Izzie's on a table with little silver nodes on her head, and Meredith and Derek are all decked out in their finest lead smocks. Mere explains what they will be doing, which Izzie knows -- Mere will show her some flashcards, then Derek puts half of her brain to sleep, and then she tries to tell Mere what she saw. Knowing absolutely nothing medically about this test except what I've just heard on TV, I have to agree with Derek that it might not be the most accurate representation of what could happen because... a full half of her brain? That's way more than just the portion Derek wants to remove, and I feel like that would have a lot of effect on things. But hey, I'm not a doctor, I just snark about them on TV. Izzie starts to show off and get too detailed in her descriptions of the images, which are of a dog, plane, and house. She chants that to herself as Derek does the brain sleep thing, but almost immediately her speech drops off. Mere tries to ask her what she saw, but Izzie can't even form words, much less remember. As it turns out, Izzie doesn't seem to remember Meredith or Derek either, and when Mere tells her to nod if she knows who Alex is, she just stares up with terrified, wide eyes.
Swender and Derek are once again arguing about Izzie's treatment in front of her. Given the results, Swender isn't totally crazy about trying out this surgery, but Derek argues that it was the worst scenario and has nothing to do with the actual surgery. His argument is that not operating is as risky as operating. This all is really helping Izzie, especially as it's taking place right in front of her. She asks Alex and again he throws it back to her, so the doctors leave them, but Alex follows Derek out. Meredith then shuts the door, turns to her friend, and announces... "You are not having the surgery."
Alex then asks Derek the question that we all saw on ABC about 47 times or so in the promo. He tells Derek to talk to him like a friend rather than a doctor, and tell him what to do. When Derek tells him that he can't, Alex pulls out the big guns and asks what Derek would do if it was Meredith. Would he choose having a few months with her knowing she was going to die and watching her in pain, or would he choose to spend his life with someone who was no longer actually Meredith? Alex calls Izzie the one good thing that has happened to him, although I would argue that Meredith was a good thing, and this job was a good thing... but it makes this scene all the heavier like that. Derek tells him that he would ask Mere to have the surgery.