Grey's Anatomy s11e14 Episode Script

The Distance

Previously on "Grey's Anatomy" Your tumor is smart.
But so am I.
I can beat it.
Any one of these approaches would likely kill the patient? I refuse to spend the last few months of my life feeling like a pile of crap.
I am going to give you more than a few months.
- Are you nervous? - Nobody thinks that this can work.
No one understands it.
You get at my tumor, you get at my knowledge, I get at my life.
Each card represents a fetus that I'm gonna teach Robbins how to fix.
I'm not ready to take this over yet.
- Where's Dr.
Herman? - She stepped out.
- What do you need? - It's Glenda Castillo.
- I need you to scan me.
- Let's go.
- I need Herman right now.
- Arizona, it's time.
Amelia? I'll get the O.
You'll inform the patient? In 1888, William Williams Keen became one of the first surgeons to successfully remove a brain tumor.
A big win.
It's true.
You can look it up.
What's harder to find, however, are stories of all the times old double-Billy K tried to pull a tumor out of a brain and lost.
The losses must have happened.
A surgeon must always be prepared to lose.
And in neurosurgery, with the big tumors We lose those battles as often as we succeed.
The key, though, win or lose, is to never fail.
And the only way to fail is not to fight.
So you fight until you can't fight anymore.
Word's getting around.
You're gonna have a full gallery.
Everybody wants to see the show.
You feeling good, confident? You're not worried, are you? Are you worried? This is where you leave me, Dr.
You okay? Do you need anything? I'm fine.
I'm great.
I just Prep alone, so I will see you on the other side.
We are doing this, okay? We're doing this.
If she's awake, she'll tell you for the 15th time to save her child's life, not hers.
Listen to her, let her say her piece, then you do what needs to be done.
I don't think that I can do No, I know I can't.
You can.
- Nicole.
- You will.
Let's get you inside now, okay? Okay, I have everything set up.
You will have all of your films, your favorite scrub nurse What is happening? I'm being a superhero.
O Kay.
There's a scientific study that shows that if you stand like this in superhero pose for just five minutes before a job interview or A big presentation or a really hard task, you will not only feel more confident, you will perform measurably better.
Seriously? Seriously.
You feel it? We're superheroes.
We are superheroes.
Hold up your head and enter the arena and face the enemy.
Fight until you can't fight anymore.
Never let go.
Never give up.
Here's the plan.
We're gonna embolize the tumor to see if we can reverse the effects on mom's circulation.
And if not, then I'm afraid Where's Herman? Never run.
Never surrender.
Glenda's platelet count is critically low, so we need to give her six packs of platelets to avoid liver capsule bleeding.
And then we'll perform the fetoscopy to reverse the cascade You keep saying "we," but I only see you.
- Where the hell is Herman? - She's not coming.
What do you mean she's not coming? Fight the good fight.
Start the clock, please.
You fight Ten blade.
Even when it seems inevitable That you're about to go down swinging.
So This is a regular thing.
You all come up here and you watch surgeries.
Why? Not just surgeries the big surgeries, the whale surgeries, the rare ones, the crazy ones.
I mean, you're on the edge of your seat.
The patient could die.
This is life or death.
The adrenaline, the rush Okay, so you watch, like, the worst day of a person's life like a movie.
No, not like a movie.
That's insulting.
This is not entertainment.
" Oh, okay.
This is where the - good part starts.
- Shh.
Excuse me.
Ah, thanks for saving my seat.
I almost got my arm torn off, but, uh, your timing is excellent.
Ah, the dye's coming in.
It's kickoff time.
Let's go ahead and inject the dye.
Lights, please.
What does the dye do? Oh, the dye makes the whole tumor glow so that we can see where the tumor ends and where the brain begins.
Nice to see you face-to-face.
Now you have to go.
Bipolars, please.
This is my favorite part.
Yeah, I thought only the tumor was supposed to glow.
That is the tumor.
Oh, we are not in Kansas anymore.
The baby's anemic.
Let's transfuse him.
of irradiated PRBC.
Robbins, we need to get in and out.
Glenda's pressure is through the roof.
Well, if we don't stop this bleeding, the baby will die.
And the idea is to save both of them, and I think that I can do it.
Do you think, or you know? I know I can.
Robbins, I respect you and consider you a friend, so it is with kindness when I tell you that you're only half a fetal surgeon, not even.
- You're half a fellow.
- You brought this patient to me.
No, I brought this patient to your boss.
I have spent the past that Dr.
Herman knows pounded into my brain.
Do you hear yourself? You want her hands, you have them right here.
- 22-gauge needle.
- Here you go.
