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The game -- they say a person either has what it takes to play or they don't. My mother was one of the greats. Me, on the other hand -- I'm kind of screwed. This is, uh... Humiliating on so many levels. You have to go. Why don't you just come back down here, and we'll pick up where we left off? No, seriously. You have to go. I'm late, which isn't what you want to be on your first day of work, so... So, uh, you actually live here. No. Yes, kind of. It's nice -- a little dusty -- odd, but it's nice. So, how do you kind of live here? I moved two weeks ago from boston. It was my mother's house. I'm selling it. Oh, I'm sorry. For what? You said "was." Oh, my mother's not dead. She's -- You know what? We don't have to do the thing. Oh, we can do anything you want. No, the thing -- exchange the details, pretend we care. I'm gonna go upstairs and take a shower, okay? And when I get back down here, you won't be here, so, um... goodbye, um... Derek. Derek. Right. Meredith. Meredith. Yeah. Mm-hmm. - Nice meeting you.
- Bye, Derek. Each of you comes here today hopeful, wanting in on the game. A month ago, you were in med school, being taught by doctors. Today... you are the doctors. The 7 years you spend here as a surgical resident will be the best and worst of your life. You will be pushed to the breaking point. Look around you. Say hello to your competition. Eight of you will switch to an easier specialty. Five of you will crack under the pressure. Two of you will be asked to leave. This is your starting line. This is your arena. How well you play... that's up to you. Like I said... I'm screwed. Okay, Martin, Robinson, Bond, Hawkins. Only 6 women out of 20. Yeah. I hear one of them's a model. Seriously, that's gonna help with the respect thing? - You're Cristina, right?
- Patton, Monroe... Which resident are you assigned to? I got bailey. The nazi? Me too. You got the nazi? So did I. At least we'll be tortured together, right? I'm George O'malley. Uh, we met at the mixer. You had on a black dress with a slit up the side, strappy sandals... Now you think I'm gay. No, I'm not gay. It's -- it's just that you were -- you were very unforgettable. O'malley, Yang, Grey, Stevens. And I'm totally forgettable. - Bailey?
- End of the hall. That's the nazi? I thought the nazi would be a guy. I thought the nazi would be a nazi. Maybe it's professional jealousy. Maybe she's brilliant, and they call her a nazi because they're jealous. Maybe she's nice. Let me guess -- you're the model. Hi, I'm Isobel Stevens, but everyone calls me "Izzie." I have five rules. Memorize them. Rule number one -- don't bother sucking up. I already hate you. That's not gonna change. Trauma protocol, phone list, pagers -- nurses will page you. You will answer every page at a run -- a run -- that's rule number two. Your first shift starts now and lasts 48 hours. You're interns, grunts, nobodies, bottom of the surgical food chain. You run labs, write orders, work every second night until you drop, and don't complain. On-call rooms -- attendings hog them. Sleep when you can where you can, which brings me to rule number three. If I'm sleeping, don't wake me unless your patient is actually dying. Rule number four -- the dying patient better not be dead when I get there. Not only will you have killed someone, you would have woke me for no good reason. We clear? Yes? You said five rules. That was only four. Rule number five -- when I move, you move. Get out of my way! What do we got? Katie Bryce, 15-year-old female, new onset seizures, intermittent for the past week. I.V. lost en route, started grand mal seizing as we descended. All right, get her on her side. Izzie, 10 milligrams diazepam I.M. No, no. The white lead is on the right. Righty, whity -- smoke over fire. A large-bore I.V. Don't let the blood hemolyze. Let's go! What do we have? A wet fish on dry land. Absolutely, Dr. Burke. Dr. Bailey, let's shotgun her. That means every test in the book -- C.T., CBC, chem-7, tox screen. Cristina, you're on labs. George, patient work-ups. Meredith, get katie for a C.T. She's your responsibility now. Wait. What about me? Honey, you get to do rectal exams. What are you doing here? Katie Bryce's labs came out clear. There's nothing in the results that explain her seizures. - I just thought you wanna know.
