Bailey: "Huh, reaction, observation, communication, any questions so far?" she turns and sees everybody's hands raised "We are doing this because chief Shepherd suggests we brush up on our patient sensitivity skills, that's why. And it just so happens, this morning was a very good time, besides, half of you were raised by wolves. Reaction" she scribbles the word on the board "Keep your face impassive. Whether prompted by a patient's appearance or lab results, facial expressions of surprise, concern, disgust, etcetera can be counterproductive." Uh, la la la la la...jokes. Don't make jokes about patients, not in front of them, not even in private."
Cristina: "Well..."
Bailey: "Yang?"
Cristina: "What if the joke is really funny?"
Bailey: "It's not. Neither was that one. Moving on."
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Sky: "We assess quickly in the ER and go to radiology."
Derek: "What if he has to be admitted? Can we get to the surgical elevator?"
Sky: "What about the freight elevator?"
Derek: "Sky, are we set up for this? I mean, our tables...do we have enough? I don't know. Is our equipment gonna be strong enough?"
Sky: "Uh-huh. You don't get to have second thoughts now. The time for second thoughts is over with. Plus they'll be here in five minutes so...we'll have to figure it out as we go" she says as they walk past a desk and Derek turns to see a man glare at him "Who's that?"
Derek: "Gary Clark. He's filed a wrongful death suit in his wife's case. I'm being deposed today."
Woman: "Chief Shepherd. Hi."
Derek: "Yeah, hi. Whatever you're selling, just leave the samples in my office. Thank you."
Woman: "I'm not a drug rep. I'm your lawyer. Lauren Turner."
Sky: "Go. Don't worry. I got this."
Derek: "Okay. Thank you. Dr. Shepherd, Lauren. Let's...follow me, please."
➿
Bailey: "Observation. Yeah" her pager beeps and she looks at it before waving it off "Ah. Okay, "use reflective listening, repeat the patient's feelings back to them." "Um, I hear that you're concerned about the surgery. Let me explain the risks."
Alex "I can see you like vegetables. After surgery, you might become one."
Bailey: "Communication. Uh, "don't use jargon. Use language that the patient can understand. Be creative in using metaphors."
Charles: "Oh, I'm terrible with metaphors. I can never come up with 'em."
Cristina: "Why, 'cause you're dumb as a box of hammers?"
Charles: "You see, that's a good one. You're an ass, but that was a good one."
Bailey: "Be clear and comprehensive. Explain all risks and all probable outcomes, leaving nothing out." Question...Adamson?"
Reed: "Why are you going so fast?"
Bailey: "It just so happens that we have an emergent patient arriving who will need a little extra sensitivity. So remember to employ your...R-O-C, and you will...hmm ... rock your patient's world. Okay, that's enough of that. Follow me to the pit. Hustle!" she makes them chuckle before they head out the room to the ambulance bay where an ambualnce and another truck arrives
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Bailey: "All right, people, remember what you've been taught. Use it throughout the day. There'll be consequences if you don't."
Alex: "What the hell is it?"
Paramedic: "All right. Let's go."
Reed: "What, did the circus come to town?"
Jackson: "No...just the elephant."
Sky: "Avery, you're off the case. Go."
Jackson: "Oh...damn it."
Bailey: "Consequences."
Bobby: "We're gonna need a bigger hospital." he jokes
Doctor: "Coming through."
Paramedic: "All right, on three. One, two..."
Bobby: "Go!"
Paramedics: "Oh!" they work to lift him off the bed inside the truck and onto a gurney
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Sky: "Easy. That's it. Let's get him a chem panel, CBC and LFTs."
Reed: "Got it."
Sky: "And type and cross for two units."
April: "Now does that hurt?"
Bobby: "Sweetheart, I can't even feel that."
Meredith: "I'm having trouble finding a vein here."
Cristina: "Or anywhere." she mutters to her
Bobby: "I'm using up all your doctors here. There's probably somebody dying somewhere, right?"
Lexie: "X- ray."
Meredith: "Now I understand the sensitivity training."
Cristina: "Yeah. No fat jokes."
Bailey: "Yang, you're off the case."
Cristina: "I said no fat j-"
Bailey: "Goodbye."
Cristina: "Are you kidding..." she sighs before walking off
Lexie: "Clear."
Sky: "Okay. Um, sir, when did the stomach pains become more acute?"
Bobby: "Oh, last couple days, I guess. It's hard to keep track. I'm a real busy guy."
Melissa: "I'm here. I'm here."
Owen: "Let's roll him."
Melissa: "Bobby, are you okay?"
Bailey: "I'm sorry. And you are?"
Melissa: "I'm his wife."
April: "Facial expressions." she whispers seeing the shocked looks on some of their faces
Bobby: "Hon, I'm fine. Melissa worries. She likes to make mountains out of molehills, and I'm already a mountain" he laughs along with Melissa while everybody stays silent "Man...tough crowd."
