Diaper Dandies

S06E07

Derek's got voiceover duty, since Meredith is still on bedrest. He talks about surgery and appreciating the quiet and finding inspiration and whatnot. Then a Seattle Grace employee named Isaac comes to Derek for a consult for a complicated spinal tumor. Turns out that they are his scans, and it is a risky surgery. Everyone wants in on it, as it could be the "big one" that makes a career. Chief, continuing to be a short-sighted idiot, tells Derek no, because if the guy ends up paralyzed he might sue. Isaac is at peace with being paralyzed, he just wants a chance to live. So Derek does it against the Chief's orders. He gives the residents a test to see who could handle a microsurgery. Dr. Avery wins, much to Cristina's dismay. Derek gets Lexie to be his "bitch." She wears a diaper in order to survive the possibly day-long service. Derek stares at the tumor for 10 hours before the Chief puts a stop to it. Isaac insists that he will come back and do it tomorrow.

Derek goes home and explains the problem to Meredith, drawing the entire spinal cord on the bedroom wall in what looks to be permanent marker. He returns the day, lies to the chief that they are cutting the cord, gets all the other attendings to cover for him and proceeds to cut into Isaac's lower back. He stops to puke, but Lexie, in her diaper, gives him orders to get back in there. I like bossy Lexie, and by the looks of it, so does Mark, who is watching her. It all comes down to one blood vessel, Derek makes a highly professional "eenie meenie" decision, and Isaac is saved. Poor Isaac thinks Derek chickened out again, but he's all teary when he finds out that he's cured.

Meanwhile, in jerky Chief land, he's got another brainy idea. He's implementing a computerized scheduling system, but it makes him even more oblivious to what's going on. Especially since he looks like he's having more fun showing it off to some random bigwigs. Then, when Derek tries to make peace and apologize for going behind his back, he fires him. Genius! Way to ax the person who could actually bring up those coveted ratings with his groundbreaking surgery. Derek wisely tells the immature ass to sleep on it.

Also, Alex is upset because Izzie's avoiding her IL2 treatment, and he's basically having a meltdown. Surprisingly, Reed's the one who comforts him. Cristina and Hunt share a nice moment as he trains her to master Derek's test for the future, and tries to understand her desire to wear a diaper. Cristina's actually really kind of adorable as she gives Meredith a blow-by-blow of Derek's surgery. And Arizona is my hero for telling the Chief off.

I liked the focus on one big surgery, and a few small personal issues. Also liked the Derek VO. Now if they could find a way to make the Chief less of a bumbling idiot, I'd be really happy. Though, technically he's not as big an idiot as Izzie, who skipped out on her cancer treatment and might die because she didn't want to face her husband. -- Angel Cohn

"Ask most surgeons why they became surgeons and they usually tell you the same thing: It was for the high, the rush, the thrill that comes from cutting someone open and saving their life. For me, it was different. Maybe it's because I grew up in a house with four sisters." Derek takes over voiceover duty this week so that Meredith can sleep in and regrow her liver, and we see him get ready for work and kiss her goodbye.

"No, definitely because I grew up in a house with four sisters, because, it was the quiet that drew me to surgery." At the hospital, he asks a very suspicious Cristina how she's doing, and Cristina is royally pissed that Meredith told him she had been down because of a lack of a "cardio god." She says that once Meredith is healed up, she's dead, but Derek gleefully tells her that she should be happy, because today she'll be on his service. "You need a god! Neuro god, right here." I guess if you're a god, you're not too burdened by modesty. She doesn't really buy his god status, but they are quieted when they reach the surgical board. Everyone is gathered around the Chief, droning about something, and the board is empty except for a piece of paper taped to it. Bailey fills in Derek, that the Chief is implementing a computer model that will schedule surgeries from now on, and that it's supposed to be efficient and money saving or some such bullshit. Well, that last part is just heavily implied by her tone. They tune back in to Richard in time for him to say that he had one of them do a trial for the last month, and then has Mark step up to tell about his experience with it. Mark is totally a showoff as he assures them all that the computer will know them better than they know themselves. Derek speaks up to point out that his schedule has been totally rearranged (he must have guessed this as this is news and there's no way he can read that paper schedule from that far away) and asks the Chief if they haven't already had enough change lately. Richard cuts him off to say, no-nonsense, that change is good. "Embrace it." He walks off, which serves as a dismissal rather than actually wrapping up his presentation, and Bailey turns to Derek and tells him the two men have to stop arguing. "It's unattractive." Derek just glares.