- Okay. I heard every year, the attending on call picks the best intern and lets them perform a procedure during the first shift. I'm just saying it's what I heard. Go away... now. Yeah, sounds good. He'll be fine? You'll be fine. If you don't count the fact that my bacon days are over, sure. So, bypass surgery tomorrow with Dr. Burke -- I hear he's good. And, after that, you can have all the bacon-flavored soy product you can eat. Mmm. Kill me now. I wish I could, but I'm a healer. You're lost. I'm not lost. How are you feeling? How do you think I'm feeling? I'm missing my pageant. You're missing your pageant? The spokane teen miss. I was in the top 10 after the first 2 rounds. This is my year. I could have won. Hello. You're so lost. What are you, like, new? Okay, so I'm just gonna insert my fingers into your rectum. No. Out. Out. Bet you missed a lot when you first started out. I twisted my ankle in talent rehearsal. I do rhythmic gymnastics, which is, like, really cool. Nobody else does it. And I tripped over my ribbon. And I didn't get stuck with someone this clueless, and that was, like, a nurse. You and I are gonna have so much fun together. This shift is a marathon, not a sprint. Eat. I can't. You should eat something. You try eating after performing 17 rectal exams. The nazi hates me. The nazi's a resident. I have attendings hating me. You know Meredith is inbred? Like it's uncommon around here to be a doctors' parents -- No, royally inbred -- her mother is Ellis Grey. Shut up. The Ellis Grey? Who's Ellis Grey? The Grey Method. Where'd you go to med school -- Mexico? She was one of the first big chick surgeons. She's a living legend. Yeah, she won the harper avery twice. So I didn't know one thing. Talk about parental pressure. God, I would kill to have Ellis Grey as a mother. I'd kill to be Ellis Grey. All I need is one good case. Katie Bryce is a pain in the ass. If I hadn't taken the hippocratic oath, I'd kevorkian her with my bare hands. What? Good afternoon, interns. It's posted, but I thought I'd share the good news personally. As you know, the honor of performing the first surgery is reserved for the intern that shows the most promise. As I'm running the O.R. today, I get to make that choice. George O'malley. Me? You'll scrub in for an appendectomy this afternoon. Congratulations. Enjoy it. Did he say me? I've seen his file. George O'malley barely made the cut to get in this program. He's not your guy. He's my guy, all right. Every year, you pick your guy, and every year, your guy suffers more than any other intern. Terrorize one, and the rest fall in line. I get it, I respect it, but George O'malley's a puppy. - Katie Bryce -- 3604?
- It's right there. Thank you. Katie, honey, mom and dad are here. They gave her a sedative for the C.T. scan, so she's a little groggy. Will she be all right? Our doctor at home said that she might need an operation. Is that true? What kind of operation? She's, um -- well... You know what? I'm not the doctor. I'm a doctor, but I'm not Katie's doctor, so I'll go get him for you. What? Katie's parents have questions. Do you talk to them, or do I ask Burke? No, Burke's off the case. Katie belongs to the new attending now, Dr. Shepherd. He's over there. Dr. Shepherd. Dr. Shepherd? This morning, it was Derek. Now it's Dr. Shepherd. Dr. Shepherd, we should pretend it never happened. What never happened -- you sleeping with me last night, or you throwing me out this morning? Because both are fond memories I'd like to hold onto. No, there will be no memories. I'm not the girl in the bar anymore, and you're not the guy. This can't exist. You get that, right? You took advantage of me, and now you want to forget about it. I was drunk, vulnerable, and good-looking, and you took advantage. Okay, I was the one who was drunk, and you are not that good-looking. Maybe not today. Last night, I was very good-looking. I had my red shirt on. You took advantage. - I did not take advantage.
