"The Self-Destruct Button"
Written by Kip Koenig; directed by Darnell Martin

Meredith is in bed with Derek, voicing over about how little sleep interns get. It’s 5:20 in the morning, and Meredith has to get ready for pre-rounds; she tells Derek he has to get out of the house before Izzie and George see him. George and Izzie are in the kitchen, talking about how they got little sleep the night before because Meredith and her mystery man were so loud. Izzie admits that she’s jealous (though George claims he’s not) but she’s a little happy that Meredith will have a long day ahead of her. Derek tries to sneak out of the house but George and Izzie spot him and Izzie comments that they know brain surgery isn’t his only skill. George can’t believe Meredith is sleeping with their boss. Izzie points out that Meredith has been scrubbing in on a lot of surgeries lately and this could be the explanation. George doesn’t think Meredith would sleep with Derek just to get surgeries, but Izzie wonders why Meredith is keeping quiet. George wonders if it was just something spontaneous that happened the night before. Meredith enters and Izzie asks who she slept with the night before. “No one you know,” Meredith lies. As they head to work, Meredith voices over, “Why do we bring more trouble down on ourselves? What’s up with the need to hit the self-destruct button?”

At the hospital, Meredith, Izzie, and George meet up with Cristina, who has just arrived on her motorcycle. Alex jogs up, bragging that he runs every day. Cristina isn’t looking well and admits that she thinks she has the flu. In the locker room, George and Izzie bring up Meredith’s romp the night before and mention that she was a little loud. After everyone else leaves, Cristina asks Meredith if the others know that she’s been seeing Derek. Meredith hopes not, since Bailey is already coming down hard on her. As the interns gather with Bailey, Meredith yawns and Bailey and George both see Derek putting drops in his eyes. Bailey gives the interns their assignments, then encounters a woman who tells her and Izzie that her boyfriend has swallowed her keys. “I didn’t want her to leave,” the boyfriend explains. Meredith’s patient is Claire Ric, a 17-year-old girl whose mother says she’s been sick since she got back from a trip to Mexico. She’s been weak, has lost weight, and passed out in the shower this morning. Claire doesn’t want to be examined, but Mrs. Rice doesn’t want to stay there all day and tells her to just let Meredith do her job already. Alex and Cristina’s patient is Digby, who let his friend shoot him “as a favor” in order to make “art.” He and Alex bond over wrestling, albeit at rival colleges.

While examining Claire, Meredith finds pink scars on her stomach that indicate that she recently had surgery. Claire asks her not to tell her parents, leading Meredith to believe that she had surgery in Mexico so her parents wouldn’t find out. George’s patient is a little girl named Jamie whose foot has been twitching for a few months. George assures her parents, Mr. and Mrs. Hayes, that Derek, who will be taking the case, is good at “just about everything.” Bailey and Izzie look at the key-swallower’s films and decide that he needs a bronchoscopy, which Izzie gets to perform. She’s happy because she wasn’t sure anyone had noticed how hard she’s been working. Bailey talks to Meredith about Claire as Cristina walks by looking sick. Bailey wonders if Claire had a botched abortion, but Meredith thinks it’s something else. Bailey sends her off to do some other tasks. Burke finds Cristina in the hallway and she blames him for getting her sick. He offers to take her home, but she refuses and tells him to go home instead. George and Izzie talk about Meredith and Derek; George doesn’t want Izzie to say anything about them and get Meredith in trouble. Izzie notes that the intern program will make or break their careers, and Meredith shouldn’t be chancing things by sleeping with an attending. George thinks that Derek shouldn’t take advantage of Meredith, but Izzie points out that she’s an adult.

George looks on from the scrub room as Derek does an operation and is joined by an anesthesiologist named Dr. Taylor. An x-ray technician comments to George that Dr. Taylor smells like bourbon, but he’s the best anesthesiologist on staff and the x-ray tech isn’t worried about him. After the operation, George approaches Derek and tells him that Jamie has been admitted. Derek asks for more CT films. Alex and Burke look at Digby’s films, finding a bullet from a previous shooting and deciding not to take it out. Bailey remembers Digby from previous encounters and says she’s “glad to see he’s still stupid.” Meredith grabs Bailey again and tells her that Claire had her stomach stapled in Mexico. The two tell Mr. and Mrs. Rice about the botched gastric bypass, and though Mr. Rice is surprised, Mrs. Rice says that it’s typical of Claire to take the easy way out. Bailey warns that without surgery to correct the problems, Claire will have lifelong difficulties with malnutrition. Mrs. Rice tells them to do the operation, complaining that over Christmas break, she had to get size 6 jeans for Claire because she’d grown out of her other pairs. Mr. Rice notes that Claire tries hard and gets good grades. Bailey announces that there’s another problem - Claire has edema and an abscess in her diaphragm, which means she might never completely recover.

