Derek’s sitting on the couch, depressed and eating cereal. The other inhabitants are talking about him. Meredith says Jen’s death and the lawsuit is a lot for him, so he needs some time. Izzie says something big happened to him, so they should give him to figure out what to do next. Lexie thinks Derek is sitting on her keys, but she doesn’t dare to ask him to move. Meredith goes over to Derek and says he should shower. She asks if he’s coming to the hospital. He has to for the deposition, where he has to talk about how he killed a pregnant woman. Meredith says he’ll feel better afterwards. Derek gets up, gives Alex his cereal back, and goes upstairs.
Cristina finds Owen sleeping on a gurney. She moves to wake him, but he pushes her against a rack. She has a cut on her arm.
Owen’s stitching up Cristina’s arm. She says it’s no big deal, figuring he had a bad dream. Cristina says they have a trauma coming in: a trampling on a football field. She’s on his service today, but Owen tells her to take care of her elbow. Meredith comes over and asks what happened. Cristina says it’s no big deal. Meredith says Derek won’t get off the couch. Cristina deems men the weaker sex.
Callie’s looking at Mark’s hand. It’s still swollen, so no surgery. She asks if he’s talked to Derek yet. He thinks Derek should be the first one to talk as he threw the first punch. Callie says Mark caught him at a bad time, but Mark says that losing a patient doesn’t give him the right to act as a drunk frat boy. Callie hides behind Mark as Arizona walks by. She explains what happened, so she’s hiding from Arizona now. Lexie comes over. She feels terrible about everything that happened. She thinks Mark should talk to Derek, who’s not doing well.
Bailey could use Richard’s help on a case. He says it must be slumming not to have a peds case and walks off.
Cristina presents Tricia, Michael, and Megan Shelley. They all tested positive for the CDH1 gene for hereditary diffuse gastric cancer. Meredith says that means they have a 3 in 4 chance of developing the cancer. Tricia says Bailey removed tumors from everyone on their mother’s side. It’s an aggressive cancer. Tricia says their family tree is down to a branch. Their uncle Bud is dead, and so is aunt Helen. The Minnesota cousin won’t live long, either. The siblings made a pact to have their stomachs cut out.
In the ER, Nicole tells Owen about Beth Dearborn, who had a grand mal seizure during marching band and seized again upon arrival. Beth is seizing again. Owen asks for lorazepam. Alex says she’s in V-fib and asks for the paddles, but Owen stops him as it could be because of the seizure. Alex can’t tell if she has a pulse and the lorazepam doesn’t work, so Owen decides they need to shock her after all, which might kill her. Owen grabs the paddles and shocks her.
Beth’s heart rhythm returns to sinus tach. Arizona says it was a good call as Beth wakes up. Arizona introduces herself. Owen says she’s going to look for internal injuries as she got beat up while marching. Beth says she took her meds to prevent the seizure. Seizing in front of the audience is like crapping her pants. Seizure patrol is going to be mad. The seizure patrol then comes in: they are supposed to drop their instruments whenever Beth seizes and roll her on her side. One of them says they were favored to win in Northwest Regional Parade until Beth took a lot of people down. Owen wants Alex to sit with Beth, in case she codes again. Alex objects as it’s intern work, but Owen doesn’t see any interns around.
Lexie presents the case of Patient X to Izzie. Izzie asks the other interns what they would do next. Pierce suggests an upper GI. She says good, and says that is what X’s doctor did next. She shows them the scan and asks what this tells them.
Meredith gives the Shelley siblings information on possible complications after the surgery. Michael doesn’t like anal leakage. Cristina says this a not like getting their appendix removed. They’re changing the way their entire digestive system works. Michael says this will turn him into an old man. Megan says it’s important to Trish, but Michael says she’s been running their lives since they were kids. He’s 23, so he can decide for himself. Trish can’t believe he wants to die. Michael says a 1 in 4 shot is something. He yells Trish is not in charge anymore. Megan also has doubts now. She needs time to think.
