"Let the Angels Commit"
Written by Stacy McKee; directed by Jessica Yu

Cristina assists Burke in surgery as Meredith voices over that being a surgeon requires commitment. Surgeons have to be willing to pick up a scalpel even though they might cause more harm than good. If they’re not committed, they shouldn’t pick up the scalpel in the first place. After the operation, Cristina gives instructions to a nurse filling out the OR board. An intern brings her coffee but Cristina says he’s not going to get to scrub in with Burke. She also doesn’t want any residents in Burke’s OR. She goes back to instructing the nurse, telling her to put the instrument tray on Burke’s left side and make sure he’s not in an OR that has a gallery. The nurse notes that Burke has been very specific since returning to work. Alex, Meredith, and George watch from nearby, amazing that Cristina is running Burke’s board. Meredith says she’s helping him, but Alex thinks she’s taking advantage - she’s getting out of rounds and getting to scrub in on all of Burke’s surgeries. Cristina suddenly takes the nurse’s marker and starts writing on the board herself, which amazes the other interns even more. The interns all meet up in the locker room, where Meredith confides in Cristina that she told Derek she broke up with Finn (see “Oh, the Guilt”) but he hasn’t called her yet. She asks Cristina to go grab a drink, but Cristina has to study up for more surgeries with Burke. Meredith makes excuses for her to Alex, saying Cristina is just busy.

George tracks down Callie and tries to get her to talk to him, but she doesn’t want to. At the trailer, Derek gets out of his shower and is startled by a woman on his bed. He asks the woman, Nancy, why she didn’t call first just as Meredith enters and gets the wrong idea. She runs off and Nancy asks if that was the “slutty intern” Derek cheated on Addison with. She explains that she’s there because Derek missed both Thanksgiving and Christmas and is now living in a trailer and getting a divorce. Derek tells her he doesn’t like her. The next morning, Izzie comes to Seattle Grace for her first day back at work and is obviously nervous. She stops off at human resources while Meredith and George continue their elevator ride and agree to be Izzie and Cristina for each other. Meredith confides that Derek had a woman in his trailer the night before. George pretends to complain as Cristina, then tells Meredith that Callie won’t talk to him or forgive him. Meredith tells him that he deserves better. They realize that they’ve become the people who the people they want to be with avoid. Meredith says they have careers and they shouldn’t be preoccupied by thoughts of doctors with perfect hair. George wants to make a no-dating pact, and Meredith announces that Derek and Callie are dead to them. Burke meets the wife of his newest patient, Pruitt Byrd, who has a cardiac tumor and needs what’s known as a Humpty Dumpty procedure - the heart is removed and cut open, the tumor is removed, and the heart is replaced. Cristina has already scheduled the surgery even though this is the first Burke is hearing about it.

In his office, Webber tells Bailey that Izzie has been cleared to return to work, but Bailey needs to explain the rules to her. Bailey is surprised that Izzie will be her intern again, since she thought it would be better for her to start fresh with a different resident. Webber thinks Bailey doesn’t want her back, but Bailey just says she wants Izzie to succeed. Webber knows he doesn’t need to tell Bailey that after Denny’s M&M (see “Oh, the Guilt”), there are doctors who have some concerns about Bailey’s judgment. He adds that Izzie was Bailey’s mistake. She asks if Webber has concerns about her judgment, too. Instead of answering, he tells her that she can’t put people’s concerns to rest unless she takes Izzie back as an intern. Addison and George receive a patient named Noelle who’s 32 weeks pregnant with twins, one of whom seems to be developing more slowly than the other. She’s there with her fiancé, Greg, though Noelle says that he’s the only person who cares if they’re married or not. Addison is surprised that Noelle was transferred from Mercy West via ambulance, since she’s not having an emergent situation. Noelle and George explain that she was sent to Seattle Grace because she has two uteruses. George feels the need to tell Noelle that that’s very rare. Izzie tracks down Bailey and tells her that her paperwork is all done and she’s officially back to work. She’ll have to undergo counseling and do some extra work, and Bailey has some other rules for her - basically, she can’t do anything except observe until she’s earned back everyone’s trust. She’ll be shadowing a different doctor every day, and today she’ll be with Meredith.

