Richard: "Our schedule for several months now. Hospitals across the country have reported substantial savings..."
Derek: "How bad is it today?" he comes to stand next to where Sky is leaning against a nurses desk
Sky: "The chief's implementing a computer model for scheduling our surgeries from now on. Something about efficiency and progress."
Richard: "And to make sure this was the right decision, I have enlisted one of our own to do a trial run for the last month. Dr. Sloan." he moves over a little and Derek raises his eyebrows at the pair as he slowly moves closer to the board
Mark: "I know what you're all thinking. It's a machine. It doesn't know me. It doesn't know what I like. But after using this new system for the past month, I gotta say, people, I'm a convert. This computer knows me better than I know me."
Derek: "Chief, this thing has rearranged my schedule for the entire week. I mean, haven't we had enough change here already?"
Richard: "Change is good, everyone. Embrace it." he walks away as the crowd disperses
Bailey: "You two need to stop bickering. It's unattractive."
➿
Isaac: "Dr. Shepherd."
Derek: "Isaac, if you don't stop calling me Dr. Shepherd, I'm seriously gonna have to cut you off." he jokes
Isaac: "Right. Forgot. Derek."
Derek: "Thanks."
Isaac: "I have your scans, Derek."
Derek: "I didn't order any scans."
Isaac: "I think they're for a consult, but I can come back if you're busy."
Derek: "No, it's okay" Isaac puts a scan up for Derek to look at "Oh. It's a tumor on the spinal cord, possibly a hemangioblastoma."
Isaac: "You've seen one before?"
Derek: "Not this big. You see how the tumor has worked its way up the spine? It's taken over the blood supply."
Isaac: "Hmm."
Derek: "It's a perfect tumor. You know if the patient still has leg function?"
Isaac: "Yes."
Derek: "Incredible. He shouldn't be walking. He should be paralyzed, dead."
Isaac: "You'd have to operate quickly, then, to take the tumor out?"
Derek: "Oh, I'd love to operate on this. But, no. No, you have to cut the cord, paralyze the patient, to kill the tumor. Who's the doctor on this one?"
Isaac: "You."
Derek: "I'm sorry?" he chuckles a little
Isaac: "These are my scans. The tumor is mine. I'd like you to take it out. I'd like you to try. One doctor said it was bad circulation, another one, pinched nerve. But when the pain started to interfere with work, I decided to run an MRI on myself."
Derek: "Isaac, had I known this was your scan, I wouldn't have-"
Isaac: "I have been to every doctor, Derek. Every time, it's the same thing. They look at the tumor and they're defeated. But not you. You were inspired. That's why I know I was right to come and work here. I needed to meet you."
Derek: "You got a job here to meet me?"
Isaac: "I have researched every neurosurgeon in this country. I know their statistics, I know who wins the most prizes, but I also know who takes the most risks. That's you."
Derek: "Isaac, I know you believe I can take this tumor out, and I wish I could. But this surgery will kill you."
Isaac: "Take the scans. Look them over. But stop your mind before the part where it gets to "no." Think "yes." Yes?"
Cristina: "Shepherd, I've been paging you. Shunt patient, OR two" she looks up at the scans and moves closer to them "Screw the shunt. Let's operate on that."
➿
Mark: "You know what this is about, right?" he asks pacing a little behind Derek as he looks at the scans
Derek: "Mnh-mnh."
Mark: "You're no longer daddy's favorite, so you've gone in search of some crazy ass tumor to get his love back."
Derek: "Actually, it's about my patient. I haven't made up my mind yet. I'm just looking."
Callie: "Isaac has a cord tumor?" she asks coming into the room
Cristina: "Oh, it's awesome. Look."
Callie: "Awesome in a bad way. It's eaten five levels of his spine. Wait, you're not seriously considering trying to take it out?"
Cristina: "Of course he is. He's Shepherd."
Arizona: "It's a bad case of telophone, right? Isaac's got a bone spur or a herniated disk, not a..." Callie holds up the scans for her to see "He diagnosed an osteosarcoma case for me a month ago. I thought it was a shadow, but it turned out to be the tiniest little lesion on an x-ray."
