Death by Teamwork

S06E06

This is one of those episodes that starts out by showing us the aftermath and then goes back to show us how it all happened. The doctors are all gathered -- every single regular player including the four main new Mercy Westers -- to each speak to Richard, Jennings, and a hospital attorney as Richard tries to figure out who was responsible for the death of a patient. That night, the ER had been overrun with injuries from a hotel fire. A teen is brought in with massive burns, a firefighter fell three stories from a ladder, a dude tried to run down a flight of stairs with a fire axe and wound up embedding it in his sternum, and a mother comes in with some burns on her chest and leg, along with her little boy who is fine. While Cristina is first to grab the chart, she immediately hands it off and April is the first doctor to see the woman. April and Reed gripe, as they watch all of the "good" patients come in, that the original Seattle Grace docs are hogging all those cases.

After examining her, April hands the woman off to Sloane for her burns and goes to help Bailey. It's the first in a whole series of flashbacks, as each doc tells the small panel what they did that night. They wind up showing that nearly every doctor at some point or another worked on the young mother. When she wound up not able to breathe, each doc sees her at a different point -- first her lung collapses, then her airway constricts completely, and eventually she suffers organ failure, bleeds out and dies. As Richard interviews each person and hears their side of the story, each doctor winds up looking pretty bad for either missing something, not being sure of what they actually did, or for not being with the patient at all when they probably should have been. Ultimately, however, Reed is the one who realizes where it all went wrong, and that's with April at the very beginning, when she got distracted by Axe Guy and forgot to visually check her patient's throat. If she had, she would have realized the woman had smoke inhalation and treated her appropriately, but since she didn't she started in motion what ended in the patient's death. Richard has no choice but to fire her. All of the remaining residents both start to come together in blaming her while still also arguing and pointing out each other's mistakes along the way, until Cristina points out that it's a mistake any of them could have made, and a maybe kinda possible sorta truce could possibly be starting. This is while another showdown appears to be brewing: Derek tells Richard that he's let the hospital dissolve into chaos since the merger, and implies that what happened as much his fault as April's. It's about time, both that there was an actual consequence for this being the most unprofessional workplace in history, and for Richard to be made to actually take some responsibility rather than just saying he's taking it. Of course, I'm not sure he'll actually take that responsibility, but at least it kind of gets the ball rolling in that direction.

It's nighttime, it's raining (in Seattle! Imagine that!), and the thunder rolls and lightning flashes ominously so we know that things aren't good. Mere tells us, "In order to get a good diagnosis, doctors have to constantly change their perspective. We start by getting the patient's point of view, though they often don't have a clue what's going on." Mere, an overnight bag packed, gets her IV taken out by a nurse while she looks anxiously out the door.

"So we look at the patient from every possible angle. We rule things out. We uncover new information, trying to get to what's actually wrong." In one of the trauma rooms, a guy mops up a massive pool of blood. Outside, Alex walks out into the rain while on his cell phone. "We're asked for second opinions. Hoping we'll see something others might have missed." Alex paces a bit, then hurls his phone into the wall, which made all the more dramatic by the sound effect they picked -- not a crunching phone, but the sound of a car crash. No, the accident of the week isn't a car crash, but doesn't it sound scary?

"For the patient, a fresh perspective can mean the difference between living and dying." Inside, Alex is back and he and all of the other regular residents and attendings are gathered in a hallway, looking somber. "For the doctor, it can mean you're picking a fight with everyone that got there before you." Reed comments rather breezily that someone is getting fired, and April tells her, horrified, to stop while Charles gripes that it wasn't his patient. Everyone's tense and cranky, and when Alex asks how long it's going to take, Avery asks pointedly if he needs to leave and make a phone call. When Charles snickers, Alex snaps and lunges at Avery, and a thousand fanfic chapters are begun. I think this is what it must be like for guys watching two hot girls have a pillow fight -- I just had to fan myself! Everyone jumps in to separate the two and Richard comes out of a room at the end of the hall and hollers, "Enough!" He lectures them all that what happened that night was inexcusable, and they'll all be there until he figures out who is responsible. Everyone is to sit and shut up until they are called, and Hunt is the first up. As he walks in Cristina tells him in a low voice that she's not going down for this, but he just tells her that someone is before going inside to face the jury.

