Burn It Down

is the tenth episode and season finale of the twentieth season and the 430th overall episode of Grey's Anatomy.
==Short Summary==
Wildfires threaten the Seattle region, leading to a flood of patients and emergency procedures. The doctors juggle overcapacity in the ER, complex surgeries and personal stress. Meanwhile, Meredith makes a rash decision that can't be undone.
==Full Summary==
Simone watches a news report on the raging wildfire near Seattle. She starts researching the Heart Center of Chicago.
Winston wakes up as Monica gets dressed. She informs him about the wildfire. They all got paged since the hospital needs all hands on deck. They agree last night was fun. She jokes about meeting her parents.
Owen closed all the windows. Teddy is paged as well. She's not sure if Catherine fired her just as Chief or as an attending altogether. Owen urges her to get dressed since they need all the help they an get.
Mika, Benson, and Simone find that the coffee cart outside is closed. They run into Lucas, who's wearing a suit. He had a video interview with Chicago's program director. He was offered the spot. He said he would think about it. They run into Dorian in the lobby. He is being discharged to the nursing facility. Bailey comes to fetch the interns. Jules is already in scrubs behind her. The interns say goodbye to Dorian and run off to get changed. Bailey then agonizes over the fact that Ben has not responded to her text.
Link instructs Levi to move the whole ortho schedule to next week. Jo comes to steal Levi since there are NICU transfers coming in from Seattle Pres and Beltran needs help. He thanks her.
Meredith and Amelia meet with Teddy, who states that she is to blame for her own decision. They move to the lab and find that Teddy's badge no longer works. Meredith's still does, which she takes to mean there is room to negotiate with Catherine. Meredith is confident that Catherine won't be able to ignore yesterday's findings.
Down in the ER, Taryn informs Bailey that all but two residents came in. Simone informs Bailey that Lucas might be leaving for Chicago. Bailey says his decision is not up to either of them. Owen announces that Grey Sloan is the only Level 1 trauma center operating in the Seattle region. Wildfires are hard to extinguish so this could go on for days. As everyone gets to work, Owen and Link head to the helipad since Medevac is bringing in an injured firefighter, Theo Ruiz. Bailey tags along upon hearing his name.
Winston, Richard, Mika, and Jules inform Garrett Oates that they are rescheduling his AAA repair since OR's are reserved for trauma patients now. Having lived through Woodstock '99, Garrett understands what disaster looks like. He's worried about how the change in air quality will affect the vinyl records in his store. Winston is paged away. Moments later, Garrett experiences some abdominal cramping. Richard decides to get a scan.
Ben arrives with Theo on the helipad. He informs the doctors that Theo was crushed by a large tree branch, sustaining abdominal crush injuries, an unstable pelvis, and an open femur fracture. They intubated him en route. The doctors rush him inside. Ben tells Bailey they'll be lucky if this is the worst injury they're bringing in today.
As they prepare things in the NICU, Jo advises Levi to chill out around Beltran. He defends his continuous asking questions as showing interest. His advantage to get the fellowship is his pre-existing relationships at the hospital. Monica arrives and asks Levi for his help. He skims the charts and finds one of the babies had a biliary atresia surgery. He proceeds to ask Monica about her experiences performing that procedure.
Down in the ER, Lucas is asked by a woman if he has seen her son and his boyfriend. They were out camping. Their names aren't in the system and people at the desk are too busy to check on the John Does. Lucas writes down their names, Nathan Bates and Andrew Smith. The mom points out a crowd of other people in the waiting area with a similar question.
Ben explains to Bailey that Theo pushed Travis out of the way of the falling branch. Teddy drops by to inform Owen that she was definitely fired. Taryn finds that there is vascular compromise in the broken leg. Ben urges them to save the leg since Theo's job is his life. Owen urges Ben and Bailey to step out since they are treating family here. Nurse Karen informs Owen that the hospital emergency coordinator wants to talk to him. Teddy decides to step in, figuring that Catherine can't blame her for saving a firefighter's life.
Garrett sings to himself as he's having his CT taken. Richard joins Mika and Jules just as the scans come up. The aneurysm ruptured but it's still contained. Richard wants to book an OR for an open repair. Mika and Jules are taken aback as they studied the endovascular procedure like Winston intended, but he's busy with an emergent CABG. He tells the interns to study up so they can do more than retract.
Benson briefly looks at a coughing woman in the ER and then berates Lucas for scrolling on his phone. Lucas put together the Fall City Wildfire People Locator, a shared database that everyone can access. Benson agrees to post the link and then tells Lucas to take the woman in bed 3. Molly Tran, an asthma patient, is coughing and wheezing and she also had a badly sprained ankle. Molly is in pharmacy school. After checking her phone for the answer, she says she was diagnosed with asthma at age 17. She suffers from amnesia after a car accident a few years ago. She's back to studying pharmacy again. Lucas will get her nebulizer treatment started.
Amelia and Meredith are meeting with Catherine. Catherine is furious that they found a correlation between things that Catherine was specifically told by Meredith that she would stop researching. Meredith points out that they are this close to proving that Alzheimer's might be preventable. Catherine will not overlook the fact that they want behind her back using her money. Meredith urges her to think about the millions of Americans that live with Alzheimer's. Meredith states she never intended to use the Foundation's money but here they are. Catherine then agrees the Foundation should be leading the way on this. She then demands they turn over all of their notes and data to Tom Koracick so he can take over and Meredith, Amelia, and Teddy get to keep their jobs.
Full summary to be continued.
