"Deterioration of the Fight or Flight Response"
Written by Joan Rater and Tony Phelan; directed by Rob Corn

As Bailey helps Burke and Denny flatlines (see “17 Seconds”), various doctors from Seattle Grace voice over about human beings needing a lot of things to feel alive, but to actually be alive, they all need beating hearts. When our hearts are threatened, we have two choices - run or attack. Bailey gives Burke CPR and he finally opens his eyes. George tells Izzie he needs to call a code for Denny, but she refuses, since she has a plan. Izzie gives George the choice of staying to help or leaving. Cristina heads to the ER, where Webber gets her out of the way by assigning her to run a trauma room. Just after she disappears, Bailey brings Burke inside with a gunshot wound to his shoulder. Cristina’s patient is the shooter, who attempted to kill himself by shooting himself in the head. In the next trauma room, Burke gets agitated and worries Bailey by not remembering seeing her outside. As Cristina tries to revive Petey, Derek enters Burke’s trauma room and Cristina is able to see him inside. She heads over to see him, then returns to Petey, wanting to save him so that he doesn’t get off easy for shooting Burke. At Mercy West, Alex keeps trying to delay Erica, who says that as soon as an hour has passed without word from Burke, she’s taking the heart. Cristina returns to Burke’s trauma room and tells him that she forgives him for not taking her to get the heart, adding that she’s there for him no matter what. He just wants her to check on Denny.

Adele secretly summons Addison to see her niece, Camille (AKA Jackie), who lost consciousness while having sex at her prom. Adele is worried about what Webber will do when he finds out that Camille was “cashing in [her] V card.” Camille’s friends Claire and Natalie and her date Brian are there, too. George pages Meredith to Denny’s room, where Izzie is manually pumping Denny’s heart to keep him alive. Cristina arrives shortly after and George announces that Izzie cut Denny’s LVAD wire. George notes that Izzie is insane and Izzie tries to convince everyone that things will be okay as Cristina tries to tell her what happened to Burke. Izzie realizes that Burke isn’t coming after all and worries that Denny will die thanks to her. George wants to tell someone what’s going on, but Meredith says that Denny won’t get the heart and Izzie will get kicked out of the program. Cristina starts to leave, worried about Burke and upset with Izzie. Izzie says that she did what she thought was best. Meredith shuts everyone up, announcing that no one is leaving and no one is dying. Denny, who happens to be conscious, is happy to hear that. Adele tells Claire and Natalie to go back to the prom, but they’re worried that she’s going to call Camille’s mother. As Webber approaches, Adele chases Brian off. Webber thinks Adele is there to see Burke, but she doesn’t even know what happened yet. She then has to tell him why Camille is there. When Addison returns, Webber tells her that Camille had ovarian cancer three years ago but has been fine since then. He then spots Brian and chases after him.

In Denny’s room, George criticizes Meredith’s plan, which is to do all of the tests Izzie was supposed to have done on Denny in the first place. Izzie notes that none of them knows how to do a cardiac echo, but Meredith says Burke showed Cristina how to do one. Cristina wants no part of the plan since it goes against so many rules. Izzie tries to get Cristina to empathize, but Cristina says she never would have fallen in love with a patient (though she did fall in love with an attending). Meredith says that no one can help who he or she falls in love with. Webber and Derek notice that Burke’s hands are cold, then look at x-rays and discuss surgery. Burke starts having trouble breathing thanks to a collapsed lung, but Webber and Derek revive him. Alex talks to Meredith on the phone, learning about what happened to Burke, and refuses to participate in Meredith’s plan until she asks him to help for Izzie. In Camille’s room, the teen tells her friends that sex was great before she had to come to the hospital. Addison asks if she’s had any problems in the past few months, and though her friends are unaware that anything was wrong, Camille admits that she’s been feeling sick for a month but didn’t say anything because she wanted to go to the prom. Addison finds Adele and they discuss the nights they lost their virginities; Adele barely remembers hers but Addison remembers every detail of hers. She also has to let Adele know that things don’t look great for Camille.

Izzie tries to get Cristina to understand why she’s doing all this for Denny, but Cristina doesn’t get it since Izzie barely knows him. Izzie disagrees, adding that they have the possibility of getting to know each other even better. Cristina thinks she should run instead of risking her heart and her career. Denny mumbles that Izzie should marry him, then passes out, leaving Izzie unsure if she really heard what she thinks she heard. Denny flatlines and the four interns work to revive him. At Mercy West, Erica has little sympathy for Burke, then tells her surgical team to extract the donor’s organs. Alex is unable to stop them. Webber discovers that Claire and Natalie have told a bunch of people about Camille and they’ve all gathered at the hospital. He sends them all home, telling the girls that people in the hospital are sick and dying. Claire says she knows. Burke tells Derek that he’s developing numbness in a couple of his fingers. Derek says he has a psueoaneurysm that might go away if they wait a couple of days. However, if Derek performs surgery to remove it, he could damage Burke’s nerves and he could lose the ability to use his arm. Derek admits that he’s not sure he’s good enough to successfully perform the operation. Burke asks what he should do. “It’s not like you to ask those kind of questions,” Derek notes. “It’s not like you not to have the answers,” Burke replies. At a nurses’ station, Adele blasts Webber for sending all the kids away, asking him to bend the rules for her, the wife who never complained about him working long hours - and who said nothing about his affair. She tells him make his family a priority or move out.

