Derek may have sworn to not say anything, but he didn't swear to not stomp around and act put-out and obvious that something is wrong, nor did he promise to not ask leading questions. He storms into the Chief's office and tells him that the OR ran out of sterile supplies the night before and surgeries were held up for an hour, but Richard replies that he already knew this, blames it on understaffing, and asks if there is anything else. This right here is what one might use in a rational, logical argument regarding whether or not to report him to the board, but of course it's the kind of thing that never actually comes up. Derek sits down and tells Richard he wants to help, and when Richard brushes it off because he doesn't get the depth of the offer, Derek repeats his offer and points out that he is no longer operating and the only person he is teaching is Meredith. He tells him that there's no shame in asking for help. Richard isn't amused and tells Derek to help by doing his own job, and asks if there is anything else. Derek spits, "No, I'm done," and then does some champion flouncing out of the office. He could really teach a class on that.
Back at the house Izzie tries to talk to Alex, but he pretends to be fascinated by his breakfast and will only give her short answers. She tells him that Mere said he might be moving on and mercifully, finally admits that she was wrong to blame him for getting her fired and that it wasn't his fault. It's too little, too late -- he tells her he doesn't want to have a big talk and has to leave for work. She says she'll see him there as she's having a PET scan later, and he asks, genuinely worried, if she's okay. It's the only time he softens during their exchange, and it's sweet that no matter what happened or will happen between them, he does want her to be healthy. She tells him that she applied for some jobs and just wants them to know she is healthy, and mentions that one commuting distance away, in Tacoma. "So... we'd be okay." She tries to start a Deep Conversation again so Alex leaves, telling her that it sucks these days and she should be happy she doesn't work there. It's not the time for that joke, and he apologizes, but she puts on some false bravado and tells him it's fine, she's going to get an awesome job in Tacoma and he'll be jealous. Even though she seems nervous when she tries to talk to him, it's kind of gross how she clearly just assumes that everything is going to work out okay just because she finally came back to town and said she was sorry, like that is going to erase everything that happened.