| “ | Metastatic. Advanced. Progressed. All words no one wants to hear from their doctor. It means despite everything you've done, every rule you followed, you may be near the end. It's the moment when fear sets in. You panic as you realize you may not survive. It's why people turn to experimental treatments and last-ditch efforts. If you knew you were dying, what would you do? If someone gave you a lifeline, would you take it? We've all felt it, a moment where all is lost. Whether it's in our jobs, family, love, we fear everything will be taken. We close our eyes, we bite our lips, and the adrenaline floods through our body. But despite how hard you try, that last-ditch attempt still may not work. | ” |
Out for Blood is the nineteenth episode of the eighteenth season and the 399th overall episode of Grey's Anatomy.
Short Summary[]
Due to a blood shortage, Grey Sloan Memorial is setting up a voluntary donation center. Meanwhile, Nick asks Meredith for help with his patient and Winston is hung up on his relationship with his brother.
Full Summary[]
Meredith struggles in surgery and is haunted by her mother calling her basic, commenting that is why the hospital has gone down the pipes. Ellis continues to taunt Meredith, telling her to always have a plan. Eventually, she takes over from Meredith and comments she has to do everything herself.
Meredith awakens from her nightmare and watches the rain outside.
Maggie and Winston get ready for work. The accreditation council is visiting again today. Winston has been thinking about going to Boston. His family think Wendell has returned there. He wants Maggie to get her money back but she thinks they should just let Wendell get himself out of the trouble that he's in so they can go back to their lives. Winston refuses to let his brother steal from his wife without consequences. He says she doesn't understand what it's like to grow up with siblings, which upsets Maggie.
Meredith and Zola are looking at real estate listings for Minnesota. Nick arrives and comments he won't miss the rain. Zola asks if they are leaving if the accreditation council okays the program. Meredith hesitates a beat and then says soon. Amelia arrives to show Meredith that their article on the Parkinson's project has been published.
Todd walks Jo and Luna to the hospital entrance. He and Jo had sex last night. He says it was amazing but she appears less enthusiastic. He hopes to see her tonight but she says it depends on work.
Jo ends up on an elevator with Link. Luna is fussy. Jo informs Link she didn't sleep well due to Todd staying the night, which will probably be the last time. Jo confesses that while having sex, Todd told her he loved her. She didn't say it back. Also, he sings when he climaxes, which woke up Luna. Link mocks her.
The residents are hanging out in Simon's room laughing about some of Levi's mistakes earlier in his career. Richard arrives and announces that many elective surgeries were postponed due to an acute blood shortage, for which they are setting up a donation center. Jamarah Blake is returning today to re-assess the residency program. Simon jokes he'll donate blood.
Teddy informs Owen that the blood bank has no more O- to send, which makes Owen they need to consider closing to trauma. After Teddy goes to move a patient, Owen is approached by John Hall, who was sent by Heather Young to help his sick Marine wife.
In a private exam room, John says Rosie returned from her last tour in Iraq with an awful cough. She was diagnosed with pulmonary fibrosis. Rosie has tried every remedy but nothing helps. Owen thinks John wants to include Rosie in his study but John says his wife is dying and in terrible pain. Since they live in Utah, with no physician-assisted suicide, he requests the meds that Owen gave the other vets to die. Rosie wants death with dignity. Owen is sorry but he can't do that. John threatens to report his actions.
The staff has gathered in the outpatient surgery clinic now doubling as the donation center. Bailey says the rain and a few massive traumas earlier this week on top of the already-low national blood supply since the pandemic has made Grey Sloan's blood supply fall to critical level. An emergency delivery from state blood banks is incoming but in the meantime, she wants the staff to donate. She goes first.
Nick catches up with Meredith and shows her the scans of Cora, a 47-year-old woman with a pancreatic head tumor involving the liver, duodenum and causing thrombosis of the portal vein. She's at risk for massive bleeding or obstruction. Meredith thinks they won't get clean margins with a Whipple. Meredith wants to meet the patient.
Levi realizes he can't donate because he has been sexually active with another man within the last three months. Taryn is upset but Levi wants to keep his head down. It's been nearly three months since he broke up with Nico so he can donate later.