"The operating room is a quiet place. Peaceful. It has to be in order for us to stay alert, anticipate complications." Reed is doing yoga and seems to be trying to piss off Alex by blocking his locker. She's successful, and just maintains that she's sore from doing surgery all night. Unsurprisingly, Alex doesn't care -- and seriously, this is an empty locker room, with plenty of other places to do yoga. She reluctantly moves away as Cristina walks in to tell Alex that Izzie hasn't called in to confirm her IL2 appointment for later that week. Alex acts like he doesn't care, so Cristina lowers her voice, and with a glance at Reed, reminds Alex that this is his wife, and she could die. Alex says she'll show up: "She's a crappy wife, but she's not an idiot." I feel like we've seen countless episodes that would contradict that statement, but fine. Cristina gives him the time of the appointment and leaves, and Reed calls out to him not to worry, "Being ditched by cancer wife won't change my mind. You're still a douche." Clearly these two are going to hook up at some point, right? With the hate that turns to passion?

"When you stand in the OR, your patient open on the table, all the world's noise, all the worry that it brings, disappears. A calm settles over you, time passing without thought. For that moment, you feel completely at peace." A lab tech named Isaac, who we have never met but who seems well-loved, comes in to show Derek some scans. They are of a monster spinal tumor, and while Derek has seen this type before he's never seen one this big -- it's worked its way up the spinal cord and taken over the blood supply. Derek is surprised to learn that the patient is still walking considering that he should very likely be paralyzed or even dead with this tumor. Isaac asks if he'd have to operate quickly and Derek tells him that while he'd love to operate on it, he'd have to cut the spinal cord to kill the tumor. He then asks Isaac who the doctor is and is stunned when Isaac tells him, "You," with a lot of dramatic drum music to back him up. Isaac admits that these are his own scans, and he wants Derek to take it out. There's a lingering shot of the giant spidery tumor on the scan that stays on the screen while everything else fades to white for the title card. They're getting fancy this season!

Isaac explains about the various wrong diagnoses he got from different doctors, and how when the pain finally started to affect his work, he did an MRI on himself. Derek tries to tell him that he never would have been so candid if he knew, but Isaac cuts him off and plows ahead. What he liked is that Derek was inspired rather than defeated by the tumor. Isaac then admits that he researched all of the neurosurgeons in the country to find one that was both the best and who took risks. Derek fit the bill, so he got the job at Seattle Grace. He's very lucky that all worked out for him given that the hospital has no money and just laid off half its workforce, but I already really like Isaac so I'll ignore all those niggling details. Derek tells him that he can't do the surgery, as it would kill Isaac, but Isaac just tells him to think it over, and to "Think yes!" During this whole talk Derek had been getting and ignoring pages, which turn out to have been from Cristina, who storms in because he's late for a procedure. She sees the scan of the tumor, however, and excitedly declares, "Screw the shunt, let's operate on THAT."

