Heart-Shaped Box

is the eighth episode of the eighth season and the 156th overall episode of Grey's Anatomy.
==Short Summary==
The doctors become nostalgic when George O'Malley's mother, Louise, returns to Seattle Grace for medical help after a botched surgery at a neighboring hospital. The residents are inspired by a medical miracle when they witness a harvested heart that continues to beat outside the body. A new pediatric fellow excites Arizona and makes Alex feel threatened. Jackson lets his suspicions about Mark and Lexie interfere with his work and Henry and Teddy have their first marital fight when he expresses interest in pursuing medical school.
==Full Summary==
Meredith and Derek are making out in bed. Meredith thinks they should practice their statements for hearing, which will take place in 36 hours, but he tells her to stop worrying and relax. They are Zola’s parents, and they only have to speak from the heart to convince the judge of that, he says. They continue making out.
Lexie meets Jackson at the hospital. She missed him this morning. He went running before work. Lexie says she needs to go to rounds but asks if she’ll see him later. He doubts it, but after watching her face, he says yes. The elevator opens and Mark asks Lexie if she’s going up. She says not, but Jackson says she is. Mark then gets excited about his procedure with Jackson later today. Meanwhile, Lexie gets on the elevator. The doors close and Jackson does not look happy at all.
Meredith is trying to talk to Bailey about the trial, but she says they have bigger things to worry about today. Meredith follows her.
Arizona meets Alex and takes his biggest cases from the day. She explains a prospective peds fellow is visiting the hospital today. She has had offers from all the other big guns, so Arizona has to give her the proper tour and that includes scrubbing in on a couple of surgeries. She admits it’s early to be meeting fellows already, but when someone with Polly Preston’s resume wants to observe in your hospital, you make time.
Derek is talking to a patient about her aneurysms, but she is too busy working on her laptop. She takes a pause and asks what’s with the aneurysms now. One of them has a leak, he says. She says he can tell her he told her so, because he’s been warning her about them for years, but she’s been avoiding the surgery. She agrees to have the surgery, but it’ll have to wait until she’s done writing her book. Derek asks Lexie to name the risks for waiting with the surgery. The patient asks her to name the risks of a botched clip, and they’re exactly the same. She can’t die and not have finished her book because she can’t do that to all her readers. She just needs to find a way to make her character Kate meet Nathan on a bridge before she’s pulled back in time. She asks them to leave, because it’s hard enough to concentrate as it is. They leave and Justine continues writing.
Bailey tells Meredith this patient is very important to her. Bailey has a very full schedule today, so Meredith will have to be her proxy. Meredith will do everything necessary and report back to Bailey. The patient has lost a husband and a son in this hospital, and she will not have another O’Malley lost under this roof. As Meredith realizes George’s mother is their VIP patient, they walk into the room and Louise is happy to see her, wanting to hug her.
Teddy and Cristina are waiting next to a box in an OR. It’s so cool that Cristina never even thought about putting it on her list, for which she’ll need more time to finish. Teddy then asks her to move a little to the left, so Henry can see the special box from the gallery. He’s been begging to observe a surgery and she figured this is the one you’d want to see. Dr. Park has taken out the heart of the donor and gives it to Teddy, who connects it to tubes in the box. The box makes the heart continue pumping blood, so the heart will go to LA without even knowing it’s left the body. Meanwhile, Dr. Park gets a call from his hospital. His patient has died, meaning the heart has no place to go.
In Louise’s room. Bailey is doing everything she can to make things comfortable. Meanwhile, Meredith is questioning Louise about her previous gallbladder surgery at Seattle Pres three weeks ago. Her sons insisted she get her surgery somewhere else because of what happened to Harold and George in this hospital. Meredith touches the abdomen and wants to check the gallbladder. Louise admits she’s had symptoms. She’s so proud to have Meredith as her doctor now. She says she kind of heard George’s voice telling her to get a second opinion at Seattle Grace. Bailey promises they’ll take very good care of her. Louise once again says it’s so nice to see them all grown up.
Teddy meets Cristina, who’s waiting in a lounge with heart in a box. They found another match at Columbia, and they’re contacting them now to arrange pick-up, but that can take hours. Meanwhile, Cristina has to check the heart hourly. Cristina thinks this is intern’s work, but Teddy says it’ll give her time to finish her wish list. Teddy tells her to page her if she needs her. A disappointed Cristina sits down next to the heart.
