On average, a healthy heart beats 115,000 times per day. When excited, the heart rate can double. The heart pumps 2,000 gallons of blood through your entire body 24 hours a day. It never rests. The heart is the hardest-working muscle in your body. But when it’s damaged, it’s just like skin. It scars, and scar tissue can be very dangerous in a heart. It weakens it. And eventually, a heart full of scars stops working. Scarred hearts don’t heal, but over time, the scars can change. They can become smoother, softer. And some scars can even fade away.

Old Scars, Future Hearts is the fifteenth episode of the fourteenth season and the 308th overall episode of Grey's Anatomy.

Short SummaryEdit

Meredith tries to learn more about Marie Cerone’s history with her mother. Meanwhile, Jo is applying for fellowships around the country and it throws Alex for a loop, and Tom Koracick helps April acknowledge her crisis of faith.

Full SummaryEdit

Meredith is going through Ellis's journals at the kitchen table. Maggie comes in. Meredith tells her Ellis described Marie as a colleague and a friend, and she even knew about Richard, whom Marie deemed Richard a distraction from work. Meredith suspects Marie may have been in love with Ellis. She then notices Maggie is distracted, but she thinks it's about Clive. Maggie rolls along with it. Amelia comes in and goes upstairs to catch some sleep, as she didn't sleep last night.

Tom is putting on April's robe and suggests he make breakfast, but she would rather he leave. She wants to vomit in private. She runs into the bathroom.

Alex and Jo are getting ready to leave for work. They are both scrubbing in on Maggie's DOR procedure. He then notices her fellowship applications to hospitals all over the country.

Outside at the coffee cart, Maggie is talking to Bailey and Richard about her DOR procedure, in which she removes scar tissue and reshapes the ventricular geometry. It requires mastery. Bailey has re-arranged her day to be able to watch the surgery. Richard and Bailey walk off. Maggie sees Jackson approaching and drops her cup. He helps her to clean up. He proposes a dinner date tonight. She says no, because she needs to exclusively focus on her surgery today and Jackson makes her hands shake.

Maggie, Alex, and Jo are in Charlie's room. His heart function has decreased considerably, so they need to do the surgery today. Charlie and his boyfriend Henry are cosplaying as knights. Charlie verifies if this surgery will slay the ECMO dragon. Maggie confirms as she plays along. Charlie's mother June tells her not to as it encourages them. Charlie wants all the encouragement he can get. Henry totally gets it, which is why he's the master of Charlie's heart. June says it's typical first love, which sparks a memory for Alex.

1994. Young Alex and his girlfriend Laura are studying biology together. Laura already took the test behind his back. She didn't exactly come over to study. They share a kiss.

Marie enters Meredith's lab with doughnuts. Meredith inquires why Marie didn't mention the falling-out with Ellis and pretended everything was okay. Marie clarifies her affection for Meredith has nothing to do with her falling-out with Ellis, which she thought Meredith knew about. Meredith stresses that whatever happened has nothing to do with her, so she hopes Marie can let the petty disagreement go in order not to ruin what could be a landmark breakthrough. Marie asks if she's interested in her side of the story, because it's not petty.

Jo has run tests on Charlie, but Alex barely pays attention. She notices he's been bothered ever since he saw her applications. She knows he did the same thing in his fifth year, so she wonders why. Alex says that is the reason he didn't say anything and tells her to do whatever she wants. Maggie and Bailey come up with the news that a donor heart has become available for Charlie in Oregon, thus eliminating the need for the DOR procedure. Maggie is sad to lose her Michelangelo moment.

The doctors just delivered the news to Charlie, but after looking at Henry, he passes on the heart. He wants the DOR procedure on his own heart. Maggie explains it's not a permenant solution. Charlie says his scarred heart fell in love with Henry and the new heart might not love him. Alex says chemicals in the brain make him in love with Henry, and they eventually fade. They always do. Jo is taken aback as he says this. Charlie says this love is exquisite and he refuses to risk it, even if it means it only lasts for a year. He asks Maggie to slay the dragon as planned.

