Derek has gotten 7 of the cysts out, so of course on the 8th there is a problem. The cyst ruptures and a worm slides out and merrily floats off through Archer's brain, which causes him to flatline. They start a previously never-seen "code clock" which gives us a giant view of how long he's down while Derek tries to get to the worm. Mere wants to start compressions but Derek stops her and tells them he's got two to three minutes to try and get the worm before they're in real trouble.
Derek strings it out for maximum dramatic effect, through a commercial break and up to where it's been 2 minutes 20 seconds since the worm got loose. All of the women upstairs are looking desperately through the glass, and Mere is trying to get him to face reality and stop what he's doing. But Derek is a god, and he's able to grab the worm and get it out. Archer's heart rate pops back up to normal, and everyone cries tears of joy for this kind of obnoxious character that regular Grey's viewers hardly know. I mean dude, we know him WAY less than we know Jen. But as Derek says to his team when he thanks them, they just made a bunch of his friends really happy, so we can just take it at that.
Night has fallen, and Izzie's game is nearly over. She, Alex and Richard are waiting for the winner, and she tells Richard that she needs a prize, but she knows it shouldn't be too big on account of them taking out their own appendixes. Dudes, they only took out one appendix -- it was monumentally stupid, but it is still probably unfair to attribute more organ removals than that. Doing stitches on one another doesn't equal full-on illegal surgery. George is there too, looking bored and sitting on the phone, which seems kind of like an encapsulation of his character on the show now. When he does appear, he's doing nothing and it's really boring for him AND for us! Izzie goes on that she knows they are still being punished and she knows Richard thinks they aren't even qualified to hold a clamp, so does he have any prizes that will work? And while it was only one appendix, she's overdoing things a little bit here by making Richard sound like a bad guy for putting the interns on probation. There's a happy medium in here somewhere, Iz. (I'm glad to see I can still thoroughly dislike Izzie as much as usual even when I'm thrilled beyond words that Denny hasn't yet reappeared.) George then reports that the interns just got their final symptoms, and that it's time to get out the finish line. Alex unrolls some tape and hands the roll to Izzie, who holds out her hand but doesn't get close to actually grabbing the roll. The pointed look Alex gives her tells us this is sign #2 that Something Is Wrong. She finally concentrates and takes the roll from Alex, and after the line is set up Lexie, Two and Ryan come racing around the corner. It's a three-way tie, and when each gets a chance to diagnose the illness from the last set of symptoms, Lexie comes out the winner and is given a giant ribbon to wear around her neck. Richard tells her that her prize is getting to scrub in on the craniotomy with Derek, where she'll get to hold the "doomsday sucker." She's beyond excited even though she doesn't know what that is, and when Izzie asks Richard quietly what it is, he says it's just a regular sucker. (Whatever that may be.)