Grey's Anatomy Universe Wiki
Grey's Anatomy Universe Wiki

First, do no harm. As doctors, we pledge to live by this oath. But harm happens and then guilt happens. And there is no oath for how to deal with that. Guilt never goes anywhere on its own, it brings its friends - doubt and insecurity. First do no harm, easier said than done. We can take all the oaths in the world, but the fact is, most of us do harm all the time. Sometimes even when we're trying to help, we do more harm than good. And then the guilt rears its ugly head. What you do with that guilt is up to you. We're left with a choice. Either let the guilt throw you back into the behavior that got you into trouble in the first place, or learn from the guilt and do your best to move on.

Oh, the Guilt is the fifth episode of the third season and the 41st overall episode of Grey's Anatomy.

Short Summary[]

Derek and Addison finalize the divorce, Burke abstains from surgeries as Bailey comes under fire at the M&M. Meredith tries to decide whether to tell Derek she broke up with Finn and Callie reveals a secret to Meredith.

Full Summary[]

Izzie is cooking breakfast for Meredith and George. Izzie jokes about what she should do now that she's a millionaire. She's going to the hospital later to clear out her locker. She spills orange juice on the check from Denny and Meredith tells Izzie she needs to put it in the bank, because it's making her nervous. Izzie say she will as soon as she's cleared out her locker. Denny wanted her to be happy so that's what she's going to do.

In the locker room, Meredith is talking about how Izzie is losing it. Izzie overhears them and says she fine. She thinks Meredith is the one with problems, since Meredith hasn't told Derek that she broke up with Finn. They all think she should tell Derek, but Meredith says he walked away so she won't make him feel guilty. She directs them back to Izzie.

Callie and Mark are laying together in bed. George is texting Callie, and Mark asks if that's her boyfriend. Callie says she doesn't have a boyfriend. He asks why the guilty face then, but she doesn't want to talk. 

Bailey is telling the interns that they need to be at the M&M in 10 minutes, even if they haven't finished their rounds. They are all excited to go, but Bailey tells them the M&M is a serious meeting to discuss the mistakes that have been made and how the hospital can improve. Bailey is interrupted by Mr. and Mrs. Nyles, who got lost on their way to admitting. Mrs. Nyles is scheduled for a mastectomy tomorrow. They have a newborn and Bailey compliments him. It's clear Mrs. Nyles is upset, as she says he isn't so cute at 4 in the morning. Bailey shows them to their room and suggests they use sugar water on the bottle. The interns discuss how sad it is a 30 year old woman has breast cancer. Cristina tells them to focus and get ready to see their bosses get yelled at.

Burke runs into Cristina as she's carrying snacks for the M&M. She asks if he has any surgeries today, because she is ready when he needs her. Burke says no and walks away.

Going into the M&M, George runs into Callie. He asks if she wants to sit with him during the event, but she says no and walks away.

In the lecture room, George tells Meredith how Callie is trying to make him feel guilty about blowing her off the other night. He decides to have fun in life. Dr. Webber starts the meeting, with patient #34986 who died of a complications following a heart transplant last month. Burke will present. The interns soon realize this is Denny. Their excitement disappears.

Izzie is cleaning out her locker and she sees her stethoscope. She puts the ear pieces in and listens to her own heart.

Burke is presenting the case about Denny. He says the cause of death during the autopsy was identified as an embolus that dislodged itself from the suture line of the transplant, which causes a CVA with brain stem herniation. One doctor asks if that's the line the hospital is going with. Burke says it isn't a line, that's the truth. Someone else asks if his left ventricle has been weakened by the LVAD malfunction. Burke says his heart was weakened by his congestive heart failure. Dr. Savoy stands up and says everyone knows that the LVAD was cut by an intern. Burke says that remains unclear, and Dr. Savoy says Burke doesn't know because he was in the ER with a gunshot wound. He asks why Dr. Bailey isn't talking, because she was the resident on the case. Bailey stands up. She goes to the stage and asks if there are any questions for her. A lot of hands rise.

Dr. Savoy asks her if her judgment was clouded by the fact that she recently had a baby, suggesting her hormone levels and sleep derivation could have played a role in this. She replies she sleeps fine. Webber reminds everyone that this is not to place blame, but to help everyone improve their medical care. Dr. Savoy continues to press Bailey about why her interns were running around without her supervision. She says she was busy with the shooting and he asks her why her interns have no respect for her authority. Alex stands up and tells him he has no idea what he's talking about. Bailey tells him to sit down. Then, the interns see that Izzie is in the back, listening to the discussion.