Derek meets with Jamie and her parents, promising to find out what’s causing her seizures. He changes his orders to George, telling him to get an MRI instead of a CT scan. Mr. and Mrs. Hayes are worried about the cost of Jamie’s medical needs, but Derek tells them not to worry. Jamie’s leg starts twitching and Derek displays some terrific bedside manner taking care of her. Izzie gets ready for key guy, JP’s, bronchoscopy as his girlfriend complains that he’s making her look stupid. He tells her that he thought she would think it was funny or romantic. The girlfriend tells Izzie that his last stunt was calling her therapist, pretending to be his own therapist, to find out what she’d said in her sessions. Izzie thinks JP is being passive-aggressive; his girlfriend adds that he’s also manipulative and needy, which Izzie calls the trifecta. “What do I win?” JP asks. Burke and Alex tell Digby that the bullet collapsed his lung and there’s blood pooling in it. Digby is all about “no pain, no gain” and Alex thinks that doctors are the same way. Digby notes that in college they would have been rivals, but in Seattle they’re brothers. Alex tells him what they’ll need to do to fix his lung, and Digby just wants to know if he can watch.

Mr. and Mrs. Rice confront Claire about her surgery, which she tells them she learned about on the Internet. Mrs. Rice says that there are much healthier ways to lose weight, though Mr. Rice doesn’t think Claire needs to lose weight at all. Claire says that college was stressful, and she thought if she didn’t have to worry about her weight, she could focus on other things. Mrs. Rice blasts her for taking yet another shortcut in life. Meredith steps in, telling Claire that her parents think the best thing is to have the bypass reversed. Claire doesn’t want surgery again, even though her health is at risk, because she doesn’t want to regain the weight she’s lost. Mrs. Rice tells her the decision isn’t up to her. Derek tells Jamie’s parents that she has Rasmussen’s encephalitis, which means that one side of her brain is fine and the other is dead or dying. Without surgery, she’ll die. However, the surgery requires removing the dying portion of her brain. He assures Mr. and Mrs. Hayes that since Jamie is young, her remaining neurons will compensate for the loss of half of her brain and she could live a fairly normal life. After the conversation, Derek tells George that if the parents consent, he wants George to scrub in on Jamie’s surgery.

George shares his news with Cristina, who thinks that George hates Derek because he knows about Derek and Meredith. George is surprised that Cristina already knows, and he pulls Izzie aside and tells her that. George doesn’t think it’s responsible for Derek to head into brain surgery with such little sleep. Cristina accuses him of being jealous, saying that “sex all night isn’t about being responsible.” She thinks that Meredith is allowed to do whatever she wants to unwind. As Alex joins the group, George mentions Dr. Taylor and wonders if he should tell someone that he’s drinking on the job. Alex doesn’t think he should open up that can of worms; plus, he wants to steer the conversation back towards sex. Burke and Alex tend to Digby, who says he’s feeling dizzy but still wants to talk about wrestling with Alex. Bailey and Meredith operate on Claire while Meredith says that she just wants her mother’s approval. Bailey tells her that after the surgery, she needs to do some postops and pick up some of Cristina’s slack. Meredith replies that she’ll mop the floors, then apologizes for being inappropriate. Bailey asks her what she thinks she’s doing with Derek, but Meredith wants to keep her private life private. She’s also willing to do whatever Bailey throws at her. Meredith’s day is complete when Claire’s bowel bursts and sprays her.

