| “ | The way kids feel at Christmas is a pretty close equivalent to the way surgeons feel walking into an OR. It's a complicated mix of anxiety and excitement that makes it almost impossible to sleep. The anticipation is the best and worst part. "Will this go my way? Will I get what I want? Will my patient live? Will they heal? Is Santa real?" Stepping into an OR is its own kind of magic. The possibility that on this day, you might save a life. Or end it. I often ask my kids, do they prefer Christmas Eve or Christmas Day? I go back and forth on that question. As a person, I prefer Christmas Eve, when life is all possibility. Falling asleep with unopened presents under a tree, filled with excitement for tomorrow. But as a surgeon, I prefer Christmas Day. The point where possibility meets reality. You tried your best, you call to close, you finish the surgery with the proper suture. And soon, you'll see if it all worked. But whichever you prefer, I can promise you this. Eventually, the holiday is over. | ” |
It Came Upon a Midnight Clear is the eighth episode and mid-season finale of the eighteenth season and the 388th overall episode of Grey's Anatomy.
Short Summary[]
The doctors of Grey Sloan Memorial celebrate the holidays. Hamilton and Meredith prepare for a milestone on their project. Link wants to spend the holiday with Amelia and Scout as a family. Schmitt is faced with a difficult decision during surgery.
Full Summary[]
Meredith is untangling Christmas lights while the kids decorate the tree in the living room.
Miranda and Ben hang a stocking for Pru on their mantle.
Winston and Maggie are in the car where mistletoe hangs in the rearview mirror. They share a few kisses.
Teddy is wrapping presents while Owen stares off at Noah’s funeral announcement.
Jo pours coffee as Link comes in declaring he’s flying out to Minnesota. He has to tell Amelia how he feels and he wants his family to be together for Christmas. Jo agrees and says she will watch Scout. Link tells her she will never be alone, that she and Luna will always be invited.
Richard and Amelia are impatient as they wait for David Hamilton. Amelia tells him that Hamilton doesn’t really care what other people like anyway. Kai and Hamilton join them as he comments that they have cleaned Grey-Sloan up since he saw it last, that it’s not as drab. He greets Richard, and Amelia introduces Dr. Bartley. Kai thanks him for accommodating their surgery and Richard retorts “the project’s already using my surgeons, might as well use my operating room”. Hamilton says Richard knows how it is, famous patient, trailblazing neurosurgery, futuristic equipment, and Meredith Grey walking the halls has made the people of Minnesota start asking questions which threatened the work. Richard wishes them luck, both for Hamilton’s sake and science. Hamilton says he wishes Richard could observe, but they can’t compromise the secrecy of the technology, essential personnel only. Richard comments that he has residents to teach anyway. Hamilton leaves them to get to his pre-op blood work. Richard questions the ‘famous patient’ comment and says Hamilton is no Bono, but Kai says in Minnesota, Hamilton is about as close as you can get. Richard reminds them that Prince was from Minnesota and excuses himself.
Meredith is in the lounge when Cormac comes in. He reminds her that only doctors who work in the hospital are allowed in the lounge, it’s a security risk. He mentions that everyone has been told to avoid OR 2 and assumes that’s where her super-secret project is happening. She tells him she can’t say, security risk. He says it’s good to see her, she agrees and asks how he’s doing as he takes a seat. Meredith realizes it’s the holidays, and comments that it’s hard. He tells her his wife loved Christmas. She collected nutcrackers and this time of year is hard for the boys. She tells him that when she was sick, she had a dream – or what she thought was dream – about Derek on the beach. That it felt so real, and he’s been with her the whole time. She doing a groundbreaking surgery, something Derek would have loved to do, which would normally make her sad. But somehow she thinks he’s here hoovering over her and soaking it all in, which makes her happy. She asks that he not tell anyone about the dream, as she knows how ridiculous it sounds. He thinks it’s very kind of her to share it with him. She tells him she could hear him on the beach too and asks if he talked to her about her kids when she was sick. He confirms and she says she heard him, and it helped. They smile at one another as he gets paged. He thanks her again and suggests he may pick up a nutcracker after work.
