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How Do I Live

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“ When training for a marathon, a runner's body composition physiologically changes. With consistent exercise, the heart improves its efficiency to send oxygen to the muscles. Muscles adapt to using and storing energy while bone density increases to make bones stronger. On average, the process takes around 20 weeks of mental and physical dedication, stamina, and complete exhaustion, to complete race that's over in a day. When people cross the finish line, or complete an impossible task, they often report feeling empty. Anticipation and motivation become replaced with apathy and disappointment. Science will tell you it's due to a drop in dopamine levels. But personally, I think it's because we're suddenly faced with the fear of not knowing what's next. ”

How Do I Live is the eighteenth episode and season finale of the twenty-first season and the 448th overall episode of Grey's Anatomy.

Short Summary[]

While the interns are excited to transition to second-year residency, an ordinary day at Grey Sloan takes an unexpected turn when a medical emergency unfolds in the operating room, endangering lives inside the hospital.

Full Summary[]

Benson meets a hungover Simone in the kitchen. She really screwed up. Her one-night stand enters and informs her that he left his number in her phone, in case she wants to have more fun. He leaves and she goes to throw up.

Once they're alone on the elevator, Jo and Link share a passionate kiss. They both long for a beach honeymoon. He gets off.

Jules spills juice all over herself when the lid comes off the cup. She enters the nearest on-call room and takes her shirt off, unaware that a shirtless Winston is sitting on the bed. He makes his presence known and admits he should have locked the door. He was up late working on Nora's case. He puts his shirt on and leaves after telling her to wait a bit before coming out, as to not give people the wrong idea.

Jules grabs a new scrub top in the intern locker room, where Lucas ignores Simone. Bailey arrives with a rack of personalized coats for the soon-to-be second-years. This is their last shift as interns. To celebrate, everyone will get to scrub in today. She hands out assignments for the day. Ben arrives to answer her page. Teddy has decided not to recommend bringing him on board permanently. Ben wants to work on his last day. She instructs him to check on Carter Samuels, an MVC patient status post-ex lap with a shattered liver.

Lucas presents Dylan Gatlin, day 5 post-op. The MRI shows no change to the hematoma. Jenna is frustrated with their waiting approach. Simone comes to inform Amelia that her next surgery will happen in OR 2.

Richard and Catherine enter the conference room to find Meredith there. Richard expected her here tomorrow to meet the new class of interns. She came early for a meeting with Catherine. She is selling her shares in the hospital to fund her research. Her project with female mice is yielding significant preliminary results. Richard is shocked that she is going to cut ties with the hospital. Meredith says they're not hopeful to get federal funding since their research is aimed at women.

Teddy and Winston present Nora and her mother with their plan to build a synthetic aorta, diverting blood from the infect graft, allowing them to staple it off and remove it. Nora's mother looks to Owen to validate their statements. Owen confirms they were lucky to get her back in their last attempt. Nora knows this is her only chance. She wants to see her kids.

Owen chases after Teddy and asks if this is actually a good idea. This has never been before, so no, she's not, but this is the only idea she can come up with. She then reveals she saw him snuggled up with Nora last night. She asks if he is in love with her. Owen only says that sleeping with her meant nothing and that he's married to Teddy. She says that is not what she asked. She leaves to prep.

Simone meets Amelia in the scrub room. She knows something is off with Lucas but Simone assures her that her head is in the game. Jenna then enters with a tank full of acetylene and a lighter. A tank like this once exploded at one of her husband's worksites and took down half the building. She orders Amelia to operate on Dylan and save her; if not, she's taking down everyone with her.

Lucas meets Ben in the ICU as he's looking for Beltran. Amelia then calls him with instructions to bring Dylan to the corridor outside OR 2. She is going to operate. She tells him not to argue and hangs up. Lucas points out to Ben that his patient is bleeding from the wound vac and leaves. Ben has Bailey paged.

Nora tells her kids that she loves them and that she'll see them after. After a hug, Nora's mother takes them away. Benson assures Nora that she can do this. He leaves, leaving Owen alone in the room with Nora. They hold hands. If Teddy's plan works, she would understand if he weren't there when she woke up after what she told him last night. She asks him to look after her mother if she doesn't make it. The orderlies arrive to move Nora to the OR.

Lucas wheels Dylan into Amelia's OR while talking about Ms. Alvarez being pissed. Only then does he see Jenna holding Simone and the tank. Jenna tells him Amelia is going to operate on Dylan. Amelia explains to Jenna that last time, she had a whole team for neuromonitoring and guidance. Going back in without that is dangerous. Jenna refuses to budge. No one is leaving until Dylan is fixed. Lucas decides to transfer Dylan to the table.

