"Remember when you were a kid and your biggest worry was, like, if you'd get a bike for your birthday or if you'd get to eat cookies for breakfast?" "Being an adult, totally overrated." "I mean, seriously, don't be fooled by all the hot shoes and the great sex and the no parents anywhere telling you what to do." "Adulthood is responsibility." "The lawyer is managing her estate with a limited power of attorney, but your mother's Alzheimer's is advancing." "While she's lucid enough to consent, she needs to sign everything over to you." "Me?" "Responsibility, it really does suck." "Look, I haven't slept in 48 hours." "I'm getting my first shot at heart surgery today." "I'm missing rounds." "Are you sure there isn't anybody here, or the attorney?" "Do I really have to be the one to handle this?" "It's her estate, finances, medical care." "You want to leave her life in someone else's hands?" "She's your mother." "Really, really sucks." "Adults have to be places and do things and earn a living and pay the rent." "And if you're training to be a surgeon, holding a human heart in your hands..." "Hello!" "Talk about responsibility!" " What was that, Dr Grey?" " Sorry, it slipped." "My hands..." "It's OK." "I'm done." "You can release Mrs Patterson's heart now, very gently." "All right." "Let's warm her up." "Get her off bypass." "Kind of makes bikes and cookies look really, really good, doesn't it?" " I wish I could hold a heart." " A monkey could hold a heart." " You're mad Burke didn't ask you." " George, I need more ice and chips." " Who else did you invite?" " The list was jocks only:" "Surgery, Trauma, Plastics." " Who else?" " Some people from Paeds." "You invited the preschoolers to Meredith's house." "Next thing, you'll say that you invited the shrinks." "She invited Mental Defects." "This party is DOA." "Meredith thinks this is a small meet-your-boyfriend cocktail thing." " Did you clear this with her?" " No, but I will." "I promise." "Why are you wasting the only weekend your boyfriend is in town on a party?" "Is he bad in bed?" "No." "I just want him to meet some of my friends." "Right." "Sixty geeks in scrubs are your friends." "Bad sex, sucks for you." " I heard there's a party tonight." " Really?" "A party?" " News to me." " No party." "We losing her or what?" " Are the grafts?" " Open." "Temperature?" " She's at 96 and rising." " She should be doing this on her own." "That's her falling." "Continue the progressions." "Come on, Mrs Patterson." "Paddles." " Sets are below 90." " Charge." "Ten joules." "Clear." "Come on, Mrs Patterson." " Give me 20." " Charge." "There." "We have rhythm." "Reluctant heart." "All right." "Let's close." "Keep an eye on her." "Good work, everyone." "The scariest part about responsibility?" "When you screw up and let it slip right through your fingers." "Hey, I heard you did a CABG with Burke." " Did you get to hold the heart?" " Yeah." "It's an amazing feeling." "You never forget the first time." "It was pretty great just to watch." " Vicarious thrills, you know?" " Yeah." "Dr Bailey to OR 7." " See you later." " Bye." "I think maybe I did something to the heart when I was holding it." "I nodded off a little, squeezed it." "Oh, please." "The heart's a tough muscle." "It can take a squeeze or two." "My fingernail popped a glove, cut straight through." "George, what if I punctured Mrs Patterson's heart?" "If you had punctured it, you would have known when they reperfused." "They got her heart beating." "The woman's OK." " So I shouldn't tell Burke?" " Tell him what?" "You know, nothing happened." "The woman's OK, right?" "She's OK." "She's fine." "She's fine." "She's fine." "What do you see, George?" "Hyperinflated lungs, cloudy with bullae." "Seriously diminished capacity." "She must be having trouble breathing." "Course of action?" "Bullectomy procedure." "Remove the bullae." "Reduce pressure." "It says we operated on her back in '99." "So she's been through this before, but talk her through it anyway." "And resist the anti-smoking lectures." "She feels bad enough already." "Do you think if they put a picture of these in a pack of cigarettes, people would stop smoking?" "How long has your back been hurting you?" "It's chronic." "Means I have it all the time." "I know what "chronic" means." "What kind of pain?" "The pain's bad, like a thousand samurai warriors stabbing swords into my spine." " I'm allergic to aspirin, most NSAIDs." " We'll start you on morphine." "No." "The only things that will work are Demerol or Dilaudid." " A ten of Dilaudid will do it." " The standard starting dose is two." "Did you see that Tom Cruise samurai movie?" "Exaggerated and overly specific description of his pain." "A self-prescription." " He's a Dilaudid junkie." " What do you do?" "Check the database