Derek is pondering, furrowing his brow like a champ. Mark (who looks weirdly baby-faced when he's more clean-shaven, and I don't like it) thinks he's just considering this so that he'll look awesome and then be back in Richard's good graces. Derek tells him it's just about the patient and that he hasn't even made up his mind and he's still pondering when Callie walks in, upset because she heard the news about Isaac. Cristina reverentially shows her the scans, calling it "awesome," but Callie of course finds it not actually so awesome. She can't believe Derek would consider trying to take it out, but Cristina, in an about-face from that morning, sings Derek's praises because clearly she wants in on this. Arizona then comes in, also upset. I said I was going to let it go but I can't help but again point out that this is someone we've never actually met, and they are all acting like he's their best friend. It's not the smoothest thing they've ever done on this show. Lexie is the to show up, but she's more like Cristina in her awe of the tumor, and she tells them that she read about a spinal surgery like this that lasted 17 hours, and the surgeon had four rotating assistants. Cristina calls her off, reminding Lexie that this is her case. When Hunt sticks his head in and mentions Isaac's name, Lexie's awe turns to sad shock. All of them are quieted when the new scan shows up -- I guess Isaac's been in the room having an MRI this whole time -- and the huge tumor is shown in all it's giant, fingered glory. Richard then sees them all and sends them scattering like pigeons back to where they are supposed to be, as he doesn't want his schedule messed with on the first day. Because as always, this is All About Richard.

Derek runs into Isaac in the hall and tells him he still hasn't made a decision, but Isaac just pleasantly replies that he's a patient man. Derek then goes back in to stare at the scans some more and finds Bailey admiring them. He wants to know what she thinks, and she asks if he's looking for a fellow attending answer or a fellow surgeon answer. He wants surgical, so she tells him that this tumor is dangerous, but sounds impressed as she also calls it smart and admits this type of thing is why she got into medicine. She tells him that if he was able to remove it, he could hang the rest of his career on this surgery.

Derek seems to have decided he wants to do it, but in a meeting with Richard, he's shut down. Because everything Richard does nowadays is out of fear for his own skin, he claims that the surgery is a malpractice suit waiting to happen, and argues that insurance might not even pay for it. When Derek tells him that this is an employee, Richard basically says they can't turn into a charity. Derek asks what all of us has been thinking, namely: what happened to him? Richard turns, instantly combating (yet again) as Derek points out that in the past he would have convinced Derek to do this surgery but now he's doing the opposite. Richard of course doesn't answer, just blusters that as the Chief he just said no, and that his medical opinion is also not to operate on an inoperable tumor. Derek tries to argue but the Chief just cuts him off and starts yelling the same thing. Derek just stares, and the Chief snips, "It's a tough job, Derek, sure you still want it?" OH MY GOOD GRAVY, for the millionth time, Derek saved your freaking job, he didn't try to take it from you. The only reason he would maybe do it now is because you're an inept, pathetic excuse for a leader who is running the hospital into the ground.

However, at home that night when Mere asks Derek what he did, Derek tells her that he scheduled the surgery. The look on her face says that this might not be the best idea ever.

Derek has gathered a bunch of residents in the skills lab and tells them about how microsurgery is all about precision (wow, really?) and that the microscope changes your perspective. He says that this can be taught, but with the surgery imminent he needs someone who is a natural. He has a Styrofoam cup with a hole cut out in the bottom, and places it top-down on a dollar bill. Looking through the microscope, he puts a pen into the hole and then holds up the bill to show that he made a red dot on George Washington's nose. He tells them that the one who gets the closest to George's nose is in on the surgery. Cristina makes a great show of yawning and stretching through everyone's turns, as each gets up and blows it. It's a montage of failure, basically, and Derek looks worried. Then Avery is up, and he hits right to George's right nostril; clearly he is the frontrunner for the assistant position. It's then Cristina's turn -- she's last up -- and she's super cocky as she goes and gets into position. Unfortunately, she then hits the cup with the pen, not even getting it in the hole, much less near George's nose. Everyone, including Derek, looks surprised, but none more so than Cristina. Avery just basks in his own glory since he gets the job.

By Lauren S

However, at home that night when Mere asks Derek what he did, Derek tells her that he scheduled the surgery. The look on her face says that this might not be the best idea ever.