Hey, Chief, any chance you could lose me tonight? What? No.
Oh, I just thought that it's kind of quiet down here, and now Dr.
Herman's surgery is happening.
Every other resident is watching that surgery.
I'm sorry you pulled the short straw, - but I need someone down here.
- Oh, so, wait.
I'm gonna be the only resident who's down here? Just you.
I'm counting on you to hold down the fort.
- Can I do that? - Yes.
I'm your girl.
Thank you.
Hunt, you pushed my meniscus tonight.
- What, uh what gives? - I needed the O.
Shepherd has taken Dr.
Herman up for her brain surgery.
Wait, Dr.
Herman's going in now? I thought she had another month.
Right here.
It's invaded the chiasmatic cistern a little.
Shepherd is examining the margins of the tumor.
Who's subbing in for you? - I'm sorry? - We're gonna be here for another 14 hours, probably more.
Definitely more.
You know the protocol Over 12 hours, have another resident sub in to replace you so you can recharge, rest, and return.
Who's subbing in for you? Hey, I have been planning this for months.
There's kind of no substitute for me.
Well, then there's no substitute for me, either.
If you're here, I am here.
We're superheroes.
I mean, I'd do the thing with the hands on the hips, but I can't break scrub.
Retract here, please, Edwards.
It's not working.
I can't embolize all the vessels.
I handpicked you.
And you are letting me down.
- I need to open her up.
- Oh, absolutely not.
We'd have to increase Glenda's anaesthesia, and He's got persistent decels.
I'm not just questioning your abilities.
Now I'm questioning mine.
All right, I could open her up, exteriorize the uterus and then resect the entire tumor.
The prolonged anaesthesia could be catastrophic to both mom and baby.
If you're gonna open her up, - then you should go ahead and deliver.
- No.
It's not an option.
This is mirror syndrome, Robbins.
You know that.
The sicker the baby gets, the sicker Glenda gets.
We deliver, Glenda will get better.
I said it's not an option.
He's not far enough along.
He won't survive.
Page Alex Karev.
Wait, stop.
What are you doing? We're delivering this baby.
It's not gonna be easy, but Karev may be able to keep him alive once he's out.
Put that phone down.
Bailey, I can do this.
Arizona, your mentor is on an O.
table right now with her skull open and you think you have something to prove.
Well, I'm not gonna let you do that with this patient.
You want to open her up? Well, do it, but we are delivering this child.
Page Dr.
Shepherd is now cutting the tumor away from the gyrus rectus.
Gyrus rectus? The area responsible for our sense of smell.
I thought Arizona would be here.
She's in surgery.
- Wait, fetal surgery? By herself? - Shh! Oh, relax.
It's not the ballet or whatever.
Though though it is a kind of a dance.
There's grace, a rhythm An elegance.
Oh, okay.
I got shushed, but the purple prose is fine.
Shh! Okay.
She is gonna pull it off, though, right? Yes.
Yeah, she will.
Shepherd is now clearing the tumor away from the midbrain structures The fornix, the thalamus.
It shouldn't be taking this long.
We're behind.
Uh, using extreme care not to violate the interior commissure.
Shepherd calls this the dream box.
Grey, I'm sorry, but "dream box"? Where we create dreams and memories and discern shapes and colors.
Read a book, for God's sake.
Webber, you okay? Oh, I'm fine.
Her shoulders are tense.
Something's bothering her.
Maybe you'll get lucky and you'll snip out the part that makes her kind of bitchy.
Why would you say that? - I was it was a joke.
- Well, you're right.
I screw this up, Nicole Herman will no longer be bitchy.
She'll no longer be able to laugh, either, or be a surgeon.
She will no longer be Nicole Herman.
She won't be anything anymore, and you want to make jokes about that? No, I'm You're right.
- Damn it.
Damn it.
- What is it? I can't get around the fornix without hitting the hypothalamus.
Well, can you move laterally to avoid it? There's not enough carotid to mobilize.
I'm trapped.
Her sats are dropping.
She's hypoxic.
Robbins, it's not going to get better.
Okay, okay.
There we go.
Oh, crap.
It's stuck.
The tumor's too big.
Hey, sorry.
I would have been here sooner.
- But I was already at home.
- Well, you should have stayed at home.
- What? - Nothing.
She's pouting.
I can't get it from this the angle.
If I force it, it ruptures.
I need I need to widen the incision.
You have to widen it anyway.
Karev's here.
- We're delivering.
- We're not delivering.
He's not viable.
I can do this.
It'll be just like last time.
What do you mean last time? We did one of these before.
Herman wasn't available, so we decided to deliver and remove the mass after.