Owen and Derek are looking at scans. Owen can’t approve this, but Derek is not looking for approval. He’s giving Owen a heads-up as a courtesy. Owen has to leave for his board meeting. Lexie comes in and notes the scans are intense cases. They will all be patients of Derek. He went looking for patients who’ve been told no by every doctor they’ve seen. He’ll tell them yes and do his best. This includes Lexie too. She’s ready, she says. She then shows Derek Justine’s AMA form, he says she’s not ready. If she can’t make a patient say yes to a simple surgery that will save her life, how can she expect she’ll be able to tackle one of the hopeless cases? If Lexie makes Justine agree to the surgery, Derek will let her in on one of these cases. She’s excited and leaves.
Jackson has expressed his worries over Lexie and Mark to April, who brings up Lexie throwing the softball at Mark's girlfriend. He thought he was just being paranoid. He needs to be off plastics for the day so he can clear his head, but April won't rearrange the entire schedule because of his girl problems. Alex comes into April’s office too and asks if they’ve heard about Polly Preston. It’s April’s no. 1 peer role model. Alex hates her for saying that. Jackson asks Alex what he’s working on and asks him if he’s interested in switching with his nerve graft. Alex agrees and April then changes the schedule.
Justine is still working. The pain is getting worse. Lexie says the surgery will help and that the publishers will extend the deadline. It’s not about a deadline. It’s about her readers, who are waiting for her to finish the series that they’ve been following for 10 years. Lexie is surprised she’s so popular. Lexie asks about her family, but Justine says she’s a writer. Her characters are her family and she cares about them. She managed to make other people care about them as well. She has to give her readers closure about Kate, Nathan, and Alexander. She owes them closure and she’s the only one who can give it to them. Lexie says she’s just trying to help her. "How fast can you type?” Justine then asks.
Cristina is working in the lounge. Richard enters to see the heart in a box. He asks her what she’s working on. She says she’s tracking down surgeries she wants to perform. He grabs her list and concludes she’s wasting this opportunity on common procedures. Cristina says she wants everything and she doesn’t know what to do. Be creative, Richard says. He instructs her to look at the heart. It’s the key to the list. She has to use it to unlock her mind. She has no idea what he’s talking about. He leaves after one last look.
Louise wants Meredith to catch her up on her life. Meredith says she got married. Louise asks about kids. They’re working on that. Callie and Arizona pass by laughing. Callie is surprised to see her and hugs her. She says she meant to call so many times and asks why she’s here. Meredith hopes Louise is okay. They’re waiting for CT to open up. Louise peeks at Arizona and greets her. An awkward Callie just introduces her as Dr. Robbins. It’s Louise’s turn for the CT. Arizona gets a call that Polly has arrived. "I’ll see you later, Dr. Torres,” she says.
Jackson is watching a nerve graft video. Mark comes in and says he was surprised to find that Jackson has been replaced by Alex Karev. They have been preparing this nerve graft for weeks and Mark was excited about them doing it, the Plastics Posse. Jackson says he’s got this paper to finish before 7 o’clock tonight, so it’s just bad timing. Mark is disappointed he’s missing a rock star nerve graft for a stupid paper. Fifth year, Jackson uses as an excuse. Mark understands.
Arizona is giving Polly a tour in the peds ward. Callie comes over and apologizes for the inappropriate introduction. She panicked, because she doesn’t know how to tell her former mother-in-law that she’s married to a woman now. Arizona tells Polly she needs a minute. Polly understands and says she’ll go take a look at the nuclear protein machines. Callie realizes she screwed up in front of the prospective peds fellow. Arizona says coming out to your friends and family is everything and she’s kick Callie’s ass if she tried to hide Arizona from them, but coming out to your dead ex-husband’s mother is not necessary for them. Callie thanks her. Arizona is now going to look for Polly, because she has no idea where they keep the nuclear protein machines.
Jackson and Alex are getting lunch in the cafeteria. Alex says he wouldn’t have taken Jackson’s place if he had known he’d be breaking up the Plastics Posse; Mark won’t shut up about Jackson. He wishes he also had an attending who had his back like that. Lexie cuts the line and says she has to get back to her patient fast. She’s reading one of Justine’s books. Alex recognizes them from his peds patients’ mothers. Lexie tells them about Kate and gives Jackson an air kiss before leaving. Alex and Jackson then see Arizona having lunch with Polly, so they go somewhere else to eat their lunch.
April, Meredith, and Cristina are having lunch in front of heart in a box. Cristina tells them Webber trashed her list. She still hasn’t figured out how the heart can be a key to making up the list. They all ask questions, but no answers from the heart. April asks who George is when Meredith asks the heart what’s wrong with George’s mother. They update her. Alex and Jackson come in and Alex asks why they’re talking about that creep. They talk about George. Jackson has heard the heart in the elevator story and he thinks George sounds badass. Alex leaves when they call him a chump compared to George; he just wanted to eat lunch. Suddenly, Cristina understands what Richard meant and calls Webber a genius as she listens to the heart in a box’s sounds. April is freaked out by heart in a box.