Derek and Addison are meeting a divorce lawyer. The only complicated thing to divide is the real estate. Derek says he only wants his land with the trailer; Addison can have it all since he had an actual relationship with Meredith, not just an one night stand. Addison tries to tell him that it was more than a one-night stand, but she fails to do so as Derek has made up his mind and considers the meeting done.

Back at the M&M, everyone comforts Izzie and tells her she shouldn't have been there to hear that. She says she is fine and that she wasn't cut out to be a doctor. She starts to leave. George tells her either she hangs out with them or they'll call her mother. Izzie says she'll be in the locker room for the rest of the day. Burke sees Izzie as she leaves the room.

Webber asks Bailey and her interns why Izzie was there. Alex says he didn't have to do with any of this. George asks if he can be with Izzie for the rest of the day because she needs someone. Richard agrees. They all apologize to Dr. Bailey for what happened in the M&M and she tells them they don't get to apologize for her mistake. They don't get to feel better because neither does she.

While waiting for an elevator, Dr. Savoy apologizes and says it's nothing personal. She felt it was personal when he brought up her hormones. Mr. Nyles comes over and thanks Bailey for the advice to feed his son. He offers to let her hold the baby, but she declines. He asks if Bailey can talk to his wife, because she is nervous about the mastectomy and is thinking about a lumpectomy instead. He asks if Bailey can talk her into the surgery. Aware of Savoy listening, she says that isn't her job, but she'll send up their plastic surgeon to discuss reconstructive options.

Burke tries to talk to Webber about his hand, but Webber asks Burke to help him focus the staff. Webber says they respond to him because he's an example, a real leader. Burke thanks him.

Meredith runs into Derek. She asks how he is and he asks her the same. They're both good. Addison pages Meredith and she says she needs to go.

Meredith asks a nurse where Dr. Montgomery-Shepherd is. Addison comes over and tells Meredith that she is just Dr. Montgomery now, as the divorce was finalized that morning. Addison and Meredith go in to see a patient, who has a foreign object stuck inside of her. They are surprised to find a man and a woman caught in a compromising position.

Addison and Meredith are taking closer looks. Sonya has her ex-husband Adam caught inside of her. A piercing of his is caught inside of her. She is supposed to meet her new husband for lunch so she'd like this to be over quickly. Addison asks Sonya if she has any piercings, but the answer is no. Sonya says they are divorced, but because they are but real estate agents, they run into each other a lot. They sometimes get together. Addison says they'll take X-rays to figure out what's going on but she advises Sonya to cancel her plans.

Cristina finds Burke and brings up the M&M. Burke says he tried to talk to the Chief about his hand, but he couldn't. He doesn't know what to do. Cristina offers to be there in surgery, but he says he isn't going to do surgeries anymore, only paperwork. He needs time to think.

Izzie says she knows she the crazy intern. George says they should talk about what she's going to do with her money. Izzie and George see Sonya and Adam. Addison says it's good to have Izzie back. She says she isn't back, but she asks Addison if she's rich. Izzie asks Addison if she ever feels guilty for being rich. She tells Addison about the check. Addison tells her to just deposit the check and the guilt will work itself out.

Meredith and Derek see each other again in the hallway. Meredith says he's everywhere and he apologizes, saying for once it's actually not on purpose. Meredith shows Derek Sonya's x-ray. He asks what it is, and she says a divorced couple who were going at it. Meredith then asks about Derek and Addison's divorce. Derek says it was time. He asks how Finn is, and Meredith says he's fine.

Mark is talking to Mrs. Nyles about implant options after the mastectomy. She says she can't deal with it right now and tells her husband to pick. He says he doesn't care. Alex and Mark urge him to care.

Mr. Nyles finds Bailey in the lobby and asks her what's wrong with his wife. Bailey says she has cancer. He knows, but his wife won't tell him what's actually wrong. She won't hold her son, but he knows she's a good mother. Bailey offers to ask for a psych consult, but he just wants his old wife back. Now she's talking about not having the surgery at all, so he asks Bailey to tell her to have it.

Sonya and Adam are getting more x-rays since the previous ones were blurry. Sonya tells Adam that they need to stop doing this. She is remarried now and the only time they were happy in their 19-year marriage was when they were having sex. Their daughter, Jennifer, comes into the room and is shocked to see her parents together.