Meredith is apologetic about the situation but Izzie says she’s fine with it (and we all know that when Izzie says she’s fine, she’s really fine). She accidentally runs into Derek, who welcomes her back and then tries to talk to Meredith. Izzie tells him she has to stick with Meredith, so they can’t exactly have a private conversation. Nancy shows up and announces that she hates the trailer, but at least Seattle is nice. Plus, she knows Derek likes ferries (“ferryboats,” Meredith and Derek both correct her). Derek introduces Meredith to Nancy, who happens to be his sister, much to Meredith’s relief. Too bad she already doesn’t like Meredith, noting that Meredith ran Addison off. Burke laments that Cristina signed him up for the Humpty Dumpty surgery; she points out that he put her in charge of his schedule, but he said that was to avoid situations like this. Cristina reminds him that not many people can do the procedure, and she knows he doesn’t want to have to tell Webber to send Pruitt somewhere else. She adds that he’ll die without the operation. Burke is upset that Cristina scheduled it without consulting him, then asks if she even knows what the operation entails. She promises that they both know what they’re doing and everything will be fine. Bailey approaches and mentions that she knows some of the doctors have doubts about her judgment after the Denny situation. She wants to know if it’s just gossip or if people are really concerned. Burke pretty much blows her off, just saying, “Sure, sure.”

Meredith’s patient is a woman named Gretchen who burned her hand while making tea before she started studying for her bar exam. She failed the last time she attempted the exam, but now she’s sure she’s ready for it. “Good for you,” says Izzie, earning a disapproving look from Meredith. Elsewhere, Derek chastises Nancy for acting the way she did with Meredith. Nancy explains that their sister Kathleen asked her to “find out why the slutty intern’s panties were hanging on the bulletin board” (see “Time Has Come Today” and “I am a Tree”). Derek complains about having four sisters, then tells Nancy he needs to concentrate on his patients. She tells him she herself has patients (she’s an OB), so Derek encourages her to go home and take care of them. He adds that she sounds more and more like their mother every day. George chats with Noelle and Greg, who shares his ham-and-eggs metaphor. In every situation, you’re either ham or eggs - the chicken contributes the eggs to the meal, but the pig is committed. Greg himself is ham because he’s absolutely committed to being with Noelle and his children. Mark summons Alex for what Alex believes will be a surgery, but he just wants Alex to wait on the phone with the DMV for him. “Thanks for thinking of me, sir,” says Alex, teasing George for being the new slave on Addison’s service. George brags that he has a pregnant patient with two uteruses, but Alex claims not to care (though he then takes a peek at Noelle’s chart).

Mark, Addison, and Nancy all meet up and talk about Derek. Nancy asks Addison if she can see Noelle, and after she heads off to talk to Derek again, Addison and Mark say that they miss her. Greg does color commentary for the benefit of one of the babies; Noelle explains to Alex that Greg can calm the baby down by talking to her. Alex has read articles about that, and Addison thinks it’s because he secretly misses her service. Addison and George tell Noelle and Greg that the babies are both healthy, but they’re different sizes because they have different due dates - the boy was conceived six weeks before the girl. Greg announces that they broke up after Noelle got pregnant because he wanted to get married and she didn’t. Six weeks after the boy was conceived, they definitely weren’t having sex…with each other, at least. Noelle confesses that she had a one-night stand with someone else. Greg is furious and storms out, and George again unhelpfully narrates that he’s not the father of both babies. Later, Addison confides in Bailey that she just accidentally told her patient’s fiancé that she was unfaithful. Bailey is a little bitter that no one will question Addison’s competence. Webber approaches them, complaining that he’s down to his last clean shirt, but it’s missing a button. Adele always handled that sort of thing for him, but he doesn’t want to bother her with something that trivial now. Bailey and Addison tell him they can’t sew the button on because they’re busy, and also surgeons, not seamstresses.

Mark examines Gretchen, noting that when she grabbed the pot she was heating water in, she must have held onto it for a while because the burn is too deep if she just picked up the pot and dropped it. This doesn’t seem to fit with Gretchen’s story, and Izzie picks up on this. Gretchen laments that she had to burn her hand right before the bar exam, but Mark assures her that she’ll still be able to take the test. She’s not as happy about this as she should be. Later, Izzie tells Meredith that she thinks Gretchen is lying. Meredith reminds her that she’s only supposed to be observing, and Izzie says she is, which is how she noticed that Gretchen wasn’t relieved that she can take the bar on time. Meredith thinks Izzie is just nervous about being back at work, and she warns her not to bend the rules so soon. Izzie tells her she’s just worried about their patient, adding that Meredith needs to get off her high horse. Meredith replies that Gretchen is her patient. Bailey sees on the OR board that Burke is performing a Humpty Dumpty procedure and decides to sign herself up to scrub in. Cristina notices and panics. George tracks down Callie and tries to explain that he was the chicken and she was the pig, but she misinterprets and thinks he’s insulting her. He tells her it doesn’t matter, since now he’s the pig. Izzie finds the other interns eating lunch in a patient’s (“really old guy”) room, where they’ve taken to meeting because it’s quiet. She tries to complain about not being able to do anything, but Cristina is studying and sends her to the other side of the room.

