We've Only Just Begun

is the first episode of the twentieth season and the 421st overall episode of Grey's Anatomy.
==Short Summary==
Meredith rethinks her plans after going rogue in last season's finale. The interns are on thin ice following a patient's death, but Simone and Lucas are immediately tested in an emergency. Richard confides in Bailey, and Teddy's fate is revealed.
==Full Summary==
The interns have gathered in the skills lab, thinking back on what happened yesterday.
Teddy is rushed to the OR by Owen and Mika.
Link and Jo arrive in the OR to find that Sam has bled out. Simone and Lucas stand motionlessly, their hands covered in Sam's blood.
Levi assures an anesthesized Teddy that they've got her.
An angry Nick arrives in the skills lab. He asks which one of them he's firing.
Amelia, Winston, Bailey, and Richard meet Owen in Teddy's ICU room. He explains she collapsed due to bacterial endocarditis caused by a dental infection. The bacterial growth caused severa aortic valve insufficiency. Levi assisted with an emergent valve replacement. Winston suggests he gets some rest. Owen refuses to leave. Winston can't focus on his patient with her husband in the room. Amelia takes him to go check on the kids. Winston inquires about the post-op CT. Levi says it's not standard rotocol but Winston insists on being hypervigilant.
Nick derived from the interns' notes that no one was where they were supposed to be according to his assignments. Mika and Lucas switched services because he was punched by his patient, whom Benson says is Griffith's ex-fiancé. Simone says at least he didn't forget about a medical directive. The interns starts arguing until Nick yells to hut up. Their actions opened up the hospital, and him personally, to lawsuits. The interns want to explain themselves but Nick is paged to the ICU. He says he's not done with them and orders them to stay here and not practice medicine until he's back.
Meredith is waiting to have a conversation with Catherine, who dragged her on her plane back to Seattle and is now working on her phone. Catherine is doing damage control with the donors after Meredith's antics, which Catherine is blaming on dehydration and exhaustion. She made the Foundation look like a joke and hired a bunch of foolish interns that are damaging the hospital's reputation. Given the two PR nightmares Meredith created for her, Catherine says she can either shut up about her deviant Alzheimer's theories or have her lab shut down. Catherine allows her to go now.
Mika answers her page to the CCU by Winston despite Simone reminding her of Nick's instructions. Lucas and Simone are quick to leave, too. Jules scoffs. Benson invites her to talk about the thing she said last night. Instead, she leaves to go check on Maxine.
Levi is curious about Nick's plan for the interns. Nick hasn't decided yet but he will carry it out on his own. Levi defends himself by saying he couldn't be in three places at once. Nick urges him to act like a Chief Resident.
Simone chases Lucas as he gets some fresh air. She wants to talk about what happened. There will be an investigation and they'll ask whose decision it was to open Sam up. Lucas is okay with her telling the truth. A paramedic beckons them for help since his ambulance crapped out. There's an intubated MVC patient in the rig. SFD is stuck in an industrial fire so there's no other rig coming any time soon. The paramedic needs help to get the patient to the ER. Lucas climbs into the rig just as Simone goes to say they're technically not allowed to practice medicine. However, at the second paramedic's request, she climbs in, too, and takes over bagging the patient. Seconds later, Lucas and Simone see a car approach that's driving erratically. The paramedic jump out of the way as it slams into the back of the rig, causing it to crash into a bus stop.
Simone and Lucas get back on their feet. She has a cut on her forearm, which he starts to tend to. The patient starts desatting as the rig is shaken up again. Lucas finds that all the doors are stuck. As they start calling for help, the car slams into the rig again.
In an on-call room, Jo is woken up by Link. They start making out until Link is paged about the arrival of Sam Sutton's mother.
Amelia updates Meredith on Teddy's condition. Amelia read all of Meredith's research but they're interrupted by Nick before she can comment. Amelia leaves to check on Owen. Meredith tells him about her meeting with Catherine. Nick says the interns' actions call for an evaluation of the surgical department, if they're staying on. Nick says in the very least, they won't touch patients for a very long time. Meredith tries to defend them but Nick is firm that they have had their second chances, especially Adams. Nick heads into surgery. Bailey appears and asks Meredith to come since the interns are in trouble.
Amelia walks with Owen as he's on the phone with Evelyn to make arrangements for the kids. Owen wants to make sure he's not missing anything but Amelia says he doesn't have to pretend it's a normal day. She takes him to go eat something.
