Izzie's still running ragged on the floor when she gets beeped and runs off to find the bypass patient being given CPR by nurses. The patient is crashing and the resident is unreachable. The wife starts freaking out and Izzie orders her out of the room as she tries to figure out what to do. The guy has a huge clot and he's going to die before anyone can come to save him. A nurse states that Izzie's going to have to cut him open right here, right now. Izzie says she's never even seen it done before; she could kill him. "You could kill him if you don't," says the nurse. They start prepping Izzie for surgery as she does what I would do in this situation; namely, close her eyes and go, "Oh god oh god oh god oh god."
The nurses walk Izzie through the reopening of the bypass stitches. She has to crack the chest, something she's never done before. Some time must pass during the DVD's version of a commercial break, because we come back after the fade out to Izzie up to her elbows in the guys chest and asking for suction. The guy's flatlining when Izzie finally decides to try and grab the clot by hand. She nabs it and it's a huge one. But he's still flatlining. The nurse tells her that she has to massage the heart. Izzie massages it by hand and, of course, they get a pulse. Izzie did it!
Annie Get Your Tumor's OR. Shepherd's surgery went so well, he's decided to check in with Burke's. Unfortunately, Annie's going through blood like Paris Hilton goes through STD tests. Shepherd marvels at the hugeness of the tumor and ponders how he's supposed to get around that large artery they were discussing earlier. Shepherd steps in and gets to work. Up in the peanut gallery, Mere enters and wonders out loud how Annie lived like that. Alex, who basically has been sitting here not doing his goddamn job for, like, ever, tells Mere to watch what she says because you never know who's listening. He then giggles at how George looks like he's about to fall into the body cavity and Mere asks him if he's really as callous and shallow as he seems. "Oh, you wanna go out for a drink later and hear about my secret pain?" he asks. Heh. Mere goes on to say that she can't go out with him, mostly because she doesn't want to, but also because she might be seeing someone. Who might that be, Meredith?
Down in the OR, Izzie enters and reports what she had to do to the bypass patient. The whole room practically falls down in surprise. She explains what the guy had and what she did and Alex runs down to talk to her as Burke leaves Annie to go check on the patient. Alex shouts at Izzie that she opened up a damn heart patient and couldn't even page him? "Needed allll the glory for yourself, huh?" Izzie shouts back that she paged him fifty times and does he have ANY idea what she's been through? Unfortunately, they're standing right outside the damn OR yelling at each other. Way to be professional, dudes. Alex checks his pager and sees the dead battery signal and says he forgot to change it. "You forgot?" seethes Izzie. "You are hateful!" She grabs the beeper and throws it to the ground and stomps on it. "You are a hateful, hateful, lazy, arrogant, hateful man! Hateful!" She storms off. Inside the OR, Shepherd says, "Never a dull moment here at Seattle Grace," just as Annie's artery suddenly starts gushing all over him. Alex watches from outside as everyone is scrambling to save her. Annie's out of blood and none's coming any time soon. Shepherd asks what Bailey cut, but she says she didn't cut anything; the artery walls were just too weak. "Annie, come on," says Alex. He then runs down the hall and intercepts the O-negative blood that's on its way to Annie. She's flatlining. Derek tries to save her but it's no good. She's gone. He declares the time of death and leaves the OR just as Alex walks in with the blood and sees that Annie's dead.