Meredith asks Jennifer to wait in the car. Jennifer tells them they need to pay for her therapy, new car, and rent. Adam agrees, but Sonya says Jennifer is old enough to know that her parents are sexual beings and that they make mistakes. Jennifer says she doesn't call this a mistake, she calls it her mother being a slut. She thought her father would move on and start dating. Addison then comes in and explains that Sonya's IUD has dislodged and got caught on Tom's piercing. It's embedded in her vaginal wall. Meredith then points out that the daughter is in the room.

Addison and Mark are talking about the divorce. Mark wants to know who got the brownstone. Mark wants to know because he left his bike in the basement and he wants to know who to talk to to get it back. Addison tells him to buy a new bike. Mark says this thing turns him on. He assumes Derek got the Hamptons house then, even though he hates the Hamptons. Mark say if Derek gave her the brownstone and the Hamptons, then that must mean he doesn't know the full story. He thinks it's unfair that Derek has forgiven her while he's still the chump who slept with his wife.

Izzie says she's going to buy Burke and Bailey presents. George suggests a CD, but Izzie says she's a multi-millionaire. Meredith suggests a house, in the Bahamas. This leads Alex to suggest buying the Bahamas, or at least a Bahama. Because you know, with 8 million dollars you could buy an island. Cristina responds by reminding Alex that he's an intern  and asking when he'd have time to go to his Bahama. He says he'd quit, but Cristina reminds him that he is a surgeon and that he operates. She apologizes to Izzie, who assures them she's fine. Alex is inspired by his patient to live life while you can. Izzie asks Meredith if she's told Derek about Finn yet. Meredith is still giving him time. Izzie thinks that's stupid, but George thinks carrying around that check is more stupid. Izzie again says she's fine.

Callie tells Meredith that she has slept with another guy and wonders if she should tell George. Meredith says she broke up with Finn and still wonders whether to tell Derek or not. She thinks she can't. Callie decides to tell George.

Mr. Nyles begs his wife to hold their son, but she turns away and tells him to stop. Bailey is listening from outside the room until Richard comes to drag her away. He tells her some hits at the M&M were justified, but compassion and empathy are a part of the job. Being a parent makes her a better doctor, no matter what Savoy says.

Burke is flexing his hand as Izzie appears in the doorway. She wanted to say hi and brings up the money that Denny left her. Burke didn't know that Denny had money. Izzie thinks she should use it to travel. Izzie says people keep thinking she's not fine, but she is. Burke says he got shot when he came back to the hospital to check on Denny because she asked him to. He's not fine. She got engaged to Denny and now he's dead, so she can't be fine. They are not fine. Izzie apologizes. They were friends and she never meant for anyone to get hurt. Burke tells her she quit while she has two good hands. She should feel guilty about that.

Meredith and Cristina are trying to position Sonya and Adam so they can unhook them. Addison is directing them while watching a live scan. Richard comes in because he heard about the case. He also gives some instructions. When they finally find the right position, Addison tells Meredith to swirl Sonya a bit. Then, they get ready to pull Sonya off. As soon as they do, Adam starts making weird noises. Initally, the doctors think he's having an orgasm, but he's actually having a heart attack. They call code blue.

Cristina is performing CPR while Richard says they need an OR to repair the man's aorta. The cardiothoracic surgeon on call is busy. Richard asks what Burke is doing. Cristina says he's not on the board yet. Richard says he is now. They start moving the patient.

Burke and Cristina are scrubbing in while going over their plan. She will be by his side and if his hand starts to tremor, he'll look at her so she can slide in to the sutures like they practiced. Cristina asks what if someone notices. Burke says he has to try because the patient is dead without him. So he needs her there. They get gowned and gloves and step up to the table. He asks for the scalpel and starts cutting.

Addison tells Sonya that they'll keep her updated on Adam and advises her to look for another form of contraception. Sonya doubts she'll be having sex any time soon since she plans on telling Tom. When it happened the first time, she felt guilty and she wasn't going to tell Tom. Then it happened again and again, and somewhere along the way, she stopped feeling guilty. The truth has to come out now. Addison understands.

In surgery, Burke starts scraping his throat. Cristina understands and asks if she can try a running whip stitch, even though she knows it's a lot to ask. He moves over and lets her. He starts instructing her while the scrub nurses are surprised. Cristina pulls it off while the other interns are watching in the gallery. George is jealous that she gets sex and perks at work. Meredith advises him to apologize again, but he won't take relationship advice from her. Izzie then lets it sink in that Cristina is doing a running whip stitch on a heart.

