Maggie’s mom’s condition worsens in an episode directed by Ellen Pompeo.
The voice-over of the episode reminisces about when Meredith’s mom, Ellis, died. Meredith found a note that said “Important: tell Meredith not to” but the note was never finished, and Meredith never got to hear the rest of her mother’s advice. Meanwhile, we see Diane Pierce going through chemo and having more scans done. Maggie is upset with Jackson for missing cancer cells during her mom’s mastectomy. Even though the margins were clear, a new spot popped up in her most recent scan. Maggie wants her mom to have surgery as soon as possible, even if it’s not seen as safe. Diane takes her daughter’s advice over her doctors’ and they do the surgery.
Riggs tells Meredith that they should have waited another week, but ultimately it was Maggie’s (… I mean, Diane’s) decision. Meredith apologizes that they haven’t went out yet, but a lot has been happening.
In the middle of the night, at home, Meredith is startled when she comes downstairs and Diane is on the couch. Diane hasn’t been able to sleep, and the couch is the only place her body finds comfort. Meredith says that she doesn’t sleep because she has three kids. At the mention of three kids, Diane says that she always wanted more kids so that Maggie could have siblings. She was worried when Maggie had moved from Boston to Seattle, but she’s glad that Maggie found her sister.
The night before, Diane mentioned that her stomach was bothering her, so they run more scans. Cells from her original tumor have traveled and grown in another place — the liver, which is a fairly common occurrence when someone has surgery to remove a tumor. If any cells are dropped or left behind, they can end up going to the liver in your body’s attempt at filtering out the bad, but it ends up stuck there and growing. Meredith tells the Pierces to take the night before making a decision, but Maggie wants to settle it now and asks if they can remove it laparoscopically, or if Meredith has a different surgical plan. Meredith explains to Diane that typically surgery at this point isn’t curative, but Maggie interrupts, saying that it could prevent further pain and complications. Maggie wants Meredith to think beyond the norm. Diane asks Meredith if the surgery is possible. When she says that she can do it, but that she won’t because she thinks it’s a terrible decision, Maggie tells her to leave so she can find a surgeon who will do it. Since it’s Diane’s decision to make, Maggie looks to her mother for solidarity, and Diane fires Meredith.
Maggie finds a clinical trial – the BXP protocol. So far, it has had favorable outcomes, and Diane meets the criteria once they remove the met. Jackson reminds Maggie that Meredith doesn’t think that that surgery is wise, and Maggie informs him that Meredith is no longer on the case. Everyone is unsure, and Webber says that he, Bailey and Jackson should read up on the trial before the surgery. Once Maggie leaves, they all vocalize that they don’t think this is a good idea. Webber gets up from the table and says that he prefers to work alone, and Bailey says she does, too. The two are still not on good terms.
Bailey rules out the possibility of a biliary bypass, due to the size and location. Meredith walks in and asks Bailey if she’s really going to resect the met, but Bailey speculates that no one would do that operation. She’s trying to figure out how to lower Diane’s LFTs so that she can get into the clinical trial. She suggests maybe a stent, but Jackson rejects it because it’s still a surgery and Diane is in too bad of a condition for surgery right now. Meredith suggests doing it under minimal sedation, and the doctors agree.
After the procedure, Maggie finds Bailey, Webber, and Jackson and asks how her mother’s LFT levels are. They tell her that they completely relieved the obstruction, and her LFTs are trending down. Maggie is excited and relieved to hear that Diane now qualifies for the trial, and she rushes off to call her contacts at Gillman. Once she’s gone, the doctors bicker about who should give their actual opinion to Diane and Maggie. Jackson is Maggie’s friend, but he had just hid her mother’s cancer from her. Webber is Maggie’s biological father, but Webber tries to pass it to Bailey because she’s Diane’s surgeon. She tries to pass is back to Jackson, but after some back and forth bickering, Webber agrees to do it.
Webber finds Diane alone and brings up the trial. He tells her that it is very aggressive. They need an aggressive treatment, but it will take an extreme toll on her body. She reminds him that Maggie thinks this is a good idea, but Webber can recognize that this is exactly the reason that doctors aren’t allowed to treat members of their own family.
As Diane prepares to start her clinical trial, she is handed a mountain of paperwork to sign, listing all possible side effects. Bailey is telling her some of them, and we watch a Montage of Diane going through treatment and experiencing so many of the side effects: nausea, night sweats, skin irritation, wound infection. She warns that it will get bad, and then it will get really bad, but then, hopefully, it will work. As Diane is getting worse, Meredith remarks that the treatment is killing Diane more quickly than the cancer. Webber tries to say that this was what Diane wanted, but Maggie essentially made the decision for her mother.
