Ratings: 11.18 Million Viewers
Medical Notes: The frame Derek attaches to his patient's head is called a stereotactic frame. Used in conjunction with an brain scan, it permits the clinician to precisely locate structures in the brain during surgery. Using a scan data, a computer can calculate the location of each structure relative to a point on the frame. Once the clinician places the frame, the computer can maneuver a probe to implant electrodes or inject drugs with a high degree of precision - in this case, ensuring that a drug dosage is delivered to the correct region of the brain in each patient.
Trivia: This is the first episode to be directed by Kevin McKidd (Dr. Owen Hunt).
Meredith (opening voiceover): Doctors practice deception all the time. We give vague answers to hard questions. We don't talk about post-op pain. We say you'll experience some discomfort. If you didn't die, we tell you the surgery went well, but the placebo has to be the doctor's greatest deception. Half of our patients we tell the other truth ... the other half, we pray the placebo effect's real. And we tell ourselves that they'll feel better anyhow, believing help's on the way, when, in fact, we're leaving them to die.
Callie: You have to say something. Words. Make words.
Mark: Holy crap.
Mark: A baby?
Callie: Yep, growing like a weed in my uterus.
Mark: Not like a weed, like a mighty oak. (Callie looks confused) We're gonna make great parents.
Callie: Mark, you don't have to do...
Mark (puts a hand on her stomach): Are you kidding? That's my kid in there, I'm a dad. (Callie laughs) We're parents. Of a baby!
Callie (smiling): Okay, you're in.
Mark: Should we get married?
Callie (smile fades): Oh, no. I mean, I'm all for raising a baby with you, but there's a line.
Mark: You're right, that's good 'cause I'm in love with Lexie... Oh my God, Lexie. What am I gonna tell Lexie?
Callie: Okay, you think about that.
Jackson: I booked the OR, I read up on the procedure, I know this thing better than my own name at this point.
Cristina: I pre-rounded on the patient and her pre-op labs are all done.
Teddy: Quadruple bypasses are exciting, right? First assist gets to sew all the grafts onto the heart. Fun job.
Cristina: I want it!
Jackson: It'd be an honor.
Teddy: I know, you're thinking whoever does this gets a leg up on the race for Chief Resident. But you wanna know a good way not to get it? That's to bug the crap outta me before my day even starts.
Meredith: You didn't say goodbye this morning.
Derek: I had a surgery. I didn't want to wake you.
Meredith: No, you were starting your clinical trial and you feel guilty that I'm not on it, so you snuck out.
Derek: You're right, but I don't feel guilty and I didn't sneak out.
Alex (walks up): Ah, patient number two Daniel Cobb admitted and in his room, his wife has some questions for 'ya.
Meredith: I... can't believe he picked you for this thing instead of me?
Alex: Well, Dr. Shepherd didn't want to leave anything to chance.
Meredith: Now you both can go to hell.
Derek: Meredith, it was open to all the residents Karev just did a better job at pitching me.
Meredith: It was open all the residents except for one!
Alex: Day one and it already blows. I got one guy begging us to get his wife on the trial and this other guy's wife wants me to steal a drug for her husband.
Meredith: Well, you're the one who wanted in on the trial of the century.
Alex: With peds, the problem is right in front of you. I mean, sick kid, worried parents. Here, you got a sick parent who doesn't even know their sick.
Meredith: Well about five years ago, I was visiting my mother and she starts telling me about how she thinks she has herpes. And how she doesn't want to go to the hospital and get checked out because she's afraid everybody will know. So, I realize that she thinks I'm her best friend from med school, and it's 35 years ago. So, I just had to just sit there and talk to my mother about her possible herpes for two hours, two very long hours. I couldn't cure her Alzheimer's but at least I could give her what she needed in that moment.
Alex: Advice about herpes?
Meredith: Advice about herpes.
Lexie: I'm putting in targon, not that I have any idea what targon tastes like but I think when people use targon it makes them seem like they know what they're doing. Basil can't do that. Anybody can sling some basil around the kitchen.
Mark: Callie's pregnant.
Lexie: Oh my God, that's great. She loves babies. Did- Did they do a turkey baster thing or- or something? I mean, wait a minute, okay, so wait. Arizona just got back... and they, we're they doing this, wait was this before... (looks at Mark who's looking down, then he looks at her, she realizes)
Mark: I saw the heart beat today. This is my kid, this is a part of me. ... Please, is there any way we can...
Lexie (teary eyed): How the hell did you get me in this position... (slams counter) twice?! It... It is... Unbelievable. You are unbelievable!
Meredith (closing voiceover): Doctors practice deception every day, on our patients, on their families. But the worst deception we practice is on ourselves. Which is why sometimes it takes us a while to realize that the truth has been in front of us the whole time.
Most modern drug investigations are conducted using the double-blind model, where neither patient nor clinician knows whether the patient has received the investigational drug or a placebo. Trials usually depend on patient descriptions to ascertain whether medications are effective. A key problem with this is the "placebo effect" in which patients report improvement even when receiving a placebo. This effect can hide whether or not (and to what degree) an investigational medication actually works. To avoid the placebo effect, patients are not told whether they are receiving the medication or a placebo, and in a double blind model, the clinician does not know, either. This prevents him from introducing his own bias into the reports or inadvertently telegraphing the facts to the patient. Yet here, we see that the medication insert reveals to the clinician (Derek) whether his patient is receiving a real medication or not. At best this is a single-blind study, a type known to be inferior to double-blind studies.
When Lexie is reading questions to the Chief during surgery from her phone, you can see that the 'text' on her phone is actually her lines.