- Want to take advantage again -- say, friday night? No. You're an attending, and I'm your intern. Stop looking at me like that. Like what? Like you've seen me naked. Dr. Shepherd, this is inappropriate. Has that ever occurred to you? Open, identify, ligate, remove, irrigate, close. Open, identify, ligate, remove, irrigate, close. He's gonna faint. He's a fainter. No, code brown, right in his pants. He's all about the flop sweat. He's gonna sweat himself unsterile. 10 bucks says he messes up the mcburney. $15 says he cries. I'll put $20 on a total meltdown. $50 says he pulls the whole thing off. That's one of us down there, the first one of us. Where's your loyalty? - $75 says he can't even I.D. the appendix.
- I'll take that action. Okay, O'malley, let's see what you can do. Here it comes. Scalpel. Scalpel. That burke is trouble. More pressure. The human flesh is a tough shell. Dig in. Pickups. Pickups. Clamp. Clamp. I'm there. Damn, he got the peritoneum open. I'm out. I told you -- he's gonna pull it off. Scalpel. Scalpel. Appendix is out. Not bad. Thank you. Now all you have to do is invert the stump into the cecum and simultaneously pull up on the purse strings, but be careful not to... break them. You ripped the cecum. You've got a bleeder. You're filling with stool. What do you do now? Uh... Think. You start the suction, and you start digging for those purse strings before she bleeds to death. Give him a clamp. B.P.'s dropping. He's choking. Come on, George. Today. Pull your balalls out of your back pocket. Let's go. What are you waiting for? Suction. Getting too low, folks. Dr. Burke. Get out of the way. Pansy-ass idiot. Get him out of here. Suction. Clamp. - He's 007.
- 007, yep. - A total 007.
- What's "007" mean? License to kill. 007. They're calling me "007," aren't they? - No one's calling you 007.
- No one's calling you 007. On the elevator, murphy whispered, "007." How many times do we have to go through this, George? 5, 10? Give me a number, or else I'm gonna hit you. Murphy whispered, "007," and everyone laughed. He wasn't talking about you. Are you sure? Would we lie to you? Yes. 007 is a state of mind. Says the girl who finished first in her class at stanford. Oh, man. It's 911 for Katie Bryce. I got to go. Maybe I should have gone into geriatrics. No one minds when you kill an old person. Surgery is hot. It's the marines. It's macho. It's hostile. It's hard-core. Geriatrics is for freaks who live with their mothers and never have sex. I've got to get my own place. Excuse me! Excuse me! Took you long enough. You're okay? The nurse paged me "911." I had to go all "exorcist" to get her to even pick up the phone. Wait. There's nothing wrong with you? I'm bored. You little... - I'm not a cruise director.
- You don't have to wig out. The pageant's supposed to be on cable, but this crappy hospital doesn't get the channel. If that cow kylie wood is gonna walk off with my crown, I have to see it. Can you call someone? Okay, this is an actual hospital. There are sick people here. Go to sleep, and stop wasting my time. But I can't sleep. My head's all full. That's called "thinking." Go with it. What do you need? Mr. Jones has junky veins, and he really needs antibiotics. I should start a central line. So start one. You don't know how. I've never done one. Well, you know what that means. Can't we just page someone else? She's the on-call resident. Okay. Okay, I'll just -- I'll wake her. - Dr. Bailey, I don't mean to bother you.
- Then don't. - It's mr. Jones.
- Is he dying? No. Then stop talking to me. What is it?! Next time you wake me, he better be so close to dead, there's a tag on his toe. Here. Take these to the lab. 4-b's got post-op pneumonia. Let's start antibiotics. Are you sure that's the right diagnosis? Well, I don't know. I'm only an intern. Why don't you go spend 4 years in med school and then let me know if it's the right diagnosis? She's short of breath. She's got fever. She's post-op. Start the antibiotics. God, I hate nurses. I'm Alex. I'm with Jeremy. You're with the nazi, right? She may not have pneumonia, you know? She could be splinting, or have a P.E. Like I said, I hate nurses. What did you just say? Did you just call me a nurse? Well, if the white cap fits. Damn it, Katie. Is she seeing anybody? I don't know. She's hot. I'm friends with her. I mean kind of friends -- not actually friends, exactly, but we're tight, and we hang out -- really, only just today. - Dude.
