It's nighttime. Addison is still performing the C-section on Noel. There's quite a crowd gathered to observe, both in the gallery and on the floor of the O.R. She tells George that she's ready to make some incision or other and that his job is to move the top uterus to the side so she can reach the other one. And then she tells him that she has two minutes to get one of the babies out and that if he moves the uterus at all while she's doing that, the baby could easily die. (Which one, I'm not sure.) Nancy is there looking over Addison's shoulder, and Alex is standing nearby as well.
In the other O.R., Cristina and Burke have Mr. Pruitt's heart in a bowl on a table near his body and Cristina is performing the surgery while Burke directs her. They pull this disgusting purple booger of a tumor out of Mr. Pruitt's heart. Nasty, is all I'm saying. Cristina anticipates what the next step in the surgery is, and Burke notes that she's been doing her homework.
Back at the C-section, it's all very gross and bloody and amazing until the fetus in George's uterus (I mean, the one he's holding -- George doesn't actually have a uterus, as far as I know) starts to squirm. And then Noel's blood pressure starts to drop precipitously. George and Addison are both getting panicky, and Alex yells at George to talk to the baby. He pushes his way up to the table and Addison tells him to back off. But he is insistent, and when George doesn't start talking to the baby, Alex leans in and delivers a blow-by-blow of the Foreman/Ali fight of 1974. As you would expect, it works -- the baby calms down, and Addison can proceed with the surgery.
In one of the suture rooms, the Chief is using a suture kit to sew a button onto his shirt. Derek walks up to him and tells him that he's giving the button too much slack. The Chief is wearing those magnifying surgery glasses. Heh. Derek starts to kibitz, and the Chief gives up in frustration, telling Derek, "You sew this on for me, I'll get rid of Addison and Sloan." Derek is eager to take him up on this offer, but the Chief tells him he's not serious. But Derek offers to do it anyway. And then the Chief asks if Derek's sister is planning on moving to Seattle and working at the hospital. You know, if his whole family slowly migrated to Seattle, I bet that would convince him to move back to New York. Derek tells the Chief that he really hopes Nancy doesn't move to Seattle. The Chief tells Derek that he knows how hard everything has been on him (Derek). Derek tells the Chief that Mark was like his brother. Which shines a disgusting new light on Mark's sexual congress with Nancy. They talk about how much divorce sucks and how hard it is to just move on and leave the pain behind. Derek asks what's up with the Chief and Adele. The Chief: "I'm sewing on a button for the first time in my life. What's that tell you?" Derek, with a laugh: "Technically, I'm sewing. I'm just saying." In some cultures, Derek and the Chief would be engaged at this point.