The merger craziness picks up where it left off last week, but mercifully only Cristina and Callie are really still crazed with it. Callie spends the hour putting off actually talking to the Chief about getting her job back and instead just keeps practicing the talk using Arizona as a sounding board. Arizona finally gets sick of it and knocks a little sense back into Callie so that she faces up to it like an adult. When Callie goes to see Richard, she is the first person to acknowledge that this must be a really hard time for him and that seems to do the trick, as he welcomes her right back to Seattle Grace as an attending. Cristina doesn't have such an easy time of it. She spends the hour skulking around, trying to find (or steal) a surgery and generally freaking out. She finally walks in on Derek and Hunt talking to Mark about a penile implant surgery he's about to do, and without knowing what the surgery entails she immediately asks to get in on it. Delighted, Mark takes her up on it and while she's not happy when she realizes what it is, she manages to suck it up and do the job with dignity, at least. She then goes to Richard and says that as long as there's no good cardio attending to teach her, he might as well cut her because he needs to make cuts, and she needs to learn and isn't learning if she can't actually get on any surgeries, especially cardio. That's left unresolved, but I think it's safe to say that one of the show's best actors isn't going anywhere.
Izzie has a patient who has his own kind of horrible cancer, and when she and Hunt open him up they find he's too far gone to be saved. Hunt closes him up and is going to send him on his way to do the last bit of living he can, but Izzie is certain that since she beat incredible odds, they could do a risky surgery and help save this guy too. The patient is really cool and nice, with a great long-term girlfriend, and of course right before his surgery he realizes he shouldn't wait for the right moment to propose and should just do it as soon as possible. We all know what this means, right? He winds up dying during surgery, and while Hunt takes the blame (and beats himself up for letting himself be talked into the surgery in the first place) he warns Izzie that she can't be both a patient and doctor on the job, she has to just be a doctor and be realistic when looking at the odds.
The star patient of the day is none other than Thatcher Grey. Lexie gets a call from a worried neighbor and finds him in a bad way, so she brings him in and as soon as he gets through the door of the ER, he throws up blood all over Meredith's shoes. Though he has been sober for 90 days, he's in liver failure, and as he hasn't been sober for a year he can't get on the transplant list. Lexie offers to be his donor but she's not a match, and so in desperation she pulls Mere's file and realizes that she is. In tears, she begs Meredith with all her heart to save him, acknowledging that he was a horrible father to Mere but pleading that he was wonderful to Lexie and it would be for her. Meredith thinks about it and finally agrees, but Thatcher at least has the grace to turn her down. She thinks she's off the hook but after a lot of thinking and tears and talking and pacing, she tries again and points out that she's doing this because she loves Lexie as a sister, not him as a father. He accepts, and we have one of the more ingenious ways to write someone out of a show for maternity leave as now Mere will need a month of recovery time after the successful surgeries.
It's a beautiful morning in Seattle, and Mere voiceovers while we see Alex get up (in some very tiny shorts -- good morning, indeed!) and go about his morning routine in the cramped, now kind of disgusting trailer. "We begin life with few obligations. We pledge allegiance to the flag, we swear to return our library books. But as we get older we take vows, we make promises, we get burdened by commitments: to do no harm, to tell the truth and nothing but, to love and cherish 'til death do us part. So we just keep running up a tab until we owe everything to everybody and suddenly think, what the..." It's cut off by a girlish scream. Alex, who had to move piles of crap out of the way just to get to the shower, dries himself off with napkins after nothing else is available, makes coffee, and then brushes his teeth in the kitchen sink. When the water doesn't work he instead uses an old beer to rinse out his mouth. Ew, that visual makes me now need to rinse the taste of vomit out of my own mouth. Once he's dressed, he opens up the door and sees a bear up on his hind legs, thus the screaming like a girl, matched by a roar from the bear.
Because she's snotty and she sucks, Izzie asks him (once he's at work) if he is sure it wasn't a deer, as the bucks can get really big. Alex isn't in the mood and as Izzie pauses to tell a patient to ice and elevate something, he yells about how he had to throw a raw steak and run in the other direction just to get to his car. It's always classy when they yell in front of the patients. Again, Richard -- maybe make a note, if you're trying to improve things. He declares that they have to move, but over another patient she asks him where they'd go as they barely make $30,000 a year. The patient is remarkably expression-free for all of this. Alex suggests going back to Meredith's, but Izzie won't do it since they are married and making a new life for themselves. She then tries to sell him on how great it is to be around fresh air and birds, but he counters that he loves plumbing. It's at this point that they go to the end of the bed and talk in hushed tones, and Izzie tells him that while she loves it at Meredith's, she can't move backwards after everything that has happened. Seriously? That's private but your salary isn't? Alex just grudgingly nods.
The Chief is meeting with his attendings in a conference room, and a great breakfast spread has been laid out on the table. He tells them he knows things aren't easy and that they want answers, but he doesn't have them. Great, I'm glad we've had this meeting, bye! Derek tells Mark that Richard only did this to make himself feel better, and when Mark points out the good Danish Derek asks him if he knows how many nurses were fired for that Danish. The Mercy West people are going to be there in three days, which means more layoffs, and Richard asks them all to be leaders, promising answers when he has them. Every single person starts to yell questions and he just tells them if they'd like to make an appointment to discuss, they can. A bemused Derek watches all the chaos and then grabs himself a tasty pastry.