Catherine, Mara, Richard and Bailey are all in to talk to Irene, their bladder recipient. Catherine is still gleefully flirting away with Richard as they assure Irene that after surgery she won't have to worry about peeing every time she laughs (or does basically anything). Richard tells her that she's going to live a full life once they are done with her and Catherine turns and saucily says that she likes to think everyone lives a full life once she's done with them. Bailey raises her own eyebrow at Richard. Seriously, did they have someone come in before this episode and give Skeptical Eyebrow Lessons?

In the OR, Lexie successfully pulls off a piece of Lori's skull (ew) and gets compliments from both Derek and Meredith on her work. Mere is basically just observing as this is Lexie's first solo cyst drainage; she's there as cheerleader. And as Derek's unenthusiastic plaything, I guess. They are interrupted by Callie who needs Derek's help immediately on an emergency spine surgery but Mere assures him that they will be fine and tells him to go. As he leaves, he reminds Meredith that Lexie knows what she is doing and Mere is just there to observe.

Jackson is giving the dullest, most monotone tour he can and is dismayed when Mara gets excited at the idea of sitting and watching a little bit of a surgery from the gallery. He tries to take his leave but she keeps talking to him and casually asks if he is still dating anyone. He notes her use of the word "still," and instead asks her about herself. It turns out she has more in common with him than he could have guessed since her father is the Director of Surgical Science at Oxford, which is naturally then where she started her own studies that eventually led to her studying under Catherine. Unlike Jackson she seems to appreciate the boost she's gotten from her family name, telling him it was a little hard work and a lot of good timing. She's quite likable but he's determined to be sullen and tries to sit and study with his flash cards until the realization hits him that this is a setup. Mara sees THE Derek Shepherd walk in the room and gets all twitterpated but when she turns to ask Jackson if they can stay and watch THE Derek Shepherd work, she finds that he's gone.

Meanwhile, Tommy's surgery takes a turn for the worse and Alex quickly does an ultrasound and realizes that his brain bleed is getting worse and he needs surgery on it right away. Arizona tells him to go get a doctor who isn't Shadow Shepherd and whose name I don't recognize, but Alex is insistent that Derek has to do this and sprints off to the other OR to get him. Teddy and Arizona share a look that might mean Arizona is starting to see that Callie could be right.