Maggie again says Charlie will keep getting sicker until he can only look at his boyfriend through a window. That is not romantic. Henry asks for a few private minutes. Maggie says they need an answer soon, and stresses that if Charlie says no, he risks being thrown off the transplant lists forever. Before leaving the room, Jo tells Charlie that while first love may hurt, it's not supposed to actually kill you.

2003. Young Jo wakes up in her car as it's about to be towed. She gets out and the tow truck driver explains she should've paid her parking tickets. As she argues with him, a group of boys passes and one of them, Chris, comes up. He pays the guy off to leave her alone for now. He tells Jo he'll see her in physics and leaves.

Maggie, Jo, and Alex are waiting at the desk while talking first loves. Maggie says she fell in love with her lab partner Steve over their cadaver named Leonard. Jo says hers was named Mort. Alex's was Road Kill.

1999. Young Maggie and Steve decide on the name Leonard for their cadaver. Neither of them has ever cut a person before, which makes them first-cut virgins. Steve proposes to make the first cut together. She squaels with joy as they both hold the scalpel and make the cut.

Henry summons the doctors back into the room. He just broke up with Charlie. He loves the cosplay, but he can't be with someone who doesn't believe in science. A depressed Charlie tells Maggie they can sedate him and cut out his heart since it doesn't matter anymore.

Marie just told Meredith that she and Ellis created the laparoscopic biliary reconstruction method together. Ellis won her second Harper Avery for it. They were going to publish together, but Ellis did it first and didn't share the credit. Meredith wants more proof than the documents Marie brought with her. Marie never cared for romantic relationship, so Meredith is the closest she has to a child of her own. Her friendship with Ellis was the love of her life, and when Ellis betrayed her, it was unimaginably painful. She went back to Spain, took over her father's company, and never returned to the US or her surgical practice. Ellis broke her. Meredith wonders if Marie ever thought that she gave Ellis too much power. Marie is sure that's true, but she thinks she has a right to the work Ellis stole from her. She was meant to be more in this life, and Ellis took that from her. If Meredith wants the patent, she has to put out a statement that the Ellis Grey procedure is now the Grey-Cerone procedure.

Meredith shows Richard the documents and asks if Ellis's second Harper Avery is based on a stolen idea. Richard only heard rumors. Inspiration is intangible. People give you pieces, like Maggie inspired his path pen. Richard doesn't believe the rumors and it's not on Meredith to undo her mother's legacy when she's not here to defend her side of the story.

Jo enters the OR, where Charlie is about to be put under. Jo tells him to vow to survive. He has to fight for Henry. True love can survive break-ups, so he has to live and fight for Henry.

April finds Tom still in her kitchen. He's looking for food. She takes vodka out of the fridge to mix herself a Bloody Mary while he settles on a yogurt. She thinks he's stalling so they can have sex again. Based on his observations, he guesses she has a 2-year-old daughter. April tells him not to feign an interest to get her back into bed, because she'll agree to that regardless. He says it's real interest. He finds her fascinating. Amelia trusted her with her life a couple of months ago. Her home looks warm. The woman he met last night doesn't live in a place like this, and neither do you trust her with your life. He wonders how April became that woman. He starts guessing and eventually hits crisis of faith. She denies it, but he knows he's right. She admits to hating God so much she wishes He were dead.

Jo is admiring the donor heart as Maggie detaches the old, scarred heart. Alex jokingly suggests she names the heart, as she does with medical waste.

1999. Steve and Maggie are done with Leonard, who will go to the crematorium now. Maggie says they should hang out to have a funeral for Leonard. They can't steal the body, but Maggie meaningfully glanses at the heart in the trash. Steve says he'll cover for her. She takes the heart out of the trash.

Jo can't believe she actually stole a heart for a boy as she brings the donor heart up to the table. She wonders when that creepy side of Maggie disappeared. Maggie takes the heart and finds that the new heart is too big for Charlie's chest. The measurements were precise, but the heart must have swollen due of resuscitative edema. Alex is determined to make the chest fit the heart. Maggie says they can attach the heart now and leave the chest open overnight in the ICU. Then they can come back in when the swelling goes down and close with a sternal flap. They'll need to take out the sternum and they'll need Jackson to close, but they can make it work. Alex leaves to update the mother.