Justine is dictating Lexie on what to write. As Lexie and Justine discuss a character’s actions, Derek comes in and calls Lexie.
Outside the room, Lexie says she’s doing what he told her to do. She’s helping Justine finish, as Justine won’t go into the OR before the book is finished. He asks how long it’ll take. "You can’t rush the creative process,” Lexie says. Derek can’t reply and walks off, after which Lexie rushes back into Justine’s room.
Meredith is doing an endoscopy on Louise. Bailey comes in and asks her what part of reporting back to her she did not understand. She says she’s doing this because of a test she ran. Bailey says she did not ask her to run that test and asks herself why Meredith can’t just do what they ask her to do. Meredith finds inflammation and scarring, meaning Louise has to have surgery. Bailey feels bad about the situation and tells Meredith to go prep Louise.
Henry and Teddy talk about Teddy’s surgery. He thinks she was amazing in there. They get into an on-call room and he asks her what happens in here. She then unzips his sweater. They continue undressing.
Meredith tells Louise the surgeons of Seattle Pres left a length of cystic duct inside of her, which is causing all her problems. They’re gonna take it out. Meredith asks if Louise has any questions. Louise says she saw a ring on Callie’s finger and asks if she got remarried. Meredith says Callie did get remarried a couple of months ago and that she seems really happy. Louise misses having Callie as a daughter and actually all of George’s friends. They were so important to him and her. Louise asks if Meredith will be doing the surgery and takes comfort in the fact that Meredith is. George always said she was the best. Louise is ready and firmly takes Meredith’s hand. Meredith feels a little awkward and says she’s gonna need her hand back for the surgery.
Mark and Alex are operating and Mark notices that Jackson enters the gallery. Mark asks him to come down and have a closer look, but Jackson declines. Richard says he’s a fool. He’s lost. Adrift. Richard says he needs to see heart in a box. Not just looking at it, but really seeing it. If he had, he’d be down in the OR right now grafting nerves. Jackson then leaves to go see heart in a box. Down in the OR, Mark asks Alex if he knows why Jackson has been so distant lately. Alex reacts sarcastically, not pleasing Mark at all.
Callie’s seen Louise’s name on the OR board and finds Meredith, who tells her what surgery they’ll do. It’s an easy procedure, so Louise should be okay. Callie is relieved to hear that. Meredith then tells her that Louise knows that Callie’s married. Callie panics, but Meredith says she only told Louise that she was happy in order to calm her down before surgery. Louise was scared and alone, so Meredith thinks it wouldn’t be a bad thing if Callie would be there when Louise wakes up.
Derek is looking at scans and Mark sits down with him. Mark says he and Avery used to have a strong connection and suddenly, he’s avoiding him and cold. He’s kind of afraid his heart will get broken. Lately, he’s been interested in teaching and he wants to see Jackson do well. Owen comes in and prefers to stay out of it. He’s carrying Derek’s patients files. Derek knows he’s going to say that the cases will make the hospital’s mortality rate go up. However, he knows that saying no is the worst part of being Chief, so he won’t let Owen do that. He advises Mark to let Jackson free, so he’ll come back. Then Mark can woo him. Derek leaves. Mark wants to ask Owen something, but Owen leaves too.
Teddy and Henry are lying in bed in the on-call room. He’s a fan of what happens in this room and Teddy agrees, saying it should be bring your husband to work day every day. Henry says he’s had this idea lately. He thought it was silly, but now he really wants to do it. He wants to go back to school. Teddy says it’s not silly, as adults to do that all the time. Medical school, he clarifies. Wow, she says, visibly surprised. Henry checks the time and says they have another surgery to get to.
Justine is still dictating to Lexie. Justine has decided to have Kate end up with Alexander, the contrary of the likable Nathan. Lexie disagrees and starts naming all Nathan’s qualities, but Justine insists Alexander is Kate’s soulmate. Lexie says they do not even want the same things. She continues arguing that Kate should pick Nathan, but Justine suddenly starts seizing. Lexie tells a nurse to page Derek. Justine’s aneurysm blew.