Derek tries to avoid Addison by ducking into an empty room, but Webber is already there. Derek says he can’t get perspective because “everything feels enormous.” Webber tells him that Camille is dying, and that 25 years ago, he had an affair with Ellis that his wife knew about but never said anything about, even going so far as to stay with him. Derek talks about how much he respects Burke and how he doesn’t want to be responsible for ending his career as a surgeon. Webber replies that Derek is as decent and honorable as Burke, and he knows Derek won’t run. Bailey stops by to see Burke, who asks for morphine, ice, and Cristina. This makes Bailey realize that she doesn’t know where Cristina is - in fact, she doesn’t know where any of the interns are. They’re, of course, still with Denny, trying to find medicine that will briefly stop his heart so it won’t beat so fast. Denny is rightfully scared, especially since the interns are only going on things they’ve seen and heard about. The medicine works just as Bailey finds them and orders Olivia to take over pumping Denny’s heart so she can yell at the interns. Izzie refuses to leave, so Bailey tells Olivia to help her out and takes the other three out of the room. Bailey sends Cristina to Burke and George to get Denny’s tests, telling Meredith to come with her. Cristina goes to see Burke, who wants to know what she thinks he should do. She doesn’t answer, saying that she needs to leave and think about it.

Bailey checks on Denny, who tells her that he cut his own LVAD wire. Izzie asks if Denny will still get the heart, and when George returns with labs, she notes that he’s more qualified than ever now. Bailey tells Izzie that as of right now, she’s a visitor and no longer a doctor, so her medical opinion doesn’t count. Izzie lets Olivia take over pumping Denny’s heart, still just wanting to know if he gets the transplant. Bailey approaches Webber and asks him if, hypothetically, a patient whose doctor had cut his LVAD wire to move him up on the transplant list would still get the heart. She notes that in the hours it would take to get a new LVAD, the patient would die, so Webber says that he would get the heart if he was at the top of the list. Of course, he knows this isn’t a hypothetical situation, and he wants details later. Alex stops Erica just as she’s leaving Mercy West with the heart and confirms that UNOS has assigned the heart to Denny. Erica argues that her patient has kids and is a good person who deserves the heart. Alex says he’s sorry, and after he takes the heart, he tells Erica that there’s a helicopter waiting on the roof. Derek chats with Burke, telling him that he can take up fishing if the surgery doesn’t go well. As Alex and Erica land at Seattle Grace, Izzie escorts Denny to surgery, ignoring Bailey’s glares. Burke heads to surgery as well, asking Derek not to kill him. Erica performs Denny’s heart transplant with Bailey and Alex, noticing that without surgery, Denny wouldn’t have lasted another hour.

Derek removes Burke’s aneurysm but possibly cuts a nerve root. He realizes that the only way to tell for sure is to perform a test that requires waking Burke up from anesthesia to see how much function he has in his hand. The interns (minus Alex) mope in a hallway, feeling like they’re in time-out and worrying that they’ll be kicked out of the program. Izzie says it’s all her fault and acknowledges that she probably should have run, but she’d “rather be running towards somebody than running away.” Webber calls an end to Cristina’s time-out by telling her to join Derek in Burke’s OR. Izzie asks George and Meredith if Denny really proposed; they confirm that he did, so she heads off to check on him. Derek tells Cristina that she needs to keep Burke calm when they wake him up, since he’ll be disoriented and in pain, and will try to fight his breathing tube. As the doctors start to wake him up, Meredith thanks George for paging her to help Izzie. He says it’s nothing and she apologizes, but he tells her he knew she never had romantic feelings for him but slept with her anyway because he wanted to have one night with her, even if that was all they would have. That means he’s the one who should be sorry, and he is. Burke wakes up but Cristina freaks and hides. Erica finishes Denny’s transplant and prepares to take him off of bypass to see if his new heart will beat on its own. Derek calms Burke on his own and determines that he can move his hand. Bailey and Erica try to get Denny’s heart started as Alex looks up and sees Izzie watching in the gallery.

THE TITLE IS A SONG BY…: The Flaming Lips

MEMORABLE QUOTES: “You press that code button, I will hurt you. Not a lot, ‘cause we’re friends, but enough so that things will break and you will lie on the floor out of my way.” - Izzie to George

Bailey: “No speaking. Nobody speaks. I do not want to have to testify against any of you in a court of law. Not one word. She cut his LVAD wire.”
(George clears his throat)
Bailey: “Look, I said no speaking!”
George: “I didn’t say anything!”
Bailey: “Then no moving!”

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