It's a good thing there's a big storm because thunder and lightning punctuate just about every dramatic moment tonight, and there are a lot. Hunt sits on one side of a long table, facing Richard, Jennings, and a woman who is their "in-house counsel" but yet is not important enough to have a proper name. As the actress' name is Saundra, let's call her that, shall we? Jennings plays good cop and tells Hunt they, "just need to get in front of this thing," but Richard cuts him off and has Hunt lay out the scene that evening. Hunt explains that the ER was slammed with victims from a hotel fire including burn victims, a "penetrating chest wound," and a firefighter with multiple injuries; there's a flash to each as he lists them. When asked he tells them that Cristina, Lexie, Alex, Reed, "That big kid whose name I don't know" (Charles), April, Avery and Callie were all working that evening. We're also treated to a shot of each of them, all looking worried and/or flustered in the middle of a whole lot of chaos. Jennings asks him who was on the patient who died, and Hunt nearly shrugs as he tells them that everyone was everywhere. Richard asks who then got the chart first, and a roll of thunder precedes his reluctantly admitting that it was Cristina.

Cut to her in the seat at the table, saying it wasn't her patient -- that she had her for two seconds and was called outside. Richard asks her to start from the beginning, and thus starts a flashback from her perspective. She flounces into Mere's room for a break to keep from killing someone, and I must say it's nice to see her showing self-awareness. Mere was frustrated because Bailey hadn't come by to sign her discharge papers. Weirdly, Cristina seems to have not known Mere was leaving, and is happy that Mere can go home, get better, and come back. She's upset because there are more Mercy Westers than Seattle Gracers and therefore the Westers are kicking the Gracers' asses. She then says she misses Izzie. Well, that makes one of us. But really what she misses is just someone on their side, and she tells Mere to get back. She jokes that Mere should get a Wester to forge Bailey's signature on her papers so that they will then get fired, but then gets a page and had to leave. As she leaves, Mere called after her to send Bailey.

She walks into the ER where Hunt is calling instructions, and then offers her two charts -- her choice of a burn victim or the woman's child. Bailey comes in and yells for help, but when a disembodied female voice says that they can help, Cristina just shoves the two charts off on her. When Richard asks her who she handed them to, Cristina thinks a moment and visualizes the scene, but the doctors are just seen from the neck down. She has to admit she doesn't know.

April is on the hot seat, as she was the recipient of the charts. We see the same scene, this time with a view of her and Reed's faces. After they get the charts, Reed gripes about how the Gracers are handing off the crappy cases while they take the good ones. They walk up to the patient in question, a woman named Cathy, and April takes her while Reed takes her young son Danny. As April works to take the temporary bandages off of her chest and leg, Cathy explains that they were on their way to Vancouver to see her husband and stopped for the night because of the rain. It turns out that they got out because they were on the first floor. April is a little bit distracted by all the action but tells Cathy she is glad they got out. Reed displays a sweet side with Danny that we hadn't yet seen, but both of the girls are distracted when another patient comes in. They are keeping score as to how many patients the Gracers get versus the Westers, and Reed gripes that no matter how good they are they'll never win because they are the newbies and the Gracers hate them. Yes, but have you given them any reasons to like you? This whole rivalry seems to be between the pots and the kettles fighting over who is the blackest. April says she won't let them hate her, and that she's easy to like, although Reed tells her that she didn't like her at first. Maybe she was also a passive-aggressive showoff when she met Reed. April seems nice enough now but she wasn't the perfect example of gracious behavior on her first day. April tries to get back to business and goes to look in Cathy's throat, but is distracted again when Cathy exclaims over the guy they are wheeling in with an axe sticking out of his chest. Reed notes that Charlie got a good case and April replies that they win before turning back to her patient. She tries to shake off the distraction and, forgetting what she was doing, tells Cathy she looks good and has only minor chest burns, but that the burn on her calf might be third degree. She calls for Sloan and when he and Lexie come over, she leaves.

