We ask a lot of our patients. We put them to sleep. Cut them open. Poke around in their brain and guts with sharp instruments. We ask for their blind trust. Irony is, trust is hard for surgeons, because we're trained from day one that we can't trust anyone but ourselves. The only instincts you can count on are your own. The only skills you can count on are your own. Until one day, you leave the classroom and step into the O.R. You're surrounded by others, a team of others. A team that you have to rely on whether you trust them or not.

State of Love and Trust is the thirteenth episode of the sixth season and the 115th overall episode of Grey's Anatomy.

Short SummaryEdit

As Derek begins his role as interim chief, he faces a potential lawsuit when Bailey and Meredith's patient awakens from anesthesia mid-surgery. Meanwhile, Teddy refuses to place Cristina on her service, as Arizona tests Alex out in Pediatrics, and Mark refuses to speak to a heartbroken Lexie.

Full SummaryEdit

In his new office, which was formerly Richard's, Derek is deciding between two ties. Meredith comes in and tells him the blue one. He's afraid the hospital staff is gonna be mad at him for having stabbed Richard in the back to get the Chief job. Meredith is mad too, but she's sure he'll do a great job. 

Cristina and Owen are passionately making out.

Reed, Charles, and Jackson are following Lexie and Alex, trying to get some news about the rumors of Derek being the new Chief. Alex jokes that they're all gonna get fired because they're from Mercy West, but Lexie says Derek is not like that.

Meredith and Bailey are almost done resecting a tumor, which means they might be just in time to catch the end of Derek's big speech. Suddenly the patient becomes tachycardic, but the anesthesiologist says everything looks fine, and Bailey can't find any bleeders. They can't figure out what's wrong, but Bailey thinks she felt movement. Meredith looks around and sees the patient is awake. Meanwhile, Derek's voice over talks about trust and the team surgeons have to lean on.

Bailey urges the anesthesiologist to put the woman back to sleep while Meredith tries to calm the patient down.

The staff has gathered for Derek's big speech. Teddy wants to talk to Owen about last night, but he doesn't want to. He joins Arizona, Callie, and Cristina, who comment on Derek's suit. Meanwhile, Mark stares at Lexie. Derek begins talking. He wants to make the transition to him being the Chief as smooth as possible. They've had a rocky few months, but he intends to right the wrongs and bring the hospital back to its former glory. Jackson now truly believes he's screwed. Suddenly, Richard and Larry Jennings join the crowd, which throws Derek off his game. He quickly thanks everyone and finishes. Arizona starts clapping, as she promised Derek she would. Teddy asks Jackson to bring her her charts, as Yang is not on her service today. Arizona heard from Bailey that Alex is the future of peds, so she wants to work together today to find out if she's right. Jackson mocks peds, but Arizona assures him that peds is hardcore.

Lexie walks up to Mark and brings up Sloan, but he ignores her completely. He walks off to Callie to ask for a consult. She yells after him that he's acting really mature.

Larry, Derek, and Richard are sitting in a conference room. Larry presents Richard his options. He can signs a first bunch of documents, which would allow him to go on an early retirement and have his license revoked, or a second bunch, which says he's voluntarily enrolling in a rehabilitation program. Derek wants him to sign the second one, so that he can come back when he's sobered up. Richard needs time to think. A nurse comes in to inform Derek that there's a situation that needs his attention.

Derek is informed about the situation in Bailey's OR. There's a chance the patient won't remember it. They enter the woman's room and say the surgery went great, but she asks how about the part she woke up, describing in detail how she experienced that.

Ben, the anesthesiologist, is trying to come up with a plan for him and Bailey to find out what went wrong. Bailey puts all the blame on him, as he's the "gas man" who's new at the hospital, previously being employed at Mercy West. Here at Seattle Grace, they expect to trust the gas man to keep the patient under while the surgeons do the real work.

