He's not actually having an emergency -- rather, he's reading a magazine and wanted to finish up the talk he and Jackson were having at dinner when he fell ill. He's happy that Meredith is there, and she beams until she realizes that he wants an answer to the question he asked her in the OR. He asks her, more specifically this time, if a spot were being held for her at the best hospital in the country, would she turn it down? She stutters, not sure what to say, and Jackson jumps in to explain that Harper has been saving him a spot as Mass Gen ever since he graduated from med school, and that this trip was to try once again to talk him in to accepting it. Harper reminds him it's a great opportunity but Jackson snaps and yells that he doesn't want the spot and doesn't want to work for his grandfather, and that's enough of that subject. Harper, obviously not used to being challenged, yells right back that he decides when Jackson has had enough and while he might be arrogant and overbearing, he's Jackson's only living grandfather and realizes his time could be coming. That time could even be now, as he passes out and alarms start blaring, and Jackson and Mere spring to action and yell for a crash cart.
Once he's stable, a CT shows that there is some sort of complication from the surgery, and Derek tells Harper that Richard is going to fix him. Harper has been weakened but he's still a bona fide control freak and announces that they aren't putting him out because clearly a mistake was made, and he's going to make sure that doesn't happen again. Derek, however, picked up a spine on his way in and tells Harper that this is his hospital and Harper will abide by his rules and will be put under for surgery while Jackson waits outside like any other family member. He adds that if Harper refuses, he'll have him declared unfit to make his own medical decisions. He adds, with quite a bite in his tone, "That is how a Chief does things. Take note."
Out in the hall, Richard is starting to wilt and he tells Derek to have Bailey do it, since he's terrified he made a mistake the first time that caused this. He wants a drink, not the life of a world-renowned surgeon depending on him. He pleads with Derek but after thinking a moment, Derek tells him instead that Bailey will assist, and that two months earlier he would have actually had a drink rather than just admit he wanted one. He pats Richard on the shoulder and says that he can do it -- it comes off less condescending than it sounds, but still has a touch of Derek's infuriating smugness to it. Richard just slumps.