This week's episode of Grey's Anatomy opens with Izzie and Cristina reading about cancer treatments at the kitchen table. Each time someone walks in, Izzie frantically covers up all the information and tries to divert attention away. First Alex, then Meredith. Apparently Cristina will be keeping this secret a while longer.
At the hospital the Chief is still most concerned with when Derek plans to return. In a last ditch effort to restore order to the hospital, Bailey asks Callie to go to the woods and talk some sense into Derek. Callie reluctantly agrees and heads off to the trailer.
Meanwhile all of the residents are preparing their interns for the biggest surgery to ever come to Seattle Grace (even bigger than the seven person kidney swap!). Dave, a man hit by a drunk driver and left with no nose and mouth, is having a face transplant. When the camera finally reveals the patient, the sight to behold is so gruesome it makes Two-Face from the recent film "The Dark Knight" look like a victim of a mild, discolored birth mark. This kind of disfigurement is horrifying.
Dr. Sloan asks the interns and residents a few questions about the procedure. Lexi answers each question perfectly and Sloan replies "You were awesome in there." He asks her to assist with the face transplant surgery, over many of the residents.
When receiving their assignments for the day Cristina learns she will be doing her first solo surgery; a hernia repair on an elderly woman. The actress is the same woman who played the uptight, rigid, Mrs. Kim on Gilmore Girls. This character is quite the opposite - energetic, frantic and worried. Rather than appease her, Cristina winds up taking a phone call in the middle of the consultation, as she tries to book Izzie an oncology appointment.
Across town Callie has arrived at Derek's trailer. She tries to snap him out of his funk by sharing her own patient death story about a man who died after a simple knee replacement surgery. Derek, still in a state of doom and gloom, asks her "How do you live with it? How do you look yourself in the mirror every day? Seriously. I am really asking." Callie looks at his cooler of beer and says "Can I have one of those?" So much for progress.
Back at the hospital Meredith and Cristina are walking the halls together, and Meredith is going on and on in her typical self absorbed way when she says to Cristina "You're not listening to me are you? I get it, you've got a solo surgery and G.I. Joe. Its a charmed life." Classic Grey's moment. LOVE IT.
After his spectacular showing last week with the band geek with the heart problem, Hunt asks Karev to assist him in harvesting the skin for the face transplant. Alex lifts the face up off of the cadaver, and like a 10 year old, says "Awesome." That seems to be a popular word today.
Down the hall, three interns are helping to treat a patient, but they all seem to be having problems. One with a black eye, one with a bleeding hand and one that can't stop crying. Meredith and George wish to ignore their clearly plagued interns, but Bailey forces them to manage the situation. She says "Do you think I wanted to get involved with your intern dramas? Getting married in Vegas, shacking up with an attending, cutting L-vad wires?" She makes a good point. Meredith tells the interns "You're scaring the patients. Cut it out."
Down the hall with Dave the face transplant patient, Izzie flips out on her interns when they mock the patient and refer to him as "blow hole". Sloan takes Izzie off the case, but she demands to have the right to stay with him before and after, pleading "he needs me."
With no sign of Derek, and now no sign of Callie, Bailey asks Dr. Hunt to go into the woods and try and retrieve Derek. He resists and she replies "You survived a war. You can do this." Hunt says "People don't really say no to you do they?" Bailey responds "Not when I say please." LOVE IT.
While waiting for surgery, Dave (the face guy) has three friends arrive. He has never met them, but they have been part of an online chat room for orchid lovers for years. They enter the room, to meet him for the first time, and wish he good luck in the surgery, when he turns away from them and starts yells "Get them out, they are strangers." The orchid friends are stunned, and only Izzie seems to understand his breakdown.
Downstairs at lunch, Izzie and Cristina are trying to talk about her oncology appointment, but so no one else catches on, they keep saying Izzie needs an enema. Finally George asks "And enema is code for what?" Izzie just gets up and walks away. This is the third episode in a row George has suspected something is up. The George I know would go to the Chief, or at least look through the Chief's files. Come on, George! Dig deeper!
Over at Casa de Derek, Hunt has arrived and is telling a story about losing two parents and having to comfort their three children, all under the age of 9. He tells Derek "Despite that, I showed up. I went to work the next day." Derek responds "And you're dead inside." OUCH. Blunt much? Callie hands Hunt a beer.
