O.K., so I always joke about the voiceover, but tonight I missed it and found myself disoriented, with no idea what to expect from this episode. Maybe it the half pitcher of pumpkin ale was a contributing factor, but I’ve grown incredibly reliant on Grey’s pre-episode summaries and philosophizing for context.

Don’t worry, in terms of long-term plot development only two really important things happen during this episode and I eventually caught the first few minutes. You’ll find a full recap after the jump. Feel free to use the comments as your virtual water cooler to discuss the finer points of our favorite pretend-local hit drama.

the first-pass recap follows, with the possibility of morning revisions and clean-up to reserved.

Over a surgical montage and locker room changing, real Meredith swigs Pepto while her voiceover sets up the episode: “At some point during surgical residency, most interns get a sense of who they are as doctors and the kind of surgeons they’re going to become. If you ask them, they’ll tell you they’re going to be general surgeons, orthopedic surgeons, neurosurgeons. Distinctions which do more than describe their areas of expertise. They help define who they are, because outside the operating room not only do most surgeons have no idea who they are, they’re afraid to find out.”

At the Burkeatorium, Preston is practicing his chicken re-assembly. Sandra Oh is tired of timing him and is certain that he’ll be re-certified for surgery. As she leaves, he looks at his quivering hand.

In the locker room, Alex harasses George for tossing Callie out on the street. He runs to apologizes to her in the hallway, saying that he has trouble talking about his feelings. This doesn’t seem to work very well, as she points out that he shared his emotions with Grey and Izzie. Yeah, but it took him like a season and a half to reveal his crush to Meredith, and we all remember how that turned out, right? As Bailey summons him for intern meetup, he says that he misses her. This seems to placate Torres a little.

Meredith looks sick, which she blames on the stress of double dating. Or rather, dating two guys. The interns converge on a chatty car salesman who’s trying to get out of the hospital. Bailey insists that he pump up his oxygen count and promise to cut out the crappy diet and the smoking once she sets them free.

Alex and Addison check in on a delayed labor. The husband is really supportive with talk of breathing and squats, which Alex dismisses. He says that they’ll monitor the progress and perform a c-section if necessary. The mother, who we remember as the woman who induced Nate’s “Narm” incident on Six Feet Under, isn’t keen on this, saying that they have a natural birth plan and wants the whole experience.

Grey’s condition gets worse in time for a massive convergence of doctors. Dempsey stops to ask Meredith if she wants to help with one of his surgeries, Addison enters, and everything stops when the sexy music plays for McSteamy’s entrance in scrubs. Meredith pukes; and the salesman’s face explodes as he lights up a cigarette near an oxygen tank. It’s really gruesome, not as bad as last season’s vaporization, but it’s still a far more effective anti-smoking campaign than those nasty claymation roadkill ads.

–

As the doctors rush roll Smoky Scabface to surgery, Meredith sips a glass of water to deal with her puke mouth. McDempsey tells her that she looks beautiful, potentially pregnant.

McDempsey confronts the Chief about the addition of McSteamy to the cast because he left New York because of him. And here he is in Seattle. The Chief reminds him that people do stupid things all the time. AND it turns out that he’s the best plastic surgeon in all of the land. Just like Dempsey is the best neurosurgeon and Addison Avenue is the bestest OB/GYN. If only these three could get along they could rule the medical world with their awesomeness.

During all of this Grey pukes again, and Addison snipes that an adulterous love child is ever so quaint.

The doctor becomes the patient. In an exam room, Meredith says that she can’t be pregnant. Sandra Oh just wants to know who the father is. Turns out that it can’t be Chris O’Donnell since they haven’t yet sealed the deal. Which can only mean one awful new nickname, McBaby. Say it ain’t so. Luckily, Bailey enters, saying that they’ll need some more tests. But Meredith gets herself a healthy dose of morphine.

It looks like someone read Atul Gwande’s story [newyorker] last week. Alex wants to do a Caesarian section, but Addison is committed to respecting her patient’s preference for a natural birth. With this, Alex presses to tag along with McPlotDevice’s plastic surgery. She says that Alex has nothing to learn from him, as he only looks out for himself.

