GREY'S ANATOMY

2x26: Deterioration of the Fight or Flight Response

Original Airdate: 5/15/2006

Written by: Joan Rater & Tony Phelan

Directed by: Rob Corn

(Bailey is in front of the hospital helping Burke who has been shot)

MVO: Human beings need a lot of things to feel alive.

(Denny's heart monitor is flatlined)

George Voice Over: Family.

(Denny is lying in bed motionless.)

Cristina Voice Over: Love.

Izzie Voice Over: Sex.

Derek Voice Over: But we only need one thing...

Burke Voice Over: To actually be alive.

(Derek is standing on the balcony overlooking the hospital floor)

Cristina Voice Over: We need a beating heart.

(Bailey is performing CPR on Burke.)

Addison Voice Over: When our heart is threatened...

Alex Voice Over: We respond in one of two ways.

George: We either run...

Burke Voice Over: Or...

(Camera switches to Burke's point of view, he is seeing blurry and sees Bailey above him. Burke opens his eyes.)

Izzie Voice Over: We attack.

Richard Voice Over: There's a scientific term for this.

Alex Voice Over: Fight...

Addison Voice Over: Or flight.

Bailey Voice Over: It's instinct.

MVO: We can't control it.

(Denny is flatlined and Izzie is standing next to him still holding the scissors.)

Izzie Voice Over: Or can we?

George: Izzie. His heart's barely beating. We need to call a code. I can't feel a pulse. Izzie, we need to call a code!

Izzie: No! I have a plan.

George: He's crashing! I need to call the...

Izzie: No! If we call a code, they will rush him to surgery and replace his LVAD and then he will stabilize. He needs to get worse if he's gonna get this heart.

George: Izzie, this is crazy.

Izzie: He has to get this heart. He will die waiting for another chance. You know he will.

George: We have to call a code!

Izzie: No! You press that code button, I will hurt you. Not a lot, cause we're friends, but enough so that things will break and you will lie on the floor out of my way.

George: Izzie...

Izzie: You have a decision to make. You can stay here and help me with this or you can go. What's it gonna be, George?

(Cristina enters the ER and walks up to Richard.)

Cristina: Chief! How bad is it? It looks bad. Um, I'm here. I can help. If there's anything surgical, I can help.

Richard: Why don't you go run Trauma 2, Dr. Yang?

Cristina: I get to run Trauma 2 all by myself?

Richard: Yes, but find me if you need help. And get consults.

Cristina: I'm on it.

(Cristina runs off to Trauma 2. Richard walks to the entrance where Bailey is wheeling Burke inside.)

Richard: How bad is it?

Bailey: Uh, GSW to the right shoulder. He's lost a lot of blood.

Richard: All right. Get him to Trauma 1 and keep the blinds closed. Yang's on the floor.

(Trauma 2)

Doctor: Self inflicted GSW to the head. Pulse is thready.

Cristina: This guy's the shooter?

Doctor: Yep. Emptied his clip, then shot himself.

Cristina: And blew off half his head. Ok, ok. Um, push one of epi and get him on the monitor.

Doctor: You're running this?

Cristina: Damn right, I am.

(Burke's ER. Burke is struggling to get off the gurney)

Bailey: Hey. Wait.

Burke: I'm fine.

Richard: You need to lay down. You've lost a lot of blood.

Burke: I'm fine. Let go. I'm fine. I have a patient that I have to go check on.

Bailey: No, no. No, you are the patient. Lay down!

Burke: (Laughing) Dr. Bailey, when did you get here?

Richard: Page Shepherd.

(Cristina's ER, she is doing CPR on Petey, Derek walks past the window and enters the ER where Burke is. As the door opens, Cristina sees Burke inside.)

Cristina: Take over compressions.

(Cristina goes into Burke's ER)

Cristina: You're shot?

Burke: Cristina?

Richard: Get back to your station, Yang.

Cristina: He's shot?

Bailey: Yang, we got it. It's ok.

Cristina: That guy shot you.

(Cristina goes back into her ER)

Cristina: Move.

Doctor: He's a lost cause.

Cristina: Move.

Doctor: He's circling the drain.

