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Hotter Than Hell

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“ When the body's exposed to rising temperatures, it has the ability to cool itself down. We sweat, our blood vessels dilate, and our heart rate increases. Our body releases as much excess heat as it can. But when the temperature starts to inch above 100 degrees, our bodies have to work overtime, leading to heat exhaustion. We become nauseated, dizzy, and confused. And we fight like hell to cool down before it's too late. For me, the boiling point is more about stuff bubbling up from the bottom. It's about stuff you haven't thought about in a while. It's about stuff that's been heating up while you weren't even paying attention. The question is, how well can you contain things before they boil over? The thing is, even if things don't boil over completely, they can still simmer. And as long as you're careful how you handle yourself, you won't get burned. ”

Hotter Than Hell is the third episode of the eighteenth season and the 383rd overall episode of Grey's Anatomy.

Short Summary[]

Seattle's favorite redhead returns and graces the Grey Sloan halls with her experience and expertise as she attempts to help Richard teach the newest crop of residents. Meanwhile, Meredith has a decision to make, and Link confides in Teddy.

Full Summary[]

In the middle of a heatwave, Meredith and Amelia get ready for the day. Amelia says there are no heatwaves in Minnesota. Meredith hopes Richard will understand she cannot combine Minnesota with Chief of General and director of the residency program. On another subject, Amelia expects things to be weird because "she" is a sister to Amelia, like Meredith. Meredith tells her to stop making it weird. Amelia has a busy morning and then a video call with Kai Bartley later. Meredith reminds her to keep it all a secret. Amelia jokes they should move to Minnesota just as Link walks in. She explains she's not actually moving but rather likely to make a few more trips there. He hates that they didn't even discuss it. As Link takes the newly delivered kiddy pool to the backyard, Amelia quietly tells Meredith it's one of Link's life-long dreams to cure Parkinson's.

Teddy meets Owen in the attendings' lounge. She got the last window unit and installed it herself. Owen has been trying to reach Noah. He has found some anecdotal stuff but no official reports on a link between burn pits and pulmonary fibrosis. Teddy puts on a pink hat and explains it's silly hat day. Bailey appointed Teddy ambassador of fun to boost morale. She puts a bedazzled cap on Owen.

The residents wonder who's coming in for grand rounds today. Even Jo is in the dark. An e-mail revealing the identity of the guest arrives.

Cormac welcomes Meredith back with a coffee. He's not a fan of the heat. Meredith asks about Austin but Cormac has no idea how he's doing since he won't talk to him. Meredith says her kids are mad because she might spend half her weeks in Minnesota. Cormac doesn't like that either. Bailey comes rushing by. Cormac asks Meredith if she has told Bailey or Webber. She hasn't.

The residents are surprised to find that the skills lab is locked. Richard and Bailey arrive and welcome to grand rounds. Today is grand rounds on its feet. Addison Montgomery then walks up and introduces herself. "And you must be the group that's been screwing up the program," she says before walking off. Bailey urges the residents to follow her.

Bailey orders an orderly to move so the automatic doors to the ER can close. Link finds her to complain about Teddy asking him to wear a hat in this heat. Bailey then joins Owen and Michelle Lin in the trauma room. They are working on Chet, who has second-degree burns on his buttocks. He was frying an egg on the sidewalk for his web channel called NakedBroStuff. He fell on his butt. Chet's buddy Truman walks in and shows Bailey the video that is going viral. Another video shows a woman being shot off the back off a jet ski. Michelle wonders where all the residents are.

En route to the patient, Addison talks about her research that brought her here today. Jo is paged away. Taryn doesn't like Addison because of her history with Meredith. None of the residents know the specifics of that situation. Addison quizzes Levi and allows him to present the patient.

The group enters Tovah Freedman's room. Addison will perform Grey Sloan's first uterine transplant today. Tovah says she and her late husband both grew up with four siblings. She had multiple miscarriages and when she finally made it to the second trimester, she suffered from a placental abruption that led to a hysterectomy. Jonathan was then diagnosed with malignant mesothelioma. He froze his sperm before treatment but then he passed away. Tovah then heard about Addison's clinical trial which would give her the chance to become the mother she was always meant to be. She wants to bring her and Jonathan's baby into the world herself. Addison says she is close to publishing her first round of results. One lucky resident will be credited when she publishes. Addison picks Levi to scrub in. As everyone clears the room, Jo introduces herself to Addison, who asks her to get her coffee.

Winston tells Rashida that a donor kidney is on its way for her. Rashida tells her followers that Winston got it done. She can't believe it's really happening. Winston is still confirming who will perform the transplant. He has a worried face as he leaves the room.

