In order to get a good diagnosis...
...doctors have to constantly change their perspective.
We start by getting the patient's point of view...
...though they often don't have a clue what's going on.
So we look at the patient from every possible angle.
We rule things out, we uncover new information,
trying to get to what's actually wrong.
We're asked for second opinions,
hoping we'll see something others might have missed.
For the patient,
a fresh perspective can mean the difference between living and dying.
For the doctor,
it can mean picking a fight with everyone who got there before you.
- Someone's getting fired. - Stop it.
- She wasn't even my patient. - What?
- Nothing. - How long is this gonna take?
Why? You need to make a phone call?
Hey, hey, hey, hey, hey.
- That's enough! - Are you kidding me?
I said enough!
What happened here tonight,
what happened to that patient was inexcusable!
We're gonna be here until I find out who is responsible for it.
So, until then, you'll sit down, you'll shut up and you'll wait to be called.
Hunt.
- I'm not going down for this. - Someone is.
Dr. Hunt, you know Larry Jennings from our board.
- This is our in-house counsel. - We're trying to get in front...
Uh, I need you to give me the lay of the land of your ER tonight.
- From the beginning. - We were slammed with a mass casualty,
a hotel fire. A half-dozen burn victims, a penetrating chest wound,
- a firefighter with multiple traumas. - What doctors were working?
Yang, Grey, Karev, Adamson,
that big kid whose name I don't know, Kepner, Avery and Torres.
Who was on the patient in question, the one who died?
- Everyone. Everyone was everywhere. - All right, who got the chart first?
Dr. Yang.
It wasn't my patient. I had it for two seconds, and then I was called outside.
- Start from the beginning. - I was paged to the ER.
I'm putting myself in a timeout before I kill someone.
Seen Bailey? She was supposed to sign my discharge papers after her appy.
Oh, good. Go home, get better and come back. 'Cause I need you.
- Are the Mercy West people bad? - They're everywhere.
There are more of them than us, and they're kicking our asses.
I miss lzzie. We need more us's, so get back here!
I have to be discharged. Wanna forge Bailey's signature?
No, that will get me fired. Ooh! Ask one of the new ones to do it.
Get them fired.
- Timeout's over. - Well, send Bailey!
Try to keep the burn unit and trauma rooms clear!
Call Respiratory. We need ventilators on standby!
We got a burn victim and her kid. Take your pick. Hey...
- Yang, come with me. - Oh, we can help!
Oh, great. Here, take these.
- I handed it off. - To who? Who did you hand it to?
I have no idea.
- I got her chart. - Yang, come with me.
- We can help. - Great. Here, take these.
Sucks. Yang's turfing us the crap cases
while she runs outside for the good ones.
- Uh, Cathy Becker? - Yes, hi.
And you must be Danny. I'm Dr. Adamson. Can you come this way with me?
- Thanks. Come on. - All right.
We were driving up to Vancouver to visit my husband. He's up there for work.
The rain wouldn't let up, so we thought, "Hey, why don't we stop for the night."
Bet you wish you'd kept driving, huh? Can you lean forward
and take a deep breath?
I'm glad you made it out.
- Thank God we were on the first floor. - I was scared.
- My mom getted burned. - Mommy's all right, baby.
You're safe. Everybody is all right, OK?
Everybody's safe now. Can you say "ah" for me?
- Ah. - Very good.
- See? One for them. - And one for us.
- Stop being so paranoid. - They hate us, April.
Doesn't matter how good we are. We'll fail. They were here first
and they rule the school and they hate us.
I'm not gonna let them turn me into someone they can hate.
- I'm easy to like. - Actually, it takes a while.
- I hated you at first. - Just shut up.
Sorry.
OK, your lungs sound good, your vitals are great.
Um, open up, please?
Oh, my God!
- Charley got a good one. - See? We win.
OK, um...
You look good. Burns on your chest are minor,
but the one on your calf might be third degree, so what I'm gonna do...
Uh, hang on. Dr. Sloan?
I'm gonna have the plastic surgeon take a look, OK?
I just did her initial exam.
She was a burn patient and she wasn't surgical.
There was nothing more for me to do.