Arizona and Alex are examining Brad, who's experiencing abdominal pain. His father suspects he's faking it in order to dodge school. Even though everything seems fine, Arizona wants to cover all the bases, so Alex suggests a triple contrast CT. Brad's father says that'll cost them a lot of money, basically begging his son to confess, but Brad insists he's not faking.

Cristina walks up to Teddy, wondering why Avery is assigned to all of her surgeries today instead of her. Teddy explains she wants to give other residents a chance too, as Cristina's been on every case with her since her arrival. Cristina understands, but she hopes to get back on Teddy's service soon. Teddy doesn't know when that will be, but today she really can't.

Meredith and Bailey walk into Leslie's room to do an exam, but Leslie doesn't want Bailey touching her. She remembers Bailey screaming and panicking in surgery with her hands inside of her. Leslie panics and becomes tachycardic again, and her incision starts bleeding. As Bailey raises her hands and steps back to keep her distance from Leslie, she instructs Meredith on how to stop the bleeding for now. 

Callie is grabbing supplies and Lexie joins her, offering her assistance. As she keeps on ripping cast padding, she blurts out all the problems with Mark. She knows they're broken up, but they still need to work together. Callie admits he's being a little unreasonable, and unintendedly tells Lexie that Mark slept with Addison more than once. Lexie is shocked and leaves.

Alex and Arizona are looking at Brad's scans, which shows there's nothing that appears to be wrong. Alex doesn't think he's faking, as he believes no kid wants to be the kid who has to leave school for hospital visits all the time. Arizona on the other hand loved the hospital as a kid. They go over the case together, and Alex suggests chronic mesenteric ischemia, which fits with all the symptoms and it doesn't show up on scans. The only way to know for sure is to perform an exploratory laparoscopy, but she doubts Brad's father is gonna consent.

Cristina finds Owen in the vent room and starts talking about Teddy. He kisses her and says he doesn't want to talk about Teddy. They start undressing.

Derek is watching Richard making up his mind and sends off a bunch of residents gossiping about him. He enters the room and tells Richard to sign the paper to go to rehab. Richard gets angry and yells that even though Derek may have stolen his office, he is not his boss. Derek admits he wanted Richard's job, but he didn't want to end Richard's career. Richard says Derek did what he had to do, but what comes next is not up to him. He tells Derek to get out, but Derek refuses. Meredith comes in and tells them to stop, as people are watching. Derek walks out and tells everyone to return to work.

Ben sits down with Bailey and asks for an apology. He shows her a test result that proves that Leslie has a condition that casues her to metabolism anesthetic drugs too fast. There's no way they could've known about it before surgery. Ben is happy that it's not their fault, and asks for an apology, but Bailey is down because Leslie needs another surgery and won't let Bailey touch her. Bailey says patients always trust her, and she doesn't know how to fix this.

Cristina is walking weirdly, which Alex notices. She confesses she's got a burn, but she insists on waiting for Meredith to take care of it. Lexie comes over to complain about her day. Alex and Lexie figure out Cristina's got the burn on her ass as Meredith arrives. She and Cristina go to a private bed, and Meredith wonders how she managed to get vent marks burned into her ass. Lexie and Alex pull the curtain aside to watch the burn themselves. Lexie has to take over dressing the wound as Meredith gets paged by Bailey. The situation reminds Lexie of the sex injuries Mark could leave her with, which makes her start crying.

Owen walks past Teddy, and tells her he's busy when she wants to start a conversation. Jackson comes over with her charts in numerical order according to room number. Teddy's used to Cristina ordering them according to priority, but it'll do.

As Arizona suspected, Brad's father is refusing to let them cut open his son without any evidence there's a reason to. The father angrily walks out, followed by his wife. Arizona asks Alex if he thinks it's okay for them to take Brad home. He doesn't, so Arizona tells him a big part of peds surgery is to advocate for the patients, as they can't do it themselves. He's confident he can do it.

