Alex tells Nikki's husband that it's time to take her to the OR. He replies that he isn't an idiot and he knows what Alex was saying to them, and that there's plenty of bad that they could focus on. But, he counters, there's nothing wrong with the opposite. As he gazes at his wife he says, "There's always hope, too." I hope Alex recovers from being hit in the face with his Lesson of the Week so blatantly.
Derek heads in to see Philip, who is having a brief lucid moment. He admits that he hates not being able to see mainly because he wants to see Jennifer. Derek tells him that he could take some more time to be with her before this ultra-risky surgery. Philip reveals that the reason he's been trying to set Jennifer up is that he doesn't want to leave her alone. He says that leaving her alone is the one thing he can't stand the thought of, and that he wants her to be all right when he's gone. Derek firmly orders him to tell her that before the surgery, while Meredith watches him from afar.
Something about the conversation gets under her skin because she willingly pops into Dr. Amy's office for a moment before scrubbing in. Meredith in surgery could be counted as even more change in the hospital, but as it's a positive step and not the demise of a relationship, it's clearly not worth mentioning. While Dr. Amy watches with her poker face, Meredith rants about how Derek told her not to get her hopes up but that he's the one with his hopes up and anyone that knows her knows she isn't a hopeful person. That's actually some good personal insight there. She concludes that it's no wonder they broke up. She then turns to run off to surgery and Dr. Amy asks, "The surgery with no hope?" With a smile, Mere tells her to shut up and Dr. Amy can't help but smile a bit herself.
The baby surgery has started, and Addison makes conversation by asking who it is that Derek is dating. "Who's the unlucky McRebound?" When no one says anything, she wonders if the Mc-thing is finally dead. Bailey finally decides to save her from herself and declares, "Addison, the woman standing immediately to your right, the one handing you the surgical instruments?" Addie turns and after a second tries to cover and cheerfully says, "Hey!" Rose deftly handles the situation by replying, "Hey! Six dates, heavy petting, lots of tongue. Good guy! Scalpel!" Addison just sighs. She must be liking the idea of L.A. and her messy love life a bit more now.
Izzie has made her way out of the chips and back to her patient, and the husband is ecstatic to hear that they might have a healthy baby. Izzie's pleased and tells them that the risks are "substantially reduced." She adds that they haven't found a doctor for the procedure yet and it might take a while, but is cut off by the furious wife. While the husband thinks they can figure anything out, the wife growls that Izzie didn't do the one thing she was asked, and that she got her husband's hopes up. She explains through clenched teeth that she was diagnosed at nineteen years old and has learned to deal with it but that she won't put that on a baby. She orders Izzie to schedule the procedure and to never come back -- she wants a new doctor. Oh, don't we all, ma'am.