Plot

Derek's malpractice deposition reveals an unhappy statistic, the interns finally diagnose 'Patient X', Karev stands up to two attendings to save a band geek, and when Webber shuts Miranda out completely she makes a call.

Derek falls apart after the death of his most recent patient, but Meredith is trying hard not to let him give up; Alex refuses to give up on a patient who had an epileptic seizure, while Izzie refuses to let the interns give up; the Chief has all but given up on everyone in the hospital and begins ranting like a madman.—Moviedude1

Derek was "fried," sitting on the couch for three days and eating cereal out of the box. Meredith, Alex, Lexie and Izzie all watched him like he was a zoo animal. Alex was mad that Derek was eating all his cereal, Lexie thought Derek was sitting on her keys, but Izzie sympathized with him, saying he was "taking stock" after a life-altering experience.

Derek finally had to get up to give a deposition about how he killed his patient. At the hospital, Cristina startled Hunt while he was sleeping and he jumped so suddenly that she fell back into a rack of medical supplies and cut her arm.

She tried to make Hunt feel better about it, saying she'd had weird dreams before, too. She tried to tell Meredith she "tripped and fell" and said it was "fine." Hunt, though, said it wasn't fine, and walked away.

Sloan was still upset with Derek for punching him and he didn't want to go back to Derek and ask him forgiveness. Callie, meanwhile, was worried about where she stood with the ped doctor, Arizona, after she poured her heart out to her at Joe's in front of Arizona's date.

Izzie's interns had some thoughts about "Patient X" (remember, Izzie is Patient X).

A trio of siblings that had the gene for a hereditary form of cancer that gave them a 3-in-4 chance of getting the cancer told Bailey they'd made a pact and decided to have their stomachs cut out to avoid getting the cancer.

A high school marching band member had a seizure on the football field and was brought into the ER. Hunt decided to shock her, which could either kill her or save her.

It worked. When she came to she said, "Oh no! Did it happen again?" She was worried she looked like she "crapped her pants." A couple of her bandmates were annoyed that her seizure ruined their chance at winning the regional championship.

Izzie had all the interns giving their theories on Patient X.

Meredith gave the stomach removal siblings a list of the possible side effects of having their stomachs removed. The 23-year-old brother was worried about the possibilities, including "anal leakage." He said their older sister couldn't continue to run their lives.

The chief was upset that Derek hadn't been around and he had surgeries piling up. Another surgeon, Dr. Nelson, who had never been noticed, volunteered to do one of the surgeries that Derek would have otherwise done. Callie later told Sloan that Nelson was like "the JV to Shepherd's varsity."

Derek sat after a meeting with the lawyers with a stack of two files -- the people he saved and the people he "killed." The second pile was higher. He left the hospital with the chief yelling at him about how he needed to get back to work. Derek left.

Meredith and Cristina commiserated about their guys, with Cristina saying Hunt wouldn't look at her "ever since he was all 'Apocalypse Now' on me this morning."

The chief and Bailey were in surgery, removing a stomach (but we didn't know whose). He was chastising Bailey for wanting to take care of children. Suddenly, there was something Bailey felt.

The interns told Izzie that Patient X was "fine," but this only made her upset. She yelled at them and said, "She's not fine." She told them they were missing something and they had to figure out what it was they were missing.

Trish, the oldest sister, was the one who'd had the operation and they found a tumor. Her little sister, Meg, was upset and told her brother that the reason Trish controlled everything was because she was the only one who could take care of them. This made Meg so upset, she said she wanted to have the surgery immediately.

Alex theorized that the marching band girl had been mistreated for epilepsy when the problem was really in her heart, but Arizona didn't want to shock the girl's seemingly healthy heart. Hunt said it was Alex's call.

George and Izzie had a heart to heart after Cristina made fun of Izzie by saying that she did so little work she was going to be the new George. Izzie said George read more journals and logged more hours in the skills lab than anyone. She said she would be proud to be like him.