Meredith catches up with Richard, who tells her he has so many ideas for the program, which includes bringing in visiting surgeons each week and video-recording surgeries again. He feels energized. Meredith thinks that all sounds great. Richard then takes the residents, who welcome back Meredith as they walk off.

Winston finds Owen and starts complimenting him. Owen deduces he wants a favor. Winston asks him to perform a kidney transplant. Webber and Grey are busy and Bailey can't know. Winston assures Owen that performing the surgery would not be a crime. Owen then agrees.

The paramedics bring in Lily, a 16-year-old who suffered a hydrostatic pelvic injury. She's the woman who was shot off the jet ski. The water plowed right through her entire pelvic region. Bailey can't believe that video was for real.

Before Tovah's put under, Addison assures her that they got her. The residents gather in the gallery while sharing the wild stories they heard of Addison and Meredith's past. Taryn urges them to focus on the groundbreaking surgery happening. Before making the incision, Richard informs the residents that they will be asked questions during the procedure. Addison starts off with a question, turning up the heat on the residents. The residents rush to the intercom to answer.

Cormac meets Bailey and Lily in a trauma room. Bailey found free fluid in the abdomen. Lily's friend Micah comes rushing in. He apologizes. He didn't notice that she fell off the jet ski. Cormac and Bailey want to call Lily's parents but Lily refuses. She hates her parents and they don't know that she was meeting Micah in real life today. Upon hearing that she is not in mortal danger, Lily firmly refuses to call her parents.

Jo arrives in the gallery just as Addison asks for the donor uterus, but she is soon paged away. As Addison asks Levi to point out the uterine artery and vein on the specimen, there is a loud whooshing and rattling sound.

Owen and Link hear the same sound out in the hall. Link finds that the AC died.

In the CT boot, Cormac deduces the AC must have been overworked, like all hospital staff. Cormac is not a fan of jet skis. It seems all teenagers are losing their minds. Bailey says they don't have minds to lose. Bailey wants to lock her kids in the house to protect them from disorder and germs, but if you lock up your kids too tight, you lock up their minds. The pandemic was a trauma and teenagers don't know how to ask for help, so they do stupid stuff. The CT scan shows a possible rectal perforation. Bailey books the OR for an ex-lap.

The temperature is rising in Addison's OR. Richard comes back to inform them that the AC is down everywhere in the building. He needs to start transferring surgeries and recruits Tseng, Ortiz, and Chee to help. Addison refuses to close now. Richard says the HVAC system controls the air filtration, meaning keeping Tovah open is putting her at risk for infection. Richard urges her to work faster. Addison needs someone with her level of experience with microvascular anastomosis of the abdomen. She requests Meredith Grey.

Richard instructs the three residents to find portable AC units for the ICU. Richard informs Owen and Winston that all surgeries are cancelled or postponed and they are diverting trauma. This means the kidney should go to the next person on the list, according to protocol. Once Richard is gone, Owen finds out that Winston is anxious because he decided not to put in a permanent port. She needs this kidney. Owen has an idea to save the kidney.

Meredith joins Addison in the OR. They accomplish each other on their groundbreaking transplant procedures. Taryn lists off several more of Meredith's accomplishments. Meredith gets gowned and gloved and joins Addison at the table.

Teddy has diverted all rigs to Seattle Pres. Richard is on the phone with the specialized industrial HVAC company, who are overwhelmed with calls from all over the city. Link comes up to complain about his double-knee replacement being cancelled. Teddy went to check on her kids. They are fine in daycare with a snow cone guy. Richard hangs up. There is no ETA on the HVAC team. Link offers to take a look and Teddy offers to assist.

Ben arrives in the ambulance bay with the PRT. Owen explains the concept to Rashida. They'll have to keep this a secret from the Fire Chief and Chief Bailey. Owen says they'll just consider this a Grey Sloan annex.

Amelia finally connects with Kai on video chat. She ran late because of a complication in the OR. Kai wonders why she's holding an ice pack to her neck. Amelia explains the heatwave. Kai tells her that the MRI scans on the latest mice group show that 74% of the transplanted cells are functional. They see it as a 26% room for improvement. Kai invites Amelia to Minnesota next week to do some trouble-shooting. Kai then guide-meditates Amelia into feeling cool, which works.

Addison asks Meredith what is next for her. Of course, Addison herself will win the Fox Award this year for her uterine transplants, but she's curious what will earn Meredith second place. Meredith thinks she could give Addison a run for first place if she could get logistics and responsibilities sorted out. She has to have some difficult conversations with Richard. Addison finds that there is no signal on the Doppler, which means there must be a clot in the vessel. They have to re-open the anastomosis.

