‘Grey’s Anatomy’: Richard Shakes Up the Hospital (RECAP)

Grey's Anatomy Season 18 Episode 4 Richard
Spoiler Alert
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Richard (James Pickens Jr.) is back in action as Grey Sloan’s residency director in Grey’s Anatomy’s October 21 episode—Season 18, Episode 4, a.k.a. “With a Little Help From My Friends.” And he’s hitting the ground running, introducing what he calls the “Webber Method,” much to Bailey’s (Chandra Wilson) concern.

[Warning: The below contains MAJOR spoilers for Grey’s Anatomy Season 18, Episode 4, “With a Little Help From My Friends.”]

With the Webber Method, Richard is authorizing the residents to do a lap chole—i.e. a laparoscopic cholecystectomy—on their own. And with Richard’s schedule, attending will scrub in for the most challenging five or ten minutes of each operation. The residents are thrilled, but once they get into the OR, their mileage varies…

Schmitt (Jake Borelli) and Khan (Nikhil Shukla), for example, perform their chole so handily that Richard assigns them a second one. But Helm (Jaicy Elliot) and Chee’s (Robert I. Mesa) one and only chole goes south when Helm clips an artery, and Bailey—who had major reservations about the Webber Method idea—has to step in to save the patient.

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That near-crisis notwithstanding, even Bailey has to acknowledge the success of the Webber Method: Thanks to Richard’s new teaching method, most of the residents have newfound confidence, and 12 patients have been saved from cholecystitis.

Schmitt celebrates his OR prowess with an on-call-room hook-up with Nico (Alex Landi), who calls him his “rock star boyfriend.”

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Helm, meanwhile, mourns her mistake on a bench outside the hospital. But Bailey gives her a pep talk. “You don’t think I never made a mistake in the OR before? Or watched Meredith Grey make a mistake?” Bailey asks. “That feeling, that awfulness, it sticks with us so we don’t ever make that mistake before. It’s how we become great.”

As for the cases of the week, Tovah—Addison’s (Kate Walsh) uterine transplant patient from last week—is experiencing post-op seizures. So Addison calls in Amelia (Caterina Scorsone) to run neuro tests, and as they wait for results, Addison peppers Amelia with questions about her relationship with Link (Chris Carmack) and his failed marriage proposal. But Addison also opens up about her own personal alive, admitting that she went “really dark” during the pandemic. She hated being stuck at home, she started resenting her husband and son, and she had fantasies of not waking up each morning.

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Later, Amelia finds an answer in Tovah’s case: Tovah is suffering neurotoxicity from her anti-rejection meds. Amelia’s diagnosis, however, means Tovah gets to keep her new uterus.

And that night, Addison tries to give Amelia some perspective, speaking from the experience of her own pandemic-era breakdown: “When one is in a mental health crisis, one might make a decision she regrets later,” she says.

But Amelia sticks to her guns, certain she made the right call with Link. “I just don’t want a ring, and I don’t want any more children,” she tells Addison. “I hated the life that he loved, so I think that the sanest and the kindest thing that I could do is to let him go, no matter how much it sometimes aches.”

Addison’s response? “Look at you. Amelia Shepherd, all grown up.”

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Meanwhile, Owen (Kevin McKidd) is still working to help the veterans who are suffering ailments related to burn-pit exposure. In fact, he’s starting a study to prove the link between the burn pits and the vets’ illnesses. His patient, Noah, takes him to a support group led by a veteran named Roy, who’s planning a trip to Washington D.C. to expose the VA’s inaction. But Roy starts coughing up blood, so Owen takes him to Grey Sloan instead.

Owen and Winston (Anthony Hill) diagnose Roy with lung cancer, in addition to Roy’s pulmonary fibrosis. The surgeons know that Roy can’t get a portion of his lung removed, so they suggest a segmentectomy to remove just the cancerous mass. Before he goes under the knife, though, Roy admits that he himself authorized burn pits while on a tour of duty, wanting to deal with the trash building up at his base.“I know that I committed the worst crime: complicity,” he tells Owen. “So, at the end of the day, I might deserve to die. Everyone else deserves to live.”

Unfortunately, Roy doesn’t make it through the surgery, and his death makes a distraught Noah rescind his offer to help Owen with his study.“You convinced me to introduce you to my family, my friends,” he tells Owen. “Look what happened. You made it so much worse.”

Jo (Camilla Luddington), meanwhile, is working with a pregnant patient named Niki, who’s in early labor. Niki’s hook-up, Dustin, drops her off at the hospital but then bails, saying he didn’t realize she was pregnant and he’s in no position to be a dad. Niki panics about becoming a single parent, but Jo, speaking from experience, tells her she’ll be all right—and that she’ll love her baby with her whole heart as soon as she meets the little one. “That is worth so much more than your fear,” she adds.

With Carina’s help, Jo delivers the baby successfully, deftly working through an incident of dystocia that traps the baby’s shoulder behind Niki’s pelvic bone. And Niki cries tears of joy when she gets to hold her baby for the first time.

The other patient-of-the-week is a teen that Megan tells Hayes (Richard Flood) about: a 14-year-old boy who’s getting winded at soccer practice and is suffering from swollen ankles. That patient turns out to be Megan’s son, Farouk. Hayes notices nonspecific ST-T wave changes and a heart murmur, and he diagnoses Farouk with constrictive pericarditis, an inflammation of the pericardium. That’s where we leave Farouk’s case, so we’ll probably see more of Megan and her son as this season progresses.

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And as tonight’s episode concludes, Meredith (Ellen Pompeo) flies to Minnesota to continue her Parkinson’s work. And when she arrives, Mer crosses paths with Nick (Scott Speedman), who’s on his way home from a donor organ pick-up. Meredith suggests they meet for dinner. (Let the romancing begin!)

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Addison Montgomery's All-Star Moments on 'Grey's Anatomy' & 'Private Practice'See Also

Addison Montgomery's All-Star Moments on 'Grey's Anatomy' & 'Private Practice'

Sizing up the pivotal moments for the doc, played by Kate Walsh, ahead of her return to Seattle.

ABC’s promo at the end of the episode teases another Station 19 crossover event, where some sort of earthquake or explosion rocks both the firehouse and the hospital, and the promo warns—ominously—that not everyone survives. That two-hour event kicks off at 8/7c on Thursday, November 11—see you there!

Grey’s Anatomy, Thursdays, 9/8c, ABC