This recap contains SPOILERS for Grey's Anatomy Season 21, episode 18 "How Do I Live."
Jules and Winston have an unexpected and awkward run-in at the beginning of the workday, and the tension between them swells. After Jules assists with his surgery, she finally confronts him about wanting to be put back on his service, but he insists that even though she's skilled and brilliant, he wants to give other residents the chance to train with him. There are other cardio surgeons, he says -- but she claps back that he's the best of them all.
Jo and Link, fresh off their fairytale wedding, long for a "real" honeymoon as they struggle to separate for a long day of work. When they meet up later in a suppy closet -- Link's surgery has been moved -- they take the unexpected shared break in their schedules to spend more quality time together. It's their version of a honeymoon. When they emerge from the closet, however, they realize that the entire time the hospital has been dealing with a hostage situation in the OR and the OB floor is being evacuated as well. After things calm down, Jo accidentally reveals they're having twin girls. Link breaks the news that his surgery is back on, and Jo lets him go even as she feels what might be a contraction.
Meredith Grey is back at Grey Sloan Memorial to meet with Catherine Fox, where Richard learns that Meredith is selling her shares of the hospital so that she can both afford to fund her Alzheimer's research and avoid bankrupting her family. Richard isn't happy about this, and continues to guilt trip her about "abandoning" the hospital where she grew up and where the two have spent years together. At least until they're informed of the hostage situation, at which point they join Catherine in trying to keep their doctors safe.
Meredith tries to talk the police out of intervening since Amelia has already started the surgery. After reviewing Dylan's case and her morning labs, she realizes that the patient needs more help than Amelia and Lucas can give her while trapped in the OR. She runs the plasma up to the OR and starts trying to talk the patient down, since she knows what it's like to be a mother worried about her kids. She stays until things de-escalate, and ends up proposing to Richard and Catherine that she spend summers at Grey Sloan as a general surgeon and the rest of her time back in Boston for her research as planned.
Miranda informs Ben that Teddy didn't opt to let him stay in his internship another year, and he tells her he wants his last day to count. He begins working on a patient who goes critical, and he calls Miranda to get the patient into emergency surgery. The entire OR floor is already shut down when they get there, though, and Ben ends up operating on the patient in the ICU. Miranda walks in and, instead of getting upset, helps him successfully complete the surgery. At the end of the day, she promises him that they'll find a better surgical residency program for him elsewhere.
Dylan's mother is distraught when a fifth day in a row of scans reveals that nothing about her daughter's condition has changed. Amelia and Simone are prepping in the OR when the mother walks in with a tank full of highly flammable gas (extremely dangerous in an operating room) and demands that they operate on and "fix" her daughter. Amela calls Lucas to tell him to bring Dylan up to the OR, and once he does, all of them are trapped and forced to begin the surgery without a team or imaging to help. Dylan's mother holds Simone while Amelia and Lucas operate. Amelia uses some of Derek's surgical wisdom to keep her calm and steady, and with Meredith's help, they are able to finish the surgery successfully. When they do, it's revealed that nothing was ever in the tank, and Dylan's mother is arrested. Everyone is safe ... for now.
Teddy and Winston prep Nora for her surgery, and Owen promises her that she will make it through. Owen tries to talk Teddy out of the risky surgery but she reminds him that Nora will definitely die if they don't at least try. She also asks him if he's in love with Nora, to which he doesn't give a full response. They are in the middle of the procedure when the OR floor goes on lockdown, and both Jules and Blue agree to stay to help. When they've completed all but one final step of the procedure, Winston tells the two interns to leave so that they're not in any more danger.
As Teddy struggles to complete the final step, she and Winston come up with a method that could make the outcome more likely to succeed. It works, and it looks like Nora will live. Afterward, Owen tells Teddy that he only wants her and loves her, but she decides that while she has always chosen Owen up to this point, she now wants to choose herself instead.
It's the end of the day, and the final minutes of the season finale. As the new intern class finishes their onboarding, Simone realizes that her one-night stand is one of them -- they'll be working together starting tomorrow. As Link begins his patient's surgery, Amelia and Lucas check on Dylan and speak with her father, who apologizes for what his wife has done. At least the tank was empty, they say -- but he reveals that it couldn't have been since there weren't any empty tanks in his trunk. As Lucas rushes to warn Weber and Link's surgery continues, from outside the hospital, a fiery explosion stops everyone in their tracks.
IYou thought there wasn't going to be a cliffhanger, didn't you? For a moment, you really thought the stress was over. You were very, very wrong.)