While Meredith examines Cora, Nick chats with Sally, Cora's aunt with severe dementia, about a telenovela. Meredith still believes they won't be able to remove the entire tumor but a Whipple procedure can hopefully help with the pain and give her more time with her aunt. Cora says Sally raised her when her mother had other priorities, disappearing with men for days on end. Sally always lied and said her mom called about her. Cora needs something better than hopefully.
Owen has briefed Teddy, who insists he rejects John's request. Teddy says they have no way of knowing that John is speaking the truth. Owen spoke with Rosie over the phone so he knows she is real. Even if Rosie turns up in the VA database, Teddy still wants to find another way to help.
Kristen is screaming for help in the ICU since Simon is not breathing. Link, Winston, and Levi rush in. Simon's sats are plummeting. The doctors want to intubate but Simon objects since he may never wake up then. He soon passes out and Kristen decides to consent to the intubation.
Amelia and Maggie are donating blood. Today should be one of the biggest celebratory days of Amelia's career but she can only think about Kai. Kai texted her that they were thinking about her but it didn't soothe the ache that she feels in her entire body. Winston hasn't heard from his brother and he's obsessing. Amelia kind of agrees with his statement that Maggie has no clue what it's like to grow up with siblings. Her Shepherd sisters can get under her skin and she can't get them out if they do. She advises Maggie to stop trying to help him. Maggie is upset that there is so much about her husband that she didn't know.
Jo finds Link in the CT booth. She heard about Simon. Link asks if she broke up with Todd yet. She says Todd is nice and kind but also obsessed with his PhD and he narrates his life out loud. That plus the singing orgasm is a lot. Link stars singing Figaro. Simon's scans then come up, revealing extensive growth of the lung mets.
Nick is pitching solutions to Meredith outside. Given the blood shortage, Nick pitches an ex-vivo surgery. Meredith says they would need an extra set of hands.
Meredith and Nick are pitching their ex-vivo Whipple idea to Richard. He deems it a bad idea. It's too risky and irresponsible to perform this today. Jamarah Blake is determining today if the hospital can continue its training program because he was too confident and tried to reinvent the wheel. Today is not the day to go rogue. Meredith says it's cutting-edge, which may be exactly what they need. Richard stands his ground and leaves. Nick suggests they keep Cora admitted and wait a few days but Meredith doesn't want to risk her dying just because Richard screwed up with his method. She's booking an OR.
Winston and Maggie are studying Simon's scans. The mets have grown in both number and size. Resection is not an option. Link says Kristen is at 36 weeks. He just needs to hold on long enough until she can safely have a C-section. Link pitches ECMO. Maggie says it is not medically indicated. Winston says there are protocols they could use to diminish the amount of blood products needed. Link begs Maggie to come meet Kristen and go over these options with her.
Richard and Bailey are walking with Jamarah. Richard assures her they followed her recommendations thoroughly. Bailey proudly says they have hired six new attendings and teaching cases have risen 40%. Jamarah also read about Amelia and Meredith's groundbreaking work. Jamarah says the visit should be short. She just needs to confirm that the flagged issues have been addressed. They then arrive in the donation center and Jamarah is not thrilled to see the residents donating blood during their shift. Bailey says they took matters into their own hands and stresses that this is voluntary.
The doctors have explained to Kristen that ECMO would bypass his lungs. Kristen agrees to ECMO. Winston says ECMO comes with the risk of blood clots, meaning he could die more quickly. Maggie adds that ECMO is usually indicated to give patients' hearts and lungs time to rest while Simon's lungs won't get better. This means that at some point, she would have to decide to unplug Simon. Kristen is prepared for that. This entire journey has been impossible but they made it this far. Finding a way to make sure that Simon would meet his son is all that she wants, even if it will be incredibly hard on her. It's just one more impossible thing. Winston and Maggie then agree to try ECMO.
Meredith and Nick have explained the procedure to Cora. Cora has taken Sally to so many doctors and she finds it's more frightening when it's about you. Cora doesn't know what will happen with Sally if she dies. Meredith says in her opinion, this procedure is the only chance of survival. Cora has put off her own health for so long. She needs to take care of herself now. Cora consents to the surgery.
Teddy and Owen meet John outside in the parking lot. They offer to help him by relocating John and Rosie to Washington and helping out with the paperwork so that she qualifies for physician-assisted death. John says that is not what he asked for. Owen says they ethically cannot give medications to a patient that they have not assessed. John repeats that Rosie wants it to look like she just died in her bed. Their children can't know that she took pills. John knows they are veterans and begs to let Rosie die with honor and dignity. Owen starts to budge but Teddy steps in and firmly says no. John leaves.