Miranda and Ben are discussing meeting with a lawyer on Friday morning. She has a sleeve gastrectomy followed by clinic duty. Ben says he still on shift on Thursday morning. Miranda asks if he can get a sub, but because of the holidays, he can’t. He asks about Monday, but Miranda doesn’t want to wait until the following week, and wonders how they are supposed to fight for Pru if they can’t fit it into their calendars. Ben reminds them that they are doing their best in a world of uncertainty, but he will look into getting a sub. He asks that she try to take it easy, that he would like to spend time as a family. He offers options, including caroling, which Bailey rejects immediately and Ben realizes it was a ridiculous suggestion. As they start to walk again, Dr. Wright joins them with multiple coffees for Bailey as he wasn’t sure if she preferred regular or decaf. She thanks him, but says she has her smoothie. Ben happily accepts the regular because he fights fires and needs it. Dr. Wright thanks her again for bringing him on to work with her and excuses himself. Ben tells Bailey she’s still got it as he leaves.
Megan is sitting by an intubated Farouk in bed. Cormac comes in and asks how she’s holding up, suggesting she take a break to go outside or take a nap. He offers to sit with Farouk while she’s gone. Megan finally answers saying if Farouk doesn’t make it, she won’t either. That if he dies, she goes with him. She’s not interested in surviving another earth-shattering pain. She apologizes to Cormac for saying it, but she needed to say it to someone, someone not in her family. She just wants someone to know that she’s loved this life, or at least parts of it, but she’s not willing to survive this. Cormac gives her a worried look as she continues to stare at Farouk.
Teddy and Owen enter the hospital as Teddy comments that the service for Noah was nice, very full. She mentions that the support group is going to buy a Christmas tree and decorations for Danny and suggests they contribute some gifts. He agrees but is clearly preoccupied. Teddy tells him Heather and Danny will be okay eventually, and thinks there’s already some relief for Heather as she knows Noah is no longer in pain. They both get paged 911 to Winston and run off.
They arrive at Farouk’s room to find a sobbing Megan. Winston tells them there is a 15-year-old from an MVC who suffered a catastrophic brain injury and has been declared brain dead. Teddy and Owen are confused, asking if he’s at GSM or if they know the boy. Winston clarifies that the patient is in Tacoma, that UNOS just called because he’s an organ donor and his heart is a match for Farouk.
Jo is running towards the elevator with Scout and Luna and is surprised to see Amelia at Grey Sloan as she and Link both thought she was still in Minnesota. Amelia explains she came back early for a surgery. Jo lies and says Link went to get a Christmas tree so she is taking the kids to daycare. Amelia offers to take Scout and then Jo lies and says she has to get Luna's binkie from the car. The elevator doors close and Jo debates with herself before calling Link. She tells him that Amelia is at Grey Sloan and if he wants any chance of telling her how he feels, he cannot get on the plane to Minnesota.
Teddy, Owen and Cormac are headed to a car to grab the donor heart. Teddy says Winston is starting Farouk on induction therapy and since they're en route to get the donor heart, he'll get Farouk into the OR to get him ready for the transplant. When Cormac realizes both Teddy AND Owen are going to get the heart, Cormac says he's joining them because Farouk is his patient and he has some things he wants to discuss with Owen.
Meredith goes to check on David and sees him with his eyes closed. She asks if he's in pain and he says no. He was praying. He's not even sure he believes in it though. David tells Meredith that if he should die today, he left notes for his wife, kids and grandkids. He tells Meredith where to find them. He said he didn't want to send the emails because he didn't want to upset them unnecessarily if he DOES pull through. He then admits that he's been awful to Meredith. He tells her that before she puts him under, he wants her to know both how sorry he is for his behavior and how grateful he is to her. Meredith appreciates the apology and assures him that she has every intention of making history today. She asks him again if he's in pain and he hesitates before saying "only the existential kind."
Taryn runs into the skills lab to find everyone waiting for her. Bailey says she deserves the respect of punctuality. Taryn blames her tardiness on Levi not waking her up. Webber introduces everyone to their new 4th year resident, Jordan Wright from Minnesota. Wright would like to say something to the group. Richard gives him the floor. Wright says he's excited to be at Grey Sloan and calls it his Yankee Stadium. He calls Bailey and Richard current legends and calls the rest of the group future legends. Bailey hands out assignments. Sung gets cardio for a heart transplant, Perez has an appy, Levi and Taryn ileostomy takedown on Devon, a podcast host Levi admires. Webber tries to give Wright a solo surgery under the "Webber Method" but Wright wants a raincheck. He wants to learn from Bailey on the surgery instead.
Amelia finds Meredith outside and says they're moving David into the OR. She senses Meredith is upset about something so she tells Meredith what they are doing. Meredith throws up and feels better.
Richard explains the Webber method to Maggie who thinks it's insane and refuses to use it in cardio.
