Derek seems to have decided he wants to do it, but in a meeting with Richard, he's shut down. Because everything Richard does nowadays is out of fear for his own skin, he claims that the surgery is a malpractice suit waiting to happen, and argues that insurance might not even pay for it. When Derek tells him that this is an employee, Richard basically says they can't turn into a charity. Derek asks what all of us has been thinking, namely: what happened to him? Richard turns, instantly combating (yet again) as Derek points out that in the past he would have convinced Derek to do this surgery but now he's doing the opposite. Richard of course doesn't answer, just blusters that as the Chief he just said no, and that his medical opinion is also not to operate on an inoperable tumor. Derek tries to argue but the Chief just cuts him off and starts yelling the same thing. Derek just stares, and the Chief snips, "It's a tough job, Derek, sure you still want it?" OH MY GOOD GRAVY, for the millionth time, Derek saved your freaking job, he didn't try to take it from you. The only reason he would maybe do it now is because you're an inept, pathetic excuse for a leader who is running the hospital into the ground.
However, at home that night when Mere asks Derek what he did, Derek tells her that he scheduled the surgery. The look on her face says that this might not be the best idea ever.
Derek has gathered a bunch of residents in the skills lab and tells them about how microsurgery is all about precision (wow, really?) and that the microscope changes your perspective. He says that this can be taught, but with the surgery imminent he needs someone who is a natural. He has a Styrofoam cup with a hole cut out in the bottom, and places it top-down on a dollar bill. Looking through the microscope, he puts a pen into the hole and then holds up the bill to show that he made a red dot on George Washington's nose. He tells them that the one who gets the closest to George's nose is in on the surgery. Cristina makes a great show of yawning and stretching through everyone's turns, as each gets up and blows it. It's a montage of failure, basically, and Derek looks worried. Then Avery is up, and he hits right next to George's right nostril; clearly he is the frontrunner for the assistant position. It's then Cristina's turn -- she's last up -- and she's super cocky as she goes and gets into position. Unfortunately, she then hits the cup with the pen, not even getting it in the hole, much less near George's nose. Everyone, including Derek, looks surprised, but none more so than Cristina. Avery just basks in his own glory since he gets the job.