Alex is trying to talk Brad's fater into giving his consent for the surgery. If they take him home while he does have chronic mesenteric ischemia, Brad will go into such intense shock that he'll be dead before they can get to the hospital. Alex understands that Jim thinks his son is faking, but he asks how sure he feels about that. Arizona smiles.

Bailey explains to Leslie, her husband, and their lawyer that Leslie needs another surgery. Their lawyer suggests a transfer, but Bailey says that enlarges the risk for infection and the amount of blood loss. Meredith explains that the dressing she did earlier is only temporary. It needs to be fixed. Leslie brings up what it was like and decides she wants Meredith to do the surgery, as she stayed calm and kind when it happened.

Derek, Owen, and Mark have gathered in Derek's office. Owen and Mark want to hear how he got the job, but Derek can't talk about it. Derek brings up the lawsuit, and Mark starts talking about his problems with Lexie. Derek thinks Lexie's one night stand is forgiveable, given what he did with Addison in L.A.. They then notice a hickey on Owen's neck. Mark and Derek agree that he and Yang are better together than she and Burke were, with Mark stating he never thought Cristina was gonna make it down the aisle. Owen's never heard that story, but Derek shushes Mark, saying it's not his story to tell.

Meredith sits down with Richard, who still hasn't made up his mind. She thinks she's ready to perform Leslie's surgery on her own. She's heard from Derek he's thinking about quiting. She thinks her mother would kick his ass if she saw him even considering it. Meredith leaves, as Richard refuses to look at her.

Arizona and Alex are operating on Brad, but everything looks good. Arizona doesn't think it was an unnecessary procedure, as it only means they're one step closer to finding out what's wrong with Brad. At least, that's what Alex is going to tell Brad's very angry parents. He's gonna have to take the heat, but Arizona firmly believes something's wrong with Brad. They decide to close up as Brad's getting unstable.

In the scrub room, Meredith suggests that Bailey operate on Leslie as soon as Leslie's under, but Bailey refuses to do that. Bailey wouldn't let Meredith operate if she didn't think Meredith could handle it. Besides, she'll be right be her side. There's no reason she can't mentor Meredith like Richard used to. The only reason he did that was because he saw her talent, Bailey says. They get ready to start scrubbing.

Alex is tending to Brad in the ICU. Reed comes in, wanting to hear if he really thinks she needs to start looking for another job. Brad's parents come in. As Alex starts explaining why Brad is in the ICU, Reed brings to his attention that there's a lot of blood in the chest tube. They move quickly and Alex cracks his chest with the parents watching him, refusing to leave.

Teddy enters the room as Alex thinks he's found the source of the bleed. Alex jumps onto the bed as they move Brad to the OR. Teddy asks to have Cristina paged.

In an on-call room, Cristina and Owen are making out as her pager goes off. She wants to go when she sees it's Teddy, but he begs her to stay with him. He kisses her passionately and she drops her pager.

Arizona enters the OR where Teddy is repearing the ruptured aortic arch dissection. They are hardly ever caught, but Alex may have worked a little miracle as he did discover it. Teddy wonders where Cristina is, as she really needs a second set of hands. Jackson offers his, knowing he's not Cristina Yang, but confident he can do it. As she has no other option, Teddy allows him to step in. They have 30 minutes to fix this, or Brad's toast.

Meredith is doing good in the OR. Bailey keeps on checking with Ben if Leslie is still under. Ben starts coming back on the "anesthesiologists are lazy"-speech that Bailey gave him earlier. Bailey admits that she yells at people when she's scared. When Leslie woke up, it was one of the scariest moments of her life, so she yelled. Ben asks if that was her apology. "Closest thing you're gonna get," she replies.

Callie meets up with Mark, who's working on a skin graft. She says she talked to Lexie earlier, and she thinks Lexie made some pretty good points. Mark is mad, offended, and disgusted about her behavior, but Callie thinks he's being hypocritical, sexist, and immature. Mark reminds Callie that Lexie dumped him for stepping up for his daughter, which was a big step for him. He yells he's not the one who's immature, and Callie's made him wreck his skin graft. Callie leaves to escape his anger.