Richard is helping a nurse fill in the OR board. He needs Derek for a craniotomy. Also, he needs a head of cardio, and general surgeons who don’t quit on him. He has surgeries piled up and no surgeons to do them. Mark tells him his hand is still out of commission so he can’t operate, but decides not to let the Chief down. Another surgeon says he can do the craniotomy. Richard agrees and tells “John” he appreciates it before walking off. “John” says it’s Jim. Mark welcomes Jim to Seattle Grace, but Jim says he’s been here 10 years. He was Head of Neuro before Derek came in. Also, he’s met Mark three times already.
The seizure patrol doesn’t understand why Beth gets to be on the band. Alex throws them out, saying he’ll take over the seizure patrol duty. Alex tells Beth her friends are asses, but she says they’re not her friends. Beth says she doesn’t really have friends. Alex says the seizures is out of her control, but she did willingly join the band. Beth likes the band, as she’s actually good at it. Alex wrestled in high school, but he is a surgeon now. Beth asks how he’d feel if he seized every time he went into the OR. Alex understands her now.
Callie is not recommending this, but Mark needs to get through his surgeries. He’ll be in a lot of pain later, though. Mark asks if she’s ever heard of Dr. Nelson. Callie says it’s Shadow Shepherd. He’s a solid surgeon, but just not as good as Derek. Callie then administers a shot into his hand.
Meredith finds Derek in a conference room. The lawyers told him his death rate. There are piles, and the kill pile is way higher. Meredith says most people were terminal when they came to him, and he takes on impossible cases. He forgets to look at the bigger picture. Derek says the death pile is the big picture.
Richard finds Derek and asks if he can operate, but Derek says he’s not operating. He keeps on walking with Richard yells after him that he’s ordering him to return to the OR today.
Meredith tells Izzie and Cristina what happened with Derek. Cristina is talking about Owen and says he’s ignoring her. She, on the other hand, faces things. Meredith says Derek walks away, so maybe it is the problem. Izzie says they’re hilarious as they keep on talking without actually listening to one another. She can totally picture them in a nursing home in 50 years. Also, Izzie loves lunch.
Alex is charting in Beth’s room. She has another seizure. He calls code blue.
Richard, Bailey, Meredith, and Cristina are operating. Richard wants to hand sew the anastomosis, but Bailey suggests to staple it for the reduced fistula rate. Using the old stapler is her speciality. Richard thought her speciality was babysitting children. Bailey snaps that she feels like she is. Cristina feels something in the abdomen.
The interns have come up with an answer: it’s a trick question. Patient X is fine. At worst, she’s got an anxiety disorder. Izzie yells she is not fine. She had hallucinations, visual, auditory, and tactile. She’s not fine. They’re missing something and they have to figure out what.
The doctors inform Megan and Michael that Trish had cancer, but it was in stage one, so the gastrectomy was curative. Trish had an endoscopy just months ago. The gastrectomy today saved their sister’s life. Megan tells Michael that Trish always plans things because everyone else is dead. She decides she also wants the surgery.
Owen and Arizona can’t figure out why Beth codes when she seizes. Alex says she goes into V-fib before seizing. He saw it and stands by that. Arizona asks if she should tell Beth and her parents that she’s been treated wrongly for epilepsy for 6 years. Alex thinks so, and then he wants to do a cardiac workup with an EP study. Arizona refuses to deliberately shock a perfectly healthy heart. Owen says it would explain the coding if Alex were right. It’s Alex’s call.
Izzie sits down with George and says that maybe teaching the interns is wrong, as Cristina said. George says Cristina just thinks it makes her the next him. Izzie says George does more research and logs more time in the skills lab than any resident. He never gives up on trying to be a better doctor and he doesn’t step on other people to do it. She would be lucky to be the next him. George asks if she was going to tell him about patient X as Lexie comes over. Izzie walks with her. Lexie thinks it was a mistake to rule out a brain malignancy. She wants an MRI with contrast and maybe a lymph node biopsy. Whatever’s wrong with Patient X is already in her brain. Izzie agrees to that.
