All of the interns have gathered around Izzie while Lexie presents what they know about Patient X, which is basically just that she had elevated LDH levels. Izzie asks what they do next and when they guess an upper GI, she says that's just what the patient did and throws up a film. She then asks what that tells them, and it feels a little like we should be able to tell something ourselves from the film on the wall, but as happens so often, it means nothing to me.
Cristina and Meredith are handing out the pre-surgery information sheets to the sibs, and Kostas is understandably horrified to read possible side effects such as "dumping syndrome" and "anal leakage." Cristina says in her best "duh" voice that this is a major surgery where they will change the way their entire digestive systems work, but it seems that Megan and Kostas didn't really understand that before the handout. I find that a little bit hard to believe, but... well, better TV and parallel storylines and all that, blah blah blah. Megan expresses just a bit of doubt but Kostas has a tantrum, yelling about how he's got a girlfriend, and he snowboards, and he's president of his fraternity and he's not sure how any of that is going to continue if he's worried about anal leakage. Megan weakly says that this is important to Tricia but Kostas is pissed that Tricia has planned everything in their lives, and if he doesn't want to butcher himself, "She can't make me." Of course Tricia is wheeled back into the room right in time to hear that and she asks if he'd rather die a slow, horrible death like their mom and all their other relatives. Kostas clings to his 1 in 4 shot of being okay and continues to yell while Megan seems more and more conflicted. She says that she didn't realize what a big deal this really was, and she has to have some time to think about it -- all of which clearly guts her older sister.
Richard is trying to schedule surgeries and his mood clearly has not improved as he keeps yelling at the poor nurse doing the writing. He's got a craniotomy and demands to know where Shepherd is but Mark walks up and says that the Chief can't rely on Shepherd, but can Mark do anything? Richard just gripes about how Derek is missing, he has no Chief of Cardio, and he's got, "general surgeons quitting on me left and right." Well, you've only got one as far as we've seen, but okay. [Well, there was Faye Dunaway who got fired/quit recently too, but since she never really did any surgeries, that doesn't seem like too much of a loss. -- Angel] Mark says that this then is a bad time for him to admit that he still can't operate. When the Chief gives him a death stare, though, Mark changes his mind and promises that Richard can count on him. Then, a short balding surgeon -- the anti-Derek, if you will -- says that he can do the craniotomy. After a somewhat rude hesitation, Richard then assigns this Dr. Nelson to the craniotomy and mumbles, "Appreciate it, John." Meekly, Nelson corrects, "It's Jim." Mark then welcomes him to the hospital, figuring he is new, and Nelson has to correct that he's been there for ten years and was the interim neuro chief, "Before Shepherd in his red cape swooped in here from New York." Mark takes a different tack and introduces himself, but Nelson points out that they've met each other three times. I'm not sure if you noticed, but he's forgettable. There will be plenty to make sure you don't forget just how unforgettable he is, though, don't you worry.