"Pain comes in all forms." "I had a good time." "Really." "Thank you." "It was the perfect evening." "Best date ever." "Whatever." "Izzie" "You know I especially liked the part where you treated me like crap the entire night." "That was fun." "I had a good time." "Really?" "Yeah." "The small tinge." "A bit of soreness." "The random pain." "The normal pains we live with everyday." "I gotta go." "Seriously?" "Seriously!" "?" "!" "?" "Then there's the kind of pain you can't ignore." "Seriously?" "A level of pain so great that it blocks out anything else." "I was sleeping!" "Oh shut it." "Shut .." "Makes the rest of the world fade away." "I don't want to have this conversation again." "You didn't sign the divorce papers." "Fine." "I get it." "End of discussion." "Meredith" "What?" "!" "?" "Until all we can think about is how much we hurt." "Oh, I usually just say and then you yell at me." "I hadn't thought past that point." "I actually didn't have anything planned." "How we manage our pain is up to us." "Hey." "What is with that?" "Hey stop it." "Ow." "Seriously?" "!" "?" "!" "Seriously?" "!" "?" "!" "Seriously!" "This is a very small bed." "He's a brain surgeon." "I look fantastic!" "I shaved my legs!" "He's a brain surgeon." "How can he be so brainless?" "Hello!" "Seriously!" "Seriously!" "Ssh." "Sleep." "Pain." "We anaesthetize, ride it out, embrace it, ignore it." "And for some of us the best way to manage pain is to just push through it." "You're dripping." "I'm back." "I just wanna make that clear." "I'm back." "I'm ready to work." "Has any one seen Dr. Shepard this morning?" "His name is on the O.R board." "He should be here somewhere." "I'm good." "I'm ready to scrub in." "I'm 100% on top of my game." "You just got discharged." "Pace your self." "I'm paced." "I'm paced." "Rounds people." "What?" "You're not talking to me anymore?" "Okay." "What happened last night?" "What is going on with you?" "I'm fine." "What's your problem?" "Fine." "You know what Alex?" "No, I'm not talking to you anymore." "Dr. Bailey." "Henry Lamott." "Aged 42" "Is scheduled with Dr. Shepard for a spinal implant to control the pain of his herniated disc." "He's allergic to all pain medication" "Is that?" "Porn." "Porn?" "As in Porn?" "!" "?" "!" "Alright." "What are we watching?" "Karev!" "Go stand in the hall." "Uh Mr.  Mrs. Lamott I'm sure you're really nice people and what you do in the privacy of your own" "Look we can't have porn in here." "This is a hospital." "It's for my pain." "My doc says it releases endorphins in the brain." "It help keeps my pain at a manageable level." "Really?" "George!" "Hall!" "What is this?" "Nasty naughty nurses um" "That does not look comfortable." "Trust me it's not." "Get in the hall!" "O'Malley." "Karev." "You're in the pit today." "Stevens there's a cardiac patient waiting up for you on 2." "Yang keep an eye on the Lamott's." "I don't want any problems." "Go." "Grey, your mother's being discharged this evening." "You've made arrangements or do you need more time?" "The nursing home is coming at 8." "All right then you're with Shepard." "Derek Shepard today." "Hey." "Life is short." "Times are hard." "The road is long with many a winding turn." "He asked for you." "Take it up with him." "Okay." "Pete Willoughby. 25 year old." "GSW to the chest." "Immediate return of 860 CCs of blood from the chest." "Oh Man!" "This hurts." "He's put out more than 200 CCs in the past hour." "They never tell you in the movies how much it hurts to get shot." "Push morphine 2mg." "Alex, is this my case." "Morphine 5mg." "You didn't even call." "I don't have to call." "I was here first." "You got here first because I let you." "Where's his chest films?" "I got it." "You always get the surgery." "Today, I'm getting a surgery." "Guys knock it off." "He's one of Seattle's finest." "You've got an entire police force watching you" "Page Dr. Burke." "Let him know I'm bringing up a GSW." "No we are bringing up a GSW." "Looks like you'll be able to go home today Ellis." "But I still have patients to see." "No." "No more patients." "I'll be back to check on you later." "You should know I'm thinking of leaving Thatcher." "I should never have married him." "I'll leave him." "You leave Adele." "And then when our residency is over we can both get jobs at the same hospital." "Why don't you get her meds ready for her discharge nurse?" "Thank