==Cast==
===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
*Jason George as Dr. Ben Warren
*Carlos Miranda as Theo Ruiz
*Scott Speedman as Dr. Nick Marsh
*Natalie Morales as Dr. Monica Beltran
*Jaicy Elliot as Dr. Taryn Helm
*Freddy Miyares as Dorian Cardenas
*Lesley Fera as Ann
*Johnny Sneed as Garrett Oates
*Dianne Doan as Molly Tran
*Vince Swann as Dave
===Co-Starring===
*Fran Nichols as Nurse Karen
*Krystin Goodwin as News Anchor
==Medical Notes==
===Link's Patient===
*Diagnosis:
*Doctors:
**Atticus Lincoln (orthopedic surgeon)
**Levi Schmitt (surgical resident)
*Treatment:
Due to the wildfire sending in multiple patients, Link had to reschedule two laminectomies and Ms. Feuer's knee replacement.
===Theo Ruiz===
*Diagnosis:
**Crush injuries
**Pelvis fracture
**Open femur fracture
*Doctors:
**Owen Hunt (trauma surgeon)
**Teddy Altman (cardiothoracic surgeon)
**Miranda Bailey (general surgeon)
*Treatment:
**Exploratory laparotomy
**Thoracotomy
Theo, 37, had abdominal crush injuries, an unstable pelvic fracture, and an open femur fracture. He was brought by helicopter to the hospital, where they examined him. He a femoral pulse in his left leg, but had vascular compromise, meaning there was a possibility of amputation. He also had free fluid in his abdomen. They placed an IO line and then took him for a CT and then to surgery. When his BP dropped on the way to CT, they decided to skip it and go directly to surgery instead. On the way, delayed by having no OR available, Teddy observed jugular vein distention and he lost pulse due to cardiac tamponade, forcing her to do a pericardiocentesis in the hallway. This relieved the pressure on his heart and stabilized him until an OR became available. In surgery, his SMA avulsed and Link said they'd have to amputate if they couldn't restore blood flow to his leg quickly. They were able to graft his vein and save his leg and he was stable after his surgery.
===Garrett Oates===
*Diagnosis:
**Abdominal aortic aneurysm
*Doctors:
**Richard Webber (general surgeon)
**Winston Ndugu (cardiothoracic surgeon)
**Mika Yasuda (surgical intern)
**Jules Millin (surgical intern)
*Treatment:
**Surgical repair
Garrett had been diagnosed with an abominated aortic aneurysm and his surgery was cancelled because of patients coming in from the wildfire. However, as he was being discharged, he had severe abdominal pain, so Richard decided to run tests. A CT showed that his AAA had ruptured. They took him into surgery and Richard allowed Jules and Mika to do the anastomosis. After his surgery, he started bleeding again and Winston took him back into surgery, but he was unable to save Garrett.
===Winston's Patient===
*Diagnosis:
*Doctors:
**Winston Ndugu (cardiothoracic surgeon)
*Treatment:
**Coronary artery bypass graft
Winston was called into an emergency coronary artery bypass graft.
===Molly Tran===
*Diagnosis:
**Sprained ankle
**Asthma
*Doctors:
**Lucas Adams (surgical intern)
**Benson Kwan (surgical intern)
*Treatment:
**Albuterol nebulizer
**Bandaging
Molly came into the ER with a sprained ankle and difficulty breathing. She said it was probably just smoke inhalation, but her boyfriend was worried because she had asthma and was wheezing in the car. Lucas listened to her lungs and asked her how long she'd had asthma. She checked her phone and said she was diagnosed at seventeen, then explained she'd been in a car accident a few years prior that left her unable to remember her life before the accident. Lucas ordered labs, a chest x-ray, and a nebulizer treatment. Then he wrapped her ankle. Later, she struggled to breathe again and Benson gave her more albuterol.
===Paloma Deshmukh===
*Diagnosis:
**Jaundice
*Doctors:
**Monica Beltran (pediatric surgeon)
**Levi Schmitt (surgical resident)
*Treatment:
Paloma had high bilirubin after birth, so Monica assigned Levi to look after her.
===Jo Wilson===
*Diagnosis:
**Pregnancy
*Doctors:
**Levi Schmitt (surgical resident)
*Treatment:
Jo collapsed while working in the NICU. Levi ran labs and told her she was pregnant.
==Music==
Song 	Performer 	Scene
"Spare Tire" 	Claud 	
*Simone watches the news and googles Maggie.
*Monica dresses and talks to Winston.
*Owen and Teddy talk.
*The interns arrive at work.
"Spinning Wheel" 	Cast (Johnny Sneed)''	
*Garret sings to himself as he gets scanned.
"Tend" 	Gem Club 	
*Richard talks to Meredith about retirement.
*Simone finds Bailey and tells her Theo's stable.
*Simone tells Bailey Ben is marked safe.
"Sweet Heat Lightning"	Gregory Alan Isakov 	
*Meredith tells Catherine she'll win.
*Link checks on Jo.
*Levi talks to Taryn about the residents.
*They check their ABSITE scores.
*Monica and Winston talk.
*Richard asks to talk to Winston about Garrett.
"Seasons Change" 	Jolé 	
*Teddy, Amelia, and Owen leave together.
*Meredith watches ambulances coming in.
*Meredith and Nick talk about her research and their relationship.
*Lucas talks to Catherine.
*The other residents come in to defend him.
*Bailey joins them.
"Spare Tire" - Claud
"Tend" - Gem Club
"Sweet Heat Lightning" - Gregory Alan Isakov
"Seasons Change" - Jolé
==Notes and Trivia==
*This episode's title originated from the song , originally sung by Linkin Park.
*This episode scored 3.48 million viewers.https://programminginsider.com/thursday-ratings-station-19-series-finale-on-abc-hits-season-high-in-total-viewers/
==Gallery==
===Episode Stills===
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==Quotes==
==See Also==
es:Quémalo
Category:All Episodes
Category:GA Episodes
Category:GA S20 Episodes