Cristina: (To Petey) You don't get to kill yourself. You do not get off that easily. Push high dose epi.

Doctor: Dr. Yang...

Cristina: What? I want to be able to tell his family that I did everything I could to save his pathetic, miserable life. Give him three of epi. Now!

(Seattle Scenes)

(Mercy West)

Alex: We should be hearing from Dr. Burke any minute.

Erica: That's what you said half an hour ago. Well, whether or not we hear from him, we hit that hour mark, I'm going in to get my heart.

(Burke's ER)

Bailey: Ok, no, no exit wound.

Derek: Entry upper right shoulder. Could be lodged in the spine. Ok, lets roll him over.

Richard: Easy.

Derek: Watch the arm.

Richard: Easy.

Derek: Hey. Dr. Burke?

Burke: Hmm?

Derek: The bullet is in dangerous property here, ok? We need to check your hand function.

Richard: I want you to try and squeeze my fingers, ok?

(Cristina enters)

Cristina: They moved my guy upstairs. How is he?

Bailey: I need you to wait outside.

Cristina: I'm not gonna wait outside. Burke?

Burke: Can we have a moment?

Richard: Only a moment. I don't want to waste any time, ok?

Burke: Cristina.

Cristina: Honey, you don't have to say anything. I know you're sorry. I know you didn't mean to kick me off the transplant and I'm not mad. I mean, I was, but I'm not anymore. So, don't even think about it. Ok? I mean, all that matters it that you get better and you get through this. And I'm here for you. Whatever you need. Anything.

Burke: I need...you...to...to go...to check on Denny Duquette.

Cristina: Ok.

Burke: Mm-hmm.

Cristina: Ok, that was my best "supportive girlfriend" and you kind of ruined it with medicine. Ok?

(Adele pulls up a curtain in the ER to reveal Addison walking up)

Adele: Addison! Thank you for meeting us.

Addison: You wanna tell me what's so important I'm keeping it secret from my Chief of Surgery?

(A young lady, Camille is on a hospital bed in full prom attire)

Adele: I was chaperoning a prom for my niece. We had a little bit of a situation.

Addison: Camille Travis, 17, lost consciousness during sexual intercourse?

Adele: Oh, keep it down.

Camille: It's ok, Aunt Adele, I'm fine.

Adele: When your Uncle Richard finds out you were cashing in your V-card, none of us will be fine.

(Two girls and a boy enter in their prom attire)

Claire-Camille?

Natalie: Mrs. Webber!

Claire: My God! Is she ok?

Natalie-She has to ok, right?

Claire-No one ever died from having sex, right?

Brian-You're not going to tell my parents, right? I mean, I even used a condom and everything.

(Denny's room. George is looking at a computer while Izzie is manually pumping Denny's heart. Meredith enters)

Meredith: George's page said it was an emergency.

Izzie: You paged Meredith?

George: We need help!

Meredith: What the hell is going on?

(Cristina enters)

Cristina: What the hell is going on?

Meredith: Exactly what I said.

George: She cut his LVAD wires!

Meredith: What do you mean you cut his LVAD wires?

Cristina: Are you trying to kill him?

Izzie: I'm trying to save him. All I have to do is confirm that his condition is worse, then Burke can call UNOS and he'll move up on the list and he will get his heart.

Cristina: About Burke...

George: She's gone insane, right? It's not just me?

Cristina: About Burke...

Izzie: Everything will be fine!

Meredith: Izzie!

Izzie: When Burke gets here, everything will be fine. He will know what to do.

Cristina: About Burke...

George: (Loudly) What?

Cristina: He's been shot!

(George is now pumping Denny's heart)

Izzie: Burke's not coming?

Meredith: Cristina, are you ok?

Cristina: I'm fine.

Izzie: Burke's not coming?

George: Why didn't I take the internship in San Diego? None of this would be happening if I was in San Diego.

Izzie: Burke's not coming.

Cristina: No, Izzie. Burke is not coming. I know your having problems here what with your possible murder charges and your unbelievably stupid idea about stealing a heart, but Burke's kind of busy right now!

Izzie: Denny's gonna die. Denny's gonna die and I killed him.

