heart-to-heart talk

Piece of My Heart (Grey's Anatomy)

"Piece of My Heart" is the thirteenth episode of the fourth season of the ABC series, Grey's Anatomy. The episode is written by Stacy McKee and directed by Mark Tinker. It aired on May 1, 2008.

Episode recap

Addison Montgomery returns to Seattle Grace to treat an expectant mother whose baby has ectopia cordis, a condition in which the fetus’s heart is growing outside of his body. Meanwhile, Mark has managed to grow a skin flap out of the baby’s stem cells to cover the exposed heart.

Ava/Rebecca returns and tells Alex that she is pregnant. He brusquely asks her if she is keeping it or getting an abortion, and leaves to attend to the ectopia cordis baby. Meanwhile, the baby’s father is extremely optimistic and reassures his wife that the baby is protected by their love. This gets on Alex’s nerves, causing him to tell the father off for not preparing for any contingencies. The father tells him that he is not stupid, but that it is also good to always have hope.

Erica continues to be extremely hard on Cristina. Callie advises Cristina to tell Erica how she feels. But after a failed attempt to ‘talk girl’ with the other residents, Cristina threatens Callie with eviction unless Callie gets her in on Erica’s ectopia cordis surgery.

Izzie bumps into Rebecca at the clinic, and takes a blood sample for testing. Alex later tells Rebecca that he is not good father material and she does not want him for a situation like this. However when the baby’s surgery is a success, Alex reconsiders his relationship with Rebecca.

After the surgery, Addison realizes that Bailey seems sad even though it was a success. Bailey confesses that her husband has moved out and she wishes that Addison would go back to Los Angeles so that the opportunity to talk about her problems would go away, and she will not have to fall apart. The Chief tries to get Addison back to Seattle Grace, but she tells him that she only returned to see if it was right to leave.

Meredith and Derek admit Philip, the brain tumor patient that was mauled by a bear, into their clinical trial. Derek warns Meredith not to get too emotionally attached to the case. Philip’s brain tumor has caused to him to act aggressively and erratically, including finding a new husband for his wife, Jennifer. Meredith reassures Jennifer that it is just the tumor talking. The doctors plan to inject a live virus into the tumor to reduce it from within, but this procedure is still untested on humans. After Philip suddenly loses his sight, Derek decides to move up his surgery.

Philip confesses to Derek that the only reason he keeps trying to propose to Jennifer relationships up with other men is because he wants her to be stable and opportunistic after his impending death. Derek gets Philip to tell what he told him to Jennifer before he goes into surgery. Despite their best efforts, Philip dies on the table. Both Meredith and Derek confess to each other that they got their hopes up, and agreed that it was a pleasure working together.

Meanwhile, Izzie has been hiding in the free clinic and is struggling to keep her rebelling interns under her control. It turns out George is very popular among the interns, and Izzie feels jealous and left out. When she finds out that George is going to a dart tournament at Joe’s with the other interns, George is forced to invite her along. Lexie informs George that the other interns will drop out of the tournament if Izzie comes, because no one wants to get drunk with their boss.

Izzie meets a couple, who come in for a pregnancy test. The test results confirm the pregnancy, but the woman is insistent on getting an abortion immediately because she is HIV positive and does not want to pass the virus to her baby. Izzie tries to get Addison to talk to the couple, but Addison uses her new "Zen" outlook on life to convince Izzie to tell the couple herself. Izzie tells the couple that they still have a chance at procuring a healthy child, which pleases the husband. However, his wife is furious and becomes disgruntled that Izzie did not schedule the abortion as requested. The wife demands to be seen by another less intrusive doctor.

George tells Izzie that she cannot play darts with the other interns because she is seen as an authority figure. This causes Izzie to realize that she has been shirking her responsibilities. Firmly gathering her interns, she goes back to the couple and apologizes for being ineffectual and unclear. She informs them that there is a 98% chance that their baby would be born healthy if the proper medication and care are taken. This causes the mother to reconsider her earlier decision.

Addison is shocked to learn that Meredith and Derek have broken up, and that Callie is now divorced. When she notices how close Callie and Erica are, she asks Callie if she is involved in a relationship with Erica. This gets Callie very flustered. Later at Joe’s, Addison, Callie and Erica are having drinks together. Addison and Erica dismiss Mark’s attempts to get them to dance, but Callie decides to dance with him. Cristina approaches Erica and asks why she is so harsh on her. Erica tells her that she has talent and there is no need to constantly seek her approval. After Cristina leaves, Erica confesses that Cristina reminds her of herself. Meanwhile, Mark and Callie leave together as Erica watches on with a twinge of wistfulness . Before Addison leaves for Los Angeles, she vents her frustration to Meredith about Meredith and Derek's breakup and says she almost wants to kick Meredith, despite her new "Zen" outlook because she is letting Derek's soupy doe-eyed nurse rebound girl have the happy ending Meredith and Derek deserve.

Back at the hospital, Izzie receives Rebecca's test results and discovers that Rebecca is not pregnant; however, it seems as if Alex has decided that having the baby would be for the best and is seen caressing Rebecca's stomach.

Title reference

The episode title refers to a song by Erma Franklin, which has been covered by artists such as Janis Joplin & Big Brother and the Holding Company, and Faith Hill.



  • Derek Shepherd's middle name is Christopher.
  • This is Kate Walsh first appearance in the show since the last season. It's believed that this appearance is due to the fact that Private Practice only lasted 9 episodes in its first season
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