When Grey’s Anatomy Season 21, Episode 5, “You Make My Heart Explode,” begins, two of its doctors are hiding. Jo Wilson is sitting in her car, panicked about the information she and her partner, Atticus “Link” Lincoln, discovered at the end of Season 21, Episode 4, “This One’s for the Girls,” which is that she is pregnant with twins. While she’s in her car, Levi Schmitt scrambles into the passenger seat. Schmitt is hiding from James, the hospital’s chaplain. They slept together in “This One’s for the Girls,” and at the end of the episode, Schmitt found James’s wedding album.
Wilson and Schmitt share their problems with one another often, so it’s no surprise that they’re confiding in each other now. Shortly after Jo shares that she is carrying twins, both Link and James show up, knocking on the windows of the vehicle. Link offers Jo tea, and James tries to speak with Schmitt, but Jo turns on the car and pulls out of the parking space to get away from Link, driving her and Schmitt to the other entrance.
Also arriving at the hospital are Lucas Adams, Simone Griffith, and Benson Kwan, who run into Jules Millin at the coffee cart. Millin grabs four coffees for herself and mentions that she has already picked up two of Mika Yasuda’s shifts that week — so has Griffith — and is exhausted. As the quartet rounds the corner towards the entrance, they run into a table of volunteers registering people to vote. Though most of the interns say that they’re registered to vote, Kwan tells the volunteers, “It isn’t really my thing.” It’s a statement that jars Griffith, who brings it up for most of the episode, trying to understand why Kwan doesn’t vote and trying to change his mind.
Teddy Altman and Owen Hunt spend the morning in therapy, working on their marriage. The therapist gives them homework to schedule sex, which Owen agrees to despite hating the idea of it. He wants his marriage fixed, but it’s almost as if he wants it fixed without having to try.
Down in the attending’s break room, Winston Ndugu and Monica Beltran run into each other, apparently not having seen each other since they slept together at the end of Season 20. Ndugu hands her an envelope with something she left behind — a piece of lingerie — but Beltran tells him that it’s not hers. Turns out Ndugu has been busy. As they’re talking about it, Amelia Shepherd comes in looking for Beltran, and while Beltran tries to hide the lingerie that isn’t hers, Amelia definitely spots it. Awkward.
Warren has been tasked with giving the interns their assignments for the day because Schmitt is already with Beltran, and first, he tries to do a line-up like he’s still in the firehouse, but the interns aren’t interested. He gives up and hands off assignments: Adams with Beltran and Schmitt, Griffith with Link, and Millin with Ndugu. Oh, and Kwan? He has over 100 hours of dictation to do, so that’s what he’ll be doing. On the way out of the locker room, Warren runs into Miranda Bailey, and they discuss that his evaluations have been sent out. First up is Ndugu.
Adams meets up with Beltran and Schmitt, and the two men learn that they’ll be picking up Beltran’s patient from Friday Harbor. Via helicopter. Schmitt seems jarred by the idea of being up in the sky, but Adams can’t wait to get on the helicopter.
In the cardiac unit, Warren and Millin are assisting Ndugu with Mr. Riley, the band director that Griffith and Ndugu worked on in “This One’s for the Girls.” Riley has been extubated but is still on ECMO and needs a CT with contrast to see what is going on in his lung. Ndugu begins to perform procedures that a resident or intern would usually do — changing Riley’s nasal cannula, and helping with transportation — and Warren starts to get concerned. Does Ndugu think he can’t do it?
While Kwan is working on his dictations, he sees one of the hospital’s custodians, Zayne, who seems to be experiencing pain on his right side. Though Zayne insists he’s okay, he eventually collapses, bringing a rack of supplies down on top of him, and Kwan rushes to his aid.
Altman and Hunt are working together on a patient, Aurelio Wheeler, who has recently had heart surgery and is desperate to go home. His 40th wedding anniversary is coming up, and he has to be home for it. Hunt suggests waiting and watching the fluid around his heart before jumping into a new procedure, and Mr. Wheeler starts waxing philosophical about his wedding and how they recreate their wedding dinner every year. Hunt shares the story of his and Teddy’s wedding — “We wanted to get married in the park, but we wound up doing it in a bar.” — and suggests they go to Joe’s for their anniversary, but Teddy’s unimpressed since they only ever go to Joe’s. She tells them she’d like to do another test, and then they’ll decide what to do next. After she leaves, Mr. Wheeler tells Hunt to pick up flowers for her on his way home. “Works every time.”