By Lauren S

Back in the conference room April finishes that after the initial exam she concluded Cathy was a burn patient and needed nothing surgical, so there was nothing more to do and she left to help Bailey. Flashback to the ER, where Bailey is working on the guy with the axe when suddenly, the axe is pulled out and Charles, who was holding it, keels over. As the open wound spurts blood everywhere and Bailey yells, April hollers that she's got it and runs over, emphasizing to the panel that Bailey really needed the help.

Richard asks April if that's the last she saw of the patient, and April says yes, that Sloan then treated the burn. But Lexie tells Richard that she was the one to treat the burn, and so he demands to know where Sloan was. Back in the ER, Cathy and Danny are having a thumb war while Sloan looks over her leg. He tells Lexie to clean while he finishes... I could never catch the correct word or figure it out using magical Dr. Google, but it looks like he's pulling off the burned skin. Cathy gasps but when Danny worries that it hurts, she assures him she's okay and that the doctors are fixing her up. Arizona then calls for Sloan so he gives Lexie directions to cover the wound with some solution and then wrap it loosely in gauze.

Sloan joins Arizona with a 16-year-old patient named Evan who has second and third degree burns covering 60% of his body. She yells at Lexie to join them when she's done, and Lexie sees Evan shivering and moaning. Back in the present, Jennings jumps right on this to ask if she felt rushed, but Lexie assures them that she took her time. We see her working on Cathy's leg and Cathy flinching, but she looks far more pained to hear the gut-wrenching moans coming from Evan's room and she pulls Danny closer. Lexie finishes up and turns to join Mark and Arizona, but as she turns runs into Hunt -- all the better to show just how crowded it is. He and Callie are bringing in another patient and Callie calls to Reed for help if she's free; Reed says she'll be right there.

There is absolutely nothing to poke fun at during this scene. Lexie goes in to where Evan is still shivering and moaning. Arizona assures the boy that he's going to be okay and that they're going to examine him and warm him up, but it's all too much for Lexie, who turns away. Evan manages to whisper for his dad, and Arizona promises they will find him. Mark, meanwhile, has Lexie smell something to bring her around and keep her from passing out. He explains quietly that burns like this are really hard and that he can get another doctor so she can switch, but she bristles and assures him that she can handle it. When she tells Richard she stayed there, he asks who was with Cathy and Lexie names Reed.

Reed, however, claims she wasn't with Cathy, she was with Danny. We see the Lexie/Hunt crash and Callie asking for help from her perspective, and then she turns and tells Danny he's fine, assuring Cathy that he's totally okay. Cathy is relieved and asks if Danny can stay with her until his dad arrives, and Reed tells her that's totally fine. In hindsight, this is totally not a good idea, but for now everything seems hunky-dory. Reed then joins Callie to treat a firefighter, Roy, who fell three stories off of a ladder and has all sorts of problems. His hip and femur might be fractured, he's got uneven pupils and his abdomen is rigid. Hunt assures him that they are taking care of him but Roy just wants to know where a particular kid is. Derek comes over, looks in his eyes and orders a bunch of tests, so they roll Roy off for all that. Roy is played by Bill Fagerbakke, and in addition to having a kickass crazy last name, and to being a Hey, It's that Guy! he is most notably none other than the voice of SpongeBob SquarePants' best friend Patrick Star. Reed tells Richard she then went to x-ray with Roy, and when Saundra asks if she heard Cathy say anything about being in pain, Reed replies in the negative.