- Dude, stop talking. What took you so long? She's having multiple grand mal seizures. Now, how do you want to proceed? Dr. Grey, are you listening to me?! She's got diazepam -- 2 milligrams lorazepam -- I just gave the second dose. Dr. Grey, you need to tell us what you want to do. Dr. Grey! - Okay, she's full on lorazepam?
- She's had 4 milligrams. You paged Dr. Bailey and Dr. Shepherd? Lorazepam's not working. Phenobarbital -- load her with phenobarbital. Pheno's in. No change. - You paged Dr. Shepherd?
- I just told you. Well, page him again, stat. What do you want to do? Dr. Grey, you need to tell us what you want to do. - Heart stopped.
- Code blue! Code blue! Code blue! Code blue! Wait. Charge the pads to 200. Charge. Clear. Still v-fib. Nothing. Charging. 19 seconds. Charge them to 300. 300. Anything? 27 seconds. Charge to 360. Come on, Katie. 49 seconds. At 60 seconds, you're supposed to admin her another drug. Charge again! Charge again. Anything? I see sinus rhythm. Blood pressure's coming up. All right. Pressure's returning. Rate's coming back. What the hell happened? She had a seizure, and her heart stopped. You were supposed to be monitoring her. - I checked on her --
- I got her. Just -- just go. Somebody give me her -- give me her chart, please. You get a 911, you page me immediately, not in the 5 minutes it takes you to get to the emergency, immediately. You're on my team, and if somebody dies, it's my ass. Meredith? You tell anyone, ever... You said it was a seizure disorder. Now you're saying it isn't? I'm saying that I don't know. What do you think it could be? I don't know. When will you know? I don't have an answer for you. - For now, Katie is stable, and --
- Wait one damn minute. We came here because this hospital is supposed to be the best in washington. That's my kid in there -- my kid -- and you have the audacity to stand here and tell me, "I don't know." Mr. Bryce -- No, I want someone else, a doctor who knows what they're doing. You get me someone else, someone better than you. Mr. Bryce, I assure you that I am working hard on Katie's case. No, you're not. If you were, you'd be able to give me some answers. I put you on the bypass machine, which pumps blood for your heart. Fix your ticker, take you off the machine -- I'm done -- simple procedure. So I shouldn't worry? I'm very good at what I do. But still it's surgery. There are some risks. I'll see you in the O.R. this afternoon, Mr. Savitch. You're not gonna leave me alone with that guy, are you? Oh, I'll be outside the O.R. the whole time. No, Dr. Burke is very good. Don't worry. I'll see you after. He'll be fine, right? Tony's gonna sail through it. You have nothing to worry about -- I promise. I gotta go. What are you doing? I'm suturing a banana with the vain hope that it wakes up my brain. What are you smiling at, 007? I'm sorry. I get mean when I'm tired. You know what? I don't care. I comforted a family, and I got to hang out in the O.R. today. All is well. Does anybody know why we're here? Well, good morning. I'm gonna do something pretty rare for a surgeon. I'm gonna ask interns for help. I've got this kid, Katie Bryce. Right now, she's a mystery. She doesn't respond to our meds. The labs are clean, the scans are pure, but she's having seizures -- grand mal seizures with no visible cause. She's a ticking clock. She's gonna die if I don't make a diagnosis, which is where you come in. I can't do it alone. I need your extra minds, extra eyes. I need you to play detective. I need you to find out why katie is having seizures. I know you're tired. You're busy. You got more work than you can possibly handle. I understand, so I'm gonna give you an incentive. Whoever finds the answer rides with me. Katie needs surgery. You get to do what no interns get to do -- scrub in to assist on an advanced procedure. Dr. Bailey's gonna hand you Katie's chart. The clock is ticking fast, people. If we're gonna save katie's life, we have to do it soon. Look, give the antibiotics time to work. The antibiotics