Bailey tells Derek that Leslie's second surgery went great, and that the family's lawyer is still drooling around. Derek sighs, but Bailey tells him that 9 times out of 10, you can make a lawsuit go away by apologizing. People like to feel heard, respected, and they like to hear an apology. That is what Webber would do.

Cristina runs up to Teddy, who angrily says that she expects an answer when she pages. She tells Cristina about the surgery she missed out on, and that she expected Cristina to at least remain professional. Cristina apologizes and assures her it won't happen again. Owen takes the blame for it. Teddy's surprised to see that now he's talking to her, and tells them to forget it. Cristina is visibly hurt and asks Owen what he's trying to do to her. He tries to explain, but she backs away.

Arizona explains to Brad's parents that they missed the cardiac problem because it presented as abdominal pain, which is rare. However, the most important thing is that Brad is doing fine. Jim doesn't think being hooked to tubes is fine, causing to angrily blurt out that they're the only reason his kid is still alive. If he had it his way, Brad would be dead now. "Think about how much school he'd be missing then, huh?" Alex says. Arizona stops him and tells him to follow her right now.

Richard is still undecisive about which document to sign when Bailey walks in. He asks her to go away, as he doesn't want her seeing him like this. She remarks everyone's seen him like this all day. She doesn't know the details of what's going on, but she does know he can't keep on sitting here like this. Richard reveals he doesn't want to do what Shepherd and Jennings want him to do, as it'd be like admitting they were right. They want him to say he's an alcoholic. She asks him if he is an alcoholic. Yes, he replies, but if he signs these papers, he has to stop drinking and go to rehab. He doesn't think he's ready to do that. Drinking feels a little bit like all he has left. Bailey replies she knows he's better than this. The way to win, to beat them, is to stop fighting them. She tells him to go and get better, become the man she's always known him to be again: the Chief. "Be the Chief," she concludes.

Arizona tells Alex he can't get emotional working in peds. There's a difference between advocating for tiny humans and berating terrified parents. She can see he's good with kids, he's got great hands, and he's as good as anyone she's ever seen when it comes to advocating for patients, but until he's raised a kid himself, he doesn't get to judge parents. He understands. She tells him to go apologize to the parents, but not before asking how it felt to save that kid's life today. It feels great, he says. She tells him this is why they're hardcore and welcomes him to peds, before rolling off on her wheely sneakers.

Derek grabs the residents' attention in the dressing room. He knows it's been a long day, but he feels like they got off on the wrong foot this morning. He doesn't expect to win their trusts overnight, but he wants each of them to know that they have his. He felt that's why he needed to come in and apologize.

That's also why he enters Leslie's room.

He wants to clear some things up, which is why he's called April Kepner and Megan Nowland to his office to offer each of them their jobs back. There still are going to be cuts down the line, but he wants to offer them a chance to fight. April and Megan happily thank them.

Derek tells the residents he's not pro, nor against the merger. Everyone gets to start with a clean slate.

Mark and Lexie wind up in an elevator together. There's an awkward silence and Lexie starts crying. Just as Mark wants to reach out to her, the doors open up and she runs out.

Cristina gets home and finds Owen waiting for her. He says he's trying to understand her, but she says he's trying to screw her into submission. She let him because the sex was so good and his ego was hurt. He repeats he's trying to understand and know her. He tries to love her, but he doesn't know how because she doesn't give him anything. She claims she gives him everything. He wants to know why her wedding to Burke didn't happen. She refuses to talk about that, which he considers proof for his statement. Maybe he was trying to screw her into submission to connect to her, but he finds that she has to give him something. Cristina says that Burke is irrelevant. "Like I'll be in three years time," Owen says, which Cristina thinks it's not fair. He asks why she can't let him love her. Cristina finally opens up. Burke took something from her. Little pieces, over time, so small she didn't notice. She made herself into what he wanted her to be. One day, she was Cristina Yang, and the next, she was lying for him and jeopardizing her career and agreeing to get married. When she stood there in her wedding dress without her eyebrows, she realized she was no longer Cristina Yang, but she still would've married him. She lost herself for a long time, and now she's finally herself again. She loves Owen more than she loves Burke and that scares the crap out of her, because when he asked her to ignore Teddy's page, he took a piece of her and she let him. And that will never happen again. He takes her hand as tears roll down her face.

