Grey’s Anatomy’s Fiery Finale: Secrets, Sacrifices & a Shocking Burn It Down Twist

As dawn breaks in Seattle, WA, Simone Griffith is watching the local news report on the nearby wildfire. While listening to the anchor talk about the state’s largest fire in recent history, which began on Station 19’s Season 7, Episode 9, “How Am I Supposed to Live Without You,” Simone begins looking up the Heart Center of Chicago, where Maggie Pierce works. In Season 20, Episode 9, “I Carry Your Heart,” Pierce offered Lucas Adams a spot as a second-year resident at the Heart Center, and Simone is worried he’ll be moving — especially since Teddy Altman and Miranda Bailey told Adams in “I Carry Your Heart” that he might have to repeat his intern year. Simone doesn’t want him to go.

At Winston Ndugu’s apartment, he is waking up slowly as Monica Beltran, who came home from Joe’s with Winston the night before, gets dressed. He asks her where the fire is, and she tells him that it’s in Fall City and spreading fast. He meant it as a figure of speech, but she tells him that they’ve been paged. When he says that their previous night was fun, she agrees and then invites him to meet her parents. She’s joking, but it was worth it for the look on Winston’s face.

Altman and Owen Hunt have also been paged, though Teddy isn’t sure she should go in. She was fired in “I Carry Your Heart,” but isn’t sure if it was just as Chief or if she can’t even perform surgery. Owen tells her that Seattle Presbyterian is evacuating and pulls the covers off of her. He’s going to need all the help he can get.

When the interns arrive at the hospital, they find Adams racing to get changed after a video interview with the Heart Center of Chicago. Griffith asks how it was, and he tells them that he was offered the job. Benson Kwan bet $20 at the beginning of their intern year that Adams would be gone by the end of the year, and he wants his money, but Adams is still thinking about it. As they come into the lobby, they find Dorian, who has been their patient since Season 20, Episode 2, “Keep the Family Close,” waiting in his wheelchair. His room was needed for patients from the fire and besides, he’s being discharged. The interns congratulate him, but their joy is short-lived. Bailey comes walking down the stairs, telling them they should have already been dressed and ready to go — they’re working at a hospital during a wildfire, after all. As the interns race off, Bailey checks her phone, hoping to have heard from Ben, who is out fighting the wildfire. She hasn’t heard a thing since the previous day, and she’s definitely worried.

On the OR floor, Jo Wilson asks for Levi Schmitt to join her on OB. He’s supposed to be working on Ortho with Atticus “Link” Lincoln, and he hates birth, but when Wilson tells him that there are NICU transfers coming in from Seattle Presbyterian and Beltran needs extra help, Schmitt is happy to join her. Link is left to reschedule the days’ surgeries on his own.

Amelia Shepherd and Meredith Grey have flown in from Boston, and they meet up with Teddy at the elevator. Meredith is apologetic about Teddy losing her job, but Teddy is concerned about the research Meredith and Amelia had been conducting being in jeopardy. As they head for the lab, Teddy discovers that her access card has already been disconnected, but Meredith’s hasn’t, which leads Meredith to believe that they might still have leverage. If they present their research, Catherine Fox can’t deny their results with a power move. Right?

Down in the pit, Taryn Helm is updating Bailey on some of the interns who couldn’t make it in because they were evacuating their apartments as they join the other doctors for an update from Hunt. Just before Hunt speaks, Griffith whispers to Bailey that Adams might be leaving, and while Bailey first responds that Catherine hasn’t made a decision yet, she is surprised to learn that Griffith is actually talking about his offer from the Heart Center. Unfortunately, Bailey points out, it’s not up to her or Griffith to make that decision for him.

As Bailey checks her phone again, hoping to have heard from Ben, Hunt announces to the room that Grey-Sloan is the only level one trauma center operating in the Seattle area, and things could go on for days. He tells them to be sure to ask for help if they need it and then sends everyone to get to work before turning to Link. A helicopter is arriving with a firefighter on it. Bailey overhears and asks for more information. Hunt tells her that it’s Theo Ruiz, who was injured by a falling tree branch in Station 19’s “How Am I Supposed to Live Without You,” and her husband is with him, so Bailey joins them on the elevator. On the roof, Ben Warren talks the doctors through Theo’s injuries, including having to intubate him on the helicopter ride over. Bailey asks him how it is out there, and Warren tells her the truth — they’ll be very lucky if Theo’s injuries are the worst thing they see.