Derek and Lexie are operating. He says they could’ve avoided this and asks if she at least finished the book. No, Lexie says, but Justine did tell her how it’s going to end and it’s stupid. Lexie wants to tell Justine that, even though Derek says it’s maybe none of her business. Lexie says it’s the same things as what he’s doing with his hopeless cases. He thinks he can change the way the patients’ stories are going to end, and if he thinks that, he’s obligated to at least try to do it. So, Lexie thinks she’s gotta try and talk to Justine about the ending. Derek then agrees.
Meredith meets Bailey in the scrub room. She’s double checked everything. Bailey doesn’t want any surprises when she gets in there. Meredith brings up that Louise thought that Meredith would be performing the procedure. Bailey doesn’t think she’s ready for that, but Meredith says Bailey herself taught her how to do a septoplasty. Bailey thinks she taught Meredith a lot of things, but seeing what Meredith did lately, she’s beginning to think she’s not much of a teacher at all. Meredith rolls her eyes and tells Bailey that she’s going to a judge tomorrow, to prove to an unknown person that she’s a good person and a fit mother. She wants her kid back so badly that she’s racking her brain for anything that’ll make her seem that way. She doesn’t know what to wear and it all makes her feel frustrated and useless. However, she knows that she’s not useless at work. Bailey is now convinced to let Meredith do the surgery.
Jackson and Cristina are with heart in a box. Cristina names procedures and then listens to heart in a box if she should scrape it from her list or not. Jackson doesn’t understand why this heart is so special. Cristina says that with normal heart transplant, the heart is put on ice, which makes it cold and dead. However, this heart continues to beat and stay warm. It’s a miracle. Cristina says that once Jackson will realize this, it’ll change his perspective. She figured out how to work on her list. If the procedure is not half as cool as heart in a box, it’s not worth her time. The heart lets you know what’s most important to you. Jackson watches the heart and seems to start understanding it now.
Henry is going over possible schools while getting ready to go in the OR. Teddy says medical school is not something you suddenly decide to do. He asks how it happened for her then. She says she was 19 and there are 3 years of prerequisites, then 4 years of actual medical school, and if he decides to go completely crazy, and wants to become a surgeon, another 5 years of surgical residency and then a fellowship. He doesn’t want to be a surgeon. There are plenty of other ways to use a medical degree. Teddy admits she loves things the way they are now and she doesn’t want to spend 10 years being married to a med student. He takes that she rather wants him to follow her around looking cute. She says he knows that that’s not what she’s saying. Henry says that he now finally has a wife and a life expectancy past 3 months, so he doesn’t want to waste any of it. He takes off his scrub cap and says he’ll see her at home.
In the OR, Meredith is ready to close. Bailey says that Louise has worked so hard to raise her son and then one day, he throws himself in front of a bus. You work and work to teach your children to do the right thing, and you wanna be so proud when they stand up for what they believe is right, but watching them destroy themselves to do what you taught them is right, is maddening. Bailey says Meredith is maddening. George was her favorite. Meredith knows. He was the good one. Meredith continues the procedure. Bailey then tells her to wear a sweater set. Surgeons are thought of as cold, intimidating and egotistical, but a sweater set says you’re motherly and warm. Meredith thanks her.
Lexie answers Jackson’s page by meeting him in the dressing room. She says she can’t go yet, as she has to follow up on her patient. She asks if he’s okay. He says he avoided a surgery today. One he wanted to do for weeks. He avoided it because of the thing between her and Mark. She says there’s nothing between them, which is what he’s been trying to believe really hard for the past weeks. But there is a thing and it’s not going anywhere any time soon. This new thing with Jackson and plastics isn’t going away anytime soon either, so something’s gotta budge. So Jackson has to walk away from her, for him. Lexie understands he’s picking Mark. Jackson has spent too many time sabotaging his own career, so he is picking Mark. Standing in the doorway, he asks her if she can tell him he shouldn’t. She realizes she can’t do that, so he leaves.
Richard sits down with Cristina. A helicopter has touched down on the roof, he heard. Cristina is ready for the heart to be taken away. She gives him her finished list. He approves and gives her a notebook. She sees he made a list too. He was inspired to do so. She sees a surgery she wants on her list too. The procurement team from Columbia enters. They take away the heart in a box.
Justine wakes up after surgery and Lexie asks some questions to test her neurological function. She asks the date, but Justine never knows the date, so Lexie asks why Kate can’t choose Nathan. Justine says Kate is going to. For now. Justine had a dream while she was under and she figured out how to stretch the series out to a few more books. So for now Kate will get to feel what it is like to be with Nathan. Lexie understands this means that after a few books, Kate will choose Alexander. "What is wrong with you?!” Lexie asks and asks her why she hates Nathan so much. Justine doesn’t; she loves him, probably as much as Lexie apparently does. He’s kind, funny, incredibly honest. It’s Kate. She doesn’t love him. Tears well up in Lexie’s eyes. "She should. It’s not fair,” she says. Justine knows that, but it makes for a really, really good read. Lexie starts crying and Justine suggests they work on the book a little bit more to make Lexie feel better. Lexie sits down and opens the laptop.
