"Grey's Anatomy" Heart-Shaped Box (TV Episode 2011) - Plot Summary Poster

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  • Jackson's suspicions about Mark and Lexie interfere with work.

  • 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.


The synopsis below may give away important plot points.


  • Meredith wants Derek to focus on practicing their speeches for the judges. Their hearing is 36 hours away. Derek says they just need to stand there and speak from the heart.

    At the hospital, Avery and Lexie are going through some stuff after Avery realized that Lexie still hasn't gotten over Sloan, who just happens to be standing in the elevator when it opens. Sloan asks Avery if he's "pumped" for their big surgery.

    Meredith meets up with Bailey, who says they have bigger things to worry about than mice this day.

    Arizona is getting ready to roll out the red carpet for a fellowship applicant, Paulie Preston. Apparently, everyone wants her for their program.

    Derek is walking a patient through her aneurysm scans. Her aneurism is leaking. Derek needs to clip it, but the woman, an author, wants to finish writing her book before the surgery. She's almost done. Derek has Lexie list all the things that could happen if the aneurysm bursts. They include stroke and death. The patient counters by asking Lexie to list the possible complications of the surgery. They include stroke and death.

    Bailey takes Meredith to her patient -- Louise O'Malley, George's mom. Bailey wants reports on every aspect of her treatment. She does not want another O'Malley to die at the hospital.

    Teddy asks Cristina how her wish list is coming along and Cristina says she needs more time. They're watching over a heart harvesting as a doctor from UCLA is getting a heart needed for his patient. Apparently, it's "bring your husband to work day" since Henry is watching from the gallery. The heart is removed and connected to a device that keeps it beating. Then the UCLA surgeon gets a phone call and learns his patient has died. He leaves, leaving the beating heart behind.

    George's mother had a gall bladder removal at Seattle Pres. He other sons didn't want her going to Seattle Grace/Mercy West because both George and his father died there. Now she's having pain so she came to SGMW. Mrs. O'Malley tells Meredith it makes her proud that she's her doctor.

    Teddy has found a match for the heart, but it needs to be monitored until it's picked up. She asks Cristina to watch it, and use the time to work on her wish list.

    Derek is looking at brain scans of patients "who were told no by every doctor they've seen." He tells Lexie she'll be in on them if she can get the writer to get her to say "yes" to the surgery that could save her life.

    Avery is trying to get April to change the schedule to get him off his surgery with Sloan. Alex comes in and asks if anyone's heard of Paulie Preston, and April says she's her "Number 1 peer role model." Alex is worried that Arizona has lost faith in his abilities. Avery gives Alex his nerve-graft surgery to Alex.

    Lexie comes to her patient and tells her she needs to get her aneurysm clipped. She insists she needs to finish her book for her readers. It's the last in a series. When Lexie says she's just trying to help, the woman asks her how fast she can type.

    Webber sees Cristina working on her wish list and takes a look. He tells her she's asking for common things on many pages. He tells her to open up her mind and to use the beating "Heart in a Box" as "the key."

    Meredith gives Mrs. O'Malley the update on her life and Callie comes around the corner. She gives "Mama O'Malley" a hug, then awkwardly introduces "Dr. Robbins" to her.

    Sloan comes to Avery and asks why "The Plastics Posse" is broken up for the day. Avery claims he has a paper to finish. Sloan seems bummed as he leaves.

    Callie tracks down Arizona and apologizes for the awkward introduction. Arizona says it's fine and that she doesn't have to come out to everybody, especially her "ex-husband's super Catholic mother".

    Alex tells Avery he wishes he had an attending who had his back the way Sloan has Avery's. Alex is annoyed seeing Paulie Preston eating in the cafeteria with Arizona.

    Cristina and Meredith sit around reminiscing about George in April's office, which annoys Alex. He just wanted to eat his lunch in peace. Avery and April never met George but Avery asks if George was the "heart in an elevator guy". Cristina then finally seems to get some inspiration from the "Heart in a Box."

    Lexie is typing furiously as her patient dictates her novel. Lexie is focused on plot points of her book and is getting into the story when Derek walks in. He's annoyed, but Lexie says she "can't rush the creative process."

    Meredith is running a scope on Mrs. O'Malley, but Bailey is upset because she didn't ask Meredith to do this. Still, Meredith discovers that Mrs. O'Malley's gall bladder surgery was botched, and Bailey has her prep Mrs. O'Malley for surgery.

    Teddy walks Henry into an on-call room. When he asks what happens in there, she rips his clothes off.