On the cardiac floor, Ndugu is discharging a patient who isn’t emergent and has Richard Webber, Jules Millin, and Mika Yasuda with him. When Ndugu is paged out of the room, Webber, Millin, and Yasuda continue to talk to Garrett, who owns the record store Both Sides Now. He’s more worried about the air quality affecting his records than anything else, but as he’s finishing packing, it becomes clear that Garrett is in pain. Since he was dealing with an abdominal aortic aneurysm, Webber wants to check him back in and get scans just in case.

In peds, Schmitt asks where Beltran is, and instead of answering his question, Wilson tells him to ask fewer questions of Beltran. He’s trying to get the peds fellowship and wants to show her that he’s interested, but it’s clear he’s driving Beltran a little nuts. Later, when he’s sharing yet another article he read with her and asking her questions about procedures she has performed, Beltran finally breaks. She tells him that she’ll recommend him for the peds fellowship if only to get him to leave her alone.

Back in the pit, Adams is cornered by a woman looking for her son and her husband. She can’t get any information from the desk, which is too busy to help, and then she points out a huge line of people who are also waiting for information. It gives Adams an idea. He puts together a database where people can share information about loved ones they are looking for to see if they are safe and sends it out to other doctors in the hospital.

When Kwan hands off an asthmatic patient that he seems uncomfortable helping, Adams makes him promise to share the link. The patient, Molly, is asthmatic and has a small sprain. Adams also learns that she was in a car accident several years prior that took some of her memory, so she has to look up when she was diagnosed with asthma on her phone.

Teddy finds Hunt in a trauma room with Warren, Link, and Bailey and tells him that her keycard was deactivated, so she was definitely fired, which is news to the other doctors. When Warren and Bailey can’t stop interjecting about Theo’s care, Hunt kicks them out of the room, telling them they can’t work on family. When someone comes looking for Hunt to talk to him about Grey-Sloan’s pre-evacuation plan, Altman takes over with Theo. “He needs surgery, and you’re short surgeons. Catherine can’t blame me for saving a firefighter.”

Millin and Yasuda discover that Garrett’s abdominal aortic aneurysm has ruptured, and Webber tells them they need to do an open procedure instead of an endovascular one. Both of the interns have studied for the endocascular procedure, but Webber is flying solo because Ndugu got called to a different emergency surgery. They seem skeptical about working with Webber solo at first, but when he offers for one of them to be able to do more than just retract in the OR, they’re all in.

Amelia and Meredith are finally meeting with Catherine to share the results of their study — that there is a clear correlation between Alzheimer’s disease and gut microbiomes, which they discovered in “I Carry Your Heart.” Catherine might find the research interesting, but she’s livid. She told Meredith to stop conducting that research with the Fox Foundation’s money in Season 20, Episode 1, “We’ve Only Just Begun,” and funding from Teddy’s budget is still Fox Foundation money. Eventually, Meredith helps her understand how important their research is, and she agrees that the Fox Foundation should continue to fund the research. Then, she tells them to hand all of their research over to Tom Koracick. Once they do, not only will Catherine allow them to keep their jobs, but she’ll reinstate Altman. Now, they have a decision to make.

From outside the trauma room, Warren and Bailey watch Altman, Link, and Griffith work on Theo. Warren tells her he needs her to be in the OR. “I need to know it’s your hands trying to fix him.” Just as Link and Altman get ready to take Theo up to CT, Bailey tells them she’ll be joining them. They need all the best hands they can get.

In Webber’s OR, Millin and Yasuda are helping him repair Garrett’s aneurysm. When Webber finishes sewing the posterior wall, he offers them a tie-breaker question to see who is going to stitch the anterior wall. Instead, Millin asks if they can both do it, and Webber agrees that they’ll split it. He watches carefully, talking them through the steps as they go.

Hunt, who is trying to get someone on the phone to understand that Grey-Sloan is at capacity and needs more IV pain meds, runs into Altman and Link as they approach the elevator. When the doors open, there’s Catherine, who immediately tells Teddy that she doesn’t work at the hospital until Meredith turns in her research. Hunt immediately defends Teddy, telling Catherine, “If you need to go on some power trip, I can’t stop you, but I have too many patients and not enough doctors. So if this man dies because your ego won’t let one of our best doctors do her job, then his blood will be on your hands.” Catherine walks away, letting Teddy go up to the OR, but she’s even more furious than before.

Adams, who is wrapping Molly’s ankle, talks to her about her memory loss. She tells him that she tried to get her old life back, but she kept failing at it, and her depression got worse and worse. Eventually, she decided to just start over, and now she feels like it was supposed to happen this way. Could that be what Adams is hoping will happen if he moves to Chicago?

