We opened on Addison bringing her brother to Seattle Grace Hospital, with her friend Naomi in tow. Meanwhile, Izzie was working on some kind of glitter-based craft project to remind her interns about why they wanted to become doctors. She had trouble finding the scissors, which were on the table in front of her. Addison started second-guessing the way Derek wanted to treat her brother, but Derek was right. Addison's brother went into arrest and Derek pounded on his chest to revive him.
An intern asked the chief about a patient "with worms in his brain." None of the interns knew the medical term for "worms in the brain." Meanwhile, Izzie excitedly handed out her envelopes to her interns to play their first game of the day. The chief told Meredith about Addison being in the hospital because her brother had parasites in his brain. "Addison's brother has neuro cystopsychosis?" she asked.
"See," the chief shouted to the interns. "That's what I'm talkin' about!"
Derek said Addison's brother hated him and picked sides in the marriage. Then it was revealed that Archer and Naomi were dating. Derek and Naomi wondered what happened to their lives after they'd all been so in love. She reminded Derek that he wrote Addison a song. He told her to forget about the song.
Jen and Rob, the pregnant woman (played by Jennifer Westfeldt) and her husband who she accidentally ran over with the car, were still in the hospital. Jen kept Rob awake all night, worried her aneurysm was going to explode. Alex came in and told Jen that Derek got pulled on to another case and her aneurysm might have to wait.
Cristina and the chief saw a new patient, an older man (played by Sam Anderson, who plays Bernard on "Lost") who'd randomly passed out. He had a hernia, but that didn't seem to be the source. His daughter was there with him. When she walked out of the room, he spilled to the doctors that he had colorectal cancer and has had three polyps removed recently. He didn't want to tell his daughter. Dr. Hunt walked in and knew the man's medical history.
"You waited until she left to come in and say hello," the man said. "It's just like you to face things like a man."
The older told Hunt he lost any right to say anything about his daughter after he broke off their engagement in a two-line e-mail. Cristina looked stunned.
Naomi, Addison and Archer were singing Derek's love song while Meredith was in the room. Things were light until Derek came in and said surgery was not an option. He said he couldn't navigate through the mess in Archer's brain without rupturing a cyst in his ventricle. Archer realized that meant he was going to die.
Izzie ran her interns through their first test, draping dummy patients for the surgery noted in their envelopes. Sadie looked confused and draped her dummy incorrectly.
Derek told Addison "there's just no way." Addison started telling Derek she'd put him in a tiny box, and now she had to let him out so he could save her brother. "I need you to be a god," she said. "Just today. Be a god."
Sam, Naomi's ex-husband, showed up. "Even I don't know why I'm here," he told Bailey. (Ratings, man!). Bailey pointed him to the right place to see Archer.
Cristina and Meredith talked about what they didn't know about each other's boyfriends -- Derek used to play guitar and sing, and Hunt used to be engaged.
Lexie told Sloan she wasn't going to do dirty public flirting with him unless he agreed to go public with their relationship. She had to ask Sloan for his "symptoms" as part of Izzie's big challenge. He told eventually her what he was supposed to say and she guessed his symptoms correctly, just as Sadie walked up. George gave Sadie a new set of symptoms because she'd overheard Lexie's answer.
Hunt wanted Cristina to ask her questions about the engagement thing. An intern came and asked Cristina for her symptoms (for Izzie's thing) and she told him. Then she moved on. That's when Owen's ex-fiancee saw him. She didn't even know he was back from Iraq. She told him she'd prayed for him every night and hugged him. She said she'd spoken with his mother and she didn't mention he was back. Hunt let her go and walked away without say anything.
Addison was in the chapel and Naomi, Sam, the chief, Bailey and Callie were wondering what she was doing. She was trying to pray, but she didn't know how. She said she could use some help, but she had no clout with God. Callie got on her knees and prayed to God for guidance about having kissed Arizona, who's perky but hot.
Sam found Derek and said he was in a midlife crisis. Sam said he met Meredith and Derek said "she's not a midlife crisis -- she's the real thing." Sam told Derek that Addison was praying and Derek said she's waiting for a miracle. He said the surgery was way too complicated because Archer had eight cysts in his brain. Sam suggested he break it down and explain how he would remove one of them at a time.
The interns were practicing on Jen and Rob, who needed a distraction. Jen asked what the prize was for the interns and Izzie realized she needed to figure out a prize. Sadie, meanwhile, was missing Jen's baby's heartbeat but Alex told her she had the ultrasound wand in the wrong place.
Hunt tried to tell Cristina he's "not as much of an ass as you think I am." She asked him if his mother knew he was back.
Derek started explaining to Archer how he was going to precisely remove the cysts from his brain and Archer said it was impossible. Derek called him a coward. He said he was a "coward, by trade," because Archer is a neurologist and they just hand off their patients to neurosurgeons who assume the real responsibility. Derek said he could bear the responsibility. "The question is, can you?"
As doctors gathered in the gallery to watch Archer's surgery, Sam noticed Bailey filling out a pediatrics surgery fellowship application. He said she didn't seem like a peds surgeon because she doesn't smile. She said she does. Sloan noticed, too, and seemed surprised. Bailey saw Sam take a puff from an inhaler because he has asthma. She asked another doctor to refill the inhaler for Sam.
Derek started the surgery, making Addison smile when he said his signature starting line, "It's a beautiful day to save lives."
Hunt was telling his ex-fiancee's father that he should tell his daughter about his cancer. He refused, then started coughing up blood. His daughter saw this and asked what happened. Hunt said it was "a complication" and said he was going to need surgery. "A complication from what?" she asked. Hunt said he would be OK.