you." "Ellis." "That was a long time ago, remember?" "We had this discussion 21 years ago." "Think about it Richard." "We should make the break now." "If we wait until residency is over, you'll be at one hospital and I'll be at another." "We could end up at opposite ends of the country." "It'll be too late." "Meredith." "Your wife is looking for you." "This is hard for me Meredith." "Well let me make it easy then." "I'm not gonna be that woman." "The one who breaks up a marriage or begs you to want me." "You can sign the papers or you cannot." "The choice is yours." "Either way when it comes to this relationship I'm out." "Now where's this patient" "I'm supposed to be helping you with." "Down here." "You shouldn't have tried to walk the dog in the rain." "Oh Lou it wasn't the rain." "I just passed out." "Actually Mrs. Bradley" "Verna." "Verna." "You presented with lateral ST elevations and reciprocal inferior changes consistent with an MI." "A heart attack." "Oh my god!" "Oh don't worry." "I've had these little chest pains before and it turned out to be nothing." "This is nothing." "Lou not in front of the doctor." "I've had a twinge in my back for a little while." "I thought it would go away." "But then last night my legs went numb and this morning my back pain is just too much." "Miss Chue." "We're going to put you on a PCA pump." "Give you some morphine which should help control the pain." "Thank you." "Okay." "But there's a greater problem here." "I've just taken a look at your MRI." "Anna!" "Why didn't you call us before coming down here?" "I'm sorry." "These are my parents." "Hi." "What's going on?" "I was just about to explain that Anna's MRI has shown that she has myxopapillary ependymoma." "It's a tumor in her spinal canal." "But the good news is we can operate." "You have a 95% chance of fully recovering if we get you into surgery as soon as possible." "We can't wait another moment." "With a tumor this aggressive even waiting another day puts you at risk of permanent paralysis." "Father?" "No." "No surgery." "Mr. Chue without surgery Anna will be paralyzed probably within the next 24 hours." "There will be no surgery today." "We're taking her home." "Anna needs the surgery." "And she can have it at another time." "Look Mr. Chue" "We are taking our daughter home." "Anna you are over 18." "You don't need your father's consent." "I am hmong and my father is the elder." "He says I go home, I go home." "Hmong?" "Let's find out what that means." "Contact social services." "See if we can get anyone down here." "And talk to them." "Do I continue to process her discharge?" "Yeah we have to." "It's insane but we have to." "It reminds of this case" "I had in New York one time one time and this woman came to the office and" "Look do you need me for anything else work related?" "Look, I was married for 11 years." "Addison is my family." "That is 11 thanksgivings, 11 birthdays and 11 Christmases." "And then one day I'm supposed to sign a piece of paper and end my family?" "A person doesn't do that." "Not without a little hesitation." "I'm entitled to a little uncertainty here" "At least a moment to understand the magnitude to what it means to cut somebody out of my life." "I'm entitled to a least one moment of painful doubt" "And a little understanding from you would be nice." "Dr. Shepard." "Still here I see." "I couldn't leave you." "You seen the other Dr. Shepard?" "I'll tell him you're looking for him." "So thanks for you know being there." "No thanks needed." "Okay." "So where are we?" "Uh the north east corner of a hospital." "Oh I'm, I'm getting back on my feet." "Fine." "That doesn't mean" "Cristina." "It's my first day back." "I've, I've got" "I'm not waiting forever." "Karev  O'Malley are bringing up a GSW." "Wanna scrub in?" "No can do." "No extra work." "I'm trying to get out of here at a decent hour tonight." "Oh you got a date?" "Yes." "Yes I do." "A handsome man is whisking me away to a love nest for the weekend." "You got shot in the line of duty?" "First night on the job." "Can you believe my luck?" "A guy pulls a gun and I freeze up." "The rookie let himself get shot." "I'm never gonna live this down." "Sure you will." "You think?" "Absolutely." "Hey I got Verna Bradley's test back." "I don't think she had a heart attack." "Yeah but look at the changes in her EKG." "She had something." "Yeah but her