"When my mother's Alzheimer's got bad," "I was going through her bills, and I found a notepad." "Written on it were the words" ""Important... tell Meredith not to..."" "And that was it." "She never finished that sentence." "Tell Meredith not to what?" "Not to drink too much?" "Not to pet strange dogs?" "Not to give her heart away?" "Not to leave the sprinklers on?" "We didn't exactly talk a lot in those days." "I regret that." "I wish we had." "I thought you said you and Dr. Cohen" " had clean margins in the mastectomy." " Yeah, we did." "But then, a spot showed up on the latest scans alongside the chest wall here." " So you didn't." " It could be nothing." "Or it could be leftover cells that weren't taken out and kept growing." " Maggie!" " I'm sorry." "I..." "Keep going." "We don't know what it is, really, until we get in there." "Yeah, I'll do a wide local excision, explore the area, remove anything I find." "We may need to do a muscle flap just to cover the defect, but simple." "Tomorrow." "No, we're thinking next week." "No, it has to be tomorrow," "The next day at the latest." "We should let her get stronger first." "She is strong." "And we don't want it to spread past what it already has." "Of course we don't, but it's a big surgery, so..." "Yeah, I can handle it." "I'm fine." "I want the next surgery as soon as you can do it." "How'd it go?" "Oh." "Thank you." "Okay, I think." "Her radiation caused some fibrosis, which made things a little tricky." "I would've preferred to have waited another week." "I wanted to wait two." "Hmm." "I'm sorry." "I haven't followed up on the... the thing." "Dinner?" "It's not because I don't want to." "It's just that I..." "Sure, I mean, you know, if..." "There's a lot going on." "There is a lot going on." "It'll happen... sometime." "Sometime." "I better get in there." " Boo." " Oh!" "God." "You can't sleep?" "Wide awake, all hours." "This chair's the only place my stomach and back can get comfortable, so..." "What are you doing up?" "I have three kids." "I don't sleep." "Motherhood." "I always wanted more kids so Maggie could have a sister or a brother." "I was worried when she wanted to move out here." "She was happy in Boston, but..." "I'm really glad she found you." "You said your stomach is bothering you?" "Damn it." "Richard?" "What are you gonna say?" "You're sure it's a met?" "It's right where the bile drains from your liver, so that would explain your pain." "You're saying I have another tumor?" "No." "No, she's saying that cells from the original tumor have traveled and grown in another place." "In my liver?" " Yes." " Maybe." "So, I know this is a lot to take in." "So why don't the two of you, um, take the night, and we can meet again in the morning and discuss it further, okay?" "We're here now." "But I just meant that..." "Can you remove it laparoscopically?" " What?" " Well, that would be better than an open procedure at this point, right?" "Then we wouldn't have to stop her chemo regimen, unless you have a different surgical plan." "Would you like to discuss this outside?" "No, no." "We're discussing my mother's treatment." " We can discuss it with her." " Okay." "Diane, typically with aggressive cancers, we only operate where the original tumor began... in this case, it was your breast." "Unless the cancer spreads beyond that, surgery is not curative." "But it could prevent further pain and complications, which there will be if the met keeps growing or spreads even further." "And we would work to prevent that using other options." "Sure, pump her with more chemo." "Well, a second ago, you were worried about stopping her chemo." "Just take out the met!" "You're asking me to perform a procedure..." "You can barely see it on the scan." "...that will not only cause her pain, but put her at risk" " It's my mother!" " for many complications." "I'm asking you to think beyond the standard and typical." "And I'm asking you to listen to yourself as a surgeon," " who should know better..." " Oh, good God, enough!" "Both of you..." "I can't even hear myself think." "Mama, we just... we need one..." "Are you saying that you can't do the surgery" " to remove the, um..." " The met." "Can you do it?" "I can, but I'm saying that I won't because, in my professional opinion," "I think it's a terrible idea." "Meredith, if you won't do the surgery, you should go." "We'll find another surgeon who will." " No, it's not..." " No." "Maggie, this is not your decision to make." "Meredith, dear..." "I'm firing you." "You're no longer one of my doctors." "Thank you for meeting with me this morning." "I found something that..." "it is called the BXP protocol, and it started at Gillman." "They are experimenting with humanized antibodies for late-stage cancer immunotherapy." "A clinical trial." "And it's successful?" "The trial's next phase was rushed into approval due to favorable outcomes." "And your mom meets the criteria?" "Once we remove that met that's obstructing her bile duct, her liver enzymes will go down, and she's in." "Um, Meredith doesn't feel that surgery is wise." "Meredith