June doesn't like that Charlie's heart will be unprotected. Alex explains they'll cover it with a sort of plastic wrap and that they'll monitor him closely. June says it's just her and Charlie. If they broke Charlie's heart and sent him into a surgery he doesn't recover from, she will break.

1994. Alex's mother comes running through the living room with a hammer in her hand as she yells that they are coming. Alex goes after her. She tries to hit him, but he manages to avoid the hammer and grabs her tight. He calms his mother down and asks a confused Laura to grab the pills from the counter, which his mother forgot to take.

Alex returns to the OR. The surgery continues smoothly, until the heart won't start beating at the temperature it's supposed to. Maggie wants to wait until the temperature has risen another degree.

Meanwhile, an emotional June is waiting.

The heart starts fibrillating. Alex asks for the internal paddles and shocks the heart twice. It results in a rhythm.

Jo and Chris are lying in her car. He likes the car, but she says he wouldn't in the winter. He says she can move in with him. She thinks his perfect parents wouldn't be too thrilled with his homeless girlfriend. He thinks they'll love her as much as he does. They share a kiss.

Maggie is checking on Charlie as Henry appears outside the room. She goes to update him and talks about the complication. Henry says he only broke up with Charlie so he would take the heart. He planned on coming back to an awake Charlie, who would kiss and thank him. Now, the last thing he said to Charlie is that he's stupid.

Jo finds Alex in a lounge and tells Alex that Pierce is staying overnight to monitor Charlie, so they can go home. Alex wants to stay here. She wants to talk because he's been brooding all day. He denies this. He just wants to stay and then she can go home and work on her applications. Jo says he's punishing her for taking steps to further her career. He just didn't think she'd be so eager to leave Seattle. Jo says for the first time, she can do what she wants without having to worry about Paul finding her. She thought he would get that. He says he's happy that she's free, but he didn't realize Paul was the only one keeping her in Seattle. He leaves.

Maggie paged Jackson for a consult on Charlie. She updates him and he agrees they can do a flap. He was hoping she paged him for dinner. She says she has to stay here. He hands her an apple so she can eat. He wishes her good night and leaves.

Tom and April are eating takeout while talking about religious books. She says there are people blatantly disregarding His teachings and facing absolutely no consequences, while others who spend their lives trying to emulate and honor Him are brutally mistreated. She doesn't expect him to get it. He reveals he grew up Catholic. He walked away, too, for a while because his kid died instantly after taking a baseball bat to the skull. The priest told him to talk to God, but Tom just wanted to strangle Him. He wanted to talk to his son. He wasn't as delightful back then as he is now. His marriage fell apart, so he went to church. In church, you can talk out loud to yourself without looking crazy. He still talks to his son. He doesn't think God left him or the other way around, they just got into a fight. He tells her it's her turn now, but she deflects and moves closer for more sex.

Meredith tells Alex about Ellis's friendship with Marie. It looks like Marie was her mother's Cristina. Alex asks if Meredith could forgive Cristina if she published shared work by herself. Meredith says no, and she might even make it her life's work to get her back. Alex says Jo might leave Seattle. Meredith says he can't take her career ambitions personally. She won't abandon him like Izzie did.

1994. Alex arrives at a party and overhears Laura talking about his mother's breakdown. She says his relationship with Alex is over, she just has to tell him. She thinks it's only a matter of time before Alex goes crazy, too.

Amelia appears in the living room and grabs some chips. Meredith notices she just woke up. Amelia says she was up all night last night and most of today. Alex asks doing what. Owen walks in to grab some water. Amelia says she was doing that. Owen goes back upstairs. Amelia says she uses ex sex to take the edge of, like Meredith uses tequila. Amelia goes upstairs, too. Meredith asks Alex if he's going home. He doesn't reply. She tells him to shut the lights off and goes to bed.

1994. Alex comes home after the party and finds his mother shouting that she can see them. Alex makes her touch his face to convince him that he's real. She recognizes him and asks if he's going out. He replies he's staying with her tonight, which she likes.