On his way out of the hospital, Ben finds Bailey to tell her that he has been called back out by dispatch. She’s scared and tells him to be careful. As the elevator doors close, he tells her, “I love you, Miranda Bailey. Always have, always will.”

In the ambulance bay, Shepherd finds Hunt as he is tagging and triaging patients. At first, she asks him a vague question and is then thrilled when he admits he knows about the secret research. Shepherd needs a job, and she knows Teddy needs one, too, but she doesn’t know what to do. She asks Hunt what he would do, and he starts to laugh. “I don’t remember one time you took my advice when we were married.” Shepherd doesn’t care about that, she’s asking now. He tells her that somewhere deep down, she already knows the answer, which she appreciates, but she still wants to know what he would do. “I just wouldn’t give it to Koracick, but that’s just ’cause I hate that guy.”

The ORs are backed up, leaving Altman, Link, and Griffith out in the hallway, waiting. The electricity flickers, which is never a good sign, and then Theo’s machines start beeping. He needs a thoracotomy, but the OR still isn’t available, so Altman does the only thing she can do and begins performing the surgery in the hallway. Altman has Link and Griffith physically pull Theo’s chest open because they don’t yet have a rib spreader, and she needs to release the pressure from around his heart. Altman’s trauma experience from the military is coming in real handy while they continue to wait for an OR.

At the same time, Garrett’s hypertensive and his pressure is dropping. Millie and Yasuda paged Ndugu for help, and he tells them that Garrett’s anastomosis might be leaking. Yasuda blurts out that Webber said they did a good job, and Ndugu is surprised to learn that they performed the procedure. He tells them to page Webber but doesn’t want them anywhere near his patient.

In the makeshift NICU, with the overflow patients from Seattle Presbyterian, Wilson and Schmitt are together when the electricity flickers, which is incredibly worrisome for babies on machines. Mere seconds later, as Schmitt heads for the nurses station, Wilson collapses.

Webber, who was in another surgery, finally joins Ndugu in the scrub room, only to learn that Garrett didn’t make it. He tells him that doing the anastomosis was a lot of responsibility for interns. Webber says they were ready to step up, but Ndugu doesn’t think they were. The posterior wall was a mess, and Ndugu wants them to get a lot more practice before he lets them work on his patients again. The only problem? Millin and Yasuda didn’t suture the posterior wall. Webber did.

Finally in the OR, Altman, Link, Bailey, and Griffith are dealing with a lot of bleeding from Theo. Helm comes in to ask about Theo’s status for his boss. Altman says to wait to tell him anything because they don’t have good news yet and then asks her to scrub in. Bailey keeps asking Griffith to check on her phone and cannot focus on the surgery. She asks Helm to step in for her and leaves the OR.

Schmitt, who is taking care of Wilson after her collapse, is annoyed that she didn’t tell him she was pregnant. The look on her face says everything — she didn’t know. Later, when Wilson runs into Link, and he asks how she’s doing, she doesn’t tell him about the pregnancy either.

Webber finds Meredith in an OR gallery, and they talk about her mother, Ellis, and what her last surgery might have been. They talk about her Alzheimer’s, and then Webber tells Meredith that his time as a surgeon might be up, but he’s afraid he won’t know who he is without surgery. Meredith gets that, and he tells her that he talked to Catherine, and it sounds like she has a decision to make. She tells him she doesn’t have a choice, and he reminds her that she might not like her options, but she does have a choice.

Griffith has left the OR and is obviously looking for someone. She finds Bailey staring out the window in a stairwell and tells her that Theo is stabilized, and she wants to know what she can do for Bailey. “Can you make it rain?” Bailey quips. They talk about Ben and then Griffith pulls up the database Adams made. Dorian’s mother used to work for the city and sent it out to her contacts so that people could get updates about first responders. There’s Ben, updated as safe by the Seattle Fire Department just two minutes prior.

Meredith has made her choice. She tells Catherine that her files are online but not so Koracick can access them. Meredith has posted her research on the NIH website and resigned. She’s not interested in playing politics when her research could help patients. “You are just like your mother,” Catherine tells her. “Great,” Meredith responds, grinning. “That means I’ll win.”

Schmitt and Helm are working on the upcoming schedule, including when Helm will be out for a trip to Paris and when the ABSITE scores come in. Helm is in the 55th percentile, and Schmitt is in the 62nd. Helm tells him that anything above 50 is gold, but he says it isn’t good enough for a Peds fellowship. He tells Helm that he needs to rethink his entire life, and she asks him if he wants to rethink it with her. In Paris.

