Tonight’s episode of Grey’s Anatomy begins with an Alex voiceover. I guess Meredith got tired of talking to herself. Alex (Justin Chambers) looks in on Izzie, where she is fast asleep in her hospital room. Callie and Arizona are at Callie’s place, “dancing it out.” In Cristina’s bedroom, Cristina (Sandra Oh) and Owen are finally spending nights with each other, relaxing by watching videos of surgeries. Cristina falls asleep, so Owen turns the TV off and shuts off the lights. He dozes off, and the peppy, happy music stops, replaced by whooshing sounds of the overhead ceiling fan turning in slow motion. The screen goes dark and the next thing we know, Owen is choking Cristina. She struggles but can’t free herself. Callie walks through the door to see if everything OK, and stops him. Callie (Sara Ramirez) calls Meredith, who rushes over to see if everything is OK. Cristina assures her that she is OK, and that Owen did it by accident in the middle of a nightmare. Owen, sobbing, asks if she is alright, and she soothingly hugs him and says that everything is OK.

Grey's Anatomy: Episode 5.19 "Elevator Love Letter" Recap (Page 1/4)

OK, but that is NOT OK, y’all. The choking scene scared the crap out of me. Even if it happens accidentally, choking anyone is not OK, especially if it almost results in killing that person.

The next morning, Meredith (Ellen Pompeo) is back at her house. She is making coffee when Derek (Patrick Dempsey) comes home. He’s still unshaven and unshowered. Without saying a word, he opens the ring box and presents the diamond ring to her. She says, “No, not like this.” She reminds him that it’s his first day back and it’s all about Izzie. He has to save Izzie.

At the hospital, Meredith chides Cristina for wearing a turtleneck to cover up her neck trauma. She doesn’t want Cristina to cover for her boyfriend because neither of them is OK. Alex wants to know if Meredith’s boyfriend is OK because he’ll be cutting into Alex’s girlfriend.

George (T.R. Knight) is upset that Izzie didn’t tell him about her illness. He doesn’t want to think about it, so he asks Callie if he can be on ortho today in order to avoid thinking about Izzie.

Bailey (Chandra Wilson) greets the residents before they go into Izzie’s room. She reminds them all that Izzie (Katherine Heigl) needs them to be her friends and not her doctors right now. There is a badass new oncologist, Dr. Swender, overseeing all of Izzie’s treatment and she tells Derek, Richard and Bailey that everything they do needs to go through Swender first. After the discussion about what her treatment will involve, the residents stand there awkwardly watching Izzie as she knits a green scarf. She reminds them that they have other patients and tells them to go save lives. The residents leave the room, and Izzie’s façade of strength fades just a wee bit.

Derek asks Alex, as Izzie’s boyfriend, if he has any questions before her brain surgery today. Alex gets avoidy and bails before going back into Izzie’s room. Later on, Richard (James Pickens Jr.) awkwardly asks Alex whether he wants to produce a sperm sample because they are harvesting Izzie’s eggs prior to radiation treatment in case she wants to have children later, and frozen eggs have a better chance of survival. Alex immediately agrees, without even discussing things over with Izzie first.

Sloan’s (Eric Dane) patient is an aging woman who is unlikely to make it through the end of the day. But her nephews and niece are all anxious to catch flights and go to board meetings, and can’t be bothered to stick around until she croaks.

Dr. Swender is so badass that even Cristina thinks that she is heartless. Swender wants to tell Izzie some bad news, but Cristina knows that telling a patient bad news before surgery often increases the chances of complications on the table.

Meredith and Callie play interference when Owen approaches Cristina, preventing him from getting anywhere near her. A little later, Owen and Derek go to the roof of the hospital to receive a head trauma patient who was helicoptered in. The sound of the helicopter makes Owen freeze up for a moment until Derek snaps him out of it.

Cristina wants to complain about Swender to Meredith, but Mer wants to discuss Owen instead. Cristina says that Owen is wounded, and it’s no different than if he came home from Iraq without an arm or a leg. She can’t possibly leave him right now.

Outside the hospital, Derek reminds Owen that PTSD is a real injury that produces real physiological changes, but it can also be healed. Owen gets defensive about it, saying that Derek is the wounded one who ran off to the woods after he killed a woman.

Richard knocks on the door of the room in which Alex is supposed to be filling his Dixie cup with his swimmers. “Karev, how’s it co— How are you doing, in there?” Richard says. Hee! Alex yells at him to go away, so Meredith takes that opportunity to come in and talk. Alex delivers a heartbreaking monologue about how he’s a doctor, and he should have known that Izzie seeing a ghost was a serious symptom of illness. But he couldn’t distinguish it from all the other crazy chicks he has been with. (If he’s referring to Ava/Rebecca, well, she had a serious illness too, and he should have seen those signs. He’s sometimes not a very good doctor.) He breaks down and cries (but in a very manly way that just about breaks my heart ) that it’s not fair and it wasn’t supposed to happen this way.

Cristina finds Owen (Kevin McKidd) down in the basement with the secret steam vent. (Eerily, there is a ceiling fan in this room too.) He tells her to stay away from him because he almost killed her. If he hadn’t woken up, she would have died. She says gently that she knows her limits and she knows how much she can handle.