Mark: "That says more about you than it does him."
Arizona: "I'm sorry. Do you even know who Isaac is?"
Mark: "No idea."
Lexie: "Hey, what's everyone...oh, a spinal tumor. I read about a case at Mayo where the surgery took 17 hours. The head surgeon had four rotating assistants, one of whom just administered fluids."
Cristina: "Okay, you know what? Don't try and Lexopedia your way on this. This is my tumor."
Arizona: "What happened to the patient at Mayo?"
Lexie: "He died. That's why it only took 17 hours."
Owen: "Hey, I just heard. Isaac has an inoperable tumor?"
Lexie: "It's Isaac's tumor?"
Cristina: "Okay, yeah, yeah. Boo-hoo, okay? Who says it's inoperable?"
Derek: "Cristina." he motions to the screens as a visual of the tumor comes up
Callie: "Oh, come on. It's all the way up to t-2."
Mark: "See, this is why I got into plastics."
Arizona: "Oh, that's gotta be..." they all start talking over each other when Richard walks past the room and comes inside
Richard: "Why aren't you all at your surgeries? Go, get to your ORs. Don't screw with my schedule on day one." he says as everybody but Derek walks out the room
➿
Sky: "Everyone said you'd found the great white of tumors, but just had to see it for myself." Derek comes into the room where Sky is looking at the scans
Derek: "And now that you have?"
Sky: "You want my fellow attending answer or my fellow surgeon answer?" she smiles at him
Derek: "Fellow surgeon."
Sky: "This tumor is dangerous...complicated...and smart...beautiful. This is like the holy grail of tumors. To successfully take out this tumor would be an achievement you could hang your hat on for the rest of your career. You could retire on this tumor." she says as he smiles at her a little
➿
Richard: "I wouldn't go near it. It's a beast. It's a malpractice suit waiting to happen, even if we could get his insurance to cover it."
Derek: "Did I mention he was an employee?"
Richard: "Our pro bono budget can't cover high-risk surgeries for every employee in this hospital. We're not a charity."
Derek: "What happened to you?" he stops him from walking out the room
Richard: "Excuse me?"
Derek: "There was a time you would've convinced me to do this surgery, but now your first instinct is no. What happened to you?"
Richard: "You came to me as the chief of surgery and I said no. As for my medical op inion, it is still no. There is such a thing as an inoperable tumor, Derek."
Derek: "What if it's not? What if I get in there, I open it up, I look around-"
Richard: "There is no way. Anything other than cutting the cord would kill this man. I don't know how many times you want me to say it. You are not operating on an inoperable tumor. It's a tough job, Derek. You sure you still want it?" he gives him a hard look before walking out the room
➿
Mark: "Word on the OR floor is that you've gone rogue." he comes over to the desk where Derek is at with Sky beside him
Derek: "I'm doing a surgery I fully believe in."
Mark: "To piss off the chief."
Sky: "Since when did you two become BFFs?"
Mark: "He's not my BFF. He's the chief."
Derek: "For now."
Callie: "Have you gone rogue?" herself and Arizona come over to the three and they stand on each side of him
Derek: "I'm doing a surgery I believe in."
Arizona: "Against the chief's orders. He'll freak when he finds out."
Derek: "There is a computer schedule saying that I'm doing craniotomies all day. He is not gonna find out."
Arizona: "No. Shh. Don't say anymore. 'Cause me, the chief, secrets? Bad idea." she whispers
Callie: "Hey, I think it is badass. Come on. Let's go."
Lexie: "Should I be offended? Because I've been trying to come up with a good reason why you paged every resident to the skills lab but me. Me. Your sister. Your sister, Derek."
Sky: "Pretty sure you're on my service."
Derek: "Little Grey, I didn't page you because I have another job for you. You gave me the idea, actually. I need somebody in the OR who's gonna remind me to take breaks, to bend my legs, to drink water. I will be your patient, essentially."
Lexie: "You want me to be your doctor?"
