It’s no secret Shonda Rhimes is a Hamilton fan (honestly, who isn’t?), so it’s clear this week’s episode title is an homage to the hit Broadway show. However, if you tuned in tonight thinking you’d hear a Hamilton reference or five, you were mistaken — in tonight’s captivating, wrenching episode, The Room Where It Happens is the OR.
Structured like a bottle episode, all of this week’s action takes place during a surgery at Grey Sloan. The patient’s an unnamed John Doe who could have either caused a car accident or been a victim of it, but either way, he’s in bad shape. Mer and Owen are scrubbed in and both running on very little sleep, so it’s not surprising when neither is happy to hear Webber — who comes in to help on what quickly becomes a very high-risk case — is well-rested and fed.
Mer and Owen argue over what course of action to take, while Webber tries to push them to teach Edwards, who’s also scrubbed in on the case. He chastises them for treating the man like he’s just a “sack of organs on a table” and suggests they play a game with John Doe — since they don’t know his name or anything about him, that they give him a name and backstory.
His choice? Gail. And once they settle on it, the white male patient’s face transforms into that of a black woman who smiles at him. “Well, this is going to be fun,” she tells Webber. (Here’s when I raised my hand and asked, “What the heck is going on here?”)
So, John Doe is now “Gail.” Gail plays the cello and has three young kids; she teaches music lessons but dreams of performing with the Chicago Symphony Orchestra. As they talk about her, Webber keeps seeing her, well-dressed and poised, playing her instrument or talking to her children.
He’s not the only one seeing things. As Webber and Meredith argue over what to do next to try and save John Doe/Gail, Owen’s mind drifts to his time operating in the field during his Army days. And while it’s there, he sees his sister (played by Bridget Regan), who sasses him as he’s performing surgery. “You only bring me around when you feel guilty,” she tells him, pressing to find out what’s wrong. “New wife isn’t working out?” Ouch, dream sister. Ouch.
NEXT: Gail’s not who we think she is
Hunt yells out, which snaps him back to the OR (is no one concerned everyone’s minds keep wandering WHILE THEY’RE OPERATING ON SOMEONE?), but Sister Hunt taunts Owen there, too. She references Meredith and tells Owen if he’d married her, he’d have kids — something we know he wants desperately — and asks why he won’t declare this current patient dead. Owen says you don’t stop until you get the final answer. You save them or find out they’re dead. “This guy isn’t me,” she tells him.
The patient is in distress, he’s talking to visions, and when his sister says she knows what to do, Owen takes action: He tells Edwards to call UNOS and removes the patient’s liver (which they had been trying in vain to repair) against Meredith’s orders. And, not one to be left out, Edwards is seeing things, too. In her mind, a young girl — her younger self — is in the OR with her, and makes her realize she knows what’s wrong with the guy and that she needs to speak loud enough to make everyone hear her. He has an autoimmune disease, she deduces, something she knows a lot about because of her own personal medical issues as a child.
And when John Doe/Gail gets a real name and background — his wife IDs him, and has her two children with her in the lobby — that triggers something in Meredith, who envisions herself breaking the news to her children about Derek’s death. My heart broke when Zola asked if her mother could fix him, and Meredith said she couldn’t because their father is dead. When they hugged her, it broke a little more.
It’s then she realizes Gail isn’t just a made-up person. It was Webber’s mother, a musician who died of pancreatic cancer. Later, he explains he used to disassociate from the people he operated on — they were tissue and fluid, not a person — until a patient died from the same disease that killed his mother. He had to tell the family and found he was completely numb to it. So he changed that, and it made him a better surgeon.
The episode ends with one last-ditch effort to save the patient — a liver transplant with a portion of his own liver, which they’d removed earlier — when everyone is present and finally working together as a team without arguing. Owen sees his sister again for a fleeting moment, and then she’s not there. Mer smiles at her kids and Edwards sees her younger self. After he’s closed up and off to the ICU, Mer sees Derek smiling at her, an aching, brief glimpse before someone walks in to scrub up and the vision is gone. And just like that, the OR is empty and ready for yet another patient to come through. It’s just like Hamilton says: Who lives, who dies, who tells your story.