is no longer on the case." "And now that I know about this trial, there is even more reason to do the surgery." "And I'd like one of you to do it." "Oh." "Um..." "You know, um," "I think we should read up on the trial..." "Mm-hmm." "...and then come up with a plan." "Yeah." "Does that sound good to you?" "Yeah." "Yeah, thanks." "Does anyone think this is a good idea?" " No." " Not at all." "All right, so we're together on that." "So, I'll bring up, uh, Diane's chart." "We'll pull together some other research and get together, see what we can come up with, huh?" "You know what?" "I'd prefer to work alone." "Me, too." "No, no, no, no, guys, that's not a good idea." "Great." "A biliary bypass wouldn't work, given the location and size of the met." "Are you actually going to resect it?" "The met?" "I'm not going near that thing." "No one would." "Right now, I'm just trying to figure out how to lower her LFTs to get her into this trial." "Did you consider stenting her?" "Mm, that's still surgery." "I mean, with her condition..." "But if it's done percutaneously, under minimal sedation..." "Yeah, it could give her long-term relief, hopefully avoiding re-intervention." "And get her LFTs down." "I like it." "Well, it's better than a complete bypass." "That's true." "Okay, good." "I was never here." "How are her LFTs post-op?" "Any change?" "Well, the procedure worked." "I relieved the obstruction 100%." " And her LFTs are trending down, yes." " Mm-hmm." "So she'll qualify for the trial." "Yes, she qualifies for the trial." "Really?" "!" "Oh, my God." "That is amazing news!" "Ah!" "Thank you, Dr. Bailey, for doing the procedure!" "Oh!" "I gotta call my contacts at Gillman." "I..." "I got to go." "All right, thank you." " Damn it." " Yep." "No one wanted to mention that we think that the trial is a completely terrible idea." "You need to sit her down and let her know what's going on." " Me?" "I'm not doing that!" " You're her friend." "Who kept her mom's cancer a secret from her." "No, you're her dad." "You do it." "You're Diane's surgeon." " So was Avery." " Oh, come on." "You led the procedure that brought her LFTs down and got her the trial in the first place." "A trial I never believed in." "Yeah, well, you're the chief." "Well, who's head of the board?" " Now you care about that?" " Never mind." "I'll do it." "She's in the waiting room." "Don't want to bother you." "Oh, come in." "Come in." "Oh." "Maggie went to get me some tea or something." "Well, that's fine." "You know, I wanted to chat..." "Well?" "...about the clinical trial." "Did I get in?" "Well, yes, y-y-you will, but, listen." " There are some things that..." " Maggie will be so excited." "She..." "She wants to start right away... the, um, the thingy." "The protocol." " Protocol." " Mm-hmm." "Will you be doing the protocol?" "I want to make sure you have the complete picture." "The trial is very aggressive." "That's what we want, right?" "Yes, but, um... the toll it's gonna take on your body... it will be difficult." "Extremely difficult." "I know." "But Maggie says it's a good idea." "Diane, there's a reason we don't let doctors treat members of their own family." "Sometimes, the need to help someone you love can... cloud your judgment." "She wouldn't do anything to make me worse." "She's my daughter." "Here we go." "Hi!" "Oh." "Hi." "What's the matter?" "What's wrong?" "Oh, nothing." "Everything's great, sweetie." "Uh, you know what?" "I'm gonna let you get some rest, and, um, we'll talk tomorrow." "I appreciate that." "See you then." "Okay." " Yeah." " Here you go, Ms. Pierce." "Oh, wha... no need for special treatment." "I..." "I'm happy in the other chemo room, in the regular one." "Right, Mom, it's a clinical trial so, um, they have to be able to control everything in your environment... the room temperature, your temperature... everything." "Oh." "I was going to ask Aurora if Lee finally passed his driver's test." " Who?" " Aurora, my chemo nurse." "Her son Lee has failed it twice, and he was supposed to go to the DMV today." "Oh." "Maggie, you work with these people." "How do you not know this?" "Um." "How we doing in here?" "Oh, been making a fuss." "Um, we will need you to sign these forms." "All of these?" "Yeah, well, the thing with clinical trials is they can list a million ways your body might react, but the truth is they just don't know." "That's why it's a trial." "You need to be prepared for anything." "Y..." "Here." "Let me..." "Let me walk you through this." "Um." "Yeah." "Um, so... so, what this says is you may experience some nausea and vomiting." "There's dehydration, weakness, dizziness." "There's fatigue night sweats, and chills skin irritation... wound infections extreme fluid buildup." "In short, it will get bad then really bad." "And then, if it starts to work, hopefully you'll start to get a little better." "This treatment is killing her faster than the cancer." "That's what Diane wants." "You mean what Maggie wants." "Mom?" "Why aren't you resting?" "Oh, I woke up hours ago feeling great." "I'll get that for you." "So, I watched