As Jamie is prepped for surgery, George thanks Derek for letting him scrub in. Dr. Taylor is also there, reading to do a crossword puzzle until he’s needed. Just as Jamie is put under, George asks Dr. Taylor if he’s been drinking. Dr. Taylor blasts him for asking a question like that, and Derek tells George he’s out of line. George thinks he’s being appropriate since a two-year-old girl is about to undergo brain surgery. Dr. Taylor orders Derek to kick George out, so Derek does so, then warns Dr. Taylor to be ready. Izzie performs JP’s bronchoscopy as his girlfriend runs down a list of reasons why she’s leaving him. Izzie finally has her kicked out just as JP starts to choke because the keys have moved farther down. Now JP’s girlfriend wants him to be okay, and as soon as he is, she accuses him of making things worse on purpose. Izzie tells the girlfriend that she should probably run as far and fast as she can. JP taunts that she’ll never figure out where he parked her car. Bailey tells Meredith to talk to Mr. and Mrs. Rice (before she’s allowed to take a shower), but first she heads to the locker room, where Izzie is “strangely happy” to see Meredith covered in Claire’s insides. Bailey tells Meredith, Izzie, and Cristina that Derek needs a replacement intern, picking Meredith for the job. Upset, Izzie blurts out her knowledge of Meredith and Derek’s relationship.

Alex tells Burke that Digby’s blood pressure is up, which makes Burke think that something is wrong. Cristina joins Derek for Jamie’s surgery as Meredith tells Mr. and Mrs. Rice that Claire has lost a lot of bowel and will never be able to eat normally again. Mrs. Rice is upset because now they’ll have even more trouble with her. Meredith points out that Claire seems like a good kid otherwise; she just feels like nothing she does is good enough for her mother. Mrs. Rice thinks Meredith is blaming her for the situation. Meredith replies that Claire is killing herself to please her mother - “she didn’t do this to herself.” Mr. Rice finally tells his wife to shut up. Alex goes to see Digby, who isn’t doing well. Alex discovers that a recent tattoo is infected and tells a nurse named Olivia (Sarah Utterback) to take him to the ICU and give him antibiotics. In the middle of Jamie’s surgery, Derek sees her blinking and realizes that she’s coming out of her anesthesia. He tries to alert Dr. Taylor, who’s fallen asleep. “He was right, wasn’t he?” Derek asks, referring to George. He kicks Dr. Taylor out and calls for another anesthesiologist. Burke finds Alex working on Digby, who is septic and whose organs are failing. As they work to resuscitate him, Derek and Cristina successfully finish Jamie’s surgery.

Outside the OR, Derek tells George that there’s a code among doctors about asking each other questions, but George wasn’t out of line. Derek should have taken responsibility and George didn’t deserve what happened to him today. He then asks if George saw him leaving the house this morning. “Oh, was that you?” George asks. Derek promises that he’s not using or favoring Meredith. Meredith tells Claire that she’s not completely better, but Claire is just happy that she won’t gain weight. Meredith tells her she’s contacting social services to talk to her parents: “Life isn’t supposed to be like this. It’s not supposed to be this hard.” Burke declares Digby dead and Alex laments that he’s lost the first person he’s met from back home. At home, Izzie frosts a cake and Meredith confirms that she knows about her and Derek. Izzie thinks everything has been easy for Meredith, whose mother is Ellis Grey and who went to Dartmouth. Izzie herself grew up in a trailer park and went to a state school, putting herself through med school by modeling. She wonders why Meredith is risking throwing everything away. Suddenly she realizes that it’s because Meredith is falling for Derek. Meredith denies it, then voices over about how may we hurt ourselves to feel real or to feel good when we stop. Burke goes to the on-call room looking for Cristina, who is in the bathroom with a positive pregnancy test. Derek shows up at Meredith’s, but instead of having sex, they decide to just sleep.

WELCOME TO SEATTLE GRACE: Olivia

THE TITLE IS A SONG BY…: AC/DC

MEMORABLE QUOTES: Digby: “So how’s the trumpet playing?”
Burke: “Very safe, compared to your hobby.”

Cristina: “You know about him and Meredith?”
George: “You know?”
Cristina: “When are you gonna figure out that I know everything?”

Alex: “You look like you need to be spoon-fed.”
Cristina: “You look like Alex.”

“If you wait a few minutes, you can have a piece of cake. Baked it chock-full of love. Actually, chock-full of unrelenting, all-consuming rage and hostility, but it’s still tasty.” - Izzie to Meredith


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