Bailey, Richard, Cristina, and Meredith are operating on Megan now. Bailey once again suggests the stapler, but Richard says to leave the technical calls up to him since she no longer wishes to be a general surgeon. Bailey was just expressing her opinion, but Richard says she doesn’t get to make decisions until this hospital is hers. This hospital is his, so he wants everyone to do what they say. Bailey says okay and decides to sew.
Before doing the procedure on Beth, Arizona asks Alex one more time if he’s sure. He is. She puts him on crash cart duty, so he can use it if he’s wrong.
Cristina tells Megan they did not find cancerous cells in her stomach. She asks if Megan’s comfortable. Her wound hurts a little, but not too bad. Trish asks Michael if he remembers how much pain their mother was in by the end. He doesn’t as he was 2 years old when she died. The only reason he knows how awful it was is because she keeps telling him. He doesn’t dream about funerals or think about cancer every time he has indigestion. Trish does. This is Trish’s fear, not his, so he wants to decide for himself when he’s scared.
Beth’s study is showing no signs of arrhythmia, until they take it up to 300. They look at the monitor and decide it could be ARVC. The right ventricle causes the arrhythmia, then the brain doesn’t get oxygen and Beth seizes. Owen tells Alex he saved Beth’s life. Alex’s hands are shaking. Owen tells him to breathe and put the paddles down.
Mark tells Richard he pushed through all of his surgeries, but Richard is thinking about Derek. Mark hasn’t heard from him either. Bailey comes over. She’s tried to let it go. She understand he’s under a lot of pressure, but the way he yelled at her is not okay. Bailey says they’re gonna have to find a way to work together, but Richard just walks off.
The interns have a diagnosis. The MRI showed a met on the patient’s right temporal lobe and the biopsy revealed dividing cells, which led to their final diagnosis: metastatic melanoma with mets to the brain, liver, and skin. Izzie asks about their prognosis. With chemo and radiation, a few months at best. The survival rate is 5%. Izzie compliments the interns’ work. The interns asks about their prize, but Izzie says not every death sentence comes with a prize. The prize is they didn’t screw up this time. They actually did something right. They were doctors today.
Adele gets off the elevator. She drags Richard and Bailey to a conference room.
Alex shows Beth her pacemaker. It’s going to regulate her abnormal arrhythmias so she won’t have any more seizures. Alex says she still has a serious heart condition, so they’re going to set her up with a cardiologist. Beth is happy because no one will have to know this. She can cover the pacemaker with a shirt. When people see that you’re sick, they don’t see anything else. The seizure patrol comes in and says they didn’t win the Parade. They suggest Beth finds something else to do, for her own safety. Alex says they fixed her. The band girl asks if Beth’s normal now. Alex says none of them is normal as they’re band nerds. The patrol leaves and Beth laughs.
Adele asks Richard if he’s running a hospital or a playground. He says hospital. Adele tells him to start acting like it and apologize to Bailey. He better not leave the room before he’s worked things out with Bailey. Adele leaves, but tells Bailey to wipe the smile of her face as she’s no better, tattling on a man to his wife.
Meredith and Trish are watching Michael eat jelly beans. Trish can’t understand Michael does not want to give up certain things for his own safety. Meredith says they’ll be vigilant. Trish says Michael will have the surgery. She’ll be on him until he does. Meredith asks what if he just wants to be left alone. Trish says you don’t leave the people you love alone. Trish says her fear is going to save Michael’s life, even if he doesn’t know it yet.
Lexie finds Izzie and tells her she learned a lot today. She thanks Izzie for that. Izzie wonders what Lexie would tell Patient X. Lexie says she’d say she was very sorry, but she doesn’t know what to say to someone who’s going to die. Izzie says you say they have a choice: they can run away, or fight. They should be with the people they love because it’s gonna be one of the toughest fights of their life and no one should do it alone. Then, you give them the odds. Even though 5% is really bad, you say… Screw the odds, Lexie finishes her sentence. Her mother died of the hiccups, and survival rate for that is 100%. The odds are that she should be alive right now. The odds mean crap. So, people should face it and fight. Maybe not those words. Izzie says exactly those words. She thanks Lexie.