Callie is sitting by Louise’s side. Louise wakes up and Callie tells her the surgery went great. Callie then blurts out she likes girls, as in romantically. Women, she corrects herself. And she met the most amazing woman, Dr. Robbins, from this morning. They got married, but before that, they got in a really bad car accident. Callie almost died, but she didn’t, and neither did Sofia, their perfect, beautiful baby. And Callie thinks she’s screwing all this up. She knows it is a lot, and she understands that it might be too much for Louise to handle, because her own mother practically disowned her. Callie notices Louise’s eyes tear up and she feels bad for making her cry. "You have a baby?” Louise asks, and she asks for pictures. Callie cries in relief and takes her phone to show off Sofia’s pictures.
Derek meets Owen in an X-ray viewing room. A patient of his is on his way to the hospital. If Owen wants to tell the man no, Derek says he can do so himself. Owen says he’s not worried about the hospital’s mortality rate. He’s worried about Derek. He’s had a lot of bad outcomes this year and Owen thinks Derek is lining himself up for more. Derek says he doesn’t have a reputation anymore to be worried about. He was going to be the guy who was gonna cure Alzheimer’s, but now he’s blacklisted by the FDA, so he doesn’t have to worry about that anymore. He gets to choose what he worries about. And he chooses the hopeless patients. He feels like he can change their story and that he owes it to them to at least try. Owen thinks it sounds pretty arrogant, but Derek replies he has a reputation for arrogance.
Alex is sitting at the bar at Joe’s. Polly sits down there too and orders a scotch while calling her boyfriend. Today was a bust, she tells him. Robbins kept going on about this guy who helped these kids in Africa. She didn’t even pay attention to her three articles. "Apparently this guy craps puppies, so who cares about me?” Polly says, and Alex agrees in silence. She warns her boyfriend she’s going to be drunk and going to cry when she arrives at the airport. Polly hangs up, drinks her drink, pays, and leaves to catch her plane.
Mark meets Jackson outside the hospital. They both apologize for today. Mark wants to be his teacher. Jackson wants to be his student. Mark has a cranial vault reconstruction tomorrow. Jackson will be there. They’re both happy that the Plastics Posse is back in action. "Kicking surgical ass and taking names!” Mark adds. They shake hands.
While Meredith’s voice over talks about how scary it is how fast everything can fall to crap, Alex, Cristina, and Meredith are drinking at Joe’s. Alex says George wasn’t a creep and admits he’d be kicking all of their asses if he were here today. He would’ve slapped Chief Resident right out of Kepner’s hands. They all agree. Alex just doesn’t like to think about George, because that makes him think about Izzie, and then he gets all sad and sappy and then he misses the chance to be all about how a drunk chick was thinking all day about how awesome he is. Which is what he should be all about. George is dead and Izzie is gone and they’re all different.
Teddy comes home and finds Henry standing by the sink, his back turned towards her. While she says it was their first big fight, he coughs. She asks if he's okay. He turns around. His hand is covered in blood and he coughs up more blood. She walks towards him and assures him it's all going to be okay.