George: (Yelling) You shouldn't have done it!

Meredith: George!

George: We have to tell someone.

Meredith: No! Denny won't get the heart and Izzie'll get kicked out of the program.

Cristina: I'm leaving.

George: What?

Meredith: Cristina!

Cristina: Burke could die, too. Complications arise all the time because of gunshot wounds! You think about that.

Izzie: Oh, my God.

Cristina: Oh, God. You know what, none of this would have happened, if you were thinking with your head...

Izzie: I did what I thought was best!

George: Did you think about the rules? Did you think for one second...

Meredith: Shut up! Shut up! Shut up! No one is leaving. And no one is dying.

Denny: Thank you. It was kind of getting on my nerves all this dying talk.

Izzie: Denny.

Denny: It's ok. I think, uh, maybe we should all listen to Meredith. It looks like she might have a plan.

Izzie: You have a plan?

Meredith: Just give me a minute.

(Outside Camille's room)

Adele: You girls should go back to the prom.

Claire: Are you gonna call Camille's parents?

Adele: Not until I have to. You knew her mom. She gets a little hysterical.

(Richard walks up to a nearby nurse's station)

Adele: Brian, disappear.

Brian: What?

Adele: Disappear! Go! Disappear! Richard. Richard.

Richard: Adele.

Adele: Hmm.

Richard: Um, what? Are you here to see Preston?

Adele: Preston? No. What happened to Preston?

Richard: Preston was shot.

Adele: Preston was shot?

Richard: Yeah.

(Richard peeks through the window over Adele's shoulder and sees Camille inside. She is now wearing a hospital gown.)

Richard: Camille. What happened to Camille?

Adele: Richard...

Richard: Why didn't you call me?

Adele: She's 17, sweetheart. She'll be 18 in a few months. Most girls lose it way before...

Richard: Uh-huh! Do you think I want to hear that? Do you think I wanna picture my baby niece..."losing it"?

Adele: Richard, Richard, take deep breaths.

(Addison walks out of Camille's room and up to them)

Addison: Well, the bleeding has stopped, but her pelvic exam does concern me. I'd like to do an ultrasound.

Richard: Three years ago, Camille was diagnosed with ovarian cancer. They only removed one ovary to try and preserve fertility, but her checkups have been clean since then.

Addison: Ok. Well, let's not worry until we have to.

(Brian walks by)

Richard: You! You wait right there! I want to talk to you! (Adele motions for him to run and Brian starts to run away) I said wait. Stop! I said stop!

Adele: Richard, take deep breaths! Richard!

(Denny's room)

George: Oh, that's a stupid plan!

Meredith: Well, if Burke isn't coming, then we have to confirm Denny's condition ourselves. We get the blood work. We do the echo. And no one even has to know what Izzie did.

Izzie: But none of us have done an echo on our own before.

Meredith: Cristina has. Burke taught her.

Cristina: I'm not involved.

Izzie: What if this were Burke? What if you were me?

Cristina: This is bad. This is bad and serious and against a lot of rules. It's not fun for me. I don't wanna play.

Izzie: What if you were me?

Cristina: Well, I wouldn't have fallen in love with a patient.

Izzie: You fell in love with an attending.

Cristina: Well, so did Mer. What's the point?

Meredith: The point is, we can't help who we fall in love with.

George: Yeah.

Izzie: Yeah.

(Burke's room)

Derek: His hands are cold.

Burke: My hands are always cold.

Richard: You hand is cold, Preston.

Burke: I have cold hands.

(Derek and Richard look at the X-rays)

Richard: The bullet could be lodged in the brachial plexus. That's dangerous.

Derek: Yes, very dangerous.

Burke: My hands are always cold.

Richard: We'll have to do an angiogram.

Derek: Yeah.

Burke: I'm always cold.

(Burke's monitor starts beeping)

Derek: Trachea's deviated to the right!

Richard: Absent breath sound on the right side! Lets go! Lets go! Lets go!

Derek: 14 gage angio

Richard: Gotta hurry!

Derek: Dr. Burke? Dr. Burke? You gotta stay with me now. There you go. That's it. There you go! You're all right. Right here. Right here. Your lung collapsed. You're ok. You're ok now.

