'Grey's Anatomy': Derek in a tailspin, and Izzie's diagnosis

These days, the docs of "Grey's Anatomy" are all kinds of broken and messy and troubled. So it's pretty much like any other day at Seattle Grace. Except that with Derek's wallow through his surgical past and Izzie's focus on getting the interns to diagnose "Patient X," coupled with some diagnostic surprises and a real jerk turn by the chief, it turned out to be a pretty good hour of TV.

Hang on to your scalpels, because here come the spoilers...

Despite all the ad teasers about Derek hanging up his scrub cap because he's beaten and disillusioned by his surgical career, the star of the episode was Izzie -- i.e., "Patient X." And if Katherine Heigl racks up too many more performances like tonight, I'm going to have to rethink my feelings about her.

She starts off walking around being understanding about Derek, who's a disheveled mess sitting on the couch eating the marshmallows out of Derek's cereal, and flashing a beatific smile while openly appreciating her friends. She tells Alex he'll be a rock star surgeon in 10 years. She's amused by Meredith and Cristina's bickering. And she devotes her time to mushing the interns along in trying to diagnose her case. When they do their typical intern shoddy job, she's annoyed and hammers them to go back and find what they missed. And she gives George pretty much his only actual interaction during the entire episode. (George's word count tonight, by the way: 68.)

Finally they come up with an answer. Patient X has a metastatic melanoma that has spread to the liver, skin and brain. Her prognosis with chemo and radiation: a few months -- a 5 percent chance of survival. It's affecting watching her hold it together as the diagnosis sinks in, but the best scene is Izzie's conversation with Lexie, as they discuss how to break the news to the patient. Between them, they manage to come up with choosing to face the diagnosis head on and fight. Izzie finds herself on the verge of telling Alex when he comes to her excited about his great day (more on that in a minute), but in the end turns to Cristina -- who not only doesn't like her much but is a robot. We close on the two of them in the boiler room where Hunt took Cristina, and Izzie finally letting it all out. So now the fight -- and judging from the preview of next week, it'll be over whether she fights at all -- is on. Welcome to sweeps.

Meanwhile, we're seeing unexpected growth all over the place -- and not because Cristina showed some compassion. Working on a trauma case with Arizona and Hunt, Alex ends up saving the day -- and the life of a teenage "band nerd" who has epileptic seizures. She keeps crashing in the midst of the seizures, making it doubly dangerous to shock her heart because it could kill her. Alex figures out that the problem is the girl's heart, insisting over Arizona's protests against a cardiac procedure that could kill her if Alex is wrong. But he turns out to be right, and reaps all kinds of impressed praise from both Hunt and Arizona. And it's remarkably sweet, if you can call Alex that, to see him excitedly react to people actually believing in him. But am I really buying him as the future of Seattle Grace? Not yet.

Bailey's big case this week -- because, as the Chief reminds her, there are no kids around for her to babysit -- is a set of three siblings who have a 3 in 4 chance of developing the gastric cancer that has killed most of their family. They're there to have their stomachs taken out. The oldest sister, who clearly saw more of their family, including their mother, suffer, is insisting. The middle sister and younger brother are less sure. Then they find early-stage cancer in the oldest sister while she's in surgery -- she should be fine now -- and the middle sister gets the procedure too. The brother is resistant, but the oldest sister promises Meredith that he'll end up getting the surgery -- because "you don't leave the people you love alone."

Which brings us to Derek. He's being sued over the death of Jen, his recent pregnant patient with the aneurysm, and during the deposition the lawyers confront him with the stacks of files on his patients who have died. That's surely enough to throw anyone, and you can't really blame the guy. But he takes it a step far when he threatens to quit operating. To her credit, the growing and ever-stronger Meredith has been understanding and has been trying to give the guy some space. But when the Chief enlists her help to bring Derek back and tells her about Derek's proposal plan -- this isn't a guy who wants to be left alone, he says -- she cowboys up.

Meredith finds Derek, drunk, sulking, and out of control, at his trailer. He's moved out of her house, and he's pushing her away, saying outrageously nasty things to try to get her to leave him. I get the pushing away part, but "there's no fixing you -- you're a lemon"? Dude. That's seriously harsh. In response, our girl calmly and firmly stands her ground and stands up to him -- and ultimately tells him she knows about the engagement ring. Which Derek promptly takes out of his pocket, removes from the box, and bats out of sight. I have my doubts about the hand-eye coordination of a drunk guy being able to hit an engagement ring with a baseball bat, but whatever. I'm curious to see how this ends up playing out, but I really like that they're not making her a saint but rather a grown-up -- and the chemistry between Ellen Pompeo and Patrick Dempsey is still absolutely palpable.

The rest:

• The Chief's behavior is totally abhorrent -- better suited for a nursery school than a hospital, much less a workplace. Loved Bailey struggling with her competing anger and understanding of what's going on, and that she stuck to her guns. Her tattling to Adele (so nice to see Loretta Devine) was hysterical, even when she got a little of her own back.
• I remain a complete sucker for Hunt and Cristina. She seems to have grown a reservoir of compassion, which is interesting, and I like that his PTSD hasn't just disappeared with the understanding of a good woman. This is complicated, painful stuff, and I'm interested to see how they work through it.
• I felt bad for "Shadow Shepherd," a.k.a. Jim Nelson, the interim head of neuro until Derek swooped in. Like it's not hard enough being a brain surgeon, but to be ignored by your boss and your colleagues even when you do good work just stinks. Part of me hopes he gets some more screen time.
• Totally bored with Callie and Arizona. On one hand, great that Callie seems to be getting a little mojo back. On the other, can't we see her be competent practicing medicine?
• Maybe it's because they barely shared a screen this week, but Mark and Lexie were OK. I must be getting soft because the "Little Grey, you're the one who put me back together" line was kind of sweet.

What did you think? Was Izzie's diagnosis as good -- or as bad -- as you expected? What's your best guess as to how it will play out? Are you too waiting to see what it will take to make the Chief man up and snap out of it? 

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