The skin is the largest organ in the body.
It protects us, holds us together,
literally lets us know what we are feeling.
Reaction, observation, communication. Any questions so far?
We're doing this because Chief Shepherd suggests
we brush up on our patient sensitivity skills, that's why.
And it just so happens this morning was a very good time.
Besides, half of you were raised by wolves.
"Reaction."
"Keep your face impassive."
Whether prompted by a patient's appearance or lab results,
facial expressions of surprise, concern, disgust, etc.,
can be counterproductive.
Uh, la la la la la...
Jokes.
Don't make jokes about patients.
"Not in front of them, not even in private."
- Yang. - What if the joke is really funny?
It's not. Neither was that one. Moving on.
We assess quickly in the ER, and go to Radiology.
What if he has to be admitted? Can we get to the surgical elevator?
- What about the freight elevator? - Richard, are we set up for this?
I mean, our tables... Do we have enough?
Is our equipment gonna be strong enough?
They're five minutes out. We'll have to figure it out as we go.
The skin can be soft and vulnerable,
highly sensitive.
Easy to break.
Is that Gary Clark?
He's filed a wrongful death suit in his wife's case.
- I'm being deposed today. - Chief Shepherd? Hi.
Whatever you're selling, leave the samples in my office.
I'm not a drug rep. I'm your lawyer.
- Lauren Turner. - Go. Don't worry. I got this.
OK. Thank you. Dr. Shepherd, Lauren. Follow me, please.
"Observation."
OK. "Use reflective listening."
Repeat the patient's feelings back to them.
'I hear that you're concerned about the surgery.
Let me explain the risks."'
"I can see you like vegetables. After surgery, you might become one."
"Communication."
Don't use jargon. Use language that the patient can understand.
- "Be creative in using metaphors." - I'm terrible with metaphors.
- I can never come up with them. - Why?
You're dumb as a box of hammers?
See, that's a good one. You're an ass, but that was a good one.
"Be clear and comprehensive. Explain all risks and probable outcomes,
leaving nothing out." Question. Adamson.
- Why are you going so fast? - It just so happens
that we have an emergent patient arriving
who will need a little extra sensitivity.
So remember to employ
your R, O, C, and you will...
"rock" your patient's world. OK, that's enough of that.
Follow me to the pit.
Hustle!
The skin doesn't matter to a surgeon.
We'll cut right through it, go inside,
find out the secrets underneath.
So did you get lzzie's message? Did you send the divorce papers?
I gotta find them, then I'll send them.
- Izzie sent you divorce papers? - Yeah. So?
Nothing. Just... congratulations.
Or... something. Excuse me.
It takes delicacy and sensitivity.
- What's her problem? - She cares. That's her problem.
She cares about you.
She doesn't. It's not like we're a thing.
Well, you should make it a thing or put a stop to it.
All right, people, remember what you've been taught.
Use it throughout the day. There will be consequences if you don't.
What the hell is it?
Did the circus come to town?
Nope. Just the elephant.
Avery, you're off the case. Go.
Damn it.
Consequences.
We're gonna need a bigger hospital.
Coming through!
All right, on three. One, two, go!
Easy. That's it.
Let's get him a chem panel, CBC and LFTs.
- Got it. - Type and cross.
Now does that hurt?
Sweetheart, I can't even feel that.
- Having trouble finding a vein here. - Or anywhere.
I'm using up all your doctors here. Probably somebody dying somewhere?
X-ray.
Now I understand the sensitivity training.
- Yeah, no fat jokes. - Yang, you're off the case.
- I said no fat j... - Goodbye.
Clear.
Um, sir, when did the stomach pains become more acute?
Last couple days, I guess.
It's hard to keep track. I'm a real busy guy.
- I'm here! - Let's roll him.
- Bobby, are you OK? - I'm sorry, you are?
I'm his wife.
- Facial expressions. - Hon, I'm fine.
Melissa worries. She likes to make mountains out of molehills.
And I'm already a mountain.
Man. Tough crowd.
Mr. Corso, we're gonna need to turn you over again.
Whoa, whoa.
Dr. Webber. Look at that.
You poppin' the hood down there?
Facial expressions.
- Dr. Altman. - Dibs!
- Do you need any help today? - I'm free.
Aren't you both on Webber's big emergent patient?