serial enzymes and her dobutamine stress cycle came back negative." "I actually think she's fine." "Get a cardiac CATH." "Izzie, be thorough." "I am thorough." "So dude what's the deal with Izzie?" "She shaved her legs for you." "And?" "And you didn't even kiss her goodnight." "She shaved her legs for you and you didn't follow through?" "Hey I follow through." "I always follow through." "You didn't last night." "Mind your own business." "Mind?" "She had expectations." "Women have expectations." "And you didn't meet them." "Hey I live with these women and every time you guys don't meet their expectations," "I have to hear about it." "I didn't get any sleep last night." "So you know it is my business." "Dude we're not moving." "Really?" "You think?" "You know how long a surgical scar takes to heal." "You must be in pain." "You should take something." "Drugs are for babies." "I hate Alex." "The non sequitur award goes to" "I'm sorry." "I hate Alex." "I broke up with Derek." "Burke wants to have a relationship." "Boys are stupid." "Yep." "If elevator should stop do not become alarmed." "Press the button marked alarm to summon the assistance." "They don't want us to be alarmed then why call the button alarm?" "That didn't work the last 5 times you did it." "Get it through your head we've lost power." "We're stuck here." "You okay?" "His pressure is falling." "Alex there's a lot more asbestosis in the pleura back." "We need to get him to the O.R." "Okay you're whispering." "Don't whisper." "I mean I don't wanna complain here but I got a bullet in my chest and whispering isn't a sign I'm gonna be A-OK, you know?" "Dammit." "It's out." "That's bad." "That's bad, right?" "Someone is gonna get us out of here." "Don't worry." "How are we doing?" "Oh can you move me to another room?" "The lights and the TV went out." "Ah." "Power outage in the east wing." "They'll have it back on soon." "You're not a critical patient, you'll be fine here." "Oh god what am I gonna do?" "You mean?" "Without my porn!" "Read a book." "Talk to your wife." "No." "School closed early because of the storm." "She had to pick up the kids" "She won't be back until after dinner." "Well I'm sure you can find some normal way of amusing yourself." "No I need my porn!" "Yeah." "Lightning hit a sub station." "We're running on back up generators." "One of them's down." "RichardBreathe." "The only direct means of transporting from the E.R to the O.R isn't working." "Don't tell me to breath." "I'll breathe if I wanna breathe." "We're caught between floors." "How bad is it?" "Two interns and a GSW to the chest." "Good air in." "Bad air out." "Come on people get those doors open." "It's jammed." "It won't open any more." "Move." "Move." "This is wide as wide as it goes." "What, What did you two do?" "Nothing!" "How's the patient?" "He's not looking so good." "Why do the lights keep flickering?" "Something about a back up generator." "This pump will provide you with a morphine drip." "It should stop your pain." "I, I told you I don't need it." "I'm going home." "You realize you'll have to sign an AMA form stating that you're leaving against medical advice." "Fine." "I know this new and confusing." "I called a social worker and she's willing to come down and talk to you" "Spare me your white girl cultural divide love." "I grew up from the street down here." "I play in a band." "I went to UDUB." "I get it." "My father doesn't." "He says no, it's no." "We're talking about your ability to ever walk again." "That's what you're talking about." "I'm talking about my family." "Have you ever even heard of the Hmong people?" "Our religion has got rules that are way old and way set in stone and way spiritual and you don't mess with them." "You don't anger the ancestors." "Even if you pierce your tongue and play in a band." "What are the rules exactly?" "All I.C.U. patients are going to the south wing." "All limitary and step-down patients north wing." "You paged me?" "Porn!" "As pain management?" "You met Henry." "Yeah there's a lot of different theories on how to treat pain." "Porn!" "As pain management?" "Look." "It's possible that pornography like art and music can stimulate the brain to produce endorphins and minimise pain." "Porn!" "As pain management?" "I didn't prescribe it." "It wasn't me." "Take it up with the treating physician." "If that man turns out to be some sort of sex