(Mercy West, Alex in on the phone with Meredith)

Alex: He's been shot? Dude.

Meredith: We're gonna have to run these tests ourselves.

Alex: UNOS gave us an hour. In a couple of minutes, our time is up. I'm telling you, this chick is hardcore. She's not gonna wait.

Meredith: Ok, well, you just have to stall her.

Alex: I'm not getting involved with this. Look I don't care if that drawling bedridden whiner ever gets a heart.

Meredith: Alex. Do this. For Izzie.

Alex: I'm not guaranteeing anything.

(Camille's room)

Natalie: So...was it totally romantic?

Claire: Yeah, before...the pain and the paramedics and everything?

Camille: Ok, so...you know that feeling when you look into someone's eyes and you're totally comfortable and you aren't self-conscious and everything just...is, like, perfect?

Addison: Camille, have you had any symptoms, um...any abdominal pain? Nausea? Anything?

Claire: No, she's been fine.

Addison: You haven't been fine, have you?

Camille: No, not for, like, a month or so.

Natalie: You've been feeling sick for a month?

Camille: I wanted to go to prom. I, I...I didn't want to be the girl with cancer, again.

Claire: You're not. She's not, right?

(Addison walks up to Adele)

Addison: Hey.

Adele: Oh. I was just trying to remember the night I lost my virginity. And I can't. I remember who it was with and I remember I was 18, but...I can't remember any of the details.

Addison: I can remember all of the details. Kind of wish I couldn't.

Adele: That bad?

Addison: No, just not good. Good came later. And then really good came.

Adele: That little girl in there's just getting started. She hasn't even seen what good is yet. Please. Addison. Tell me she's going to have a chance to see what the good stuff is.

(Addison doesn't say anything but from the look on her face you can tell the answer is no)

Adele: Oh.

Addison: I'm so sorry, Adele.

(Denny's room)

Izzie: How's his heart looking?

Cristina: His left ventricle's shot and he's barely pushing blood out.

Izzie: I'm sorry. I know that you're worried about Burke.

Cristina: You know, whatever. It's fine.

Izzie: Cristina, can't you just try to understand? I love him.

Cristina: You don't even know him.

Izzie: I do know him.

Cristina: No. You've never even seem him outside the four walls of this hospital. You don't know him.

Izzie: I know him. Maybe I don't live with him or work with him like you do with Burke, but I do know him. And there's...there's possibility here. And given the choice of running or staying...

Cristina: You should run. A sane person, a person who values her career and everything she's worked for, a person who values her own heart, for God's sake...that person would run.

Denny: A sane person...would marry me.

Izzie: What? What did you say? What did he say? He said marry me? He said marry me, right?

George: He did.

Izzie: Denny. Wake up. Denny.

(Monitor starts beeping loudly)

George: What's happening?

Izzie: I'm pumping harder. I don't know.

Meredith: He's flatline.

Cristina: No, no, no. He's not flatline. There's movement in his heart. Ok, um, uh, lets shock him. Uh, charge the defibrillator.

Izzie: Ventilate George!

George: I am.

Izzie: Charging to 200!

Cristina: You got it?

Izzie: Yeah. Clear.

(Mercy West)

Erica: Is Dr. Burke alive?

Alex: Yes.

Erica: Shame. He'd probably have made a good donor. (To her team) Ok, people, let's get our organs and get out of here.

Alex: Hey! That heart is not yours yet. Seattle Grace is still waiting for test results.

Erica: Well, I'm not. Ten blade.

Alex: You can't do that.

Erica: I just did.

(Richard walks down a set of stairs into the waiting room, which is full of teenagers dressed in their prom attire.)

Richard: Girls.

Claire: Um, I called Jillian.

Natalie: And I called Tessa.

Claire: And then they called Simon and Bianca and Deborah.

Richard: Girls...

Natalie: It's her prom, Dr. Webber. She can't miss her whole prom! So...we, like, brought it to her.

Richard: (Loudly) Kids! Kids! Listen up. Look, I know you wanted to see Camille. Why don't you come back tomorrow? During the day. In smaller groups. (Quietly) Look, I'm sorry, girls. I can't have a bunch of teenagers running in the hallways. People are sick. People are d...