Jo comes home to an empty and dark loft.

Jo and Alex are scrubbing in. She says she missed him last night. He missed her, too.

2003. Chris walks Jo back to her car after meeting his parents. She was amazing. He wants to have a life with her, with a house and kids. He asks her to move in with for college. It's only a half-hour commute so she can finish high school. They can start their life together tomorrow. He asks her to come pick up so she can drop him off. Then she can decide if living with him is better than living in her car, which it is. She agrees to the plan.

Maggie says Charlie's heart is strong, so he can handle the reconstruction. They start operating.

1999. Steve and Maggie are burying Leonard's heart. Steve says a small eulogy. Maggie has a poem to read, which praises Leonard and ends with her telling Steve he's her cadaver. Steve visibly dislikes the turn of events.

Maggie can still recite the poem today. Alex mocks Maggie for likening Steve to the cadaver. She thought Steve would get that she loved him as much as the two of them loved Leonard, but he didn't. That blew it for her on the dating scene since everyone thought she was into cadavers. It gave her the nickname Zombie in med school, but Steve turned out to be gay anyway. The poem was ahead of its time. Jo has taken out the sternum, so Maggie says it's time to page Jackson for the flap. Jackson replies he's already there. He heard the poem. He asks which flap they are going for, omental or pectoralis. He thinks pectoralis.

Charlie wakes up after surgery with his mother by his side. Henry comes in dressed a knight with the costume made out of drawn-on hospital gowns. He professes his love for Charlie in a knightly manner. Charlie starts smiling while Jo looks at Alex.

2003. Chris and his parents are waiting for Jo on their driveway. He's sure she'll show up any minute. Meanwhile, Jo is driving out of Connecticut.

April is surprised to see Jackson show up with Harriet at her house. She forgot it's Tuesday. She takes Harriet and greets her. Jackson offers to keep Harriet with him for a little longer. Tom comes up dressed in April's robe, expecting Kung Pao chicken. April thanks Jackson for bringing Harriet by and closes the door on him.

Marie drops by Meredith's lab before she leaves for the airport. Meredith says she can't continue her work without the polymer, and she can't undo Ellis's legacy without hearing her side. Marie understands, but she knows Meredith will understand that Marie will dedicate the entire company to Meredith's idea. The mini livers will be known as the Cerone method. Meredith hopes there is some other way. Marie acknowledges it's not fair for Meredith to have to clean up her mother's messes, but she doesn't find it surprising.

Maggie enters the bar and sees Jackson. She wants to leave, but decides against it and sits down next to him. She says she is known for naming medical waste and medical instruments, and she had an imaginary friend named Ralph. But to be clear, she was also the first of every class. She can do sign language, she's ordained to perform weddings, and she can change a tire. And she can tell anyone what happens by chapter in any of the Harry Potter books. So, if Maggie's undone by Jackson, he should also be undone by her. Jackson says she had an imaginary friend named Frodo, half troll, half gremlin, who feasted on the tears of his imaginary enemies. Just because he was prom king on four consecutive occassions, doesn't mean that he doesn't have real pain. He has real wreckage and insecurties. He shows her a bandage and confesses he stapled a lap pad to his hand this morning after seeing her. So yes, he's also undone by her. He wants to take her to dinner. She agrees to that. 

Alex comes home to Jo waiting for him, surrounded by candles. She tells Alex she never fit in anywhere. She kept trying to belong, but nothing ever worked out, so she had to keep moving. Or maybe she was running from her circumstances or herself or anyone who dared to love her. He asks her to pause and starts looking for the ring. She tells him she's wearing it. She kneels in front of him. She always thought there was something wrong with her and she always wanted to run, until she met him. He's so screwed up that he makes her make sense. They fit and she does not want to leave him. She wants a big career, but she never wants to go anywhere without him. He is her home and her heart. She asks if he wants to marry her. He kisses her, which stands for hell yes.