By Lauren S

The day, Mark sidles up to Derek and says he heard that Derek went rogue. Derek tells Mark that he's just doing a surgery he believes in, but I think there's a little bit of neuro god ego there too -- Isaac did a good job tapping into that to get the desired result. Mark, on the other hand, thinks he's just trying to piss off Richard, and Derek asks when Mark and Richard became besties. Seriously. Mark just says that he's the chief, and Derek mutters, "For now." I guess this means maybe they will have him gunning for the job sooner than later. Callie and Arizona come up and ask if he went rogue, having basically the same conversation. Derek points out that the computerized schedule says he is doing a craniotomy, so Richard won't find anything out. Arizona shuts him up since she is bad with secrets, but Callie compliments him on his badassness and then the ladies walk off. Lexie then walks up, completely offended that she wasn't asked to the skills lab to try her hand at the pen/George task, reminding Derek that she is his sister. Interestingly, she rubs it in repeatedly but never adding the "in-law" at the end of that. Mark reminds her that she's on his service, and Derek then says that if Mark will let her, he had a special job in mind. He needs someone to watch over him, remind him to take breaks, bend his legs, and drink water; basically, she would be his doctor. Lexie is thrilled, and Mark of course lets her off of his service, telling her, "Go get your rogue on."

An excited Lexie gets a drink from the vending machine, to where Avery is getting a snack. Lexie makes small talk about being nervous to be in the OR that long, but Avery is just a completely cocky ass and asks why she's nervous since Derek didn't even let her compete. When Lexie tells him about her special role as Derek's doctor, he snickers and says that he thinks it sounds more like Lexie is his bitch. What is it with these Mercy West people and being someone's bitch? She just points out that Avery is going to need to take a bathroom break and when he does, she'll be there to take over. Avery just responds, ultra-confident, that he doesn't take breaks, and that he's lasted that long on a surgery before -- for starters, he knows to stop taking fluids beforehand. With that, he points to the drink Lexie is sipping and tells her to have fun playing nurse. Lexie's pissed, but then notices a supply rack nearby and looks at something with interest.

By Lauren S

Cristina is on the phone with Mere, bitching about how Izzie might have had the right idea. As she paces, she looks through the window and sees Lexie holding something, so she says she'll call right back and runs in.

Inside, she demands to know if what Lexie is holding is what Cristina thinks it is. Lexie says no and tries to hide it, but Cristina runs around and grabs it -- the diaper that Lexie has been contemplating. Lexie defends herself and is ready to be teased, but Cristina actually thinks that it's a genius idea because then she wouldn't have to leave surgery and yet could hydrate all she wants. Lexie can't really believe she's serious and so she says it's not like she was going to use it -- Cristina orders that of course she will, because it's hardcore, like the astronauts. It would be too easy to reference that poor astronaut who drove all night to confront her love rival, and did it in a diaper, wouldn't it? It would. Cristina orders her to put it on and offers to guard the door.

With a lumpy butt under her scrubs, she helps wheel Isaac towards surgery, all the while fidgeting with her undergarment while Avery shoots her weird looks. Derek warns them that if anyone says anything, they are fired, including a cheerful Isaac, and then they walk past the surgical board where Richard is showing off the new system to some board members. Richard says that this must be Mrs. Taylor for her craniotomy, but Derek just tells him that it's Mr. Taylor, and Richard assures the board they are working out the kinks. For someone who considers himself involved, it's interesting that he doesn't recognize Isaac, considering how invaluable he seems to be to everyone else that works there. Derek then wheels him along, brown-nosing that he wants to keep everything on schedule.

Once in the OR, Derek tells Isaac that if he gets in and it's too dangerous, the responsible thing to do would be to close him up. It's kind of a weird maybe-kinda-question, and Isaac firmly tells him that if it's too complicated, Derek should just cut the cord and paralyze him. He then tells Derek that he survived war and his family dying, including his wife and child dying in a refugee camp, and so he can also survive the loss of his legs if he must. He's relentlessly upbeat through this whole speech, and tells Derek that there is always a way, even when it looks like there is not, and that he and Derek are both people who are inspired when something looks impossible. He then offers one piece of advice, "To the world's foremost neurosurgeon." If he becomes frightened, he should turn that around to become inspired. It feels reminiscent of some outstanding advice from Barney Stinson. Isaac then tells them that he's ready.

