Richard is now 45 days sober, which is awesome, but when he comes back to Seattle Grace he doesn't find his job waiting for him quite like he expected -- Derek reminds him that his being reinstated as Chief is dependent on board approval (which seems to not yet be there) and in the meantime, offers him a position as an attending surgeon. Richard is understandably miffed by the offer, but does agree to come back and give a lecture as part of the lecture series that Derek has revived. He takes us back in time to when he and Ellis were residents with a particularly baffling case. In between their own bouts in the on-call room they realize that their resident might have what will come to be known as AIDS, though in 1982 they didn't even have that name for the disease, much less a test for it. The patient himself won't even be honest with them until things get really bad, but they manage to convince him to let them operate and they manage to prolong his life for a few extra months. When toasting to the guy's memory, Ellis gives Richard his first taste of vodka, and between that and admitting to her that he's not going to leave Adele, we see how he started down his own unfortunate life's path.
Bailey is also chosen to give a lecture, and she talks about a patient who came in with abdominal pain that can't be explained. Her resident has quite the attitude and clearly hates Miranda ("Mandy") and her already awesome brain, and they butt heads during the months in which the patient has various surgeries that all turn up nothing. For her first solo surgery, Bailey even takes out the woman's appendix -- only to discover that it's healthy and not causing any of her problems. Finally, after looking at her patient's whole history, not just her symptoms, Bailey figures out the problem and gives her resident a massive dressing down when telling her what is really wrong. Richard calls her to his office and then has her pretend to look upset while he pretends to yell at her so that her resident can save face, but really he tells her what an awesome surgeon she's going to be one day.
Callie is the third lecturer of the day, and after some ridiculous bullshit about her having massive stage fright, which totally doesn't fit with what we know about her, Alex and Arizona help her tell her story of a patient with horribly misshapen legs, who she promises will walk again. Richard thinks she's reckless for telling the guy so, but she decides to prove him wrong and when Alex comes to her looking to help, she brings him on the case. She thinks he's the intern who performed heart surgery in the elevator, and Alex decides to play along with that and not correct her. After the first surgery has to be cut short, they need to be convinced to continue by the patient himself to continue their efforts, and in his next surgery his heart nearly gives out. Callie tells Alex to do what he did in the elevator to help him out and Alex has to admit that he lied and he totally wasn't the one who did that, but she convinces him that he can do it now and they save the guy. After a few more procedures, they help him to walk and celebrate... by hooking up!! Alex! Callie! That I didn't expect. (And clearly neither did Arizona.)
By the end of the day the doctors have all seemed to learn something about learning from each other and not giving up on the tough cases, and when Richard ends his speech with a shortened Hippocratic Oath, they all give him a standing ovation. Before he leaves that night, Derek comes and tells Richard that the job offer still stands, and Richard says, if only to himself just yet, that we'll see.
"I've seen a lot of surgery residents come and go in my time, and they're all addicted... to surgery." This week's voiceover -- more commanding than we've heard in a long time -- is delivered by Richard, and he's better at it than all of the recent guest voiceovers. And he's way, WAY better at it than Meredith. "It comes before food, before sleep, it becomes the most important thing. The only thing." Bailey is in a fuchsia suit primping in front of the mirror, and Dr. Warren comes up and watches her with a smile. She freezes when she notices him and then orders him away, but he just laughs and tells her she looks nice. She orders him away again and he listens, but then she allows herself a happy little smile once she's alone.
"What they don't know is living on that high can eat them alive." Callie has food poisoning? Stomach flu? It must be something horrible as Arizona is brushing her hair while she sits next to the toilet, crying. Oh wait no -- she's terrified of public speaking and hates Derek for making her speak in front of a giant room full of people. Arizona tries to assure her (a bit weary, having clearly been doing this a while -- I guess she's over needing Callie to be sexy and perfect, the stupidest forced character trait all season, at least until now) that all she needs to do is talk about being a great surgeon. This doesn't seem to help, and when she thinks about going on stage Callie leans in to puke again.
"Some make it through, they come out on the other side. They survive with their sanity intact. They become better doctors and stronger people. I didn't. I broke. I didn't kill anybody, and I give thanks for that every day, but I hurt people. And scared the hell out of myself. I am 45 days sober today. I am Richard, and I am a grateful and recovering alcoholic." The people listening all clap for him; we've been hearing him speak at an AA meeting and really sound more in control than he has in quite a while.
He then goes to meet with Derek, and is not hiding his displeasure at the way things are going. He reminds Derek that he was told that if he went to rehab his job would be waiting but Derek, acting like it wasn't he himself who used this as a selling point for rehab, reminds him of Jennings' "Pending board approval" catch. He says he's sorry, not sounding terribly like it, and then tells Richard that he's been authorized to offer him a job as an attending general surgeon. While Derek isn't my favorite person, and I think he's hiding behind the board here a bit -- isn't 45 days kind of soon to jump back in to running a hospital? I would think that would be something Derek could point out, rather than just mentioning that the board might reconsider in a few months. Regardless, Richard is ticked and turns down the offer to work under his former employee before walking out.