Lucas Adams, who disappeared from the home he was sharing with Simone Griffith and Mika Yasuda at the end of Season 20, Episode 3, “Walk on the Ocean,” is staying with his aunt, Amelia Shepherd, and he is ruining her morning. From his belongings strewn all over the place to having drunk the last of her coffee, Adams has taken over the place. When it seems like Shepherd might actually break and yell at him, Adams ducks out, telling her that he’s late for an important meeting.
At Grey-Sloan Memorial, Ben Warren has finally gotten his wrist brace off, which means he can go back to full duty at Station 19. Warren is thrilled but his wife, Miranda Bailey, is less excited. He’ll be putting himself in danger again, and she’s not ready for that.
Elsewhere in the hospital, the five interns — Adams, Benson Kwan, Jules Millin, Simone Griffith, and Mika Yasuda — are meeting with lawyers about the two events from Season 19, Episode 20, “Happily Ever After,” that got them into trouble. Kwan and Millin are asked about the details related to Millin’s roommate, Maxine, being intubated despite having a DNI and a DNR, and Yasuda, Griffith, and Adams are questioned about Teddy Altman’s collapse and the opening of patient Sam Sutton on the table. The final question posed to Griffith is the one that could change everything: “If you were in the OR by yourself without Dr. Adams, would you still have opened up the patient?”
Shepherd, now running late, thanks to her nephew, meets Owen Hunt at the elevator doors. As she presses the elevator button, which Hunt tells her he has done already, she asks him if you can evict family. Things are not going well with Adams sleeping on her couch. Hunt affirms for her that she’s a clean person to live with and that it shouldn’t be too hard to pick up after oneself as Monica Beltran arrives at the elevators. When she presses the button, both Shepherd and Hunt tell her that they’ve done that already, but the doors open right away for her. “Maybe it just doesn’t like you,” Beltran jokes. Annoyed, Shepherd opts to take the stairs.
Now with Bailey, the interns are still stressed from their meetings with the lawyers, not to mention incredibly preoccupied with completing their procedure logs, which Bailey assigned them in Season 20, Episode 2, “Keep the Family Close.” Bailey, as usual, doesn’t care what the interns want. She has something much more exciting in store. When Griffith asks if it would make sense to focus on their procedure logs instead of wherever she is taking them, Bailey tells them, “It would make sense for you to trust that anything I ask of you will make you a better doctor.” She walks them into an auditorium, where they find Shepherd, Jo Wilson, and a third surprise doctor waiting for them.
Arizona Robbins, who left Grey-Sloan Memorial in Season 14, Episode 24, “All of Me,” has returned for a complicated and ground-breaking surgery. Their patient, Vida Madera, is 26 years old with a history of vision loss and is 30 weeks pregnant. Vida originally met Wilson and Bailey in the clinic, where they told her that she was pregnant. In a recent ultrasound, a Vein of Galen Malformation (VOGM) was discovered in the fetus’s brain. Robbins asks the room what a VOGM is, and it’s Griffith who answers. It’s a rare arteriovenous fistula, which is an abnormal connection between the artery and the vein. An artery in the brain connects to the vein directly, causing dysregulated blood flow, which isn’t a problem in utero, but once born, the baby’s heart and lungs will be overwhelmed by a massive overflow of blood. The overflow of blood could lead to seizures, heart failure, or even death.
Shepherd tells the room that the standard procedure is to embolize the defect after birth, but babies with a VOGM typically either don’t survive or end up with a massive brain injury. That’s why Bailey called in Robbins, who is a world-renowned fetal surgeon. Robbins has been running a clinical trial with a team of interventional neuroradiologists where they operate on the baby’s brain before delivery. Adams raises his hand to ask how many times this kind of in-utero surgery has been done before, and a smile breaks over Robbins’s face as she says, “None. So, who wants to make history?”
Altman, who has returned to work as the Chief of Surgery, greets Richard Webber and Winston Ndugu at the surgical board. Altman feels ready to operate and would like to be cleared to perform surgery. She has been practicing in the skills lab, but Ndugu isn’t having it. He tells her that it’s about stamina, not skills, which Altman finds infuriating. She’s sure he is keeping her out of the OR for no good reason.
