After a round of steamy (sadly, off-screen) fireside love-making, most guys would roll over and fall asleep. Not Dr. Derek Shepherd. He's too busy figuring out a way to remove Izzie's tumor. Wasn't that supposed to be inoperable? Again, not for Dr. Derek Shepherd.
Dr. Swender isn't sold on Derek's plan to operate. The surgery is risky and the IL2 treatment Izzie is getting has kept another "miracle" patient tumor-free for two years. Izzie is also worried about the speech and memory side effects of surgery. The debate begins. Surgery or radiation? Yeah, we don't know what they should do either.
They do some tests to see how Izzie's memory might be affected by the surgery. During the testing, she's unable to speak, or even nod, when Meredith asks her to tell her who Alex is. Needless to say, the test doesn't do much to convince Izzie or Dr. Swender. Even Meredith is switching sides. Alex, on the other hand, asks Derek, "What if it was Meredith?" Derek tells him, "I would ask her to have the surgery."
George, Owen and Callie treat a soldier back from Iraq. Their patient is suffering from some phantom pain in his leg. The soldier wants to have it amputated. This way he can get a prosthetic, start rehab and hopefully get back to the front. Callie wants nothing to do with it, but George is intrigued by the soldier's dedication. Owen is, of course, supportive as well. Against her better judgment, Callie performs the amputation.
Alex can't believe Izzie has decided against the surgery. "It's not just your life at stake anymore," he shouts. Derek is furious with Cristina for talking Izzie out of the surgery, until Meredith tells him she's the one who talked to Izzie. Meredith tells Derek how her mother wasn't her mother anymore once she got Alzheimer's. Derek insists it's not the same thing. Izzie's condition is treatable. He orders Meredith, as his resident, to talk Izzie into the surgery.
Izzie is talking over her decision with Dr. Swender's "miracle" patient when the woman collapses. Her surgery doesn't go well. Izzie looks on as Swender tells the woman's family she'll never be able to come off the ventilator.
Izzie asks George what she should do. "You know what to do," he says. "You've already made the decision." Izzie tells Derek he can operate, but she doesn't want to end up on a ventilator. She signs a DNR but Alex wants her to tear it up. Izzie doesn't want Alex to go through the pain she went through with Denny. "If it comes down to it, just let me go." We all know that's the last thing in the world Alex ever wants to do.
The Chief tries to lure Bailey away from pediatrics and back to general surgery. Arizona has something to say about that. She vows to fight the Chief for Miranda. George, meanwhile, appears to be gearing up for a fight as well. So inspired by his soldier patient's passion, George joins the Army. We say again-George joins the Army!
Owen tells Cristina he's going back to Iraq. His nightmares are the result of "unfinished business." She tells him she doesn't want him to die. He says, "Come with me." They arrive at Owen's old house. When his stunned mother opens the door, Owen simply says, "I'm home."
After seeing Izzie wheeled off to surgery, Meredith tells Derek, "I don't want to spend another day not being married to you." We're willing to forgive the blatant double-negative if it means Mer-Der will finally tie the knot. For we don't want them to not be married either!