By Lauren S

Richard is back to asking about Cathy -- Alex is pretty pissed and repeats that he never saw her, but Cristina tells them that she was the one who ordered Cathy's morphine. Again we see Cristina point out the initials on the chart, but we stay with her and Avery, and he asks how long it will be until they insert a bug up his ass too, noting how cranky they all are. Oh honey, don't pretend with those gorgeous wide eyes that you haven't also been ticked off at the whole situation sometimes. Cristina gets him back by reporting to Richard that Avery seemed consulting on a patient not his own, so she took care of it. Cathy reported that the pain was just localized to her chest; Cristina checked the chart for drug allergies and interactions, and then ordered morphine. When she lists off everything Cathy had been given, Richard seems surprised and suspicious that Cristina memorized the chart, but Cristina points out that she checked the chart three times to be sure as it wasn't her patient. However, she admits to dropping the ball a little when he asks if she followed up, and she has to admit that she did not as her patient was back from CT.

Back in the ER, Callie makes an announcement that the burn unit and ICU are all full, so all the patients are staying there until beds open up. Mark then pokes his head out of Evan's room to request that the trauma rooms be kept clear for burn cases. Cristina goes to check on Roy's films, which show an official diagnosis of Lots of Bad Shit. Worse than his physical problems, though, is his mental anguish as he hears Evan scream. Apparently he was trying to save Evan when he fell and he blames himself for what is happening to Evan now. Reed tries to convince him that he saved Evan's life, but an inconsolable Roy is convinced that he killed him.

Saundra breaks in to the flashback to ask if Cathy had pain in her chest or on her chest. Cristina says that it was the burns on her chest, but when Saundra thanks and dismisses her, Cristina gets defensive, wondering if they think Cathy had chest pains and she gave the wrong medication. Richard tells her it's hard to say as the note on the chart is Lexie giving Cathy a chest tube, but Saundra then pretty firmly cuts him off and dismisses her again.

Lexie tells the Three that she was supposed to be with Evan, but we flash back to see how she came to give Cathy a chest tube. She's in the room with Evan when Callie and Mark make their announcements and then when Mark comes back in, he tells Evan gently that he has to cut into the burn to restore the circulation in his arm. Again, this scene is positively devoid of any humor or levity -- it sounds hellacious. Evan, crying, asks about his dad again and Arizona promises they are finding him. She then tries to ask him about his college search -- the reason he is in town -- and Evan says in a small voice he's not sure he could take the rain in Seattle. Just then, Mark starts to cut and Evan lets out an unholy wail. Mark clearly feels horrible and keeps saying he's sorry, assuring Evan he's going to be okay. Arizona tries to stay upbeat and talks about the rain and how it's not that bad, but when she asks Lexie for backup, the normally perky resident is sobbing in the corner and can't answer. Arizona tells her sternly to leave and come back when she's collected herself. Out in the ER, Lexie gulps at the air when Danny (not the best child actor this show has ever seen, but a super cute little boy) tells her she can't breathe. Lexie thinks he's talking about her and assures him that she's okay, but Danny actually means his mom can't breathe. When Lexie pulls back the curtain, we see the same purple-lipped shot of Cathy gasping for breath.

Lexie reports that Cathy had a pneumothorax (collapsed lung) and back in the ER, she's got an oxygen mask on the patient while she holds a giant needle over her. Cathy gasps at her not to let Danny see her die, but Lexie promises that she's not going to die, and starts counting Cathy's ribs on her side. Richard keeps interrupting Lexie's storytelling which creates the same kind of tense, distracted atmosphere that was going on in the ER at the time, when Avery interrupted what Lexie was doing. She loses count (she has to go in through a particular space or could puncture Cathy's diaphragm) because Avery walks up and dramatically plunges something into Cathy's chest and she gasps for air.

Lexie is by far the most flustered of all the doctors and can barely get her story out. She did get the chest tube in, though we cut to Avery saying she missed a step. Back to him stabbing Cathy, he tells an appalled Lexie that it was a tension pneumothorax and he had to relieve the pressure so Cathy didn't die before Lex could get the tube in. He then offers to do it but she's pissed from everyone doubting her, resumes her count, and puts it in the tube. Excuse your recapper for whimpering in the corner as they sort of show the beginning of this process, which is my worst nightmare. It's like this is my payback for all of the bad things I've said about the show -- having to watch and relive my own painful surgical procedures. Avery tells Richard that she got the tube in though she was distracted, but we hear say that while she was working, "Dr. Yang was making a toddler cry." Isn't that just every day at Seattle Grace? At least she didn't have creepy Mr. Bear with her this time.

