The Elephant in the Room

S06E21

So this week, a miracle occurs. Someone finally realizes that the staff of Seattle Grace Mercy West is one of the most insensitive groups of people ever assembled, and that person is Bailey. She throws together a sensitivity course knowing that a patient who needs it is on his way in, and manages to get a few quick pointers in before the guy, Bobby, is brought to the hospital -- all 700 or so pounds of him. Avery and Cristina are quickly dismissed for their comments and so go to work with Teddy instead. They wind up with a patient who is in the midst of a heart attack, and have to rush her to surgery leaving her 9-year-old daughter with no one since they were just visiting Seattle. Teddy has Cristina stay with her, and she spends the better part of the day cranky and praying for someone to take the girl off of her hands. However, when the mom takes a turn for the worse and is rushed to surgery, Cristina sees how terrified the girl is and decides to stay with her. She winds up being rather awesome and when she realizes the girl's mom has died in surgery, she talks the girl through what she might feel and how she can get through it, based on Cristina's own experience of her dad dying when she was the same age. Afterward, however, she finally loses it because the whole thing ripped open all of her own emotional scars, and she winds up sobbing into Owen's shoulder because she misses her dad.

Owen's rather nervous when he finds out she's upset, because he thinks she knows about his trying to have Derek not hire Teddy back. See, Derek told Meredith, who gave Owen such a stink eye that he realized Derek told her, and he's now terrified she's going to tell Cristina. Owen yells at Derek for spilling something he thought was confidential to his wife, and Derek in turn yells at Meredith for not keeping it to herself. (She argues that she didn't say anything to Owen, but finally someone points out that giving someone a Death Stare isn't in fact the subtle unnoticeable gesture everyone there seems to think it is.) Derek's not in the mood to deal with wife or staff problems since he's had a wrongful death suit filed against him and the hospital by the husband whose wife died a few episodes back -- the one whose plug they pulled based on the paperwork she had signed three years earlier. His lawyer has told him to be as impersonal as possible when giving his testimony but Derek is seeensitive with all his upstanding feeeeelings and so he has a hard time doing so when face to face with the weeping husband. Ultimately he gets the job done, but clearly it takes a toll for him not to be able to really stand up for himself and to get the husband to understand him and what a good guy he really is. Back to Owen -- when Mere finds him and tells him that Cristina has asked for him, all upset, he clearly thinks he's walking in to have a showdown about Teddy. However, it turns out that he's really just there because she just needs her boyfriend, at least for now. (Because while Derek ordered Mere to not say a word about anything, I doubt she's really going to be able to stick to that for long.)

Nearly all of the remaining docs are on Bobby's case, and they are all stunned to realize that he has a cute, petite wife who adores him. She catches them all making fun of him at lunchtime and then gives Alex a huge talking-to later when he tries to apologize. Bobby doesn't want to have the surgery he needs because he's got a child on the way and he'd rather die before the kid arrives so that they don't have to grow up to be ashamed of their dad. But once his wife yells at Alex, Alex in turn goes in and talks to Bobby to point out how selfish he is to want to die when he has a wife who loves him so much. Bobby agrees to the surgery and ultimately survives, and Alex celebrates by signing his divorce papers and then making out with Lexie in public in what appears to be the first step to them actually becoming a proper couple.

It's kind of the opposite of what happens to Callie. She's got a really hot patient who spends the day hitting on her and finally writes her phone number on Callie's hand in permanent marker. Callie goes home and shows it to Arizona, who has been happily planning a vacation, and admits that while she's not going to call she can't help but wonder if that girl wants a baby. The two realize that while they love each other they can't stay together when they each want something so different, and they pretty much agree to break up.

"The skin is the largest organ in the body. It protects us, holds us together, literally lets us know what we are feeling." After Mere ushers us into this week's theme -- do you think it will be about having thick skin and all sorts of different feelings? I have no idea, it's all so subtle. Bailey is teaching some sort of class to a very bored group of doctors. Hey! Charles and Reed are still doctors in this hospital. Who knew? No one watching the last few episodes, that's for sure. No one knows why they are there so Bailey explains, rather distracted, that Chief Shepherd thought they could use some brushing up on their patient sensitivity skills and this morning just so happened to be a good time. "Besides, half of you were raised by wolves," she adds, not understating the lack of manners generally displayed at Seattle Grace Mercy West. She tells them to keep their faces impassive no matter a patient's appearance or results and to not make jokes either in front of the patient or in private. Cristina, of course, tries to make a joke and Bailey is decidedly not amused.