Claire: Dying? Yeah, we know.

(Burke's room)

Derek: How're you doing?

Burke: I'm developing numbness in my...fourth and fifth fingers.

Derek: And there's a pseudo-aneurysm in the subclavian artery. You know the drill. Wait a few days, maybe the aneurysm won't grow.

Burke: Yeah, if...if it stays this size, there's too much damage.

Derek: We'll just go in there and we'll fix it. Relieve the compression on the nerves.

Burke: But the operation could cause damage to the nerves.

Derek: Yes.

Burke: And I could...lose function of the entire arm.

Derek: Yes.

Burke: You can do this? You're good enough to do this?

Derek: I think so.

Burke: But you're not sure.

Derek: But I'm not sure.

Burke: So...what do I do?

Derek: It's not like you to ask those kind of questions.

Burke: It's not like you not to have the answers.

(Adele walks up to Richard who is standing at the nurse's station)

Adele: How dare you send those kids away?

Richard: Adele. Please. You're emotional. Ok?

Adele: I just told my sister her baby's cancer is back. You're damn right, I'm emotional. If you don't want to bend your precious rules for Camille, fine. Don't do it for her. Do it for me. Do it for your wife who never asks you for anything. Who says nothing about your long hours. Who looks the other way while you have an affair with another woman. Who sobered you up when that woman left you. Who stayed with you when everyone, everyone said I would be better off alone. I'm not asking you, I'm telling you, you're going to make this up to Camille. You're gonna prioritize the needs of your family above those of your other patients. Or...you're going to find a new place to sleep.

(Derek is walking through the hall, Addison walks up behind him.)

Addison: Derek.

Derek: Not now, Addison.

Addison: Derek.

Derek: Not now.

(Derek enters a dark conference room)

Richard: There's never a good place to hide in this hospital.

Derek: I'm trying to get perspective. Everything feels enormous. Like it's all just...I ...I can't get perspective.

Richard: My niece's cancer has come back. She's 17 years old and she's going to die. Plus...25 years ago, I had a secret affair with...Ellis Grey. And today, I find out that my wife knew the entire time. There was no...secret. And she stayed with me.

Derek: Hmm. I respect him, you know? Dr. Burke...I...I respect him. He's decent. He's honorable. An arrogant ass who just hogs the OR but thinks he's God, but...he's decent and he's honorable. I respect him. He's one of the foremost cardiothoracic surgeons in the country and I've gotta just...it's his hand. I cannot get perspective. I can't do this. I can't be responsible for it.

Richard: Preston's an honorable and decent man, but, Derek, so are you. You are honorable and decent. And you're too honorable and decent to run. (Looks at his coffee cup) You don't know how much I wish this was bourbon.

(Burke's room, Bailey enters)

Bailey: Anything I can get for you, Dr. Burke?

Burke: No. I'm fine.

Bailey: Um, there...there must be something.

Burke: It would be nice...to have some ice chips. And a touch of morphine if I'm allowed. And, uh...Cristina.

Bailey: Coming right up. Where is Cristina? Where are...where are all of the suck-ups?

Burke: Excuse me?

Bailey: My interns. My ass kissing, surgery-hungry, competitive suck-ups. Where are they? Why aren't they here fetching you ice chips and morphine? Why aren't they here sucking up? You know something.

Burke: I'm a patient.

Bailey: Preston Xavier Burke...what have you done with my suck-ups?

(Denny's room)

Izzie: What do we do? What do we do?

Meredith: I'm starting dopamine and dobutamine drips. We can use those together, right? What about milrinone?

Izzie: I don't know.

Cristina: You know, none of us do. Just start the dobutamine and dopamine.

George: What about...what about...gluceratide? That might help.

Denny: I feel like my chest is running away.

Meredith: His heart rate's 217.

Izzie: He's in SVT.

Cristina: No, no. Izzie, stop pumping. Stop.

George: No, there's no change.

Meredith: We need that medicine?

Izzie: What medicine?

Meredith: I'll know it when I see it.

George: I think...the one that stops the heart. Here hold the mask.

