Chapter Summaries

Adam welcomed Dr. Dixon to the Medical Center and toured her around while the hospital tried to persuade her to join its Cardiothoracic Surgery department. Dr. Dixon prepared to lead a heterotopic heart transplant, and the chapter left the team getting ready for the operation.

• Richard Webber asked Adam to help convince Dr. Dixon to stay at the Medical Center, and Adam agreed to meet her.
• Dr. Dixon arrived carrying her work clothes and told Adam she was there to perform a heart transplant.
• Adam showed Dr. Dixon around the hospital and introduced her to the Cardiothoracic Surgery department.
• Adam had Melendez retrieve the patient's chart and prepare for surgery.
• Melendez briefed Dr. Dixon on the case, and she corrected him by explaining that the procedure was a heterotopic heart transplant.

Adam and Dr. Dixon operated on Mr. Bidony, who wanted his transplanted heart removed for religious reasons, but discovered his original heart had recovered and was beating normally. After the surgery, Dr. Dixon debated faith with Mr. Bidony and told the Chief of Surgery she liked working at the hospital.

• Mr. Bidony told Adam and Dr. Dixon he wanted the transplanted heart removed and returned so he could hold a memorial for it.
• Adam explained to Shorty that Dr. Dixon's social difficulties did not mean she lacked compassion, and that they should respect her abilities and approach.
• Dr. Dixon led the operation with Adam and Shorty assisting, and Adam discovered that Mr. Bidony's original heart had recovered and was beating.
• Dr. Dixon asked Adam whether his friend also had Asperger's Syndrome, and Adam described his friend's many conditions and genius.
• After waking, Mr. Bidony debated faith and science with Dr. Dixon, and neither tried to force the other to agree.
• Dr. Dixon told the Chief of Surgery that she liked working at the hospital.

On Christmas Eve, Adam treated Mr. Kramer after he got a foreign object stuck while trying a method from a magazine to rekindle his relationship with his wife. Adam removed it and warned him against risky attempts at excitement, leaving the Kramers to decide how to approach their relationship.

• Adam urged George to go home to Mrs. O'Malley, but George said the family was already together and one more person would not help.
• Lexie and Shorty offered help to a middle-aged couple, but the husband refused and asked to wait for a more mature doctor.
• Rachel revealed that she and her husband had followed a magazine's advice and gotten an object stuck inside him.
• Adam ordered an abdominal X-ray, then had Carter and George bring Mr. Kramer for imaging.
• Adam guided Carter through a sigmoidoscopy and removed the object while Mr. Kramer lay on the operating table.
• Adam warned Mr. Kramer that risky attempts to rekindle his relationship could backfire.

Adam treated a man shot repeatedly by his young daughter, Mandy, and saved him despite the violence he had inflicted on Mandy and her mother. The chapter ended with Mandy and her mother leaving him for good after saying goodbye.

• Adam treated Mike Colson, who had been shot twenty-five times, while Mandy and her injured mother arrived at the hospital.
• Dr. Montgomery learned that Mandy had shot her abusive father to protect her mother and that her mother had tried to conceal the abuse.
• Adam operated on Mike and saved him, while the social worker encouraged Mandy and her mother to leave.
• Mandy and her mother visited Mike after he regained consciousness, said goodbye, and left, intending never to see him again.

On Christmas Day, Adam met Leonard and agreed to visit the Hofstadters with Paige, while planning a special gift for Dr. Dixon. The chapter ended with Adam at the Medical Center, reflecting on Dr. Dixon’s distress and how Leonard’s gift might create an alternative first meeting between Leonard and Sheldon.

• Adam met Leonard at Princeton, where Leonard invited him and Paige to the Hofstadter family’s Christmas paper discussion.
• Adam agreed to visit the Hofstadters and arranged for Leonard to help him prepare a favor.
• Adam told Paige about the visit, arranged for Lisa to handle Christmas gifts, and went to the Medical Center.
• Adam and Cristina discussed Dr. Bailey’s treatment of Dr. Dixon during the previous day’s surgery and the distress it caused.
• Adam recalled how pressure had helped calm Dr. Dixon and looked forward to her reaction to the special Christmas gift from Leonard.

Adam gave Dr. Dixon a Hug Machine designed by Leonard Hofstadter, which she loved, then went with Paige to the Hofstadter family’s Christmas gathering. The chapter ended as Leonard welcomed them while a young man on the staircase glared at Adam with hostility.