Derek and Richard, meanwhile, are discussing an incoming and seemingly difficult patient in really vague terms, all the better to shock us when said patient arrives. They refer to his possibly not being able to fit in a regular elevator but Richard just tells Derek that they will have to figure it out as they go as the patient is five minutes away. Derek doesn't respond, though -- he's distracted by Gary Clark glowering at him as he walks through the hospital, and everything goes slow-mo as Mere continues her VO: "The skin can be soft and vulnerable, highly sensitive, easy to break." Richard recognizes him and Derek mumbles that he's filed a wrongful death suit against the hospital and Derek's deposition is that day. A woman comes up who Derek assumes is a drug rep and he tries to brush her off, but it turns out she is his attorney, Lauren. Hey, I like this woman already! Richard tells Derek he'll handle the mystery patient who might not fit in an elevator.

Bailey tells the class about the importance of observation and listening to a patient. No one is taking it at all seriously, and there's a whole lot of mocking and joking as Bailey then goes through the importance of communication. She's clearly rushing through everything and gets a little bit frantic, so Reed asks her what's up -- today is the day that people actually notice these kinds of things which in the past are sometimes treated like they are incredibly subtle movements that only we the viewing audience are savvy enough to pick up on. Bailey admits as if it's totally unrelated that there just happens to be a patient who could use some extra sensitivity arriving in a few moments. She then reminds them again of "Reaction, Observation and Communication," adding that if they use these three things they will "ROC" their patient's world, and then runs out with the others filing out behind her.

By Lauren S

"Skin doesn't matter to a surgeon. They'll cut right through it. Go inside, find out the secrets underneath." Richard and Hunt are already waiting outside and everyone else joins them. Mere asks Alex if he got Izzie's message that she sent divorce papers, and Alex tells her he will have to find them and then will sign them, acting like it's totally no big deal whatsoever. It's a bigger deal to Lexie, whose ears perk up and she awkwardly congratulates him on this step. Meredith rolls her eyes heavenward at the palpable awkwardness while Alex just looks confused yet disdainful, and when Lexie runs off he asks what's up. VO: "It takes delicacy and sensitivity." Real Mere tells him that Lexie cares about him and when Alex says she doesn't because they don't have a Thing, Mere warns him to make it a Thing or to end it. It's good that someone said it, and Alex doesn't have time to argue with the advice because an ambulance rolls up... and then right past, followed by a truck and a whole parade of emergency vehicles. Bailey turns and reminds them sternly to remember what they were just taught or else, as the firefighters pull down the back of the truck and when Cristina asks if the circus came to town, Avery sees a GIANT dude hanging out in a bed in the back of the truck and quips, no, just the elephant! He's immediately thrown off the case, and it can't make him happy that the patient himself, Bobby, starts making jokes at his own expense as he calls to the assembled doctors, "We're gonna need a bigger hospital!"

Once they get Bobby in bed in an exam room, the doctors all go to work on him and it's clear that he's a personal and jovial guy with no problem cracking jokes -- he points out that he's using up all the doctors and wonders if there isn't someone else dying somewhere. But due Bailey's training earlier, they all remain stonefaced as they work. Meredith comments to Cristina that now she understands the training and Cristina agrees and adds, "No fat jokes." Bailey promptly kicks her off too, despite her arguing that she didn't actually make any joke at all. As he answers questions about the stomach pains he's been having, a super cute, petite woman runs in asking Bobby if he's okay; the whole gang has to remind themselves to control their facial expressions when he introduces her as his wife Melissa. He tells them that she worries, making mountains out of molehills, "And I'm already a mountain!" They are the only two that laugh and he finally comments that they're a tough crowd. Richard tells him they have to turn him over again but as they get ready, Alex lifts his stomach and sees that all of the skin in the fold is covered in red, raw sores. Bobby laughs and asks if they are popping the hood because he certainly can't see what they are looking at, and apparently also can't smell yet what the other doctors can as they once again try to maintain their poker faces.