- He got kicked off for making a joke. - She got kicked off, too.
- But for not making a joke, so dibs. - Both of you.
I've got a consult in the pit.
- Jamie Anders? Hi. - Hi.
Dr. Torres.
Oh, wow. What the hell did you do to your knee?
Some jackass mowed me down on my bike and then took off.
Hit and run? That sucks.
OK, this is probably gonna hurt a little,
but I need to get in there and see what's going on, OK?
Go for it.
- No, no! Don't go for it! - Sorry. You OK?
- Wow! This really blows. - That's one messed-up patella.
- Plus, I'm out 20 bucks. - What do you mean?
My friend said there's always an upside to an injury,
and I said she was on crack, and she said, "Watch, the doctor'll be hot."
I said, "The doctor will be old and gnarly."
Now you show up, which means I owe her 20 bucks.
Nancy Temple, 39, complaining of nausea and dizziness since waking today.
Then she threw up. Twice.
Kelly said I had to go to the doctor.
At school, you have to if you vomit.
Good call, Kelly. Let's have a listen.
- How's her EKG look? - It's coming up right now.
Having any chest pains or numbness in your arms or fingers?
No, not at all. Why?
Nancy, heart attack symptoms show up completely differently in women
than in men. They're often missed.
Sometimes, they just look like stomach problems.
- Are you saying? - You're having a heart attack now.
Let's hang a nitro drip and call the cath lab.
What about my daughter? We're here alone.
We're flying back to Miami tonight. And my husband...
We'll call your husband, let him know what's going on.
Dr. Yang will take care of Kelly until your tests are done.
- No! I mean... - It's patient sensitivity day,
- right, Dr. Yang? - It's not a day.
Take care of Kelly and Avery will page you when we're ready.
- Mommy! - Sweetheart!
- I want to go with her. - I know, I know.
So do I.
How long has he had that infection?
I've never seen it before. Nothing like that.
- What is it? - We don't know yet.
It could be superficial, or it might be something
- worse going on internally. - I'm gonna be fine, baby.
Don't worry.
- Oh! - Karev!
Crap. I thought we'd clear it. Let's take the sides off.
We should put a "wide load" banner on this thing.
We have a gurney right here. Couldn't we move him onto this?
- No, I don't want to have him... - Yeah, I can do it.
No, no, no. Sir, let us move you.
Come on, come on. It's only two steps.
It's either that or you gotta grease me up like a stuck pig.
- Nobody wants that job. - He hasn't walked in a year. Bobby!
OK. Easy, easy.
- I didn't think I could do this! - Oh, my God, baby, you're standing!
You know what this reminds me of?
Our wedding.
Um... Bimalleolar ankle fracture. It was too weak to support his weight.
- He can go to CT now. - He's not going in that CT.
- I think if we can position him... - It's rated for half his weight.
If it breaks, he gets hurt again, it's not available
for the 50 other patients who need it.
What about the zoo? They gotta have a CT for, like, rhinos, right?
Percy, off the case. Goodbye.
That wasn't a joke. That was an actual suggestion.
- Go. - It's a pretty good idea, actually.
- It's a terrible idea. - We will spare this man
the indignity of treating him like a zoo animal.
If we can't get an image, we'll go with clinical labs and tests.
I could do a nuclear stress test on his heart.
I just wish I could get him on a treadmill.
That's not gonna happen.
All right. I have a lawyer waiting for me, I have to go.
I want a meeting with all of you when his studies come back,
before we go any further down this road, OK?
Let's work him up.
So just a couple more questions.
His diabetes, did he have it before he was...
immobilized? No. That's since he put on the weight.
And that's been, um? How long has?
How long has he been like this?
Five years ago, his company laid off 300 employees.
He tried to find work for two years. No one was hiring.
And then he stopped trying.
It was real hard on him. And food, well, food made him feel better. So...
I think he's been in pain for a while.
He'd tell me it's indigestion, but I couldn't ignore it.
- After the news, I just had to call. - The news?
Well, we're gonna have a baby. I'm pregnant.
How?
I mean... Wow! Congratulations!
That is... That's joyous news.
You're off the case.
- Hi. - Hey.
- Your deposition's today? - Yeah. Let me ask you something.
Teddy and Owen, can they work together?