Ndugu finds Beltran, and they make plans to go to his place that evening. Just as they do, Webber rounds the corner, looking for Ndugu. He wants to talk to him about what really happened during Garrett’s anastomosis, making sure to start with the fact that Millin and Yasuda were not at fault.

In the pit, Molly is struggling to breathe, but Adams isn’t around. Kwan jumps in to help, giving her albuterol. While he’s administering the breathing treatment, Molly seems to recognize him, asking if they’ve met. He tells her no, but it’s clear they have. Adams returns and asks Kwan to monitor her for him so he can say goodbye to Dorian, but Kwan doesn’t think that’s a good idea. Adams pushes him about knowing her and, finally, Kwan admits that she used to be his fiancé.

Yasuda finds Millin in the basement and starts to apologize for telling Ndugu that they helped with the anastomosis because she knows he is kind of Millin’s mentor, but Millin jumps in to tell her that Garrett died. Yasuda starts to have a panic attack because they sewed his aorta, and it takes Millin pressing on a pressure point for her to start to calm down. Their foreheads pressed together, the two of them nearly share a kiss but are interrupted by Kwan, followed closely by Griffith.

Griffith wants them to come with her, but before she can explain, their ABSITE scores come in. Yasuda and Kwan are both in the 73rd percentile, Millin is in the 78th, and Griffith is in the 75th. They should be feeling celebratory, but they’re not really, and Yasuda asks why it feels weird. “That’s why I was looking for you,” Griffith says.

Bailey and Adams say goodbye to Dorian, who will finally get the cheeseburger he’s been craving. He thanks them for everything and Bailey thanks him for creating the database, tell him that he helped a lot of people. “That was all Adams,” he says. “I just helped get it out there.”

As Dorian leaves, Bailey tells Adams that his ABSITE score came in, and it was the highest score in his intern class. Adams smiles, thrilled, but then remembers—he still has his meeting with Catherine to go to.

Altman finds Hunt as she’s coming off the elevator and tells him that Ruiz is stable and Link was able to fix his leg. She also thanks him for standing up for her since that might have been her last surgery. Hunt reminds her that she saved a firefighter, and she wonders if it will be enough to change Catherine’s mind. She gets her answer pretty quickly when Shepherd comes out of the lab with a box, revealing that she and Meredith published, and she no longer has her job. Hunt tries to lead them through a locked doorway as they talk, but his keycard doesn’t work. It appears he may no longer have a job, either.

On her way out of Grey-Sloan, Meredith walks through the ambulance bay. She watches the other doctors for a moment and then turns to go and finds Nick Marsh waiting for her. He asks if she saved her research or burned everything down, and she hints that she maybe did both. He tells her that her standing up for what she believes in is one of her best qualities, even if her putting everything on the line when she wants something can make it hard to know where he stands in her life. She reminds him that she wants a life with him, and he tells her that what she actually did was describe a life and ask if he was in, but he’s been in for a while. He doesn’t want to follow her around the country anymore, he wants to do life with her, side by side, until one or both of them forgets the other. They share a kiss and leave together, and as they walk away, Meredith mentions moving again. Not too far this time, though — she’s put in an offer on the house he found in Chestnut Hill, just outside of Boston. Just taking him to tour it didn’t feel like a big enough gesture.

In the final moments of the episode, and of Season 20, Catherine meets with Adams. She asks him what he was thinking when he attempted the thoracotomy in Sam Sutton. He tells her he thought the patient would die, and she tells him that he got that right. Catherine gets up and looks out the window as she begins to talk to him about the GME recommendation that he repeat his intern year, and when she turns around, the entire intern class has entered to defend Adams.

Griffith urges Catherine to reject the GME council’s recommendation. When asked why, Millin steps in and says that Adams completed Bailey’s procedure logs just like the rest of them. Kwan says that they’re all human, and they all make mistakes and that what is most important is not to repeat them. “We all push each other to be better,” Yasuda says. “It wouldn’t be the same without him.” Griffith tells her that while intern year is challenging, they’re working through it together. They don’t want to leave anyone behind or lose anyone.

Simone says, “If Adams goes…” and Catherine interrupts. “What? You all go? Is that really a threat you want to make right now? I can have all of you replaced by tomorrow.”

The door opens, and from behind the group of interns comes a voice. “What about me?” Miranda Bailey breaks through the group and stands next to Adams. “Can you replace me?”

Burn It Down was the final episode of Grey’s Anatomy’s historic 20th season. The show will be back for Season 21 in the fall. Until then, it can be streamed on Hulu and Netflix.