Having been banished from the "good" case, Avery calls after Teddy as she walks down the hall but Cristina is right behind him and she tries to call dibs. They both have to admit that they were kicked off the other case, but Cristina points out that Avery made a joke and she didn't, so she gets dibs on whatever Teddy is doing. Teddy doesn't seem totally thrilled to have her followers that day but tells them to come with her to do a consult.

Callie is consulting with her own patient, a super cute woman named Jamie who was hit by a car while riding her bike. Jamie immediately turns on the charm -- it's not hard as she both looks like a model and is totally personable -- and tells Callie that she had a bet with her friend who said that a possible upside to the injury would be getting a cute doctor. Jamie thought her doctor would be old and ugly but then she got Callie, so she's now out $20. Callie's clearly embarrassed but flattered at this way-too-perfect to be believable patient who is hitting on her in her time of relationship distress.

The Cardio Three meet with a woman whose young daughter Kelly ordered her to come in after she threw up, since that's what they make you do in school. Teddy asks about the EKG readout which Cristina is handling as she asks the woman about her symptoms, due to the fact that for women heart attacks often present as stomach problems. The patient, Nancy, asks what they are saying and Cristina informs her that she is in fact in the middle of a heart attack at this very moment. I'm not sure it's a good idea to drop that information so suddenly on someone already in that fragile state, and Nancy does in fact start to get a little panicky as they jump into action. Kelly is also freaked out, and Nancy asks what she should do with her -- they are in from Miami and were flying home that evening. Teddy volunteers Cristina to watch her and when Cristina protests, Teddy reminds her that this is patient sensitivity day. Cristina tries to tell her it isn't a whole day, but Teddy doesn't budge and they all run off. Cristina has to grab Kelly who tries to run after and cries that she wants to go with her, and as Cristina puts her hands on her shoulders she very sincerely replies, "So do I."

As the docs escort Bobby's bed down the hall to do more tests, Bailey asks Melissa about how long he's had the infection, but she doesn't know and has never seen it that bad, and asks what it could be. Richard tells her they don't know, that it could be superficial or it could be something much worse internally, but Bobby assures her that he'll be fine. He's interrupted by a giant crash as the sides of the bed hit the door frame, and Alex realizes they will have to take the sides off to get him in. On the other side, Reed points out that they have a gurney but no one wants Bobby to try and walk... that is, no one but Bobby, who is convinced he can make it a few steps despite Melissa's reminder that he hasn't walked in a YEAR. As everyone argues and pleads with him he gets up and excitedly takes a couple of steps -- Melissa's arguments die out because she's ecstatic to see him on his feet. Bobby stops joking and just gazes at her as he tells her that this reminds him of their wedding, and they look lovingly into each other's eyes until there is a horrific crunch that is hopefully like no sound at their wedding, as something in his leg snaps and he falls to the floor howling in pain.

By Lauren S

Callie has been pulled away from Hottie Bicyclist long enough to diagnose Bobby with a fractured ankle, which causes some issues with the docs outside because he should have a CT, but Derek points out that he's too big and would probably break the machine. Charles has the enterprising idea to see if the zoo has a CT for rhinos, but that gets him kicked off the case despite the fact that he meant it as a legitimate suggestion. Dude, it was probably the rhinoceros comparison that didn't quite jibe with the morning's teachings. Owen thinks it's actually not a bad idea, but Richard puts his foot down at treating Bobby like a zoo animal and says they'll do it with good old-fashioned labs and tests. Teddy muses that she wishes she could get him on a treadmill and Owen scoffs at her that that's never going to happen, and Serious Derek watches them closely during this exchange. He has to leave to go meet with his lawyer but tells them that he wants a meeting with all of their results before they continue any treatment.

Lauren is prepping Derek for his deposition, and tells him that the opposition doesn't have a case, and Gary Clark is just grieving. She then preps him to not call Mrs. Clark by name and to just use "the patient" instead of names or pronouns. Basically, he's to be cold and impersonal and the opposite of everything Bailey is trying to teach the others that day, as that will keep the testimony less emotional. He then asks why Gary is there and adds that he doesn't need to hear what's coming, and Lauren mistakes this for Derek being worried that it will throw him off his game. But Derek is of course Mr. Upstanding and instead is worried that hearing the testimony is going to bother the man, despite it being his right to be there as the plaintiff. There's no time to discuss, though, as he gets a page and excuses himself.