In Friday Harbor, Schmitt and Adams meet Ofelia Lopez, a 10-year-old girl who fell off a moving tractor and has a bad leg injury and a TBI. Schmitt begins his exam and learns that while Ofelia’s oxygen is low, the hospital only has one ventilator, which is in use, so she hasn’t been intubated. Schmitt introduces himself and Adams to Ofelia’s parents and then to Ofelia, telling the girl that the two of them are going to make her feel better. He hands his number to her parents, who are surprised to learn that they can’t ride in the helicopter with her, but there isn’t enough room. They’ll have to drive the three hours from Friday Harbor to Seattle, but Schmitt promises that they’ll take excellent care of Ofelia. Her parents tell her they love her and that God will protect her, and then the local doctor escorts them out of the hospital. Schmitt tells Adams they need to get her intubated for transport right away — if they don’t get back fast, they might have to amputate her leg.
Bailey finds Kwan helping Zayne and begins to chastise him for not doing his dictations before realizing that the patient is a member of the Grey-Sloan Memorial Staff. Zayne mentions that he’s been dealing with the pain for months and doesn’t want to be fussed over, but Bailey insists that they’re taking him to the ER to get checked in and even invites Kwan along.
Link and Jo are on the OB floor, waiting for an appointment with Carina DeLuca, who is mentioned several times but continues not to make an appearance. Link makes a comment about needing to get a minivan for all their car seats, but Jo is stressed thinking about carrying the twins and what it will be like to come back to work while taking care of two newborns. When she gets an update about her patient, who is 29 weeks and about to give birth to triplets, Link tells her that it could be worse. Jo could be carrying three babies. That’s definitely not the right thing to say, so when he gets a page about an ER consult, Jo tells him to go. He wants to stay for the ultrasound, but she’s over it. “It’s going to show the same as it did yesterday,” she tells him. “and then you’re gonna smile and say, ‘We’ve got this.’ And right now, I really — frankly, I really don’t need that.” Link leaves, but the change in his mood is immediate.
Ndugu, Millin, and Warren have taken Mr. Riley for his CT scan, and Ndugu continues to seem to want to do everything himself. Warren starts to panic a little and asks Millin if Ndugu is always like that. She tells him that he once let her sew a patch graft angioplasty by herself. “Maybe it’s you,” she jokes. Helpful, Millin. Very helpful.
Down in the ER, Griffith has arrived as part of Link’s team to consult on Zayne, who they learn has sickle cell anemia when he begins listing off his medications. He wants to do the gene therapy that cures sickle cell, but his insurance won’t cover it. Link tells Griffith to take Zayne for an MRI, and Bailey adds an abdominal CT, but Zayne seems concerned about how long the procedures will take. Bailey tells him that it won’t take long and that if he needs anything, the interns are at his beck and call.
Now, in the helicopter, Schmitt and Adams are trying to care for Ofelia while a storm builds around them, which is doing wonders for Schmitt’s apparent fear of flying in a helicopter. Adams notices that Schmitt’s phone is going off and asks him if someone is trying to get ahold of him, and Schmitt tells him that it was a mistake. “Just because it’s a bad match doesn’t mean it’s a mistake,” Adams says, and Schmitt tells him that he’s right; it wasn’t a mistake, it was a failure, though he won’t say much else. Ofelia’s blood pressure spikes and her other systems indicate that she might have organophosphate poisoning. As Adams is looking for atropine for the poisoning, Ofelia begins seizing, and they discover that the clasp on her tourniquet is broken. Schmitt holds pressure until Adams gives her the medication, and then they swap, with Schmitt reaching for another tourniquet. They discover that there’s an injury to her superficial femoral artery and at first think it’s beyond repair, but then Schmitt remembers that they have IV tubing. He suggests they make a temporary shunt to reconnect the femoral artery with the tubing. It’s going to take them longer to get back because the pilot is having to re-route, and she’s going to lose it if they do nothing, so Adams is in. Can they save her leg?
Hunt finds Altman in the attending’s break room and tells her that Aurelio’s labs are back. She asks for an ultrasound and a pericardiocentesis kit, but Hunt thinks that isn’t necessary yet as the effusion, or the collection of fluid, is still small. They begin to argue, both about their marriage and the patient, only stopping when Richard Webber comes into the room. Altman tells Hunt that she’ll wait an hour, but they’ll need another set of scans and a repeat echo before leaving. Richard, who just wanted some tea, watches them leave, confused.