Jules tells an unconscious Maxine that she told Blue that she loves him while crying. Her job is on the line because of what he did but she is glad that Maxine is alive because of him. Richard comes in to check on Maxine's lungs. He hopes they can extubate soon. Jules brings up how she wasn't involved as much in what went wrong yesterday as the others but Richard points out that her name appears all over Maxine's chart as her doctor while also being her medical proxy. She's absolutely involved.
Teddy's CT is showing no other source of infection. As Levi inquires who put Mika on the case, Winston says they'll proceed with vascular checks. Winston is not interested in honoring the interns' probation since Teddy is in critical condition and they need surgeons to watch her at all times. He then finds that Teddy's leg is cold. Doppler confirms no signal. Winston has Levi call ahead to the IR suite for an embolectomy and he asks Mika to find Owen.
Meredith and Bailey arrive at the crash site. There's a patient inside the RoGo self driving vehicle as well. It continues to repeatedly back up and slam into the ambulance. Bruce yells from the backseat that his arm is swollen. Until the car is deactivated, he can't be evacuated safely. The doors and windows are locked. Meredith and Bailey check on the interns inside the rig. Mr. Campbell's blood pressure is tanking. The paramedic informs the doctors that the company's sending someone. It's the third incident this week. They're 20 minutes out. Bailey tells the interns that they'll have to run a trauma for the first time.
Link and Jo are meeting with Sam's mother. He explains to her what killed Sam. Sam spent his life doing death-defying things so she can't understand that he died in a hospital surrounded by medical professionals. As parents, they must understand the ache she's feeling inside. Sam hated being in the hospital but he mentioned his doctors, who apparently meant something to him. As Link's pager keeps going off for an emergency, Mrs. Sutton thinks Sam was just another patient to them.
After a quick bite, Owen wants to go check on his department while Amelia thinks they can manage just fine without him. Amelia insists that Owen can't treat patients now. Owen says he ignored Teddy's toothache and gave her a smoothie. Mika comes up to fetch Owen.
Jules finds Benson still in the skills lab. He says he would never ignore another patient's DNI but Jules loves her and he wanted to spare her from the feeling of losing someone you love, which he knows all too well. Benson hears sirens outside. After peeking out the window, he leaves, too.
Link and Benson arrive at the crash site. Simone briefs the attendings that the patient is about to code. The patient's abdomen is distended. Meredith and Bailey strongly suspect that the patient has an internal bleeding, meaning he needs an ex lap. Lucas will have to make quick cuts in between the repeated impacts. Simone is in disbelief that they actually want them to open the man up.
Winston needs Owen's consent to handle the clot. They must act quickly. Owen freezes for a moment. Winston has done hundreds of these procedures and Teddy trusted him enough to appoint him Chief of Cardio. Owen gives his consent.
Link urges Bruce to keep his arm as still as possible since it's likely fractured. The car's override function appears to be malfunctioning.
Meanwhile, Meredith and Bailey talk Simone and Lucas through the steps of doing the ex lap. Simone is hesitant. She's thinking about Sam and how he might still be alive if they hadn't opened him up. Lucas refuses to do nothing but Simone is not okay with having another death on her hands because of him.
Bruce says they designed the AI for the car to simulate human decision making but it comes with the trolley problem of whatever or not the car should prioritize pedestrians over the passenger or not.
Simone asks Bailey and Meredith if they can buy time with fluids without cutting. They can't answer that without seeing the patient. Lucas insists they need to make the cut. Meredith tells them to cut now if they're going to do it. Lucas does so.
As more aid cars arrive, Meredith urges the interns not to panic upon seeing the blood. While Simone starts compressions, Lucas finds that the bleeding is coming from the liver. Bailey tells him to perform a Pringle manoeuvre. Fingers can replace the clamp they'd normally use. Lucas hesitates so Simone steps in. As she finds the right spot to apply pressure, there's another impact. With Simone's move, the systolic pressure holds. Benson, meanwhile, finds a screwdriver and jams it into one of the car's tires, finally causing it to shut down. The sensors start to work again, allowing them to open the door. The doctors get Bruce onto a gurney while FD start working on opening the ambulance doors.
In the waiting area, Owen asks Amelia to talk about anything to distract him from thinking about worst case scenarios. The fact that Teddy's dental infection caused damage to her heart, two body parts completely separate from one another, has her thinking that maybe Alzheimer's is caused by something outside of the brain. Amelia tells Owen to let go of the smoothie thought, like Owen helped her to stop agonizing over her last words to Derek.