  • Meredith Grey
  • Alex Karev
  • Miranda Bailey
  • Richard Webber
  • Owen Hunt
  • April Kepner
  • Jackson Avery
  • Amelia Shepherd
  • Jo Wilson
  • Maggie Pierce
  • Tom Koracick
  • Marie Cerone
  • Charlie Peterson
  • Young Jo Wilson/Brooke
  • Chris Cleaver
  • June Peterson
  • Henry
  • Helen Karev
  • Laura
  • Young Alex Karev
  • Young Maggie Pierce
  • Steve
  • Teacher Assistant
  • Tow Truck Driver Jim

Main CastEdit

Guest StarsEdit


Medical NotesEdit

Charlie PetersonEdit

  • Diagnosis:
    • Heart failure
  • Treatment:
    • ECMO
    • Heart transplant

Charlie was in the hospital on ECMO after three years awaiting a heart transplant. He was scheduled for a DOR procedure, but before he could have it, a heart became available. He initially refused the heart transplant, but was eventually persuaded to accept it. During his transplant, they discovered that the heart was too large for his chest cavity due to edema. They transplanted the heart anyway and used plastic to wrap his chest cavity while they waited for the swelling to go down so they could close his chest. Maggie called in Jackson for a consult on constructing a flap to cover the defect. They operated the next day and were able to close his chest.


Song Performer Scene
"Love So Soft" Kelly Clarkson
  • Meredith tells Maggie she was up all night trying to figure out why her mom hated Marie.
  • Maggie is distracted and claims it's about Clive.
  • Amelia comes in. She didn't sleep at all all night.
  • April wakes up to Koracick wearing her robe. She asks him to take it off and leave.
"I Don't Want to Lose You" Luca Fogale
  • Henry says he broke up with Charlie so he'd have the surgery.
  • Marie was upset with Ellis because they developed her technique together, but Ellis took all the credit.
"Smaller Than My Mother" Overcoats
  • Alex rejoins the surgery on Charlie.
  • Charlie's new heart hasn't started beating, which worries them.
  • Charlie's mom waits in the waiting room.
  • They're able to defibrillate and finally establish sinus rhythm.
"Ain't 2 Proud 2 Bed" TLC
  • Flashback to Alex attending a party.
  • He finds Laura talking to a group about his mother.
"Human Beings" The Wind + the Wave
  • Maggie confronts Jackson about her weird habits.
  • He talks about his odd habits as well.
  • He asks if he can take her to dinner finally and she agrees.
  • Jo explains to Alex what she's doing.
  • Alex looks frantically for the ring, but Jo says she's wearing it.
  • She says she never wants to go anywhere without him and asks him to marry her.
  • He says yes.

Notes and TriviaEdit

Grey's Anatomy 14x15 Promo "Old Scars, Future Hearts" (HD) Season 14 Episode 15 Promo

Grey's Anatomy 14x15 Promo "Old Scars, Future Hearts" (HD) Season 14 Episode 15 Promo

  • This episode's title originated from the song Old Scars, Future Hearts, originally sung by All Time Low.
  • This episode scored 7.18 million viewers.
  • The episode features flashbacks to the childhood of Maggie, Jo, and Alex.
  • This is the first episode set in the hospital since the introduction of the hospital's new interns not to feature any of them. 
  • The scene where Jo proposes to Alex was filmed on Camilla Luddington's birthday, December 15. Coincidentally, Camilla was proposed to only two weeks later while the ring was already hidden in her house at the time of filming the proposal scene.
  • Goof: As Alex is following his mother into the kitchen, a yellow mark for Kelli Goss can be seen on the floor.


Episode StillsEdit

Behind the ScenesEdit


Marie: Meredith, I never married. I never cared much for romantic relationships. My closest thing to having children was you. My friendship with your mother was the greatest love of my life and when she betrayed me, it was unimaginably painful. I went home, I ran my father's company, I never returned to the United States or to my surgical practice. She broke me.
Meredith: Do you ever think maybe you gave her too much power?
Marie: I'm sure that's true. But now I believe I have a right to the work that your mother stole from me. I believe I was meant to be more in this life and the person that I trusted the most in this world took that from me. So if you want my patent, you must make a public statement that the Ellis Grey Procedure is now the Grey-Cerone Procedure. It's up to you.