On the drive back with the donor heart, Teddy says if everything goes smoothly, this heart will be the best Christmas present. Cormac asks "What about Megan?" He stresses that she is not alright. Teddy thinks that anyone going through what Megan is with her son on ecmo and waiting for a new heart is going to be sleep deprived and anxious. Cormac says this is different. He addresses Owen and says he knows Megan is his sister and it's hard to hear. Owen interrupts and says Megan is tougher than Cormac thinks and she's been through worse than he can imagine. Cormac knows this but still thinks Megan needs serious help. Teddy reminds him it's a good day. They have a heart for Farouk. And when he's okay, Megan will be okay. Cormac is adamant that Megan is profoundly depressed.
Levi and Taryn are explaining the surgery to Devon. Devon is fine with whatever they have to do. He just wants some quality time in the woods again. Devon explains his podcast to Taryn.
Meredith and Amelia join Kai in David's room and are surprised to see he hasn't been prepped. Kai says they're not prepping him. It's not the equipment. David has a low grade fever. David says 99.6 is not a fever. It's nerves. He says he's in charge of the project and paying their salaries. Before he can finish, he winces in pain. He calls it a cramp and Meredith berates him for lying earlier. His abdomen is rock hard and he needs a CT.
Teddy is on the phone with Megan. She tells her they have the heart and they're on their way. She tells Owen and Cormac that Farouk is prepped and Winston is going to bring him up to the OR. Suddenly their driver passes out behind the wheel and causes them to crash. They land on their side and Owen sees the driver has a blown pupil. Most likely a stroke. Cormac and Teddy are both fine. No dents to the cooler with the heart. Teddy says someone needs to call for help. No one can get a signal. Teddy wants to get out to get reception but Owen tells her not to move. They seem to be in a ditch. He asks Cormac what he can see. Cormac looks and panics and tells everyone not to move. We see that the car is teetering against a tree inches from a cliff.
Winston tells the team they are about 25 minutes out with the heart so they are going to get Farouk on the table and start immediately. He tells Megan she needs to wait in the waiting room. Evelyn says she'll sit with her. They watch as Winston and the surgical team wheel Farouk away.
Levi greets Devon in the OR. Devon is ready for the surgery. Levi asks Devon if he minds if he listens to Devon's podcast during the surgery instead of music. Devon agrees and he's put under. The podcast and Levi goes to scrub. Maggie and Richard watch from the gallery.
In Bailey's OR, she's very impressed with Wright's technique on the sigmoidectomy. Wright says before every surgery, he draws it out. He draws the anatomy and what he would do to it. Even sketches out every possible complication and the solutions. Bailey asks why, if he knows this surgery from start to finish, he didn't want to do it on his own. Wright says he studies every move his attendings make so he can anticipate what they need. He says he's not here to learn the surgery. He's here to learn Bailey.
Carina and Jo are trying to turn Sylvia's baby. Carina is walking Jo through what to do and Jo apologizes when Sylvia screams out in pain. Carina tells Jo she's doing it right and then tells Sylvia they need to turn the baby around in order for her to have a vaginal birth. Jo continues the somersault method. She's interrupted by Link who is now freaking out. He starts saying how much he loves her and all he cares about is her and Scout and he doesn't need to be married. All he needs is them together now. It sounds like he's professing his love for Jo but he's using her as practice for when he talks to Amelia. Jo looks disappointed and then tells him it's perfect.
David is in the CT and starts talking about the relationship between stress, anxiety and Parkinsons pain. Meredith is exasperated and orders him to stay still so they can get the scan. Kai calls him stubborn. Scan comes up and shows he has a perforated bowl. They need to do an ex-lap. They can't inject the cells now. Meredith says they're not done. Just delayed. They'll get a new window from the FDA.
Teddy says the hospital will try to contact them, and when they don't hear from them, they'll send a rescue unit. But they can't wait if they want to save Farouk. By the time the rescue unit gets there, the heart won't be viable. No one can open their windows. Owen gives Cormac a device and tells him to smash the bottom of the window to break the glass. Owen wants Cormac to go first and then he and Teddy will follow. But when Cormac moves, it moves the car closer to the edge. Teddy says the car may fall but they cannot let this heart fall because a child died and his family had the grace to give the heart to them for Farouk. Cormac says the heart will stop being viable in about 3 hours. 2 of them have to stay in the car one on either side to stabilize the weight while one of them climbs out with the heart to get help. Owen thinks Teddy is the best one to get out with the heart and flag down a car. Teddy points out that Cormac is a single parent. Owen says if Cormac gets out, then his and Teddy's kids will lose BOTH their parents. Teddy suddenly tells everyone not to move. The car is pulling the tree out of the ground.