Alex is on the phone arguing with Swender's office about Izzie's appointment the day -- it sounds like she still hasn't confirmed, and he tells them to call her cell and begs them not to cancel the appointment. Reed comes up and comments, a little too nonchalantly, that he missed the contest, but Alex just snarks that he heard she tanked it. She brushes it off and goes on to say they are doing Shepherd's rounds for all his cancelled craniotomies. She then offers an olive branch -- that while she'd love to watch the crazy surgery, she could take care of everything herself so he can deal with Izzie. Alex both isn't in the mood and seems to not believe that she's sincere, telling her he had more respect when she called her "cancer wife," which was at least honest. She tells him she's trying to be human, but he claims she's trying to get all the glory for doing everything herself, which makes her the douche. She says she tried, tells him to throw away his marriage, and leaves for rounds, but he grabs the chart out of his hands to do it himself. Good grief, you two, just make out already.

Mark, Arizona and Callie are outside, and Mark watches through the window, and Mark is commenting on how Derek has cracked. They just give him a look, and Arizona reminds him not to be smug since it's one of their own on the table. Callie takes her turn at the window and says that it's depressing that after 10 hours of staring he can't figure out what to do. Naturally, the Chief is right behind her and hears this -- Callie stutters and tries to cover it up, so he glares at Arizona since he knows she has issues with authority figures.

Clearly she caved, because the Chief then walks inside and asks Derek if he cancelled all his surgeries to work on a spinal cord tumor. It's a dumb question, and Derek doesn't say anything, so Richard walks further in and reminds Derek that the risk of infection increases the longer he keeps Isaac open, plus this is costing thousands of dollars for him to do nothing. At least he pretends to care about the patient first, though you know that was just his single smart move of the day because I'm sure the thousands of dollars are foremost in his mind. He demands that Derek close up and leave the OR, and while he hasn't said a word the whole time, after a moment Derek quietly agrees. The Chief makes a point of stopping the surgical clock.

Once Isaac wakes, Derek tells him there was no way to do the surgery without risking his life, and that he won't cut the cord while Isaac is still walking but they can reassess in a few months. Isaac is just as zen as ever, and tells Derek he knows that he worked hard and is tired, and they'll just try again tomorrow. Derek tries to tell him know but Isaac just smiles at him and says, "Go home, sleep on it, we'll talk more tomorrow."

At home that night, Meredith tells Derek that she doesn't understand, and he tries to convince her that there isn't anything to understand -- he stared for 10 hours. He tries to change the subject and asks about her day, so she lets him know that she slept, ate a box of cereal, left messages for Izzie and tried and again failed to read Anna Karenina. He recognizes that she's trying to get back to talking about the tumor and she agrees, so he turns and seems really excited to start to explain it all to her. They go back and forth a bit and he tells her there was no path for him to cut, but when she asks why he has no answer. After thinking a moment, he jumps up, pulls the bed from the wall and then around so that Meredith is facing the space where her headboard just was, and pulls out a Sharpie to start drawing the spine and tumor on the wall. She points out that now he's lost his mind and she's really not wrong -- seriously, who does that, even if they are some surgical (or any other type of profession) god? But she smiles at him as he talks it out and draws on the wall, right underneath their framed marriage post-it.

It's now morning, which we can tell by the birds chirping, the pale light in the window, and the now multicolored and labeled drawing on the wall. Derek is going over how anything they propose could go horribly wrong, so Meredith finally suggests cutting the draining veins to expose the arteries. He tells her that they are thin and could burst, leaving him a quadrapalegic, so he might as well cut the cord. Meredith reminds him that he didn't cut the cord even though Isaac said he could, which, does he seriously need reminding of that? Why not try if the worst outcome is the one he was prepared for in the first place? She goes on that Derek stood there for 10 hours, knowing the Chief would stop him, and there must have been a reason. Sheer panic is not one she mentions, and so Derek thinks it over. There is quite an impressive amount of thinking (and pondering, and musing) in this episode.