Denny: No. The whole point is to keep my heart beating.

Izzie: No, no, no. It only stops it for six seconds.

George: Meredith, it's adenosine.

Cristina: Uh, his heart is speeding up! Guys!

Izzie: You guys! We have to do something! He cannot take this for much longer.

George: What about shocking him?

Meredith: Found it!

George: Cristina, come over here. Lift up his arm. The nurses always lift the arm when they push adenosine. It gets to the heart faster.

Izzie: Ok, Denny. You're gonna feel, um...

Denny: Izzie!

Izzie: No, it's ok. It's ok. It just feels like...

Denny: I'm gonna die.

Izzie: You're not gonna die, I promise. It's the meds.

Cristina: Yeah, we're heading back to flatline. Are you sure we used the right drugs?

George: The book said it was right.

Meredith: I used the one I know.

Izzie: He's not going to die, right? Right? Right?

(Flatline for six seconds then heart begins beating again. Bailey enters)

Bailey: You fools better have a good explanation for this. Step away from the patient. (Everyone steps back except Izzie) Step away from the patient.

Izzie: I can't. I have to pump his heart.

(Bailey notices the cut LVAD wire)

Bailey: Olivia, take over for Dr. Stevens. Izzie, you're done here. I need you to leave the room.

Olivia: Izzie...

Izzie: No! Do not touch me!

Bailey: Olivia, stay with Dr. Stevens. Help her if she'll let you. You three. Outside. Now! Where was rational thought? Where was cognitive thinking? First do no harm? The morals, the ethics? Where was sanity when you three decided to help that girl?

Meredith: We didn't...

Bailey: No, no. No speaking. Nobody speaks. I do not want to have to testify against any of you in a court of law. Not one word. She cut his LVAD wire. (George clears his throat) Look, I said no speaking!

George: I didn't say anything!

Bailey: Then no moving! Cristina. Burke is asking for you. Go! I'm assuming you ran labs? I'm asking a question. Answer me!

Meredith: You said no speak...

Bailey: I know what I said.

Meredith: Yes.

Bailey: O'Malley, get me the lab results. Do not pass go. Do not even talk to another living soul. Get the labs! Get back here! Grey...come with me.

(Cristina is standing outside of Burke's room)

Cristina: How are you? You look good. Are those your films? Oh, Burke...

Burke: Shepherd, uh, doesn't know if he can fix my hand. Maybe I'll wait it out. See if this numbness subsides.

Cristina: Yeah.

Burke: Or I could let Shepherd operate.

Cristina: Yeah. Yeah.

Burke: I could lose all hand function. What if I can never operate again?

Cristina: Yeah.

Burke: Cristina:

Cristina: Yeah.

Burke: Stop saying yeah.

Cristina: Ok.

Burke: I need...I need...you said you were here. For me.

Cristina: Yeah. Oh, sorry.

Burke: Cristina.

Cristina: Hmm?

Burke: I need you to tell me...what you think I should do.

Cristina: I...I...I told Dr. Bailey that I would be back. Ok? I...I told her that I wouldn't be long.

Burke: Cristina...

Cristina: I'm...I'm...I'm...going to think about it. I mean...I'm going to think about it. Ok?

(Cristina enters a dark closet. She just stands there breathing deeply.)

(Denny's room)

Bailey: How you feeling Denny?

Denny: Really, really good. Like an athlete or a superhero. Or some other kind of really healthy person.

Izzie: You're funny. You're a funny guy.

Meredith: Izzie. No speaking.

Denny: I cut my own LVAD wires, you know? I went rogue. All by myself.

Bailey: Shush. You're weak enough as it is. Please don't waste energy on lying.

(Cristina enters the room)

Izzie: Dr. Bailey?

Bailey: I did indeed say no speaking.

Izzie: I don't care! He's gonna get the heart right? You're gonna sign the charts and talk to the transplant coordinator?

(George enters the room)

George: Here are the labs.

Izzie: See? See, his BUN and creatinine are increasing. He clearly has pulmonary edema. He deserves to move up to 1-A status on the transplant list. UNOS will give him the heart. You just have to call.