- What do you mean? - Nothing. I was just surprised
he didn't go to bat for her getting the job. It was like he wanted her to go.
- Really? - I gotta go.
Good luck.
Hey, what are you doing?
- Um... Bobby Corso's labs. - Still on Fatty Fatty Two By Four?
- No fair. - Uh, name calling...
- Who's this? - My patient's kid.
The social worker won't return my page.
- That's not very social. - Where's Callie?
She's been whining for a kid.
Cristina?
What?
Um... Er, never mind.
They have no case. Gary Clark is grieving.
You can do me one favor in there.
Try not to refer to her as "Mrs. Clark" or "she."
Don't use pronouns, just stick to "the patient."
- It keeps it less emotional. - OK.
- So why is he here? - Sorry?
Gary Clark. He shouldn't be here for this. He doesn't need to hear this.
He's the plaintiff, it's his prerogative. Don't let it bother you.
I'm more worried it's gonna bother him.
Sorry. I have to go.
Hey. Is the meeting with Shepherd in the conference room?
Mm-hm.
Thank you.
My contract came in, and
Cristina told me you put in a good word.
So... thanks.
Of course.
- What? - Nothing.
What are we looking at?
The patient's got a severe deep tissue infection under his belly.
There's a significant abscess. Hunt and I need to get in there and debride,
- clear out the infected fat. - Sudden fat loss is dangerous.
It's preferable to him dying of an infection. It's a risky surgery, yes.
Have Bailey and Webber on standby
- in case he goes south. - What is the surgical risk calculation
- on a patient like this? - Almost too high to calculate.
Five times the risk of heart attack, respiratory failure,
- airway complications. - He's diabetic,
- there's risk of a ketoacidotic coma. - High risk of pulmonary embolism.
Believe it or not, he's malnourished,
which leads to slow healing, renal failure...
Nerve damage, post-op infection.
I'm saying no. The risk is too high. That's all. Thank you, but that's it.
You're saying we send him away to die?
We send him to a bariatric center prepared for a patient like this,
instead of us spending our time and resources caring for someone
who obviously doesn't care for himself.
Derek, he's me.
Just swap out the booze for the food.
You don't think I care about myself?
He has an illness that he cannot control, he needs help.
- I'm sorry. I... - That wasn't you in there.
And that wasn't about Bobby Corso. It was about Gary Clark.
You're seeing potential lawsuits where you used to see patients.
It's the job, Derek. The job can change your priorities.
- Excuse me, Shepherd? - Derek, don't let it.
Tell Sloan to go ahead and open him up.
Yes?
The conversation we had about Altman, did you share that with anyone?
- I... - Did you share that with your wife?
Did Meredith say something?
When I make a professional recommendation about a fellow attending,
I expect it to be kept in confidence. I do not expect to hear about it
from one of my residents. I thought I could assume that much.
How's your day going?
- Dr. Grey. - Uh, yeah.
Jamie, we're going to open up your knee and wire all the pieces
- of your patella back together. - Are you gonna do the operation?
- Yep. - You'll hold my hand
through the whole thing?
I think it's better if I'm holding the scalpel.
- But I can hold your hand right now. - Fine.
OK.
Do you have any other questions?
I can't think of anything, but I don't want the hand holding part to end,
so can we sit here a minute?
You are so bad. I will see you in the OR.
Wow. Should we have left you two alone?
- What? - Getting a little steamy in there.
Give me a break. I'm in a committed relationship.
- That was chit-chat. - Yeah, there was steam.
- It was steamy chit-chat. - With hand holding.
Yeah, physical contact is an important part of establishing a patient's trust.
Bailey did patient sensitivity this morning. Did she teach you nothing?
So there was no flirting going on. I was just imagining that.
She was flirty, and I was flirty back, because I'm trying to put her at ease.
Talking to the patient the way the patient talks to you,
makes them feel understood. And safe.
And... you're morons.
Oh, and a little pervy. Jeez.
- Put me down for 715. - Got it.
- What happens at 7:15? - 715 is her bet.
I'm making a pool on Bobby Corso's actual weight.
Twenty bucks. Closest without going over wins the pot. You want in?
How are you still on that case?
Artificial insemination. It had to be.
- What are we talking about? - Bobby Corso.
How did they make a baby?
He hasn't left the house in five years. It took a truck to get him here.