Now, out of the auditorium, Robbins, Wilson, Shepherd, Bailey, and the interns meet with Vida and her husband, who have been reading all about Robbins. Everything seems copacetic, but as Griffith begins presenting the case, Vida interrupts, telling them that she can’t do the surgery. Bailey asks if it’s because it hasn’t been done before, but Vida is more concerned about losing the baby. As a low-vision mother, she was already prepared to have to fight for her baby, as many blind and low-vision mothers have children’s services called on them just for being blind or low-vision, and the idea of sticking a giant needle into the fetus’s brain before it’s born doesn’t feel like something she can do. Shepherd tries to remind her that the chance of the baby surviving after birth or even living without brain injury is incredibly minute, but Vida doesn’t care. She’s sold on the small possibility that everything with this baby could be fine, and the surgery won’t be happening.
After the interns leave Vida’s room, Yasuda ends up in the ER, where she is greeted by a patient who is waiting for Dr. Millin. Yasuda offers to help, but he is set on seeing Millin, so Yasuda approaches Hunt, hoping to place a chest tube as it’s the last item on her procedural checklist. Hunt directs her to a patient who needs a rectal disimpaction instead. Before Yasuda can get to her patient, Millin comes into the ER, asking about why she was paged. Yasuda directs her to the patient waiting, but Millin isn’t sure she knows him. The patient immediately tells Millin that she’s not the Dr. Millin they were waiting for. Moments later, a man in purple scrubs greets the patient, who addresses him as Dr. Millin and tells him that there’s another Dr. Millin. “He is not a doctor,” she says, just before the man clarifies that the female Dr. Millin is his sister.
Outside of Vida’s room, Bailey tells Robbins and Wilson that Vida has asked to be discharged, but Wilson doesn’t want to send her home because “she’s just scared.” Bailey wants to know why Robbins didn’t tell her that Vida would be the first patient in the clinical trial, to which Robbins responds that someone has to go first and that Vida is the perfect candidate. Bailey reminds her that the patient has to be completely on board, and since she is not, it’s over. Wilson is disappointed, and so is Robbins, but there isn’t anything they can do.\
Dorian Cardenas, who became a patient at Grey-Sloan in “Keep the Family Close,” is finally awake, and it’s taking Ndugu, Kwan, and Levi Schmitt to hold him down and keep him from panicking. Ndugu is finally able to explain where he is, which calms him down, but when he starts asking questions, Kwan begins to over-explain by sharing that he died, they brought him back, and they’ve had to perform several surgeries on him. Bailey cuts him off, as it’s clear Dorian is overwhelmed.
In the skills lab, Altman comes running in after a 9-1-1 page, only to find Webber and Atticus “Link” Lincoln very calmly waiting for her. They’ve set up a mock OR for her based on Link’s experience working with athletes, who always have to practice before playing a real game. Altman is annoyed at first, but eventually, she plays along, beginning to perform CPR on the dummy that Webber has put into cardiac arrest.
Downstairs, Adams gets off the elevator and runs into Griffith. He asks her about her meeting with the lawyers, but she excuses herself quickly, not wanting to talk about it. Before he can even attempt to chase after her, Shepherd shows up, chastising him for taking her car without asking that morning. She gives him permission to use it, but not without asking her first, and when he tells her that he left her a note, she wants to know which pile of stuff it was under. Things are about to get worse before they get better, though — Adams is on her service for the day, which Shepherd is thrilled about. Adams leaves to round on her patients, and Shepherd is greeted by Beltran, who asks if Shepherd is having intern woes. Shepherd dismisses it, then tells Beltran that the fetal surgery is canceled because the “mom got spooked.” Beltran says that it’s a spooky surgery full of big needles and metal coils going into a tiny brain, and when Shepherd tells her that the surgery is the best shot that the baby has, Beltran begins to walk away, offering only a parting shot of, “Doesn’t make it any less terrifying.”
In the ER, Millin is irritated that her brother is there, invading her workplace. He tells her that the patient, Joshy, is a subscriber, to which Millin responds, “Are you still making those dumb videos?” Doug fancies himself a healer, but a doctor he is not — which Millin points out by reminding him that he’s attended one yoga retreat and dated a pilates instructor, so he’s an influencer at best. He tells her it’s branding, like Dr. Dre or Dr. Seuss, but it’s different. “They don’t wear scrubs and tell people what to eat,” Millin says, just before they’re interrupted by Joshy. He’s in pain, so Millin begins to examine him, looking specifically at the swelling on Joshy’s back. Doug can barely stomach looking at it.