We're treated to Cristina yelling at Danny to stop something, and Danny starting to wail. Cristina defends herself and promises Richard he would have yelled too. In her own interview, Reed claims she has no idea how Danny got there -- forgetting that she herself said he could stay with Cathy until his dad arrived. The time Reed saw Cathy, she was coding, though that wasn't before Roy got his turn to do so. Hunt goes to get ready for Roy's surgery, leaving him with Callie and Reed. Callie tells him that his whole crew is in the waiting room and he's a hero, but Roy is still bereft over what happened to Evan and keeps apologizing and crying. Reed explains to Callie what he's talking about and Callie tries to tell him that it was an accident. Roy's body has finally had enough, though, and they lost his pulse. Lowering his bed, Reed gets the paddles ready but Cristina just slams her fist into his chest, which restarts his heart again. Hunt, who has come back to witness this, is impressed but Reed isn't, and she hands the paddles back up, annoyed she couldn't save the life today. Danny then reaches up and grabs the paddles, causing Cristina to yell, causing Danny to cry, as we just saw. Richard wants to know who was supposed to be watching the kid -- something Cristina really wants to know too.

When Cristina walks up with Danny, Lexie claims she can't take him because she has to be with Evan, but then she looks in and sees Evan crying as Sloan and Arizona dress his burns and she changes her mind and offers to take the kid. Richard can't believe she left Cathy, but Lex argues that Cathy was stable and she had to stay with the boy. Richard points out that Cathy had a collapsed lung (so, presumably wasn't okay to be left there) but Lexie corrects that she was supposed to actually be with the other boy, Evan.

Arizona finds her in the waiting room playing with Danny and is none too happy. She calls a candy striper away from flirting with the waiting firefighters to take the boy so that she can rip Lexie a new one. When Lexie apologizes and tries to tell Arizona how she felt, Arizona -- all traces of the sweet pediatric surgeon gone for now -- yells that she's not allowed to feel anything because Evan is feeling everything on account of his nerves all being exposed. They have to make him feel worse before he can feel better, so Lexie has to shut down any of her own feelings and talk to him, reminding him he's got a future. She finishes by ordering that if she can't do this, her job, she needs to find someone who can. Back at the Table of Judgment, Richard asks if Lexie saw Cathy again. She didn't, nor did she see Alex perform an emergency cricothorotomy.

Charles, however, did see. From here on out, Richard really takes to interrupting and second-guessing everything they say, making the flashbacks choppy, but I'm going to try and keep the scenes together as much as possible for the sake of everyone following along at home. After Arizona finishes yelling at Lexie, Charles asks her if she's seen Alex, and it's really amusing how Lexie can't stop staring at his half-finished sutures and the thread that's hanging down and taped to his cheek as she tells him she hasn't. When Charles gets back to the ER, Tyler yells at him that Cathy isn't breathing, so Charles tries to intubate while another nurse cuts off the extra thread and removes the tape from his face. Charles can't do it because there is too much swelling, so Reed tries it herself and runs into the same problem. Richard tries to get them to admit they can't intubate but both of them argue that they just couldn't do it on this particular patient because her airway was totally closed off. They then hear Alex yell at them to move.

Back to Lexie's interview -- she tells them that Reed and Charles both tried to intubate and when that failed, Alex performed the emergency crich. Richard points out that she said she didn't see it, and she admits that she did. For someone whose biggest fault was getting overwhelmed by her emotions, she manages to make herself look pretty guilty with her inconsistent answers. Richard asks her in his best "duh" voice if she then tried to help.

Her flashback shows that she didn't, and she tells Richard that her patient needed her. After seeing Alex run in and start the procedure, she takes a deep breath and goes into Evan's room. Sloan and Arizona watch as she sits to the crying teenager and starts telling him about the rain, her friendly, perky demeanor back. She starts to talk to him about the rain and how beautiful things are after it stops, and eventually he is able to stop crying and look at her, so she beams. She finishes by telling Richard that Alex seemed to have the situation at Cathy's bed under control.