should have worked by now. She's old. She's freaking ancient. She's lucky she's still breathing. I got a shot to scrub in downstairs on a patient that wasn't alive during the civil war. Don't page me again. Hey, I want in on shepherd's surgery. You've been the intern on Katie since the start. You want to work together? If we find the answer, we have a 50-50 chance of scrubbing in. I'll work with you, but I don't want in on the surgery. You can have it. You're kidding? It's the biggest opportunity any intern will ever get. I don't want to spend any more time with Shepherd than I have to. What do you have against shepherd? If we find the answer, the surgery's yours. Do you want to work together or not? Deal. So she doesn't have anoxia, chronic renal failure, or acidosis. It's not a tumor, because her C.T.'s clean. Are you seriously not gonna tell me why you won't work with Shepherd? No. What about infection? No, there's no white count, and she has no C.T. lesions, no fevers, nothing in her spinal tap. Just tell me. You can't comment, make a face, or react in any way. We had sex. What about an aneurysm? No blood on the C.T. and no headaches. Okay, there's no drug use, no pregnancy, no trauma. Was he good? I mean, he looks like he'd be good. Was it any good? We're out of answers. What if no one comes up with anything? You mean what if she dies? Yeah. This is gonna sound really bad, but I really wanted that surgery. She's just never gonna get the chance to turn into a person. The sum total of her existence will be almost winning miss teen whatever. You know what her pageant talent is? They have talent? Rhythmic gymnastics. Oh, come on. What is rhythmic gymnastics? I can't even say it. I don't know what it is. I think it's something with a ball and a -- What? Meredith, what? Get up. Come on. The only thing that she wouldpossibly need is an angiogram. Oh. Oh, Dr. Shepherd, just one moment. Katie competes in beauty pageants. I know that, but we have to save her life, anyway. She has no headaches, no neck pain, her C.T. is clean. - There's no medical proof of an aneurysm.
- Right. - But what if she has an aneurysm, anyway?
- There are no indicators. She twisted her ankle practicing for the pageant. - I appreciate you trying to help, but --
- She fell when she twisted her ankle, she fell. It was no big deal, not even a bump on the head. She got up, iced her ankle, and everything was fine. It was a fall so minor, her doctor didn't even think to mention it when I was taking her history, but she did fall. You know what the chance is that a minor fall could burst an aneurysm? One in a million -- literally. Let's go. Where? To find out if Katie's one in a million. I'll be damned. There it is. It's minute, but it's there. It's a subarachnoid hemorrhage. She's bleeding into her brain. She could have gone through her entire life without it ever being a problem. - One tap in the right spot...
- And it exploded. Exactly. Now I can fix it. You two did great work. Love to stay and kiss your asses, but I got to tell Katie's parents she's having surgery. - Katie Bryce's chart, please.
- Here you go. Dr. Shepherd, you'd said that you'd pick someone to scrub in if we helped? Oh, yes, right. I'm sorry I can't take you both. It's gonna be a full house. Meredith, I'll see you in O.R. Good. Thank you. Cristina... Wow, that was quick. His heart had too much damage to give him a bypass. I had to let him go. It happens -- rarely, but it does happen -- the worst part of the game. But I told his wife -- I told gloria that he would be fine. - I promised her that --
- You what? - They have four little girls.
- This is my case. Did you hear me promise? The only one that can keep a promise like that is god, and I haven't seen him holding a scalpel lately. You never promise a patient's family a good outcome! I thought... You're important enough to make promises to Mrs. Savitch? You get to be the one to tell her that she's a widow. Izzie. - Maybe Meredith couldn't --
- Izzie. - I'll tell him I changed my mind.