David tells Meredith not to report the issue to the FDA. Just fix the bowl and tell the FDA it was an equipment malfunction. Meredith says she can't do that.
While operating on Devon, Levi wants to move forward even though Taryn reminds him that according to the Webber method, they are now supposed to wait for an attending before continuing Levi says he'll just get it started but something happens and Devon starts bleeding. Levi can't find the bleed and orders suction.
Cormac tells Owen to tell his kids he loves them. Owen tells Teddy that they'll stabilize the car. She just has to get back to the road and get help. Teddy climbs out and takes the cooler from Cormac. She reluctantly leaves.
Kai is walking outside and Amelia approaches and tells her David is heading to surgery. It'll be a few hours. She tells Kai to close their eyes. She gives them a visualization. Kai opens their eyes and kisses Amelia which is witnessed by a disappointed Link.
Teddy is standing on the road with the cooler waiting for someone to come.
Wright and Bailey are still in surgery when they get a page from Levi's OR asking any attending to show up. Wright says he's good to close up and Bailey leaves.
David becomes Hypotensive as Meredith is scrubbing in.
Levi and Taryn are still trying desperately to save Devon. Maggie sees it from the gallery and says they need to follow protocol and she's coming down. The OR floor is flooded with blood. They've lost him. Bailey demands to know what happened. Taryn says they were doing the procedure and everything looked good and then Levi put traction on the IMA. Bailey asks why did they not call for an attending. Taryn says they did. But Levi started the disection instead of waiting. He thought he could just get it started but there was a bleed. Levi figured out it was coming from the base of the IMA at the aorta. They couldn't control it. Bailey tells Levi to call time of death. Taryn starts to but Bailey stops her and tells Levi it's HIS patient, his OR, his hands that operated and orders him to call it. Levi looks at the clock and calls time of death. 1:19. Bailey tells Richard this is on him.
Meredith and Amelia operate on David.
Evelyn and Megan wait anxiously.
Teddy sees a car approaching and yells for them to stop. Back at the car, Owen orders Cormac to get out of the car. He tells him to tell Teddy and Megan and the kids that he loves them. Cormac refuses. Owen says no child deserves to grow up without parents. He assures he'll be right behind. The only way is for Cormac to leave. He makes Cormac promise that if he doesn't make it, he gave Noah the drugs to die and he told Noah that he would give the same drug to 3 other dying soldiers. He wants Cormac to make good on that. He tells him where to find them and that Heather has the names. Cormac gets out of the car and the car slides down the cliff with Owen inside.
Cast[]
Main Cast[]
- Ellen Pompeo as Dr. Meredith Grey
- Chandra Wilson as Dr. Miranda Bailey
- James Pickens, Jr. as Dr. Richard Webber
- Kevin McKidd as Dr. Owen Hunt
- Caterina Scorsone as Dr. Amelia Shepherd
- Camilla Luddington as Dr. Jo Wilson
- Kelly McCreary as Dr. Maggie Pierce
- Kim Raver as Dr. Teddy Altman
- Jake Borelli as Dr. Levi Schmitt
- Chris Carmack as Dr. Atticus Lincoln
- Richard Flood as Dr. Cormac Hayes
- Anthony Hill as Dr. Winston Ndugu
- Scott Speedman as Dr. Nick Marsh (credit only)
Guest Stars[]
- Jason George as Ben Warren
- Stefania Spampinato as Dr. Carina DeLuca
- Jaicy Elliot as Dr. Taryn Helm
- Debra Mooney as Evelyn Hunt
- Greg Tarzan Davis as Dr. Jordan Wright
- E.R. Fightmaster as Dr. Kai Bartley
- Octavio Rodriguez as Devon Gomez
- Nikhil Shukla as Dr. Reza Khan
- Aniela Gumbs as Zola Grey Shepherd
- Abigail Spencer as Dr. Megan Hunt
- Peter Gallagher as Dr. David Hamilton
Co-Starring[]
- Sylvia Kwan as Mabel Tseng
- Zaiver Sinnett as Zander Perez
- Bardia Seiri as Farouk Shami Hunt
- Heather Knobel as Sylvia
- Annabelle King as Luna
- Brody Goodstadt & Ryder Goodstadt as Bailey
- Ella Faris & Gracie Faris as Little Ellis
- Ryker Murphy & Ryden Murphy as Scout
Medical Notes[]
David Hamilton[]
- Diagnosis:
- Parkinson's Disease
- Perforated bowel
- Doctors:
- Meredith Grey (general surgeon)
- Amelia Shepherd (neurosurgeon)
- Treatment:
- Exploratory laparotomy
David came to Seattle to have his surgery at Grey Sloan. Before his surgery, he developed a fever. Meredith examined him and then ordered a CT, which showed a bowel perforation. Meredith took him in for an exploratory laparotomy. He became hypotensive while Meredith was scrubbing in, forcing her to rush into surgery.