Reed, however, thinks he was totally out of control, and describes him as pale and shaky. There's a Cathy-view cam of Alex leaning over her, and he's comically sweaty and nervous. Seriously, the nerves needed to be dialed back a little bit here to be convincing because this looks like a cartoon or a spoof of some sort. As Reed freaks out because there are no landmarks for Alex to know where he's going in, Alex sprays iodine on her neck and starts mumbling to himself, "Hit the carotid," over and over. When Reed gives this detail to the panel, they all look Very Concerned, and we cut back to Alex, well, cutting into Cathy's neck and feeling around.

Before we see what happens, Richard asks Alex if he gave blood. Alex is in an especially combative mood and seems to not get what this has to do with anything. Richard tells him about the "pale and shaky" claims and points out that one guy passed out, but Alex won't bite, and tells them that he regularly gives blood, and a bunch of people gave blood that day. "Just because some dumbass didn't eat a cookie..." Richard sees what Alex is doing and finally asks him specifically if he gave blood that day. We flash back to a shot of him scowling in the chair while Avery and Charles talk about him, and then after a moment, he gives his answer to Richard: "No." I will confess I was totally duped; I thought Alex was lying and was going to be on the chopping block or something because his Izzie problems clouded any bit of good judgment he had left. I actually said, "Oh, ALEX," at the TV.

Then we see how it actually played out: He's in the chair and the nurse is rubbing his arm while he talks on his cell phone with Izzie's mom. It sounds like Izzie either isn't there or her mom is lying, and of course this is right when the boys turn to around to call him a douche. No wonder he's got an even bigger scowl than usual. Everyone's pagers go off, and it turns out that the nurse was standing with the needle, just about to stick Alex. He tells her to wait and then rips off the blood pressure cuff and heads to the ER, no blood having been donated. Phew.

Alex tells Richard that there was no problem but Reed thinks the complete opposite. We see her get back from taking Roy to surgery, and she's stopped by another firefighter who asks if they can line the hall for him when he gets out to show their support. She seems to be probably the best at dealing with patients, but she winds up brushing off the firefighter when Charles waves her over to Cathy's bed. While it's kind of abrupt and I think she could have been a tad nicer, I think the firefighter didn't need to look so surprised given that he's used to emergencies and how sometimes there isn't time for chitchat. Fortunately this never comes back up, so maybe after that surprised look he really did get that she couldn't give him an answer right then.

It turns out she didn't need to cut the guy off as Charles was actually trying to get Alex's attention since he was on the phone. Richard is positively incensed to hear that, but Alex tells him (and we see) that he hangs up the phone and comes over to do the crich. Richard won't accept this and yells that he got there after another doctor got there first, and reminds him the patient was dying. Alex rubs his forehead, trying to keep his cool, and repeats that he got off the phone.

Back to a few minutes earlier, he's sewing up Charles as tightly and painfully as he can when he gets a call from a restricted number. It's finally Izzie, and so Alex frantically tapes the extra thread to Charles cheek and goes into the hallway for a bit of privacy. From his side of the conversation and his begging her to wait, it sounds like she has no interest in ever talking to him again. He looks in and sees the commotion at Cathy's bed but it's right when Izzie seems to be telling him that she's not coming home. He tries to get her to tell him if this means "yet" or "at all," and of course this is when Charles starts waving him over. He begs Izzie to give him a number but she's always been a selfish bitch and things aren't changing now, even though Alex is begging her more and more frantically. Finally, though he clearly wants to track down his missing wife, he hangs up on her and goes to do the crich. (And can someone tell me what the difference is between this and a tracheotomy? It seems the same to me, and even the quick internet search I did didn't explain it so that a non-doctor like myself could really understand. All I learned is that this is less invasive, though I have to say from my sofa it looks like exactly the same thing.) After the same scene from before we finally see that he was successful, and Reed again looks pretty put out that he succeeded. Guys, let it go just long enough to be glad a patient didn't die (yet), okay?