Bailey enters Mrs. Nyles' room. Bailey says when she's driving home at night, all she can think about is getting home to her son. Anna doesn't want her to tell her to fight the cancer so she doesn't miss out on the joys of motherhood. Bailey ignores her and says then she gets home and the baby's crying. The exhaustion hits and she resents the baby's presence in her previously quiet house. She then picks a fight with her husband, she bitches about the neighbors, and if she's really pissed off, she blames the baby. She understands that Anna feels that if she hadn't been breastfeeding, she wouldn't have thought that the lump was a plugged milk duct. She would have gone to the doctor straight away and the cancer wouldn't have gotten this far. And then she wouldn't be here to make this decision. Anna wonders what kind of mother blames her son for cancer. Bailey says a human mother who is overwhelmed. Anna thinks if this is going to kill her eventually, it would be easier if it happened now that Gus is still little. Bailey says this is the part where she tells Anna to fight the cancer so she doesn't miss the joys of motherhood.

Addison catches up with Derek, who tells her they deserve a medal for how adult they are about this. Addison says Mark wasn't a one night stand. They lived together for two months when Derek left, because Addison wanted to believe she hadn't thrown her marriage away over a fling. But he's Mark, so Addison caught him with someone else and then Richard called. They both had relationships so they are equally liable. She offers Derek the brownstone, but Derek still only wants Seattle. He also wants to never see Addison again.

Derek finds Meredith on an elevator. He gets on. She tells him he's everywhere, so she can't not tell him. She kept quiet all day because she thought it was kind to give him space. She tells him she broke up with Finn. All he says is okay. She's disappointed, but now she's told him. He gets off the elevator without another word.

Burke tells Jennifer that the surgery went well. She hugs him and Cristina smiles.

Izzie finds Richard and tells him she has 8 million dollars. He's heard about that. Izzie says all she wants to do is a running whip stitch. Richard says as an intern, he had a stable patient who blew out his lung on the way to CT. He called a code, but the patient died by the time everyone got there. The patient would have made it if he had inserted a chest tube right away. He made a mistake, but he stayed and worked hard and never made that mistake again. If he had quit, that mistake would have been all he had, but now he gets to save lives every day.

Mark finds Derek in a lounge. He knows Addison finally told him. Mark knows what Derek is thinking since they grew up together. He thinks that he wasted a year of his life trying to make it work with Addison while he could have been happy with Meredith, that they could have had a real chance. Mark still thought he owed Derek the truth, as his friend. Derek says he's not his friend and leaves.

Bailey is holding the Nyles baby as Savoy passes. He asks if she's babysitting. She says she is indeed, being all unprofessional and emotionally involved, while her patient and her husband are having a moment. She tells Savoy to go since she can feel a rush of hormones coming and there's no telling what she might do. As he walks off, Alex comes over and asks about Anna. Bailey thinks they're leaning towards a mastectomy. Alex brings up Izzie. Alex says he didn't do anything. He knew what Izzie was going to do and he didn't do anything to stop her. So Bailey wasn't the only one. Bailey thanks him.

Callie opens the door of her hotel room. George is there with fried chicken and movies. Callie says the other night was her breaking up with him. He thinks he would have noticed that. She says he didn't, and that's why she broke up with him.

Mark and Addison are naked in bed. He says at least she doesn't have to feel guilty now. She tells him to shut up.

Izzie puts the check back on the fridge. She has decided not to deposit it until she knows what good she's gonna do with the money. George and Meredith stare at the check as she walks off.


Main Cast[]

Guest Stars[]


Medical Notes[]

Anna Nyles[]

  • Diagnosis:
    • Stage 2B breast cancer
  • Treatment:
    • Mastectomy
    • Breast reconstruction

Anna, 30, was scheduled for a mastectomy to treat her breast cancer. She was unsure about that plan and thought she might go for a lumpectomy instead, so she had a plastics consult to talk about reconstructive options.

Denny Duquette, Jr.[]

  • Diagnosis:
    • Congestive heart failure
    • Stroke
  • Treatment:

Denny's case was presented at the morbidity and mortality report.

Sonya Cowlman[]

  • Diagnosis:
    • Foreign body
  • Treatment:
    • Controlled extraction

Sonya came in with a foreign body stuck inside her. The object was her ex-husband. He had a penile piercing which got hooked on her IUD while they were having sex and got lodged in her vaginal wall. They used x-rays to manipulate the two until they were able to separate them.