Derek: "If Dr. Rivers is okay with you giving up her services, of course." he says as they look over at Sky
Lexie: "I am your favorite here. You've said it before." she reaches over to grab Sky's hand
Sky: "Go get your rogue on." she nods her head as Lexie gives her a big smile before rushing off
➿
Derek: "Anybody opens their mouth and they're fired. You, too." they stop at a door where they're about to wheel Isaac to the OR and see Richard standing by the OR board with a group of people
Richard: "Oh, Dr. Shepherd, I was just describing our new schedule to some of our board members. This must be...Mrs. Taylor. And she's undergoing a craniotomy."
Derek: "It's Mr Taylor, cheif. It's..." he motions down to Isaac who nods at him
Richard: "We're, uh, still working out a few kinks, clearly."
Derek: "We should go. Keep the trains running on time. Nice meeting you all."
➿
Derek: "Isaac, if I get in there and it looks too dangerous to remove, the responsible thing is to close you back up."
Isaac: "No, don't close me up. If you get in and if it's too complicated, cut the cord. Paralyze me if you must. I survived a war. Did you know that?"
Derek: "No."
Isaac: "I survived a war where they put bodies into mass graves where there's once a playground. I survived the death of my family...my parents, my brothers and sisters. Then I survived the death of my wife and child when they starved to death in the refugee camp. I survived the loss of my country, of hearing my mother tongue spoken, of knowing what it feels like to have a place to call home. I survived. And I will survive the loss of my legs. If I have to, I'll survive it. Okay? But, Derek."
Derek: "Yes?"
Isaac: "There is always a way. When things look like there's no way, there is a way. To do the impossible, to survive the unsurvivable...there's always a way. And you? You and I have this in common. We're inspired. In the face of the impossible, we're inspired. So if I can offer one piece of advice to the world's foremost neurosurgeon...today if you become frightened...instead become inspired. Hmm? Okay. I'm ready now. Put me to sleep."
➿
Nurse: "1 hour 13 minutes on the surgical clock."
Derek: "The dura's opened. Let's get our first look at the tumor."
Jackson: "Wow. That's, um...wow."
Derek: "The vessels are more intricate than the MRI showed. There's no way I can get the tumor out without rupturing one and killing the cord."
Jackson: "So, uh, what do we do?"
Derek: "If I start t-2, I could avoid hitting the feeding vessels, so maybe I should go lower? There's less vascularity around t-7, so that does seem better, no?"
Jackson: "It does seem better. And you'd only get function loss below the chest."
Derek: "But I risk rupturing the anterior spinal artery there."
Lexie: "Probably. The tumor tapers off there."
Derek: "Higher is better maybe? Either way, I risk sending him into hemodynamic collapse."
Jackson: "He's not talking to us, is he?" he asks sotfly to Lexie after noticing how Derek mutters to himself
Lexie: "Not at all."
Derek: "T-2 shows less potential for bleeding. At t-3, the vessels have...increased."
➿
Derek: "If I clip the draining veins without getting the feeders, they'll burst."
Lexie: "Dr. Shepherd, I really think it's time for you to take a break. It's been over 8 hours."
Derek: "I could go under the tumor here, but I might cut the radicular artery. Let's look for, maybe if I go..."
Lexie: "Dr. Shepherd-"
Jackson: "Dude, if you need a break, just take a break."
Lexie: "Please. I don't need one. I'm hard-core."
Jackson: "Are...are you wearing a diaper?"
Lexie: "Shut up. At least bend your legs."
Jackson: "You can't bring yourself to use it, can you?"
Derek: "Shut up! Shut the hell up. Grey, I don't need a break. If you do, take one. Either of you open your mouths again, you're out of the OR." he snaps as Lexie rushes to the door
Lexie: "Bathroom break." she says to Bailey when she opens the door
Bailey: "Um, Dr. Shepherd."
Derek: "What?!" he yells out before seeing her standing at the door
Bailey: "Okay, I'm sure this is a completely authorized surgery, but I thought you might like to know that the chief is scheduled to do a surgery across the hall in OR three shortly. So if you're planning on doing something, anything, you might want to do it soon."
Derek: "Thank you, Dr. Bailey."
➿
Mark: "This is why you don't go rogue. Look at him. He's cracked. I coulda told you this was gonna happen." he says to Sky, Callie, and Arizona as they stand outside the OR
Arizona: "Don't be smug. This is one of our people's lives at stake."