weirdo it's on you." "That's all I'm saying." "oh and you're wife's looking for you." "I know." "Derek." "Yes?" "You need to talk to Anna's father." "I'd do it myself but I guess having testicles is a requirement." "What happened to social services?" "According to Anna they can't help us." "Apparently Anna's father believes she's missing something that she needs for surgery." "Missing something?" "Missing what?" "One of her souls." "We don't need a social worker, we need a shaman." "A shaman." "Cardio tells me that your CATH went just fine." "Is that much bruising normal?" "Your one looks good Mrs. Bradley and so do the results on your CATH." "You don't have any blockage in your arteries." "Which means?" "You definitely did not have a heart attack." "So I can go home?" "Not yet." "Your EKG shows significant changes." "And I'm gonna find out why before you leave the hospital." "Hey what are you doing?" "I have to get home." "Pete you're in the hospital." "Need to get home.No. Need to get home." "What's his blood pressure?" "It's not reading." "He's too agitated." "How's his pulse?" "Steady but it's still there." "Do you have any instruments?" "Uh, just a code box and some gloves." "You didn't bring an open chest tray?" "No we thought" "You don't have time for excuses." "O'Malley blood pressure." "I've taken it 3 times." "And?" "I can't hear systolic over 50." "He's gonna die." "Intubate him." "I'll be right back." "Wait." "Where are you going?" "To get an instrument tray." "You guys are going to have to open up his chest." "Are you sure about that?" "No." "When's Burke coming back?" "Is Dr. Burke coming back?" "Alex?" "Oh would you shut up." "Mr. Chue!" "You won't take on our help but a healing ritual?" "When sickness comes it means one of her souls is missing." "Anna needs every soul intact before she has her surgery." "She needs a shaman." "You could of, told me that." "Why?" "So you can call me a fool." "I respect that you have traditions that I can't understand." "But you're standing beside me in a 3000 dollar suit, so I also know that you respect the fact that" "I'm telling you Anna needs a surgery in the next 24 hours if she's going to continue to walk." "She can't leave this hospital." "She can't undergo surgery without her soul." "She'd die." "Alright then." "We're just gonna have to get a shaman." "Today in the hospital." "Shaman's aren't listed in the yellow pages." "Our shaman is 500 miles from here." "You are an arrogant man." "No." "I'm just a guy with access to a helicopter." "Thank you." "Finding her soul won't be easy." "Never is." "This is incogitable." "There's not enough power to move those elevators?" "They're doing what they can to replace the back up generator now." "Fire department is standing by." "All critical patients?" "Moved to the south wing." "Incoming trauma?" "Re-routed to Mercy West." "Look that back-up generator should've been replaced last year." "Yes, sir." "Why didn't it happen?" "Chief you eh have to ask maintenance, I wouldn'tknow" "Dr. Bailey." "You know everything." "Tell me whose butt to kick." "That would be your butt Chief." "You didn't authorize the replacement generator." "Saved the money for the new MRI machine." "Um I need to get back on down to the" "Hey!" "This isn't gonna be too sterile but we can still try." "Prep and drape the patient." "Hey can you get me copies of all of Verna Bradley's medical records and page me." "I'll be on the O.R floor." "Hey wait where where are you 2 going so fast?" "Burke is talking George  Alex through heart surgery in the elevator." "Shepard is setting up a shaman healing ritual." "Rock on!" "I have porn guy!" "Help please." "Oh." "Mr. Lamott." "What's wrong?" "Pressure's elevated." "Pulse is racing." "You're really in pain!" "Whatcha think?" "You're telling me the porn actually sedated you?" "Oh what did you think" "I'm some kinda pervert watching that stuff in front of you?" "Well yes." "Oh okay, okay." "Uh you're allergic to most narcotics and NSAIDS." "I, I suppose uh we could try droperidol and dihydroemetine." "No." "That put me into a coma last year." "Well ah um I can get anesthesiologist down here." "Oh no but with your surgery tomorrow" "I don't think he'll give you an epidural block." "What am I gonna do?" "Uh hold on." "We're really going to do this." "Take these." "Karev take the scalpel." "Alex." "Come on." "Alex!" "Ventilate!" "I