Bailey: Isobel Stevens, I take my medical advice from doctors. You are a visitor.

Izzie: What?

Bailey: As of now, you are a visitor in this hospital. You will not be a doctor in this hospital again until I decide you are. Olivia, take over the heart pump.

Izzie: He gets the heart though, right?

(Bailey walks up to Richard who is standing at a nurse's station.)

Bailey: Sir? Uh, I need to ask you a hypothetical question.

Richard: Can we do this another time?

Bailey: Uh, if someone on the staff deliberately unhooked a transplant candidate from his LVAD in an attempt to worsen his condition and get him moved up on the donor list...? Hypothetically, sir.

Richard: I think you need to tell me exactly what's going on here, Dr.

Bailey: Believe me, sir, you want this to stay a hypothetical. Because I'm thinking if something like that did happen, you'd be duty bound to report it and the hospital would be in danger of losing its accreditation as a transplant site.

Richard: So hypothetically?

Bailey: Hypothetically, if the patient got worse, would it be unethical for him to receive the heart even though, medically, his worsened condition now puts him at the top of the donor list? Hypothetically?

Richard: How bad is he?

Bailey: In the few hours it would take a new LVAD to be delivered, he'll be dead.

Richard: Our responsibility is to the patient. If, medically, he's at the top of the list, then he should get the heart. Hypothetically.

Bailey: Thank you, sir. (she starts to walk away)

Richard: But practically? Whoever removed the patient from the LVAD, I expect to be given names and there will be severe, severe consequences.

Bailey: Yes, sir.

(Mercy West, Dr. Hahn is walking down the hall carrying a cooler. She passes Alex who is on the phone.)

Alex: Wait. Hold on. Dr. Hahn? Dr. Hahn!

Erica: Can't stop now, Karev. I only have a few hours to get this heart into my guy.

Alex: Dr. Hahn.

(She stops, and has a knowing look on her face.)

Erica: UNOS gave the heart to Seattle Grace.

Alex: The transplant coordinator already called and stopped your guy from being prepped.

Erica: Oh, come on! He has kids. They're four and five. Do you know how long he's been waiting for this? He's a good person. He deserves a heart.

Alex: I'm sorry.

Erica: I'll bet you are.

Alex: No. I am. Believe me.

(She hands Alex the heart.)

Alex: Listen, we have a chopper waiting on the roof.

Erica: And?

(Seattle scenes)

(Burke's room, Derek is there)

Derek: You could take up fishing.

Burke: I don't fish.

Derek: Fishing's a lot more fun than surgery.

Burke: I have 80 percent hand function now.

Derek: Hmm. 80 percent's not enough. Not for you.

Burke: Fishing, huh?

Derek: You don't fish.

(Roof of SGH, the chopper lands and Erica gets out with Alex. SGH hallway, Izzie is escorting Denny through the hall. Bailey gives her a nasty look and he enters the OR area. Burke is going into surgery.)

Burke: Shepherd.

Derek: You don't have to thank me. I'm sure you'll return the favor one day.

Burke: I was going to say, please try not to kill me.

(Everyone in the OR laughs)

Derek: I'll do my best.

Burke: Ok.

(Denny's OR. Dr. Hahn is performing the transplant.)

Erica: Hmm. Look at that thing. (She lifts out Denny's heart)

Alex: Left ventricle's excessively dilated.

Bailey: He wouldn't have lasted another hour with this heart.

Erica: No, he wouldn't have.

(Burke's OR)

Derek: Ok, retract that little bit right there. Ok, I am now removing the aneurysm from the nerve cluster.

Doctor: NAPs are dropping.

Intern: Arterial pressure's down 50 percent.

Richard: Did you cut the nerve root?

Derek: I don't see any discontinuity of the nerves. All right, lets do a, um, reflex test on his hand. Chief.

Richard: Ok. Nothing.

Derek: Damn it. Try it again.

Richard: Uh-uh.

Derek: This doesn't make sense. I'd know if I severed a nerve.

Richard: Derek, is the arm paralyzed?

Derek: I have to do a wake-up test.

Richard: Derek.

Derek: There's only one person who can help me figure out whether or not I've damaged the relay or not, and that's Burke.