    Meredith explains Mrs. O'Malley's situation to her. Mrs. O'Malley asks Meredith about Callie's wedding ring. Meredith says Callie got married and she's happy without giving more details.

    Avery watches from the gallery as Sloan and Alex work on the nerve graft. Webber leans over to him and tells him he's a fool for watching from the gallery when he should be down in the surgery. Webber tells Avery he has to go see "Heart in a Box."

    Meredith sees Callie and suggests it wouldn't be a bad thing if she were there to hold Mrs. O'Malley's hand when she gets out of surgery.

    Sloan goes to talk to Derek about Avery. He's afraid of getting his heart broken by Avery.

    Henry tells Teddy he wants to go back to school -- medical school. Teddy's surprised.

    Lexie continues typing as her patient's novel reaches its climax and the main character opts not to stay with the nice, good-looking man, but chooses to go back to her soul mate who is a criminal. Lexie can't believe it. As they argue the point, the woman suffers a seizure.

    Derek and Lexie operate on the author when Lexie explains that she has to try to talk her into changing the ending of her novel.

    While scrubbing in for Mrs. O'Malley's surgery and Meredith tells Bailey that Mrs. O'Malley thought she'd be the one doing the surgery. Bailey doesn't want to let her do it, but Meredith talks her into it. Meredith says that she doesn't know what to wear to the court hearing. She wants to look respectable and responsible.

    Avery is now sitting next to Cristina and they're both looking at "Heart in a Box." She explains that "Heart in a Box" is helping her narrow down her list by reminding her what's most important. She says that they're sitting in front of a miracle, and if what she's thinking about isn't half as cool as "Heart in a Box," it's not worth having on the list. Avery focuses in.

    Teddy tells Henry that "medical school isn't something you just decide to do." She tries to explain all the years that go into it. She then admits she doesn't want to spend 10 years married to a med student. He tells her that after nearly dying, she helped give him a new life and he doesn't want to waste any of it. She's acting like she thinks he can't do it. He's upset that she isn't more supportive of his decision.

    Bailey stands next to Mrs. O'Malley and talks about how parents work so hard to teach their children to do the right thing, and George went and threw himself in front of a bus to save someone else. Bailey says it's good to see children do good things, but not to see them destroy themselves in the process. She says it's "maddening." Then she tells Meredith that she is "maddening." Bailey goes on to say that George was her "favorite." Meredith says she knows. Then Bailey gives Meredith advice on what to wear to her court hearing. A sweater set. She'll look motherly.

    Lexie meets up with Avery, who paged her. He tells her he avoided a big surgery because of the thing with her and Sloan. He says it's not going away anytime soon. And he's not leaving plastics. So he has to walk away- from her. She asks if he's really "picking Mark" and he says, "Yes, I'm picking Mark." He starts to walk out the door and turns to ask, "Can you tell me I shouldn't?" Lexie says nothing.

    Cristina hands Webber her new, one-page wish list, saying he was right about "Heart in a Box" being the key. He shows her his own list. She wants to add one of his to her list. The team from another hospital comes to take "Heart in a Box."

    Lexie goes back to her patient and asks why her character can't choose the nice guy. The author says it's the woman who doesn't love the right guy. But she'll leave her with the nice guy for now and extend the series for a few more books. But, in the end, the roue is the soulmate. Lexie cries and sits down to work on the book a bit more.

    Callie is holding Mrs. O'Malley's hand when she wakes up from surgery. Callie tells Mrs. O'Malley she likes girls, she married Arizona and had a baby. Mrs. O'Malley cries and asks to see pictures of Callie's baby. Callie cries as she pulls out her phone to show them off.

    Derek realizes that Hunt is worried about Derek's reputation if he takes all these impossible cases. Derek says he no longer has a reputation because the FDA blacklisted him. He now is choosing to help the people who no one else wants to try to help. Hunt says that that's really arrogant. Derek says that he has a reputation for being arrogant.

    At the bar, Alex happens to find himself next to Paulie Preston and overhears her calling home and saying her visit was "a bust" because Arizona kept talking about "some guy who takes care of kids from Africa and craps puppies." Alex says nothing and smiles when Paulie leaves.

    Sloan and Avery clear the air and suddenly "the Plastics Posse is back in action,"

    Back at the bar, Alex finally admits, "O'Malley wasn't a creep." He says O'Malley was better than all of them and would be chief resident if he hadn't died. He just doesn't like thinking about George because then he thinks about Izzy and gets all sad and sappy.

    Teddy gets home and wants to talk to Henry about their first real fight. But she finds him coughing up blood. She looks him in the eye and tells him he's going to be OK, but she doesn't seem so sure.

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