Alex tries to get information about Noelle out of George, who thinks he’s mocking him and taunts back that Alex is on “glorified plastics scut.” Izzie says she’s happy to be back and has no complaints about Meredith being in charge of her. George admits that he called Callie a pig and Meredith asks what happened to their agreement that Derek and Callie are dead to them. Meredith leaves once her card game with George is over, and Izzie is saddened to realize that she and George have “a thing” she doesn’t know about. Cristina complains that everyone’s disturbing her, then storms out. Izzie laments that everything has changed. Cristina tends to Pruitt as Mrs. Byrd confides that since her husband’s illness, she’s become a different person (one she thinks is horrible). Cristina says she’s just looking out for her husband and doing what she needs to do to protect him: “That does not make you horrible. That makes you smart.” She then heads to the OR board and erases Bailey’s name from the Humpty Dumpty surgery. Addison heads to Noelle’s room, where George tells her that Noelle is hyperventilating and one of the babies’ hearts is beating quickly. Noelle is really upset about Greg leaving and tries to convince herself that they’ll get through their problems. She starts having some cramps and Addison and George try to get her back into bed. Nancy and Derek have lunch at the ECB, where Derek says nice things about Meredith and Nancy notes that he’s never acted like this about any other woman, even Addison. Nancy thinks Addison isn’t that bad of a person for sleeping with Mark, since everyone does, but Derek tells her they had more than just a fling.

Meredith finds Cristina studying near the OR board and asks if she’s mad at her for something. “Not everything is about you, Meredith,” Cristina shoots back. Meredith asks what her problem is, but Cristina doesn’t tell her anything. Bailey passes the board and realizes that her name is missing. Later, Burke and Cristina get ready for the Humpty Dumpty procedure and he notices that something seems off with Cristina. She doesn’t tell him what’s going on. George runs into Greg, who asks how Noelle is. George blasts him for leaving, but Greg is having a hard time digesting the fact that his daughter isn’t really his daughter. George tells him that Noelle needs an emergency C-section to deliver one of the babies and hopefully stop labor on the other in the process. Greg wants to know whether the girl or the boy is being delivered. “Greg! Ham or eggs?” George responds. Alex researches Noelle’s situation at a nurses’ station, where Mark catches him and blasts him for not showing him he really wants to be a plastic surgeon and not an OB. Alex notes that staying on hold with the DMV has nothing to do with his career in plastics. Mark argues that it does, since he’s the one who controls Alex’s future in the field. Alex overhears a nurse ordering blood for Noelle and heads off to help. Meredith dresses Gretchen’s burn, telling her that she won’t need to have any skin grafts. Gretchen wonders how long that would take to heal if she needed them. Meredith finally starts to get suspicious and asks to hear the story again. Izzie finally asks if Gretchen burned herself on purpose. Gretchen admits that she did because she didn’t want to fail the exam again. Izzie can relate - she doesn’t need people making her feel pathetic for failing when she already feels that way herself.

As Alex and Nancy observe, Addison begins Noelle’s C-section with George tasked to hold one uterus aside so she can get to the other. She warns that she’ll only have about 120 seconds to get the first baby out, and if George moves wrong, the second uterus could rupture and kill the second baby. In another OR, Burke and Cristina start the Humpty Dumpty surgery and Burke is impressed with the amount of studying Cristina has done. Addison is about to deliver the first baby when George tells her that his baby is moving and he can’t hold it still. Noelle starts to go into distress, but George still can’t get the baby to stay still. Alex jumps in, ignoring Addison’s instructions to stay away, and tells the baby about a boxing match until it settles down. Derek finds Webber sewing on his button in a suture room and tries to give him some advice. Webber thinks he can handle it by himself, but he can’t, so he promises to get rid of Mark and Addison if Derek sews for him. As he works, Derek laments that Mark was like a brother to him, and now he just has annoying sisters. The two bond over how hard divorce can be and how they both want to move on. Sloan blasts Alex for helping out with the C-section, warning that he’s effectively given up on a future in plastics. Burke praises Cristina for her great work on Pruitt; she tells him she’s always prepared. He admits that he couldn’t have done it without her. Bailey approaches and tells Burke that she didn’t know he was one of the doctors who doubted her. She wants to know why her name was erased from the board. He has no idea what she’s talking about but realizes that Cristina is responsible. He covers for her by telling Bailey that he just couldn’t use her.

