Izzie is walking Sadie through a chest x-ray and doing her own bad job of acting breezy. Sadie wonders why they would be doing an x-ray on a woman with the flu, but Izzie bullshits that they need to rule out pneumonia, and then walks Sadie through the procedure. She's to be quick and efficient, smile, and, "make stupid happy small talk to keep them distracted, and not panicky." Sadie asks a bit pointedly if she should make the small talk now, but I have a feeling I was supposed to read that as her being snide rather than her suspecting that Izzie is feeling panicky. Izzie brushes her off and takes a deep breath so that Sadie can get the film.
Richard seems to be getting ready to perform the (thankfully) mystery extraction while at the same time excitedly asking Derek how he's going to propose. He thinks it should be a grand gesture, and won't take no for an answer when Derek meekly tries to say that Mere isn't really a "grand gesture" kind of girl. Richard argues that he has to, since the proposal will set the tone of the marriage and he should go all out, including, "Flowers, candles, exotic foods, live musicians and a rowboat!" All at the same time, that just sounds like a recipe for a stomachache. He adds, "Skywriting is not out of the question..." but cuts himself off when Mere comes to get Derek for a consult. She's again kind of wigged out since she realizes she interrupted something, but she and Derek head off to the patient while Richard heads in to surgery.
The consult is for Jen, who is surprised by having a seizure but still cheerful. Derek tells her they might need to do an MRI and asks to look into her eyes; when he tells her to look down she notices the ring box and squeals. Derek immediately sends Meredith away and then asks Lexie and Jen if they can keep a secret, showing the two women the ring. There are few things I hate more than the plot device where literally every single character learns a secret except for the one that it impacts. It's cheap. I feel dirty. But I feel better watching Jen, who is kind of too cute for words. She asks how he's going to propose and he mentions the possible grand gesture, but she assures him that it will be special anywhere. Rob proposed to her in a supermarket, since that's where he saw her for the first time. "So I said yes between the cat food and the tampons." Did they literally call it the "cat lady" aisle? What store are you shopping in that has those two items in the same vicinity? Anyhow, the moral of the story is that anything can be romantic, and Lexie just beams listening to the conversation. Derek gets back to medicine and tells Jen she needs an MRI just to be safe, and she asks if she should be scared. He tells her no and asks, "Should I?" Jen assures him not, Lexie raises an eyebrow that I still don't know the meaning of, and Derek leaves.