Adam Morris[]

  • Diagnosis:
    • Myocardial infarction
    • Aortic dissection
  • Treatment:
    • Surgery

Adam had a heart attack and his aorta dissected, requiring emergency surgery. His surgery went well and he was expected to make a full recovery.


Song Performer Scene
"Clonie" Nellie McKay
  • Izzie is making breakfast when George and Meredith come in.
  • George and Meredith are shocked when Izzie spills juice on the check.
  • She says she's going to the hospital to clean out her locker.
"Kaleidoscope" Kate Havnevik
  • Meredith shows Derek an x-ray and asks if it's blurry.
  • She mentions that she heard his divorce was final.
  • He asks her about Finn.
"Wild is the Wind" The Second Band
  • Izzie talks to the other interns about what to do with the money.
  • Callie tells Meredith she slept with another guy and doesn't know if she should tell George.
  • Meredith doesn't know if she should tell Derek about Finn.
  • They each make their own decision.
"Be Good or Be Gone" Fionn Regan
  • Bailey talks to Anna about her treatment.
  • Addison tells Derek Mark wasn't a one-night stand.
  • Derek gets on the elevator with Meredith, who tells him she broke up with Finn.
"Don't Mistake Me" Keisha White
  • George takes movies to Callie's. She says they were broken up and closes the door.
  • Mark and Addison are in bed together. He says she doesn't have to feel guilty now.
  • Izzie decides she's not ready to deposit the check because she doesn't know what to do it.

Notes and Trivia[]

  • This episode's title originated from the song Oh, the Guilt, originally sung by Nirvana.
  • This episode scored 22.05 million viewers
  • In the locker room scene Meredith's mini whiteboard on the inside of her locker door states that she is scheduled to "eat eye boogies" at 2 PM.
  • Denny was patient number 34986.
  • It is revealed that George has Izzie's mother's telephone number on his cellphone and Meredith is aware she lives "a few hours away".
  • Cristina says she'd buy a hospital if she had Izzie's money, something she'd later actually do.


Episode Stills[]


Izzie: Morning.
George: I thought we were all done with the whole muffin thing.
Izzie: This isn't muffins. This is breakfast.
Meredith: Are you okay?
Izzie: Of course I’m okay. I’m a millionaire. Fruit? What do you guys think about B&B's? I'm thinking about opening B&B in Vermont where the foliage is, you know?
George: Maybe you should go back to sleep.
Izzie: Can't. I'm going to the hospital.
Meredith: Are you going to talk to the Chief?
Izzie: I'm going to clean out my locker. I could buy a hotel. How much do you think a hotel costs? (Izzie pours orange juice and spills it on her check)
George: That is 8 million... (He quickly cleans up the juice.) Eight million dollars does not like to have juice spilled on it.

Meredith: (about Izzie) She almost battered and deep-fried an 8.5 million dollar check.
Cristina: For that kind of money I'd buy my own hospital and stock it full of sick people. Valvuloplasties and ruptured aneurysms.
George: You're a psycho.

Lawyer: Derek says that neither of you brought any assets into the marriage.
Addison: Well I had my trust fund, and a sparkling personality uh, and a futon couch.
Derek: Yes, Addison had a very ugly, very heavy, futon couch.
Addison: Whatever happened to that couch?
Derek: We gave it to Mark. She can have him.
Addison: I don't want him.
Derek: Okay, well that's settled. What else?
Lawyer: Aside from Addison's trust fund which will remain in her name, we'll split everything, stocks, bonds, 401K's down the middle. The only thing that gets complicated is the real estate.
Derek: Well, let me make this simple. I'd like to keep my trailer and the land is Seattle. Addison can keep the rest.
Addison: Hold on...
Lawyer: That's the house in the Hampton's and the Brownstone overlooking central park. That's very generous of you.
Addison: Hold on. He's up to something. I came here to fight over CD's and books. Go to war over a crystal vase. What are you up to Derek?
Derek: The divorce is my fault, let me take responsibility.
Addison: We both had affairs.
Derek: You had a one night stand with Mark.
Addison: Actually it was...
Derek: Okay it was two nights. You made a mistake. Meredith and I, we had a relationship. Make these changes. I'll sign them today.

Mark: She told you. I've known you my whole life, I grew up with you so I know what you're thinking. That there is a year of your life wasted. Trying to make it work with Addison and you could have been with Meredith. That you could be happy right now. That all this, everything. That you and Meredith could have had a real chance. Still, I thought you should know the truth. Thought I owed you that, as a friend.
Derek: You're not my friend.

See Also[]

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

The Grey Matter blog post on this episode can be found here.