Outside the hospital, Robbins is grabbing a coffee when she is chased down by Vida’s husband, who doesn’t want her to leave. She tells him that she can’t do the surgery without their consent or their trust, and he tells her that she has his trust. He thinks she’ll have Vida’s too, but Vida needs more time. He begs her to stay and continue prepping for the surgery. “Whatever you do, Dr. Robbins,” he says, “don’t leave.”
Millin, still trying to help Joshy, finds Yasuda in the ER. Yasuda tells her to call Hunt — it’s not a chest tube so “no, thanks,” — but Millin doesn’t want to, a revelation which intrigues Yasuda. Millin admits that the patient was waiting for her brother, “Dr.” Millin, and she doesn’t want to ask anyone else when they started the day being interviewed by hospital lawyers. Yasuda is in on one condition: she gets to ask him as many questions about Millin’s childhood as she wants. What’s Millin going to do, say no?
Kwan, who is working on Dorian with Schmitt, brings back labs and tells Schmitt that Dorian’s subclavian central line is infected. Schmitt tells him to put in a new one on the opposite side, but Kwan hesitates. He’s done them before, but never without supervision. Schmitt doesn’t have time for Kwan’s insecurities. “You’ve seen it. You’ve done it. Just trust your instincts,” Schmitt says before walking away from a nervous-looking Kwan.
In the lab, Robbins, Wilson, Bailey, and Shepherd are preparing for the surgery, even though they don’t have Vida’s consent yet. Bailey is pacing, which Robbins finds annoying, and threatens to disinvite her from the OR if she doesn’t chill out. Shepherd is practicing on 3-D printed “phantom skulls,” which approximate possible densities of the skull. It gives Shepherd the opportunity to feel what it would be like when the needle gets through different densities, but Griffith wants to know how that’s anywhere close to the real thing. Before Shepherd or Wilson can answer, Adams jumps in, wondering why they’re practicing if they don’t have Vida’s consent yet. “Shouldn’t we be in there talking to Vida right now, explaining the consequences of not going through with the surgery?” He asks. Shepherd tells him that they don’t convince people to have surgery, and he asks her if they should recommend the procedure at all. Shepherd, at her wits’ end with her nephew, tells him and Griffith to leave, but Arizona stops them. She has an idea.
Millin and Yasuda are still trying to handle the abscess on Joshy’s back, and Yasuda wants to know what Millin was like as a kid. Doug says that she was basically the same, but when Yasuda says, “smart, cool, weirdly good skin,” Doug tells her that he was going to say that she was mean. Then Doug tells Joshy to hydrate after the procedure because “our bodies are 60% water.” Yasuda and Millin exchange a look, and then Yasuda makes another incision, but nothing happens. She can’t get the abscess to drain either and says they need to call Hunt. Millin would rather not, and Yasuda tells her, “I’d really rather not get in trouble for doing something without an attending after already being in trouble for something I didn’t do,” and goes to get Hunt. Millin tells her brother to wait outside the procedure room now that Hunt is coming, threatening to drag him on every message board on the internet if he doesn’t do what she asks.
Griffith and Adams have been tasked with watching the 3-D printer for Robbins, and Griffith finally opens up about her meeting with the lawyers, telling him the question that they asked her and that she had answered no — she would not have opened up Sam Sutton if he hadn’t been in the room. “So you threw me under the bus,” he says, shocked. “By slitting my throat.” “You told me to tell them the truth, so I did,” she tells him, then reminds him that they could have aligned stories before the meeting, but he moved out. She asks where he is living, but he doesn’t answer her, instead telling her, “We have to focus on work.”
In Dorian’s hospital room, Kwan is putting in a new subclavian central line while answering some of Dorian’s questions about the procedures and surgeries that he has had thus far. Things are going fine, but then Dorian starts having pain on the left side of his chest, and all the machines he’s connected to are setting off alarms. Kwan gives him oxygen and yells for someone to page Schmitt.