Derek, Avery and Lexie are in a meeting with Richard, and it seems Derek told him he wants to just cut the cord. After Richard is assured that Isaac knows what that means, he reluctantly agrees and reminds Derek that it will only take 1-2 hours, and Hunt has the OR right afterward. In other words, it's a way to insure Derek gets out -- as if he thinks he has any control over what these doctors might actually do. He leaves, and Derek turns to his two residents and announces that they aren't cutting the cord. His mistake yesterday was making a plan when there can't be a plan, he has to just pick somewhere and cut. Lexie reminds him what happens if he hits an artery, etc. -- again, what happens is just what Isaac said they could do in the first place. Come on, guys! Think outside the box! Derek tells her that (finally): That Isaac wanted them to take the risk, and they have to try. He leaves, saying he'll see them in the OR.

By Lauren S

Back in Isaac's surgery, Derek makes another cut that results in a ton of blood, some alarms, and lots more panic. Cristina is upstairs in the gallery giving Mere a play-by-play on the phone, while at home Mere follows along with her new wall décor. Derek freaks out as they think they are losing him, and says they should have cut the cord. However, things calm down and it turns out everything is still fine. Derek steps back, and Lexie realizes something is wrong but not what, exactly. Derek yells at her to take off his mask and as soon as she does, he vomits on the floor. Wow, I hope none got in the open spinal cord right there. Everyone is kind of in shock, and Lexie rubs his back.

Everyone is gathered around him and while someone puts a mat over the puke splash, Mark gives Derek a pep talk. Lexie tries to get him to have some water and he gets pretty bristly about it and insists he doesn't need it -- that is, until Lexie yells an order at him to drink it. Shocked, he has some, while Mark looks on admiringly. It's very reminiscent of Alex forcing Izzie to have some water and take her pill, back before she got fired and ran off and made all of our lives more pleasant for a few weeks by not being here.

Speaking of, Alex is waiting in the chemo room, but there is no Izzie to be seen. He looks a bit like a lost little boy as people come and go and get treatment around him.

Hunt comes around the corner from the OR when he runs into the Chief, who is surprised he isn't in surgery. Hunt tries to cover with a story that Callie needed the OR, but Callie of course pops up at mention of her name and all is blown, as Richard realizes this means Derek didn't cut the cord. Callie tells Hunt that Bailey will stop him, but Hunt says Bailey is in the OR. Callie is dismayed because she knows who that leaves, and sure enough, Arizona steps in front of Richard to block his way. He tells her to move but this time, she finds her own inner hardcore badass and holds firm, reminding him that Derek is operating on a spinal cord and that any minor disturbance could cause him to make a mistake. She reminds the Chief that the patient is one of their employees and that she personally also wants to see him saved, "So no. You don't get to go in there and be a bully. Not today, Chief. Not on my watch." They stare each other down, but Richard caves first and walks off grinding his teeth. Callie is thrilled because she thought it would go differently, but Arizona deflates just then and starts to cry, which is more of what Callie had expected.

By Lauren S

Cristina drags her ass up to Owen, standing at the surgical board, whining about having been woken from a nap. He's first surprised and then glad she got the rest, and then shows her their surgery on the board. It turns out it's a huge one that could take 10 to 15 hours, and he happily tells her to gear up. She beams and tears out to get ready, but just then Derek walks up and asks for a favor.

Lexie and Cristina and their hardcore lumpy asses walk down the hall, and the ladies each give each other a nod and smile of respect. Cristina only feels good for a moment, though, because the second she hears Hunt call her name she can tell that they aren't going to actually do the surgery. He tells her that Derek needs the OR, and she shuffles off, mumbling about having put on the diaper. Hunt seems shocked that she actually did that, and I'm shocked that he's shocked -- I figured that's what he knew she was going to do, and how can he still be surprised?