Griffith, who has been pestering Kwan about voting all day, asks if he even participates in public surveys, and he tells her that he sends them straight to spam. She looks stricken like she can’t fathom not participating in civic engagement, but their conversation is cut short by Link’s arrival. Bailey, Kwan, and Griffith discover that the sickle cell has done a lot of damage to his body, including on his hip, which needs the joint replaced, according to Link. Kwan says that Zayne isn’t going to like that, and Link tells him that he doesn’t have a choice if he wants to stop the joint from completely degenerating. It’s clear he’s upset, and Bailey is beginning to be able to tell.
As Link leaves the MRI room, Beltran tries to talk to him about Ofelia, but he blows her off, telling her to give the kid to his fellow. Shepherd also stops by and tells Beltran that she isn’t super worried about Ofelia’s TBI but that she’ll do another exam when they land, which should be in about 25 minutes. Beltran tries to tell Shepherd that what she saw with Ndugu wasn’t what it looked like, but Shepherd cuts her off and tells her that it’s none of her business. Beltran still looks concerned, though it’s unclear if it’s because Ndugu used to be married to Shepherd’s sister-by-marriage, Maggie, or because Beltran likes Shepherd. Perhaps it’s a little of both.
Ndugu, Warren, and Millin are telling Mr. Riley that they need to take his lung, and they aren’t sure if his other lung will be able to oxygenate enough by itself because of Mr. Riley’s smoking history. Ndugu tells him that he’ll have to stay on ECMO until they can get him a lung transplant, and he wants to know if that will happen before a specific marching band performance. Ndugu tells him that there will be others, and Mr. Riley starts talking about his alto sax, the first instrument he ever picked up. He hasn’t been able to play in weeks and is worried that he won’t be able to play, or even teach, ever again. “Music and teaching, it’s in your bones,” Ndugu tells him. “Losing a lung won’t change that. Just might need a little extra practice after surgery, that’s all.”
In his hospital room, Zayne is getting dressed and ready to leave. Kwan comes in to tell him about the avascular necrosis in his hip and that if he doesn’t do something right away, the pain will only get worse. Zayne is worried about his son, who needs extra attention, but is surprised to learn that his surgery will be covered by insurance. “Instead of curing my pain, they’re gonna let every joint and organ in my body deteriorate, and then they’ll pay to fix it?” Kwan tells him that he understands what it’s like to deal with a terrible system, one that doesn’t care for him, and then Griffith, who has just arrived, jumps in to encourage Zayne to think about his son. Zayne agrees to do it, but when Griffith says she’ll let Dr. Lincoln know, Kwan cuts her off. “Don’t worry, I’ll do it,” he snaps, though it’s unclear why. What is he so mad about?
Altman goes to Richard for advice, and they start by talking about Richard’s upcoming meeting with Balcom Medical. Altman begins to talk about a board member who “only hears what he wants to hear, which is himself.” Seconds later, it seems as if Altman isn’t talking about the board member at all but her husband, telling Richard that “he” often overlooks how hard she is trying to make things work. Richard recognizes that she isn’t talking about Balcom and asks if she wants advice or a pep talk. She wants whichever one is less irritating, so Richard reminds her that she and Hunt have already been through a war together, and they can work through whatever is happening now. As he leaves, she yells after him, “That’s the least irritating one?”
Sometimes, you’ve just got to accept the situation at face value so you can keep moving forward.
In Ndugu’s OR, Warren and Millin share stories about their experiences with instruments as kids, but when Warren asks Ndugu if he needs more traction and Ndugu does it for him and then hands him the instrument to hold, Warren snaps. “With all due respect, I may be on a trial basis, but I’m coming in as a fourth-year resident. I’m perfectly capable of retracting and prepping patients for transport and moving them to the CT. Hell, I’m capable of a lot more than that,” Warren says. Ndugu doesn’t even acknowledge him.
Bailey walks into the other OR to see how Zayne is doing, and Griffin tells her that she thinks it could have been a much less extensive surgery years ago. Bailey reminds her that seeking treatment for sickle cell is hard, so it’s not on Zayne. Link, still sporting his attitude, yells at Kwan to be careful with the drill and then takes over, immediately breaking the drill bit himself while he’s yelling about how Zayne had to live in silence because “nobody cares or believes in him.” When he demands a new drill bit, the room is silent. “Are you done?” Bailey asks, and Link stares at her for a moment before realizing he was in the wrong and saying yes. “Whatever you’re going through, go through it on your own time,” she tells him. “We are taking care of Zayne right now, I cannot take care of you, too.” Link, embarrassed, hands the drill back to Kwan.