Winston meets Teddy in the scrub room while Nora is installed on the OR table. She's not sure what mindset to be in for this hail mary. "Go big or go home" is the only option Winston sees. He's confident they can do this. He picks up on the fact that there seems to be more going on than regular nerves.

Amelia has started the surgery with Lucas assisting. Lucas is preoccupied with getting help in here. Amelia needs him to focus. They will look for the gel foams they left earlier to help guide them to the bleed. Lucas then makes eye contact with Monica, who has appeared in the gallery and picked up on the fact that something is off. Monica quickly leaves after taking a scan of the room.

Meredith catches up with Richard. She says it's just business. He says her move cost the hospital thousands of research dollars and potential surgeries. People came here because of her. He just regrets that this hospital is one of the costs of her research. Monica comes up to inform them of the hostage situation. She calls 911.

Bailey meets Ben on the elevator with Carter. His bleeding has picked up and while he responds well to blood products, he gets tachycardic between units. He needs a takedown, washout and re-exploration. Ben would like to scrub in. They arrive on the OR floor but Owen blocks them given the hostage situation. They are evacuating the floor. Anything emergent is to be sent to the ICU. They can bridge with blood until the OR's open up again.

Link meets Jo in a supply closet. His arthroscopy got moved because of the evacuation. They don't know what the reason is. He figures they have an hour before the OR's are open again. They start making out.

A conference room has been turned into the command center. Monica explains Dylan's case to Catherine. The ventilation system has been turned off since they don't know what gas they are dealing with. Meredith insists on staying since it's her family in the OR. Richard requests a direct line to the OR.

The phone in the OR rings. Jenna tells Amelia to keep going. She has no idea where she's going given all the swelling. Amelia recalls Derek's advice to always look for normal anatomy. She finds the facial nerve and then tells Jenna she cannot continue to operate while the phone keeps ringing.

Eventually, Jenna answers the phone. She tells Richard his doctors are in the middle of surgery. Amelia says they are okay. The officer inquires about the substance in the tank. It's acetylene from her husband's truck. She threatens to light it up the second someone enters the OR. Amelia finds the path to the angioma, which causes Jenna to order Simone to unplug the phone. She moves Simone back to the other side of the OR.

The police decide to bring in SWAT. Meredith argues that that mother is not in a rational state. If they send in officers, it's over. Amelia has already started so she deems it safest to let Amelia operate. Monica adds she's doing so without imaging or a neuromonitoring team. Meredith is confident that Amelia can do it. She asks for details on the case.

Owen enters Teddy and Winston's OR to check why they ignored the evacuation page. He updates everyone on the situation in the OR next door. Teddy says at this point of the procedure, closing means that Nora dies. She is staying. Winston, Benson, and Jules also decide to stay while the majority of nurses leaves.

Carter's bleeding has increased even more. He is getting acidotic. Ben decides to re-open him right here. He claims there is no time to wait for an attending and asks for gowns and gloves.

Jo and Link have finished their floor sex in the OB supply closet. It's not the ideal honeymoon. They pretend to be in a seaside hotel.

Bailey enters Carter's ICU room. She's surprised to see the surgical situation. She can't believe he did this. Ben points out they can't exactly fire him. He left her out of it so they wouldn't fire her. Bailey feels forced to step in and help.

Jenna tells Simone that Dylan wanted to be a doctor when she was 5. Amelia reaches the hematoma. It is pretty big. They move to suction away the blood.

Richard and Meredith study Dylan's scans. The blood appears impossible to access. Richard says Amelia will find a way. She has a stake in this hospital. Owen comes up to say that all but one of the other OR's has been evacuated. Richard and Owen want to send the police in but Meredith urges them to give Amelia time. Jenna has not set out to hurt anyone, all she wants is to save her kid. Monica brings up Dylan's morning labs.

The surgical team has completed the anastamoses. All that's left to do is staple the aorta, for which the interns are no longer needed. Winston sends them out. Teddy is overcome by doubt. The moment they staple the aorta, the pressure from the heart could blow the staple line and she'll die. Winston says they knew that going in. They could also blow up any moment. Teddy says a failed surgery means that it would be her hands that killed Nora.

Dylan's blood keeps oozing. Dr. Knox shows her the lab results. She needs FFP. Jenna suspects that Amelia has done something wrong for Dylan to be bleeding again. Lucas uses the moment to grab a scalpel. Jenna grabs Simone more tightly and orders Amelia to fix her daughter. Amelia says that is all she ever wanted. Jenna yells that they never should have let her operate in the first time. Simone says they can still fix this. Jenna did nothing wrong. Lucas then charges at Jenna, who backs away. Just then, Meredith enters with FFP.

Meredith says she is a surgeon who came in to help. Dylan's blood is struggling to clot, which is why she is still bleeding, but they can treat it. She explains what FFP does. Meredith explains she is a mother too and understands the pain that Jenna is feeling. Jenna consents to the FFP. Jenna says that Dylan was a breach baby. She would always nuzzle up to Jenna's chest to make herself feel safe. Dylan trusted her to keep her safe and she failed her.