Elsewhere, Dempsey manipulates Preston’s arm, but he’s still pre-occupied with Seattle Grace’s newest plastic surgeon. Sandra Oh stops by to assert that her boyfriend is perfect. By the way, Grey’s not pregnant with any doctor spawn. Impressed by his range of movement, Dempsey clears him for surgery.

At Joe’s bar Izzie is meeting someone she’s never met. An older ex-Marine type who turns out to be Tin Man Denny Duquette Senior.

—

After the commercial Denny Sr. tells Izzie that she’s pretty and not at all Denny Jr’s type. He liked smart dark haired girls (not that she isn’t smart, since she’s a doctor). She reminds him that she’s not a doctor anymore. The Chief told him that she quit and that he’d need to talk to her to get the whole story about the Denny’s last days.

Scabface’s wife tells Alex and McSteamy that her husband needs to know that his face will fixed, missing the fact that his face is all sorts of burned? In case I forget to mention it in future scenes, she pretty much reminds whoever’s listening that her guy is a salesman (implied: no fool would buy a car from a disfigured person). The doctors say that they’ll need a neuro consult before they can proceed. Also, he wants a bone dry cappucinno. The dude’s a total contrivance, but he knows a good espresso beverage.

Waiting for test results, Meredith is high on morphine. Sandra Oh, her best friend in the whole world is there, despite her hatred of being around stoned people. It seems that Grey isn’t full of growing Dempsey spawn, she just has a little appendicitis. Bailey tells George that he’ll be scrubbing in, and this causes concern all around because Meredith remembers what happened the last time George tried to help out with a nasty appendix. Grey thinks that Bailey is pretty. And she wants ice chips.

In the Stairwell of Frequent Meetings, George runs into Callie. She wants to have dinner at the “Archfield”. He wonders how she’s affording to live there and she promises that she has plenty of more interesting secrets to show him if he agrees to meet her.

In the hallway, Oh meets up with casual friday Burke. He doesn’t think that Dempsey should have cleared him for surgery.

I’m not really sure what the point of Alex/Addison’s difficult delivery case it. Narm Girl from Six Feet Under fends them off, because she wants to stick to her birth plan. She refuses to be a weak weak women who gives up for a cushy surgical birth and chases them out of the room while she writhes in labor pain. Outside Bailey expresses her surprise that Addison was into McSteamy, that is, a woman who “gets the hots for man candy and cheats on her husband”. Although she finds the comment rude, Addison agrees that the whole man candy thing is true. Bailey, apparently Addison’s new b.f.f. (only f.f.) reminds her that no man defines her identity.

In Morphine Meredith’s room, Patrick Dempsey performs a mini exam of his own, teasing her about the benefits of having a boyfriend who works in the hospital. She points out that he isn’t her only boyfriend just as Chris O’Donnell enters the room. Grey is really happy to be all drugged up.

–commercials [digression: how did laura linney get involved in man of the year??]–

As Dempsey and O’Donnell banter for superiority, George enters to prep Meredith for surgery. She’s still stoned out of her mind and exclaims, “now all my boys are here!” and reveals that George is such a good kisser. When the current Elimidate contestants seem confused by this comment, she explains that they weren’t so much dating, it was just a disastrous sexual experience. Bailey clears the room, but they both promise to be back for her return.

Miraculously healed Burke is found in the poorly-lit morgue practicing procedures on a corpse. Sandra Oh insists his hand is fine. He looks mad, but tells her to forget it, tossing her a stopwatch and asking her to time his skillz.

Back at the bar, Izzie is trying to explain the Tin Man’s last days, saying that the transplant went better than expected. Just as she gets to the juicy part about the machine, Denny Senior interrupts to say that he knows what killed his son: a bum ticker. What he seems curious about is not the obvious malpractice question, but about how a girl like her ended up becoming his fiancee just a day before he died. It’s only now that we remember that the Tin Man, in addition to having a sucky heart, was a world class ultra-rich adventurer.

