George heads back to the ER and reports that Tucker is waiting, provided Bailey is out soon. Naturally, at that moment another complication arises, so she sends George back out to ask Tucker to wait even longer. George protests that he just scrubbed in, but Bailey's having none of it and orders him out. After he leaves, she turns and glares at an unconscious Shane and mutters, "A person can only rise so high. Now I'm rising above, but there's a ceiling, and I'm about to hit it." As if he heard her and wants to be an even worse human being than he already is, another alarm goes off to signify yet another complication.
In the outdoor OR, Hahn is looking at the ultrasound while Richard explains that they're going to start, but since Ray's upside down, the blood isn't pooled at the bottom of his heart. Hahn jumps in to say that they should still use the somethingorother instead of the thisandthat. Richard leans in to make sure Meredith heard, and after she confirms it, she asks Ray how he's doing. Outside, Hahn leans in to say be careful because she could nick an artery. Izzie then guesses that she could cause a rupture, and Hahn rogers that and lists a number of other things that could go horribly wrong. "Basically there's about six different ways she could kill him." While most TV shows pretend that standing two feet away from someone, or standing around a corner, means they can't hear what someone else is saying, this time we're actually seeing something realistic. Ray pulls off his oxygen mask to ask, terrified, if they're talking about him. Meredith tells him not to listen and then turns around and orders, "Dr. Hahn, shut up." Hahn looks shocked but then yells inside, full of false cheer, that Ray's going to be fine. She then turns and quietly tells Izzie to get an 18-gauge needle, "before this man's heart explodes in his chest."
Alex is finishing up the last of the surgery, and Callie asks how he's doing. His nose itches, which she says is the anxiety since he knows he can't scratch it. But it turns out his anxiety was warranted, as some blood then squirts out of Jacob's chest onto Alex. I like to think that, while filming this episode, the special effects team was running around having the equivalent of a water fight with all their squirty-blood contraptions, because they clearly have a lot of them on hand. Callie and Alex go into crisis mode; she asks what he did, but he claims nothing. Upstairs, Ava jumps up at the commotion and Alex looks up at her yet again. Man, no wonder this guy's chest exploded -- it probably was craving Alex's attention after all the time he spent staring after his lovah instead of at the incision.