for history, refer to a programme and discharge." " After you give him something." " That's exactly what he wants." "You still treat his pain as if it were real." "Why?" "First rule of pain management:" "Err on the side of caution." "He's in our care." "He says he's in pain." "Start a central line." "His veins are shot." "The surgery before was supposed to help." "But it never felt right." "Would have been a good idea to quit smoking." "I did!" "Four-pack-a-day habit." "It was hell." " Here you go, Mrs Drake." " Didn't do any good." "Really?" "Because it looked..." "I mean, from the damage, we all thought you probably were still smoking." "Cold turkey, five years ago, and what did I get for my trouble?" "I still had to quit my job at the restaurant." "But even sitting, it hurt." "Here you go." "Nobody believed me." "They all said it was in my head." "I've seen the films." "It's not all in your head." "You're right about that." "Hey, come here." "You're too damn young to be a doctor." " Hey." " What?" "I'm older than I look." "Do you think this is going to work this time?" "I think it's your best option." " Straight shooter, huh?" " Yes, ma'am." "I like that." "Hi, Mr Patterson." " Hi." " Haemodynamics stable?" "Map has stayed around 80." "Cardiac output at five." " That's good, Dr Grey?" " That's fine, Mr Patterson." "But it's not good." "Heart surgery takes a lot out of the patient, but we're monitoring your wife very carefully, and she should be fine." "Mr Sterman, let's see about getting you out of here today." "How are you feeling?" "OK, except I don't think I ever want to have a bowel obstruction again." "Really?" "We get people in here all the time requesting them." "So, you keeping down clear fluids?" "My favourite question:" "Have you pooped yet?" "I'm not exactly sure." "I think you'd probably know." " Passed gas?" " Yes." "Really?" "Because if I bring in my lie detector..." "OK, no." "And I shouldn't try and lie, I know." " I went to medical school." " You went to med school?" "Yeah, dropped out my last year at clinical." "Too many hours, and I was staring into the ice-cold eyes of divorce." "Yeah, I do research now, and I have a life, a family." " No offence." " No, no, that's OK." "I'm just one of those people who believe you can have both." "Maybe so." "But your first responsibility's always gonna be your patient." "Dr Shepherd to the ER, stat." "Just coffee." "Good." " OK." " OK." "We call this "a spaghetti procedure."" "We cut and deflate the bullae to facilitate gentle manipulation of Mrs Drake's lung." "Dr Bailey, do you see that?" "Sir?" "Oh, my ever-lovin'..." "We need to open her up." "I'm taking out the scope." "You heard him, let's move." " Lights." " Let's get set up." " Ten blade." " Here you go." "Retractors." "Retractors." "Scalpel ready." "Towel." "Rib spreader." "Suction." "Is that a towel?" " Get a pan." " Where did that come from?" "Best guess, her surgery five years ago." "Something careless this way comes." " A towel?" " Not good." "She complained of pressure on her chest." "Nobody took her seriously." "Not good for the patient or the hospital." "Not good." "Cristina, hit the files." "Find out about that initial operation." "Who was in the room?" "Who was responsible for closing?" "George, stay with the patient." "Keep her happy." "She likes you." "Right, OK..." "How long do you think?" "I mean, just technically, I'm off at 6:00." " Am I invited?" " Excuse me?" " Am I invited to the party?" " Well, yeah." "Yes, yeah, of course." "What was I supposed to say?" "OK, yeah, great." "All right, 14 cases." "What kind?" "I don't know." "Maybe an assortment." "Microbrews, locals." "Make sure they throw in some bar nuts." " I'm ordering office supplies." " Oh, yeah, sure." "Microbrews, local." "And throw in some bar nuts." "7:00 would be better than 5:00." "Hey, any luck?" "If I do, will you invite me to the party?" "Yeah, great." "OK, thanks." "Take it easy." " Mr Frost." " Where have you been?" "!" "We're going to take care of you." " Where the hell have you been?" "!" " How's that?" "When I tell you to start a central line, you do it, no judgment, no question." "He's been in seven hospitals in four months." "He's an addict." " He has a three-lumbar fusion." " He's a junkie." " We shouldn't be giving him..." " He's an addict, but his pain is real." "Lose the attitude, get down there, start a central line." "Told me I had a towel inside me." "Who told you that?" "A surgeon, an older man." " Handsome." " That's Dr Webber." " He's our chief." " Yeah." "It was a towel that somebody left the last time." "Yes, ma'am." "Who would do that?" "That doesn't seem right, does it?" "No, ma'am, no." "It doesn't." "I was walking around with a towel inside of me." "How could that happen?" "So?" "What