==Cast==
808MeredithGrey.png|Meredith Grey
808CristinaYang.png|Cristina Yang
808AlexKarev.png|Alex Karev
808MirandaBailey.png|Miranda Bailey
808RichardWebber.png|Richard Webber
808CallieTorres.png|Callie Torres
808MarkSloan.png|Mark Sloan
808LexieGrey.png|Lexie Grey
808OwenHunt.png|Owen Hunt
808ArizonaRobbins.png|Arizona Robbins
808TeddyAltman.png|Teddy Altman
808AprilKepner.png|April Kepner
808JacksonAvery.png|Jackson Avery
808DerekShepherd.png|Derek Shepherd
808LouiseO'Malley.png|Louise O'Malley
808PollyPreston.png|Polly Preston
808HenryBurton.png|Henry Burton
808JustineCampbell.png|Justine Campbell
808Dr.Park.png|Dr. Park
808CTTech.png|CT Tech (left)
808TransplantSurgeon.png|Transplant Surgeon
808ORNurse.png|OR Nurse
===Main Cast===
*Ellen Pompeo as Dr. Meredith Grey
*Sandra Oh as Dr. Cristina Yang
*Justin Chambers as Dr. Alex Karev
*Chandra Wilson as Dr. Miranda Bailey
*James Pickens, Jr. as Dr. Richard Webber
*Sara Ramírez as Dr. Callie Torres
*Eric Dane as Dr. Mark Sloan
*Chyler Leigh as Dr. Lexie Grey
*Kevin McKidd as Dr. Owen Hunt
*Jessica Capshaw as Dr. Arizona Robbins
*Kim Raver as Dr. Teddy Altman
*Sarah Drew as Dr. April Kepner
*Jesse Williams as Dr. Jackson Avery
*Patrick Dempsey as Dr. Derek Shepherd
===Guest Stars===
*Debra Monk as Louise O'Malley
*Vedette Lim as Dr. Polly Preston
*Scott Foley as Henry Burton
*Alfre Woodard as Justine Campbell
===Co-Starring===
*Keong Sim as Dr. Park
*Martin Yu as CT Tech
*Anthony Johnson as Transplant Surgeon
*Teresa Huang as OR Nurse
==Medical Notes==
===Louise O'Malley===
*Diagnosis:
**Remnant cystic duct
*Doctors:
**Miranda Bailey (general surgeon)
**Meredith Grey (surgical resident)
*Treatment:
**Septoplasty
Louise O'Malley came into the hospital after having had her gallbladder removed at Seattle Presbyterian Hospital. She had returned to Seattle Pres a few times, but they told her she was okay, so she went to Seattle Grace instead. She was left with a remnant cystic duct, which had to be removed in surgery.
===Arizona's Patients===
*Diagnosis:
*Doctors:
**Arizona Robbins (pediatric surgeon)
**Polly Preston (surgical resident)
*Treatment:
Arizona took two patients, one with esophageal atresia surgery planned and one with pyloric stenosis, from Alex for Polly Preston to operate on.
===Justine Campbell===
*Diagnosis:
**Aneurysms
**Seizure
*Doctors:
**Derek Shepherd (neurosurgeon)
**Lexie Grey (surgical resident)
*Treatment:
**Aneurysm clipping
Justine had three aneurysms in her brain. One began to leak, causing a massive headache. Justine wanted to wait to have surgery until she finished writing her book. Lexie helped her finish her book by typing as Justine dictated. While Lexie was typing, Justine's aneurysm burst, and she had a seizure. She was rushed into surgery. Derek was able to operate successfully and stop the bleeding.
===Dr. Park's Patient===
*Diagnosis:
*Doctors:
**Dr. Park (cardiothoracic surgeon)
*Treatment:
A heart was retrieved and put into a special box to keep it viable as it was transported down to UCLA for Dr. Park's patient. However, while waiting for the heart, his patient died. The heart was then redirected to another patient on the transplant list at Columbia.
===Heart Patient===
*Diagnosis:
*Doctors:
*Treatment:
**Heart transplant
After Dr. Park's patient died, the heart in the box was redirected to a patient at Columbia who was a match.
===Plastics Patient===
*Diagnosis:
*Doctors:
**Mark Sloan (plastic surgeon)
**Alex Karev (surgical resident)
**Jackson Avery (surgical resident)
*Treatment:
**Nerve graft
Alex took over and performed a nerve graft with Mark in Jackson's place.
===Mark's Patient===
*Diagnosis:
*Doctors:
**Mark Sloan (plastic surgeon)
**Jackson Avery (surgical resident)
*Treatment:
**Cranial vault reconstruction
Mark asked Jackson to scrub in with him on a cranial vault reconstruction.
===Henry Burton===
*Diagnosis:
**Hemoptysis
*Doctors:
*Treatment:
Teddy came home to find Henry coughing up blood.
==Music==
Song 	Performer 	Scene
"Shoot Me" 	Miss Li 	
*Derek and Meredith are making out. He tells her to stop worrying about their hearing.
*Lexie and Jackson talk, interrupted by Mark who's pumped for his surgery with Jackson.
*Bailey tells Meredith there are bigger things than the trial today.
"Hold On" 	Mozella 	
*Alex wishes he had an attending having his back, like Mark has Jackson's.
*Lexie is reading one of her patient's books.
*Alex sees Arizona and Polly and decides to go somewhere else to eat his lunch.
"How Come You Never Go There"	Feist 	
*Teddy and Henry start making out in on-call room.
*Meredith tells Louise Callie remarried. Louise misses Callie and all of George's friends.
"I Can't Get You Off My Mind"	Miss Li 	
*Richard tells Jackson he's lost. He needs to see heart in a box.
*Mark is worried about Jackson.
*Meredith tells Callie about Louise.
