"When something begins, you generally have no idea how it's going to end." "The house you were going to sell becomes your home." "The roommates you were forced to take in become your family." "And the one-night stand you were determined to forget becomes the love of your life." " Hey." "How long have you been up?" " All night." "I was trying to figure out how to get the tumour out of lzzie's brain." " Then why are you smiling?" " 'Cause I figured out how to do it." "Once lzzie's in the clear, we go to the Bahamas, and have our wedding on the beach." "The One  Only Beach Club." "You're gonna actually have drinks during the ceremony." "Sure you're OK to be up and around?" "Yes." "I have good days and bad days." "Plus, I don't want to spend our entire honeymoon in a hospital bed." " This is not our honeymoon." " It totally is." " I want you to meet my friends." " I know all your friends." "You know all my doctor friends." "I'm a patient now." "You gotta meet my patient friends." "And they are gonna love my new husband." " Don't make a big deal." " I'm not gonna make a big deal." "I'm a bride!" "Lz, come on." "I'm getting her a real one." "I love this one." "That makes it a real one." "OK." "Everybody, this is Alex." "My husband." "Husband, this is Austin, Star, Meg, Miguel and Alison." "Can you turn him around so we can see the butt?" " Yes." "Alex?" " Are you kidding me?" "A big trauma just came in." "That's..." " That's quality booty." " Right?" " Congratulations, lzzie." " Thank you." "So I had a good session with my shrink this morning." "Did you talk to her about your mom?" "Have you seen your mom yet?" "'Cause she lives a few miles away, and she thinks you're in Iraq." " I am planning to see her." " When?" " Dr Hunt?" "I'm not on trauma today?" " Follow me, O'Malley." "Lieutenant Lowell, I'm Dr Hunt, we spoke on the phone." "Major Hunt, it's good to finally meet you." "My CO's told me a lot about you." "You shouldn't believe anything Steve Mason tells you." "This is Dr O'Malley, you've met Dr Torres." "I'm looking at Charlie's scans, but not finding anything" " functionally wrong with the leg." " Except I can't walk or run or move without serious pain." "I've tried everything." "Medications, physical therapy, nothing works." " Which could indicate nerve damage." " Or chronic pain syndrome." "And we can look into pain management, but surgically," "I'm afraid there's nothing I can do." "Actually, there is." "You could cut it off." "You can cut it off, replace it with a prosthetic leg so I can get back to Iraq, where I'm needed." " Did you know why he was here?" " No." " Is it such an unreasonable request?" " Unreasonable?" " Cutting off a limb is dismemberment." " That kid made lieutenant at 19," " spending his life in the military." " They'll take him back with one leg?" "There have been amputees who've returned to duty with prosthetics." " Voluntary amputees?" " I don't know." "I have to turn this kid away?" "His CO sent him here because he trusts me." "We could get another set of scans and then try an epidural for the pain." "Dr Torres?" "Fine." "Do an MRI and an epidural." "I'll take a look at the scans, but if the leg is healthy, I'm not cutting it off." " Dr Bailey, you busy today?" " That depends." "You got any dying children you want me to become overly attached to" " before they expire?" " I have an eight-year-old neuroblastoma patient and he's gonna live." "I feel it." " So scrub in with me and see the joy." " Dr Bailey, may I borrow you?" " Who is Santa Claus?" " An old, white man who lives at the North Pole and enters people's homes inappropriately?" "No." "I'm Santa Claus." "All systems ready." "Oh, no, you did not!" "Oh, yes, I did." "The Da Vinci S-I HD Surgical System." "Tell me you didn't wait until I'd all but left the general surgery programme" " to buy the Da Vinci." " Care to take it out for a spin?" "Santa!" "Hey." "I was thinking, you know, with Derek and Meredith getting married, they probably don't want us hanging out in the attic much longer." "So I was thinking I'd start looking for a condo." "Perfect." "Then you'd finally have a place of your own." "Actually, I was, you know, thinking maybe you'd you'd come with me." " Absolutely." "I'd love to see it." "I am so happy for you." "How much of that did you hear?" "The part where you asked her to move in with you or where she shot you down?" "I was here for both." "And, by the way, it's just way too early for you to be moving in