Lexie wanted to biopsy Patient X and this made Izzie smile.

The chief got upset with Bailey questioning him in surgery and shouted about how it was his hospital and he wanted people to do what he said.

Alex and Arizona prepped for his suggested test on the marching band girl's heart. Arizona handed him in the paddles and told him to be ready to use it if it was needed. They monitored her heart rhythms and figured out Alex was ready, even though there was a tense moment when he thought he'd have to shock her. Alex was right, but he was very shaken by the experience of having had the girl's life in his hands and on his conscience.

Bailey told the chief it was "not OK" that he yelled at her in surgery and in front of her residents. He walked away without saying anything.

Lexie came to Izzie with their diagnosis. They used the MRIs and biopsy information to figure out that Patient X had a melanoma that spread to her skin, liver and brain. Her prognosis was three months with treatment, "if she was lucky." Then one intern said, "She's pretty much toast." Izzie teared up slightly before telling them they did a good job. The interns asked for a prize and Izzie lambasted them, telling them they shouldn't expect a prize every time they do their jobs and hand someone a death sentence.

Adele showed up at the hospital and pulled the chief and Bailey into a conference room.

The marching band girl was very happy her seizures were over and she had a pacemaker that could be easily hidden. When her bandmates suggested she try out for choir because they didn't get a trophy, Alex told them that she was fixed. He said it was an "epileptic bone." They asked if she was "normal" and Alex said none of them were normal. They were "band nerds."

Adele straightened out the chief and Bailey, telling them they were both being childish. He apologized.

Lexie thanked Izzie for teaching them, saying she learned a lot by diagnosing Patient X. Izzie asked Lexie what she would say to Patient X. Izzie told Lexie what she should say to the patient, telling them that even if a 5 percent survival rate wasn't great -- the Lexie interrupted and said "screw the odds." Izzie told that's exactly what she should say.

Arizona and Hunt told Alex he did good work and he could be the future of the hospital. He ran to Izzie to tell her the good news, and told her she had to "stop wasted time with this Patient X crap" because he wanted her to be with him as the future of the hospital. She kissed him.

Bailey told the chief she thought he was upset that she was doing "something soft." She said he was scared he'd "gone soft." She told him to embrace it.

Cristina told Hunt it was going to take a lot more than a bad dream to scare him off. He said, "It's more than a bad dream." She touched his head and said, "I know."

The chief went to Meredith and asked her to help bring Derek back. She said that sometimes people just want to be left alone. The chief told Meredith that Derek was planning to propose. "That's not a man who wants to be left alone," the chief said.

Lexie went to Sloan and said that maybe they had a 3 percent survival rate. She was worried she broke him. He said, "You're the one who put me back together."

Dr. Nelson asked Sloan if he wanted to get a drink after work. "How about a rain check, John," Sloan said.

"It's Jim," Dr. Nelson said.

Callie and Arizona ran into each other in the elevator. Arizona asked Callie out to dinner. Callie said, "Maybe." Then she said, "How's tomorrow?"

At the end of the night, George told Izzie, "I'm still here. I still care." He knew she didn't want to talk about whatever the problem was. She said, "Not yet."

Izzie went to Cristina to tell her something because she knew Cristina could take it.

Meredith went to the trailer to find Derek. He'd cleaned out his clothes from her closet at her house. She told him he was hiding. She said, "So what, you made a mistake?" She told him not to quit.

He told her she wrote the book on quitting. He told her he was done operating. He kept insulting her -- he was drunk -- and he told her to leave. He yelled at her, saying this was her way out.

She said, "I know there's a ring." She said the chief told her about it.

Derek, who'd been swinging at empty beer cans with a baseball bat, pulled out the ring and said, "Here's your ring."

He tossed it in the air and knocked it into the distance with the bat. He went into the trailer and told Meredith to go away. She said she wasn't giving up, that they were in this together.

Back at the hospital, Cristina and Izzie were in the dreaded vent room, where she told Cristina about her cancer.