got it." "What do I do?" "Make a large anterior lateral, mid-auxiliary incision in the 5th intercostal space." "How, how large?" "As long as possible." "You need to get 2 hands in there." "It needs to be long and deep." "Use the scissors if you have to." "Okay." "But be sure you don't cut into the lower of the heart." "Uh, how can I be sure of that?" "You just have to be sure." "We're not in Kansas anymore." "You're shaman's late." "My shaman is never late." "You guys see anything?" "Poor George, doesn't have the steadiest hands." "Izzie." "Yeah?" "He can hear you." "O'Malley how are you doing down there?" "Uh fire department's here." "You can get the doors open." "No." "Nobody moves." "Nobody works on the elevator." "I have an open chest and a very nervous intern in there." "Keep them back until I give the word." "O'Malley." "I didn't cut the heart or the lungs" "Dr. Burke, I didn't cut the heart or the lungs!" "Good, good." "Good." "Good O'Malley." "Really good." "Now check for injuries and do a pericardiotomy." "Uh I'll need some lap pads, forceps, metzenbaums and satinksy clamps." "Yes you will." "You tell anyone I did this for you, not only will I kill you;" "I will sell your body parts for cash." "Okay." "So there were these women." "Nurses. 3 nurses." "And they were ." "naughty." "Really, really, naughty." "They were 3 naughty nurses." "Uh saucy even." "They were saucy and, and bad and naughty 3 saucy, naughty, bad nurses." "They were taking a shower together." "Soaping each other up." "And then this doctor walks in and he sees these 3 naughty bad nurses with these great big" "Mrs. Bradley do you realize you've been admitted to the hospital on this date for the past 7 years?" "Oh that can't be." "I don't remember the date exactly but" "I have the medical records." "On this date for the past 7 years you have what looks like a heart attack." "No." "No." "I know I've had some scares but I, I don't" "Every year on this date?" "Is there some significance to this date for you personally?" "No." "Nothing." "What we're you doing the first year?" "The first time you had a cardiac episode?" "Oh I couldn't remember back that far." "We were in the yard." "I remember because our neighbor what was his name?" "Ted." "That's right." "He died of an aneurysm I think." "And we watched as the funeral home people took him away and you had your first attack." "And you were close to Ted?" "We barley knew Ted." "That was all very sad but what does that have to with Verna's heart?" "I've removed the small clot from the pericardium." "No obvious cardiac injuries." "Any change in the vitals?" "BP's still too low to register on the monitor." "We need to cross clamp the aorta." "Stick your hand in and bluntly dissect down until you feel 2 tube like structures." "The esophagus will be more medial and anterior." "Ah I feel one tube that is easily collapsible and the other is more muscular and spongy." "I can ah feel the spine just underneath it." "Yes you're touching the aorta." "I'm touching the aorta." "Wrap the index finger of your left hand around it and apply a satinsky clamp with your right hand." "Got it." "Wait I think I can localize the bleeding. ." "I think it's coming from the inferior vena cava" "Can you find the lesion?" "Yeah." "Yeah." "I think I can feel ah it's too far in to repair." "How big is it?" "Small." "Maybe smaller than a dime." "Okay O'Malley." "I want you to take your finger and plug the hole." "I think I can feel his heart starting to fill more." "It's beating a little stronger." "Excellent." "Keep your finger there." "Okay now what?" "That's it." "That's it?" "I just stand here with my finger plugging the hole?" "Until we can get you out of that elevator and into the O.R." "Dr. Bailey, tell the fire department to get my guys out of there." "Will do." "Okay we're ready." "O'Malley." "Yes sir?" "You just flew solo." "Thank you sir." "Okay Anna." "We're going to shut off the PCA pump now which means you'll be in a lot of pain for the duration of the the healing ritual." "Are you okay with that?" "Yeah." "I can't find my soul if I'm medicated." "No pain, no gain right?" "Well it's not just for your father." "You believe it too, right?" "I know it sounds like a load of crap but watch the ritual." "You'll see." "See what?" "The moment it happens." "I'm ready." "Oh yes I'm so very, very naughty Bianca said as she