happens now?" "Now you keep this to yourself while we work it out." " Do this for me." " Dr Stevens, call CCU." " You OK?" " Yeah, yeah, I'm good." "Are you sure?" "Because you seem not OK." "I'm fine." "CABG was long." "Let me take you to dinner tonight." "Tell me about it." "Real food, waiters, big chunks of carbs in a basket." " I can't." " Forget the party." " You know about the party?" " You and I can be alone somewhere else." " How do you know about the party?" " Thanks for not inviting me." "Think about dinner." "Perfect opportunity." "Well..." "Swelling over her sternum, then blood started gushing." " Dr Burke is on his way." " Is she dying?" "Somebody get him out of here." "Keep applying pressure." "Tyler, call for an OR." " What happened?" "She got her protamine?" " Per protocol." "No allergic, anaphylactic or histamine responses." "Her last counts?" "BT, PTT, INR, platelet counts were all stable." "Even her HNH were stable." "What the hell went wrong?" "Let's move." "Hold on." " I popped a glove." " What?" "In surgery, when I was holding it, I popped a glove with my fingernail." "I think I may have nicked her heart." "Let's go, people." "What were you thinking?" "You had every opportunity to speak up before I closed her chest." " Suction." " I'm sorry." "And then you confess in front of her husband?" "You don't know if you were the cause." "You have no idea." " I'm sorry." " Sponge." "There." "Over here." "There." "Look at the wall rupture." "It's a hell of a lot more than a fingernail." "Her ventricular walls are weak." "I just had a conversation with Mr Patterson." "I want copies of his wife's chart in my office by 5:00." "Tomorrow, the two of you meet with me and Legal, and you better damn well be able to explain what happened here." "People poking holes in hearts and leaving towels." "You're gonna go back and talk to the husband." "Review the history." "Apologize profusely." "Your ass is on the line here, Dr Grey." " You got called before the chief?" " Tomorrow morning." "I could get kicked out of the programme." " I could." " You're not getting kicked out." " Patterson's just gonna sue." " Patterson won't sue." "You're not getting kicked out." "What were you thinking?" "Telling Burke?" "I told her not to." "I got to take this." "Thanks." "Thank you." "Very comforting." "I'll watch your books." "OK, so the beer is coming at 7:00, and some of the floor nurses are bringing wine." " You invited nurses?" " Did you clear this with Meredith?" "A few more people won't make a difference." "A party is a party." "And the bigger the party, the less time for bad sex." " Would you stop saying that." " OK." "Hank and I have great sex, all the time." "We'll probably have sex after the party, or during." "As long as you clear it with Meredith." "Hank needs to see that doctors can have fun." "We're not all workaholics with God complexes." "We are workaholics with God complexes." "And the notary can be there at 6:30 too?" "And the home's physician will be there to attest to her mental competency?" "OK." "Is there anything else I need to bring beside my licence?" "My chequebook." "6:30." "I'll be there." "I heard." "It's a notary thing, a thing to get notarized." "I'm talking about the heart thing." "Do you want to talk about it?" "We're adults." "When did that happen?" "And how do we make it stop?" "Dr Yang." "Dr Burke." "That bypass graft got a little complicated." "It's nothing I couldn't handle." "Good." "Yeah." "Listen, I'll call you back." "That was my lawyer." "He's advising me not to talk to you." "Mr Patterson, I know that you're frustrated and angry, but I need..." "We need some more information about your wife." "Her heart walls are abnormally thin." "Don't blame this on my wife." "I heard from your very mouth what happened." "I know." " We can't treat her." " She was in the best shape of her life." "You ask her cardiologist." "She'd lost 100 pounds." "Don't you dare try to hang this on her." " Mr Patterson, please." " We're through talking." "You don't like me very much, do you?" "Jerry, it's not you specifically." "It's just..." "It's just people like you, that's all." "Doc, I'm feeling pretty good." " Pain's about a three." " A three?" "That's excellent." "I'm glad we could help you, as well as County, Mercy West, Seattle Pres." "A lot of people have helped you lately." "Pleased we could do our part." "Who's on discharge today, Dr Karev?" " Stevens." " Dr Stevens is gonna discharge you." " You can't discharge me." "I'm in pain." " You were in pain." "Now you're not." "Dr Karev will recommend some wonderful treatment programmes for you." "Go home." "Get some help." " You can't just do that!" " He just did, my friend." "OK, any luck yet?" "Looks like you'll have to spend another night." "I hate to miss