Back in Miranda Bailey's OR, our girl is literally popping up over Sloan's shoulder in order to try and drive from the backseat. When she sees Sloan begin to dissect in an area that she knows from Carrie's history has a lot of scar tissue, she objects quite strenuously. Sloan tries his best to shoo her concerns away, but Avery, to his credit, addresses them head-on. He says most of that scar tissue was in an area Sloan isn't dissecting in, and he learned this from reading the file like Bailey told him to. This shuts her up for a moment, but only until Sloan hits a big ol' bleeder and he and Avery scramble to contain it. Miranda -- her panic at war with her fury -- grits at the both of them that she told them so.
After the break, Meredith is making the case for salvaging one finger (albeit shortened), but Callie points out that the thumb is pretty clearly done for. Callie says without the thumb, there's no point in attaching the finger, since so much of hand function is thumb-related (all monkeys: "Tell me about it!") and he'll be better off with a prosthetic. This doesn't seem to be Callie giving Meredith a hard time either. It just seems like they couldn't make it happen. Meredith won't settle for that, though. So she digs into her bag of tricks and comes up with this idea that she read about somewhere: removing the man's big toe and placing it where his thumb was. I can't think of anything I'd enjoy more. Callie thinks it's ridiculous, as the big toe is pretty important for all the walking and such. Mere seems to think adjusting to that would be preferable to losing the hand. She's adamant that this is the fix. The twinkly music here suggests that this is the moment Meredith wins Callie over, but Callie maintains the big toe is not the fix. The second toe is. Same benefits but reduce potential disability. Plus he won't have a big honking TOE THUMB! Just a demure little toe-thumb like Megan Fox. First they have to get the patient's consent. Guys! Mention the Megan Fox thing!
Derek finds Amelia working her procedure out on a computer. He presents himself as relatively open to the idea, but when she explains she's going through the carotid, he says it's too dangerous, and they start arguing again. He tells her not to try this -- she's too fragile if it goes wrong. Amelia really objects to the "fragile" thing. She says she's an addict, one who's fallen off the wagon twice, but who's also gotten back on both times. This doesn't make her fragile, it makes her strong. "I am in a building full of pills," she tells him. And even though she's aware of that every second, she's doing her job. And that's not fragile. Derek finally hears her, and he quietly asks her to show him what she wants to do. He still doesn't think she can do it, mind. But she's going to do it anyway, so he's going to be with her. Well, really, Derek. About time.