Anspaugh and Kaysen explain the heart surgery to Ruby, using illustrations. Abby walks in and asks angrily if they're definitely going ahead with the surgery. Kaysen and Anspaugh just stare at her. Ruby asks the doctors to confirm that surgery is the only way to go. Kaysen and Anspaugh say that they could try to treat Ruby's condition medically, but that "surgery's the only definitive treatment." Abby jumps in and informs Anspaugh of Ruby's kidney problems. Kaysen ignores her and gives his pre-surgical orders. Abby doesn't take the hint and starts blathering about Ruby's decreased lung capacity. She stops when she notices that everyone is staring at her. She says angrily, "What I mean is, shouldn't we be discussing the risks?" Ruby says that they already discussed them, and Anspaugh cheerily says that they'll continue discussing them. Anspaugh asks to see Abby outside.
In the hallway, Anspaugh curtly says, "I take it you have a problem with Mr. Rubadoux's decision to have the surgery." Abby says that she thinks he hasn't made an informed decision. Anspaugh asks if that's because Abby failed to inform Ruby of the risks, and Abby looks down, kind of busted. Anspaugh asks rhetorically why he would operate on someone who didn't want it, and then tells her that if she has concerns, she should ask the consulting doctor to step outside. He works up to a yell as he concludes, "You do not, in front of a patient, attempt to subtly disagree with a senior cardiologist and the Chief of Surgery!" I feel like I'm supposed to think Anspaugh's being an ass, but he's totally right. Abby may be correct about the surgery, but she went about it all wrong. Abby's dressing-down concludes, and she appears chastened. Anspaugh starts to head back into Ruby's room, and Abby finally pipes up, "I have concerns." He stares at her for a minute, and then goes into the room anyway.
Abby sighs, and suddenly someone puts his hands over her eyes. It's Jake, and he guesses that Abby hates it when people do that. Man, talk about your bad timing. Abby says that she really does hate it, and Jake lets go, but asks her if she appreciates that he knew that about her. Abby doesn't answer, and stomps away. Jake chases after her and asks if it's bad timing, and whether she wants to talk about it. Yes, and no, respectively. Jake says that he's back. Abby keeps walking and then stops and turns and apologizes profusely, asking how San Francisco was. Jake was apparently visiting potential employers, and he thinks San Francisco is a long shot. Abby tries to encourage him, but she's distracted by looking for Carter. She never does stop and give him her full attention, or even explain why it's bad timing. Jake says that he might match at County, and asks what that would mean. I think he's talking in terms of their relationship, but Abby either doesn't get it, or pretends not to get it.