Today is really Dempsey bicker day. He and McSteamy [will someone please suggest a better nickname? I fucking hate this one, but am stumped for something better.] fight about whether the burn victim should be observed before going into surgery. Dempsey insinuates that having a massively damage face repaired is just cosmetic surgery. One track mind wife just wants her salesman’s husband fixed. The doctors don’t really care about Scabface enough to leave their battles behind. McSteamy says that if his sleeping with Addison was so unforgivable, how does Dempsey justify his hookup with Meredith. With no immediate answer, he says that they’re exactly the same. Well, they both like “ferry boats”.

Morphined Meredith bellows for Addison, who checks her chart and finds that she isn’t pregnant. Grey asks if Addison’s O.K. She reluctantly plays along, saying that she’s find and asking about the Meredith’s condition. She reveals the uncomfortable truth that she’s trying to choose between two men and asks how Addison know that her husband was “The One”. Addison is taken aback. Meredith says that she knows that Addison hates her, and doesn’t owe her anything. She wants Patrick Dempsey to be The One, but is worried that she wouldn’t be question his Oneness if he was The One. Addison says that she didn’t know, she just knew that he wouldn’t hurt her on purpose. Druggy Grey mumbles that he hurt her when he chose his wife over her. The drugs are having a nice effect on everyone, and Addision thinks that she should have been a better person let him go. She doesn’t hate her, but is only talking to Meredith like this because she’s high as a kite and won’t remember the conversation. Still, it was a nice moment.

Leaving the room, she runs into Dempsey, pausing to tell him not to hurt Meredith again. Before they can talk it out, Alex rushes in to say that Lady Narm is in trouble and they need to do a C-section, stat.

—

In the birthing suite, the machines are making bad noises. Addison tells the patient that there’s no time for conversation about hippie ideas about natural birth and they wheel her off to surgery.

At Joe’s bar, the conversation continues. Daddy Denny wants to know why Izzie quit her job after Denny died. It’s fairly clear that he’s trying to out her as a golddigger and not a murderer. Isabel changes the subject to find out why Daddy wasn’t at his son’s bedside when she was there nonstop. Dad says that if Denny Jr. told her that he and his wife abandoned their son, then he didn’t tell her the whole truth.

In the morgue, Presto’s having a shaky corpse surgery. Sandra Oh is still there, shocked that his hand isn’t fine. He freaks out, saying that she wanted to believe it and only likes him for his hands. They’re all that he has of value and if he can’t finish this fake surgery, he’s in trouble. The both look grim at the prospect of such a future. Crossing to his side of the table, she gets a bright idea to give him a hand. Frustrated, he resigns himself to see her point: if she holds the vessel, he can attach the graft. It looks like they have a brand new little secret.

Later, the Chief tries to convince Dempsey that the addition to McSteamy to the staff was purely a business decision. He wants to get personal, asking why the Chief left Mother Grey. It turns out that although he could have left his wife, the Chief would have had too much guilt-filled baggage and never could have been happy. He loved Meredith’s mother enough to walk away, leaving her to suffer from Alzheimer’s Disease all alone for years. This made him feel like a better man. Speaking of Mother Grey, how long has it been since we’ve seen her?

For those who cared about this irrelevant plotline: the c-section went fine. Lady Narm thanks Addison as she hands off the healthy-looking newborn.

Alex pops in for the Face/Off action, but is quickly dismissed when he enters the O.R. without the requested cappuccino.

Surprise: Meredith doesn’t die in surgery. Bailey even lets George lead the appendectomy. While they’re cutting away at her intestines, Patrick Dempsey finds Chris O’Donnell in her room. They talk about their love of fishing (tip: Coronet Bay) and the vet’s dead wife. Dempsey sees how much his rival’s a really good guy who likes Meredith.