"Where Do I Even Start?" 	Morgan Taylor Reid 	
*Henry doesn't want to waste any of his new life.
*Meredith operates on Louise. Bailey talks about raising children and admits George was her favorite.
*She tells Meredith what to wear for her trial.
*Jackson tells Lexie there is still a thing between her and Mark. He walks away from her, for him.
*She can't tell him he shouldn't pick Mark over her.
"Addicted" 	Morgan Page feat. Greg Laswell	
*Callie tells Louise O'Malley she has a family together with Arizona and shows her pictures of Sofia.
*Owen talks to Derek about Derek's plan to operate on inoperable cases.
*Alex overhears Polly Preston talking at Joe's.
"Looking For You Again" 	Matthew Perryman Jones 	
*Jackson tells Mark he'll scrub in with him.
*Alex tells Meredith and Cristina he doesn't like to talk about George, because that makes him think about Izzie and that makes him sad.
*Teddy comes home, finding Henry coughing up blood.
"Shoot Me" - Miss Li
"Hold On" - Mozella
"How Come You Never Go There" - Feist
"I Can't Get You Off My Mind" - Miss Li
"Where Do I Even Start?" - Morgan Taylor Reid
"Addicted" - Morgan Page feat. Greg Laswell
"Looking For You Again" - Matthew Perryman Jones
==Notes and Trivia==
thumb|300px|right
*This episode's title originated from the song Heart-Shaped Box, originally sung by Nirvana.
*This episode scored 9.52 million viewers.https://web.archive.org/web/20111106134548/http://tvbythenumbers.zap2it.com/2011/11/04/thursday-final-ratings-big-bang-theory-the-x-factor-parks-recreation-the-office-vampire-diaries-greys-anatomy-adjusted-up/109650/
*This episode marks the end of Lexie and Jackson's relationship.
*This is the last appearance of Louise O'Malley.
==Gallery==
===Episode Stills===
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===Behind the Scenes===
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==Quotes==
:April: I'm not gonna rearrange the whole surgical schedule just cause you're having girl problems. Just suck it up!
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:Mark: It's just you and me, the plastics posse. Kicking surgical ass and taking names.
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:Arizona: Hey, look, coming out is important! It's everything with your family and your friends, I'd kick your ass if you tried to hide me from them. But coming out to your dead ex-husband's super Catholic mom? Not necessary. I mean, not for you. And certainly not for me so... it's okay.
:Callie: Thank you.
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:April: Heart-in-a-box is starting to creep me out.
:Cristina: Don't talk about her that way.
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:Mark: Any idea what's going on with Avery? He seems so distant.
:Alex: You want me to put a note in his locker?
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:: Mark: Derek, you know me. I never gave a crap about teaching in my life. But lately, I like the idea of passing it on. And I, you know, I just- I want to see him do well. Maybe I just need to back off.
:Derek: Ah, Hunt, just in time. Mark is afraid that Avery is gonna break up with him.
:Mark: Can't this just stay between you and me?
:
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:(After they had sex in the on-call room)
:Henry: I gotta say, I'm a big fan of what happens in this room.
:Teddy: Mmm. Every day should be bring your husband to work day.
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:Meredith: I can do a septoplasty. You taught me a septoplasty.
:Miranda: I thought I taught you a lot of things, now I'm thinking, I must not be much of a teacher at all.
:Meredith: I'm going to court tomorrow... to prove to a judge that's never met me that I'm a good person, a fit mother. I want my kid back so badly I'm racking my brain looking for anything that'll make him see me that way. I want to dress the part. So, I'm thinking my navy dress, but there's a button missing and it shows too much cleavage. My charcoal pants have a hole in the ass. I've got one shot at this, I'm useless... and frustrated. But I know how to do an E.R.C.P and I know when to double check labs and I know how to do a septoplasty. I'm not useless here.
:Miranda: Fine. Do the surgery.
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:Jackson: I don't get it. I mean, Webber talks about this thing like it's a magic eight ball. It's a heart... in a box.
:Cristina: Okay, when you take an organ out for a transplant, what do you do?
:Jackson: Put it on ice.
:Cristina: Okay, you put it on ice and run to place it in the recipient's body and then you wait and hope for this cold, dead heart to warm up and come back to life, right? But she--
:Jackson: She?
:Cristina: She has never stopped beating. She's never stopped being warm, never stopped living.
:Jackson: Sure, it's pretty--
:Cristina: It's a friggin' miracle, okay? You're standing before a miracle and once you realize that, she'll change your perspective. Okay, here's what I do. I look at an item on my list and I look at heart-in-a-box and if that surgery on my list isn't half as cool as heart-in-a-box then it is not worth my time. She lets you know what's most important to you. That's what heart-in-a-box does. And she's nice to talk to.