Derek is at the microscope again when Mark walks in, saying he heard he needed the support. Derek is surprised, not really in a good way, but Lexie tells him he needs an experienced surgeon to talk to, and he can't say no because she's in charge and she's prescribing it. He actually accepts this and then thanks her, heaves a big sigh, and makes his first cut. Alarms go off and everyone nearly panics, but then Derek says that the cut was successful -- one down, a whole bunch to go.

Alex and Reed are working on Derek's other patients -- the ones with things like measly brain tumors, not tumors that have basically grown into five inches of their spines -- but Alex keeps looking at his watch since it's time for Izzie's appointment. Reed finally gets him outside to talk to him and points out how distracted he is, and he should go while she finishes up. Alex bristles and tells her to mind her own business and asks why she even cares, and she says basically it's for Izzie. Girl power? I guess? She tells him there's a girl waiting for him, but Alex counters that she's the one who left and didn't even have the guts to do it to his face, then tries to shut Reed up and get back to work. Reed gives up, but not before a parting shot that this time, he's the one making the decision, not Izzie, and he'd better be at peace with whatever comes from that. It's finally what makes him turn around and stomp down the hall.

By Lauren S

Speaking of, Alex is waiting in the chemo room, but there is no Izzie to be seen. He looks a bit like a lost little boy as people come and go and get treatment around him.

Bailey looks out the window and catches the end of the showdown, but when Derek asks what happens she tells him anything out there isn't his concern. The clock goes from 8 hours to 13 hours. Callie is now in there, and Derek admits to her that he can't tell if one particular vessel is feeding the cord or the tumor. He'd have to make a blind cut, and if he chooses wrong the patient could stroke out and die. He decides to come back later, which causes Callie to ask if he really would finish the whole thing only to then cut the wrong vessel and have it be for nothing. Derek's fully aware of this but decides to wait anyway. It wouldn't be my choice, but I'm not a world-class neuro god, so what do I know?

By Lauren S

Sunrise comes 21 hours into the surgery, and he has less than two inches to go. There's new drama, though, when Avery's hands start to cramp. He shakes like a leaf and Derek orders him not to move while Isaac's blood pressure starts to drop, but he can't. Instead, Lexie reaches in, talking calmly, and steadies his hands, ordering him to close his eyes and breathe. Derek then asks him if he has had anything to drink -- he's smarter than the average bear and knows that cramping means he is dehydrated, and that he's dehydrated because he didn't have any fluids, because he didn't want to take a break and give Lexie a turn holding the retractor. Avery has to admit sheepishly that it's true, and Derek calmly tells him not to apologize, but rather to step aside so his diaper-wearing sister can take over.

Hour 26, and it's time to come back to that tricky vein, to choose the red wire or the blue wire. He asks Lexie what to do and she babbles a bit, so he calls her on stalling and asks Avery, who wisely tells him he's not into gambling. He then asks Mark, but Mark tells him he won't let Derek blame him for a wrong choice for the rest of his life. I kind of think that if Derek can forgive Mark sleeping with his wife that he could eventually forgive anything, but Mark's right that it still would be a good amount of time for the blame game. Derek isn't happy that they're making him decide, and there's lots of tense waiting and looking at everyone's faces while they wait. Arizona can't watch while Callie and Cristina get a rush from it, and Hunt points out there's no logical way to make the decision.

He actually resorts to "Eenie Meenie Miney Mo" but when Lexie calls him on it, he laughs a bit deliriously and admits he knows it's a bad idea. There's a whole lot more dramatic shots of everyone's eyes and the drums reach a crescendo... then Derek's voiceover begins again. "Ask most surgeons why they became surgeons, they usually tell you the same thing. The high. The rush. The thrill of the cut. For me, it was the quiet." After a few more beats, Callie yells that he made the cut, and Mere begs Cristina to tell her if it was the right one.

