Derek is still having Lexie walk him through the surgery but they reach a point where he shoots down every suggestion she makes by pointing out each will leave him paralyzed or dead. This isn't to say it is Lexie's fault, but just that the tumor is that nasty. Finally, over her protests, he tells her they have to just close him up. She argues that they can't do that and that they have a 5% chance, but he tells her that they don't even have that any more. As a last resort, she holds her hands out over the incision so that Derek can't do anything and blurts out that Wes knows he has a tumor, adding that he's known all along. Well, he's known since the last doctor, it sounds like, but the point is that he knows. She feels awful since she promised Wes they would try their best. Derek isn't getting any joy out of this but he knows what has to be done, and he orders Lexie out of the OR so that he can go ahead and finish.
Owen heads to the conference room for Richard's party and is surprised to see everyone dismantling the room, including taking down the banner with three exclamation points. He is more surprised, though, when he sees Alex tucking in to a large piece of red velvet cake. He asks why he's not in surgery and Alex, too enthralled with the cake, says that Teddy and Cristina took it. When he realizes how pissed Owen is, he calls halfheartedly that he could be wrong, but Owen storms out.
Lexie makes her way back over when Derek is scrubbing out, and she says that Derek has to tell Wes. I don't quite follow what she says but the gist is that she thinks they have to admit to him that they didn't do the surgery since his mom is just going to tell him that everything went great and Lexie doesn't want the kid going home thinking everything is hunky dory and having no idea he's going to die in three months. Derek is sad but firm as he reminds Lexie that Mrs. Connors is the parent, so it's her call, not theirs. It's true, this is a very good example of how it can sometimes suck to be a surgeon when you have to finally admit you can't fix something.
Cristina and Teddy are working away and congratulating themselves on a surgery well done when Cristina looks up and sees a steaming Owen glaring at her from the scrub room. He storms in and the ladies exchange a look as he demands to know what is going on. Teddy just replies that McQueen wasn't qualified, and when Owen yells that he thought he was clear, Teddy shrugs him off and says that as head of the department, this is the call she made. Cristina just continues to work and conscientiously ignore the argument going on, as Teddy tries to pretend there was no time to inform Owen of what happened and that when she saw him, she didn't even know yet that they were doing it. He announces that he thinks they are lying. And of course he's totally right, but with the two of them as a united front he's pretty helpless to actually do anything right now. Cristina finally pipes up to say that this is a complicated procedure, so can they all talk later? Owen finally allows this but orders Teddy to come talk to him afterwards. The dismissive "Mmm-hmm" she gives him is a pretty clear sign she has no plans to do anything of the sort. He finally storms out but before the door is even closed, Teddy and Cristina start laughing about the look on his face and he hears every word and cackle. He's the grown-up version of April right now, with a staff that seems not to respect much of what he says. Well, at least when it comes to Teddy and Cristina, and as those are the two most important people in his life, it might as well be everyone.