Meredith re-joins the gang in the VIP Lounge as Altman and Hunt brief the delegation from the Vaguely-Rendered Arab Emirates on "the Emir's" condition. He's got a tear in his coronary artery, and when one of the Arabs asks if the tear was sustained in the crash, Hunt says there's no way of knowing, despite Day trying to ask him not to answer that. Altman says they stabilized him with a balloon pump, but they will have to perform open-heart surgery. At this, Jonathan-Charlie's eyes go downcast. One turbaned man asks for reassurances that "his highness" will be operated on by the finest surgeons they've got. Richard steps forward to say that, yes, Drs. Altman and Hunt are the heads of his Cardiothoracic and Trauma units. But they weren't asking Richard, they were asking the state department if these were the best doctors the whole country had to offer. Day starts to say that this is why maybe they'd rather take him back home and operate there (he's eager to get the Emir off American soil, for diplomatic reasons), but Altman speaks up over the resulting discussion and says that they're out of time and out of options -- she is the only person who can keep the Emir alive today. She also says that if they knew her better, they'd feel better about their chances. Credit to Kim Raver for not making that line feel needy or overly cocky. Meanwhile, Jonathan-Charlie pulls Meredith aside and tells her that they cannot operate on the Emir, for reasons which he feels the need to whisper in her ear. She jolts into action and pulls him out into the hallway.
Cut to a rather pitched pedeconference in which Jonathan-Charlie explains to Mere, Hunt, and now Derek that the Emir was diagnosed with an unruptured cerebral aneurism about four months ago. It apparently didn't show up on the CT, but now he's got a blown pupil, so they think it's burst. J-C tells Mere he was sworn to secrecy until after the election, and he's not sure if he's betraying the Emir or not. Meredith tries to reassure him that he's trying to save the man's life, but J-C says the Emir is trying to save thousands of lives. You know, he lives under constant pressure, get it? Mere says she thinks he'll understand. If, you know, he lives. The doctors join Altman, who's looking at the current CT scans, which show a rather sizeable brain bleed. Derek starts giving her shit about using the shock paddles seven times and giving him blood thinners, like she was trying to do anything but get his heart beating again. She tells him to get off her ass, she's apparently got the fate of the entire Middle East on her hands. Derek says he does too, as they're not going to have to perform simultaneous brain and heart surgeries. Altman looks like she's thrilled at the idea.