the party." "You gonna make it?" "You are the last person on my list, so it's looking pretty good." "Doctors have lives after all." "Who'd have thunk?" "Dr Stevens, discharge my guy in 342." "Don't look at me like that." "It's not gonna take very long." "It's not." " You page me?" " I'm gonna be a while." "Could you get home to sign for the beer?" "Why don't you have your boyfriend sign for it?" "You have a very annoying way of sneaking up on people." " Maybe if you were less creepy..." " I wouldn't come." "I hate big parties." "Is Meredith the only one who doesn't know the size of this thing?" "I'm telling her." " You can't." "She's gone already." " What, already?" "I think she had... excuse me..." "an errand to run." "You don't think Meredith's going to mind?" "I want you to make it clear to her that I had nothing to do with this party." "Nothing." "I'm sorry I'm late." "It was the traffic." " It doesn't matter, dear." " Don't tell me the notary didn't show." "Everybody's here." "It's just your mother isn't." " Mom?" " What do you people want from me?" "We need you to sign the lawyer's papers." "I have a cranial reconstruction shortly." "I need to go." "OK, Mom." "We're all here." "We have a notary." "I need you to focus, and I need you to sign these papers." "Mom, look at me." "It's an emergency surgery." "I don't have time for this." "She can't sign anything now." " We should have done this earlier." " I couldn't come earlier." "I have a job and a life, and I'm here now." "You'll have to come back tomorrow, when she's lucid." "You know, why did she put this off for so long?" "And why did you let her?" "Doesn't it strike you as irresponsible?" "I mean, what the hell is wrong with you people?" "!" "Dr Lewis to Paeds ICU." "Izzie, I'm gonna kill you." "You could touch that, but I'd have to kill you." " So, about that towel thing?" " It's been taken care of." "OK." "You don't need to concern yourself with it." "So, what's gonna happen?" "We're not gonna talk about it is what's gonna happen, we clear?" "Or you had too much alcohol to understand me?" " We're very clear." " Good." "You have any bourbon?" "You can't discharge a man in pain." "You're hurting me!" "You're the one making it difficult." "Stop resisting." "Just give me the Demerol." "The Dilaudid hasn't worn off yet." "Look, I'm not leaving." " I'm calling Psych." " No, no." " Don't call Psych." " Wait, wait, wait." "Stop, Jerry." "Stop." "Stop." "Jerry." "Jerry!" "Concussion?" "He's blown his left pupil." "Page Shepherd." "We got to get him to CT." "That was one hard fall." "What do you see?" " Subdural bleed." " With midline shift." "We have to evacuate this now." "Anywhere else you have to be, Dr Stevens, or are you in?" "Brain surgery?" " Are you kidding me?" " That's what I thought." "Here you go." "Where is lzzie?" "!" "She didn't clear it with you?" "This was supposed to be a meet-the-boyfriend get-together little thing!" "Lzzie has a lot of friends." " Izzie doesn't know this many people." " I told her to clear it with you." " I can't handle this." " You want me to kick everyone out?" "I'm going to kick everyone out." "Baby, you made it!" "Screw it." "Hold this." "And give me this." "I made it!" "George, come here." "Come on." " See it?" " It's hard to miss." " More than he bargained for." " Maybe he's lucky." "Maybe this is his way out of the hole." "The hole?" "Interesting expression." "My father was into smack." "He was a musician." "It's tolerated in his line of work." "Not good for the family at home." "Why do we want to be surgeons anyway?" "Surgery is a very serious business." "Full house." "Royal flush." "Get naked, baby boy." " Surgery is stupid." " You're so sexy!" "It's stupid." " It's stupid." " Give me that." "You're drunk." "I'm not driving." "I'm not on-call." "I'm in my own house." "My life is crap." "And it's my party, and I'll get drunk if I want to." "Is lzzie Stevens?" "You must be Hank." "He's very large and hockey-like." "No, lzzie's not here right now." "OK." "You and Izzie will give birth to very tall, blonde people, kind of like Barbies." "Izzie didn't say there was going to be a party." "Which pisses both of us off." "Would you like some tequila?" "When do you think she'll get here?" "Don't know." "Look, we're low on ice, Hank." " I'm serious." " So am I." "We're interns, Hank." "The hospital owns us." "It's what we do." " Bye." " Nice to meet you." "Can you see him through recovery?" " I'll take it." " No, I can do it." " That's OK, Stevens." " He's my patient now too." "No, I got it." "See your hockey player." "I'm serious." "Yeah, OK." "I guess." "Thanks, Alex." "No problem." "What are you doing here?" "I'm sorry I didn't have a chance to call." "My patient needed brain surgery." "Like, we were inside his brain." "How