Farouk Shami Hunt[]
- Diagnosis:
- Dilated cardiomyopathy
- Doctors:
- Cormac Hayes (pediatric surgeon)
- Winston Ndugu (cardiothoracic surgeon)
- Reza Khan (surgical resident)
- Treatment:
- ECMO
Farouk was still in the hospital waiting for a heart transplant. A heart became available, so they took him to the OR and opened his chest in preparation.
Organ Donor[]
- Diagnosis:
- Brain injury
- Brain death
- Doctors:
- Treatment:
- Organ harvest
A 15 year old was in a car accident and had been declared brain dead. His parents decided to donate his organs, including his heart, which was directed to Farouk.
Mabel's Patient[]
- Diagnosis:
- Doctors:
- Mabel Tseng (surgical resident)
- Treatment:
- Heart transplant
Mabel was assigned to a heart transplant.
Zander's Patient[]
- Diagnosis:
- Appendicitis
- Doctors:
- Zander Perez (surgical resident)
- Treatment:
- Appendectomy
Zander was assigned to an appendectomy.
Devon Gomez[]
- Diagnosis:
- Ulcerative colitis
- Ileostomy
- Doctors:
- Levi Schmitt (surgical resident)
- Taryn Helm (surgical resident)
- Treatment:
- Ileostomy reversal
Devon was in the hospital for an ileostomy reversal. When Levi reached the point in the surgery where he was supposed to wait for the attending, he instead decided to start the dissection. However, Devon started bleeding profusely. Levi and Taryn worked to stop the bleeding after finding the source at the base of the IMA at the aorta, but they were unable to and Devon was pronounced dead at 1:19.
Jordan's Patient[]
- Diagnosis:
- Diverticulitis
- Doctors:
- Miranda Bailey (general surgeon)
- Jordan Wright (surgical resident)
- Treatment:
- Laparoscopic sigmoidectomy
Bailey and Jordan operated on a patient with diverticulitis.
Driver[]
- Diagnosis:
- Stroke
- Doctors:
- Treatment:
While they were on their way back to the hospital, the driver of the medical transport had a stroke and passed out.
Sylvia[]
- Diagnosis:
- Pregnancy
- Doctors:
- Carina DeLuca (OB/GYN)
- Jo Wilson (OB/GYN resident)
- Treatment:
Sylvia was pregnant and the fetus was in a breech position, so Carina talked Jo through a forward somersault technique to rotate the fetus into a head down position.
Music[]
| Song | Performer | Scene |
|---|---|---|
| "Christmas (Baby Please Come Home)" | Sleeping at Last |
|
| "Strange Time to Feel Alive" | TRVSTFALL |
|
| "Carol of the Bells" | The Big Moon |
|
Notes and Trivia[]
- This episode's title originated from the Christmas carol It Came Upon a Midnight Clear, originally written by Edmund Sears.
- This episode scored 4.20 million viewers.[1]
Gallery[]
Episode Stills[]
Quotes[]
See Also[]
|
A complete overview of this episode's crew can be found here. |
| Grey's Anatomy Season 18 | ||||||
| #01 | "Here Comes the Sun" | #08 | "It Came Upon a Midnight Clear" | #15 | "Put It to the Test" | |
| #02 | "Some Kind of Tomorrow" | #09 | "No Time to Die" | #16 | "Should I Stay or Should I Go" | |
| #03 | "Hotter Than Hell" | #10 | "Living In a House Divided" | #17 | "I'll Cover You" | |
| #04 | "With a Little Help From My Friends" | #11 | "Legacy" | #18 | "Stronger Than Hate" | |
| #05 | "Bottle Up and Explode!" | #12 | "The Makings of You" | #19 | "Out for Blood" | |
| #06 | "Everyday Is a Holiday (With You)" | #13 | "Put the Squeeze On Me" | #20 | "You Are the Blood" | |
| #07 | "Today Was a Fairytale" | #14 | "Road Trippin'" | |||
| << Season 17 | Season 19 >> | |||||