Alex tells Owen and Arizona that Beth is stable. Owen will make sure the Chief will know about what he did. Arizona says he could be the future of this hospital if he fixes his attitude. “You go, Karev!” she says.
Alex finds Izzie and says Hunt is letting him do this distal anastomosis on his fem-pop. It’s crazy. They just told him he could be future of this hospital. He’s not the kind of guy who rises, but now he’s getting all this respect. He tells Izzie to stop with this patient X crap. She needs to start treating real patients with real surgeries, because one they see you as weak, it’s over. They could be great together. She just has to stop screwing around, because he doesn’t want to be the future of this hospital if she’s not there with him. Izzie kisses him and smiles as she walks off.
Richard can’t believe Bailey told Adele on him, but Bailey says he didn’t leave her with many options when he stopped speaking to her. Bailey asks if he regards peds a soft specialty. He says that’s ridiculous. Bailey says it seems like she’s dead to him whenever she takes time to do something that seems soft to him, like having babies, or taking time off to see her baby, or specialize in babies. She thinks he’s scared that he’s gone soft. He keeps blaming the hospital’s decline on it, but maybe it’s time for him to get a little soft. They tell each other they’re sorry.
Cristina finds Owen and assigns herself to a trauma with him. She gets to decide for herself when she’s had enough trauma. It’s gonna take more than a bad dream to scare her off. He says it’s more than that. She knows.
Richard sits down with Meredith in the empty cafeteria. He needs her to bring Derek back. Derek is not fine. Meredith says sometimes people just want to be left alone. Richard then says Derek’s been planning to propose. That’s not a man who wants to be left alone. He thought she should know that.
Lexie finds Mark and says the odds are against him and she keeps breaking him. Their survival rate is 3% and that’s bad, but she doesn’t think they should give up on it. Mark hushes her. He says she didn’t break him; she put him back together. As they leave, Jim Nelson asks Mark if he wants to get a drink later, but Mark asks “John” for a rain check. Jim again says it’s Jim.
Arizona gets on an elevator with Callie. Arizona says she’s had quite a day, as Alex Karev, a second year resident, handed her her ass. Callie says they don’t have to be friends. It’s a big hospital, so they can avoid each other. Arizona means that she can misjudge a situation. So, if Callie’s up for it, Arizona would like to take her to dinner. Callie says maybe as the elevator arrives. She gets off and says her schedule’s busy, so she’ll get back to Arizona. The doors start to close, but Callie blocks them with her arm. She asks if tomorrow works for her. Arizona smiles at her.
Meredith wishes Izzie a good night as she leaves. George tells Izzie he’s been keeping his distance because she’s with Alex, but he wants her to know he’s still there for her. He still cares. She thanks him, but she doesn’t want to talk about it yet. He leaves, too. Izzie then sits down with Cristina. It’s good that Cristina doesn’t like her very much, because she needs to tell Cristina something and she’s a robot. Cristina can take it. However, Izzie can’t tell her here, in the residents lounge.
Derek’s swinging a bat outside his trailer. Meredith arrives and says she noticed he cleaned all of his clothes out of the closet at the house. He tells her to go home. She asks how long he’s gonna hide out here. Meredith says he can’t hide from the mistake he made. Derek says he’s not hiding. He’s done operating. Derek says she should understand she wrote the book on quitting, running, and hiding. Meredith says that may be true, but she’s here now. Derek says she’s wanted him out since the day he moved in, because she’s incapable of commitment. She told him she was healed, but there’s no fixing her. Meredith says he’s drunk and angry and she gets that, but that doesn’t give him the right to behave like this. Derek says he’s giving her an out, like she wants. He yells at her to leave. She’s not going anywhere. She says she knows there’s a ring as the Chief told her. He shows her the ring, and then hits it with his bat. He goes into his trailer. She yells she’s not bailing. They’re in this together.
While Meredith’s voice over talks about facing your fear to get rid of the shadow that’s following you everywhere, Izzie tells Cristina about her cancer in the vent room.
