As interim chief, Burke gets a little abuse from his fellow surgeons: It's lonely at the top. Derek and Burke are jealous of each other and competitive, but when push comes to shove, Burke defends Derek, showing him respect as a fellow surgeon. Meanwhile, Richard is not a very good patient. We meet Richard's wife, Adele, who was on vacation. Richard had brain surgery and didn't tell his own wife. An abusive father/husband needs a liver, which Cristina doesn't believe he deserves.
The son is a potential donor (has a choice to donate part of his liver), and Alex relates to him because Alex's father was also abusive. Bailey and Meredith's patient swallowed 10 Judy doll heads. Bailey needs all the interns to help her dissect the doll heads from the patient's bowels. Meredith relates to the patient when he says he feels empty. Meredith still feels betrayed by Derek, and feels empty, like "a sink with an open drain." George's transplant donor is not brain dead as anticipated. She has a tumor on her brain stem, which Derek operates.