So let's get this out of the way, shall we? While Bailey and Mere are performing a surgery, their patient WAKES UP. I thank goodness I didn't really connect with the patient in any other way so that I could remove myself from this a little, as it's definitely near the top of my, "No seriously, this is one of the scariest things I could literally ever imagine" list. Anyhow, Bailey and the new anesthesiologist fight a lot about it (and since this is television, I'm sure this will lead to luuuuurve down the line) until they get test results that the woman's body doesn't react like most people's to the anesthesia and as it's something they never could have known beforehand, neither of them is at fault. That turns out to be a good thing as she needs a second surgery, and this time they will be able to keep her under, but she will only agree to it if Meredith does the surgery and Bailey doesn't lay a finger on her. Meredith is terrified -- I guess when she's not covering up the Chief's drinking problem, she has a better perspective of where she is in her medical training -- but Bailey convinces her that she can do it, and all goes well. The anesthesiologist, meanwhile, tries to get Bailey to apologize for blaming him for the debacle, and she finally gives him as close to an apology as Bailey can give.
The whole situation is a bummer for Derek, as it is his first day as Chief of Surgery and now he has a lawsuit looming. The general consensus is that he threw Richard under the bus (though no one actually knows what really happened) and the rumors fly about people potentially losing their jobs when he cleans house. He also has to go through a meeting with Jennings and Richard, in which Jennings offers Richard an early retirement settlement, while Derek offers Richard the option of going to rehab and then working to get his life in order so that he can then take back his job. Richard takes time to think about it, which amounts to moping in the conference room all day, broken up only by a fight with Derek which almost everyone witnesses on account of the phenomenal number of windows throughout Seattle Grace. Bailey finally goes to see Richard to give him a bit of a pep talk, and he admits that he is an alcoholic and that he's not sure he's really ready to give up the sauce. She gets through to him somehow, though, because that night he gives Derek the paperwork to sign himself up for rehab. Derek, also having learned a lesson from Bailey that day about apologizing, tells Richard as he leaves that he is sorry, and though Richard doesn't say anything, he pauses long enough to show that it got to him. Derek then goes to apologize to the patient who woke up earlier, hoping that will help convince her to not sue the hospital.
That is actually the overbearing theme of the entire episode -- saying sorry. Alex is on rotation with Arizona and they have a kid with nebulous abdominal pain whose dad thinks he is faking it to get out of school and who doesn't want to pay for exploratory surgery. Alex convinces them to go through with it and they find nothing, but when the kid is recovering an artery bursts and it turns out he had some horrible heart problem that they are able to fix as he was already in the hospital when it happened. The dad then switches his wrath from his son and the not-actually-faking and turns on Alex, so Alex just yells back things that are all true but that aren't actually appropriate for a doctor to say to a parent. Arizona reads Alex the riot act and sends him off to apologize, but not before getting him to admit that it feels awesome to have saved a life and also that peds is actually a hardcore specialty.
Teddy, still feeling weird about the whole Cristina-offering-Owen thing, picks Avery to be on her service but clearly finds him inferior to her protégé. Cristina is upset to not be working with her, but she's kept distracted for much of the day by Owen, who is making sure they have sex in as many different locations as possible in a single day, one of which actually results in a rather spectacular sex injury. They are busy getting it on when Teddy is working on Arizona's patient, and rather than have Avery help she pages Cristina to the OR. But Hunt convinces Cristina to ignore Teddy's page for some hot loving, and after some inner struggle, Cristina agrees. When she finds out what she missed, she gets super pissed at Owen and storms off. Owen, meanwhile, has heard a bit about Burke and their almost-wedding from Mark. (It's all Mark has to offer as he spends the rest of his time stewing in his own hypocritical juices, ignoring Lexie and getting mad at Callie when Callie points out that Lexie might not be the only one in the wrong in their situation.) When Cristina gets home she finds Owen in her apartment, and he begs her to open up and let him really know her, and asks about Burke. After a little while, Cristina admits that Burke took a lot from her, and she changed who she was for him, and now that she's back to herself she has no plans to do it again, though it happened when Owen convinced her to ignore Teddy's page. These two, however, are awesome, and they are the only couple that actually works through their problems, (as opposed to just pulling out the "Post-It" trump card when it suits them) so it seems like this is something that now they can start to work through. Look, if you can make it through your boyfriend trying to choke you in a PTSD haze, I think you can make it through almost anything.
Watch Cristina's Burke meltdown.
When you take over your former boss' office, you not only take over his job, you take over voiceover duties. Derek is standing in his new office among boxes of his things, and he's trying to decide which tie will look more chiefly. "We ask a lot of our patients. We put them to sleep, cut them open, poke around in their brains and guts with sharp instruments. We ask for their blind trust." Mere walks in with two coffees, which is more welcoming than the actual look on her face, which is still rather wary. She tells him to pick the blue tie that brings out his eyes, though Mere, you're the only resident who is worried about his dreamy eyes anymore. Derek is thinking out loud as he tells her that the staff lovea Richard and will think that Derek stabbed him in the back and be mad just like Meredith. She agrees that she's mad but also tells him she knows he will be a great chief. Derek safely VO's, "Irony is, trust is hard for surgeons. Because we're trained, from day one, that we can't trust anyone but ourselves." Oh, is that the excuse we can use for why all these couples are never able to actually function for an extended period of time? The learned solidarity?
Cristina and Hunt are still trying to buck the trend and function as a couple, and they're currently doing it with some really hot sex as Derek continues, "The only instincts you can count on are your own."
The residents are all heading to hear what New Chief Shepherd has to say, and the newbies are trying to find out what Alex and Lexie know; they don't believe that Lexie doesn't know more than they do. Alex snaps, wondering if they have their own friends to talk to, which I love as a meta comment on how, for the sake of the show, these people are mingling all the time that honestly would still probably be keeping more to their own circles in real life this soon after a merger. Charles is there to yet again do nothing except be a one-man Greek Chorus of sorts, asking questions or giving pointed comments to move us along. He says that he heard Derek is going to clean house, and this starts a bunch of sniping between the Gracers and the Westers about who would be cut. Alex figures he's safe on account of his being Derek's roommate and figures that, since Shepherd hated the merger, he'd cut the Mercy Westers first. Lexie says this isn't true because Derek is loyal and fair but Avery just chuckles and predictably points out, "Tell that to Webber." Derek VO's, "The only skills you can count on are your own.