Okay, any blowhard who says you can sleep when you die? Tell'em to come talk to me after a few months as an intern.
George and Izzie catch Derek sneaking out of the house, finally figuring out that he's the mysterious stranger who's been sleeping with Meredith. George immediately becomes jealous, but Izzie is bothered for completely different reasons no wonder Meredith is getting in all the good surgeries lately.
A flu is going around the hospital, and Cristina feels sick to her stomach. She blames Dr. Burke. A gunshot wound victim gets Alex's attention as he awaits attention in the lobby. Alex wants to know why he isn't in the emergency room. Answer: Because he has an appointment. It was a schedule gunshot wound. His friend shot him - with permission. The scars, apparently, make a great addition to his tattoos. Meredith assists Bailey on a case where a normal sized teenager (who is not now, nor ever was, obese) went to Mexico to get a gastric bypass operation a bad one without her parent's permission. Now they have to undo the damage that's been done. Izzie has to help a man who swallowed his girlfriend's keys just as she was dumping him.
George gets to be a part of the biggest surgery of the day well, at least initially he does. George works with Derek on the case of toddler with terrible tremors. After viewing films of the girls' brain just a couple months apart, Derek finds that her brain tissue is dying at too quickly a rate, and that the only way to halt the deterioration is with a hemispherectomy in layman's terms: removal of half the brain (in a young brain like hers, the remaining tissue still has time to adapt and learn how to replace the missing tissue). To George it's an amazing procedure to be done by a man who can seemingly do everything including Meredith. But George has one other issue on his mind: he swears he smelled bourbon on the breath of Dr. Taylor, the anesthesiologist who is to scrub in on the hemispherectomy. Dr. Taylor outranks George, though, and has a great reputation behind him. George doesn't know if he should say anything.
Alex and the tattooed gunshot victim bond over the fact they both wrestled collegiately in the state of Iowa. They also share the same ethos about pain being good for you. Burke, who has seen this patient before, has a hard time hiding his contempt for such self mutilation. He prefers safer hobbies: like playing the trumpet.
George speaks up to Dr. Taylor in front of Derek just before the hemispherectomy. Dr. Taylor is offended George would even suggest such a thing (essentially accusing him of being unfit to administer anesthesiology). Derek, somewhat reluctantly, has to side with his fellow attending Dr. Taylor, and George is kicked out of the surgery, replaced with Cristina.
Meredith discovers that there is more behind her patient's troubles than just a desire to be ultra skinny. She's under extraordinary to live up her Mother's lofty expectations for perfection. "Life shouldn't be this hard" Meredith tells her. Unfortunately, the procedure to reverse the gastic bypass doesn't go well. There's complications, the least of which is the patient's bowel exploding on Meredith. The girl, unfortunately, will have to struggle to achieve proper nutrition for the rest of her life.
Alex's tattooed patient begins to crash, as the stress on his body from the gunshot wound has ecsacerbated an infected tattoo he already had. They can't fight the infection though, as it has spread too far, and the patient dies.
During the hemispherectomy, the little girl begins to wake up as Derek is in the process of removing half her brain! Her anesthesia is too light and Dr. Taylor is fast asleep. Derek kicks Dr. Taylor out of the surgery, and later apologizes to George, where he also comes clean about Meredith, and his intentions with her.
Izzie, who's been giving Meredith a hard time all day, finally confronts Meredith over her indiscretions with an attending. Izzie's vitriol, though, subsides when she makes a startling conclusion: Meredith is actually in love with Derek. And now Izzie isn't quite so upset. In fact, she feels a little sorry for Meredith.
Cristina, thinking her flu like symptoms might not be a flu at all, takes a pregnancy test. Two of them. And doesn't like what she finds.