We’re delighted to find this week's episode revolving around Derek, especially after all those new Mercy Westers of the past two weeks. As we see Derek dressing for the day, giving Meredith (still recovering from liver surgery) a kiss goodbye, and heading off to Seattle Grace going on about his love of the operating room's quiet calm, we're glad to be back in the Derek-centric Grey's of yesteryear.
When he and Cristina arrive at the hospital, the chief is announcing a new computer model for scheduling surgeries, boasting of its "efficiency and progress." This all sounds a bit like surgical communism, and we're not sure why we're supposed to care about Seattle Grace's scheduling system except that it has rearranged all the day's surgeries, and as a result, everyone's scrubs are in a bunch. Izzy is still MIA (Katherine Heigl went off to shoot a romantic comedy), Alex is taking out his frustration by being a jerk to everyone, and the new Mercy West girl pauses from her yoga session to call him a douche. We give her points for honesty, but the poor guy's cancer-stricken wife just left him. Cut the guy some slack!
A hospital lab tech named Isaac has a tumor wrapped around his spinal cord, and he tells Derek that he got a job at Seattle Grace specifically to convince the doctor to operate on him. This is a bit creepy, especially because Isaac is smiling through all this. Pretty soon the whole gang is oohing and aahing over Isaac's bizarre MRI scans — no one as much as Cristina, who's dying to get in on the action.
To choose who's going to scrub in with him, Derek holds a funny little competition involving a pen, a Styrofoam cup, and a dollar bill. (This sounds dirtier than it is.) Cristina fails, and the new Dr. Avery gets to scrub in instead. (We remember him as the attractive nude model from Sisterhood of the Traveling Pants, and even that image doesn't make him any less annoying.) Lexie also gets to scrub in as a backup of sorts — and decides that she can outlast everyone by wearing a diaper and therefore heading off bathroom breaks. Cristina finds Lexie mulling over her Depends, grabs them, and pumps her up like a coach before the big game: "This is the definition of hard-core. You're like an astronaut. This is surgery, NASA-style. Put these on, right now, I'll guard the door." And this is why we love Yang.
The chief doesn't approve of the surgery, asserting that it's too risky and expensive, and he forbids Derek from operating. Of course this only makes Derek want to do it even more, so he goes “rogue” and goes forward anyway. Genius, right? Of course, a hullabaloo ensues. But at least Derek briefly gets to look like a badass.
Umpteen hours of surgery later, Derek does the impossible and removes Issac's tumor (no way!); Cristina sulks, and Dr. Hunt consoles her; and Izzy, meanwhile, never shows up for her scheduled cancer treatment, which neither surprises nor bothers us, except that Alex is tormented by her loss, and the show was so much more fun back when he was just the cute guy having sex in the on-call room. Finally, the chief tells Derek's he's fired — but McDreamy just flashes him a suave smile and tells him to sleep on it. And because this is Grey's Anatomy, that should do the trick.