- At that point, you went? - I went to go help Dr. Bailey.
Uh! What did I just say?!
I got it!
Dr. Bailey really needed some help.
He fainted.
- He fainted? - He fainted.
- From what? - Better have a brain tumor,
'cause that's unacceptable.
There was a blood drive today.
This place is a freakin' maze.
- I've gotten lost 11 times, no joke. - I lost a patient.
That's bad, dude. How'd he die?
No, I lost her. Parked her in a hallway, went to get her labs,
couldn't find the hallway. No one would help me.
Yeah, don't even ask for help. These Seattle Grace people are kinda douchey.
- Case in point. - Douche.
It's the ER. Mass Casualty.
Hey, I need to, uh...
Emergency! I'm a surgeon! Hello!
Apparently, he grabbed the fire axe out of the case
- and tried to run downstairs with it. - Mom was right.
No running on the stairs.
OK, on my count: One, two, three.
OK, I want a CBC, chem panel and make sure there's an OR ready.
Wait, wait. Just stop.
Uh, I need to see what I'm looking at.
- Do you have steady hands? - Yes, ma'am, in college I...
I don't want your life story. I need both hands on this handle.
Do not push the axe in,
do not pull the axe out,
- do not move, understand? - Yep.
OK...
In retrospect, I should have had a cookie.
- Wha? - Whoa.
Stupid. Stupid, stupid, stupid, stupid.
- Whoa. - What did I just say?!
- I got it! - OK.
Apply pressure. OK, come with me.
Hey, Karev! Clean that up.
- That was the last you saw the patient? - Yes.
- With Dr. Sloan, who treated her burn. - No, he didn't. I treated her burn.
- You did? Where was Sloan? - Uh, Karev! Clean that up.
OK. Ready? One, two, three, four, I declare a thumb war, go!
I'd say this is deep second-degree. Start cleaning while I finish debriding.
- Does it hurt? - A little bit, sweetie, but it's OK.
The doctors are making it all better. Now, you gotta watch or I'll getcha...
Dr. Sloan? Need you.
Finish debriding, cover the wound with silver sulfadiazine,
- then loose gauze, loose, not tight. - I got it.
Evan Lang, 16, second and third degree burns over 60 percent of his body.
Hey, Grey, come when you're done, we need hands!
So Robbins was rushing you? You felt rushed?
No, I didn't rush. I took my time.
- Oh. - Sorry, I know it hurts.
No. No, I'm fine.
I'm just fine.
And then I joined Dr. Sloan and Dr. Robbins.
OK. This is all set.
I'm sorry! Sorry!
- Are you free? I need a hand. - I'll be right there.
It's OK, you're OK. We're gonna examine you
and then we'll get you warmed up again, OK, Evan?
My dad? Where's my dad?
You give me his name and we'll find him, OK?
He's gotta be looking for you, too.
Here. For the smell.
Listen, burns like this are really... difficult.
You don't really...
Want to switch with someone? Karev or somebody?
- You think I can't handle this? - No. No, I...
'Cause I can. I'm good. I'm here.
You stayed with the patient in the trauma room.
I... Yeah, I did.
- And who was with Mrs. Becker? - Reed Adamson.
- OK, this is all set. - No, I was never with Mrs. Becker.
I was with her little boy. I had just finished with him, actually.
I'm sorry! Sorry!
- You free? I need a hand. - I'll be right there.
So, good news, big guy. You are fine.
His pulse-ox looks good, everything looks good.
- He's totally fine. - Thank you.
Uh, hey, can he stay in here with me, just until his dad comes?
No problem. It's a full house anyway.
So I went to help Dr. Torres.
Roy Macinaw, 56-year-old firefighter, fell three stories from a ladder.
Looks like a hip and femur fracture, maybe radius, too. He's waking up.
What happened? I had him... I... I... I got to the window...
Roy, you fell from the ladder. It was a bad fall,
but we'll fix you up. Give him ten of morphine and get him admitted.
Where's the kid? I had him.
- He was going after a kid? - Shepherd!
- Yeah. - He has uneven pupils.
Abdomen's rigid. He's gonna need an ultrasound.
Yeah, he needs a head CT, too.
- Page me. - He needs everything.