Bailey comes in to check on Izzie. While checking on the monitors, she quizzes Izzie on medical stuff so that she won’t get rusty. She wants Izzie to be able to do all this stuff and teach other residents how to do it a year from now. When Izzie asks her if she really thinks she’ll be here a year from now, Bailey says matter-of-factly, “Yes, I do.”

Derek spends a considerable amount of time in the practice lab going over the surgery he has to perform on Izzie. He looks stressed out.

Alex deposits his cup of sperm on the table right next to where Richard is eating lunch. Richard gets all grossed out, and reminds him that he needs to talk to Izzie about procreating and such. The residents eat their lunch in the cafeteria, but none of them have checked in on Izzie. Bailey goes in to check on Izzie again and is surprised to see that Izzie has finished the scarf she was knitting. She had a lot of time to knit since none of her friends came to visit. She doesn’t blame them, though, because she probably wouldn’t want to visit either.

Callie confesses to Arizona in the hospital chapel that she wanted Izzie to die for so long while she was with George. Callie feels so incredibly guilty that she wished death upon someone, but Arizona reminds her that she isn’t praying for Izzie’s death anymore.

Alex’s old lady patient starts coding again, and her relatives kind of roll their eyes impatiently, wondering if this is the time she is actually going to die. Alex throws them out of her room, charges up the paddles and revives her. The old lady regains consciousness and hears Alex tell Lexie (Chyler Leigh) not to let her heartless nephews and niece in the room again. But the old lady says no. They are impatient for her death, but they always come to be by her side. They are her people, and having people is better than having no people. This makes Alex realize that he probably should be by Izzie’s side (duh!), so he runs to her room. But he is too late; she has already been taken to the OR.

Right before Derek goes into the OR to operate on Izzie, he runs out to tell Meredith that he’s not ready to operate because he needs her to say yes to his proposal. Whatever happens in that operating room today, he needs to know that he still has Meredith afterwards. Meredith is completely awesome here. She says no, she can’t say yes just to make it OK for him if Izzie dies. She tells Derek firmly that she loves him and he better go back in there and operate because she knows he can do it.

On the table, right before they put her under, Izzie tells Bailey that the scarf she was making was for her. Derek says his usual, “It’s a beautiful day to save lives.”

Callie finds George angrily pounding away at casts or whatever. He says that he doesn’t want to talk about it because he’s mad that Izzie kept her condition from him, and that when she needed help, she turned to Cristina, of all people. Callie knows that what’s really upsetting George is that his best friend could die on him.

Lexie is all by herself with the old lady. Lexie can’t revive her when the old lady starts coding. She tells the impatient relatives that their aunt is finally dead. But then, the heart monitor starts up again, and they get all, “Are you kidding me? Again?” But Lexie says that it’s just her pacemaker causing the monitor to go off, and she’s really dead. She’s only an intern, however, so she has to get Mark to call it. Lexie tells the relatives that they can go catch their planes and go to their board meetings, but now that the old woman is actually dead this time, they get sad and decide to stay a bit longer to pay their respects.

Swender crashes Izzie’s surgery, second-guessing Derek’s every move. He finally gets his groove back and tells Swender that he knows what he’s doing. In the meantime, all the residents and interns wait anxiously out in the hallway for the surgery to be over. Bailey comes out to tell them good news and bad news. The good news is that Derek was able to take out all of the tumor from her brain, and that she is OK. The bad news is that they were all terrible friends to Izzie today, and they all better do better tomorrow. Bailey rocks my world, especially with her new-new hairstyle.

After the surgery, Derek whines to Richard that Meredith turned down his propsal twice. Um, dude? Shut up. Richard tells Derek that it was Meredith’s idea to have Izzie’s eggs harvested today because she was confident that Derek would be able to save her. She believed in Derek.

Cristina approaches Owen in an on-call room to tell him that Izzie’s surgery went well. Owen asks to hold Cristina. As sad hipster music plays loudly, they start kissing, and then undressing each other. They fall down on the bed and start making love. So sad! They finally consummate their relationship just when they are beginning to realize that they can’t be together. As they lie together in each other’s arms, Cristina whispers that she is afraid to fall asleep. She doesn’t want a relationship with someone who she is afraid of in this way.

Meredith tries to walk into an empty elevator, but Richard stands in front of the door blocking her way. She’s all, “WTF?” She presses the elevator button again, and the other one opens. Oh my God! It’s the proposal! Derek is in the elevator! He has plastered the walls of the elevator with MRI scans of all of the successful surgeries they have had together. He points out certain surgeries, like the first one they scrubbed in on together, or the one when he first realized she would become a great surgeon, and the one he just performed on Izzie for which Meredith believed in him. He tells her that she doesn’t freeze. She’s seen the worst and has been through the worst, but that is how she has the strength to help everyone through their times of hardship. Her dark and twistiness is a virtue, not a flaw. He doesn’t get down on one knee. He doesn’t ask any questions. He simply says that he loves her and wants to spend the rest of his life with her. Squeee! OMG. I usually don’t gush over grand romantic gestures or anything because I have a stone-cold heart, but this is quite possibly the most perfect proposal ever. Meredith kisses him. So, I guess that’s a yes.

Since they are MerDer, though, there is no actual celebration of their engagement. Instead Meredith goes over to Cristina’s where she learns that she broke up with Owen. Derek runs an MRI of Owen.

As Alex’s voiceover brings us to the end of this episode of Grey’s Anatomy, he climbs into Izzie’s hospital and holds her hand.

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