Callie is lying in bed with Mark, who's feeling better now. "This really isn't gonna work for me," Arizona says.

As Derek's voice over says he plans to look at all the promise the hospital has to offer in the future and to honor Richard Webber and his legacy, he and Meredith are sitting in his office as Richard walks in. He has signed the rehab document. Derek apologizes to him as he leaves. 


  • Meredith Grey
  • Cristina Yang
  • Alex Karev
  • Miranda Bailey
  • Richard Webber
  • Callie Torres
  • Mark Sloan
  • Lexie Grey
  • Owen Hunt
  • Arizona Robbins
  • Derek Shepherd
  • Teddy Altman
  • Lawrence Jennings
  • Reed Adamson and Charles Percy
  • April Kepner
  • Jackson Avery
  • Reed Adamson
  • Ben Warren
  • Jim Walker
  • Leslie Wilson
  • Dina Walker
  • Brian Wilson
  • Brad Walker
  • Megan Nowland
  • Nurse Kate
  • Lawyer

Main CastEdit

Guest StarsEdit


Medical NotesEdit

Leslie WilsonEdit

  • Diagnosis:
    • Abdominal wall tumor
    • Internal bleeding
  • Treatment:
    • Tumor resection
    • Surgery

Leslie was in the hospital having a tumor in her abdominal wall resected. She woke up during her surgery, startling her surgeons. They were able to put her back out and finish her surgery. Afterward, when Bailey went to check her incision site, she panicked and tore her stitches. She wouldn't allow Bailey to touch her, so Meredith had to change her dressing. It turned out that she had a condition that caused her to metabolize anesthetic drugs quicker than most people. She needed another surgery because her incision site wouldn't stop bleeding. She agreed to have the surgery, but only if Meredith did it because Meredith was calm when she woke up in her first surgery. Meredith performed her surgery successfully and Leslie was stable afterward.

Mark's PatientEdit

  • Diagnosis:
    • Hip decubitus ulcer
  • Treatment:

Mark had a patient who had a decubitus ulcer on his hip. He asked Callie to check it out.

Brad WalkerEdit

  • Diagnosis:
    • Ruptured aortic arch dissection
  • Treatment:
    • Exploratory laparoscopy
    • Central line
    • Chest tube
    • Surgery

Brad came into the hospital with severe abdominal pain. His father believed he was faking it, but he insisted that he wasn't. They ran some tests and those didn't show anything. They suspected chronic mesenteric ischemia, but they needed to do an exploratory laparoscopy to confirm. His parents resisted, but Alex convinced them that it was necessary. The surgery confirmed that he didn't have mesenteric ischemia, but there was definitely something wrong. After surgery, he was in the ICU with a central line. The central line kinked and he started bleeding from his chest tube. They had to open his chest in his room. Alex found the source of the bleeding and was able to slow it down. He had a ruptured aortic arch dissection, which Teddy repaired in the OR.

Cristina YangEdit

  • Diagnosis:
    • Burn
  • Treatment:
    • Bandaging

Cristina got a vent mark burned on her butt while having sex. She had Meredith dress the wound. When she got paged away, she had Lexie finish.

Richard WebberEdit

  • Diagnosis:
    • Alcoholism
  • Doctors:
  • Treatment:
    • Rehabilitation

Richard agreed to enter rehabilitation to quit drinking.


