Mark (Eric Dane) is out of commission, surgery-wise, since his hand was hurt in his fight with Derek last episode. That, coupled with the fact that Derek isn't showing up for work, makes Richard stress out about getting all the surgeries done, until Dr. Nelson, a.k.a. "Shadow Shepherd" steps up to do a craniotomy. Nelson is a bespectacled, diffident sort, who used to be the head of neurosurgery before Derek swooped in with his red cape from New York. He has been at Seattle Grace for 10 years, but nobody seems to remember him, which explains why we have never seen him before on Grey's Anatomy.

Izzie, since she is soon to be poor, dear, departed Izzie, gets nostalgic and misty-eyed at random times during the episode. She tells Alex that he'll grow up to be a great surgeon some day, and she tells Cristina and Meredith in the cafeteria that she can just see them years from now, in a nursing home together, talking at each other but not listening just like always.

Bailey, Richard, Meredith and Cristina take out the stomach of the oldest sister and find that she has stage one cancer. Richard is still being a pain in the ass, undercutting Bailey's suggesting to use a stapler, rather than hand-sewn sutures, to patch up the patient's stomach. He gets all up in her face, saying that she shouldn't be calling the shots in a surgery (that I'm sure she's done a thousand times) since she'll be going to peds anyway. After the operation is over, the doctors tell the other two Siblings of Cancer that they caught their sister's cancer at such an early stage that the gasterectomy was probably curative. This puts the fear of God into the other sister, making her immediately change her mind. Now she wants the surgery.

Band Geek Beth starts coding and then has a seizure, which isn't the normal way an epileptic seizure usually happens, leading Alex to believe that she actually has a heart condition instead of epilepsy. He wants to do a cardio workup, which involves shocking her heart. Arizona Robbins doesn't agree because if the girl's heart is fine, it could kill her. Major McHottie, once again, exhibits the flimsiest backbone ever for a trauma surgeon, and leaves the decision up to Alex.

Back at Patient X Central, the interns think that Patient X might be fine, but Izzie angrily tells them to keep looking because there is something definitely wrong with her. George (T.R. Knight) finally gets to say more than one syllable at a time. He and Izzie have a nice moment in which she praises him on his work ethic and says that she would be proud to become the next O'Malley. But as soon as George starts to ask her what the deal is with Patient X, she runs off.




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