He makes his way to the gallery and sits down next to Smash to observe from above. Smash is almost giddy over the awesome technique she's about to use, which he starts explaining to Derek until he kindly tells him he's got it, and holds off on pointing out that he's the real brain behind this operation. Ba-dum-bump. Don't forget to tip your waiters, ladies and germs. Pretty quickly something goes wrong and Ramsey's attempt to fix it is of course totally wrong. Derek runs downstairs and into the OR to yell instructions at her and while she follows his first recommendations she then thinks she's got it and uses a different technique than he suggests to stop a bleeder. She has one moment to bask in her success before the patient codes because she somehow doesn't yet know that Derek's brilliance is never to be questioned. This must mean she's a sub that's filling in while he is gone, and also that she's been living under a rock until now to not know to follow The Brilliance of The Shepherd.
After he tells the story to Mark, Mark assures him it's not his fault she couldn't do the surgery but Derek is pissed because of course, he could have pulled it off without a hitch if he has both his mitts in working order. When Derek starts to despair about never operating again Mark reminds him that he's the original Champion of Hopeless Cases and it gives Derek something to think about. Mark assures him that he'll get back to 100%.
Some time after that -- they are decidedly vague about how much time has actually passed from vignette to vignette -- Callie examines his hand and is happy with his progress. As he puts his brace back on they talk about his upcoming surgery and he asks Callie her opinion. She is a little bit too over-the-top as she assures Derek that Schacter is "the best" so Derek realizes she might have a different idea for surgery. After pushing her she suggests that he could have a nerve graft, which would be a riskier procedure but, if successful, could get him back to full strength. Derek points out that they risk leaving him with even less mobility, and Callie immediately backs down and tells him he's right, and that's surely why Dr. "The Best" Schacter didn't suggest it. She's floored when Derek replies that he wants Callie to try it. She tells him no and then when she realizes how serious he is, tells him absolutely, without a trace of hesitation, that she refuses.