• Adam brought Dr. Dixon a Hug Machine and explained how Leonard had designed it as a child.
• Dr. Dixon tried the machine’s hug, back-patting, and singing functions, then thanked Adam and praised Leonard’s ingenuity.
• Adam finished his work at the Medical Center and went home before heading to the Hofstadter family’s Christmas night with Paige.
• Leonard opened the door to Adam and Paige, while Alfred watched from behind him and a young man on the staircase eyed Adam with hostility.

Adam brought Paige to Leonard's house on Christmas Eve, where she met Leonard's family and Adam announced their breakthrough viral treatment for Malignant Glioma. The family eagerly gathered to review the paper Adam and Paige had brought, leaving Leonard to fetch his own papers as well.

• Adam introduced Paige to Leonard's family, and she refused Michael's offered handshake by addressing him as Mr. Hofstadter.
• Adam and Paige greeted Leonard's cat as Dr. Puss in Boots Hofstadter, further upsetting Michael.
• Lecher asked whether Adam and Paige were romantically involved and proposed working with Adam to produce the next generation, embarrassing Leonard.
• Beverly congratulated Adam on the Duncan-Adler procedure and learned that he and Paige had submitted their paper to The Lancet.
• Paige explained that Adam had brought the paper for the Hofstadters to review, and Beverly, Lecher, Alfred, Michael, and Leonard went to fetch their papers.

On Christmas Eve, the Hofstadter family held Paper Night and examined Adam and Paige’s research. Adam’s hand-drawn cover illustration impressed everyone, while Paige’s calculations left Lecher struggling to understand the paper.

• The Hofstadter family, Adam, and Paige gathered with their latest papers for Paper Night.
• Lecher, Michael, and Leonard admired Adam’s detailed illustration of Adam and Paige for their paper’s proposed Lancet cover.
• Lecher questioned Paige’s calculations, and Paige said they were too simple to need explaining.
• Adam explained the calculations to Lecher, who realized that her doubts had come from approaching them incorrectly.

Adam discussed his thesis with Beverly, Lecher, and Paige at Leonard's home, while the Hofstadter family tried to make their Christmas thesis night feel less awkward. The evening ended with Adam and Paige leaving after a lively debate about how to make the proposed viral treatment practical.

• Adam invited Beverly and Lecher to analyze his thesis, and their feedback gave him new ideas that he checked with Paige.
• After half an hour of being left out, Alfred suggested that he, Leonard, and Michael exchange theses, but Alfred soon focused on Michael's work.
• The gathering split into three groups, leaving Leonard alone until he drifted between them and praised his father and brother's theses.
• Lecher questioned whether Adam's complex treatment calculations could be used widely, and Adam explained how computers and a growing case database could simplify them.
• Paige and Lecher traded barbs over who would ultimately develop a perfect tumor-targeting viral serum, and Adam ended the discussion by leaving with Paige.

Adam annotated Michael’s law paper, provoking Michael and making Leonard reconsider his place in his family. Adam later explained why Beverly approved of Michael studying law, then cheered Leonard up by promising him an early Lightsaber gift.

• Adam annotated Michael’s paper and criticized law as a field, while his comments on the paper impressed Michael and left him stunned.
• Leonard realized that Beverly’s preference for the natural sciences should place his physics studies above Michael’s law studies in her academic hierarchy.
• Leonard called Adam and explained that Aunt Diane’s career as a defense attorney had influenced Beverly’s favorable view of law.
• Adam reassured Leonard that he had a bright future and offered him a Lightsaber signed by Master Yoda.
• Leonard eagerly accepted the early Christmas gift, then fell silent when Adam asked whether he would choose a future girlfriend or the Lightsaber.

Adam made Christmas calls to his family and friends, but his greetings turned into awkward matchmaking conversations with Juno and Karen’s relatives. He later spoke with the Green Family, where he learned Jill was studying hard for her plan to surprise Warren at Harvard Law School.

• Adam called his family, heard his parents and siblings praise him, and hung up when Amy started asking about his romantic life.
• Adam called Juno and Karen, whose relatives took turns greeting him and urging him to stay close to their daughters, while Juno’s and Karen’s younger sisters chatted with him.
• Adam called Paige’s mother after playing with the bell on Paige’s ponytail, then continued making his holiday calls.
• Adam discovered that Leonard had invited Mike Ross to celebrate Christmas with the Green Family, apparently hoping Mike would become Jill’s future husband.
• Jill thanked Adam for arranging a tutor and described her plan to pass the law school entrance exam and surprise Warren at Harvard Law School.