Callie: "Oh, this is so depressing. Ten hours staring into his spine, and he can't figure out what to do."
Richard: "What did you just say?" he appears behind them making everybody jump a little
Callie: "What? No, I didn't...did I? I didn't..."
Richard: "Robbins?"
➿
Richard: "Dr. Shepherd. Dr. Shepherd" he stands near the door holding a mask up to his mouth "Am I to understand that you canceled your surgeries today to operate on a spinal cord tumor? Dr. Shepherd" he moves closer to Derek when he doesn't respond "The rate of infection for this patient is increasing every second you keep him open. Not to mention the thousands of dollars you are wasting standing here doing nothing. So I am demanding that you close this man up. Close him up and relinquish the OR right now, Derek."
Derek: "Okay. That's it. Let's close him up." he says after a moment and Richard turns the clock off
➿
Derek: "Okay. I've gotten the plane. Ready to make our first cut."
Mark: "I heard you needed some support." he announces when himself and Sky come into the OR
Lexie: "You need people to talk to...experienced surgeons. And you can't say no because I'm in charge, and this is what I'm prescribing. And also Sky bosses you around better than I can."
Sky: "That is true." she nods her head
Derek: "Thank you, Dr. Grey. Okay. Let's start" he says as Mark and Sky go to stand on either side of him to watch "Making the first cut."
Jackson: "What, did you...you paralyze him?" he asks after the machine beeps and they turn to look at a monitor
Derek: "No. One vessel down. Settle in. We have many more to go."
➿
Derek: "I've cleared a path at t-5. And if I continue along this plane, I-"
Mark: "MEP tracing's losing amplitude. What just happened?" he asks after the machines start beeping eractically
Derek: "A vessel burst. It might have been connected to the cord."
Lexie: "But if there's not enough blood reaching the cord-"
Derek: "I could've just paralyzed our patient, yes. Suction, please. Suction. Easy. Careful. More suction."
Jackson: "There's too much blood."
Mark: "We're losing him."
Derek: "I should've just cut the cord. This is too risky."
Sky: "Wait. It's back. Amplitude's up."
Lexie: "So the cord didn't stroke out? You didn't paralyze him?"
Derek: "The vessel was connected to, the, uh, tumor. We're okay."
Sky: "Nice work, Derek."
Derek: "Thanks."
Lexie: "Dr. Shepherd?" she asks when Derek backs away from the table
Derek: "Take off my mask."
Lexie: "What?"
Derek: "Take off my mask. Take off my mask!" Sky comes next to him and lifts it off his face just as he throws up and she rubs his back
➿
Mark: "Get in there. Take a breath and get back in there. You can do this."
Lexie: "You really should drink something." she holds a water bottle out to Derek
Derek: "I'm fine."
Lexie: "You're not fine. You're dehydrated and you're stressed. You really should drink something."
Derek: "I said I'm fine."
Lexie: "Drink the water. I said drink it!" she says as he takes the bottle from her and Mark and Sky give her an impressed look
Sky: "Nice."
➿
Richard: "Dr. Hunt." he sees the man come around the corner
Owen: "Uh, chief."
Richard: "Shouldn't you be in OR one?"
Owen: "Yes, actually, but I, uh, swapped with Torres. She has an emergency laparotomy."
Richard: "Dr. Torres is doing a laparotomy?"
Callie: "What am I doing?" she asks coming up from behind Richard and seeing the look on Owen's face "What? I just heard my name."
Owen: "Chief..."
Richard: "He didn't cut the cord."
Callie: "Bailey will stop him. She's at the door." they follow Richard as he moves towards the OR
Owen: "Bailey's in the OR with Shepherd."
Callie: "Then who's at the door? Oh God."
Arizona: "Ooh, no...whoa, whoa, whoa."
Richard: "Move."
Arizona: "No."
Richard: "Dr. Robbins."
