Jackson gets ready to start his surgery but he hesitates once he's standing over a tiny baby's face with a blade. Arizona realizes that he's not ready but instead of shooing him away, she coyly starts to talk about how this surgery will shape the rest of this boy's life. He could wind up awesome and happy, or could die alone and unattractive. She gets right under Jackson's skin and then, when he still hesitates, quietly asks if he wants her to call Mark.
Meredith is doing well and gets to the point in the surgery where she needs to pick a clip. She looks back and forth from her choices to the guy's open brain and finally picks one up. Derek doesn't even ask and certainly doesn't miss a beat as he orders her to use a smaller one. When she says no, he acts like she just defied the word of God Himself. They start to argue and he continues to order her to put it down while she argues right back that she knows what she is doing.
Cristina might have gotten a little too into making the interns squirm earlier because when she gets to cross-clamping the appendix at the base, she then draws a blank. Teddy thinks she's just being stubborn because she doesn't want to play along and tell Teddy each thing she's doing anymore, but Cristina shushes her and finally admits that she can't remember what comes next. The surgical nurse working with them gives her a very disgusted look over her mask.
Alex has Sam open on the table but once he starts to inspect the bowel, it's obvious that it's totally not viable; what he pulls out is all black and limp and clearly not healthy even to me as someone who is very happy that she's never had to contemplate what her healthy bowels really look like.
Teddy is giving Cristina one heck of a lecture, yelling at her that this is why she needs to have a solid foundation in the basics, and wonders why she would possibly let Cristina replace a valve in someone's heart when she can't remember how to remove an appendix? Cristina just begs her to shut up so she can think.
Alex finally gets the dye injected and has them turn off the lights, but only a little, tiny, few-inch-long piece of bowel lights up and April says sorrowfully that they don't have enough to work with.
Derek and Meredith are still arguing but she is also concentrating on her surgery. When she just moves ahead with using the clip she wants to use, Derek's head nearly explodes as he screams at her. He's a consummate professional.
As evening falls over Seattle, it's time for Mere to test out her handiwork. She does, and after a few beats of tense music, declares that it is holding perfectly. I would have found it very hard to not turn and add, "SO THERE," to Derek, or at the very least to not stick out my tongue at him behind my surgical mask.