Denny Sr. recounts the confusion of his son’s unexpected illness. One day, they found a note and he’d run off to spare them from dealing with his uncomfortable death. In fact, they’d assumed that he was long dead. Isabel says that if she’d known, she never would have let her patient/lover get away with such rotten behavior. She tells him that she worked her way through school and paid her debts, but doesn’t mention the underwear modeling. The point is that she didn’t need his money. And she had everything she needed until he died. She really misses him. Hearing this, Daddy Duquette hands her an envelope from Denny.

–

At the hospital, George breaks his date with Crazy Callie saying that he has to go home for Izzie. Sick of being the other woman, she saves him the trouble of deciding whether she’s his girlfriend or just someone to mess around with by dumping his sorry ass.

Salesman Scabface’s surgery went well, but McSteamy says that his face may never be exactly what it was. Go figure — It’s still looking really really charred and puffy. When the plastic surgeon is unable to come up with any response to the wife’s repeated reminders of his pretty faced salesman days, Bailey jumps in with some inspiration. She reminds him that he as an incredible wife and salesman buddies waiting to visit. She assures him that the important thing isn’t his face or his job, it’s about people in your life who love you. She takes his hand supportively while McSteamy look confused at the concept of compassion.

Dempsey finds O’Donnell and Meredith discussing the hilarity of her morphine high. When Chris is sent out for ice chips, she asks how badly she embarrassed herself. Dempsey sits down on the bed and tells her that she deserves to to be with someone who makes her happy, not someone who complicate you life. He thinks that she needs someone who won’t hurt her. He says that O’Donnell is the better guy. She looks panicked and confused as he declares with a sad smile that he’s walking away.

Back at the Intern Party House, Izzie has summoned George to provide moral support while she listens to the message that Denny left on his parents’ answering machine. He takes her hand while she dials the number.

Addison has a quick conversation with McSteamy. She doesn’t want him here, but says that if he insists on staying, they’ll be co-workers and nothing more. While she’s cutting people loose, she sets alex free of her OB/GYN service, saying that she suspects he’ll miss her.

As Izzie listens to the answering machine, tears streaming down her cheeks, Denny provides the ending voiceoiver: “Dad, mom, it’s me. I’m calling from Seattle Grace Hospital where the beautiful, talented, incredibly stubborn Dr. Isobel Stevens has just given me a new heart and promised to marry me. I know we’ve had our differences and I’m sorry we’ve been out of touch.”

At home again, Burke is making dinner for Sandra Oh (vs. practicing his chicken carcass surgery)

“believe it or not, I was trying to make everything better. I know you’re angry. I hope you’ll forgive me. It turns out, sometimes you have to do the wrong thing … ”

McSteamy and Torres close out the night at Joe’s Bar. Both have had bad days. All the she knows about him is that he’s allegedly “dirty bad”. He moves closer and offers to buy a drink; she chugs hers and invites him back to her hotel.

“… sometimes you have to make a big mistake … to figure out how to make things right.”

As the evening ends Chris O’Donnell asks Meredith when he can come back for morning visiting hours, but she tells him that he shouldn’t do that. He’s confused, until her face tells him that she’s choosing Dempsey. He asks if he’s allowed to ask why (other than his four episode contract). She tells him that he’s a great, wonderful guy who may even be the better guy, but Dempsey is The One. She wishes that he wasn’t. Making his exit as she cries a little bit, he predicts that Dempsey is going to hurt her again and he won’t be there when he does. Taking a last look, he tells her to take care of herself. Not quite as sad as the death of Doc the Dog, but I guess the show can’t really handle perfect characters for more than a few episodes. Otherwise it gets boring.

As Denny’s voicemail from beyond concludes, Izzie’s quiet crying intensifies. “mistakes are painful, but they’re the only way to find out who you really are. I know who I am now. I know what I want. I’ve got the love of my life, a new heart, and I want you guys to get on the next plane out her and meet my girl. Everything’s going to be different now. I promise. From here on out, nothing’s ever going to be the same. I love you. Bye.”

Along the way We catch sight of the contents of the envelope. A check for 8.7 million dollars. Now we see why Daddy Denny was so suspicious. Since there’s no Law & Order : Medical Victims Unit, she’s probably in the clear for clipping that LVAD wire.

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