Winston finds the clot but it's too big to get endovascularly. They'll have to perform an arteriotomy. Mika quietly urges Teddy not to die, causing Winston to throw her out of the IR suite and replace her with Levi. Winston explains to Levi that he needs to work fast and can't use an assist who's distracted by personal feelings. Levi says he's good. They make the cut.
Meredith, Bailey, and Lukas are moving Mr. Campbell to the OR while Simone rides along on the gurney to hold pressure. Nick is baffled to see the interns enter the OR as Bailey asks Meredith if she's scrubbing in. She catches Nick's gaze and says yes.
Now in the ER, Bruce doesn't understand what happened to the car. Benson thinks self-driving cars will lead to more injuries. Bruce disagreed. Automation is about safety. Drivers are distracted by emotions or they're tired. Feelings don't belong behind the wheel as they lead to errors. Benson defends compassion and connection, which can save lives. Bruce asks if Benson actually thinks he's saved more lives than surgical robots have. Link comes to take Bruce to the OR. Bruce wants to know where the car is being towed.
Jules informs Richard that she finished his patients' progress notes and took herself off of Maxine's case. She hopes he'll put in a good word for her with Nick but he stresses the importance of accountability. It makes people learn from their mistakes and it goes hand in hand with forgiveness. Nurse Linda calls for Richard to extubate Maxine. Jules decides to stay out of the room.
As they scrub in, Bailey informs Meredith about Teddy. She trusts Winston. She brings up Nick's uncertainty on how to handle the interns, which Bailey understands. That job is like parenting. She adds that Meredith's class was as bad as this one. They enter the OR. Lucas informs them that the patient is ready and massive transfusion protocol has been activated. Simone is prepared to leave but Meredith tells her to forget about Nick. Being in the room is how they'll learn how to be better. Lucas goes to scrub in while Meredith and Bailey get to work. Once they've placed a clamp, Simone lets go.
In the IR suite, Winston has Levi insert a catheter and deploy the balloon. They don't have much time to save the leg.
Amelia, Owen, and Mika sit in the waiting area.
Bailey finds the liver lac. She opts for a primary vascular repair. Meredith instructs Simone to suction.
Taryn sits down with Mika and checks if she's okay. Mika decides she can't sit and leaves.
Jules watches from outside the room how Maxine is extubated.
Mika runs into Jo in the hallway. Mika asks her where she was, after stressing so many times that she was one of Sam's doctors. Sam's blood is still on Mika's shoes and her hands kept Teddy's heart beating alive. Winston threw her out and she can't think. She may be fired from the only place that would hire her as a surgeon. They are interns and Jo was supposed to be there when they called. She walks off as Jo is hit with guilt.
Bailey's looking at her award. People keep asking her what's next. Richard wants her to take over his patient for the next few days. He confesses that he ordered a drink, which he did not drink. It's been in his mind ever since and he can't trust himself right now. Bailey says he's been here before and he knows how to get back. Starting over can be hard but it'll remind him why he's made it this far. She agrees to cover his service.
Winston informs Owen and Amelia that he restored circulation in Teddy's leg. They'll continue to monitor closely. Owen thanks him and Amelia goes to fetch him some coffee. Winston tells Levi to go home and get some rest. Once he's left, Winston sits down to take a breather.
Meredith finds Nick in the ICU. She knows he's mad. Nick says the interns screwed up again. Meredith thinks this is different. The patient was dying and she was guiding them. Nick says if they keep screwing up, he can't move to Boston,. He can't leave in good conscious if the program is falling apart again, even if it's to be with her. He does hate Boston but he believes in second chances. He's sure she can find a way to save her job after what she did today. Meredith has an idea.
In the stairwell, Jules informs Benson that Maxine is talking and annoyed. Benson invites Jules to come over tonight but she reminds him that she also said she hates him. When she said she loved him, she was in emotional distress and vulnerability leads to extreme emotions. She said both of those things to a lot of people. She does not subscribe to mononormativity. She can't walk around here worrying about disappointing the one person she's supposed to love. She apologizes for giving him the wrong idea. Benson says it's a relief. He agrees it's better this way. Mika comes by and informs them Nick wants to see them in the lab.
Lucas finds Simone in the tunnels and says Bailey needs them to check on the patient's labs in an hour. Simone wanted to be a surgeon her entire life and she may be losing everything once again because of him. Lucas points out she decided to help him. Simone says she cannot say no to him. Good surgeons own their failures and apologize. She wonders why he can't admit that what they did was wrong. Lucas disagrees. He won't ever apologize for trying and he doesn't live with regrets. Simone says that's where they're different. She doesn't regret them but everything happened so fast that she needs a minute. They are paged by Nick.