the news, did a little laundry." "Then I noticed that the pantry was a little cluttered, so I reorganized it." "Mom, you don't have to do that!" "Well, I did." "And you got up at the perfect time." "It's lasagna time." "Lasagna?" "You're going to make my lasagna." "Oh, no, Mom." "I-I don't..." "I..." "That's your thing." "I don't know how to make it." "Well, you need to learn." "No." "Stop it." "I don't want you passing things down." "That's not..." "I-I don't like that." "Oh, that's not why." "It's just that I have decided I don't have to do this anymore." "I am a woman of a certain age, and I have earned the right to sit down, put my feet up, and let you cook for me." "Mom." "And you're not gonna like it when I'm gone and you're missing my lasagna." "Invite your friends." "It'll be fun." "Okay, I just need to go, um, take a shower." "Unh-unh, I don't think so." "Grab that flour." "We're doing this now?" "Okay." "It's awesome." "Hi!" "Why are you all here at once?" " Hi!" " Uh, we... we carpooled." "We thought it'd be fun." "Yeah, Webber drove us." "And we have wine." "You guys, she made me make the noodles from scratch." "You know you can buy noodles in a box, right?" "Wait, hold on." "You were 2?" "2 years old." "And when I say she was reading, it was reading." "Maggie was not sounding out words or anything." "Okay, Mom." "And you didn't teach her?" "Oh, nobody could teach her." "My baby was a genius." "That brain of hers..." "Okay." "That's..." "Thanks, Mom." "I have you to thank for that, I guess." "Well I don't know about that." "Oh, and your mother." "I'd like to pay my respects to Ellis." "I'm here, I'm staying in her house, and it's the right thing to do." "That's very nice, but you don't need to do that." "Oh, but I want to." "Where is she buried?" "Um..." " A place where she loved..." " We dumped her ashes down a scrub sink in OR 2." "...by the water." "Oh, my God!" "Well, it was her favorite OR, and it seemed like the right thing at the time." "We're terrible people." "I love it!" "I love it!" "There you go." "Oh, no." "That's okay." "That's okay." "It's okay." "It's okay." "It's okay, Mom." "Okay." " I just heard... an esophageal tear?" " Yeah." "Hopefully, it's contained and I don't have to open her chest." "What are you doing?" "I should do the EGD." "You're too close." "Go take care of Maggie." "Let me do this for you." "Don't pretend you're doing this for me." "You've made it very clear for some time that my well-being is the lowest of your priorities." "Do..." "Hey, I'm just trying to help." "If I needed help... you'd be the last person I'd call." "You had to do a thoracotomy?" "Yeah." "The tear was full thickness." "Conservative management wasn't the way to go here, Maggie." "No, you're right." "Thank you." "So, we'll start her on tube feeds?" "Um, we're... we're..." "we're not there yet." "Uh." "She's on TPN for now, and I'm also concerned about sepsis, so we've started her on broad-spectrum antibiotics." "She's still sedated for the pain, and we'll keep her on PCA." "Hey, keep her comfortable." "Do you need anything from home?" "Do you want us to get you anything?" "We need to get her on her feet ASAP." "If she misses any of her infusions, she'll lose her position in the study." " Maggie..." " I'd like for us to get Diane through the next 24 hours, okay?" "And then, we'll... we'll see where we are from there." "Maggie." "I really don't need you trying to talk me out of anything right now." "This protocol is making Diane so sick that her esophagus tore." "That could just be from the cancer." "But you can't wait to get her to her next infusion." "Because my mom wants to live!" "And this clinical trial could give that to her." "She wanted to do it." " She could've said "no."" " How?" "How can she say "no" when her daughter, who is a surgeon, is standing right there, pushing it on her?" "There have been favorable outcomes!" "I just need to get her to the end of the treatment." "She won't make it to the end of the treatment." "She's already dying, and now she's suffering because of it." "At least I'm doing something." "At least I'm not just giving up and saying "no."" "We are only doing her harm." "You don't get it!" "You wouldn't!" "Meredith, I love my mother enough not to say, "Screw it,"" "and throw her down a damn drain." "What do you need?" "What can I do?" "Where's Maggie?" "Diane... you don't have to keep putting yourself through this." "Not if you don't want to." "I was born in a two-room shack with an outhouse, six brothers, not a lot of food or love or... anything." "Getting out of there was..." "When that social worker put this little baby in my arms, when I looked down at my Maggie..." "Maggie is the universe giving me a gift." "She is... a happy person." "She's cheerful." "Maggie is rare." "She's special." "This..." "This will give her darkness." "How could I do that to the most special person in the whole world?" "When I die, she needs to know that she did everything that she could." "Diane, she has." "Maggie's done everything there is to do." "I can't stop." "I-I can't do that to