Grey’s Anatomy season 11, episode 4, “Only Mama Knows” shed some new light on the Ellis Grey of the past and the Richard of the present.

Cases:
•Roy: Spinal graph blocks spinal blood flow
•Nadia: 10 year old with a giant abdominal tumor

Round One: Ellis Grey, visionary, motivator to women in medicine, yet not the ideal mother figure. The word audacious is thrown around the episode like it was on clearance in the writer’s bin, but when you have a woman who names her discovery “The Grey Method,” what else would you call it?

Meredith and Derek are still going the rounds with no end in sight for their reconciliation. Derek is growing impatient with his wife, who claims she needed to stay in Seattle to shine. He wants results and he wants them sooner rather than later. Coming to terms with his own poor decision to abandon the DC job is not Meredith’s problem.

A Unanimous Decision: Karev is back on the pediatric floor of Grey-Sloan Memorial, taking over the duties as an attending, helping out Arizona as she works through her fellowship. A bit of unsettling news reaches Alex’s ears when he finds out that Bailey won the board unanimously.

Another nearly unanimous decision sweeping the board, Maggie Pierce cannot leave the hospital. Turning in her resignation, Pierce’s departure will cause a PR nightmare for the hospital that cannot hold onto chief cardiac surgeons. Leave it to Miranda “The Nazi” Bailey to keep the place from looking like a clown car. Richard is indifferent to her departure, but Amelia Shepherd tries out her own tactic.

Pierce cites “personal and professional reasons” for her resignation. Amelia decides that since she cannot betray the information she received in the confidence of AA, Derek might be able talk to Pierce.

Misdirection: Pierce is a brilliant cardiac surgeon and in an impressive split second decision, she is able to redirect blood flow from her paralyzed patient and offer him a life with his legs in tact.

Meanwhile, a 10 year old arrives at the hospitals bay doors appearing to be pregnant and possibly in labor. An ultrasound confirms that she is not, but a massive tumor still serves as damning evidence for the mother of the girl who let her daughter get that sick. Alex is able to point out the girl is sporting a Dutch braid, not unlike the ones he used to tie for his sisters. Neglect was not the reason for Nadia’s abandonment. Her family is in the country without papers and her mother explains that she made a choice. She could have helped her daughter and gone back to a country to work as a stripper or prostitute, but instead she chose to pray. Lawyers were able to help out in Nadia’s case and Karev agrees to see her treatment through.

So, what exactly happened in 1983?

We’ve seen this all before, literally. The flashbacks to the time Ellis spent as a resident working with Richard. Her later years in the hospital suffering from Alzheimer’s. And those moments when she recognizes her daughter as a success and as a failure.

The Parallel: Richard and Derek, Ellis and Meredith. In 1983 Ellis Grey receives the Harper Avery award nomination, decides to leave her husband and start a life with Richard, and attempts suicide. In 2014 Derek is offered an amazing opportunity, turns it down, and lives with a wife who regrets his decision enough for both of them.

Meredith’s memories creep back throughout the episode: calling 911 after her mother’s blood pools on the kitchen floor, moving away to Boston, the cries in the hospital as her mother turns away her new child, and the silence at the carousel.

The memories, once explained to Derek, cause a momentary truce, but for Richard, they bring back a dark time in his life. A time when he realized that if he left Adele, he would spend the rest of his life in Ellis Grey’s shadow. He was hateful and jealous, and seeing his failures illuminated left him feeling ruined.

Derek takes Maggie aside and is happy to have her as not only a member of the family, but as a companion to travel the bumpy road back to Meredith. The journal of the spring of 1983 opens the door for many of the doctors in Grey-Sloan Memorial. Derek is able to pause their argument to get a sense of where his wife’s head is swimming. Richard relives the spring and sees the future with Maggie as an opportunity better seized than dismissed. And Meredith, try as she might, admits that while she is still learning about her mother, it is fine if she lets Maggie try to understand her a bit too.

The writers of this week’s episode certainly had a productive summer break. Combing through the old episodes featuring Ellis Grey, they were able to bridge the moments that already occurred and layer them with more meaning than originally intended.

What did you think of ‘Grey’s Anatomy’ this week?

Watch Grey’s Anatomy season 11, episode 5, “Bend & Break,” Thursday, October 23 at 8:00 p.m. ET on ABC.