Link comes home at the penthouse and cuddles up with Jo on the couch. She inquires if he feels guilty about Sam. He feels badly and admits he could have been a better version of himself around him. Link says he died because of a complication that even the most talented cardiothoracic surgeons can't always fix. Jo feels wrong being this happy when others won't ever get that chance again. Link points out she has had a lifetime of hard. It broke his heart whenever she went through something awful. She's fierce, kind, smart, and loyal. The years that she wasn't in his life were dark. He thought of her every day. They have been through too much, together and apart. He believes that they deserve this. He wasted 20 years of his life not acting on it.
At an AA meeting, Richard is talking to the group. He didn't break his sobriety on the outside but it feels like he did. He wants to ask for their help with a reset. Tonight, he is one day sober. He's given a day one chip.
Catherine gets on the elevator with Meredith, who says she'll focus the research back on the plaque. She'll stick to what's being funded. Catherine wins. Catherine says she always does.
Meredith meets Amelia in a lab. Meredith paged her for a mysterious favor. She takes everything on her research out of her bag. She's actually gotten a little further than she's led her to believe. Meredith wants Amelia's help to keep it going. But nobody can know.
Teddy wakes up in the ICU. She asks what happened. Owen is relieved to hear her talking.
Nick meets the interns in the skills lab and announces they all still work here. But he no longer does. It's not because of them. He'll always believe in them and he's not worried as he's leaving them in very capable hands. He opens the door for Bailey, who announces that she has five rules.
==Cast==
20x01MeredithGrey.png|Meredith Grey
20x01MirandaBailey.png|Miranda Bailey
20x01RichardWebber.png|Richard Webber
20x01OwenHunt.png|Owen Hunt
20x01AmeliaShepherd.png|Amelia Shepherd
20x01JoWilson.png|Jo Wilson
20x01TeddyAltman.png|Teddy Altman
20x01LeviSchmitt.png|Levi Schmitt
20x01AtticusLincoln.png|Atticus Lincoln
20x01WinstonNdugu.png|Winston Ndugu
20x01SimoneGriffith.png|Simone Griffith
20x01BensonKwan.png|Benson Kwan
20x01JulesMillin.png|Jules Millin
20x01MikaYasuda.png|Mika Yasuda
20x01LucasAdams.png|Lucas Adams
20x01CatherineFox.png|Catherine Fox
20x01NickMarsh.png|Nick Marsh
20x01TarynHelm.png|Taryn Helm
20x01MaxineAnderson.png|Maxine Anderson
20x01RitaSutton.png|Rita Sutton
20x01BruceFuller.png|Bruce Fuller
20x01ParamedicDaniels.png|Paramedic Daniels
20x01ParamedicGarza.png|Paramedic Garza
===Main Cast===
*Ellen Pompeo as Dr. Meredith Grey
*Chandra Wilson as Dr. Miranda Bailey
*James Pickens, Jr. as Dr. Richard Webber
*Kevin McKidd as Dr. Owen Hunt
*Caterina Scorsone as Dr. Amelia Shepherd
*Camilla Luddington as Dr. Jo Wilson
*Kim Raver as Dr. Teddy Altman
*Jake Borelli as Dr. Levi Schmitt
*Chris Carmack as Dr. Atticus Lincoln
*Anthony Hill as Dr. Winston Ndugu
*Alexis Floyd as Dr. Simone Griffith
*Harry Shum Jr. as Dr. Benson "Blue" Kwan
*Adelaide Kane as Dr. Jules Millin
*Midori Francis as Dr. Mika Yasuda
*Niko Terho as Dr. Lucas Adams
===Guest Stars===
*Debbie Allen as Dr. Catherine Fox
*Scott Speedman as Dr. Nick Marsh
*Jaicy Elliot as Dr. Taryn Helm
*Juliet Mills as Maxine Anderson
*Gina Hecht as Rita Sutton
*Dustin Ingram as Bruce Fuller
===Co-Starring===
*Paul Yoo as Paramedic Daniels
*Daniel Steven Gonzalez as Paramedic Garza
==Medical Notes==
===Teddy Altman===
*Diagnosis:
**Bacterial endocarditis
**Aortic valve insufficiency
*Doctors:
**Winston Ndugu (cardiothoracic surgeon)
**Amelia Shepherd (neurosurgeon)
**Levi Schmitt (surgical resident)
**Mika Yasuda (surgical intern)
*Treatment:
**Aortic valve replacement
**Embolectomy
**Heparin
Teddy was rushed into surgery after collapsing while operating. An echo showed bacterial endocarditis, due to a dental infection, so she had an emergent valve replacement. Winston asked Levi to get a post-operative CT and Amelia said she'd do a neuro exam on her. While checking her circulation, Winston observed that her leg was cold, so they took her into the IR suite for an embolectomy. They found the clot, but it was too large, so they had to open up her leg to remove it. She was stable afterward and woke up.