Take him now, let's go.
And you left the ER at that point?
I took him to X-ray, yes.
Did you hear Mrs. Becker say anything about pain?
- No. - The nurse did.
He said she was in a lot of pain.
Whose patient is Bed One? Cathy Becker?
- Not mine. - She's complaining of pain.
At this point, who was in charge of Mrs. Becker's care?
- Whose patient was she? - I was never on her.
- I was in the OR with Dr. Bailey. - I'm not... I don't...
- Not mine. - No idea.
- Did you order pain meds? - No, Yang did.
Next time I saw her, she was... she was dying.
When you saw her, she was dying?
No, she wasn't dying. She said she had some pain.
Whose patient is Bed One? Cathy Becker?
- Not mine. - She's complaining of pain.
- Hey, Karev, you got Bed One? - No.
Your initials are on the chart.
- So you checked with Karev? - I tried to. He was on the phone.
I never even seen that patient. I was stitching up Nosedive.
- Nosedive? - What's-his-name. Dude that fainted.
- Dr. Percy. - Nosedive. That's gonna stick.
- So you were with Dr. Percy. - He was supposed to be.
- Karev, you have Bed One? - No.
Your initials are on the chart.
lz, I'm done.
I'm done leaving you messages, I'm done talking to your mom
- who's probably lying to me. - Are you gonna help me with this?
Listen, it's been a week, lz, and I don't know if you're alive or dead.
So if I don't hear from you by tonight,
I am calling the police and reporting you as a missing person.
- So who gave her the morphine? - No idea. I never even saw her!
I ordered it. I did.
Your initials are on the chart.
How long do I have to work here before they insert a bug up my ass?
You guys are all so cranky.
Dr. Avery seemed uncomfortable consulting on a patient that wasn't his,
so I checked with the patient and asked about her pain.
She said it was localized to her chest burns so I checked her chart
for any allergies or drug interactions
and saw she had silver sulfadiazine,
and one gram of cefazolin and 800 of ibuprofen.
- So I ordered two of morphine. - You memorized her chart?
I checked it three times 'cause she wasn't my patient.
So you ordered morphine. Did you follow up?
Uh, no, my patient had come back from CT.
All right, people! Listen up!
The burn unit and the ICU are full. All patients are staying here
- until some beds open up. - Let's keep the trauma rooms clear
- for the burn cases, please. - Head CT was fine,
abdominal scans show liver lac and kidney hematoma.
I'll go check on an OR. Page me when he's stable.
Uh-huh.
That's him.
The kid. The kid in the window.
Is he dying?
I don't know what he's here for.
He's fine, he's being taken care of.
- You saved his life. - Oh, no!
No... I killed him.
Can I ask something?
You say the patient asked for meds for pains in her chest?
- No, on her chest, she had burns. - All right. Thank you, Dr. Yang.
Are you saying she had chest pains? I ordered the wrong medication?
It's hard to say. The next entry on her chart was Dr. Grey
- putting in a chest tube... - Thank you, Dr. Yang.
- Meredith? - No, Lexie.
- I thought Lexie was on the burned kid. - Thank you, Dr. Yang!
I was. I was supposed to be with the burned ki... with Evan Lang.
All right, people! Listen up! The burn unit and the ICU are full.
All patients stay here until some beds open up.
Let's keep the trauma rooms clear for burn cases, please.
- I can't get a pulse on the doppler. - OK.
Evan, I have to do an escharotomy. I have to cut into the burned skin
- to restore circulation to your arm. - Did you find my dad?
I'll ask again in a sec, OK? Push another 25 of fentanyl.
Evan, you're gonna talk to me, all right?
You're in town looking at a college?
I got a scholarship to Cornish.
I'm not sure I can take the rain.
No! No!
I'm sorry, I'm sorry. I know. You're OK, pal. You're gonna be OK.
That's what I thought at first, too. About the rain.
Dr. Grey, you grew up here, right? You get used to the rain...
Lexie!
Dr. Grey, step out. Come back when you've got it together.
Go.
- She can't breathe. - It's OK. I'm OK.
My mom. She can't breathe.
- It was a pneumothorax. - What's that?
Her lung collapsed.