with Lexie." " You don't have to do everything I do." " This is not about you." "I have my own future to think about." "Life is short." " Look at what's going on with Stevens." " Don't worry about Stevens." "I got a plan." " You want to remove her hippocampus?" " One of them." "It's a common procedure." "Removing her hippocampus could compromise her memory, her speech." "She wouldn't be able to practice medicine." " I've performed this hundreds of times." " On cancer patients?" " No but it's..." " If you do it, I could lose my memory?" "It's unlikely, but it's possible." " And if you don't do the surgery..." " We could shrink the tumour with IL2." " If the tumour doesn't kill me first." " Why take the chance?" " Have you done a Wada test?" " Putting her brain to sleep and asking her to remember flash cards is not an accurate..." "But it would tell us whether or not she could function after." " As her physician..." " I'll do it." "It's unnecessary." " The surgery is unnecessary." " She's having hallucinations." "Nice ring." "Alex outdid himself." "We're gonna have beautiful kids, don't you think?" " Is four too many?" " Four is perfect." "Ideally, it would be two boys and two girls." "One of which will definitely be a tomboy." "And I should have them close together, though that might be stupid." " Why wait?" " Exactly." "That way, if I'm not able to practice medicine anymore..." " You won't want to." " You don't think?" " Do you?" " I'm asking you." "Why do you keep agreeing with everything I say?" "Because I am you." "I'm your tumour." "You're talking to yourself." " Right." " At least until you have surgery." "If you have surgery." "Are you gonna have surgery?" "If Derek cuts the tumour out, I could lose my memory." "And if he doesn't, I could die." "I don't know what to do." " Alex, tell me what to do." " I can't tell you what to do." "Of course." "You're my husband." "That's what husbands do." "They stomp around telling their wives what to do." "It's your job." " My job is to support you." " I don't know what I want to do." "That's why I'm asking you." "OK, I have an idea." "Let's put it to a vote." " All in favour of the surgery." " We're not voting." "No one's voting." " Opposed?" " I'm opposed." " To voting." " Just decide for me." "Please?" "You don't have to know right now." "Think about it." "I don't have time." "Captain Mason told me you saved his life four times in the field." "A couple in the canteen, but don't tell Mace I told you that." "So you think I'll get to go back?" "Are you sure you want to?" "I mean, why do you want to cut off your leg just to go back to the war?" "Don't you have family?" "You know what it's like to have family who don't know you, don't get you," " maybe don't even like you?" " Yeah, actually, I have brothers." "Me too." "So there's that family, the guys I grew up with, and we've got nothing in common." "And then there's my guys in Iraq." "My real family." "Whatever we got into, we were in it together." "But here, I'm alone." "I'm nobody." "And I've tried." "I've tried fitting in here." "I've tried being a regular person." "I've tried getting a job, but there aren't any." "There are a lot of things I wanted to be in my life, things I wanted to do." "But none of 'em's here." "This is Alison Clark." "She was referred to me two years ago." " Mets in her brain, liver, kidney." " She ended up having five surgeries and extensive chemo, which worked." "But then..." " The mets came back." " That's when I started her IL2 therapy." "And now, after three treatments in as many months..." " The mets are gone?" " The mets are gone." "Dr Stevens should be patient." "She should give her therapies a chance." "As surgeons, we like to cut." "But sometimes there's a better way." "Let me retract that small bowel so you'll have better visualisation." "You know what, chief?" "Thanks to Leo, you don't have to." " Leo?" " Leonardo." "Da Vinci." "Watch this." "See?" "Five hundred and forty degrees of wristed movement." " Can't do that with a laparoscope." " Or in open surgery." "Feels pretty good, doesn't it?" "Dr Bailey?" "Are you making lightsabre noises?" "Not anymore, sir." "You know, Dr Chalikonda at Cleveland Clinic is doing single-incision gallbladder removal through the belly button." "We can try that on the next one." " If you're up to it." " Don't tease me, sir." "I'm not." "Why should Dr Chalikonda have all the fun?" "It's impressive, but it took two years to get these results." " These