I knew it.
I knew it.
- That was entirely different.
- Sounds the same to me.
You're trying to prove that you're Herman.
I thought you had something.
I thought you were special.
Just do the "C," Robbins.
I'll keep him alive.
I thought you would be better and in less time.
But today? Today, you embarrassed me.
Excising the tumor.
- Gonna need lots of kellies.
- Robbins, listen to me.
Do the right thing.
- Deliver this child.
- I don't have time for you to catch up.
I don't have time for three strikes.
Something like this happens again, you're out.
Stop it.
Stop talking.
Stop it right now! You're right, Dr.
I am not Dr.
I am Dr.
Robbins, and I am the fetal surgeon here.
And I have chosen to do this procedure, and there was a point at which you could no longer be on board, but that point is long gone.
I am in the middle of a woman's uterus.
And any slip I might make could result in catastrophic blood loss.
And and if I slip, it will be because you were screaming in my ear and not because I don't know what I'm doing.
You either need to get on board and shut up or you need to get the hell out.
I mean, she sounds like Dr.
She hasn't moved a muscle in 15 minutes.
- What do you think it is? - I don't know.
But her game face is slipping.
- Yeah, maybe I should - Hmm? April.
I'm not working.
I'm I'm just I'm not ready to work yet.
No, no, no, it's fine.
I'm just I'm glad to see you.
I'm just gonna sit.
Herman was with me on my worst day.
I just wanted to be with her for hers.
How's this going? Uh, she's trying to dissect around the fornix.
But she still has a long way to go.
So, why are they not operating? Dr.
If I go any further posteriorly, I violate the hypothalamus.
If I take a lateral approach, I hit the carotids.
If I go inferiorly and I wreck her optic apparatus - You could - I am lost here.
I am lost in the forest.
There is no clear path.
Just pick a path, and you will be fine.
I am trying to find a way to keep her whole, Edwards.
I can't move without letting a piece of her go.
What do you need? I thought I could help, maybe be a sounding board.
We could work through whatever it is you're stuck on.
Kill the intercom, please.
Webber, step over here, please.
Edwards, would you mind taking a step back? You can be a big help.
I need you to call my brother.
Tell him he needs to get on a plane.
He's in D.
, so if he goes now, he could be here in, - what, six hours, seven? - I'm not sure that's the best idea.
I am in over my head.
I made a mistake.
I took on an impossible task, and my hubris is going to kill her.
Get him on the phone.
Get him on a plane.
Get him here.
This is taking way too long.
Uh, mom needs increased ventilatory support.
Robbins, come on.
That baby's right there.
- I've got this.
Let me have him.
- Ligating the last artery.
We've lost the fetal pulse.
Is the cord compressed? No.
He's in cardiac arrest.
Put your hands under him just like this.
Now apply pressure on the wound.
He won't break, okay? Just hold him there and keep his chest up.
Good, good, good.
Just like that.
All right, push five micrograms of epi while I start compressions.
Oh, dear lord.
You know what you're doing.
Please just call him.
I'm not even halfway through.
If I can't get past this step You have it in your head that he's better than you.
But it isn't true.
I've seen him standing exactly where you are now, staring at an impossible spinal tumor, terrified, unsure where to go next.
I know that tumor.
He's got it hanging on their bedroom wall.
A drawing, not the actual tumor.
- He found a way.
- Yes.
Which is why I need him here.
Shepherd, I can tell you right now what would happen if I called your brother.
He would hop on a plane, and seven or eight hours from now, if she hadn't already herniated, Derek would come in here and he would take this surgery, your surgery, away from you.
Then he would kill her.
Because this is your plan.
He wouldn't know where you've already been or where you need to go next.
You are on your own here.
No one can help you, and you do not need them to.
He's not here.
You are.
Now what's next? Robbins, he's not coming back.
Karev, shut your damn mouth.
It's okay.
It's okay.
Come on, baby.
Oh, come on.
You can let go now, Bailey.
It's time to put him back in.
Uh, uh - He's not even - I held him in my hands.
He's not even born, and I held him in my hands.
I know that feeling.
It's privilege, great privilege.
Navigation probe.
Edwards, you're on.
Intercom, please.
Shepherd is identifying the lamina terminalis so that she can go around the commissure, laterally dissecting away from the perforated arteries.
Can you avoid splitting the fornix? - I sure as hell hope so.
- So far, so good.
Keep going.
Find your way out.
How you feeling, Edwards? Good.
I'm good.
You sure? I can try and find someone if you need a break.
You're not gonna find a better assist than me.
I earned this spot.
If Dr.