By Lauren S

In the aftermath, we see shots of all of the doctors just standing, confused, while the alarms continue to beep. Elsewhere, Lexie sits with Evan, who is calmer now, and as she talks to him, he manages a small smile. Danny and the Candy Striper are the only two people left in the waiting room when Danny's dad arrived, who scoops his son up in a hug, thankful he's okay. It's heartbreaking when he happily says, "Where's Mommy? Let's go find Mommy!" Mommy had the misfortune of coming to one of the worst-run hospitals in TV history, sir.

With the hospital finally calmer, Mere starts the closing VO: "When we're headed toward an outcome that's too horrible to face, that's when we go looking for a second opinion." Derek is sitting at the table while Richard packs up his things, and he tells the Chief that it's not about the doctors, that they all are good. Richard seems surprised and claims to know that, then starts his usual (of late) blustering, asking Derek what he thought all of this was for. For Jennings it was all a legal matter but Richard needed to know who was finally responsible, and he's glad he was able to do that. Derek gives a well-practiced brow-furrow and heaves a pointed sigh, so Richard tells him to spit it out. Derek suggests that the problem wasn't one doctor but was too many who don't know or trust each other. He tells Richard that when he got to the room it was pure chaos, "Because that's the system now. Chaos. That has been the system that has been in place since this merger. Your system." Richard has been looking away pointedly, like a belligerent child, but finally looks at Derek as he adds, "I'm saying you should look into who's responsible." Derek then gets up and leaves. I'm not thrilled that it was Derek who said it, given that Derek can be a preachy, self-righteous ass, but he's totally right and maybe, MAYBE this will start the process of the Chief pulling his head out of his behind for the first time this entire season.

Alex walks out into the rain, on his cell again, but my guess is that he's leaving another message rather than actually talking to Izzie because after a moment, we see the scene from earlier when he throws it into the wall. Mere narrates, "Sometimes, the answer we get just confirms our worst fears.

"But sometimes, it can shed new light on the problem." Everything must have worked out after all because the firefighters are in fact lined up along the hallway when Roy is wheeled out of the elevator after his surgery. He seems much more peaceful than before, and they all congratulate him as he's rolled along.

By Lauren S

There was so much swelling, and no veins were available, so the docs had to do a central line. April tells the panel hopelessly that everything was failing at the same time. Cristina arrives as Cathy starts to code, and they try to shock her to get a heartbeat back. Things only go from horrifically bad to unimaginably worse when Reed notices that she's bleeding into the tube coming from her throat -- she's bleeding out on top of everything else. As Reed sits facing the Big Three, something clicks in her mind and she tells them, horrified, "I know what happened. I know why she died."

Back in the ER, blood is streaming from Cathy's nose and is pooling everywhere. The doctors are all yelling and trying to help, but the yelling is intermingled with the steady alarm of her heart not beating. Derek wades into the chaos and after doing some yelling himself finally manages to quiet everyone, telling them that it's over. He then tells someone to call it, but no one pipes up, even when he asks whose patient it is.

Back in the present, Reed comes out of the panel room and tries to walk away through the others but April grabs her arm. With tears in her eyes, Reed says that she's so sorry just as Richard comes and calls April inside. April goes from confused to scared in the blink of an eye and asks what Reed said, but Reed just shakes her head and runs off, so April turns and goes inside.

Once inside, she looks like she's about to hurl while Richard says that he doesn't know her, but that Reed just spent 20 minutes telling them what a good doctor she is, which is also what all of her school records and recommendations show. He tells her that he believes she's good, but when she starts to speak he cuts her off and says that therefore, she should be able to tell him what caused Cathy to die from multi-system organ failure. April goes through everything, with an accompanying flashback for each -- she cites Cathy's burns and collapsed lung (accompanied by a totally gratuitous shot again of Lexie about to insert the chest tube -- thanks, Show!) but Richard just asks her why Cathy's lungs would have failed. Hannah gets flustered and Richard keeps up the rapid-fire questioning, finally asking what might have caused her restricted airway. April tells him that soot or smoke inhalation would do it, and when Richard asks how her throat looked, April catches herself and everything seems to click into place. She tries to defend that Cathy wasn't hoarse or coughing but Richard asks again what it looked like, and when April finally crumbles we flash back to her examining Cathy. She's about to look in her throat when they are distracted by Mr. Axe Chest. It was a pretty obvious moment earlier in the episode -- even though I didn't know the medical reason for why that led to everything going wrong, it was telegraphed that it was where everything started. That said, it didn't take away from this being a really good, well-done episode.