Sky: "Mr. Corso, we're gonna need to turn you over again."
Alex: "Whoa, whoa. Whoa, whoa, whoa. Dr. Rivers. Look at that." he shows them how his skin is stuck together and is pulling apart
Bobby: "You poppin' the hood down there?"
Meredith: "Facial expressions." she whispers
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Bailey: "Now how long has he had that infection?" she asks Melissa as they wheel Bobby down the hall
Melissa: "Oh, I've never seen it before. Nothing like that. What...what is it?"
Sky: "We don't know yet. It could be superficial or it might be something worse going on internally."
Bobby: "I'm gonna be fine, baby. Okay. Don't worry."
Richard: "Karev!"
Alex: "Crap. I thought we'd clear it. Let's take the sides off."
Bobby: "You should put a "wide load" banner on this thing."
Reed: "We have a gurney right here. Can we move him onto this?"
Sky: "No, I don't want to have him out-"
Bobby: "Yeah. Yeah, yeah. I can do this."
Bailey: "No, no, no, sir. Let us move you."
Richard: "No, Mr. Corso-"
Bobby: "Come on. Come on. It's only two steps." they help him start to get off the bed
Bailey: "Oh, my..."
Bobby: "It's either that or you gotta grease me up like a stuck pig, and nobody wants that job."
Melissa: "He hasn't walked in a year. Bobby..."
Bobby: "Oh, okay."
Sky: "Okay. Easy, easy."
Alex: "Come on, sir. Okay."
Bobby: "I didn't think I could do this." he takes a couple of steps through the doorway
Melissa: "Oh, my God. Baby, you're standing!"
Bobby: "You know what this reminds me of? Huh? Our wedding" he smiles at her and his ankles twist and break making him fall to the floor "Oh!"
Lexie: "Uh..." they hurry over to help
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Callie: "Um, bimalleolar ankle fractures. Too weak to support his weight. He can go to C.T. now."
Derek: "He's not going in that C.T."
Sky: "Look, I think if we can position him, we could-"
Derek: "It's rated for half his weight. If it breaks, he gets hurt again, and it's not available for the 50 other patients who need it today."
Charles: "Oh, what about the zoo? They gotta have a CT. for, like, rhinos, right?"
Bailey: "Percy, you're off the case. Goodbye."
Charles: "No, that wasn't a joke. That was an actual suggestion."
Bailey: "Go."
Owen: "It's a pretty good idea, actually."
Teddy: "It's a terrible idea."
Sky: "We will spare this man the indignity of treating him like a zoo animal. If we can't get an image, then we'll go with clinical labs and tests."
Teddy: "I could do a nuclear stress test on his heart. I just wish that I could get him on a treadmill."
Owen: "Well, that's not gonna happen." he says making her scoff at him
Derek: "All right. I have a lawyer waiting for me. I have to go. But I want to have a meeting with all of you when his studies come back before we go any further down this road, okay?"
Richard: "Let's work him up." he says to Owen as the two of them along with Teddy go different ways
Owen: "Mm- hmm."
➿
Lexie: "Uh, so just a couple more questions. Um, his diabetes, did he have it before he...he was im...immobilized?" she asks Melissa when they come out his room along with Alex and Sky and Bailey move over to them
Melissa: "No, that's since he put on the weight."
Lexie: "And that's been, um...how long has...has-"
Melisaa: "How long has he been like this?"
Lexie: "Yeah."
Melissa: "Uh, 5 years ago, his company laid off 300 employees. He tried to find work for two years. No one was hiring. And then he stopped trying. It was real hard on him, and food...well, food made him feel better, so...I think he's been in pain for a while. He'd tell me it's indigestion, but I...I couldn't ignore it. After the news, I just had to call."
Lexie: "The news?"
Melissa: "Well, we're...we're gonna have a baby. I'm pregnant."
Lexie: "How?" she gives a breathy chuckle making Sky's eyes widen at her and Bailey hangs her head "Uh...um...I mean, wow. Congratulations. That is...that's...that's joyous news."
Sky: "You're off the case." she mouths to her with a hard glare and Alex clears his throat
Lexie: "Mm." she hands Sky the chart and walks off and Bailey rubs Melissa's back in comfort and Alex clears his throat before giving a small smile
➿
Derek: "What are we looking at?"
Mark: "Patient's got a severe deep tissue infection under his belly. There's a pretty significant abscess. Rivers, Hunt, and I need to get in there and debride, clear out the infected fat."
Derek: "That much sudden fat loss is dangerous."
Owen: "It's preferable to him dying of an infection. But it's a risky surgery, yes."
Mark: "But we'll have Bailey and Webber on standby in case he goes south."
Derek: "What is the surgical risk calculation on a patient like this?"
Bailey: "Almost too high to calculate. Five times the risk of heart attack, respiratory failure, airway complications."