were three months apart." " Izzie may not have three months." "That tumour could start bleeding in three days." "Or three seconds." " Since when are you not about cutting?" " It may not be in the best interest." "Derek's not acting in lzzie's best interests?" "They're ready for us in radiology." " OK, lz, I'm going to show you..." "...a series of images you want me to try to remember once Derek puts the right side of my brain to sleep." " Hit me." "Show me what you got." " OK." "Is that a schnauzer or a Scottie?" "How specific do I need to be?" "Dog is fine." " It's either a 727 or a 747." " Plane." " A two-storey Victorian mansion." " We would also accept the word house." "Schnauzer, 747, mansion, schnauzer, 747, mansion." "Or dog, plane, house." "I'm putting the right hemisphere of your brain to sleep now, OK?" "Dog, plane, house, dog, plane, house..." "Dog, plane, house, dog, plane, house..." "OK." "And now we wait for the brain activity in that area to stop." "Dog, plane, house, dog, plane..." "OK, lz, are you gonna tell me what you saw?" "Show her the cards." "What's this?" "Dog." "Can you say "dog"?" " What's my name?" " Just stick to the cards, Meredith." "Meredith." "You know my name." "You can say my name." " This is what I was afraid of." " OK." "Who's Alex?" "Lz, you don't have to speak." "Just nod your head for me if you know who Alex Karev is." "The test impaired your memory to such a degree that I strongly recommend" " you don't have the surgery." " Izzie, it was the worst-case scenario." " It has nothing to do with the surgery." " We don't know that." "I do know that not operating is every bit as risky, if not more so." "But it's up to you." " What do you think?" " I think he's talking to you, not me." " I'll leave you two alone to discuss." " I'll come with you." " I have a couple of questions." " Alex." "Think about what you want to do for a second." "I'll be right back." "You are not having the surgery." "I need you to not talk medicine to me." "Talk to me like I'm your friend, like I'm the guy whose cereal you eat in the morning, and tell me what to do." " Karev..." " Please." " Karev, I can't tell you what to do." " What if it was Meredith?" "What would you do if you had to choose between spending a few more months with Meredith knowing she was gonna die, watching her hurt, watching her sick or spending the rest of your life with someone who looked like Meredith," "but wasn't her anymore." "She's the one good thing that ever happened to me." "The one good thing." "So I need to know what to do." "I need you to tell me, what if it was Meredith?" "I would ask her to have the surgery." "You couldn't remember anything." "You didn't know my name." "You didn't know who Derek was, you didn't know who Alex was." " You couldn't remember how to speak." " Why don't I remember this?" "The tumour is sitting right in the middle of everything that makes you you." "I was standing there talking to you exactly like I am now, only you weren't there." "You weren't you." "You were gone." " So what do I do?" " Swender has a patient, female, 22 years old, metastatic melanoma." " Alison Clark?" " After three months of IL2, her mets were gone." "All of them." "You're not having this surgery." "Don't do it." "That's my vote." "Don't have the surgery." "I didn't." "I freakin' hate surgery." "I'm hallucinating, Alison." "I have really long conversations with dead people, and I see things that aren't..." "Right now, I'm pretty certain there aren't birds flying over your head, because this is a hospital and that would be weird, but that's what I'm seeing." "I have a brain tumour." "Am I really not gonna let them cut it out?" "I didn't let them cut out mine." "It's like, OK, one minute I'm this college kid, rowing crew and being an idiot and forgetting my sunscreen and thinking it doesn't matter because I'm me, and life has worked out pretty well for me." "And then, the next minute they're cutting into my body every other week." "I had 15 surgeries." "And then I said enough." "Forget it." "I'll row crew in heaven, or whatever." "And then the IL2 worked." "It worked." "I come here every three weeks, I get my medicine, and I don't have a brain tumour anymore." "Charlie, if we admit you, if we do what you're asking us to do, the pain in your leg, there's no way of knowing if amputation will cure it." " But it might." " Yes, it might." " And once I get the prosthetic..." " It will be months before I can even begin