cool is that?" "Oh, my God." " There's a party at your house." " Yeah, did you hang out?" "I wanted you to meet some of the people I work with." "I don't care about the people you work with." "I want to see you." "You didn't mind meeting the people I worked with when they were models." "Yeah, well, when they were models, you actually showed up to your own parties." "Yeah." "This is my life now, Hank." "I work 100-hour weeks." "I can't always show up to my parties." "My patients have to come first." "It's just..." "I just flew across the entire country and there's 100 people at your house." "100 people who understand what I do all day." " I shouldn't have to apologise." " No, you shouldn't." "Look, let's just go by the party for a little while." "You'll like everyone once you get a chance to know them." " I should just go." " Hank, come on." "I'll call you." "You know, in some states, you get arrested for that." "You blew me off for a bottle of tequila." "Tequila's no good for you." "Doesn't call, doesn't write." "It's not nearly as much fun to wake up to." "Take me for a ride, Derek." "You know, it sounds like the party's winding down." " Listen to me!" " What?" "We should probably sneak inside now." "We've done enough sneaking tonight." "It was good sneaking, but enough." "Yeah, I'd say we're pretty good sneakers." "You mind moving this tail wagon?" "You're blocking me in." "Apparently not good enough." "When's your meeting with the chief?" "In an hour." "Holy mother of destruction." "You missed Doctor-palooza." "Apparently, you didn't." "I should probably never speak to you again." "I'm so sorry, Meredith." "I had no idea it was going to get so..." "It's OK." "Really, I don't care." "What would I be doing anyway?" "Preparing for your career-altering meeting." "Sorry." "That heart wall shouldn't have torn." "Anything in the patient's history?" "Husband said she was in the best shape of her life." "She lost 100 pounds last year." "100 pounds in a year..." "How's her muscle mass?" "Do you even know whose that was?" " I'm hoping it was yours." " No." "What do you think?" "50 says Meredith gets tossed out and Burke walks away clean." "Please be nice to her." "So, I have done a lot of research on this, and Dr Burke has been kind enough to help me." "And I understand my responsibility in what I've done wrong here." "However, I do think the patient's history is significant in this case." "She still weighs 200 pounds, which is why no one even noticed it." "But with that kind of a weight drop, it doesn't matter how much you weigh." "You're anorexic." "Along with all that fat, she was losing heart muscle." "That could be the reason for a small poke to become a large tear." "That still doesn't change the fact, the poke wasn't reported at the time of occurrence." " And if I could change that..." " And you can't." "You left yourself and the hospital open to tremendous liability." "Not if the weight loss caused the problem." " I have no choice..." " I spoke to the husband." " I believe if his wife remains stable..." " I can't take your beliefs to the bank." " Dr Grey made a huge error." " She reported it." "Too late." "And in front of the patient's husband." "But she reported it." "She spoke up." "Five years ago, as a CT fellow," "I had a feeling I didn't check the body cavity of a lung patient closely enough before I closed." "The patient seemed fine post-op and I was in a hurry." "And yesterday you and Dr Bailey pulled a towel out from under that patient's lung." "Why didn't I report it at an appropriate time?" "Maybe because I was afraid that I would be called into a meeting where some hospital lawyer's fear of liability could end my career." "Even great doctors make mistakes, and when we do, we've got to have a chance to speak up without fear of retribution." "Or everyone suffers." "Dr Grey spoke up." "Responsibility:" "It really does suck." "Meredith." "You OK?" " Yeah, one-month probation." " That's good." "Yep." "Burke saved my ass in there." "Don't you all have something better to do?" "Come on, move!" "He was gonna tell them about the towel." "Just wanted to wait for the right time." "Information is power." "Once you get past the age of braces and training bras, responsibility doesn't go away." "Jerry, this is Sloane." "She's here to talk to you, if you want, about options for rehab." "It can't be avoided." "Mrs Drake, I cannot begin to tell you how truly sorry I am." "Either someone makes us face it, or we suffer the consequences." "Izzie!" "I did it!" "I pooped!" "All right!" " Missed your party?" " Life as a surgeon." "And loving every minute of it." "And still, adulthood has its perks." "Thanks for the coffee." "I mean, the shoes, the sex, the no parents anywhere telling you what to do." "That's pretty damn good."