Owen: "He's diabetic, so there's a risk of ketoacidotic coma."
Teddy: "High risk of pulmonary embolism."
Richard: "And believe it or not, he's malnourished, which leads to slow healing, renal failure-"
Mark: "Nerve damage...post-op infection."
Derek: "I'm saying no. The risk is too high. That's all. Thank you very much, but that's it."
Sky: "So you're saying we're gonna send him away to die?"
Derel: "I'm saying we send him to a bariatric center that's prepared for a type of patient like this instead of us spending our time and resources caring for someone who obviously does not care for himself." he walks out the room making Owen scoff and Bailey turns to give Sky a look
➿
Sky: "Derek."
Derek: "Sky-"
Sky: "He has an illness that he cannot control. He needs help. And we can help him. You and I both know that sending him away is not the option."
Derek: "I'm sorry. I-"
Sky: "That wasn't you in there. And that wasn't about Bobby Corso. It was about Gary Clark, am I right? The lawsuit. Look I'm not even gonna pretend to understand the job of being cheif. But from what I can tell, it makes you see potential lawsuits instead of patients."
Owen: "Excuse me. Shepherd?"
Sky: "Derek, don't let it."
Derek: "Tell Sloan to go ahead, open him up." he sighs after a moment
Sky: "Thanks." she nods her head before walking away to give the two some privacy
Derek: "Yes, Hunt."
Owen: "That conversation we had about Altman, did you share that with anyone?"
Derek: "I-"
Owen: "Did you share that with your wife?"
Derek: "Did Meredith say something?"
Owen: "When I make a professional recommendation about a fell attending, I expect it to be kept in confidence. I do not expect to hear about it from one of my residents. I thought I could assume that much." he storms away and Derek turns to find Lauren standing behind him
Lauren: "How's your day going?"
➿
Sky: "The fat under your skin has become necrotic...has...has died, and the infection is eating through your skin."
Bobby: "Well, I suppose it had to come to that. I've eaten everything else."
Sky: "The operation is extremely risky. You have a higher than normal chance that a surgical complication can kill you."
Bobby: "If I don't have the surgery, I die? How long will I have, do you think?"
Richard: "Mr. Corso, you want the surgery. You want to try-"
Bobby: "I've tried...everything. High protein, the low carbs, drugs, pills, hypnosis...I have tried everything."
Bailey: "You have a baby on the way. Think about that."
Bobby: "Who do you think I'm thinking about? You...you dream of having a kid. You picture yourself playing ball with him. You picture her standing on your feet...while you dance around with her, you know? You don't picture them bringing you food and...cleaning you up. I can't walk four steps to go to the bathroom. You tell me...who deserves that guy as a father? No...I just...want to be gone before the kid has a chance to know who I am. Don't tell my wife about this, okay? Let's just tell her it's too risky. Let me go home" he says and Melissa then comes into the room "Oh, hey, peanut."
Melissa: "What's going on?"
➿
After Alex helped convince Bobby to have the surgery they all then set up the OR to begin
Alex: "How'd you get back on the surgery?"
Charles: "They said they needed big guys."
Sky: "Karev, Percy, retracting the abdomen. Adamson, stay there. Kepner, over there."
Meredith: "Where do you want me?"
Sky: "Oh uh-"
Owen: "Actually, I think we are good. That's all we need." he says making her walk out the room
➿
Mark: "The infection's really deep. Underneath all this fat is just..."
Owen: "More fat."
Sky: "Yep. I'm down to the abdominal wall."
Richard: "How's the fascia?"
Mark: "Not too good. Want to take a look inside?"
Sky: "It's probably a can of worms, but...yeah."
Mark: "Let's have a...little peek."
Owne: "Ah, damn it. Gonna have to go in." he says once the machines start beeping eractically
Sky: "Bailey, Webber, scrub in...fast."
Richard: "Okay."
➿
Bailey: "No. Uh, pull that back more. I can't see what I'm doing."
Reed: "This? Is this good?"
Bailey: "No. More."
Richard: "I think I found the culprit. Diverticulitis...perforated colon, completely infected."
Bailey: "How long's he been under?"
Mark: "Too long."
Richard: "This abscess will kill him if we don't get it under control."
Sky: "Oh, okay, keep it together" she says once the machines start beeping more "Okay, let's pick up the pace, people."
Richard: "Laps. Come on. More. Pack it in."
➿
Sky: "Bobby, you survived the surgery, but you're not nearly out of the woods. We still have to watch you very closely for post-op infections, and you're gonna have to make some serious lifestyle changes."
Bobby: "I know. I need to lose the weight."
Bailey: "You have no choice if you want to survive."
Bobby: "Well...then I have no choice. Right?" he looks over at Alex who nods at him. Sky smiles at them before glancing outside to see Derek. They make eye contact before she looks back down at Bobby