dropped her stethoscope." "Me too said Crystal as she snapped on her surgical glove." "And then there was Marta" "Where was I?" "Marta." "Oh yes Marta was the naughtiest nurse of all because she knew how" "Oh thank god." "How long do you think it takes to retrieve a lost soul?" "I don't know." "Way to go George!" "I have my finger in a heart." "Very cool." "You have stress cardiomyopathy." "Cardiomyopathy?" "What does can you tell me what that is?" "It's Ted." "Ted?" "Ted." "Not just the neighbor you barely knew was he?" "I don't know what you're talking about." "Cause every year on the day he died you get a rush of adrenaline caused by stress." "Your pressure rises." "You have chest pains." "And you end up here." "27 years." "I loved the man next door and he loved me." "I know how this is gonna sound but Ted was my soulmate." "And then he just died!" "Its grief." "Your heart stops because you're grieving for Ted." "So what do I do next?" "I mean how do you treat it?" "I wish I knew." "I told Thatcher that I'm leaving him." "You left Thatcher Ellis." "But I couldn't bring myself to leave Adele." "Do you remember?" "Painted horses." "Yes." "We were on the carousel in the park." "It was raining." "I have an offer from Boston General." "You took it to get away." "We swore to never to talk again about what we had together." "It was gonna always be our secret." "Richard." "Yes Ellis?" "Carousels give me the creeps." "How do you put up with it?" "I mean 'Nasty Naughty Nurses 4' and I'm assuming 1, 2  3." "He's my Henry." "I know but don't you find him misogynistic and degrading and kind of 24 hours a day of porn." "Seriously that's your life?" "I'm grateful for it." "It takes away his pain." "You see the thing is Henry Henry takes away my pain." "I lied." "I'm not out of this relationship." "I'm in." "I'm so in it's humiliating because here I am begging" "Shut up." "You say and I yell remember?" "Yeah." "Okay here it is." "Your choice." "It's simple." "Her or me." "And I'm sure she's really great." "But Derek I love you." "in a really, really big pretend to like your taste in music, let you eat the last piece of cheesecake, hold a radio over my head outside your window unfortunate way that makes me hate you" "So pick me." "Choose me." "Love me." "I'll be at Joe's tonight." "So if you do decide to sign the papers meet me there." "Goodbye Ellis." "I'm going to come see you tomorrow, okay?" "He doesn't love her." "He can't." "But he'll stay with her anyway." "She's his wife." "Mom?" "Mommy." "Meredith." "You grew up." "I did." "Hmm." "It's a shame." "It's awful being a grown-up." "But the carousel never stops turning." "You can't get off." "Okay." "You think he'll show?" "He'll show." "Hey!" "How's your patient?" "The one who got her soul back?" "She's gonna be fine." "Gotta go." "Look at you." "You're like a girl." "Is that your date?" "He's my husband." "You're married?" "10 years today." "How come I didn't know you were married?" "You never asked." "You haven't signed those divorce papers yet have you?" "Bailey." "Tell me what to do." "God why does this have to be so hard?" "It's not hard." "It's painful but it's not hard." "You know what to do already." "If you didn't you wouldn't be in this much pain." "Pain." "You just have to ride it out." "Hope it goes away on its own." "Hope that the wound that caused it heals." "So here's where we are." "I work too much." "I'm competitive." "I'm always right." "And I snore." "What?" "I'm trying here." "Ohhhhh." "Oh." "Oh!" "Oh." "Yeah." "So?" "Okay." "We're a couple." "Whatever." "Don't make a big deal about it." "There are no solutions." "No easy answers." "You just breathe deep and wait for it to subside." "He's not coming." "You don't think he's coming." "He might come." "Yeah." "You never know." "He's definitely coming." "Do you want her doing tequila shots all night?" "I'll be the one cleaning up the vomit." "Besides I touched a heart today porny." "Most of the time pain can be managed." "Pour me another one." "But sometimes the pain gets to you when you least expect it." "I'm telling you any second." "It's way below the belt and doesn't let up." "I have been looking everywhere for you." "Well you found me." "So?" "You gonna sign those divorce papers or not?" "Pain." "You just have to fight through because the truth is you can't out run it." "And life always make more." "Manu2005"