesses she just cut off a healthy leg, making her feel like butcher. Swender says her miracle case is on life support. She thought she had one miracle. She hates this job sometimes, and Callie doesn't know why they do this. Bailey asks them to come with her.
In the PICU, they watch Arizona deliver the good news. They watch the joy of the parents. The joy comes around so rarely they can forget it happens, Bailey says, but the joy is why they do this. Callie and Swender smile and nod.
Cristina and Owen have parked their car. He asks her if she's coming with him. He gets out of the car.
At the U.S. Army Recruiting Station, a recruiting clerk tells the recruiting officer they got one more. He's a doctor who says he needs to sign up today. The officer nods and the clerk closes the door.
Someone knocks on the door.
"Come in," the officer says.
Owen is standing in front of the door that his mother opens. She can't believe her eyes. "Owen?" she asks. Cristina is standing next to him. He greets his mother and says he's home as he hugs her. She is delighted to see him again.
Someone gives a signed document back to the recruiting officer, who congratulates the doctor on having joined the army. They shake hands, and we see it's George who signed up. As Meredith's voice over says the future is never the way we imagine it, George thanks officer Seiver.
- Ellen Pompeo as Dr. Meredith Grey
- Sandra Oh as Dr. Cristina Yang
- Katherine Heigl as Dr. Izzie Stevens
- Justin Chambers as Dr. Alex Karev
- T.R. Knight as Dr. George O'Malley
- 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
- Patrick Dempsey as Dr. Derek Shepherd
Special Guest Star
- Kimberly Elise as Dr. Rebecca Swender
- Jessica Capshaw as Dr. Arizona Robbins
- Zach Gilford as Charlie Lowell
- Liza Weil as Alison Clark
- Debra Mooney as Evelyn Hunt
- Webster Williams as Alison's Father
- Chelsea Taylor as Alison's Mother
- Jon Rowland as Alison's Boyfriend
- JF Davis as Recruiting Officer
- Brock Cuchna as Recruiting Clerk
- Stage IV metastatic melanoma
- Brain tumor
Derek figured out a way to remove Izzie's brain tumor. He planned to remove her hippocampus. The other option was to attempt to use chemo to shrink the tumor. They did a wada test to determine a possible outcome of the surgery. She was unable to remember the pictures on the card after her brain was put to sleep. Because of this, she decided against the surgery and instead wanted to continue with the IL-2. However, after Alison died, Izzie agreed to have the surgery, but she signed a DNR before the surgery.
Austin, Star, Meg, and Miguel were friends of Izzie's from chemo.
- Bowel resection
- Mechanical ventilation
Alison, 22, was in the hospital being treated for cancer. She'd been a patient of Rebecca Swender for two years. When she came in, she had mets to her brain, liver, and kidney. She'd had five surgeries and chemo, which worked, but the mets came back. She then started IL-2. She'd had three treatments in three months and her mets were gone. However, she later coded. They rushed her into surgery. They searched her bowels for a perforation. They had to resect a portion of her bowel, but they weren't able to finish the surgery because she was too unstable. Her family was informed that she likely wouldn't be able to come off the ventilator.
- Katharine Wyatt (psychiatrist)
- Talk therapy
Owen told Cristina that he had had a good session with Wyatt. She asked if they had talked about his mom.
- Idiopathic leg pain
- Palliative amputation
Charlie came into the hospital with leg pain after having surgery. He said he'd tried medication and physical therapy, but he wasn't able to do anything without pain. He wanted palliative amputation. Callie initially denied his request, but she eventually acquiesced after all other options were exhausted.
- Arizona Robbins (pediatric surgeon)
Arizona had an 8 year old patient with a neuroblastoma she was planning to remove. The surgery went well and the patient was stable and awake after surgery.
Bailey operated on a patient with the Da Vinci Surgical System.
Bailey's Second Patient
- Gallbladder removal
Bailey removed a patient's gallbladder through their belly button with the Da Vinci Surgical System.
|"Charmed Life"||Joy Williams||
|"Where the Road Meets the Sun"||Katie Herzig and Matthew Perryman Jones||
|"Hold On To Me"||Sugarplum Fairies||
Notes and Trivia
- This episode's title originated from the song Here's to Future Days, originally sung by Thompson Twins.
- This episode scored 16.58 million viewers.
- Although aired together with Now or Never, Shonda Rhimes has commented that this episode was not meant to be a two part finale.
- Including his two appearances on Private Practice, this episode marks the 100th appearance of James Pickens, Jr. as Richard Webber.
- This episode marks the 100th appearance of Chandra Wilson as Miranda Bailey.
- Sometimes this episode is incorrectly called "Here's to the Future".
- In this episode, Cristina mentions getting hit by a car. This could be foreshadowing what happens to George in the next episode.
- This is the last episode to feature Denny.
- There is no Grey Matter blog post for this episode.
- Derek tells Meredith they'll go to the Bahamas and have a beach wedding. While not as he envisioned, they do end up having a beach wedding.
Behind the Scenes
- Cristina: (to Owen) God, it doesn't matter how good you are. Or how hard you work. You can do all the research, you can master all the latest techniques, I mean you can be the best. You can be the best surgeon in the world, but your patients are still gonna die. 'Cause the next day, or the next month, or the next year, you know they're just gonna get hit by a car. Or find a mole on their back. There's nothing you can do about it. (looks at Owen) I don't want you to die.
- Owen: I realized the reason why I haven't told my mother I'm back is because part of me is still over there. I made a commitment to the army that I wasn't able to fulfill. If my unit hadn't been destroyed. I would still be there. So, no wonder I can't sleep at night, or look my mother in the eye. No wonder you and I, we can't move forward. My work there isn't done. Until it is, I have no business being here. So, I've decided to go back.
A complete overview of this episode's crew can be found here.
|Grey's Anatomy Season 5|
|#01||"Dream a Little Dream of Me, Part 1"||#09||"In the Midnight Hour"||#17||"I Will Follow You Into the Dark"|
|#02||"Dream a Little Dream of Me, Part 2"||#10||"All By Myself"||#18||"Stand By Me"|
|#03||"Here Comes the Flood"||#11||"Wish You Were Here"||#19||"Elevator Love Letter"|
|#04||"Brave New World"||#12||"Sympathy for the Devil"||#20||"Sweet Surrender"|
|#05||"There's No 'I' in Team"||#13||"Stairway to Heaven"||#21||"No Good at Saying Sorry (One More Chance)"|
|#06||"Life During Wartime"||#14||"Beat Your Heart Out"||#22||"What a Difference a Day Makes"|
|#07||"Rise Up"||#15||"Before and After"||#23||"Here's to Future Days"|
|#08||"These Ties That Bind"||#16||"An Honest Mistake"||#24||"Now or Never"|
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