Shepherd is here, I am here.
This is the point of no return.
Once we start this, we don't stop until the last of this tumor is gone.
Are you ready? - Are you? - Smartass.
Here we go.
Glenda's not out of the woods, but her numbers were definitely improving.
I'm gonna head up to the ICU and keep an eye on her.
You did good, Robbins.
I wasn't trying to pick a fight in there.
It's just, from where I was standing Six months ago, I would have picked the same fight.
Well, for what it's worth, Herman picked the right person to pass the torch to.
She's not passing anything.
She hasn't gone anywhere.
I think I cleared the optic nerve.
That wasn't so hard.
No comments from the peanut gallery.
We are going radioactive, folks.
Let's get this room turned over.
All non-essential personnel, hit the street.
Non-essential means you, Dr.
I appreciate you coming down here.
You have no idea.
I'm happy to stay.
Edwards and I have it from here.
Right, Edwards? Edwards? - Whoa.
- Oh! I'll get the O2.
Hold her head.
Or maybe you could scrub in.
All she has to do now is place her radioactive seeds.
They'll kill whatever tumor cells are left behind and keep them from coming back.
Well, I'm happy to help.
I'm just saying, "why me?" She needs an assist who she doesn't have to worry about.
And if I remember correctly, you were this close to specializing in neuro.
Well, I haven't been that resident in a very long time.
Have her back.
She just needs to feel you're there.
She'll do the rest.
Damn it! Damn it! I just got here.
I haven't had a chance to screw anything up yet.
I need to be able to place these seeds precisely if I'm gonna prevent the tumor from recurring.
I had a pre-op map to help identify my landmarks.
But with a tumor this big, everything will move after you resect, like a mudslide or an earthquake.
I didn't count on this much intracranial shift.
I'm gonna have to use the ultrasound to map out the shift and then morph it back into the pre-op plan.
Okay, so you're pretty much eyeballing it.
Yeah, pretty much.
Sounds like a plan.
Let's do it.
How long have they been at it? Six minutes.
They've only placed three seeds.
Even with the gloves and the vests, they can only be exposed to that level of radiation for, what, another 20 minutes? She needs to move faster.
I need to move faster.
These gloves are so thick, I can't feel what I'm doing.
You're doing fine.
It's not a race.
Except that it is.
Amelia, what are you doing? - Shepherd, what are you doing? - It's so much easier like this.
You're exposing yourself to direct radiation.
You need to put that glove back on right now.
- Amelia.
- It's fine.
I got it.
I got it.
Robbins, you're not gonna hear this from me too often, so savor it.
You did very, very well in there.
Oh, I'm so touched, I could cry.
I am exhausted.
You'd think a tumor would give you extra energy or something.
Mm, I wouldn't.
Mm, maybe not.
We're getting down to it, Robbins the final stretch.
After those dozen cards, that's it, we're done.
You'll have completed a yearlong fellowship in less than six months, and I'll have kicked the bucket.
I knew I picked the right horse when I picked you.
Yeah, please don't call me a horse.
It really is an accomplishment.
Not just to do it, but to become as good as you have become.
It's a real exercise in perseverance.
Really something to be proud of.
Thank you.
I'm not talking about you.
I'm talking about me.
You were a complete disaster when we started.
But I persevered, and after all of my hard work, you are actually becoming a fetal surgeon.
I deserve a medal.
Arizona? Hey.
You okay? Yeah.
I heard you flew solo tonight.
I did.
How did it go? - Great.
- That's Congratulations.
Thank you.
I looked for you in Shepherd's gallery.
She's still at it if you want to head up.
- I can't go up there.
- Okay.
I want to, but I can't watch.
I just can't.
Over the past four months, that woman beat the hell out of me, trying to shove every piece of knowledge and experience into my head, and she did.
It's there, all of it.
She's in my head.
But I'm I'm not ready for my head to be the only place that she exists.
Grey, stop her.
She needs to put that glove back on right now.
She's almost done.
She has a Without the glove, she's cutting her exposure time in half.
She's over her limit.
Shepherd! Hunt, if I don't place these seeds, the tumor recurs, and everything I have done for her counts for nothing.
You're gonna make yourself sick.
Amelia, he's right.
The tumor could recur anyway.
But it won't be because of me.
Shepherd, put on the glove! Amelia.
I'm done.
Get this gear out of here, bring back the troops.
It's time to close.
- That was - Really dumb? No, badass.
Hey, um, I've got a post-op abdominal-wall reconstruction in the ICU.
Do you mind if I run up and check on him before we head home? Yeah, sure.
I'll just I'll hang here.
- I'll be fine.
- Okay.