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:Henry: What do you think about the University of Washington?
:Teddy: Um, I'm not sure.
:Henry: It's not like Harvard or Stanford. It feels...I don't know, it feels doable.
:Teddy: Doable? Okay, I'm- I'm sorry but medical school isn't something that you---you--you--you just decide to do.
:Henry: Really? How did it happen for you? The lady of the lake appear with a gilded scalpel and anointed you a med student.
:Teddy: Ha. Ha.
:Henry: I'm actually being serious right now. I mean, how is my decision to go to med school any different than yours?
:Teddy: First of all, I was nineteen.
:Henry: All right, great. So I'm old. What else?
:Teddy: Um, I don't know. Have you taken your three years of prerequisites? How about the MCAT?
:Henry: No, I have not. But I do have a college degree. I may have been a baseball player but I think I remember how to study.
:Teddy: Okay, that doesn't account for the four years of actual med school. And if you decide to go completely crazy and you want to try to become a surgeon, that's five years of residency, a fellowship--
:Henry: No. I never s--I never said I wanted to be a surgeon. There are plenty of other ways to use a medical education.
:Teddy: Okay, fine. Fine. I love the way things are right now. I really do. And I don't want to spend ten years married to a med student.
:Henry: No. You just rather I followed you around looking cute.
:Teddy: Okay, you--you know that's not what I'm saying.
:Henry: I was gonna die. My disease was going to kill me. And then I met you. You came into my life and suddenly I have insurance, I have a wife, I have a life expectancy beyond the next three months. Sue me if I don't want to waste any of it.
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:Miranda: He was my favorite... George O'Malley. He was...my favorite
:Meredith: I know. He was the good one.
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:Lexie: You okay?
:Jackson: Yeah. I just--I missed a surgery today that... That's not true. I avoided a surgery today, one I wanted to do for weeks because of this thing with you and Mark.
:Lexie: There is nothing between me and Mark.
:Jackson: Yeah, I've been trying really, really hard to believe that. But there is a thing and it's not going anywhere anytime soon. And this new thing with me and plastics, that's not going away either. Something's gotta budge. So, I have to walk away... from you... for me.
:Lexie: So... You're picking Mark?
:Jackson: I've spent way too much time sabotaging my own career, Lex. So, yeah... I'm picking Mark. Can you...Can you tell me I shouldn't?
:(Lexie stays silent. Jackson walks off.)
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:Louise: Callie.
:Callie: Hey. Meredith said that the surgery went great. I like girls, uh, as in, romantically. It turns out I like girls. Uh, women. And I met the most amazing woman. Do-- do you remember Dr. Robbins from this morning? Yeah, we got married and uh... Oh, no, but before that we, um... got in an accident, a car accident, a really bad accident and, uh, I almost died. But I didn't and Sofia-- Neither did Sofia, our baby. Our perfect, beautiful baby. And I'm uh... I'm... Screwing all this up. Look, I know this is a lot, and I ...and I understand, and if this is too much for you to handle, believe me, my own mother practically disowned me, so I understand. Oh, God, I'm making you cry. Please don't cry.
:Louise: (teary-eyed) You have a baby?
:Callie: I- I do.
:Louise: Do you have any pictures?
:Callie: You wanna see 'em?
:Louise: Are you kidding?
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:Owen: I'm not worried about the hospital's mortality rates, Derek. I'm worried about you. You've had a lot of losses this year and I'm concerned that you're lining yourself up for more.
:Derek: You're worried about my reputation.
:Owen: Well, there is that...
:Derek: I don't have a reputation anymore. See, I was gonna be the guy who cured Alzheimer's, now I'm blacklisted by the FDA so, I don't have to worry about that anymore. I get to choose what I worry about. And I choose them. I feel I can change their story. I owe it to them to at least try.
:Owen: That's... pretty damn arrogant, don't you think?
:Derek: Well, I have a reputation for arrogance.
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:Alex: O'Malley wasn't a creep, okay? If he were here right now, he'd be kicking all of our asses. He would've slapped chief resident right out Kepner's hand. I just don't like thinking about him because then I have to think about Izzie and then I get all sad and sappy and... I totally miss the chance to nail hot, drunk chicks who spent the day thinking about how I'm awesome. Which I should be all about. George is dead and Izzie's gone and we're all different. We're different.
==See Also==
de:Das Herz im Kasten
fr:Le coeur dans la boîte
Category:All Episodes
Category:GA Episodes
Category:GA S8 Episodes