Richard: He's been through a lot of trauma today.

Derek: I'm trying to prevent the trauma he's going to feel if I have to tell him he's paralyzed.

(George, Cristina, Izzie and Meredith are sitting on the floor below the OR board.)

George: Bailey's treating us like we're children. We're not children. We shouldn't have to sit out here like we're on a time out, or something.

Meredith: It is a time out. What we did is way in need of a time out.

Cristina: You realize we could get kicked out of the program for this?

Izzie: Not we. I did this. I did this. And you're probably right. Maybe I should run. But I'd rather be running towards somebody than running away.

(Richard walks into the hall)

Richard: Yang? Shepherd's asking for you.

Cristina: Uh, for Burke's surgery?

Richard: Yes. Hurry up.

Cristina: Uh...I-I can't. I'm...I'm in a time out.

Richard: Time out's over. Right now.

Cristina: Yes, sir.

Richard: Yang, we need you.

(Richard and Cristina walk off)

Izzie: He said marry me, right? He did? That really happened?

George: It really happened. '

Meredith: It really did.

Izzie: Screw this. I'm checking on Denny. (Izzie walks off)

(Burke's OR)

Derek: Ok. How we doing?

Doctor: He's just at the edge of consciousness. Very light. He should be up soon.

Derek: Ok. Yang? You're up.

Cristina: Oh...what? I'm sorry. What do you need me to do?

Derek: When he comes to he's doing to be disoriented and he's probably gonna fight the intubation. We can't numb the arm because we need him to move his fingers. So, he's gonna be in a lot of pain. So we need you to keep him focused, ok?

Cristina: Ok. Yeah.

Derek: Ok, let's, let's wake him up.

Cristina: Burke?

(George and Meredith are still sitting in the hallway.)

Meredith: Thank you. For calling me about Izzie.

George: Hey, I didn't do you any favors.

Meredith: Well, it meant something that you called. It meant something to me.

George: It didn't mean anything.

Meredith: Right. Ok. Sorry.

George: Stop saying that you're sorry! You want to know something? I knew. I knew you didn't feel that way about me. Even during...when we were in bed, I knew. I knew and I still let it happen. Because...um...I...I figured that one night with you was better than never. So will you just stop saying that you're sorry cause you didn't know any better. But I did. And...I'm sorry.

(They look at each other)

George: I'm sorry, Meredith.

(Burke's OR)

Cristina: Burke, it's Cristina. I'm sorry. Wake up. Wake up. Wake up. Burke. Baby, wake up. Do it for me. Open your eyes. Hi!

(He starts fighting)

Derek: Get ready. Get ready. Hold him down. Calm him down.

Richard: Yang!

Derek: Cristina, get in there. Get in his face. Talk to him, Cristina.

Richard: Yang!

Derek: Get in there. Hold him down. Hold him down. Calm him down. Cristina.

(Denny's OR)

Erica: Scissors.

Alex: It's beautiful work, Dr. Hahn.

Erica: The hard part is still to come. All right, let's start taking him off bypass. See if this heart will beat on it's own.

Bailey: Nothing.

Erica: All right come on, Denny. Beat for me.

(Burke's OR)

Derek: Cristina! Hold him down, Chief. Hold his arm. Preston? Preston, look at me. Look at me. Right here. Listen, listen. Calm down. Calm down. Calm down. Listen, there was a complication. We can fix it. We need you to move your fingers on your right side. Can you do that? Come on, you can do this. Look at me. Look at me. On your right hand. Ok? I know, I know. It's just you and me. We can do this. Ok. Come on. Focus. Focus. Now you're going to move your fingers on your right hand. Can you do that? Come on, Preston. You can do it. Move your fingers. Move your fingers. Come on. Come on. Come on, come on, come on, come on.

(Denny's OR)

Bailey: No response. Charge to 20.

Erica: Clear. Come on. Come on. Come on.

(Alex looks up and sees Izzie in the gallery)

(Burke's OR, he is still coughing.)

(Denny's OR, Erica is still massaging the heart.)

Erica: Come on

(Burke's OR, still focused on his hand)

(Denny's OR, Izzie watching intently from the gallery)