Hey, you've been out for hours.
Wait, what? Congratulations, Dr.
You were in surgery Doesn't really happen anymore with hospital regulations.
Your class doesn't get a chance to build up that kind of stamina.
- I missed it? It's over? - Oh, no, no.
It's not over.
They're They're still closing.
Uh, no.
Now, you you lay back.
Let me get you some water.
Thank you.
How are you doing? Just need to get the dura closed with a watertight seal.
This is the easy part.
Which anyone else can do, so why don't you let someone else take this? Dr.
Shepherd, I'm here.
I'm I'm back.
I'm good to go.
Just please tell me it's not too late.
No, Edwards.
You're just in time.
You can finish closing.
Really? You started this with me.
You should finish it.
Don't let Edwards screw up the stitch, okay? I don't want Herman seeing a big ugly scar every time she looks in the mirror.
Not a problem.
Hey, Glenda.
You just about ready to go? Oh, my God.
So ready.
And no offense, but I am so done looking at this boring room.
Well, enjoy the fresh air while you can.
I will see you in a month for your post-op checkup.
In the meantime, rest.
Take it easy, eat well.
Thank you so much.
Well, don't hug me.
Robbins saved both your life and your son's.
Um I don't know if you guys can tell me, but How's Dr.
Herman? Dr.
Shepherd is identifying the lamina terminalis so that she can go around the commissure.
Go home.
I need to figure this out.
No, you need to take a break.
There's no swelling, no edema.
I don't know why she's not awake.
It could be any number of reasons.
Don't tell me what it could be.
Don't you think I know every possible thing it could be? I'm sorry.
I just need I know.
You need it to be over.
I need her to wake up.
Is that What? I don't know.
It's it's probably nothing.
It's tiny.
What? Is that a small lacunar infarct right there? Did she have a stroke? Good work, Edwards.
She's gonna wake up.
She might.
But if she doesn't, I'm gonna have to make some decisions.
And you did this for Mark.
I did.
But you're not gonna have to, okay? I can't do this by myself.
I can't make that call.
And I know what she wants.
But I don't think that I can make that call.
Hey, you are not by yourself, okay? You're not alone, do you hear me? It's okay.
Mommy? Is that you, Mommy? God, I'm fine.
I'm fine.
Do you know where you are? - The same place I always am.
- What's your name? Uh, that hasn't changed, either.
Squeeze my finger.
And here.
Gross motor functions intact.
Follow the light, okay? - How are you feeling? - Shh.
Hey, it's all right.
It's okay.
I'm okay.
You got it all, didn't you? Edwards, did she get all of it? Yeah.
She got all of it.
Hey, no crying in here.
Crybabies out.
Gentlemen, looking good.
So are you.
So far, so good.
Oh, we're glad to hear it.
Shepherd did an amazing job.
Yeah, yeah.
I brought the tumor.
That made her look pretty good.
Give us a second, would you? Robbins and I have some work.
Why don't we step outside, give them a moment? I will be back soon.
- We will need a full work-up.
- Yes, ma'am.
Good to have you back.
Tell me about Glenda Castillo.
Um Glenda is recovering well, and, uh, she's still pregnant.
The baby's doing well, too.
I knew I picked the right horse.
Please stop calling me a horse.
Uh, I knew it.
I knew you would not let me down.
I had no doubt.
Can you see anything? Anything at all? No.
Completely blind.
- You better not be crying.
- I'm not.
Are you all right? I don't know.
It'll take a while to sink in.
I don't think you're gonna want to be around me when it does.
That will be ugly.
I will be.
If you want me to, I'll You're missing the point.
You're so thick, Robbins.
You're always just to the left of the point.
The point is I'm going to get to figure it out.
Something is going to happen next.
The point is I'm alive.
And I wouldn't be if you hadn't been such a pain in my ass.
I picked the right horse.
Why do we even try when the barriers are so high and the odds are so low? Why don't we just pack it in and go home? It'd be so, so much easier.
It's because, in the end, there's no glory in easy.
We were so close.
We were more than close, Edwards.
Herman lost her sight to her tumor.
We took revenge on the tumor by killing it, by tearing it out and decimating it and decreasing its odds of killing Nicole by 100%, by sending death running like a crying bitch, by telling death to screw himself That is the battle.
And it is the only battle worth fighting.
You should be on a high right now.
And you should be chasing that high for the rest of your life.
You defeated death.
Mere mortals cannot do that.
Only we can.
No one remembers easy.
Only superheroes.
They remember the blood and the bones and the long, agonizing fight to the top.
Only freaking superheroes.
And that is how you become Legendary.

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