'Grey's Anatomy': Domino Theory -- with kidneys

No one on Grey's Anatomy is an island, no matter how much they sometimes wish they were. This week we find everyone wrestling with expectations -- their own and others', plus some cool surgeries, preening and scowling by the male attendings and some banter that was better suited to Showtime than the 9 p.m. timeslot on network TV.

A cascade of falling spoilers ahead...

As she rushes out the door to answer Bailey's early page, Meredith sees Derek reading from the Annals of American Neurosurgery, on the cover of which his smiling face appears, recognized for the clinical trial he and Meredith did with viruses and inoperable brain tumors. The article dubs the treatment "The Shepherd Method." Never mind that Meredith was the one who came up with the idea and convinced him to work with her on the trial.

At the hospital, seeing the magazine, the Chief is excited that the hospital is getting some good publicity. The dreaded rating again -- this rears its ugly head throughout the episode, and makes me wonder how the Chief could keep any medicine in his one-track mind.

Bailey is preparing for a huge case, and has bogarted all the surgical residents to help her. She's set up a domino surgery -- a set of interconnected procedures, all dependent upon one another. A group of six patients who need new kidneys will get them via paired matching donation; the donors are all connected to the recipients, but none of the recipients will get "their" donors' kidneys. The son of one man will give a kidney to the husband of a woman whose kidney will go to another woman, etc. They're doing all the surgeries at once so that no one backs out. Because if someone changes his or her mind, the whole thing comes apart. So it's important to keep the patients happy.

Added to the Shepherd Method and the surgeries, there's one more main storyline. Callie and Hahn got physical for the first time (forgive me for being dainty; I'm not easily shocked or offended, but the frankness on this topic, while welcome, suddenly made we want to sit up straight and button my top button. That said, I like how the Callie-Hahn relationship has been playing out, and Callie's need to talk through her feelings endlessly makes for high comedy). And Callie wasn't into it. She couldn't exactly go all the way, and she desperately needs to discuss it with the one person who would understand: Sloan. Who, as it turns out, wants no part of it and finds the whole conversation depressing. To make matters worse, Hahn had a good time, and wants to get together again. After the past couple of weeks with Callie being obviously conflicted about being with a woman, this is no surprise, but I partially wonder if Callie's psyching herself out.

Back to the medicine. The patients, as it turns out, are an interesting bunch. It looks as though one man is paying his estranged son $10,000 to donate his kidney. One woman doesn't seem to be connected to anyone, until she snaps under everyone's admiration for her selflessness and it comes tumbling out that for the past three years she's had an affair with one of the men, Stan (George Newbern), whose wife Nancy (Colleen Flynn) is giving a kidney to a young Asian woman. (Quick aside: Colleen Flynn has a flair for medical drama shows; she played a woman who dies in childbirth in "Love's Labor Lost," a brilliant 1995 episode of ER.) Nancy, crushed, decides to pull out of the operation, and after another donor is unavailable via UNOS, the whole thing falls apart.

Everyone's talking about Shepherd's turn as a coverboy. Sloan starts researching a clinical trial of his own. Meredith, haunted by her mother's brilliance, slowly simmers about not getting her share of the credit. Finally Derek says he'll ask the editors to make a correction and call it the Shepherd-Grey Method. But Meredith, quite rightly, says she wants him to give her credit because she worked hard and deserves it. But you don't deserve it, he tells her. You're a baby. You have the potential to be a good surgeon -- maybe a great one. But you haven't even scratched the surface on what you need to learn. Ouch.

P.J., the son who's getting the payoff keeps rubbing it in his father's face. P.J.'s mother died when he was a kid, and his father, Kurt, worked all the time when he was growing up. This infuriates Izzie, who rants to Alex about the kid's ingratitude and lack of compassion for his father. His father must have done something really bad to make the kid so angry, Alex says. Or maybe the moron is too emotionally stunted to let his father care about him, she shoots back. Izzie's learned a lot since last week about cowboy combat, and her aim at Alex is perfect. Later, she tells the father not to blame himself for his son's behavior, because some people are just broken. Wham. Post-surgery, Alex unloads on the kid, telling him that his father may be dying and he doesn't know the kid cares -- and if something happens the kid will have to live with that forever. Given Alex's behavior of late, it's an uncharacteristic move to take the kid to see his father, but he does, and they seem to make up.