How's he supposed to go to a fertility clinic to fill up a cup?
- How does he find it to fill up a cup? - They can still do it.
- The regular way. Right? - Have you seen the guy move?
'Cause he can't, really. At all.
Maybe he doesn't have to. Maybe she does all the work.
- But how? I mean... - I'm finished.
Oh, um...
Get yourself some ice cream.
But I'm not allowed to have that much sugar.
- Get some roast beef then. - She can sit.
No, she can't. We're talking about S-E-X.
I'm nine, and you just spelled "sex."
- That's good. - OK. Know what?
Let's say this is the wife.
- No! Don't do that. - And this is... him.
- I won't be eating that now. - She's gotta be on top.
She might get altitude sickness.
Guys.
- Sorry. Um... - It's all right. I get it.
You're trying to figure how my husband and I managed to get a baby in here.
There are some logistics involved. You want me to tell you?
But first, how about you tell me how you like to do it with your husband.
Or your girlfriend? Any favorite positions?
Or kinks! Let's talk about that!
Because I know you all must have a freakshow of your own going on.
Who wants to go first?
No? Nobody?
OK.
Well, it's probably none of my damn business anyway.
The fat under your skin has become necrotic.
It has died.
And the infection is eating through your skin.
I suppose it had to come to that. I've eaten everything else.
The operation is extremely risky.
You have a higher than normal chance
that a surgical complication can kill you.
If I don't have the surgery, I die?
How long will I have, do you think?
Mr. Corso, you want the surgery.
- You want to try. - I've tried.
Everything.
High protein, the low carbs,
drugs, pills, hypnosis.
I've tried everything.
You have a baby on the way. Think about that.
What do you think I'm thinking about?
You...
You dream of having a kid.
You picture yourself playing ball with him.
You picture her standing on your feet
while you dance around with her, you know?
You don't picture them bringing you food and cleaning you up.
I can't walk four steps to go to the bathroom.
You tell me,
who deserves that guy as a father?
I just want to be gone before the kid has a chance to know who I am.
Don't tell my wife about this, OK?
Let's just tell her it's too risky.
Let me go home.
- Hey, peanut. - What's going on?
- Can we see my mom now? - I'm trying to find out.
- Is she gonna be OK? - You want an honest answer?
- Yes. - I don't know.
Do you know anything?
I hear that you're scared.
It's scary when your mom or dad gets hurt
- and you feel alone. - How do you know?
'Cause when I was your age, my dad and I were in a car accident
and he was hurt and I was really scared. So I know.
Was your dad OK?
Yep. He was fine.
Now, let's go see about your mom.
Get back, get back!
- What happened? - Echo shows a ventricular wall rupture.
- OR 2's ready, they're waiting. - Yang, you coming?
- Yeah. What about the kid? - I'll take her.
Mommy?!
Mommy!
- Do you need me? - What?
- You have Avery. Do you need me? - Yang, in or out. Let's go.
Um...
You wanted me to sign discharge papers?
Mrs. Corso, I'm sorry about the thing in the cafeteria.
It's easy to make jokes about him.
You didn't know him before.
You don't know that inside all that is the same man I've always known.
Who can make me laugh till I can't breathe.
He's been trying to make you guys laugh all day,
but you're too disgusted to even smile or joke with him.
Make him feel like a person.
I brought him here because I thought you would help him.
But you're only making him feel worse.
So unless you want to tell me the next step to getting him out of here
and home, I don't need to hear anything from you.
Are you bringing my forklift around?
We thought we'd just open up the loading dock and roll you out.
That's good.
Right into Puget Sound.
Float me home like a barge.
- I got a good one. - Yeah?
What did they call the guy who was so fat, he couldn't get out of the house?
- What? - Dead.
And selfish.
Yeah.
'Cause you left a 700-pound mess for your wife to clean up.
That's a good one.
Look, I'm sorry that we've been tiptoeing around you all day,
trying not to make jokes,
but you're the one who's gotta stop.
Stop calling yourself the fat guy.
You got a wife who loves you.
You know, who stuck by you through all this.
You did something right to deserve that.
I know what it's like to have life hand you so much crap
you just want to sit on the couch and die.
But you gotta look at what's in front of you.
You can't just walk out on her now. She deserves better.
Look, chances are, you're gonna die on that table.