her." "Well, she can take it." "You may not see it, because you knew her since she was a little girl." "I mean, I didn't." "I only know the woman you raised." "And that woman is smart and strong as iron, especially for the people she loves." "Now well, now I see where she gets it." "I don't want to die." "Hey." "So, I'm gonna put out a couple of calls to some old professors from Boston." "Do you remember Dr. Luckett?" "He specializes in radioactive..." "Maggie..." "Don't you dare quit on me now." "Y-You can't." "You can't quit on me." "We can beat this." "You have to fight." "I'll help you." "Sweetie..." "Sit down and let me talk to you." "Get those to the lab for me." "Thank you." "You all right?" "No." "Do you want to sit down?" "No." "I just wish my dad was here." "Maggie?" "Meredith doesn't get it." "She's just worried about you." "I just got started." "My mom has been sick for months without me knowing... months." "I feel like I left the house with the oven on and went about my business and came back to find the whole house engulfed in flames." "And no one will let me in." " No matter what I do, I can't get inside." "I can't save anything." "I could've stopped it if I had known." "S-So, I can't give up." "I can't give up, not now." " Hey." " What are you doing?" "What?" "Come here." "Thank you." "Mnh." "Thank you." "She's gonna go... and I'm not ready." "I'm not ready." "You're never ready." "You just do it." "Listen to her." "Talk about whatever she wants to talk about and record her voice in your mind and memorize everything." "And just keep sitting there." "♪ My own true love" " Orgasms." " No." "It's not a dirty word." "No, no!" "I'm dying." "I have to impart wisdom." "This wisdom, right now?" "You have got time." "You don't have to go there right now." "Mm." "I've had orgasms." "Oh, well, good." "They're not a gift." "It's your right." "Don't let anyone tell you otherwise." " And this is important." " Mm-hmm." "At least once a day." "Sometimes, I like to wait until right before bedtime, but..." "No, God!" "No, Mom!" "Stop." "You are too intense." "Have some fun." "I have plenty of fun." "Which color?" "The darker." "Oh, did you call about my eyelashes?" "You know I wanna die with my eyelashes on." "Eyelashes are tomorrow." "Good." "You were always so good." "What do you mean?" "Incredible grades, a clean room, ooh, you never talked back, and you never messed around with the boys." "Most parents would appreciate that." "Oh, I did... then." "But now..." "You need to shake it up a little." "Mm." "Be a little lazy or a little slutty." "Make a mistake." "I have a job." "Well, you're never gonna look back and say," ""I wish I'd been more uptight."" "Okay, Mom, you have to be still, or else I can't finish this." "And stop always saying what everyone wants to hear." "Tell someone off." "It's good for 'em and better for you." "Especially if it's a car salesperson." " Do you like the color?" " I do." "Okay." " And don't forget the t..." " The topcoat, I know." " Want some water?" " Mm." "Mnh." "Mnh." "Mnh." "Mnh." "Want me to keep going?" "I brought my engagement ring to Seattle." "It's at the house in my jewelry bag, and I want you to have it." " Mom." " Your father gave it to me." "He'd want you to have it, too." "So, please." "Okay." "Thank you." "I want you to fall in love." "And it has to be somebody who's worthy." "Find a decent man who loves you just a little more than you love him." "How about equally as much?" "How about that?" "No, he needs to think he is lucky to have you and not the other way around." "Other hand." "Never make yourself small for anyone." "Be your own person." "And try wearing a little lipstick." "You know, Mom, if you keep going at this rate, you're gonna run out of advice before tomorrow." "Mm." "Phew, this polish smells." "Want me to open a window?" "Oh." "That would be nice." "It stopped raining." "Okay, I'm not gonna leave it open too long, or you'll catch a chill." "Typical." "Bring you to a hospital, help you catch a cold." "Mom?" "Mom?" "Mom?" "Mommy." "Listen, I..." "I-I know the flight the helicopter had to be expensive, and so I'll write you a check." "Hey." "No..." "No need." "No." "This is family." " Thank you." " Yeah." "Thank you." "Daddy?" "Daddy." "Hey." " Hey." " ♪ Here comes the spark" "How's Pierce?" "Not great." "Yeah." "I'm sorry to hear about Diane." "She's gonna need me now." "For how long, I don't know." "I know." "Our timing's just... off, I guess." "I think about my mom's note all the time." "Tell Meredith not to..." "Not to cave?" "Not to care?" "Not to give up so easily?" "Not to fall in love?" "Not to have children?" "Not to tell a lie?" "She left me wondering what to do, what not to do." "Damn it." "What?" "She left me knowing everything was up to me." "And me alone." "Ellis never forgave me." "She went to her grave without forgiving me." "It robbed me of so many things... so many things." "Let's not do that to each other." "And she left me with no one to ask." "So I would decide what she meant to write." ""Tell Meredith not to be afraid."" "Goodbye, Mom."