Nancy tells Derek about the C-section, then promises that she’s going home in a couple of hours. She says she’ll tell their mother that he’s still himself and “still running circles” around the women in his life. He denies this, but Nancy points out that he hasn’t been single for a long time. She doesn’t think he’ll be happy until he has some space, especially away from Addison and Meredith, so that he can figure out what he wants. Derek thanks her for coming to visit. Meredith and Izzie take Gretchen upstairs on an elevator, not telling her where they’re going until they get to the psychiatric floor. Meredith wants Gretchen to stay for 72 hours just in case. Gretchen protests that she’s not crazy, and Izzie tells her they want her to get help so she doesn’t hurt herself again. “Everyone needs help from time to time,” Izzie says. “To make sure they’re okay, they’re ready. I have that. And you need that right now.” Gretchen consents, repeating that she’s not crazy; she just doesn’t want to fail. Noelle wakes up after surgery and asks about her babies, then Greg. Addison tells her the babies are fine and Greg is gone. This happens two more times, as Noelle is still coming out of the anesthesia, but the third time, Greg shows up to prove that he’s ham. Mark finds Callie and tries to flirt, but she doesn’t want to have any more sex with him. Neither realizes that Alex can hear their conversation. Derek runs into Meredith, who notes that Nancy doesn’t like her. He says that he should have called, and adds that he wants things between them to work out, but it’s complicated and he needs some time. Meredith understands but isn’t happy about it.

As Meredith voices over that we sometimes have trouble with commitment, Webber runs into Izzie as they’re leaving the hospital and tells her that Meredith filled out an evaluation on her first day back. He’s proud of the way she handled Gretchen’s case and is glad to have her back. Callie waits for George and tells him she’s sorry for the way she talked to him earlier. She also now understands what he meant about being involved vs. being committed. However, it’s too late because they’ve already broken up. She wants to be happy as a single woman, but George makes it hard by saying things like this. “Please don’t chase me anymore unless you’re ready to catch me,” she says. Meredith voices over that sometimes we’re surprised about the commitments we’re willing to let go of. Meredith finds Cristina in the locker room and tells her she’s there whenever Cristina decides she’s ready to talk. Meredith voices over that we may be surprised about the commitments we’re willing to make. Cristina writes on the OR board as Meredith’s voiceover continues that commitments require effort and sacrifice. Burke catches Cristina writing but neither says anything. Bailey passes by next, and as Meredith voices over that we have to learn how to choose our commitments carefully, she seems to realize that something is going on with Burke and Cristina.

THE TITLE IS A SONG BY…: Howle & the Tantrums

MEMORABLE QUOTES: George: (re: Cristina) “She’s writing on the board!”
Alex: “Maybe I should sleep with Burke.”

Meredith: “Derek had a woman in his trailer last night. She was ugly, very ugly. Except she was tall and beautiful…and he was naked.”
George: “Oh, uh, McDreamy was doing the McNasty with a McHottie? That McBastard.”

Derek: “Meredith, this is my sister Nancy.”
Meredith: “Sister? You’re one of Derek’s sisters?”
Nancy: “Well, I knew you didn’t think I was the wife, seeing as how you already ran her off.”

Nancy: “What are you doing here, Mark? Are you trying to torture him?”
Mark: “He’s my family, Nancy. Plus I needed a change of pace. Plus I slept with my tennis partner’s wife and he went out and bought a gun.”
Nancy: “There it is!”

“I have many skills. Surgical skills. Your button ruptures an esophagus, I’m your woman. Otherwise….” - Bailey to Webber

Webber: “You sew this on for me, I’ll get rid of Addison and Sloan.”
Derek: “Really?”
Webber: “No.”
Derek: “Well, I’ll do it anyway.”

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