Bailey walks right up to the line of impropriety as she's giving Nancy her discharge papers. According to UNOS rules, she's not supposed to say anything to try to persuade her patient to do the surgery. But she does get Nancy to realize that this surgery is about more than just her husband. And Nancy agrees. Later, Bailey takes her to see the young woman who got the kidney, whose entire family is gathered around the bedside, and it seems to do her a world of good to know that she did something to help someone else.

But then there's that surgery. After carefully washing the transplant kidney with saline and preparing it to be implanted, Meredith DROPS IT ON THE FLOOR. No one knows what to do until a panicked Bailey starts yelling, "Five second rule! Five second rule!" (Which, by the way, Ted Allen totally debunked.) After a shaky start, the kidney ends up fine, and the patient, over whom Meredith diligently watches, seems OK. The Chief, who spends the bulk of the episode focused on the good press the surgeries will bring them, since the higher-rated Mercy West isn't taking on such complicated cases, snaps out of his press fixation to have a teaching moment with Meredith. Kurt got a healthy kidney and nothing went wrong, and he's really sick. There's only so much good -- or bad -- that they can do, he says.

Callie, meanwhile, tells Hahn that their night together wasn't good for her -- and then goes to find Sloan for a, ahem, tutorial in the "Sloan Method." There's lots of "take off your pants" talk -- first Sloan to Callie, then Callie to Hahn. Alrighty then. It is a teaching hospital, after all.

At the end of her big day, Bailey runs into Derek in the lobby, and like a Greek Chorus, she totally sets him straight about Meredith. Would it kill the guy to say thank you? I mean really. And to his credit, Derek seems to get it. He goes to find Meredith at Joe's bar with Cristina, lamenting the day, and presents her with a thank-you gift: one of the diseased kidneys in a jar -- a trophy all the residents were vying for at the start. Turns out the thing glows in the dark, which is just doubly cool. But the best part of the whole Der-Mer interaction is that they have a conflict, they think, they figure out a solution, they move on. It's almost like watching healthy adults in a relationship. And it's a relief not to watch her be so twisty and dysfunctional any more.

George's new status as a resident makes an appearance as a secondary storyline this week -- he needs interns, and Meredith, Izzie, Cristina and Alex each need to give him one of theirs. But the interns aren't making the transition from George-as-peer to George-as-supervisor well, and the poor guy gets no respect. Hopefully that'll be resolved in one good yelling match scene in an episode to come. What will likely play out over many episodes is Lexie's love for George, which she's making more obvious and to which he's oblivious. Hopefully Lexie will dial back just a bit on the neediness.

Back at the house, Izzie confronts Alex. Quietly. "I care about you, and I'm not going to go crazy, and I'm not going to try to kill myself, and I'm not going to stop caring about you no matter how hard you try to push me away," she says. "And I know you care about me too. It's not to late for us." Whoa. She advances, repeating the "I care about you" refrain until they end up kissing. Again, hats off to Katherine Heigl for finding the right note in her anger and a way to confront in a way that's firm but not shrill.

And finally. It's uh, been a while for Cristina -- and as a result she's starting to check out the interns. Wisely she discards the idea, and is just complaining to Joe about the lack of real men ("Burke was a man," she told Meredith) when -- you guessed it! -- we hear Major Owen Hunt (Kevin McKidd) belly up to the bar and order a drink. But just a beer, because he starts work tomorrow. I could not anticipate this development more eagerly, and Cristina practically drools. The question, though: What should his moniker be? McDirty? Or McJourneyman?

What did you think? Are Derek and Meredith on their way to becoming grown-ups? Do Alex and Izzie stand a chance? Do you want to see George and Lexie get together? Are you psyched about Major Hunt joining Seattle Grace too?

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