Derek's got voiceover duty, since Meredith is still on bedrest. He talks about surgery and appreciating the quiet and finding inspiration and whatnot. Then a Seattle Grace employee named Isaac comes to Derek for a consult for a complicated spinal tumor. Turns out that they are his scans, and it is a risky surgery. Everyone wants in on it, as it could be the "big one" that makes a career. Chief, continuing to be a short-sighted idiot, tells Derek no, because if the guy ends up paralyzed he might sue. Isaac is at peace with being paralyzed, he just wants a chance to live. So Derek does it against the Chief's orders. He gives the residents a test to see who could handle a microsurgery. Dr. Avery wins, much to Cristina's dismay. Derek gets Lexie to be his "bitch." She wears a diaper in order to survive the possibly day-long service. Derek stares at the tumor for 10 hours before the Chief puts a stop to it. Isaac insists that he will come back and do it tomorrow.
Derek goes home and explains the problem to Meredith, drawing the entire spinal cord on the bedroom wall in what looks to be permanent marker. He returns the next day, lies to the chief that they are cutting the cord, gets all the other attendings to cover for him and proceeds to cut into Isaac's lower back. He stops to puke, but Lexie, in her diaper, gives him orders to get back in there. I like bossy Lexie, and by the looks of it, so does Mark, who is watching her. It all comes down to one blood vessel, Derek makes a highly professional "eenie meenie" decision, and Isaac is saved. Poor Isaac thinks Derek chickened out again, but he's all teary when he finds out that he's cured.
Meanwhile, in jerky Chief land, he's got another brainy idea. He's implementing a computerized scheduling system, but it makes him even more oblivious to what's going on. Especially since he looks like he's having more fun showing it off to some random bigwigs. Then, when Derek tries to make peace and apologize for going behind his back, he fires him. Genius! Way to ax the person who could actually bring up those coveted ratings with his groundbreaking surgery. Derek wisely tells the immature ass to sleep on it.
Also, Alex is upset because Izzie's avoiding her IL2 treatment, and he's basically having a meltdown. Surprisingly, Reed's the one who comforts him. Cristina and Hunt share a nice moment as he trains her to master Derek's test for the future, and tries to understand her desire to wear a diaper. Cristina's actually really kind of adorable as she gives Meredith a blow-by-blow of Derek's surgery. And Arizona is my hero for telling the Chief off.
I liked the focus on one big surgery, and a few small personal issues. Also liked the Derek VO. Now if they could find a way to make the Chief less of a bumbling idiot, I'd be really happy. Though, technically he's not as big an idiot as Izzie, who skipped out on her cancer treatment and might die because she didn't want to face her husband. -- Angel Cohn
"Ask most surgeons why they became surgeons and they usually tell you the same thing: It was for the high, the rush, the thrill that comes from cutting someone open and saving their life. For me, it was different. Maybe it's because I grew up in a house with four sisters." Derek takes over voiceover duty this week so that Meredith can sleep in and regrow her liver, and we see him get ready for work and kiss her goodbye.
"No, definitely because I grew up in a house with four sisters, because, it was the quiet that drew me to surgery." At the hospital, he asks a very suspicious Cristina how she's doing, and Cristina is royally pissed that Meredith told him she had been down because of a lack of a "cardio god." She says that once Meredith is healed up, she's dead, but Derek gleefully tells her that she should be happy, because today she'll be on his service. "You need a god! Neuro god, right here." I guess if you're a god, you're not too burdened by modesty. She doesn't really buy his god status, but they are quieted when they reach the surgical board. Everyone is gathered around the Chief, droning about something, and the board is empty except for a piece of paper taped to it. Bailey fills in Derek, that the Chief is implementing a computer model that will schedule surgeries from now on, and that it's supposed to be efficient and money saving or some such bullshit. Well, that last part is just heavily implied by her tone. They tune back in to Richard in time for him to say that he had one of them do a trial for the last month, and then has Mark step up to tell about his experience with it. Mark is totally a showoff as he assures them all that the computer will know them better than they know themselves. Derek speaks up to point out that his schedule has been totally rearranged (he must have guessed this as this is news and there's no way he can read that paper schedule from that far away) and asks the Chief if they haven't already had enough change lately. Richard cuts him off to say, no-nonsense, that change is good. "Embrace it." He walks off, which serves as a dismissal rather than actually wrapping up his presentation, and Bailey turns to Derek and tells him the two men have to stop arguing. "It's unattractive." Derek just glares.
"The operating room is a quiet place. Peaceful. It has to be in order for us to stay alert, anticipate complications." Reed is doing yoga and seems to be trying to piss off Alex by blocking his locker. She's successful, and just maintains that she's sore from doing surgery all night. Unsurprisingly, Alex doesn't care -- and seriously, this is an empty locker room, with plenty of other places to do yoga. She reluctantly moves away as Cristina walks in to tell Alex that Izzie hasn't called in to confirm her IL2 appointment for later that week. Alex acts like he doesn't care, so Cristina lowers her voice, and with a glance at Reed, reminds Alex that this is his wife, and she could die. Alex says she'll show up: "She's a crappy wife, but she's not an idiot." I feel like we've seen countless episodes that would contradict that statement, but fine. Cristina gives him the time of the appointment and leaves, and Reed calls out to him not to worry, "Being ditched by cancer wife won't change my mind. You're still a douche." Clearly these two are going to hook up at some point, right? With the hate that turns to passion?