fitting you with a prosthetic." "Which won't feel anything like a new leg, by the way." "It'll feel like five pounds of metal that hurts and pinches." "And what if the Army says no, what if they don't take you back?" " They will." "Chances are..." " You really want to take that chance?" "You're asking me to remove one of your limbs." "You think I don't know that, you think I want to cut my leg off?" "Of course not." "Am I sure about this?" "No." "The only thing I'm sure about is I'm in hell right now." "That I'm sure of." "I've lost everything." "Everything I've worked for, everything I care about, and I traded it in for a six-times-a-day pain pill habit that doesn't work." "So don't waste both our time trying to scare me, because you don't scare me." "After everything I've been through, nothing scares me." "So are we gonna do this or not?" "Dr Robbins, Dr Bailey just performed Seattle Grace's first single-incision gallbladder removal." " Wow!" "Cool!" " Through the patient's belly button." " And now it's kind of creepy." " No, you should've seen it." "No scars, no bleeding, and about half the time" " it would've taken laparascopically." " You want to do one after lunch?" " I've got another colon." " You don't mind?" "So I guess I'm on my own for this afternoon?" "My neuroblastoma?" "No, don't worry." "You don't have to." "You'll have the rest of your life to do neuroblastomas." " Then I'll see you after lunch, sir." " OK." " Chief?" " Yes, Dr Robbins?" " Chief..." " Did you want to tell me something?" "I am going to cry." "I just want you to know that I know it's going to happen, and I just want you to ignore it." "And I'm not crying because I'm upset." "It's just what happens when I get mad" " at people of authority." " You're mad at me?" "I am mad at you." "And I'm crying because you're the boss, my boss, which brings up issues with authority and my dad, who you remind me of." "Not that you're old." "But you command respect." "People respect you." "I mean, I know I do." "I know Bailey does." "Which is why I am mad." "Because it's wrong, sir, it's wrong and mean to use a robot to lure Bailey back to general surgery." "I don't have a robot." "All I have are little kids." "They're not as fun as a robot." "And they're not shiny and new and silver, and they don't have things coming out of their belly buttons but..." "I will fight you." "And I will win." " Sir." " You think you can fight me and win?" " Yes." " Good luck." "Because I have something you don't have." "I have joy!" "Sir." "Dr Toretto, pathology." "Dr Toretto, pathology." " What's going on?" " We're going over lzzie's IL2 schedule." "For after the surgery?" "I decided not to have the surgery." " What?" " Maybe we should come back." "Dr Yang." " You're having the surgery." " What?" " Shepherd said this is your last shot." " But I just..." "I am your husband, I say that you are having the surgery!" "What happened to, "This is your decision..."" "That was when I thought you were gonna make the right one!" "You chose wrong, so you don't make this decision on your own, you married me!" "It's not just your life at stake anymore!" "It's my life, too!" "My life with you!" "You can tell Swender whatever you want, but I'm telling Shepherd, and you, you are having the surgery!" "She may be your friend, but that doesn't give you the right to talk her out of a surgery you know nothing about." "You're Swender's resident." "What you did was inappropriate, it is unprofessional." "You crossed a line!" "No, she didn't." "I did." "I'm the one who convinced lzzie not to have surgery." "I'm the one you should be yelling at right now." "Well, I'm gonna go now." "Unless you wanna apologise..." "OK." "My mother disappeared right in front of me." "Everything she had, everything she was, her dignity, her memory." " In the end, she wasn't even my mother." " Izzie is not your mother." "She doesn't have an untreatable brain condition." "She has a tumour." "And it can be treated." "Don't make this personal." " I wasn't." " You went to lzzie, as her friend, and you made up her mind for her." "As my resident, go back there and change it." "Because this tumour will kill her." "Quick consult, Dr Yang?" "What are you doing?" "The reason I haven't told my mother I'm back is part of me is still there." "I made a commitment to the Army I wasn't able to fulfil." "If my unit hadn't been destroyed, I'd be there." "No wonder I can't sleep at night, or look my mother in the eye." "You and I can't move forward." "My work there isn't done." "And until it is, I have no business being here." "So..." "I've decided to go back." "I have to go." " Cristina, come on." " What?" "What am I supposed to say?" " I could use your support." " You don't have it." "Dr Torres?" "Dr O'Malley?" "I just wanted to apologise." " It's OK." " You don't have to." "I do. 