One, two, three.
Danny! Don't let him see me die.
You're not gonna die, I promise.
- One, two, three. - You got the chest tube in?
- No, I was getting there... - Did you go in below
the fifth intercostal? You could have punctured her diaphragm.
- I know, I lost count. - Why?!
...three, four, five...
Did you get the chest tube in?!
I did. I did!
- I just... - She did, she just missed a step.
One, two, three, four...
- Why did you do that?! - I had to. She was running out of time.
Tension pneumothorax. Relieve pressure so she doesn't croak
before you put the chest tube in.
- You want me to do it? - No. I can do it. I got it.
- Three, four, five. - And did she have it?
Yeah, I watched. She was a little distracted, but...
You were distracted?
- What were you? - Dr. Yang was making a toddler cry!
Stop! What the hell are you doing?
Let me just say, for the record, that it was no toddler.
- He was, like, five if he was a day. - Yang...
- You would have yelled at him! - Why was he there?
I don't know how. The patient was coding...
- The patient was coding? - Coags are stable.
Good. OR's ready. Let's take him up. Yang, you're with me.
Torres, Adamson, call you when we're ready for the femur.
Your whole crew's in the waiting room. They'll see you after.
- They're saying you're a hero. - Tell him I'm sorry.
Tell him I'm so sorry.
- Who's he talking about? - The kid in Trauma Two.
- Roy, he's fine. - I almost had him.
I was at the window. I could feel his fingers in my hand.
I went to pull him out and...
I missed the step. One stupid mistake...
- You fell, Roy. It was an accident. - He was burning!
And I...
- V-tach! No pulse! - Start CPR, bag him,
- push one of epi! - Charging to 200!
Or that works, too.
Thanks. Had it.
Stop! What the hell are you doing?
- Who was watching that kid? - That's what I said!
- Hey. Who is watching this kid? - I took the kid.
He was with me.
But I can't watch him, I'm supposed to be in Trauma Two.
All right, I got him. I'll take him.
Come on.
- You left his mother alone. - She was stable.
- I was supposed to be with the boy. - His mother had a collapsed lung.
Not that boy, I was supposed to be with the other boy.
Want something to eat for dinner?
- What the hell are you doing? - I have to sit with him
until his dad comes. I left him alone and...
You left him! Come here.
Hey, can you sit with him until his dad comes? Thanks.
You left him alone. When were you planning to?
- I'm sorry, I feel like... - No. You don't get to feel anything!
Because he's feeling everything! His every nerve is exposed and raw
and we have to make him feel worse before he feels better.
So if you're having feelings, you shut them down.
You shut them down and talk to him about his future
and remind him that he has one, past all his pain. And if you can't do that,
if you can't do your job, then find someone who can and send them to me.
Did you see Mrs. Becker again?
No.
Did you see Karev perform a cricothyrotomy?
- I wasn't there. - I was right there. I saw it.
...then find someone who can and send them to me.
Have you seen Karev? He didn't finish my stitches.
No, I don't...
Doctor?! She's not breathing.
Move. Get me a seven-ET tube.
Aah! Crap. She's completely closed off.
- I can't see her cords. - You can't intubate a patient?
Of course I can. I just... I was having trouble.
Her airway was closed off. I couldn't tube her either.
What's going on?
There's too much swelling in the airway. Get me a smaller tube, a 6-0.
6-0, here you go.
- Damn it! - Move!
- Did Karev try to intubate? - First Charles tried to tube her,
then Reed came to help, then Karev performed the crike.
- I thought you didn't see it. - I did.
And you didn't try and help?
Too much swelling in the airway. Get me a smaller tube, a 6-0!
6-0, here you go.
Move! She needs a crike!
My patient needed me.
OK. Here's the thing about the rain.
It usually just drizzles. It's not like tonight.
But when it stops,
everything is super green and it's beautiful
and it smells like trees. You know that smell?
Dr. Karev seemed to have it under control.
- Karev seemed totally out of control. - Move! She needs a crike.
- Give me an Ambu bag. - He was pale, shaky.
Just really unsteady.
She's got no landmarks. I was hoping that...
What are you? You're going in blind?