Robbins comes to Vida’s room, hoping to talk to her about the procedure. Vida says she isn’t ready to make a decision, and Robbins begins to explain. Her colleague, Dr. Nicole Herman — last seen at Grey-Sloan Memorial in Season 14, Episode 23, “Cold As Ice” — is also low vision and likes to walk through surgeries with Robbins when they’re preparing for them. Robbins wants to try that with Vida before she leaves, but Vida is under no obligation to make a decision. Robbins hands Vida a 3-D printed model of her last ultrasound so she can feel the baby’s face and head, and then shows her an MRI of the baby’s brain and walks her through each step of the surgery. Then Robbins softens her tone. “I know that it’s hard when you can’t hope based on what others have done before you. And it’s one thing to have faith for yourself, but to have it for someone else, to have it for your child…no matter how many times I tell you that I know exactly what I’m doing, you’re still gonna be scared. And I know that it’s painful, but this pain — this pain has purpose. This pain could have life on the other side of it.”
While Vida and her husband are deciding, Schmitt is joining Kwan in Dorian’s room. Kwan explains that Dorian dropped a lung and needs a chest tube. Schmitt wants to know why he’s just standing there. Kwan was waiting for him. Schmitt explains to Dorian that this complication can happen but that Kwan will insert a chest tube to reinflate his lung. Kwan starts, but he panics and tells Schmitt that he should do it, backing away from Dorian. Schmitt, annoyed, steps in and inserts the chest tube, barely glancing back at an embarrassed Kwan.
Hunt finally joins Millin and Yasuda in the procedure room, where they introduce him to Joshy. He tells them that the abscess is deeper than they’ve been cutting and talks them through finding the abscess with their finger and cutting deeper. The result is gross, and he promises that they’ll never forget the smell. Joshy is relieved and grateful for “Dr.” Millin, who is leaning against the window outside the room and passes out just as Hunt comes into the hallway. Hunt asks if anyone knows who the guy is, and Millin looks like she could crawl under the table, pus-covered face shield and all.
Up in the skills lab, Altman is still annoyed that she’s having to practice on an old dummy, but she’s pushing through. When she stretches briefly, Webber offers her the opportunity to take a break, but she’s good. “This patient needs a bypass, and I am going to give him one,” she says before asking Link for a specific pair of scissors that he’s never had to use in his orthopedic surgeries and that he can’t identify. Webber tells him, “You’re no BokHee,” everyone’s favorite nurse at Grey-Sloan, and Altman looks at Webber, who is holding the graft she needs incorrectly, and says, “Neither are you.”
Ndugu comes into the skills lab, and Altman greets him by telling him that she has been standing for several hours and has performed CPR, cracked a chest, and is operating on a heart. “I can assure you, I have stamina,” she says. He tells her she still isn’t cleared because recovery from open heart surgery isn’t linear. “If you came back early and something happened to a patient, I wouldn’t be able to live with myself, and neither would you,” he says. Webber offers to take Altman to the OR since he’s been with her all day and knows what she can do. Webber says he’ll sign off on her return, and Ndugu finally relents. “If he signs off, then I do, too.” Took him long enough.
Exiting Vida’s room, Shepherd finds Beltran talking to Adams and giving him assignments. Shepherd accuses her of stealing her intern, and Beltran reminds her that the surgery was canceled. “It’s back on,” Shepherd says, but Beltran is still hoping to use Adams since the interns aren’t allowed in the OR. Adams wants to get the peds hours, but Shepherd tells him to prep Vida. As he heads in to do so, Robbins exits the room, telling him that she’ll see him in the OR. “I won’t be there,” he says, and Robbins asks if she’ll see Griffith. “No,” Adams tells her, “interns aren’t allowed in the OR.” Robbins is stunned. “Says who?”
Robbins pulls Bailey into a storage room, demanding to know what happened to her. “You once put an HIV virus in a kid because you read two papers that said it might cure his SCID, okay? Had it ever been done before? No. But you did it anyways because — because otherwise the kid might have died!” Bailey tries to interrupt, but Robbins isn’t done. “I’m still going, okay?” she says, her voice filled with passion. “You got an award for teaching, which is not surprising because you raised surgeons like Cristina Yang and Meredith Grey, and you were finally recognized for that. So can you imagine how excited I was to come back here and to stand next to you and to teach? But…interns are not even allowed in the OR? Bailey, we might fix a baby’s brain inside a womb. That is magic. And I don’t know — I don’t know what the interns did to get themselves banned, and I’m sure that it was awful. But if you don’t let them see the magic, then how will they be motivated to get back in?” Bailey looks up at the ceiling, and it’s clear from the look on her face that Robbins is right.
