Arizona trots up to Alex and asks him to sign papers that would release Zola's records so that she can be transferred to Seattle Presbyterian. While she was obviously hoping he'd just accept this with no fuss he instead has a fit, despite her protests that this is a pretty big conflict of interest to have her at the hospital where Meredith and Derek work. Hey, it only took social services weeks to figure that out, too! No wonder Mere and Derek are still waiting endlessly. He grabs the paperwork away and yells about how they shouldn't be taking her from her doctors, then walks away and tells a doubtful Arizona that he'll take care of it.
Derek and Lexie's patient is a teenage girl who came from San Francisco to see the great McDreamy and his magic hair and hands herself. She has a somethingbadsoundingtoma which Lexie explains is a non-cancerous tumor sitting on the girl's hypothalamus. I don't ever want an anythingtoma sitting on any part of my brain with that many syllables, cancerous or no. They go inside and see that the patient is having a seizure but her mom is calmly holding her, clearly used to this. She's having more and more seizures each day and her mom, only known on IMDB as Mrs. Baer, has done her research on Derek. She knows he has an amazing success rate with surgery and wants him to do this one. Derek tells her that with the current accepted procedure he can only get part of the tumor, but Mrs. B just wants any measure of relief that they can get. Derek, however, wants to try a different procedure he thinks can get the entire tumor. She points out that none of the eight other neurosurgeons they saw suggested this procedure and he admits it's never been done before. She asks about the risks and Lexie takes her through the awful list of thing like memory loss, stroke, or, oh, death. But then again, isn't that a possibility with most brain surgeries or even really, any surgery, period? Mrs. B is absolutely against it, and so Derek asks to see the list of surgeons that she has seen and then politely recommends one of them to do the surgery before wishing her luck and leaving.
Owen finds Derek to ask him, rather reasonably, why he just heard from a mother that Derek is refusing to treat her daughter. Derek has his prissy pants hitched up high and mightily and tells Owen he thinks he's amazing enough to try out a brand new surgery on the girl and everything else is wasting his time. I'm not paraphrasing as much as you would think. Owen is not pleased since these people got on a plane specifically to be treated by the Great Derek Shepherd but Derek staunchly refuses, saying the tumor will eventually grow back if he does the old-fashioned surgery. His reasoning is that his daughter was taken away and now all he can do is sit back and hope for the best, so he refuses to do that in other areas of his life too. Owen is still not impressed, and tells Derek that this isn't a hospital that sends patients home. Derek thinks a moment and agrees... that he's going to prove to the mom that his brand-new brain surgery technique will work.