Hit the carotid. Hit the carotid.
He kept saying something about hitting her carotid.
Did you give blood today, Dr. Karev?
What?
You've been described as looking pale, shaky and unsteady.
We already had one doctor pass out after giving blood. I'm asking...
We all give blood. Avery gave blood, Yang gave blood, Grey gave blood.
I give blood every two months. Because some dumbass didn't eat a cookie...
I'm asking if you gave blood today, Dr. Karev.
No.
And you haven't heard from her since then?
You'll tell me if she calls?
Right.
I know, Robbie.
- Thanks. - Don't even ask for help.
These Seattle Grace people are kinda douchey.
- Case in point. - Douche.
Wait, wait. Don't stick me. I gotta go.
Sorry.
- So what was the problem? - There was no problem.
There was a problem. I came back from seeing the firefighter up to surgery.
Hey, my guys would like to line the hall for Roy
when he comes out of surgery, make a show of support.
- He's 35 years on the job, so... - That's great.
Excuse me.
And there was a problem and Charles waved me over to help.
I wasn't waving at Reed, I was waving at Karev.
- But he wouldn't get off the phone! - He what?
Crap, she's closed off. I can't see her cords.
...so we can talk.
- I hung up the phone. - What the hell was so important?
I hung up the phone, I came over and I criked her.
After a doctor got there first. A patient was dying.
Look, I hung up the phone!
Ow! Yeah, that's good and tight, there.
Ow!
Hello? Lzzie?
Lz.
Uh...
Hello, lz?
- Hey! - Where are you? Are you OK?
- I know, your mom said she didn't... - You left him alone!
- When were you planning? - Sorry. I feel like...
I'm asking you to wait, please. No, I got... Just wait!
Lz. Just come home and we can talk about it.
Move. Get me a seven-ET tube.
What does that mean?
- Coming through. - You're not coming back yet?
Or you're not coming back?
Just... Wait, wait.
What's going on?
Lz, just give me a number.
Give me a number and I'll call you back. Give me a number so...
I have to... Just give me a number!
Give me a smaller tube, a 6-0.
I... wait.
- Izzie, just... - Damn it.
- Move! She needs a crike. - Ambu bag.
She's got no landmarks, I was hoping...
What are you? You're going in blind?
Don't hit the carotid, don't hit the carotid,
don't hit the carotid.
Got it. Start ventilating.
I got there in time. I did the crike.
I got off the phone.
- I stayed with her after that. - You had her under control.
It was a good crike.
She was stable. Then, out of nowhere, we started to lose her.
She's got pulmonary edema. Switch to jet ventilation.
Get a CBC, lytes, ABG. Just shotgun her, get everything.
She had ARDS, BP was dropping, we started fluids.
- She was sinking fast. - Trauma One's clear. Move her.
- What happened? Why is she? - I don't know!
Hey! Can you give me a hand?
Somebody page Hunt and get me those labs!
I got her labs. I was shocked.
You're AK, right? April Kepner?
Uh... No, no. This is Alex Karev.
Wait a second... What the hell?
Her carbon monoxide level was 28 and she was spiraling down.
BP's 69 over 32. Pulse is 158.
We're already filling her with fluids. Yeah.
She was acidotic. We pushed bicarb.
They needed more hands.
Keep her on 100 percent oxygen. No, do not,
not until she's more stable. Cristina, scrub out, go see if you can help. Go!
There was so much swelling, we couldn't find good veins,
we had to start a central line.
We can't use a hyperbaric chamber until she's stable.
Her CK level is over 75,000. She's got fulminant rhabdo.
The kidneys, liver, lungs.
- Her chart was like a phone book now. - She's in SVT. Push 6 of adenosine.
Systolic's in the 70s. Start dopamine, 5 mikes.
She was coding when I got there.
What the hell?!
- She's in V-fib! - OK, starting manual ventilation.
Charging to 200.
Clear!
Three hundred!
Clear!
Oh, there's blood... Wait!
She started bleeding out.
She's got blood in her crike tube. She's got blood in the tube!
Oh, my God.
I know what happened.
I know why she died.
- No, it's fine! - Get an amp of bicarb.
- Push one of epi. - What about calcium?