Altman and Webber are getting ready to perform a VATS procedure, but something is off with Webber. Altman’s voice starts to fade out, and he is looking at the patient and the medical equipment like it’s brand new to him. Altman asks him if he’s ready, but he can’t do it. He removes his gown and his gloves and walks out of the OR without saying a word to Altman, who is completely confused.
In a different OR, Robbins does one final check-in with Vida before they put headphones on her and begin the procedure. Just as they’re about to start, Bailey brings in all five interns and lines them up against the wall. Robbins smiles under her mask, her eyes crinkling around the edges, and then they begin.
Twenty minutes later, they still haven’t been able to give the fetus the paralytic that’s required because the fetus isn’t in the right position. Wilson is manipulating the womb from the outside, but it’s a waiting game the interns are bored with. Schmitt pages Kwan, who leaves, even though Bailey outranks Schmitt, and then Millin’s phone begins to ring. It’s Doug, so she also leaves, which annoys Bailey to no end. Just as she does, Wilson is able to get the baby into the right position, and Robbins injects the paralytic and anesthetic. Now Shepherd can begin.
Millin finds Doug in the ER, furious that he called her when she was in surgery. He woke up alone and didn’t know, and he tells her to calm down, calling her “Julie Jules.” She reminds him that it’s Dr. Millin, and he says, “You’re my sister. I don’t make you call me that.” It’s the final straw for Millin. “You’re not a doctor!” she snaps, trying to keep her voice low. “I have spent every dollar and every ounce of my energy to achieve that title. I have fought, sweat, and scraped my way through mess, and I am done with anyone who tries to take that away from me. Do you hear me?”
What Millin doesn’t know is that Hunt is behind her, listening. “Dr. Millin can’t treat you because she’s your sister,” he says, walking over to them. “We have strict rules about family treating family, but I assume you know that, being a healthcare professional and all.” Doug looks down at his lap, caught. “Listen, I know it can be hard to take advice from family,” Hunt continues, “so I’m going to say this to you. Misleading others in their health and wellness is questionable at best and, as you saw today, can have severe consequences. So I recommend you find other ways to influence people. And, I hope you’re proud that you’re related to an excellent physician,” he finishes, gesturing to Millin and then telling Doug he can leave.
In the OR, it has been fourteen minutes since Shepherd began the procedure when Robbins tells Shepherd to stop and hold completely still. Keeping her voice calm, she tells the room that the fetus is moving, so she’s going to need to inject more paralytic, but very carefully, as there is still a needle in the fetus’s head. Robbins is able to get it in and the baby goes still, but they’re running out of time. Shepherd has to move fast.
Up in the gallery, Altman finds Webber, who is watching the surgery. He asks her about the surgery, but she handed it off to someone else, and then he tells her that he used to be able to take a break from the OR and, no matter how long, as soon as he was in an OR again, he would feel “it” come back to him. Not this time, though. He’d been away from the OR for three weeks, and standing in there with her, “it” wasn’t coming back. Altman tells him that it’s still there and that she was watching him while they were in the skills lab just as much as he was watching her. He has her back, always, so she asks him to let her have his. “Trust me, if I ever believe that you do not belong in there, I will tell you.”
Altman looks out into the OR just as they finish the procedure. Shepherd has deployed all the coils and removed the needle. Robbins asks for the pre-op ultrasound to be pulled up, and they can see immediately that the procedure worked. “It’s gone,” Wilson says. Robbins shakes her head. “It’s not gone, it’s repaired.” Wilson, Robbins, Shepherd, and Bailey have tears in their eyes as Bailey says, “Magic,” but when she turns around to see the reaction from the interns, they could not care less. Adams is stretching, eyes closed; Griffith is watching with no reaction, and Yasuda is on her phone. Bailey can’t believe what she’s seeing.
Kwan, who is back with Dorian, steps out of the patient’s room to update Schmitt. Before Schmitt can get too far, Kwan admits that he saw Maxine in his head when he was putting in the chest tube and panicked. “You’ll keep seeing Maxine,” Schmitt tells him. “That’s just how it is. The memorable complications, the ones that we think will affect our entire careers, they follow you, whether it’s a good or bad outcome. Soon, it’ll start to dull, though.” Kwan asks him if it will go away, and Schmitt tells him that it won’t, but he’s not sure they want it to.