Jo and Link get dressed again. He finds it weird that he hasn't been paged yet. He's pretty sure his 82-year-old patient has not bailed on the procedure as he wanted to go back to his ballroom dance class.


Full summary to be continued.

Cast[]

Main Cast[]

Guest Stars[]

Co-Starring[]

Medical Notes[]

Carter Samuels[]

  • Diagnosis:
    • Mesenteric tear
  • Treatment:
    • Exploratory laparotomy

Carter had had an exploratory laparotomy for a shattered liver. Bailey had Ben monitor him in the ICU. When he started bleeding into his wound vac, Ben tried to take him back into surgery, but due to the hostage situation, the ORs were closed, forcing them to take him back to the ICU and give blood products to buy him time. When he became acidotic, Ben decided to open him up in the ICU. Bailey found him operating and joined him. They found a tear in the mesentery and repaired it, stabilizing him.

Dylan Gatlin[]

  • Diagnosis:
    • Locked-in syndrome
    • Hematoma
  • Treatment:
    • Craniotomy

Dylan, 9, was five days post-op and still experiencing locked-in syndrome. The blood in her brain hadn't absorbed like they hoped. When her mom threatened Amelia, Amelia took her back into surgery. She had a hard time navigating without neuro monitoring, but found the hematoma. Due to the bleeding, Dylan needed FFP, which Meredith brought. Amelia was then able to evacuate the bleed. Dylan was stable after her surgery.

Ms. Alvarado[]

  • Diagnosis:
  • Treatment:

Ms. Alvarado was scheduled to have surgery in OR 2, but her surgery was delayed.

Nora Young[]

  • Diagnosis:
    • Aortoenteric fistula
  • Treatment:
    • Surgery

Nora was in the hospital to have surgery to have an aorta built for her out of a synthetic graft, which would reroute the blood flow away from the affected area in her chest. When the time came to staple her aorta, Teddy worried about it not working. They decided to lower her blood pressure to give the staples a better chance of holding. It worked and Nora was stable after her surgery.

Link's Patient[]

  • Diagnosis:
  • Treatment:

Link's arthroscopy was moved due to the ORs being closed. He later operated on his patient, but when he used electrocautery, it caused an explosion.

Monica's Patient[]

  • Diagnosis:
    • Intussusception
  • Treatment:
    • Surgery

Jules asked to scrub in on Monica's intussusception and Monica said she could.

Music[]

Song Performer Scene
"Me, Myself and I" Lauren Light
  • Simone tells Benson he screwed up.
  • Simone's hookup comes in and talks to her.
  • Link and Jo wait for an elevator to empty and then kiss.
  • Jules spills on herself.
  • She has an awkward moment with Winston.
  • Simone and Lucas ignore each other.
"Baby Mine" Madison Davenport
  • Amelia operates on Dylan.
  • Bailey and Ben operate on Carter.
  • Teddy and Winston operate on Nora.
  • Nora's repair holds.
  • Amelia announces that Dylan's not bleeding anymore.
  • Jenny starts crying and apologizes.
  • The police come in and arrest her.
"Garlands" Gem Club
  • Jules and Winston talk in the elevator.
  • Jules leaves the elevator upset.
  • Bailey and Ben look at the stars together.
  • Ben stands by his choices.
"Flicker" Ronen
  • Teddy tells Owen she's choosing herself.
  • Amelia talks to Dylan's dad.
  • They learn the OR is still flammable.
  • Jules asks to work with Monica.
  • Lucas runs toward the OR.
  • Link operates on his patient.
  • There's an explosion in the OR.

Notes and Trivia[]

  • This episode's title originated from the song How Do I Live, originally sung by LeAnn Rimes.
  • This episode scored 2.28 million viewers.[1]
  • Danielle Savre shadowed Debbie Allen as she directed this episode.[2]
  • This episode ends with a note reading, "Producers are grateful to Payton Silver for 423 amazing episodes."

Gallery[]

Episode Stills[]

Quotes[]

Owen: You changed what was possible today. You changed medicine.
Teddy: And yet, I still lose.
Owen: I do. I do have feelings for her but I do not want to be with her. When she leaves here, I will never speak to her again. I only want to be with you. I am in love with you. You are the mother of our children and you are my best friend.
Teddy: From the moment, the moment I met you, you made my world feel whole. I changed my career, I moved continents because being without you felt impossible. But sometimes, what we think is impossible, is just... It's just failure of imagination. There is no invisible force keeping us together. It was a choice, picking you every time. And I am not sure that I want to make that choice again.
Owen: You're giving up on us?
Teddy: I'm choosing me.

See Also[]

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


References[]

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