On Christmas Eve, Adam teased Sheldon about Christmas and Georgie Jr. rejected Sheldon as his company’s new accountant because Sheldon’s past dispute with the Tax Bureau had brought his family years of scrutiny. The conversation ended with Adam joking that Sheldon’s accounting skills were sound but his nerves and loose tongue made him too risky to handle company finances.

• Adam called the Coopers’ home and exchanged Christmas greetings with Mrs. Cooper before speaking with Sheldon.
• Sheldon objected to Christmas and called the holiday Newton Day, prompting his mother to stop him from criticizing it.
• Georgie Jr. told Adam he had fired his accountant and planned to hire a replacement, while Sheldon defended his tax-filing abilities.
• Georgie Jr. recalled that Sheldon’s challenge to the Tax Bureau had led to an investigation and three years of special scrutiny for the Cooper family.
• Adam joked that he would trust Sheldon’s professional skills but worried about his bladder, and Georgie Jr. and Missy laughed.
• Adam reflected that Sheldon’s rigid approach and tendency to reveal secrets made him too dangerous to employ in any company’s finances.

Adam and Paige’s paper appeared in The Lancet as the Medical Center staff waited for the national teaching hospital rankings. The Medical Center placed fourth, and Dr. Richard Webber blamed its shortfall on the rest of the staff holding Dr. Duncan back.

• Adam and Paige’s paper was published in The Lancet, featuring Adam’s cover illustration.
• Cristina and the Medical Center doctors gathered at the nurses’ station to check the teaching hospital rankings.
• Cristina read that Hopkins, Mayo Clinic, and Cleveland Clinic took the first three places, leaving the Medical Center in fourth.
• Dr. Richard Webber called the review committee, which said the Medical Center would have ranked twelfth without Dr. Duncan’s achievements and influence.
• Dr. Webber stormed off, and Mark Sloan’s colleagues blamed him for jinxing the rankings before they left.

After the Medical Center ranked fourth among teaching hospitals, the Chief of Surgery blamed weak interns and residents for holding it back and began shadowing staff to enforce higher standards. He publicly reprimanded Sadie and Meredith, making clear that everyone, including himself, would have to work harder.

• Adam told Meredith to avoid the Chief of Surgery because the hospital's fourth-place ranking had left him furious.
• The next day, the Chief of Surgery shadowed hospital staff and reprimanded Sadie after she failed several times to start an IV.
• The Chief warned Sadie that the Medical Center would no longer tolerate people who muddled through their work.
• Cristina told Meredith that she and the other staff were holding Adam back, echoing his warning to take the Chief seriously.
• After Vincent Kra died despite treatment, the Chief angrily berated Meredith and said she could stay at the hospital only because he allowed it.
• Dr. Shepherd objected that not every patient could be saved, but the Chief insisted that everyone had to work as hard as Adam, and the staff understood that he was serious.

After Cristina nearly endangered a patient by suturing a renal artery like a heart, Dr. Dixon and the Chief of Surgery challenged her foundations. At the New Year meeting, the Chief announced broad training reforms to improve the Medical Center’s standing, leaving the staff facing a demanding year.

• During surgery, Cristina struggled to repair a renal artery tear, and Dr. Dixon told her that her weak general-surgery skills made her unfit to specialize in cardiothoracic surgery.
• Cristina recognized that her arrogance and lack of understanding of different tissues had nearly harmed the patient.
• At the New Year meeting, the Chief of Surgery declared that the Medical Center would aim for first place after finishing fourth in the national rankings.
• The Chief announced comprehensive surgical training, restrictions on specialized research for junior doctors, and training plans that could not favor personal relationships or preferences.
• Adam saw that the reforms echoed his own training methods, while George, Lexie, Shorty, and Carter reacted to the prospect of a tougher year.

During superstar rounds, Lexie proposed an obscure treatment for Barry Patmore’s seven-year headache, and a simple test confirmed her diagnosis. The Chief of Surgery praised her and assigned her to assist Mark Sloan, but Lexie sensed that Mark was attracted to her.