Jo: Charlie, you have to vow that you're going to survive. Because you have to fight for Henry. True love survives arguments. Sometimes it even survives break-ups, so you have to live, and then you have to fight for him.

Tom: God is dead.
April: No.
Tom: Ah, yes.
April: No, He's not dead. I just hate Him so much I wish He was.

Tom: The Bible, the Qur'an, the Baghavad Gita, they're all the same book, aren't they? They all just generally say how not to be a jerk.
April: Well, I don't know those other books, but I know the New Testament. And the Sermon on the Mount, Jesus gets up there and he says how to behave and how not to behave. People flagrantly disregard His teachings and receive absolutely no consequences, while other people who spend their lives trying to emulate Him and honor Him are brutally mistreated. God's off making a bet with the devil while good people eat crap sandwiches, and we're supposed to eat those sandwiches with a smile on our face. We're supposed to rejoice. Look, I mean, if you didn't grow up in the church, you wouldn't understand, so I don't...
Tom: Oh, please. Please, I grew up Catholic. Between the mean nuns, the hard kneelers, the touchy priests, Catholicism told me that I would go to hell for playing with myself after I'd been doing it ceaselessly for two years! I mean, how about a head's up, God? I walked away, too, for a while. I get it.
April: Why, 'cause you couldn't masturbate?
Tom: No, no. 'Cause my kid died. Freak accident at school. Took a baseball bat to the skull, died instantly. He was 10. It was unfair. So unfair. The priest said talk to God, but I wanted to find God and choke the life out of Him. I didn't want to talk to God. I didn't care what He had to say. I wanted to talk to my son. I was not as delightful then in that period as I am now. I was not fit company. My marriage fell apart. I was alone. So I went to church. Because in church, you can talk out loud all by yourself and not look crazy. So I would go to Mass, and I would talk to my son. I still do. I don't think God left me or I left God. I just think we got in a fight. That's all. Your turn.
April: I thought you were here for more sex.

Alex: Jo might leave.
Meredith: What?
Alex: She's applying for fellowship outside of Seattle.
Meredith: Okay, so she's pursuing her career.
Alex: I know.
Meredith: So you can't take her career ambitions personally. She's not abandoning you. She's not Izzie.

Meredith: Are you just waking up?
Amelia: Don't judge me.
Meredith: I'm not judging.
Amelia: I was up all night last night and most of today.
Meredith: Doing what?
Owen: Oh, hey.
Amelia: Doing that.

Meredith: Marie, I need your polymer. I can't continue my work without it. I can't undo my mother's legacy, not when she isn't here to tell me her side of it. I can give you any amount of money you want, but I can't do that. I won't do that.
Marie: I do understand. But I know that you will understand that I have an entire company that will dedicate itself now to this idea of yours. I have my polymer, and I have your science. The mini livers will be known as the Cerone method.
Meredith: Marie, is there some way, anything? Is there some other way?
Marie: Darling, I know that it isn't fair. It isn't your crime, and it shouldn't be your burden. I'm sorry that your mother left you to clean up her messes. Unsurprising, though.

Jo: I never fit in anywhere, and I kept trying. I kept wanting to belong, but nothing ever worked out, so I had to keep moving. Or maybe I was running from my circumstances, running from myself, running from anyone who dared to love me.
Alex: Just give me a minute. Just one second.
Jo: Wait, Alex.
Alex: It's right here. I put it right here.
Jo: No, Alex, I'm still talking.
Alex: Damn it, it was just right here!
Jo: Alex, I'm not done yet!
Alex: Where the freak is my ring?
Jo: Alex, I'm wearing it! I always thought that there was something wrong with me, and I always wanted to run until I met you. You're so screwed up that you make me make sense. You and me. We just fit. And I don't want to leave you, Alex. I want a great, big, giant career, but I never want to go anywhere without you. You are my home. And you are my heart. Alex Karev, will you marry me? Wait, so that's a...
Alex: It's a yes. It's a hell yes.

See AlsoEdit

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

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