Get two more units... Bring some FFP.
Where's all this blood coming from?
DIC. Organs are shutting down.
- No, no! - She's bleeding out!
Just stop!
Stop! Everybody, stop! It's over! You've lost her.
Somebody call it.
Well, whose patient is she?
Whose patient is this?
I'm sorry. I am so, so sorry.
Dr. Kepner?
What did you tell them? What did you say?
I don't know you.
But Dr. Adamson just spent 20 minutes in that chair
telling me what an excellent doctor you are.
Your school records, your evaluations from Mercy West,
all say the same thing. And I believe it.
I believe you're good.
- Dr. Webber, I don't... - So you should be able to tell me
what would have caused Cathy Becker to bleed out
and die from multi-system organ failure.
She had DIC. Burns can cause massive tissue injury.
The burn was cleaned and dressed.
There must have been more damage. She had a collapsed lung.
That's right.
She needed a chest tube.
But why would her lungs have failed?
She went into respiratory distress. They said they criked her.
I wasn't there for this.
Why would she need a crike? Why not intubate?
Her airway was too swollen.
What would cause that kind of inflammation in her throat?
Soot? Smoke inhalation?
How did Mrs. Becker's throat look?
She wasn't hoarse. She wasn't coughing...
- How did it look? - Her breath sounds were good, she...
What I'm asking you...
...what it looked like.
OK, your lungs sound good and your vitals are great.
- Open up, please? - Oh, my God!
OK, um... You look good. These burns on your chest are pretty minor,
but the one on your calf might be third degree.
You never looked.
You didn't look in her throat,
because if you had, you would have seen soot
and you would have intubated immediately.
And none of this would have happened.
- That's... It... I got distracted... - I know.
- It was insane. - I know.
It was a simple mistake.
And the circumstances you were under...
I'm sorry, Dr. Kepner.
- I missed one step. I... - No.
And look what it's led to.
- She's bleeding out. - Just stop. Stop! Everybody, stop!
It's over. You've lost her.
Well, whose patient is she?
Whose patient is this?
Time of death is 12:45am.
You're fired.
Oh, my God, Danny! Oh, my God.
Oh.
You're OK.
Where's Mommy, pal? Let's go find Mommy. Huh?
When we're headed toward an outcome that's too horrible to face...
...that's when we go looking for a second opinion.
It's not the doctors, Richard.
They're all good doctors.
I know that.
What do you think this was for?
For Jennings, it was about legal, but this was for me.
I needed to know who finally was responsible.
At least I was able to do that.
- Say it, Derek. - Maybe it's not one doctor.
Maybe it's too many doctors,
who don't know each other and who don't trust each other.
When I got to that room, it was chaos.
Because that's the system now. Chaos.
That has been the system that has been in place since this merger.
Your system.
I'm saying you should look again at who's responsible.
And sometimes...
...the answer we get just confirms our worst fears.
But sometimes...
...it can shed new light on the problem.
Make you see it in a whole new way.
Is she gone? Did she leave?
She was good. She was a better doctor than I am.
Just please shut up.
- Hey. You talk to April? - No, I haven't.
What?
I'm just waiting to see if you're gonna try to hit me again.
- I'm sorry. I was just... - Forget it. Rough night, right?
So April missed the airway? That's so stupid.
- "Airway first." - That's med school 101, right?
It's pretty basic.
It was one second! She got distracted and she made a mistake.
- That we all nearly got fired for. - Nosedive's got a point.
- Thank you... What? - We nearly got fired
for trying to fix what she screwed up in the first place.
Because that's our job!
You didn't make any mistakes today?
You've been distracted for the week. Who knows what you screwed up.
But our patients didn't die, that's why we didn't get caught.
It could have happened to any one of us.
After all the opinions have been heard...
...and every point of view has been considered...
Here she comes.
...you finally find...
...what you were after. - April.
The truth.
But the truth isn't where it ends.
Thank God. I was beginning to think you went home and left me here to rot.
- Go home. - That's it?
- Ready to go? - Very.
I've been waiting for Bailey all night.
That's just where you begin again.
- You OK? - Yeah.
Let's go home.
What happened today?
With a whole new set of questions.