Link and Teddy arrive on the roof. They find that the HVAC system is nothing like a window unit. Teddy says she's sorry to hear about Link and Amelia. They're not sure what exactly their plan is.

Bailey and Cormac are working on Lily when Richard comes in to yell because people don't seem to understand his order to close down the OR's. Bailey says the risk of infection did not outweigh Lily's need for immediate surgical care. The longer Richard keeps arguing with her, the longer it'll take for her to finish.

Addison and Meredith work in sync. They manage to evacuate the clot and restore blood flow.

Winston and Owen are performing the transplant with Ben as the anesthesiologist. Ben is happy that the PRT is being used again and he explains to Winston why it got shut down. Grey Sloan paid for the PRT so it can decide what to do with it. Ben and Owen were never ones to follow rules. Winston is usually a rule follower unless it means his patient can't get her kidney. Bailey told him to fight the broken system. Ben can't imagine she meant breaking the rules by that. Owen finds that there is urine in the Foley, meaning the kidney is functional.

Link lets out his frustration. He needs to fix something. He is in love with Amelia, who apparently doesn't even think about him. Amelia seems to think that his wanting some commitment from her equals controlling her. He doesn't get it. This is not what he wanted for Scout. Teddy has been in that situation. They then laugh at her idea of silly hat day.

The residents line up as Meredith and Addison exit the OR. They walk straight past the residents, who comment on the tension between the women. Meredith says they can hear them as she and Addison get on the elevator. The residents rush to the stairs.

On the elevator, Meredith and Addison have a laugh. Addison then starts crying and Meredith stops the elevator. Addison thought she would feel Derek's presence being in the city he loved with the people he loved. This makes it all so real that he is not here. She's sorry to be breaking down over that in front of Meredith. Meredith tells her that Derek is here. He's also in his children. She would love for Addison to come and meet them. Addison then tells Meredith she was never one to shy away from fighting for what she loves. If she believes in this next big thing, she should fight for it. Richard will understand. They then share a short hug before resuming their seemingly cold and tense appearances as they get off the elevator. The residents watch them walk off from the stairwell.

Richard congratules Addison on the transplant. Everything is looking good so far but the true success will be when Tovah gets pregnant and delivers a healthy baby. Richard apologizes for the HVAC failure. Addison tells Richard that his residents are almost there. Richard recalls training Addison and Derek in New York. This new generation only wants to complain. Addison says the residents are just standing up for themselves. They don't want to be worked to death by an inhumane system. Addison considers that progress. There is definitely room for improvement. Richard is glad to have her here.

Micah enters Lily's room as Cormac is checking up on her. Cormac tells him she has a long road ahead of her so he needs Lily's phone to call her parents. Micah says her parents don't know her and are controlling. Cormac wonders how her parents are supposed to know her if she keeps secrets. Micah says her parents only yell at her. Cormac says it's hard when you love your kid their entire life and then they stop talking to you. As a parent, you can see that your kid is hurting. It's hard being a teenager but being a parent to one is also really hard. If Lily's parents have been controlling, they may have had a reason to be scared. Cormac then tells Micah to unlock Lily's phone unless he wants to help clean up the bag that Lily will be crapping into for the next six months. Micah complies.

Meredith meets Richard in the attendings' lounge. He applauds her for saving the surgery. The HVAC team arrived and fixed the problem. Richard is looking forward to revamping the program with Meredith. Meredith says it won't be the two of them. He thinks she took the job in Minnesota. Meredith says yes and no. She was made an offer she couldn't turn down. She can't tell him any more than that. She'll split her time between Minnesota and Seattle but she has to give up the program. Also, it's wrong for anyone else to hold that job but Richard. Richard agrees to accept the position.

Sara and Winston are checking on Rashida, who is doing well. Rashida tells Winston he should celebrate with his wife. Winston says she is out of town but he did score an invite to the coolest place in the hospital. Sara wonders where that is.

Winston and Sara arrive at the morgue. Teddy has set up a snow cone party there so people can cool off. Jo and Levi are present as well. Jo is jealous that Levi got to assist with Addison. Bailey arrives and compliments Teddy on her idea.

Addison meets Amelia in the lobby. They share a hug. They have been waiting for this moment all day. Addison tells Amelia that Meredith invited her over to the house for dinner. They leave together.

Owen visits Noah Young at home. Noah tells him no and shuts the door on him. Owen yells that there are other people like him who are hurting. They need to at least try and fight for what's right. That is what they do. Owen will help Noah every step of the way. Noah opens the door and asks what Owen needs from him. Owen wants to hear Noah's story and what the VA told him. Noah invites him in.