Then you get what you want.
But at least your wife will think you tried.
She'll tell your kid you tried.
Give 'em that at least.
- How'd you get back on the surgery? - They said they needed big guys.
Karev, Percy, retracting the abdomen. Adamson, stay there.
Kepner, over there.
Where do you want me?
I think we are good.
That's all we need.
Did you irrigate the ears to induce an ocular response?
- No. That was not necessary. - Why?
- The patient had a pupillary response. - So you saw life in her eyes?
- There was a pupillary response. - Yet you declared her dead.
- No, you misunderstood. - Absence of a pupillary response
is one of the signs of brain death, yet you declared her brain dead.
I never declared her brain dead. She had minimal brain activity.
I'm sorry, I tried to explain to you...
So she was alive until you withdrew care.
- Until you pulled the plug. - I'm sorry. I'm not being clear.
According to the letter of her advance directive,
there was a level of brain activity
- that I judged... - That you judged. You decided.
It was my opinion to...
Should we stop?
I'm gonna suggest we take a break.
Get ourselves together, resume later on.
- Does that sound all right? - Fine.
You remember when I told you they don't have a case?
- Yes. - With respect, Dr. Shepherd,
please stop trying to give them one. Do not apologize.
OK.
The infection's really deep.
- Underneath all this fat is just... - More fat.
- I'm down to the abdominal wall. - How's the fascia?
Not too good. Wanna take a look inside?
It's probably a can of worms, but here.
Let's have a little peek.
Damn it! We have to go in.
- Bailey, Webber, you scrub in? Fast? - OK.
So there's a hole in the wall?
Right, and the blood is supposed to go from one room to another,
except it's just rushing outside through the hole.
And it can't get to her brain? Got it.
Yes. Or to her lungs.
- So they're gonna sew up the hole? - They'll try to.
But the heart has to be strong, like, um...
Like nylon. Like your shoes.
Your mom's heart is weak. Like paper.
What happens if she dies?
We'll talk about that if it happens.
Gotcha. Mine.
If your mom dies...
you'll feel a lot of things.
First, you'll feel like, uh...
you could have done more to help her, but...
that's not true.
You did everything you could.
It won't feel that way, but...
remember me telling you this:
You did everything you could.
And it will hurt, every time you think of her.
But over time, it will hurt less and less.
And eventually...
you'll remember her and...
it will only hurt a little.
I'm not gonna be here in the morning when they let you go,
so if it hurts before your follow-up, give me a call.
OK? And if it's oozing green stuff, call me.
Can I call you if it's late at night and I'm kind of drunk
and I run across an old John Hughes movie on the tube?
Wow, um...
- I don't, uh... - Here.
I don't think...
- Just... - What?
- Use that... - Um...
if the spirit moves you.
Now, get out of here.
- I'm on drugs. - Uh...
OK.
Pull that back more. I can't see what I'm doing.
- This? Is this good? - No! More!
I think I found the culprit. Diverticulitis.
Perforated colon. Completely infected.
- How long's he been under? - Too long.
This abscess will kill him if we don't get it under control.
- OK, keep it together. - Let's pick up the pace, people.
Laps. Come on.
More.
Pack it in.
Hey. How's the deposition going?
- Apparently, I can't tell you. - Why?
Why did you tell Hunt what I told you?
- I didn't, I told him nothing. - He came to me and said you knew.
No. I told him nothing. I looked at him...
You looked at him. When you're pissed, your face says everything.
So now I have a staff that can't trust me.
So, what am I supposed to do, control my face?
- Yes. Control your face. - Maybe you shouldn't tell me things
you don't want me to know. Control that!
Then I can't tell you anything.
Then 80 percent of my day is off limits and I don't want that.
I don't want that either. I'm sorry.
I know. It's just...
- But I have to tell Cristina. - Damn it! What are we talking about?
Owen lied to her.
And he must have done that because he still wants Teddy.
- Doesn't matter! - It doesn't matter to you.
Cristina is my best friend. I get that you're the chief now,
but she's still the person she's always been.
Am I supposed to stand around and watch her get hurt? What am I supposed to do?
Chief Shepherd, they're ready.
Nothing. You do nothing.
Where's the little girl?
Social Services came. We put her to bed in a patient room.
Her dad should be here by the time she wakes up.