Up in the helicopter, Adams and Schmitt are trying to put in the shunt while the pilot navigates a difficult storm. They’re able to do it, only to learn that the pilot is going to need to attempt an emergency landing. They have no service, so they can’t alert Beltran or anyone else at the hospital, and Ofelia is on borrowed time.
Aurelio is in cardiac tamponade, which Altman is furious about, and reminds Hunt that this type of event is why she wanted to do the procedure earlier. Hunt is prepared for a needle aspiration bedside, but Altman wants to go to the OR. Before they can do anything, Aurelio’s wife rushes in, and then the staples on his chest open up, blood flowing everywhere. His heart basically explodes, but just as Altman is asking for a crash cart and for a nurse to get his wife out of the room, Aurelio opens his eyes. They still have to rush him to the OR, but he’s not dead.
After Zayne’s surgery, Griffith and Kwan are in the scrub room, and he asks her what she would do with $3 million, the amount of money it would take for Zayne to get the sickle cell treatment. She tells him she would fund voter registration drives because that’s how the system gets fixed, and he rolls his eyes and tells her that she has to spend the money on herself. Griffith tells him that she’d hire an at-home nurse so that her grandmother wouldn’t have to live in a facility, pay off her loans, and start a maternal health non-profit. Kwan thinks she’s boring and tells her that he’d get his own place, travel, and buy an obnoxious car. Then he says that if he had a curable disease, he’d spend every penny to heal himself. Griffith expresses frustration that Zayne, who works at the hospital, can’t get his sickle cell treatment, even though he’d probably be a perfect candidate. She tells Kwan that they have everything they need to cure his sickle cell except the money, which seems to give Kwan an idea.
Elsewhere, Ofelia’s parents have arrived, but Schmitt and Adams still haven’t, which worries both her parents and Beltran, especially because they haven’t heard from them in a while. Beltran starts to panic, telling Shepherd that she chose to send Schmitt and Adams instead of just going herself, and now she’s going to have to tell his family — and Shepherd’s family — that something has happened to them. She’s gone to the worst-case scenario, but Shepherd gets it. “I’ve experienced enough that I always go to the worst-case scenario,” Shepherd tells Beltran as they sit on the floor together. “Sometimes you’ve just got to accept the situation at face value so you can keep moving forward.” Just as Beltran seems to take a deep breath, the phone rings. They’ve arrived, down in the ambulance bay. Schmitt is doing compressions as they get off the ambulance, but Beltran and Shepherd take over, rushing Ofelia inside.
Up in Webber’s office, Kwan and Griffith come in to talk to Webber about Zayne, sharing that he needs an important procedure but that his insurance won’t cover it. They know the hospital can’t treat everyone pro bono, but Zayne works there, and how can they really look him in the eye and tell him that they can’t help him because “some idiot suit in an insurance office says” they can’t? Richard cringes, which is when they realize he’s not alone — the partners from Balcom Medical are in his office, though Kwan and Griffith couldn’t see them behind the door. They excuse themselves quickly but they both know — this could be very bad.
In the cardiac unit, Ndugu finally talks to Warren. Ndugu shares with Warren and Millin that Mr. Riley worked through the illness because he would instead drop dead surrounded by people than at home, alone, and all Ndugu has done since he showed up is give him bad news, which he has handled alone because he doesn’t have any family and his students can’t visit. “My personal interest in providing Mr. Riley’s care has nothing to do with anyone’s capability,” Ndugu says. “I just don’t want him to feel alone.” Well, that one’s a punch in the gut, isn’t it, Warren?
Now, out of the OR, Hunt and Altman are in the scrub room. “His heart exploded, and now he’s completely fine,” Hunt says, and both he and Altman start laughing hysterically. “That poor wife!” Altman says, and Hunt recalls that she was covered in blood. Their laughter only comes harder when Altman says that she can still feel his blood in her socks. It’s the perfect reset for them, given that so much of their relationship comes from their trauma bond, and Teddy tells him that they don’t have to schedule sex. Owen tells her that now it’s their homework and that he’s always been a straight-A student, and she tells him that they’re going to get through the rough patch because they’ve gotten through a lot worse. He jokes that he doesn’t know if she’s talking about Iraq or the kids and then asks if he can take her on a date — to somewhere that isn’t Joe’s.
