April calls Meredith and Arizona in to look at Kyle's scans because it turns out that his lump is something really bad called a cystic hygroma, and it's starting to close off his trachea. Arizona thinks out loud that maybe Stark can take her surgery so that she can operate on Kyle right away, when Stark himself appears after hearing his own name, reminiscent of Voldemort. Arizona asks him about taking her surgery while he looks at the scans and insults the parents for not having gotten this checked out earlier. The girls calmly explain the situation, with Nancy getting Alzheimer's and Mr. Nancy working like a dog to keep their insurance, and say that Kyle is helping care for them as much as vice versa since the family is struggling a little at the moment. Stark takes all of this in and then calmly orders them to call protective services. The girls are all horrified at the idea but Stark is proudly matter-of-fact as he reminds them that the story they just told is of his parents not caring for him adequately. They try to argue but he just shoos them off so that he can use the room for his own patient and flippantly reminds Arizona she has an immediate surgery to perform unless Kyle's airway closes off and kills him, in which case no one will have to call protective services. And while technically he's right, he's so... Stark about the whole situation that the girls all just gape at him, speechless.
Once they get their voices back, they discuss the idea and Arizona wonders if they should just call and have a social worker say a quick hello to placate Stark. I'm amazed that as a pediatric surgeon Mere seems more familiar with the system then Arizona, and Mere points out that once they are in the system it will only get worse. They all agree that the family is doing the best they can and that when Nancy is facing losing her memory they can't also take away her son for the last bit of lucid time she has left. Arizona really doesn't want to stand up to Stark, so April finally pipes up and says she'll do it, figuring it can't hurt to try. Arizona clearly thinks that this can hurt an awful lot, which I guess is why she's not trying herself, but doesn't say anything.
She at least goes with April to confront Stark but before they can say anything he cuts them off to say he'll take Arizona's surgery and to work out the schedule with his assistant. He has an assistant? I don't think any doctor we've met yet has had that perk. That was one successful contract negotiation on his part, it seems. April then tells him they don't want to call protective services because they don't want to pull the family apart when Nancy has little lucid time remaining. But Stark is ready for them and points out that they only take the child away when said child is in danger. April makes the mistake of saying that a social worker could have a kneejerk reaction to the situation so Stark does what he does best, which is hoist himself up on his high horse where he can proclaim that he knows better than anyone else. He trips up April by asking her if she thinks these people are idiots and then gives a lecture on how being a social worker is a thankless job because they are branded as heartless for only trying to do what is best. When Arizona says that Kyle isn't being harmed Stark just asks if she's sure beyond a shadow of a doubt, and when she has no answer to this he tells her to be a good example to her residents and make the call. She just swallows a response that would probably only have gotten them all in deeper.