• Lexie questioned the plan to treat Barry Patmore’s chronic headache with a Bilateral Cingulotomy and suggested testing for Anterior Ethmoidal Nerve Syndrome.
• Dr. Shepherd approved Lexie’s proposed nasal test, and Barry agreed to try it.
• Mark Sloan inserted a tube into Barry’s nose, and Barry’s reaction confirmed that Lexie had identified the source of his pain.
• The Chief of Surgery praised Lexie and told her to assist Mark with the operation.
• Lexie noticed Mark looking at her with desire and felt disgusted, while Mark wondered whether he had gotten old or women’s tastes had changed.

Meredith dealt with Mr. Aubrey’s extraordinary bad luck as his aneurysm treatment was repeatedly disrupted, while Adam was called in to perform his surgery. Shorty used Mr. Aubrey’s reputation to have him reorder applicants for Adam’s clinical research project, leaving Meredith struck by how much Shorty resembled Adam.

• Cristina reported Jack O'Bry’s condition, and the Chief of Surgery reassigned his care to Meredith after Cristina’s work was complete.
• Meredith struggled to move Mr. O'Bry’s wheelchair, and he fell while trying to walk; the Chief of Surgery ordered Meredith to monitor him hourly.
• The CT scanner malfunctioned while Mr. O'Bry was inside, so the Chief of Surgery made him the hospital’s top priority and arranged for Dr. Duncan to operate.
• Meredith reassured Mr. O'Bry that Adam could help, while Adam accepted the Chief of Surgery’s request during an operation with Carter.
• Shorty brought Mr. O'Bry an application list and persuaded him to rank which applicants should receive treatment first, prompting Meredith to remark on Shorty’s resemblance to Adam.

Adam and Shorty operated on Mr. Aubrey as a disastrous leak flooded the hospital, forcing the evacuation of its operating rooms. After Adam saved the exposed patient from a ceiling collapse, the surgeons discovered a malignant pancreatic tumor, adding another crisis to Mr. Aubrey’s already unlucky day.

• Adam praised Shorty for using Mr. Aubrey to improve the odds of Adam’s clinical research and told Meredith to sit out the surgery.
• A roof leak worsened until a floor cracked and flooded, but the Chief of Surgery delayed shutting down the operating rooms.
• During Mr. Aubrey’s operation, Adam spotted water falling from the ceiling and shielded the patient with a table and chairs as concrete and water crashed down.
• Adam moved Mr. Aubrey to another operating room, and the Chief of Surgery shut down the other rooms and arranged transfers to other hospitals.
• Adam and Shorty found a malignant tumor on Mr. Aubrey’s pancreas while checking his chest cavity for debris.

Adam discovered Mr. Aubrey’s pancreatic cancer early during surgery and removed the tumor successfully. After Mr. Aubrey and the operating-room staff won Powerball first prizes but missed the jackpot by one red ball, Adam continued through the name lists Mr. Aubrey had sorted.

• Adam rushed a biopsy and learned that Mr. Aubrey had Stage One pancreatic cancer, then removed the tumor without complications.
• Adam told Shorty to have Mr. Aubrey reorder the list and suggested that he buy a Powerball ticket, prompting the operating-room staff to buy matching tickets.
• Mr. Aubrey chose a set of numbers and bought a ticket with a tenfold multiplier, while Shorty, the anesthesiologist, and the nurses bought the same numbers with twofold multipliers.
• The group watched the drawing and matched all five white balls, but the red ball was wrong, leaving each of them with a two-million-dollar first prize before taxes.
• Shorty thanked Adam, who checked off the last name on Mr. Aubrey’s first list and the first name on his second.

Adam and Paige joined the Medical Center surgeons’ expanding camping trip after Adam arranged a custom elf-archer outfit and real bow for Paige. At the mountain, the group gathered around Adam’s enormous supply bag as he revealed he planned to teach Paige archery.

• Adam accepted Dr. Shepherd’s invitation to a hiking and camping trip and asked Paige, who agreed to go.
• Adam sketched an elf-archer outfit for Paige and told Lisa to have ten sets made, along with a real bow.
• Adam and Paige arrived at Meredith’s apartment building and found the Chief of Surgery joining the trip, only for him to realize it was a couples’ outing.
• More Medical Center staff joined until the group became a large convoy driving out of New York.
• At the foot of the mountain, Adam brought out his supplies and told the others he had packed bows and arrows to teach Paige archery.