Song Performer Scene
"Bang Bang" Melanie Fiona
  • Derek is choosing a tie for his first day. Meredith comes in and helps.
  • Owen and Cristina have sex.
  • The residents discuss Derek being Chief.
"Do Do Do" Nellie McKay
  • Alex knows Cristina is injured.
  • Meredith comes to treat Cristina, who has vent marks burned into her butt.
  • Alex and Lexie come in and Meredith has Lexie take over when she gets paged away.
  • Lexie knows it's a sex injury.
"In Knowing" Swimming in Speakers
  • Mark, Derek, and Owen play basketball and talk about Derek being chief and their relationships.
"I'm Still Dancing" Minuit
  • Alex gets into Brad's chest and stops the bleeding.
  • Teddy arrives and takes him to surgery.
  • Owen and Cristina are having sex and Owen tells Cristina to ignore a page from Teddy.
  • Teddy is waiting for Cristina, but Jackson steps in because Cristina's not there.
"Wait Til You See My Smile" Alicia Keys
  • Bailey convinces Richard to admit that he's an alcoholic and stop drinking.
  • Arizona gives Alex a lesson and welcomes him to peds.
  • Derek tells the doctors he trusts them and apologizes.
  • Derek goes to Leslie's room and apologizes.
  • Derek offers Megan and April their jobs back.
  • Mark and Lexie ride an elevator together and Lexie runs off when it stops.
"Yours" Fay Wolf
  • Cristina tells Owen about Burke.
  • Mark is Callie and Arizona's bed with them, upset about Lexie.
  • Richard gives Derek the paperwork saying he'll go to rehab.

Notes and TriviaEdit

Grey's Anatomy 6x13

Grey's Anatomy 6x13

  • This episode's title originated from the song State of Love and Trust, originally sung by Pearl Jam.
  • This episode scored 12.55 million viewers.
  • Jason George makes his first appearance as Ben Warren.


Episode StillsEdit


Alex: What'd she say?
Jackson: That you're the best babysitter in the hospital.
Alex: Shut up.
Arizona: You don't think Peds is hardcore? Cause you can say that to my face Avery.
Jackson: (clears throat) No, Ma'am.
Arizona: Mm-hmm. Don't let the roller skates fool you. Peds is nothing but hardcore.

Cristina: Please don't cry on my ass.

Cristina: (to Owen) Burke was- He took something from me. He took little pieces of me, little pieces over time, so small I didn't even notice, you know? He wanted me to be something I wasn't, and I made myself into what he wanted. One day I was me Cristina Yang, and then suddenly I was lying for him, and jeopardizing my career, and agreeing to be married and wearing a ring, and being a bride. Until I was standing there in a wedding dress with no eyebrows, and I wasn't Cristina Yang anymore. And even then, I would've married him. I would have. I lost myself for a long time. And now that I'm finally me again, I can't. I love you. I love you more than I loved Burke. I love you. And that scares the crap out of me because when you asked me to ignore Teddy's page, you took a piece of me, and I let you. And that will never happen again.

Derek: Hi. I know it's been a long day, and you're all anxious to get home. But I feel like we got off on the wrong foot this morning. I don't expect to win your trust overnight. But I want each of you to know you have mine. Which is why I felt it was important to personally come in here and apologize. I am neither pro nor anti merger. From this point on, everyone has a clean slate. I am not focused on the past. I'm looking to the future to all the promise this hospital has to offer. I plan to honor Richard Webber and his legacy, not undo it, which is why I'm both humbled and honored to be your new Chief of Surgery.

Richard: I can't give them this. Shepherd, Jennings. If I do what they want me to do, it's like saying that they were right, right about doing this, right about me.
Miranda: Say they're right about what?
Richard: They want me to say I'm an alcoholic.
Miranda: Well, are you an alcoholic?
Richard: Yes. But if I sign these papers, I'll have to stop drinking and go to rehab and I don't think I'm ready to do that. Drinking feels a little bit like all I have left.
Miranda: You are better than this. I've seen you be better. Look, the way to win, the way to beat them, is to stop fighting them. You go get better. You be the man that I've always known you to be. You be the Chief! Be the Chief!

See AlsoEdit

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

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