Robbins and Wilson tell Vida about the procedure and explain what will happen after the baby is born, including how long she’ll stay in the NICU and that they’ll continue follow-up for at least two years after that. Then Vida asks for Bailey. “Thank you,” she says, reaching for Bailey’s hand. “For the clinic, for following up with me, for introducing us to Dr. Robbins, for everything.”
Downstairs, Yasuda and Millin find each other at a vending machine and swap stories about their crazy families. Then Millin tells Yasuda that Maxine is more family to her than her own family, and now her son may not want Millin to be Maxine’s medical proxy anymore. Yasuda reminds her that they might all be named in lawsuits anyway, and Millin says the thing Yasuda has been waiting to hear. “Okay, but why you? You didn’t even do anything wrong that night.” Yasuda is delighted. “This is what I keep saying!”
Shepherd, on her way out, is looking for her keys. Adams left them “at the desk” but didn’t specify which one. Frustrated that she can’t find them, she asks the nurse to page Adams just as Beltran walks up behind her. “Wow, you really have it out for that intern,” Beltran says, startling Shepherd. She asks if Adams made a mistake on one of her patients, and Shepherd tells her the truth. “He’s my nephew and he’s crashing at my place, and he’s a slob. Also, he has my car keys.” Beltran offers her a ride home, which Shepherd turns down, and then says, “Cut him some slack. I mean, his aunt just performed ground-breaking surgery, and he can’t even enter labs correctly.” Shepherd asks if he messed up her labs and Beltran says he did but that “we were all interns once.” Beltran then congratulates Shepherd on her surgery before heading for the elevator, leaving Shepherd surprised at their interaction.
Robbins finds Bailey in the attending’s break room, where Bailey finally tells her what the interns did and that she returned them to the basics. Robbins reminds her that they might still make mistakes; after all, they are interns, but she knows that Bailey knows that, so something else is obviously going on. Bailey tells her that Ben has been sidelined at work because of his broken arm but that he’s back doing the dangerous stuff now. “It is so hard letting them out of our sight,” Robbins says, referring to both Ben and the interns. “But you have to trust in things you can’t see. Sometimes, you just gotta trust that it’ll be okay.” Bailey admits that doing that isn’t easy for her, but it’s clear she knows. Then Robbins asks if they’re going to be let back into the OR. “Hell no,” Bailey says. “They didn’t even appreciate the magic.” Robbins laughs. There is the Bailey she’s been looking for.
Yasuda is ecstatic walking into the intern locker room — she’s completed her procedure log. She’s the first one and tells the other interns that she’s a good doctor, “unlike the rest of you, who gravitate toward malpractice.” Yasuda heads for her locker, and Griffith asks Adams which one of them is rounding on Vida in the morning, to which he responds, “Whatever.” She knows he’s angry but asks if he can at least be civil. “I didn’t say anything,” he says before Millin jumps in to ask them to “please not.”
“I could say the same to all of you,” Bailey says, surprising the interns. “I gave you the opportunity to watch medical history be made today, and all you care about is which one of you is doing what procedure, how many, or whose fault it is. Everything in that OR today happened because some of the best surgeons put their heads together, they communicate, they anticipated. You want to get back in the OR, you need to learn to work together.” Then, she tells them that all of their procedure cards have to be completed before anyone can operate. Yasuda says that she just finished hers, and Bailey responds, “Good for you. You can help your colleagues finish theirs.” Great.
At Shepherd’s place, Adams walks in with groceries and tells her that he bought replacement coffee. He looks exhausted, and she tells him that the intern year is hard. He asks if she almost flamed out in her first few months, and she says “If I’m being honest, yes.” He asks if she alienated all her friends, and she tells him that she did when she wasn’t sober. Then he asks the big question: “Did you have to live in your family’s shadow, wondering if you’d ever live up to those expectations?” “Your Uncle Derek was a legend,” she says. “You have no idea what it was like working here with him.” Adams looks up at her and says, “I meant you.” She tells him to come sit on the couch with her, and then he asks, “What if I’m not cut out for this?” “You find something else to do, and the family legacy dies with me,” she jokes. “But I think you’ll be fine.”