The other docs have gathered their info and are waiting for Derek to come down so that they can present. As they are waiting Teddy tries to break through Owen's attitude and she genuinely thanks him because she got her contract and Cristina told her that Owen put in a good word. He's not very good at looking unsurprised at things but she doesn't notice, and happily walks away. Of course, as soon as she leaves, she gives Meredith a straight line of sight, and the younger doc just stares at him. He realizes this and asks her what, but she just chirps a pointed, "Nothing," as she maliciously clicks her pen and puts it in her pocket before walking off. Finally, FINALLY, someone actually realizes that this behavior isn't nothing -- Owen certainly gets that she seems to know that he never actually put in that good word and in fact tried the opposite.

Once in their meeting they bring up all the x-rays and put them together like a puzzle so that they can see Bobby's whole frame. Mark tells Derek that he has a really deep tissue infection and that he and Hunt have to get in and take out the infected fat, but Derek points out in his super know-it-all voice that that much fat loss is dangerous. Hunt points out that it's better than dying of an infection but admits that it's risky, and Mark adds that Richard and Bailey will be on hand to scrub in if they need to. When Derek asks about the risk, Bailey admits it's basically too high to calculate -- all of the docs have a different list of the horrifying things that could go wrong, most of which end in death. Derek just shakes his head, declares that the risk is too high and tells them no to any treatment. Richard is stunned and asks if he's saying they should send him away to die, but Derek has the answer to send him to a bariatric center more prepared to care for a patient like this. I hate to remotely encourage any of his famous smartypants attitude, but it's not the worst idea I ever heard. However, he then destroys the good in what he said by adding that he doesn't want to spend their time treating someone who obviously doesn't care for himself, and then he marches out in a cloud of self-righteousness, leaving the other docs stunned and wondering what just happened.

Richard is stuck on Derek's insensitive comment, and goes after him to say that Bobby has an illness just like he does -- does Derek think Richard doesn't care about himself? Derek can only say a very perfunctory sorry so Richard, the only one who knows, once again plays Chief's Advisor and tells him it wasn't him in that meeting and it wasn't even about Bobby but rather about Gary Clark and how Derek now just sees potential lawsuits instead of patients, especially now that his hair is shorter and out of his eyes. Okay, that last part was me, not Richard. But his Chief Hair is almost distracting in its shorter lacquered state -- so un-McDreamy. Owen calls after Derek so Richard just warns him not to let being Chief change his priorities and it works, Derek says to tell Mark to go ahead with the surgery and Richard heads off. He then turns to face Hunt, who asks if he went and blabbed to Mere about their conversation. Derek basically tells him yes when he asks if Meredith said anything, and Owen gets rightfully pissed and growls at Derek that when he gives a "professional opinion" about a colleague he expect it to be confidential rather than to hear about it from a resident. Granted, he's only actually pissed because it has to do with his personal life and his still-not-super-believable flip-flopping feelings, but at least he has the professional thing to make his tantrum look more legit. Hunt storms off and Derek heaves a hugely put-upon sigh, turns, and sees Lauren, who asks him how is day is going. Derek gives his mouth an angry wipe and basically looks like he could fall apart at any second.

Lexie and Charles, the other ill-behaved and rejected residents, are working with Callie and go with her to Jamie's room so Callie can explain how she's going to wire Jamie's kneecap together. Honestly, I had to just stop and cradle my own knees at that painful thought -- yowie. Jamie is still in hyper-flirt mode and asks if Callie will be doing the surgery and if she'll be there to hold her hand through the whole thing; Callie points out that it will in fact be better if she holds the scalpel but offers to hold her hand now, which delights Jamie to no end. Charles and Lexie are not totally blind and dumb and realize what's going on, especially as Jamie jokes that she doesn't want it to end, but Callie giggles girlishly, tells her she'll see her in the OR, and leaves.

Out in the hall, Charles asks her if they should have left them alone, and Callie acts genuinely surprised, reminding them that she's in a (miserable, incredibly troubled) committed relationship. Lexie and Charles won't let up though, with Lexie pointing out that it was steamy and Charles reminding her about the hand-holding. Callie claims she was just making physical contact to establish trust, which should have been something they learned just that morning, and finally admits that while there was a little bit of flirting it was just to put her patient at ease like they are supposed to. When they just keep smiling at her, she calls them pervy morons and takes off.