'Cause you were trying to do your job in there, your job is to put people back together, not take 'em apart." "I get that." "I know it doesn't make sense to you that I want to go back to a place where people get hurt and die, but we're there because we're trying to help people." "Save people." "The same as you." "It's my job." "It's who I am." "It's..." "If something happened and suddenly you couldn't be a doctor anymore, if someone told you you couldn't do it anymore, wouldn't you wanna do everything you could possibly do to be a doctor again?" "We haven't even been married 24 hours, and we've already had our first fight." "That's a good sign." "Fighting leads to good make-up sex." "Are you watching birds fly around my head again?" "Am I, like, totally Snow White right now?" " I just don't want to hurt him." " He'll come around." "It might take a while, but once that tumour disappears, once you're back at work cutting open other people, he'll come around." "Is it hummingbirds at least?" "I really like hummingbirds." " We need to go talk to lzzie." " We are not talking lzzie into having surgery because your future husband is mad at you." "He has a right to be mad." "We didn't talk lzzie out of the surgery as doctors," " we did it as her friends." " Our job as doctors is to present the options, answer questions and let the patient decide the course of treatment." " That's what we did." " Right." "Except I may have presented her options as, "You're having this surgery over my dead body."" "He has a right to be mad." " Crap." " Who is it?" "Come on." " Izzie, what?" " What happened?" " I don't know." "Where's Swender!" " Izzie, let me take over." "Yeah, lzzie, come sit down." " The vessels and nerves are separated." " Skin flap is done." "Remind me again why I'm doing this." "Someone remind me again." "You don't know what's gonna happen to this kid, how many fights he could win, how many lives he could save." "If you don't do this, he's never gonna get the chance." "We're not doing harm." "We're not hurting him." "We're saving him." "We're doing what he wants." "It's what he wants." " BP's still dropping." " We need more blood." " We need to move faster." " OK, I'm done." "I'm at the end." " I didn't see any bowel perforation." " It's there somewhere." "Run it again." " Dr..." " Run it again." "Yes, ma'am." "So much for IL2." "You think this is my fault?" " You think I did this to her?" " No, ma'am." "There is no cure for cancer, Dr Yang." "There's only us, the two of us, right here, fighting this thing as aggressively as we know how." "And sometimes that means pumping toxins into the patient to kill the cancer." "And, yes, sometimes, not very often, those toxins kill the patient as well." "But Alison had three months to live when she first came to see me, and I have managed to keep her alive for two years." "So I am not about to give up on her, or the IL2, anytime soon, and neither are you." "I wasn't asking you to see the condo." "I was asking you to move in with me." "If that's what you want." " I do." " You do?" " Yeah." "Not right away." " No, of course not." "In like a year." "I'm sorry, what, now?" " Ten years." "Well, because I'll still be a resident for, like, six more years, and then I'd want to get my practice up and running, so..." " How about seven?" " How about five years?" " I'll still be a resident." " So?" "Stevens and Karev are residents." "Meredith's a resident." "Bailey's a resident." "All married, or soon to be." "And happily." "Or whatever." "I'm sorry, are you asking me to marry you?" "No!" "Why?" "Would you?" " Should we be having this conversation?" " Probably not." "OK..." " Impressive work today, Dr Bailey." " Thank you, sir." "It was fun." "Yeah, it was, wasn't it?" " Sounds like you guys had a good day." " How'd the neuroblastoma kid do?" "He was awesome." "The surgery was easy, he's gonna make a full recovery." "That's kinda why I wanted you there." "Because the kids you can save almost make up for the ones you can't." "Anyways, I'm gonna go monitor him at post-op, and then I'll tell his family the good news." "Stop