There's a convenient surgical clock on display that I've never noticed before, so now we can see how much time has elapsed. 1:13 in, Isaac's back is open and Derek is just staring at the tumor. He exclaims quietly that it's more intricate than the scan showed, and there's no way to get to it without rupturing the cord. He then starts throwing out different ideas he could try, and both Avery and Lexie offer comments on his suggestions. They realize, though, that he's not talking to them at all, he's in his own world and talking to himself. Lexie keeps her eyes right on him as he mumbles.
Cristina is watching all of this from the gallery, totally morose, when Hunt comes in and tells her he's sorry about the contest. She demands to know who told him and is upset to learn that people are talking about what happened. She shuts down his attempts to discuss it and tells him that it's punishment enough to watch Lexie wear a diaper. Hunt guffaws at this little tidbit and points out that it's another reason to be glad she's not in the surgery, but she adamantly shoots back that she WANTS to be down there to do that. Hunt clearly doesn't know his girlfriend as well as he thought he did if he's surprised to hear that she wants to pee in a diaper. She does clarify that she doesn't want to pee, she wants to have to pee in a diaper, because she's in a surgery so long and difficult that she can't leave. Hunt looks a little scared of her and is speechless as Cristina gripes that Derek still hasn't made a single cut.
I don't know how long she waited up there, but down below now eight hours have passed and Derek is still just staring into Isaac's spine and mumbling. Lexie tries to get him to take a break but he refuses, and when Avery asks if she's wearing a diaper and starts needling her about needing a break because she can't bring herself to use it, Derek snaps and yells at them both to shut up. He tells Lex in no uncertain terms that he doesn't need a break, she should go if she does need one, and if either of them say another word they're dismissed. Lexie runs out past Bailey, who is walking in, and Derek snaps at her too. She just raises her eyebrows at him and tells him that while she's sure this surgery is totally authorized, she thought he would want to know that Richard is about to do a surgery across the hall so if he's going to make a cut, he should make it soon. Chastised, he thanks her, but she just gives him a "screw you" look and leaves.