A tangled web
The entire episode concerned the death of a patient named Cathy Becker who appeared with her son in a flood of patients from a hotel fire. As the Chief and several other hospital higher-ups questioned the staff about how she died, the story unfolded in flashbacks.
Cristina saw Cathy's chart first, but handed her off to Kepner and Adamson (the two women Mercy West doctors). Fascinated by more interesting-looking patients and the concern that the Seattle Grace doctors were getting an advantage, Kepner checked her over, determined she was basically fine, and packed her off to Sloan for a plastic surgery consult. But Sloan was called away, so he handed her off to Lexie, who in turn went to help Arizona with a more severely burned patient. Lexie thought she left Cathy with Adamson; in fact, Adamson wandered off with Callie to work on an injured firefighter.
Things start to go bad
When Cathy complained of pain, Cristina tried to pass her to Alex, who was distraught over the missing Izzie. Cristina ordered morphine for Cathy and returned to caring for the firefighter. Lexie found herself overwhelmed by Arizona's traumatized patient, so she stepped out — only to find that Cathy couldn't breathe.
Lexie diagnosed a collapsed lung and, with an emergency assist from Avery, she got a chest tube in. But she was distracted by Cristina, who was yelling at Cathy's son for playing with cardiac paddles. Lexie tried to choose babysitting, but was soon hauled back to Arizona's patient.
Alex steps in
Meanwhile, Cathy's breathing worsened. By the time Percy and Adamson got there, her throat was swollen shut. Alex performed an emergency cricothyrotomy — a procedure to cut open an airway in her throat.
It worked, but Cathy deteriorated. Her organs shut down, and even with everyone's attention now on her, she died, with no doctor willing to claim her as a patient.
In the end, Adamson realized that Kepner — the first doctor to treat the patient — had become distracted while doing the initial exam and never looked at Cathy's throat, missing the fact that it was full of soot. The Chief fired Kepner on the spot, because out of all the mistakes and distractions, hers happened to be the one that led to the patient's death. “I made one mistake,” she said in disbelief. “And look where it led,” the Chief told her, as the episode flashed back to the sequence of complications that followed.
The Chief felt like he had sniffed out the culprit, but Derek argued that the real problem is the chaos created by the merger and the Chief's poor handling of it, which led to the confusion, and to poor patient care, and to Cathy's death. Meanwhile, Cristina reminded the doctors from both hospitals that they'd all made mistakes all day that had simply not been caught, so there was nothing to be smug about.
Linda Holmes is a writer in Washington.