Grey's Anatomy

Meredith: Since the early 1900s,

morbidity and mortality conferences, or "M&M"s,

have helped surgeons learn from cases

where there was a serious complication.

During M&Ms, we assess both systematic and personal errors.

We review every step, every decision.

We get to the bottom of what happened and how it happened.

Yeah?

Room service.

Hi. Thank you.

You, uh, get your kids to school?

I did.Good.

They're never five minutes early.

What's your day look like?

Tedious.

I have a follow-up with Hamilton, and then I have

to watch someone I really like get interrogated in an M&M.

Anything good?No, he avulsed the IMA

right off the aorta during an ileostomy takedown.

Patient bled to death.

And there was no attending in the room.

Oof.

Yeah. What time's your flight?

I have to leave for the airport in about 20 minutes.

I wish you were staying.

I have 20 minutes.

We consider what we could have done better or differently...

Wow.

I know.

Oh, you were right.

This is fun.

...and hope we never make the same mistake ever again.

Hey.

Hey. How was Mr. Yeyni's CABG?

Oh, smooth. Yeah.

Were you able to talk to Richard?

No.

All he said when I asked him about it was,

"Save it for the M&M."

Well, I mean, he's not wrong.

We are a teaching hospital.

I know M&M's are essential, but I hate them.

Both things are true.

Woman over PA: Dr. Manner to the E.R. Dr. Manner to the E.R.

Grey! Here, take this.

A ventral hernia repair.

Patient's name is Franks. 1443.

Wait.

Right now?Yeah.

What about the M&M? A-Aren't I supposed to weigh in?

No one else is available, and I need to run the M&M,

so unless you're needed on a plane,

I really need you in O.R. 3.

Okay. I'm on it.Okay.

But, you know, go easy on Schmitt.

I'm sure he's suffering enough, and he's come a long way.

He's still not here yet. Where is he?

I don't know.Doesn't he live with you?

I don't put GPS locators on my roommates, do you?No need to be rude.

Do you think you'll have to go up there? Since you were in the room?

Hey, where's Schmitt?

I don't know!Okay.

Okay, we all have surgeries and clinic,

so I'm gonna go ahead and get started.

Um, ask questions as they arise.

Keep them constructive. We are a teaching hospital.

This is how we learn.

Dr. Schmitt will be presenting...

Uh...

Okay, so, our first case is colorectal surgery service.

26 year-old male...

Dr. Schmitt.

The case is a 26-year-old male

with history of ulcerative colitis.

...at which point, we were about ready to proceed

with stapling the anastomosis,

but I felt that I needed better exposure of the small bowel,

so I reached into the cavity.

Questions are not encouraged -- They're required.

Dr. Wright, ask a question.

Um...

Uh, had you observed any bleeding at that point?

No.Did you have good visualization

on what you were putting traction on?

I believed I did.

Okay.

At that point, everything was dry

and ready for anastomosis.

As stated, the patient...

Devon: It's been so long since I've seen a waterfall in person.

Dr. Schmitt? Dr. Schmitt?

Continue.

Um, everything was dry and, um...

the field was clean, so I asked for the GIA stapler.

But there was --

Um...

There, uh -- There was no indication

of any abnormal anatomy or friable structures, right?

That you could see, I mean.

What?

Meaning you couldn't have predicted

that the aorta was gonna rupture...

This is just the best.

Yeah. I'm gonna stay here awhile, you guys.

It was an unanticipated complication.

Is there a question in there somewhere, Helm?

I didn't think so.

Schmitt, go.

Uh, that -- that was the...

the f-- the field, it filled with blood, and, um...

I'm -- I'm sorry.

Levi: You're Devon Gomez.Devon: Never knew I had a groupie.

It's nice to meet you, Dr. Schmitt.

Bailey: Schmitt, call it.

I killed Devon. I, uh...

I just -- I killed him. He's dead.

Dr. Schmitt, look, we are here --

Dr. Schmitt, no, no.

We are here to determine what ha-- and how to --

Hey, no, no, no! The M&M isn't finished.

Um, un-until Dr. Schmitt returns,

Dr. Webber will take the questions.

If Dr. Schmitt was the primary surgeon

and you're the attending, who's in charge?

The Webber Method dictates that a resident cannot go on

to the next step in the procedure

without an attending being present.

Yeah, I-I understand what the method is, sir.

I'm just not sure I understand the chain of command.

I beg your pardon?

Well, I mean, the -- the Webber Method

seems to rotate authority during surgery

depending on which step you're on,

which, with all due respect, sir, seems...confusing.

Perhaps a little more time in our program

would help clear up any confusion.

Alright, let's get back to the next question, please.

In a Webber Method surgery, can you just remind us

what exactly happens if a complication arises,

even if it's not at the predetermined step

when an attending would need to be called?

Well, an attending should be called anyway.

Right, but for all intents and purposes,

your method sets up these senior residents

asthe attendings, right?

Didn't you specifically use the word "attendings"

when you first introduced the method?

"Today you will be the attendings." ...you will be the attendings.

Welcome to the Webber Method.

[ Maggie clears throat ]

Dr. Webber, was there ever a meeting of department heads

to discuss whether we should adopt

this particular teaching style?

Does that make a difference?

Well, yes, I mean, we have meetings to discuss

what brand of sutures we're going to buy.

Why not meet about this?

Are other hospitals using this, Catherine?

Other foundation hospitals?

Michelle: Dr. Webber is your chief medical officer, Dr. Fox.

The method's named after him.

You never considered that there would be

negative consequences or a P.R. nightmare?

Dr. Lin, you recently promoted the Webber Method

while recruiting new residents.

This is a teaching tool, my dear,

not some risky cure for cancer.

It's a teaching tool that cost a patient their life.

Dr. Bailey, you initially

expressed reservations about the method.

What changed for you?

Is the M&M on the patient or the Webber Method?

Because the method didn't hold the scalpel.

Thank you.

Well, there are clearly residents who are not ready.

Michelle: What about the American Board of Surgery?

Have they sanctioned it?Everybody, just please.

Dr. Webber is just prioritizing our education.

-We're here to learn. -Okay, everyone.

Why would they weigh in on a method for general procedure?

We need to get back to asking questions.

-What they need to approve... -This hospital...

Here we go.

How's the pain?

It's okay. It's not terrible.

Good.

Listen, Owen,

I-I know that you have gone through

something horrible, and I've given it two days,

but now I'm gonna sit here until you tell me

what the hell is going on.