Back in Seattle, he and Meredith meet with Callie and doc named Schacter, who I'm guessing is a well-regarded specialist based on the way that Callie beams and gets flustered when he compliments her work. She shows them Derek's current scans and explains that she went in and cleaned up the job that they did in Boise. Schacter is there to try and repair the nerve damage, and Derek optimistically adds that he thinks this surgery can get him back into the OR. Schacter gently tells them that there is hope, but at least conservatively he knows he can get Derek back to the offensive 80% we heard him yelling about earlier. The others in the room exchange Meaningful Worried Looks while Schacter tries to smile.
At home later Derek tells Meredith that he can teach or consult if he can't ever operate again but Meredith also won't hear that kind of talk from him. Her aggressive optimism is kind of scary. He reminds her that he is at least still alive and Zola still has both of her parents, and as she gives him a big hug he concludes that that is enough. Shockingly, at this moment in time, I actually do believe that he is happy with just that.
When yet another previously-unseen brain surgeon at Seattle Grace needs some help with a tricky tumor, Derek is there to look at the scans with her and Owen. He naturally has a better (and riskier) method than the one she wanted to go with and she is suitably impressed and plans to try it. Owen happily comments that this is why they keep him around and while in text that seems extremely condescending at a time like this, Derek actually seems to take it the right way. I totally don't think this mellow Derek will stick around, but it's a bit of a relief with all of the other tensions in the crash aftermath. The surgeon, Dr. Ramsey, happily invites Derek to join her and there's a rather awkward pause to accommodate the elephant in the room that has wrapped itself around Derek's arm. She invites him to observe but he tells her smoothly that he probably has a class to teach. It has to be an excuse because there's no way he'd have gotten set up with teaching this quickly, but Owen does assure him that he is invaluable.