Lunchtime! As Alex and Lexie buy food, eed runs by and tells Alex she's in for 715. Lexie asks what's happening then and is completely appalled when Alex explains he's got a pool going to guess Bobby's weight and the closest without going over wins. She absolutely can't believe he's still on the case and turns down his offer to join as they sit down with Mere and Cristina. The two women are trying to figure out how Bobby could have possibly impregnated Melissa, and figure that artificial insemination had to have been involved even though they don't know how he could have made it down to a clinic to, er... harvest a sample. Lexie figures that they could have done it the good old-fashioned way but no one can totally figure out how, and Cristina is annoyed to be interrupted by Kelly and tries to shoo her away to buy some ice cream. Kelly is rather precocious and points out that she's not allowed that much sugar, so Cristina points out that she can buy some roast beef instead, and Mere laughs as she says Kelly can stay. Cristina doesn't want her to because she's too interested in the conversation they were having about s-e-x, forgetting that at nine years old Kelly can spell just fine and Kelly points this out to her, completely fed up, before marching off to snack on some lunch meat. Back to the subject at hand, Cristina laughs as she decides to try and illustrate the logistics using a french fry as Melissa and a burger as Bobby. Unfortunately, Melissa walks by right then and Lexie has to clear her throat a few times before the others realize it. Melissa totally realizes what's going on and says there are definitely logistics, and do they want to know? Everyone sits in shamed silence so Melissa goes on that first maybe they want to share how they do it with their own partners, or what their kinks might be. When the silence continues she gives up and admits it is, "Probably none of my damn business anyway," before marching off, leaving the doctors all properly chastised.

Meanwhile, Richard and Bailey have to deliver the news to Bobby that in fact things are pretty bad -- the fat on his stomach has essentially died and is eating through his skin. Bobby makes some jokes but this time it's not just their wanting to remain proper that's keeping Bailey and Richard's faces somber, but the fact that it's a super high-risk surgery, and Alex walks in as Richard explains. Bobby finally gets serious himself and asks how long he has if he doesn't have the surgery. Richard tries to convince him he wants it, if not for him for his baby, but Bobby gives a glimpse again into how desperate he really feels and Bailey gets teary as he explains that kids should be playing ball and dancing with their dad, not bringing him food and cleaning it up. He declares sadly that he wants to be gone before his child has a chance to know him, and then asks them not to tell Melissa what he said -- rather, he wants them to say the surgery is too risky. Melissa walks right in and fortunately didn't hear through the audio forcefield that they've turned on in his open doorway, she just gives Alex a look and tries to be cheerful until she realizes just how somber everyone appears to be. She doesn't notice that Richard and Bailey give infinitesimal, sad nods of agreement to one another, presumably to keep the secret like Bobby has requested.

By Lauren S

He goes into Bobby's room, and Bobby asks if they are bringing his forklift around and is clearly delighted when Alex goes with it and says they're going to open the loading dock and roll him out. He adds that they can roll him into Puget Sound and float him home like a barge, so Alex says he's got another good one and asks what they call the guy so fat he couldn't get out of his house. Bobby asks what, but his face goes straight as Alex says they call that guy dead and selfish for leaving a 700-pound mess for his wife to deal with. Alex then apologizes for all of the doctors' pussyfooting around him but says that he has to stop making jokes about himself because he's got an awesome wife who loves him and he must have done something right to deserve her. And while Alex admits he knows that life can get so crappy that it can make someone want to just sit at home and die, he has to at least make an effort for his wife. And yes, Alex probably has had the most crap thrown at him, but I'd like to take a moment on behalf of all the man-loving viewers of the show that he obviously decided ab workouts were the way to deal with these issues. Speaking of, can we please have more shirtless Alex before the end of the season? Thanks. Alex tells Bobby that chances are he'll die during surgery and get his wish, but at least his wife will think he tried and will tell his child that, and asks him to give her that at least. Poor Bobby just looks so sad, having to really face his demons rather than joke them away.

It clearly worked, though, as the thing we see is an army of doctors and technicians setting up a double-size operating table, and then we see them actually bring Bobby in using a giant sling, basically, and they put him on the table. There's a whole lot of area they have to prep and the docs have a while to get ready and scrub in. Owen and Mere scrub in to each other uncomfortable, while Charles is already inside, having gotten back on the case when he convinced them they would need big guys to help. Owen gives them all their orders and pointedly doesn't call on Mere; when she asks what she can do he says, lightly but incredibly pointedly, that they are all good. She thinks a moment, realizing that shit's ON, and then stomps out of the OR.

