This was one of those episodes where there wasn't much in the way of light storylines to balance out the dark ones. The lightest one we get is that Richard is having a hard time adjusting to being just another doctor, because everyone still treats him like the Chief and he can't fit in. He eventually tries to talk about how hot one of the nurses is to fit in with the rest of the boys, but it falls flat and eventually, he seems to come to terms (at least somewhat) with his in-between status and he gives Derek some advice on how to better handle being Chief. Earlier that day, when Mere told Derek about an amazing surgery she was assisting on, Derek wound up stealing the surgery for himself and has to later admit that not operating is driving him crazy. Richard gives him some tips, and even offers to become his lunch buddy in the future, so that Richard has someone to eat with and so that Derek doesn't get bombarded by everyone wanting something from him while he's trying to have a sandwich. Awww.
Callie's patients are a couple of guys who were caught in an avalanche while doing some daredevil skiing. She and Mark work on them and all the while, Mark tries to get Callie to admit to Arizona that she wants kids, pointing out that she is going to have to be honest about it because it's not just something one can continue to sweep under the table. She inadvertently gets her daredevils to admit that they don't want to live on the edge and would rather go wine tasting, and their joyous realization that they all feel the same way prompts her to finally talk to Arizona. Arizona freaks because she thinks that Callie is breaking up with her, but when Callie admits she wants a baby at some point, Arizona pulls away and what with all the talk of death in this week's voiceover, it seems their relationship might wind up dead.
Teddy has the bulk of the story this week as she has a terminal patient who has requested physician-assisted suicide. She needs a second doctor to sign off so she grabs Hunt, but rather than sign off he walks out and then proceeds to have flashbacks all through the day about Iraq. We see that he and Teddy were super close friends, and their commanding officer Dan thinks they should just get together already even though Hunt keeps insisting he is with Beth. Just after a bunch of wounded soldiers are brought to their camp for treatment, they have to leave because of a sandstorm; Teddy leaves on a helicopter with his patient while Hunt and Dan take theirs in a Humvee. In the middle of nowhere, they hit a roadside bomb, the truck flips, and the driver and all of their patients die immediately. Dan is seriously wounded and Hunt tries to care for him as best he can, up to and including sticking his fingers in Dan's neck to plug an artery that bursts. After hours out there, Dan knows it's his time to die and tells Hunt he has to let go, and, after much arguing about it, Hunt finally does but the act clearly takes its toll. Back at Seattle Grace he raises a ruckus and tries desperately to convince the patient not to do what she is going to do, but she then tells him why she's doing this and manages to convince him that it's the right thing for her and she's at peace with it. Outside later, the woman's husband finds Hunt as he's totally scared about what's going to happen though he's obeying her wishes. Hunt convinces him that there will be a moment when she's gone that he'll know he did the right thing, and then warns him to hold on to that because there's going to be a whole other shitstorm of feelings as well, which is clearly what has been consuming him all day. That night Cristina realizes he's not sleeping (though she doesn't realize this has been going on for a while) but Hunt manages to convince her that everything is fine and to go back to bed. Clearly though, everything is not, which I'm sure is going to carry us the home stretch of the season.
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This episode, we shake things up and get some Huntover: "Dying isn't easy. The body was designed to stay alive. Thick skulls, strong hearts, keen senses." The clock shows that it's just after three in the morning, and he is wide awake while Cristina sleeps soundly next to him. He gets up and proceeds to do a bunch of pushups, make some toast, and watch the news. After chasing the toast with some OJ he gets carefully back into bed at 4:59, so that when the alarm rings a minute later Cristina wakes up and thinks he's been there the whole time. She then proves to be a far better woman than I and, instead of hitting snooze fifteen times and cuddling with her hot boyfriend, gets right out of bed. He stares forlornly at the ceiling.
"When the body starts to fail, medicine takes over." Teddy is at the hospital and walks in to her patient Kim's room and greets her and her husband Sean, asking how they are doing. Kim, obviously a cancer patient with the scarf on her head, pulls her oxygen mask away and tells Teddy that she's ready and today is the day. We don't know yet for what (unless we've seen the title of the episode), but Teddy pointedly asks Sean how he's doing and he numbly and fairly unconvincingly says that he's fine.
"Surgeons are arrogant enough to think that there is no one we can't save." Teddy pages Hunt and explains to him that Kim has stage four lung cancer that has spread to her lymph nodes and liver -- basically, all sorts of bad stuff is happening and breathing is getting really difficult. Hunt asks if Teddy is going to have to intubate but Teddy carefully says that Kim doesn't want that, and as Hunt muses about how he's not sure what else to do, the camera zooms in close to her face so we know she's about to say Something Big. She tells him, "She wants us to help her die." Huntover finishes: "Like I said, dying isn't easy."
He goes back to Kim's room with Teddy but looks troubled as she explains to Kim how this works: The state requires that two doctors sign off, hence her bringing in Hunt. Teddy tells us/Kim that she has less than six months to live, she has informed Kim of all of her options, and psych has declared her mentally fit. Kim just has to make a second oral request to Teddy, at least 15 days after her first request, which would be now. Kim jokes ruefully that it's like she's applying to die, and Sean hopefully jumps in to suggest maybe she's having second thoughts. Kim immediately reminds him how bad she was the night before and how things will only get worse, and then says -- as firmly as someone who can't breathe very well can -- "I would like to end my life through physician-assisted suicide." Hunt can't take it and after a moment, excuses himself and flees. Teddy excuses herself to go see what's going on but Kim calls after her to ask how long it will take to die after she takes the barbituates. I assume the really formal way she asks this is so that all of us learn exactly how this process works, which is actually legal in the state of Washington. Sean absolutely doesn't want to have this conversation yet but Kim assures him that it's time, and Teddy answers that it takes about 45 minutes to die.