By Lauren S

Richard tells April what she fully knows: if she'd looked in Cathy's throat she would have seen soot, intubated immediately, and none of this would have happened. She's terrified and defends that she got distracted due to the insanity of it all, and Richard is sympathetic, telling her it was a simple mistake. Saundra cuts him off with well-timed throat-clearing, though, and Richard stops and sighs. April pleads pathetically that she just missed one step, but Richard answers, "And look what it's led to," followed by rapid-fire flashes of everything that went wrong that night. The flashes stop and we pick back up with Derek staring at all of the doctors, and when no one claims the patient he calls time of death. And with that we also have the death of April's short Seattle Grace career when Richard fires her.

By Lauren S

"Make you see it in a whole new way." Reed is watching the procession when Cristina comes up and asks if April left yet. It's totally characteristic Cristina -- her voice is totally matter-of-fact, not mean, but definitely insensitive and poorly timed -- but Reed both doesn't know all that and probably wouldn't be in the mood for this even if she did. She starts to storm off but then comes back to assert that April was an even better doctor than Reed was, so "just please... shut up." Avery walks up and asks her if she spoke to April, which she didn't. Alex then walks by and after a moment, demands, "What?" from Avery. Avery says he's wondering if Alex is going to hit him again. Alex then does the unthinkable and apologizes, which Avery readily accepts and assures him to forget it since it was a rough night for all.

Charles, who so far I really feel is the big, dumb animal of the group, walks up and comments how stupid it was to miss looking at the airway, Lexie adds that the airway is always first, and Avery calls it med school 101. It marks the first time the two groups of residents have been able to find any common ground, but Reed isn't happy that it's at the expense of one of them and yells that it was a one-second distraction that led to a mistake. Charles adds that they all nearly got fired for that mistake and Avery backs him up: "Nosedive's got a point." Charles agrees before he realizes he's gotten a new nickname, which -- hee! The bickering continues until Cristina, of all people, jumps in to remind them that fixing mistakes and saving lives is, in fact, their job. She calls out Alex for being distracted all week and tells Avery who knows where he screwed up. However, their patients didn't die, so they didn't get caught, and what happened to April could have happened to any of them. Reed visible softens as she sees that Cristina might not be totally awful after all.

By Lauren S

"After all the opinions have been heard, and every point of view has been considered, we finally find what you were after. The truth." April walks up in street clothes, looking wounded, but none of her Mercy Westers seem to find the right words and they wind up saying nothing to her. I guess Charles was right -- it really was different there, since I'm fairly certain our usual gang wouldn't just watch one of their own get fired like this and go home without saying anything. She walks off and Reed finally calls after her, but she just keeps going out the door.

Mere waits in her room as she VO's: "But the truth isn't where it ends." Bailey swoops in and hands her the papers to sign, and while Meredith isn't completely nasty about it she does get in a dig about how she thought Bailey had gone home and left her. Bailey just tells her, "Go home," and breezes back out past Derek, who has arrived to take her home. Mere's more than ready to go and gets in to her wheelchair, griping that she was waiting for Bailey all night. Seriously, she's in the hospital and friends with all of the staff. Doesn't she know they had a mass casualty to deal with? Chill out, girlfriend. VO: "That's just where you begin again..." She smiles at Derek, who is definitely subdued, but when she asks if he's okay he lies that he is. As he wheels her down the hall she seems to get a clue and asks, a bit concerned, "What happened today?" She wraps up her VO, "...with a whole new set of questions." The ever present thunder lets out another ominous rumble for good measure, and then we're out.