Derek's deposition is in full swing and Gary's lawyers are all over his every answer, pointing out that Mrs. Clark's symptoms didn't show brain death. Derek looks over at Gary, who is glaring at him with an almost psychotic level of rage, and he says that he never declared her brain dead, he just said she had minimal brain activity. He finally tries to talk to Gary directly, rather than the lawyer, and to once again explain about her advanced directive and why he made the decision, but Gary's lawyer cuts him off to announce that she was alive until Derek pulled the plug. Derek is obviously fighting to keep his cool and again brings up the advanced directive, but when he used the words, "I judged," the lawyers jump all over him for this all just being his opinion and not a good medical decision. He has a hard time answering because Gary has started to fall apart and weep, so Lauren suggests that they take a small break.

Out in the hall, she asks Derek if he remembers when she told him they didn't have a case -- he does. She then sternly tells him not to give them one, and therefore not to apologize for what he did. He looks up to see the lawyers and a crying Gary walk out, and agrees tersely before walking off himself.

In the OR, the docs have found that Bobby's infection is really deep, and they're having a hard time with the sheer amount of fat inside. Mark finally gets in deep, though, and asks Owen if he wants to look around. He does, but unfortunately something starts to bleed that shouldn't, and he tells Bailey and Richard to scrub in while the docs start packing the wound and we see a montage of Tense Looks over Surgical Masks to convey just how serious things are.

Cristina and Kelly have settled down to play cards in the waiting area -- Cristina enjoying a can of super-appetizing looking "Lemon-Lime" soda -- and Cristina is explaining what is wrong with her mom's heart, describing it as two rooms, with one having a hole in the wall. Kelly is in good spirits as she wins a few hands of cards and seems to understand what Cristina is telling her, including that her mom's heart is weak. Avery comes out very quietly and watches them from afar for a few minutes as Kelly asks what will happen if her mom dies. Cristina tells her that they will talk about it if it happens, and then she wins a hand -- she looks afterward and notices Avery who gives her the tiniest sad nod to let her know things didn't go well. Cristina then starts to tell Kelly evenly that if her mom dies, she'll feel a lot of things, and she'll think she could have done more but she needs to remember that she did everything she could. Kelly doesn't say anything, but her face goes stony and she seems to realize that Cristina is telling her this because something is wrong, even if she doesn't fully realize yet that her mom died. After assuring her she did everything she could, Cristina admits that it will hurt when Kelly thinks of her but that over time it will hurt less and less until it's only a very little. She smiles at Kelly but the conversation is obviously getting to her as well. That said, it's probably the best she's ever been with a patient, and this one a kid at that.

Callie is in with Jamie post-surgery and tells her to call if she has any pain or "oozing." Jamie smiles seductively and asks if she could also call if it's late and she's drunk and watching a John Hughes movie, and Callie is fully taken aback and has to admit to herself that this truly is slightly dangerous flirting. She stutters but Jamie just grabs a pen from her coat and writes her number on Callie's hand, Callie looking around nervously the whole time. That's true, where is Arizona? I guess they needed that money for us to see Reed and Charles for their grand total of two minutes of screen time, since I can't be the only one who wondered if they were just going to disappear altogether. Jamie tells her to call if the spirit moves her, and then sends her away. Callie looks down at the number and despite herself, smiles. Who can blame her, though? It's always nice to get a little bit of positive attention when your personal life is as messy as a pigsty.

Bobby's surgery is still underway and we see (and unfortunately hear) as they throw giant pieces of excess diseased fat to the floor. I am relieved that I didn't happen to be eating anything during that appetizing sight/sound combo. Richard finally discovers that he has a perforated colon but unfortunately he's been under longer than they would like already, and alarms start to blare. They kick into super-urgent-operating-mode while Derek watches from above with his Troubled Stern Chief face.