Nick and Meredith are operating on Cora with Taryn assisting. They have reached the tumor. Nick checks if Meredith is comfortable to keep going. She says there is no other choice. She wants to mobilize the right colon first. The surgeons look up and see Richard entering the gallery with Jamarah. Taryn wonders if Richard's no meant he wasn't participating or if the surgery shouldn't be happening at all. Meredith only tells her to focus on the suction.
Kristen tells Simon "hello forever". They used to live in this two-story house with an upstairs office that Kristen was sure was haunted. Every time she would go upstairs to work, he told her "goodbye forever", which made her laugh, until his diagnosis. He then changed it to "hello forever". She's ready now. The doctors got to work on putting Simon on ECMO.
Meredith asks for another unit of blood. Everything has been clamped off and divided. Meredith counts down and they take the organs out en bloc. They move the tray to the back table. The surgeons get to work on removing the tumor. Sally, meanwhile, is obliviously watching television.
Link finds Kristen in the waiting area and hands her some food. Kristen wonders if she's being selfish for putting Simon through this. Link talks about the first time he saw his own son. The amount of love he experienced in that second was incredible. Link didn't care what the rest of his life would bring; that feeling was enough. Kristen finds comfort in his words.
Winston and Maggie work fast but both of their incisions are oozing. A nurse hangs another unit of blood. His blood pressure starts dropping. The doctors pick up the pace.
Bailey is told that the blood is delayed due to the rain. Levi barges into her office and says his blood is just as helpful as anyone else's. He has donated blood before. Multiple units of blood are now circulating in an ECMO machine and he can't help due to this absurd prejudice. Bailey knows that the rules are wrong but she won't allow him to donate anyway. She points out he helps out in many other ways but he doesn't feel that is enough. Once Levi is gone, John appears in the doorway and says he needs to report a crime committed by one of her doctors.
Jo runs into Todd in the lobby. He brought a huge teddybear. She says this is not a good match. He is taken by surprise since they had sex. Jo says she sees this more casually than he does. She says sorry and walks off. He dumps the bear with a janitor.
Up in the gallery, Richard tells Jamarah that only a handful of surgeons know how to pull off ex-vivo surgeries. Zander is so glad that Meredith postponed her departure. Jamarah is shocked to hear that Meredith is leaving.
Down in the OR, Meredith has removed all the tumor from the liver. Taryn brings the basin to Nick and tells him that she approves of him and Meredith. Meredith soon joins them at the table to re-implant the liver.
Kristen enters Simon's room. He tells her "hello forever". He dreamed up a name for the baby: Jamal. It means "beauty".
Outside, Maggie asks Winston for his blood type. She feels like they knew each other better before, when their relationship was long-distance. She's constantly surprised by things about him and the decisions he makes. Like everything he never told her about his brother and how angry it makes him. Maggie once again brings up his comment about siblings. He wonders why she's making this a fight between them. Maggie says it all just makes her feel like she doesn't know him and that he doesn't get her. She thinks they got married too quickly.
In the attendings' lounge, Teddy tells Owen to stop pacing and help her pack. He's trying to call Heather again but Teddy reminds him that she got them into this mess. Owen proposes he go to Utah and offer the help that Rosie deserves. Teddy loves Owen's giant heart and his intense inability to see reality when he's busy believing his ideals. She won't watch him go off to prison and raise the kids by herself. She confirms that they are, in fact, running away because that is the only option he left them. Bailey enters the room. She hopes John is a lunatic spreading ridiculous lies and that she has to call the cops on him rather than on them.
Meredith sends another specimen to pathology. They have reperfused the liver and intestines. Taryn and Nick find bleeding coming from the portal vein anastomosis. Dr. Knox says they need more units of blood since Cora's BP is dropping.
Owen has confessed to Bailey and says he stands by his decision. He clarifies that is all happened a while ago.
While Nick tries to fix the bleeding, Meredith says they still need to do the gastrointestinal reconstruction. Taryn asks if there is a plan. Meredith says yes. Cora is acidotic and her PaO2 is plummeting. They have maxed out on pressors.
