Alex is on the phone arguing with Swender's office about Izzie's appointment the next day -- it sounds like she still hasn't confirmed, and he tells them to call her cell and begs them not to cancel the appointment. Reed comes up and comments, a little too nonchalantly, that he missed the contest, but Alex just snarks that he heard she tanked it. She brushes it off and goes on to say they are doing Shepherd's rounds for all his cancelled craniotomies. She then offers an olive branch -- that while she'd love to watch the crazy surgery, she could take care of everything herself so he can deal with Izzie. Alex both isn't in the mood and seems to not believe that she's sincere, telling her he had more respect when she called her "cancer wife," which was at least honest. She tells him she's trying to be human, but he claims she's trying to get all the glory for doing everything herself, which makes her the douche. She says she tried, tells him to throw away his marriage, and leaves for rounds, but he grabs the chart out of his hands to do it himself. Good grief, you two, just make out already.
Mark, Arizona and Callie are outside, and Mark watches through the window, and Mark is commenting on how Derek has cracked. They just give him a look, and Arizona reminds him not to be smug since it's one of their own on the table. Callie takes her turn at the window and says that it's depressing that after 10 hours of staring he can't figure out what to do. Naturally, the Chief is right behind her and hears this -- Callie stutters and tries to cover it up, so he glares at Arizona since he knows she has issues with authority figures.
Clearly she caved, because the Chief then walks inside and asks Derek if he cancelled all his surgeries to work on a spinal cord tumor. It's a dumb question, and Derek doesn't say anything, so Richard walks further in and reminds Derek that the risk of infection increases the longer he keeps Isaac open, plus this is costing thousands of dollars for him to do nothing. At least he pretends to care about the patient first, though you know that was just his single smart move of the day because I'm sure the thousands of dollars are foremost in his mind. He demands that Derek close up and leave the OR, and while he hasn't said a word the whole time, after a moment Derek quietly agrees. The Chief makes a point of stopping the surgical clock.
Once Isaac wakes, Derek tells him there was no way to do the surgery without risking his life, and that he won't cut the cord while Isaac is still walking but they can reassess in a few months. Isaac is just as zen as ever, and tells Derek he knows that he worked hard and is tired, and they'll just try again tomorrow. Derek tries to tell him know but Isaac just smiles at him and says, "Go home, sleep on it, we'll talk more tomorrow."