He walks out and runs into his Post-It bride, who asks about the depo, and very maturely he snits that he apparently can't tell her, then asking if she told Hunt what they talked about. Mere defends herself but admits that she did look at him, and Derek FINALLY points out to her that when she looks at someone they can read all of her thoughts on her face. He's pissed that now his staff doesn' trust him -- seriously, this coveted Chief job is just going from bad to worse -- and when Mere asks if she's supposed to control her face, he tells her that yes, she is. Hi Meredith, it's called tact and self-control, and these are things that the rest of us have to employ quite often in our day-to-day lives. Her solution is that he not tell her what he doesn' want her to know, but he spits that then that would be everything. Ah, I love how his go-to mode when he's frustrated is always pissy immaturity. They sort of apologize to each other but then Mere has to go and announce that obviously she's going to have to tell Cristina. Good lord -- while I get it, her announcement as if it's a foregone conclusion is ridiculous and Derek's consequent disbelief is, well, unbelievable. Mere -- you know this would piss him off. Derek -- you know she'd never, ever be able to keep this kind of thing from Cristina. Lauren walks up as they start to fight, with Meredith asking what she's supposed to do because while he's the Chief now, she's the same person. Lauren tells him they are ready so Derek can appropriately turn on his heel and stalk off self-righteously, but not before ordering Meredith to do nothing.

Cristina is working on a chart when Avery walks up and asks about Kelly, and Cristina reports that social services put her to bed in a patient room and her dad will be there when she wakes up. He tells Cristina that she was great with her, and she thanks him, but then he makes the oh-yeah-he's-still-a-newbie mistake of asking her about her personal life, asking when her mom died and then when she says her mom is alive asking when her dad died, then. Cristina gives him a Look and he apologizes for being too personal but says it was really obvious that she was speaking from experience. Cristina is having none of it, and tells him sarcastically that he's a super sensitive and insightful man, but what she did was listen to a patient's concerns, speak in a language they could understand and lay out the possible complications and outcomes. She wraps it up as, "kicking patient sensitivity ass," and then stalks off.

What she's really running from, though, are the tears that are about to spill. Mere finds her and walks up from behind, asking if she wants to go drink, but then babbles selfishly (and really obviously, trying to give away that she Knows Something) that maybe she shouldn't because then she would talk, and she's not allowed to do that. Cristina stops at the door to the on-call room and yells at Mere to go away so Mere immediately asks her what's wrong, but Cristina asks her to get Owen. Mere looks confused but I'm certain she thinks the cat is somehow out of the bag.

Derek is back at his horrible deposition and describes Mrs. Clark's stroke, so Gary's lawyer asks if after that and her EEG, he recommended that care be stopped. Derek again tries to answer by referring to the advanced directive but then cuts himself off and just says yes. Okay, I hate defending Derek but honestly, isn't that directive basically the whole crux of this matter? As Richard himself pointed out when this was going on, they could face legal action if they didn't follow that. But as none of the lawyers are talking about that, maybe I'm wrong here. They are only interested in how long it took him to make up his mind, and when Derek answers that he had to talk to the family and pull together an ethics review committee, they cut him off and ask him how long it took personally. Derek stares at him and then finally admits that it was less than a minute. Gary glowers at him, practically shaking with rage, as Derek says that in his professional opinion there was no other option. Gary can't keep it in any more, and he starts yelling about how long they were married and how Derek decided to kill her in under a minute. Even his own lawyers realize this is no good for anyone and try to stop him, but they can't. Derek says he's sorry but Gary spits it back at him that he hid behind the legalities and then didn't even pull the plug himself, finally screaming that he's a coward and a killer. His lawyers finally usher him out of the room, and Derek drops his head into his hand.

As Gary and the lawyers wait for the elevator Derek walks towards them, but stops when Lauren calls after him asking for a word. She then admits that she was just holding him back until the men could leave, and they get on the elevator with one last glare from Gary. [People, let this be a lesson to discuss your wishes with your spouse, especially if you are going in for surgery and are already ill -- I do believe from the original episode that his wife really would have wanted what happened, minus the heartbreaking rage and grief on the part of her husband.] Lauren tells him that the best thing he can do for Gary and for the hospital is to say nothing; that Gary is grieving and Derek can't help him. She reminds him again that they have no case and finally tells him that though she knows he wants to do more, it's over. Derek doesn't like it when people don't realize he's just a good guy who knows best, and so he glares at her and stomps off -- she calls after him drily that it's been a pleasure.