Good. You were great with her today.
Thanks.
So when did your mom die?
- She didn't. - Your dad, then?
I'm sorry if that's too personal.
It was just clear from the way you were talking to her today.
It's been a long day. I thought you might want to talk about it.
That's very insightful of you.
You're a super,
super sensitive man.
Let me tell you what you saw today.
I reflectively listened to a patient's concerns.
I spoke to her in a language she could understand.
I clearly stated possible complications and probable outcomes.
That's all you saw today.
Me kicking patient sensitivity ass. So go be someone else's dish rag.
Hey, what are you doing tonight? Do you wanna drink? We should drink.
Although, maybe I shouldn't, because then I'll talk.
And I'm not allowed to talk or make a facial expression.
Can you go away, please? Just go. Go away!
What is it? Cristina, what's wrong?
Owen. Can you get me Owen, please?
And describe what you saw in Mrs. Clark's scans.
The patient suffered an acute hemorrhagic stroke
- in the left temporal lobe. - Based on those scans and the EEG,
you recommended that care be withdrawn.
According to the advanced...
- Yes. - How long did that take?
From the time you looked at the scans until you decided to end her life,
- how much time elapsed? - We talked to the patient's family,
- assemble an ethics review committee. - I'm talking about your assessment.
How long did it take you to decide to recommend that she should die?
- Less than a minute. - Less than a minute.
In my professional opinion, there was no other option.
Thirty-two years.
I... I think we have everything we need.
Alison and I were married for 32 years.
I loved her for more than half my life.
And you decide to kill her in less than a minute?
Mr. Clark,
- I'm so sorry... - I begged you.
And you just kept saying you're sorry.
You just kept saying legal this and legal that.
- This is no longer productive. - Gary...
I begged you!
But you signed her death sentence! You didn't even show up to do the job!
You're a coward, Dr. Shepherd! You're a coward and a killer!
Come on.
Come with me.
- Dr. Shepherd, can I have a word? - What?
Nothing. I'm just keeping you here until Mr. Clark has gone.
You're a kind man, Dr. Shepherd. I respect that, I admire that.
But he's grieving, and they have no case.
He got to say what he needed to say.
And the kindest thing you can say to him is nothing.
You can't help him, and you won't help your hospital.
It's over.
I know you want to do more, but it's over.
It was a pleasure working with you.
- So you told her. - I didn't say anything to her.
What? What is it?
What happened?
I miss my dad.
Bobby, you survived the surgery,
but you're not nearly out of the woods.
We'll still have to watch you very closely for post-op infections,
and you're gonna have to make some serious lifestyle changes.
I know. I need to lose the weight.
You have no choice, if you want to survive.
Well, then I have no choice.
Right?
How did it go?
Derek, you can talk to me.
I don't want to think about what I can and can't say
and who I can and can't say it to.
I can't do it anymore today.
I love you. You know that, right?
I love you, too.
No matter how thick-skinned we try to be...
- Did you find out Bobby Corso's weight? - 678.
So who won your stupid pool?
- Bailey. - Bailey?
She bet in your pool? After all of that.
Are you kidding me? My God, the hypocrisy!
There's millions of electrified nerve endings in there.
- You going home? - Yeah.
You want to go together?
Open and exposed...
and feeling way too much.
Hey! We scored! My cousin said we can use their timeshare.
So Fiji. We can either go at the end of this month
or we could save up three weeks of time, rearrange our surgical schedules
and go at the end of next month.
Try as we might to keep from feeling pain...
What's that?
This cute girl's number. And I can't get it off.
And I'm not gonna use it, I don't want to use it.
But I can't stop wondering if maybe she wants a baby one day.
I love you.
Everything about you.
But there's this one thing that I need.
I can't change it, I can't ask you to change,
- I don't want you to change... - I can't be the one
that keeps you from having a baby.
I love you, too.
- And we can keep going. - But I don't know where we're going.
Come here.
Sometimes, it's just unavoidable.
God, what are we gonna do?
Well, I'm gonna get my stuff together.
Oh...
And what? We'll just...
We'll see each other at work.
I'm so sorry!
I love you.
Me, too. Me, too.
Sometimes, that's the only thing left.
- Thanks. This was a good idea. - No talking.
- You shanked it. - No talking.
Just feeling.