Meredith is preparing ice cream for dinner. Amelia and Addison arrive. Meredith introduces Addison to Zola and Bailey. Addison gets emotional and confirms that she is a friend of their father's. She introduces herself but adds that their father called her Addie. The kids invite her for ice cream. She sits down with them and they go over all the toppings. Meredith and Amelia watch them with a smile on their faces.

Cast[]

Main Cast[]

Special Guest Star[]

Guest Stars[]

Co-Starring[]

Medical Notes[]

Amelia's Patients[]

  • Diagnosis:
  • Treatment:
    • Craniotomy

Amelia had back-to-back craniotomies scheduled for her morning.

Chet[]

  • Diagnosis:
    • Second-degree burns
  • Treatment:
    • Debridement

Chet was in the hospital with second-degree burns to his buttocks and upper thighs after he fell on the hot sidewalk. His wounds were debrided in the ER.

Tovah Freedman[]

  • Diagnosis:
    • Hysterectomy following placental abruption
  • Treatment:
    • Uterine transplant

Tovah, 33, was at the hospital for a uterine transplant following a hysterectomy due to placental abruption, in the hopes of eventually carrying a viable pregnancy. Addison was operating on her as part of a trial she was doing. She selected Levi to scrub in with her. As she went to place the graft, the HVAC system went out, meaning they had to hasten the surgery, so she called Meredith in to help. They attached the graft, but there was no blood flow, which they determined to be due to a clot, so they detached the graft, cleared the clot, and reattached it. They were then able to close.

Rashida Flowers[]

  • Diagnosis:
    • Renal failure
  • Treatment:
    • Kidney transplant

Rashida was told a kidney had become available for transplant. When the HVAC system failure threatened to cancel her surgery, Owen had Ben bring the PRT to the hospital and they used the OR in there for her transplant. Her kidney started working immediately and she had a bag full of urine when she woke up.

Lily[]

  • Diagnosis:
    • Hydrostatic pelvic injury
  • Treatment:
    • Exploratory laparotomy

Lily, 16, came to the hospital when she fell off a jetski and the jet of water ripped through her pelvis. She had free fluid in her abdomen, so they took her for a CT, which showed a perforated rectum, so they took her for an exploratory laparotomy. After her surgery, her friend was told she would live, but would have a long recovery.

Music[]

Song Performer Scene
"Broke" Teddy Swims
  • Amelia and Meredith get ready for the day while talking about the heat.
  • Amelia talks about her day.
  • Link is helping moving boxes.
"Beautiful Place" Aaron Espe, DJ Stanfill
  • Addison and Meredith work together.
  • Owen and Winston transplant Rashida's kidney while Ben talks about the PRT.
  • Rashida's new kidney starts working immediately.
"Brighter Days" Blessing Offor
  • Jo and Levi talk about residency.
  • Bailey congratulates Teddy being ambassador of fun.
  • Amelia and Addison hug as the air turns back on.
  • They leave together to go to Meredith's for dinner.
  • Owen goes to Noah's house and tells him to fight.
  • Meredith cooks hiker Zola and Bailey chase each other.
  • Addison comes in and meets the kids.

Notes and Trivia[]

  • This episode's title originated from the song Hotter Than Hell, originally sung by Dua Lipa.
  • This episode scored 4.05 million viewers.[1]
  • This marks the first appearance of Kate Walsh as Addison Forbes Montgomery since the season eight episode If/Then. Addison is only featured in the alternate reality portion of that episode, meaning she hasn't actually been in Seattle since delivering Sofia Robbin Sloan Torres in Song Beneath the Song.
  • This episode marks the first time Addison visits Meredith's house. This makes Erica Hahn and Cormac Hayes the only main cast members not to have visited the house on screen. However, given the fact that Cormac and Meredith briefly dated, it is possible that he did visit the house off screen.
  • Norman Leavitt, the show's former head of the make-up department, returned to the show to do Kate Walsh's makeup despite having retired in mid-season 14. He also returned to do Patrick Dempsey's make-up for his return in the previous season.[source?]
  • The episode features a historic heatwave; another heatwave was featured in the episode Both Sides Now.

Gallery[]

Episode Stills[]

Behind the Scenes[]

Quotes[]

Addison: I thought, coming back here, to Seattle, to Grey Sloan, that he'd be here. That I would be able to feel that he was still here. In the city that he loved with the people he loved. But he isn't. And it's real. He's not here. And I'm really sorry I'm doing this in front of you because you're the one who had to actually go through it.
Meredith: Addison, he is here. And he's in his children. And they are very real. And I would love for you to come and meet them.
Addison: Meredith, you've never been one to shy away from fighting for what you love. So if you believe in this next big thing, fight for it. Richard will understand.

See Also[]

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


References[]

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