Derek and his beard walk into the kitchen carrying a bag, so I suspect that he has not actually moved back in yet. She sits down at the table with coffee and toast, clearly unhappy, and he sits down just as glumly and sets a ring box in front of her and gazes at her with puppy dog eyes. She just answers, "No. Not like this." That's a proposal, Derek? Give me a break. Also, does anyone know if this is his mother's ring, that maybe he went and found it in the grass? I don't think so -- as I recall, this one looks slightly different -- but I'm not sure and you eagle-eyed viewers are very good at that. She tells him that it's his first day back (clearly just for our benefit since obviously they are both aware) and that today is about Izzie and his operating on her. She tells him, "You have a gift. And you can do this." He just silently takes the ring back and then grabs his bag, mumbling that he's going to shower before work, for which I'm sure his colleagues will be eternally grateful since it's not 100% clear that he's showered at all up to this point.
Cristina is at work with a turtleneck on under her scrubs, which Meredith notes is ugly. "Not as ugly as the fact that you hugged him..." Cristina gets it and wants Meredith to move on but Meredith won't drop it and repeats that Cristina, the situation, and her boyfriend are all not okay. Alex then joins them and asks Meredith if her boyfriend is okay, taking the ladies by surprise. He explains, "To be cutting into brains today. Is he okay to be back?" Meredith tells him that Derek is fine but this isn't really the crowd for pithy reassurances and Alex points this out, reminding her that he was in the OR when Derek melted down and took out half of Jen's brain. This isn't just any patient, it's Izzie. Does that mean it's okay to slice up the brain of someone you aren't dating? Interesting theory.
Derek, his beard, and the Chief walk by as the three residents walk downstairs. A little ways away Callie is staring into space when George walks up. She's surprised he's not in Izzie's room for the big presentation but he's livid that he didn't know Izzie was sick and that he heard the news third-hand from Bailey, as well as being really hurt that Izzie trusted Cristina more than him. Callie tries to stand up for Izzie but George doesn't want to hear it and just asks for work on her service. He then takes a chart and storms off to fill a patient's room with sunshine and light.
Bailey walks up to Cristina, Mere and Alex outside Izzie's room and as other doctors file in, explains that she's the resident on the case and will prep Izzie for surgery. If they are in the room, it's to be her friends rather than more doctors. They then follow her in and stand next to Izzie's bed in front of some docs in distractingly bright red scrubs. Izzie gets all business-like once everyone is there and hands off some knitting she's been doing to Meredith. Bailey goes over the general info about her illness and says she's got a lot of procedures and surgeries over the next few days. Richard jumps in to say that he and Bailey will be taking the mets off of her liver, and that also a Dr. Parker from OB will harvest any healthy eggs she has before she undergoes radiation. Izzie is a little bit grim about the idea of babies, but Bailey kindly said they are leaving the option open for her. Derek then says he'll be taking off the mets on her brain and comments that he's surprised they didn't catch these sooner given that they can cause headaches, seizures, and "intense hallucinations." I guess that means the correct term for the drivel we had to suffer through earlier this season is "intense hallucination sex" rather than "ghost sex." My bad. Alex pointedly looks like someone kicked him in the stomach at that little comment. Once Derek is finished a female doctor we have never seen before, who is wearing dark blue scrubs but is standing with all the reds, asks, "Are you people done?" She then announces that Izzie will be having three major surgeries and seven outpatient procedures, and most likely even more than that once they get inside of her and see if there's any more stuff to take out. She's the oncologist, Swender (the same one Cristina fought for the appointment with last week) and announces how it's going to be aggressive and harsh, she's going to be overseeing everything, and that means that everyone in the room now answers to her. She's really competing for Miss Congeniality here and clearly we aren't supposed to like her much as she finishes, "Welcome to the cancer wing, folks." Derek then gives Izzie an actual genuine smile, probably bonding over Swender's bitchiness, and says he'll see her in the OR.