- Don't do me any favors. It's fine. - Cristina --
- You did a cutthroat thing. Deal with it. Don't come to me for absolution. You want to be a shark, be a shark. - I'm not --
- Oh, yes, you are. Only it makes you feel all bad in your warm, gooey places. No, screw you. I don't get picked for surgeries 'cause I slept with my boss, and I didn't get into med school 'cause I have a famous mother. Some of us have to earn what we get. Gloria, there were complications in the surgery. Tony's heart had a lot of damage. We tried to take him off bypass, but... there wasn't anything we could have done. What are you talking about? He... Tony died. He's dead. Gloria... I am so sorry. Please... go away. I promised I'd make her look cool. Apparently, being a bald beauty queen is the worst thing that happened in the history of the world. Did you choose me for the surgery because I slept with you? Yes. I'm kidding. I'm not gonna scrub in for surgery. You should ask Cristina. She really wants it. You're Katie's doctor. And on your first day, with very little training, you helped save her life. You earned the right to follow her case through to the finish. You shouldn't let the fact that we had sex get in the way of you taking your shot. I wish I wanted to be a chef or a ski instructor or a kindergarten teacher. You know, I would have been a really good postal worker. I'm dependable. You know, my parents tell everyone they meet that their son's a surgeon, as if it's a big accomplishment -- superhero or something. If they could see me now. When I told my mother I wanted to go to medical school, she tried to talk me out of it -- said I didn't have what it takes to be a surgeon, that I'd never make it. So the way I see it, superhero sounds pretty damn good. We're gonna survive this, right? She's still short of breath. Did you get an abg or a chest film? Oh, yes, sir, I did. And what did you see? Oh, well, I had a lot of patients last night. Name the common causes of post-op fever. - Uh, yes.
- From your head, not from a book. Don't look it up. Learn it. It should be in your head. Name the common causes of post-op fever. Uh... the common causes of post-- Can anybody name the common causes of post-op fever? Wind, Water, Wound, Walking, Wonder drugs -- the five W's -- most of the time, it's Wind -- splinting or pneumonia. Pneumonia's easy to assume, especially if you're too busy to do the tests. What do you think's wrong with 4-b? The fourth "W," "Walking." I think she's a prime candidate for a pulmonary embolus. How would you diagnose? Spiral C.T., V/Q scan, provide O2, dose with heparin, and consult for an IVC filter. Do exactly as she says, then tell your resident that I want you off this case. I'd know you anywhere. You're the spitting image of your mother. Welcome to the game. All right, everybody. It's a beautiful night to save lives. Let's have some fun. I can't think of any one reason why I want to be a surgeon... but I can think of a thousand reasons why I should quit. They make it hard on purpose. There are lives in our hands. There comes a moment when it's more than just a game... And you either take that step forward or turn around and walk away. I could quit, but here's the thing... I love the playing field. - It was good surgery.
- Yeah. We don't have to do that thing where I say something, and then you say something, and then somebody cries, and there's a moment. Yuck. Good. You should get some sleep. You look like crap. I look better than you. That's not possible. That was amazing. You practice on cadavers... you observe... and you think you know what you're gonna feel like, standing over that table, but... that was such a high. I don't know why anybody does drugs. Yeah. Yeah. I should, uh, go do this. You should. I'll see you around. See you around. See you. So... I made it through my first shift. We all did. The other interns are all good people. You'd like them... I think. I don't know -- maybe. I like them. Oh, and I changed my mind. I'm not gonna sell the house. I'm gonna keep it. I'll have to get a couple of roommates, but... it's home, you know? Are you the doctor? No. I'm not your doctor, but I am a doctor. What's your name? It's me, mom -- Meredith. All right. I used to be a doctor, I think. You were a doctor, mom. You were a surgeon. Transcript: RaceMan - Synchro: Amariss