Owen and Meredith are on their way to Cristina, and Owen clearly thinks that he's about to face a firing squad and accuses Meredith of telling her. Mere angrily whispers that she didn't say anything, and Owen walks in to find Cristina sitting on the bed like a miserable statue. He asks what it is, not quite as gently as maybe he should, but proving that he thinks he's about to have a showdown. Cristina just gets up though, and puts her arms around his neck and begins to sob that she misses her dad. He just holds her and rubs her back while she cries.

Bobby is out of surgery and Melissa is standing with him as Richard warns him that while he survived he's not out of the woods as they need to watch for infections, and adds that he needs to make some serious lifestyle changes. He tells the docs that he knows, and when Bailey tells him he has to do it if he wants to survive, he looks up happily at his wife and then says that he has no choice. He then looks to Alex and asks, "Right?" Alex nods, but as Melissa turns and looks at him her face goes from a smile to a glare. Fortunately Alex doesn't have the pathological need for people to like him, and since he did the right thing by Bobby it doesn't seem to bother him much. Derek walks up to the window and sees them inside, and when Richard turns and notices him, Derek's somber face causes Richard's face to go serious, like he's a little kid who's been caught doing something bad. It's really odd.

Mere walks up to Derek and asks him how it went, and Derek petulantly won't reply so Meredith assures him he can talk to her, and he pouts that he doesn't want to think about what he can and can't say and to who just then. She sighs, realizing she's not going to work him out of this mood just yet, and asks if he knows that she loves him? He does, but he just kisses her on the cheek and leaves, the tortured hero. Mere heaves another big sigh -- man, if you'd been playing a "heaved-a-put-upon-sigh" drinking game during this episode you'd be passed out on the floor at this point.

Voiceover time: "No matter how thick-skinned we try to be..." Alex looks at his divorce papers while I lament having no champagne chilled and ready to celebrate the official end to her wretched tenure on this show. Lexie comes up and asks about the weight pool, and when she finds out that Bailey was the winner (678 lbs) she starts to pitch and indignant fit about the utter hypocrisy. Alex tosses the signed papers into the outgoing mail and then reaches over and gives Lexie a long, awesome kiss, which stuns her into silence. She's confused but incredibly pleased and Mere continues, "There's millions of electrified nerve endings in there." Alex asks her if she's going home and she manages a nod, so he asks if she wants to go together and they walk out hand in hand. So it looks like he's going to listen to Mere and try making this a Thing, at least for now.

By Lauren S

"Open and exposed. And feeling way too much." On to far less happy couples, Callie comes home with what appears to be the weight of the world on her shoulders. Arizona doesn't notice because she's too excited about planning a trip to Fiji for the two of them, and she babbles excitedly about plans until sits down right in front of her and shows her the phone number on her palm. VO: "Try as we might to keep from feeling pain..." Callie explains to Arizona that it's the phone number of a cute girl, and while she has no plans to use it, she can't help wondering if that girl wants a baby one day. It's Arizona's turn to sigh, and her smile has completely vanished. Callie starts to cry as she tells Arizona how much she loves her but that she needs this one thing, yet she can't and doesn't want to ask Arizona to change for her to give her that thing. Arizona sounds a little choked up herself as she tells Callie she can't be the one to keep her from having a baby. Both are sad and Callie is rather desperate and starting to panic -- when Arizona says that they can keep going Callie interrupts to wail that she doesn't know where they are going, and Arizona puts aside the computer and pulls her onto the sofa and into a long kiss. Mere VO's, "...sometimes it's just unavoidable. Sometimes, that's the only thing left." Callie asks what they are going to do and Arizona quietly says she's going to get her stuff together, and when Callie starts to cry she says that they will see each other at work. Callie cries that she's sorry and loves her, and Arizona struggles to not start crying herself as she tells Callie she loves her too.

By Lauren S

We then see a shot of a golf ball getting hit off a tee, and then see that Mark and Derek are on the helicopter pad hitting balls. Derek tells him this was a good idea and Mark just orders that there is no talking. I assume they are hitting them into the sound, but what happens if they shank it, like Derek does and Mark totally points out? Derek only reminds Mark that there's no talking. Mere finishes: "Just feeling." Derek and Mark both hit shots and stand in their golf stances watching as the balls soar away, while behind them the elevators go up and down the Space Needle. That must be a pretty entertaining shot for anyone there, to look over and see two doctors potentially grievously injuring passerby below as they try to release their own stress.

Watch the entire episode.

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