Back at the hospital Cristina is frantically looking for Izzie to see how her appointment went. Cristina finds her in the locker room, she never went. Izzie confesses "What are they going to call me? Swiss cheese for brains? I don't want to stick around to find out what they are going to say about me when I'm the patient." Earlier meltdown explained.
Back in Dave's room Lexi explains he can't have the surgery without his friends present, because Psych requires him to have a support system in place for post-surgery. Lexi says "You know, they didn't look away from you. You looked away from them. You didn't trust them." The camera moves to Izzie. You can actually see the light bulb go off.
Dave's friends do come back and he explains he didn't want them to see someone so ugly. In a very touching moment, one of the friend kisses Dave on the cheek and says "Please do not call my dear friend ugly. You are a survivor and its written all over your face." Awww.
In the hallway Bailey tells the Chief that in an attempt to bring Derek back, she also lost Callie and Dr. Hunt. The Chief decides to take matters into his own hands and heads to the woods. Derek is furious with him and begins ranting and raving. He screams "Why would you send Meredith out here expecting a ring? I hit the ring into the woods. You destroyed me." The Chief yells right back at Derek and says he refuses to accept ownership for Derek's meltdown. Derek starts to cry. He confesses "I don't think I can get her back." The Chief explains that Adele discovered he was having a multi-year affair and still found a way to forgive him. He assures Derek "You can make your way back from anything."
Back at the hospital Meredith and George and trying to find out what is going on with their three interns. After pressuring a weak link they find out Pierce, Steve and Megan are in a bit of a love triangle. Meredith and George take all three of them into the bathroom. Meredith tells Pierce to put ice on his eye, tells Steve to get his hand stitched up and tells Megan to head down to O.B. since she is pregnant. She says "Use the good sense the lord gave you and never act this way again!" George whispers "That was very Bailey." HA! Love it!
Its finally time for Cristina's solo surgery. While on the table her patient starts freaking out since Cristina never answered any of her questions. Cristina assures her she will take care of her, but you can tell Cristina is feeling some kind of unrest. All of sudden she looks up, straight across the table to Alex and Bailey and says "Izzie has stage 4 cancer and she is resisting treatment. (Pause) Scalpel please." As Cristina gets that weight off her chest and prepares for her first solo cut, Alex and Bailey are still staring as if Cristina's words are hanging in the air.
Its finally time for Dave's face transplant, and everyone in the gallery is watching Sloan's every move. He decides to let Lexi assist him in putting on the face. When they have succeeded, they both look up to see everyone in the gallery mocking them. When they check on Dave post-op, he asks to see his face. All of his friends are there, holding his hand, when his new face is revealed. Izzie is moved by their support and escapes outside for a minute.
Izzie is sitting outside on the bench when Cristina comes out to join her. Cristina admits she told Alex and Bailey, who are telling Meredith and George. Cristina says "I want you to fight. For whatever that's worth, I want you to fight." Izzie, clearly having had an "ah ha" moment says "Thank you" in a way that shows a purpose, and perhaps a glimmer of hope that she will accept treatment.
Inside the hospital, Sloan has finished his post-op with Dave and comes to find Lexi. She grabs his face and plants a huge kiss. She looks across the hall at the other interns and says "They think you are taking advantage of me. They think that I am using you. They think we are ugly, but I think we are beautiful. We will adapt to this hostile environment." Aww, directly lifted from Dave's "I am like the orchid" speech earlier. Jeez Shonda, some new material please!
In the second to last scene of the episode, Meredith drives up to Derek's trailer. The following conversation ensues:
D: I love you.
M: I know.
D: Would you still love me if I wasn't a surgeon?
OUCH! Meredith follows her "no" by explaining Izzie has stage 4 cancer in her brain, skin and liver and Derek is one of about twenty people that can help to save her. If he walks away from a gift like that, she could never respect him. She pulls out Izzie's films for him to review and walks away. Well, at least we know they are speaking again. Now if only one of them could head into the woods and find that diamond! Priorities people!
Finally, in a scene with no dialogue, Izzie changes out of her scrubs and into a gown, and leaves the locker room for a hospital bed. Surrounded by all her friends, she succumbs to her medical reality.
In scenes from next week we see that Alex has a tantrum about Izzie becoming ill, Derek returns to the hospital to operate on Izzie and George is completely devastated by the idea of losing his best friend. Since we all read US Weekly, we are well aware that Katherine Heigel (Izzie) is leaving the show, so we know her character is likely dying. We just don't know when and exactly how. Something tells me she won't be going quietly.