By Lauren S

Isaac wakes after his surgery, and while Derek sleeps in a chair, Isaac wiggles his toes and his face crumbles. He's devastated and keeps moaning "no" waking a confused Derek. He asks Isaac what is wrong (how on earth he didn't guess for himself is totally beyond me, as this was a crazy risky improbable surgery) -- Isaac thinks that he once again couldn't go through with the surgery. Derek immediately corrects him that no, the tumor is completely gone. Isaac can't believe it and asks about his toes, so Derek repeats himself and assures Isaac will be fine. With tears rolling down his face, it finally sinks in, and he asks if he's going to be okay. Derek tells him yes, and after asking again Isaac starts to laugh, and takes Derek's hand, telling him he's a very good man. I really hope we see Isaac again as he's awesome, but even though he's supposedly a well-loved employee, I get the feeling he's really just another Patient of the Week. Oh well.

Derek VOs: "Peace isn't a permanent state. It exists in moments. Fleeting. Gone before we even knew it was there." Alex is still waiting in a darkened chemo room that night when Reed comes in, dressed in some very elfin, pointy boots. She reports on Derek's surgery and that she finished all the pre-ops so everything is good to go, but he just sits there like he did when he first got Izzie's note, kind of broken. He admits that Izzie didn't show up, and then says that she can't be this stupid, as a woeful female voice starts up on the soundtrack. He can't believe she didn't show for something that saved her life and starts to cry, asking, "Who doesn't show up?" Your spiteful, ridiculous wife, that's who. Reed doesn't quite know what to do, and just steps towards him as he sobs. Derek: "We can experience it at any time. In a stranger's act of kindness.

"A task that requires complete focus." Cristina is in the skills lab, practicing with the pen, the cup, and the dollar bills. She has a pile of discarded bills in front of her, and all have a red dot at the edge of George's mouth. Hunt comes in and after watching her, tells her she's standing too close. She refutes this and when he says he'll show her she asks, "You? Look at your hands. They're hams! Mine are tiny little geniuses." It's a relief, though, that this sounds more like Old Cristina -- super contrary, but not filled with straight-up venomous anger at all times. He tells her it's not about the hands and comes over to correct her stance. It's pretty sexy to see him move her body just slightly, and once he makes his adjustments, she tries again and gets George square on the nose. He tells her that if she stands too close, it throws everything else off, which sounds suspiciously like a Lesson we're going to get in an upcoming episode.

By Lauren S

"Or simply the comfort of an old routine." The man behind the voiceover walks up to Richard as he writes up all the surgeries on the board again, old-school style. Derek waits a moment and when Richard doesn't say anything, tells his boss that they can't keep doing this, that he's tired of fighting and they should put it behind them; he can move on if Richard can. Richard's response, however, is to turn around and tell Derek, "You're fired. Immediately. Get the hell out of my hospital." He really is just a pathetic excuse for a leader, clearly threatened and scared and unable to make a single good decision. Derek seems to know this, and his face remains calm. As Isaac told him the day before, Derek advises Richard, "Go home. Sleep on it. We'll talk more tomorrow." He has one moment of real shock on his face but it's only for a half-second, and after he gives Richard that advice he looks both calm and smug. Ah, some things are eternal, and Derek's fantastically large ego is one of them.

"Every day, we all experience these moments of peace. The trick is to know when they're happening. So that we can embrace them. Live in them." He walks into the bedroom with a bottle of bubbly for a delighted Meredith, and crawls onto the bed to her and puts his head on her shoulder. She happily tells him she wants to hear his version of the events from the very beginning, but when there's no answer she realizes he's already fallen asleep. Fair enough, after 26 hours of surgery. She's my kind of girl, though, and opens the champagne anyway within view of the wall that they are now stuck with, with a beautifully detailed, full-color Sharpie mural of a spinal tumor. Derek finishes, "And finally, let them go." Thus ends another surprisingly good episode of GA and, dare I say it? I'm kind of looking forward to seeing what comes . Who could have possible expected that?