Zayne wakes up and is still tired, but Bailey, Griffith, and Kwan tell him that the surgery went well just in time for Dr. Webber to come into the room with a woman from Balcom, who wants to discuss a potential grant for the sickle cell treatment with Zayne. But when he asks about how the treatment will work, Zayne starts to get discouraged again. There are a number of steps, and Zayne will have to be in isolation for at least a month at one point, which he can’t do. He can’t afford a caretaker for his special needs son or to be away from him for that long. Webber tells him to think about it and see if he can figure it out. On their way out of the room, Kwan tells Griffith that the system still sucks. “Yeah, if only there was something we could do about it,” she says, referencing voting. It wouldn’t be surprising if this storyline comes back — both Zayne and the role doctors and other individuals can play in changing the system.
In the pediatric unit, Ofelia is okay, and they were able to save her leg. She’ll likely need more surgery but should regain function, which the parents are so grateful for. When Adams takes them into Ofelia’s room, Beltran asks Schmitt if he thinks peds is his calling. He reminds her that he applied for the fellowship, but that’s not what she means. She knows he’s interested but wants to know if he truly believes that peds is what he’s meant to do. Schmitt tells her about a moment from his childhood where his mom bought her helicopter-obsessed son a helicopter tour of Seattle, only for him to freak out and spend the whole time with his eyes closed. But in the helicopter with Ofelia and Adams, he wasn’t worried about the helicopter at all, just about making sure that Ofelia was safe. “I know peds is my calling,” he tells her. “But I don’t know how to prove that to everyone else.” He’s proven it to her, though, and she tells him that she wants to help. She suggests that maybe he do research before his fellowship. She has a colleague in Texas who needs help with a clinical trial and asks if he’s interested, which he absolutely is. (Could this be the character’s exit storyline?) Beltran reminds him that he knows more than he thinks and that he should trust himself, which seems to be a running theme for Schmitt. Maybe he finally will.
On their way out of the hospital, Warren and Ndugu run into each other, and Ndugu shares that he’ll just be across the street, so he can handle it if things come up. When Bailey comes up to see if he’s ready to go, Warren tells her that he’s going to head over to Joe’s with Ndugu. Bailey says that she doesn’t want to go to Joe’s, but that’s fine. “It’s a good thing you weren’t invited,” Warren says to her, causing Ndugu to laugh. She seems a little irked but also seems to like seeing Warren making friends at the hospital again.
Schmitt tells Adams to go home so that he can monitor Ofelia, but Adams wants to know if he’s still avoiding James. Schmitt basically tells him that it’s none of his business, but he’s not asking for fun — James is right behind them. Adams leaves, and though Schmitt tries to get away, James catches up with him. Schmitt admits that he knows about Ryan and that he thought what they had was real. “It’s hard to know when to tell people about your dead husband,” James says, shocking Schmitt. Eventually, James realizes that Schmitt thought he was cheating and proceeds to reassure him. “I think what we have is real,” James says. “You’re kind of the best thing that’s happened to me in a really long time.” Well, that makes Schmitt feel better, but it could certainly complicate going to Texas.
I’ve had an extremely long day. I just wanted to end it with you.
Outside, Kwan finally stops by the voter registration booth and fills out some paperwork, and Beltran is able to corner Shepherd, first thanking her for her help. Shepherd says that she just did a neuro exam, but Beltran was talking about when she freaked out, and Shepherd calmed her down. Shepherd laughs, telling Beltran that there’s an irony she would see if she knew Amelia better. Beltran explains about Ndugu again, telling Shepherd that they were just going through something similar, but Amelia doesn’t feel like she’s owed an explanation. “You and I are good,” she tells Beltran before heading for the parking lot. Good enough for a date? Let’s get a move on, ladies!
Jo catches up to Link in the parking lot, telling him that the ultrasound went well, and then apologizes for how she talked to him. She asks him if he’s mad at her, and he reminds her that she locked him out of the car and kicked him out of the ultrasound. Jo tells him that she’s scared, and he makes sure she knows that he is too — not just for the babies, but for her. “We’re supposed to be partners,” he tells her. “If we’re falling apart just thinking about having twins, what’s going to happen when we actually have them?” It’s a good question, but Jo doesn’t answer it. She just walks away.
The sweetest moment of the episode comes at the very end when Griffith arrives home. Adams has lit candles all over the living room and kitchen and is cooking dinner for her. When she asks him what is going on, he kisses her and says, “I’ve had an extremely long day. I just wanted to end it with you.” Talk about heart eyes, Lucas Adams.