===Sam Sutton===
*Diagnosis:
*Doctors:
**Lucas Adams (surgical intern)
**Simone Griffith (surgical intern)
*Treatment:
Sam bled out and died in the OR after Teddy collapsed while operating on him.
===Maxine Anderson===
*Diagnosis:
*Doctors:
**Richard Webber (general surgeon)
*Treatment:
Maxine was still intubated. Richard monitored her and was able to extubate her.
===Mr. Campbell===
*Diagnosis:
**Liver laceration
*Doctors:
**Miranda Bailey (general surgeon)
**Meredith Grey (general surgeon)
**Lucas Adams (surgical intern)
**Simone Griffith (surgical intern)
*Treatment:
**Exploratory laparotomy
A paramedic asked Simone and Lucas for a hand after the ambulance engine died while transporting a patient. Mr. Campbell, 43, had been in a car accident and had been intubated. They had called for a replacement rig, but the fire department was stuck at an industrial fire. Lucas and Simone entered the ambulance and began treating the patient. While they worked, a self-driving car rammed into the back of the ambulance. Because its system was malfunctioning, it continued to ram them every 30 seconds, trapping them inside the ambulance. From outside, Bailey and Meredith determined that he was bleeding internally and talked them through opening Mr. Campbell's abdomen and staunching the bleeding. Simone was opposed to the idea, wanting to continue with fluids, but Lucas made the incision. Once the abdomen was open, he saw that the bleeding was coming from the liver, so Bailey told him to do a Pringle maneuver. Bailey talked Simone through using her fingers in place of a clamp, which they didn't have. His blood pressure started going up, indicating success. Once they were freed, Mr. Campbell was taken to the OR for surgery. Afterward, he was stable.
===Bruce Fuller===
*Diagnosis:
**Arm fractures
**Scalp laceration
*Doctors:
**Atticus Lincoln (orthopedic surgeon)
**Benson Kwan (surgical intern)
*Treatment:
**Surgery
Bruce was testing out a self-driving car as its passenger when it crashed. The system malfunction, so it repeatedly crashed into an ambulance, trapping three people inside. Bruce was also trapped into the test vehicle. He reported that his arm was throbbing with pain and he also had a scalp laceration. Link examined him through the window and diagnosed a probably fracture to his arm. Benson stabbed one of the tires, which deactivated the car. He was taken inside the hospital, where multiple arm fractures were diagnosed. He was taken into surgery to treat those.
==Music==
Song 	Performer 	Scene
"Fadeaway" 	AG, LA5 	
*Firefighters work to open the ambulance doors.
*Amelia and Owen talk about Teddy and Meredith's research.
"Head and My Heart" 	AG, Ruelle	
*The interns help operate.
*Winston operates on Teddy.
*Owen and Amelia wait in the waiting room.
*Taryn comes to sit with Mika, who is also waiting.
*Mike gets up and leaves.
*Richard extubates Maxine.
*Mika runs into Jo.
"We Only Go One Direction"	Texada 	
*Jo and Link kiss.
*Richard talks at a meeting.
*Meredith tells Catherine she'll refocus her research.
*Meredith shares her research to Amelia and asks her to keep it going secretly.
*Teddy wakes up and asks what happened.
*Nick tells the interns they're not fired, but he's leaving.
*Bailey is their new residency director.
"Fadeaway" - AG, LA5
"Head and My Heart" - Ruelle & AG
"We Only Go In One Direction" - Texada
==Notes and Trivia==
*This episode's title originated from the song , originally sung by Carpenters.
*This episode scored 3.62 million viewers.https://programminginsider.com/thursday-ratings-9-1-1-network-debut-and-season-premieres-of-greys-anatomy-and-station-19-lift-abc-to-key-demo-victory/
*The episode picks up shortly after the end of Happily Ever After?.
*This is the first time Scott Speedman is credited as a guest star since his first appearance.
==Gallery==
===Episode Stills===
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===Behind the Scenes===
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==Quotes==
==See Also==
de:Wir haben gerade erst angefangen
es:Apenas hemos comenzado
Category:All Episodes
Category:GA Episodes
Category:GA S20 Episodes