by, come see the joy." "OK." "We had to resect part of her bowel." "Unfortunately, we weren't able to finish the surgery because she was too unstable." "Right now, she's on a ventilator because she can't breathe on her own." "But you'll be able to finish the surgery, right?" "Yes, if she stabilises." "And then she'll be able to breathe on her own again?" "Your daughter's heart stopped during the surgery, which means her brain wasn't getting oxygen." "So it's unlikely she'll be able to come off a ventilator." "Izzie?" "Lzzie." "Izzie." " You're paging me." "Are you OK?" " No." "I don't know what to do." "I don't know if I should have the surgery." "I'm gonna die either way." "You gotta tell me what to do." " You know what to do." " No, I don't." " I don't." " Yes, you do." "You're just scared to do it." "All this back and forth, it's just fear." "But... you've already made the decision." "You made it." "You made it the second you decided to fight this thing." "Just look..." "look where you started." "Look where you are now." "I mean, now you're this incredible surgeon and teacher." "You're a doer, remember?" "You know exactly what you have to do." "Come in." "You can do it." "You can cut into my brain again." "OK." "You can do it, but I don't want to end up a vegetable." " Izzie, you won't..." " No, just listen." "I want the surgery right now." "But, if something goes wrong," "I don't want to end up on a ventilator." "So I'm signing a DNR." " Please." " Alex..." "You went crazy." "When Denny signed that DNR, you went crazy." "That what you want?" "You want me cutting LVADs?" "You want to wreck my career?" "'Cause I will." "I will freakin' cut LVADs before I let you just..." "Wait!" "Stop!" "You don't get to quit." "You don't get to quit on me." "Please." "Tear it up." "The DNR." "Tear it up!" "Where your eyes are supposed to be right now," "I see white, sandy beaches." "And there's an ocean behind your head and ghosts wandering in and out." "I can't live like this." "And I can't live..." "If something goes wrong in that surgery, I don't want any extraordinary measures taken to keep me alive." "It's not what I want." "I went crazy when Denny signed the DNR because I didn't understand." "I didn't understand, but now I do." "And I need you to understand." "I don't want you to go crazy." "I want you to have a brilliant career." "And I hope I get to be here for it." "But if I can't," "I just want to go to the other side." "I don't know what's there, but it's gotta be better than hospital beds and tubes down my throat." "So please." "Please don't cut LVADs." "Just if it comes down to it, just let me go." "And right now, kiss me." "Please just kiss me and close your eyes, because the beach is so distracting." "I always thought it would be me." "I'd get Alzheimer's, like my mother, and forget everyone." "Let's go to city hall tomorrow." "I don't want to spend another day not being married to you." "OK." "It doesn't matter how good you are." "Or how hard you work." "You can do all the research, you can master all the latest techniques," "I mean, you can be the best... you can be the best surgeon in the world but your patients are still gonna die." "Because the next day or the next month or the next year, you know, they're just gonna get hit by a car or find a mole on their back." "And there's nothing you can do about it." "I don't want you to die." "You OK?" "I cut off a healthy leg." "I just cut it off." "It was for the patient's own good." "But still I feel like a butcher." "My miracle case is on life support." "I thought I had one." "One miracle." "I hate this job sometimes." "I don't know why we do this." "Come on." "Come with me." "OK." "What are we doing here?" "We came to see that." " What?" " The joy." "It comes around rarely." "So rarely, we forget it can happen." "But that..." "That's why we do this." "The joy." "We spend our whole lives worrying about the future, planning for the future, trying to predict the future." "Will you come with me?" "As if figuring it out will somehow cushion the blow." "But the future is always changing." "We've got one more." "He's a doctor." "He says he needs to do it today." "Come in." "The future is the home of our deepest fears..." "Owen?" "Hey, Mom." "I'm home." "... and our wildest hopes." "But one thing is certain:" "When it finally reveals itself..." "Congratulations, doctor." "Welcome to the Army." " ... the future..." " Thank you." "... is never the way we imagined it."