Bailey asks if it happened so long ago that it's outside the statute of limitations. She asks if he even looked up the statute of limitations on murder before committing his crimes. Owen denies that it was murder. He did right by soldiers who fought for this country. Bailey asks if he even took one minute to think about her and the hospital.
Taryn presses Meredith for a plan. Meredith takes a beat to answer, again haunted by Ellis taunting her for being indecisive. Ellis always told her to have a plan no matter what. Meredith then announces that they should stop until they have blood.
Bailey answers a call from Ben. He's at an accident.
Nick says Cora's digestive tract isn't completely connected. Meredith says they'll take care of it once the blood arrives. Richard grows desperate.
Ben informs Bailey that all of her emergent blood is trashed. He is standing out in the rain at the accident site, surrounded by containers and units of blood spilling into the puddles of rain.
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
- Anthony Hill as Dr. Winston Ndugu
- Scott Speedman as Dr. Nick Marsh
Guest Stars[]
- Jason George as Dr. Ben Warren
- Kate Burton as Dr. Ellis Grey
- Jaicy Elliot as Dr. Taryn Helm
- Skylar Astin as Todd Eames
- Dawnn Lewis as Jamarah Blake
- Sandy Martin as Sally James
- Cedric Sanders as Simon Clark
- Bianca Santos as Kristen Clark
- Kristin Lehman as Cora James
- Lea Coco as John Hall
- Zaiver Sinnett as Dr. Zander Perez
- Aniela Gumbs as Zola Grey Shepherd
Co-Starring[]
- Sylvia Kwan as Mabel Tseng
- Payton Silver as Dr. Knox
- Fran Nichols as Nurse Karen
- Annabelle King as Luna
Medical Notes[]
Simon Clark[]
- Diagnosis:
- Metastatic synovial sarcoma
- Doctors:
- Winston Ndugu (cardiothoracic surgeon)
- Maggie Pierce (cardiothoracic surgeon)
- Atticus Lincoln (orthopedic surgeon)
- Levi Schmitt (surgical resident)
- Zander Perez (surgical resident)
- Mabel Tseng (surgical resident)
- Treatment:
- ECMO
Simon was still in the hospital, receiving supportive care to keep him alive long enough to meet his son. When Simon struggled to breathe, he asked them not to intubate him as he feared the tube would never come out, but when he passed out, Kristen told them to intubate. Scans showed that his previous mets had grown and he had new ones. Link asked Maggie to consider putting him on ECMO to give him the time he needed to meet his son. After speaking with Kristen, they put him on ECMO.
Cora James[]
- Diagnosis:
- Pancreatic head tumor
- Doctors:
- Meredith Grey (general surgeon)
- Nick Marsh (general surgeon)
- Taryn Helm (surgical resident)
- Treatment:
- Surgical resection
Cora, 48, had a 12-centimeter pancreatic head tumor that involved her liver, duodenum, and was causing thrombosis of her portal vein. Meredith said she didn't think a Whipple would be effective in her case, but wanted to examine Cora herself. After the exam, Nick and Meredith discussed it and planned to do the surgery ex-vivo, removing all the involved organs, dissecting out the tumor, and then replacing the organs. They asked Richard to scrub in with then, but Richard said it was a bad idea. Despite this, Meredith booked the OR anyway. When they opened, they found that the tumor was more involved than they believed, but decided to proceed anyway, using a cell saver to transfuse as much of her blood as possible back into her body. After they replaced her organs and began re-attaching them, Taryn found some bleeding and began looking for the source. They decided to stop operating with the organs still detached.
Music[]
| Song | Performer | Scene |
|---|---|---|
| "Let's You Fly" | Bryar |
|
| "Hold the Line" | AG, Daniel Saint Black |
|
| "At the End" | Valerie Broussard |
|
Notes and Trivia[]
- This episode's title originated from the song Out for Blood, originally sung by Sum 41.
- This episode scored 4.19 million viewers.[1]
- The blood shortage was foreshadowed in Should I Stay or Should I Go when Amelia orders three additional units despite knowing there was a shortage.
- Danielle Savre, who plays Maya Bishop on Station 19, shadowed Kevin McKidd as he directed this episode.[source?]
Gallery[]
Episode Stills[]
Behind the Scenes[]
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 >> | |||||