One morning, Diane wakes up early feeling energized. She watched the news, did laundry, reorganized the pantry. When Maggie comes downstairs, she sees her mother in the kitchen, ready to teach Maggie how to cook her lasagna. Maggie doesn’t want her mother to be passing things down because she can’t accept that her mother may die. Diane reassures her that she just wants Maggie to cook so that she can be lazy for once. Once the lasagna is done, her friends come over for dinner. Sitting around the table, Diane speaks highly of her daughter and how Maggie had learned to read at the age of two. She thanks Webber and the deceased Ellis Grey for giving her daughter such amazing genes. Wanting to pay her respects to Ellis, Diane asks where she is buried. Meredith and Webber exchange a look before confessing that they dumped her ashes down a scrub sink in her favorite OR. After a few moments, the table erupts in laughter. Diane’s laughing fit turns into coughs expelling blood, due to an esophageal tear.
An ambulance takes Diane and Maggie to the hospital and the other doctors meet them there. Webber hopes that it’s contained and that he won’t have to open her chest. Bailey starts scrubbing in, taking Webber’s place so that he can be with Maggie. Webber refuses her help, still bitter from the Minnick betrayal. Once Diane is stable, Webber updates Maggie. Maggie throws out suggestions until Webber tells her what he has planned. More than anything, Maggie wants them to figure out a way to get her mother back on her feet so she doesn’t lose her place in the trial.
Meredith confronts Maggie that this protocol is doing more harm than good, but Maggie doesn’t want to hear it. She is doing everything she can think of to keep her mother alive. She believes her mother will be fine once Diane completes it, but Meredith doesn’t believe she’ll live long enough to see the end. Riggs sees the encounter and asks Meredith what he can do for her, but Meredith walks right by.
Webber makes sure that Diane knows that she can stop the trial at any time. She tells a story about her life as a child with five siblings, and how there was never enough of anything. When the social worker gave her Baby Maggie, it felt like the universe giving her a gift. Maggie is a happy, cheerful person, and Diane feels guilty that her death will bring darkness into her daughter’s life. Diane has went along with everything Maggie has said because she wants her daughter to know that she did everything she could. Webber tells Diane that Maggie is as strong as iron, like Momma Diane. Diane admits the one thing that is hardest to hear from a dying loved one — “I don’t want to die.”
Maggie tries to make more calls to her various medical contacts, but her mother stops her. She won’t accept Diane giving up, but Diane asks her daughter to sit and talk with her. Next, we see Maggie crying in the hallway, pressing herself into the wall. Webber walks up, wanting to comfort her, and Maggie says that she wishes her dad were here.
Riggs sees Maggie looking at her mother’s scans, and Maggie opens up about how Diane knew about her cancer for months before she told her. Maggie makes a simile that it feels like she left the oven on, and came home to find the entire house engulfed in flames, and no one will let her inside to save anything. She thinks she could have stopped it if she knew earlier. Later, Meredith finds Maggie in the same place, but by this point, Maggie is sitting hopelessly on a couch. Meredith tells her that she will never be ready to lose her mom, but that it will happen anyway. She advises Maggie to spend this time listening to her mom and recording her voice in her brain.
We see a composed Maggie (whether more time has passed is not clear) prepping her mom for a manicure while Diane gives some advice. She tells her daughter to not always be so perfect. She should be a little lazy and a little slutty. She should make a mistake. She should yell at a cars salesman. “You’re never going to look back and say ‘I wish I had been more uptight.'” Diane starts coughing and Maggie gives her a glass of water. Diane continues her advice to say that Maggie should fall in love with a man who is worthy of her, and that he loves her just a little more than she loves him. She views it as important that he feel lucky to have Maggie, and not the other way around. They are burning through topics and Maggie wants her mother to slow down on the advice-giving. Maybe save some for tomorrow. The scent of the nail polish starts becoming bothersome, so Maggie opens a window. When she walks back to the bed, her mother is dead. Between sobs, Maggie picks up the bottle of nail polish and finishes the rest of Diane’s nails.
A helicopter lands on the roof of Grey-Sloan, and Mr. Pierce appears. Webber is there to greet the man who raised his daughter. Whether Mr. Pierce knows that the man in the elevator with him is his daughter’s biological father or not is unclear, but there are more important things to think about right now — such as the song choice. In recent history, the music department has decided that any song can fit into any situation, as long as it’s a mellowed down cover. Call me old-fashioned but I just don’t think a cover of Tegan and Sara’s Closer is the best choice to play while characters grieve someone’s death. It’s a good song and it sounds beautiful, but it was a little too distracting from the moment for me. Maggie’s fathers walk into the room, and Maggie rushes to the one that raised her.
Meredith finds Riggs before he leaves the hospital. He asks how Maggie is holding up, and Meredith tells him that Maggie is going to need her sister now. The two of them observe that their timing has never been right.
Bailey passes by the gallery of an OR and notices Webber sitting by himself. Realizing that Diane has died and Webber may need a friend, she walks up, sits beside him, and hands him a pack of tissues. He starts talking about how Ellis never forgave him. Over all of the years, and until she died, she never forgave him. He suggests that he and Bailey not be that way.
At home, Maggie sits alone at the kitchen table, in front of the lasagna she had made. Her sisters, Meredith and Amelia, walk in, sit down, pick up forks, and the three of them silently eat out of the pan. The episode ends with Meredith’s voice-over saying that Ellis’s unfinished note forced Meredith to finish the note herself, and decide what it is that she should and should not do.