Arizona: "I said no. Dr. Shepherd is operating on the inside of man's spinal cord right now. Even the most minor disturbance could cause him to make a mistake on that patient, a patient who happens to work here and whose life I personally would like to see Dr. Shepherd save. So no, you don't get to go in there and be a bully. Not today, chief. Not on my watch." she declares as he glares at the room before walking off and Owen and Callie look at her impressed
Callie: "Okay, I totally thought that was gonna end different" she smiles and watches as Arizona starts to tear up and puts her head on Callie's shoulder "Yeah, more like that." she pats her head a little
➿
Derek: "Dr. Bailey, care to fill us in?"
Bailey: "No, I would not. Because anything outside of this OR is not your concern. Your only concern is this patient. Now keep going."
➿
Derek: "Damn it."
Callie: "What is it?"
Derek: "I can't tell which one of these vessels feeds the cord and which one feeds the tumor. I have to do a blind cut."
Sky: "Like a tripwire?"
Derek: "If I cut the wrong one, the entire cord strokes out. Okay, we'll come back to this later."
Callie: "Later? So you could finish the entire surgery only to cut the wrong one? This will all have been for nothing?"
Derek: "Exactly. But thanks for pointing that out."
➿
Arizona: "How many inches left?"
Derek: "Uh, less than 2. So if I do my math, we got, uh, four or five more hours ahead."
Jackson: "Crap. Oh, crap. Oh, crap. Oh, crap." he groans
Derek: "What is it?"
Jackson: "It's my hand. It's cramping. Damn it."
Derek: "Ok. Don't move. Don't move."
Jackson: "Ah."
Arizona: "BPs dropping."
Derek: "Okay, we're touching the cord. If we disturb it any more, we run-"
Arizona: "Pulse is down to 52."
Jackson: "It's getting worse, guys. It's..."
Derek: "Easy, easy. Don't move. Easy. Don't move. Just take it easy."
Lexie: "Okay, it's okay. Just stay still. I'm...I'm going to reach in. Hey, close your eyes and breathe. Okay? It's just a spasm."
Arizona: "BPs back up. 100 over 68."
Derek: "Have you had anything to drink today, Dr. Avery?"
Jackson: "What?"
Derek: "Muscle cramps are a sign of dehydration. You went without fluids so Dr. Grey couldn't get her hands on the retractor. Isn't that right?"
Jackson: "I, uh...sorry. Sorry."
Derek: "Don't apologize, just step aside. Dr. Grey, take over. Easy. Got it. Easy."
➿
Derek: "Okay. Hmm."a'' or "b"? Dr. Grey..."a" or "b"?"
Lexie: "You're done? You got it all out?"
Derek: "Except for the blind cut. I just have to pick one, and we're good to go. "a" or "b"?"
Lexie: "You're kidding."
Mark: "You're stalling."
Derek: "Dr. Avery?"
Jackson: "I don't like to gamble."
Derek: "Dr. Sloan?"
Mark: "What, so you can blame it on me for the rest of your life? This is all you."
Derek: "Right. My call. Great."
➿
Callie: "He's deciding which one to cut." she says as the four look down at the OR from the gallery
Owen: "Guessing which one. There's no logical way to make that call."
Arizona: "I-I-I can't...I can't look. I..."
Cristina: "Oh, my God, Mer, this is so good."
➿
Derek: "Eeny, meeny, miny, moe. Catch a tiger by its toe. If he hollers-"
Sky: "Are you playing eeny, meeny, miny, moe?" she scoffs at him
Derek: "Yeah."
Sky: "No."
Derek: "Yeah. It's a bad idea?" he asks as they both chuckle before he takes a deep breath "Let's see. Okay. Okay."
➿
Owen: "Come on, Shepherd."
Cristina: "Oh, my god. Oh, my god. Oh, my god."
Arizona: "Please don't be wrong."
Callie: "He cut. He made the cut."
Meredith: "Cristina, was it the right one? Cristina? Tell me. Cristina?"
➿
Derek: "We can't keep doing this, Richard" he comes over to where he's writing the surgery schedule on the board "I'm tired of fighting you. Let's try and put this behind us and move on. I can...if you can." he says as Richard turns around to look at him
Richard: "You're fired. Immediately. Get the hell out of my hospital."
Derek: "Go home. Sleep on it. We'll talk more tomorrow."