In surgery, Derek deflated a cyst, removed it and dropped it into a petrie dish, where a work wriggled out of it. "One at a time," Derek said to himself.
Jen (of Jen and Rob) was starting to panic about not getting her surgery, so Alex set her up with a clear ultrasound look at her unborn child and told her to use that to hang on.
Cristina told Hunt that his ex needed to know about her father's cancer. They couldn't protect until it was over.
In surgery, Derek had seven of the eight worms out of Archer's brain, but wouldn't ya know it -- the eighth one broke loose inside the brain and Derek has just a couple of minutes to find it. He needed two minutes, maybe three.
The clocked flashed 2:22 and Derek caught the eighth worm and scooped it out.
Izzie asked the chief for a prize for the winning intern and he waited until the interns raced to the finish line. Lexie won and the chief said she could scrub in on Derek's craniotomy and "hold the Doomsday Sucker." While setting up the "finish line" with a roll of Scotch tape, Izzie missed the roll when Alex tried to hand it to her (that's probably going to be important).
Hunt's ex said he didn't look like himself. He looked "hard." She said she deserved more than two lines in an e-mail. Hunt told her about her dad. He said her dad was trying to spare her "any more pain."
Meredith lamented the fact that Derek seemed like he was a totally different person. Cristina said she felt like she didn't know Hunt. "We don't," she said.
George offered to help Sadie after noticing she was having trouble. She said she didn't need a tutor. He told her she needs to know how to diagnose patients during surgery. "Can you do that?" he asked. "Because they think you can, and they'll put you in situations where you have to." She walked away as George shouted, "Sadie, you could hurt someone."
Hunt confessed to Cristina that he calls his mother every week and says he's still in Iraq. He said his mom would look at him like he's not there -- the same way Beth looked at him. He said the only time he doesn't feel like a ghost is when Cristina "sees him." He said she's the only person who sees him.
Derek apologized to Jen for delaying her surgery. He wanted to do it the next morning but she begged him not to make her wait another night.
Addison introduced herself to "Little Grey" while she was talking to Sloan. Derek said he was going to do the craniotomy that night and told Lexie to meet him in the O.R. in preparation for holding the Doomsday Sucker. Addison started to talk about "Little Grey" and Sloan quickly changed the subject, mentioning that Derek was going to propose to Meredith.
Alex asked Izzie what was wrong. She said she was fine.
Sadie was talking to the chief and George told Meredith what it was about. Sadie quit and told Meredith she thought she'd pull her through. Meredith said they weren't 25, "sleeping our way through Europe every night." Sadie said this wasn't the Meredith she knew. Meredith said she was the same person, but this was where she wanted to be.
In surgery, Derek asked Lexie if the sucker was at the ready. She realized he was mocking her. "Only a little bit," he said. There was a mild complication and Lexie really did have to use the Doomsday Sucker, and it worked. Derek said he'd never mock an eager young intern again.
At Joe's bar, Sloan told Addison he was "an ass" for blurting the thing about Derek proposing to Meredith. "A little warning would have been nice," she said. She said she expected to feel something, but seeing her brother on the operating table changed her perspective. Derek arrived at Joe's and the old group of friends gave him a hard time about the song he wrote, singing it even through a bit of awkward silence where Addison looked at Derek, who looked at Sloan, who gave him a reassuring nod.
Cut to the hospital and Jen was in bed gasping for air. Alex called to someone to page Derek.
And now, "Private Practice"...
Back in L.A., Addison's friends at the co-op were wondering what the situation was with Archer and trying to decide whether to call Addison.
The old friends were still partying at Joe's into the wee hours, but Derek was sitting in a booth on the phone. He said he had to go back to work. He said it wasn't about Archer, but they ran over to the hospital in case he was lying. In Archer's room, Archer was trying to talk but the drugs were still making him woozy. Sam took an awkward puff of his inhaler and passed out. Naomi was worried because she'd never seen Sam have an attack that bad.
Derek tried to reassure Jen that he would figure out what was happening to her.
Charlotte was upset with Cooper because of Violet's pregnancy, and the fact that he wanted to be there to help her through it. Cooper wanted Charlotte to think about getting to know Violet better.
A woman with an infant was panicking about whether her baby was OK. She was acting oddly when Cooper told her not to answer the phone when the baby is in the tub. Cooper took the baby back and told the mom to get some rest. He took the baby and went to get Violet, but when they returned to Cooper's office the mother was gone.
Back in Seattle, the chief told Addison he wanted to write a story about Derek saving Archer to get some good press for the hospital. Archer wasn't so sure Derek had saved him. He wanted a CT to see if Derek missed something.
In L.A., Cooper and Violet found the mom laying in a bed with stirrups. She started talking quickly and frenetically about her birth experience and saying she wasn't as good of a baby as she was before she was born. "I love her," Rachel said. Cooper kept the baby and Violet stayed with Rachel. "You're really tired, aren't you?" Violet asked.
In Seattle, Addison told Derek what Archer had said about having blurry vision. Derek said Archer's vision was impaired "because he can't see past his own ego." He refused to do another CT because Archer's post-op exam was fine. Addison asked Derek what was wrong. He told her about Jen, and said he'd never seen a post-op complication like this. Addison told him to run a doppler, explaining that the baby could be the problem.
Addison realized Jen was "mirroring" the baby. She said the symptoms were very real, and the baby was anemic. She said they should take it one step at a time.
In L.A., Violet was setting Rachel, the mother, up with Pete who was going to use "the needles" (acupuncture) to help her get some rest. Rachel laid down and started rambling about all the distractions that were keeping her awake.
Archer was complaining about Derek not wanting to do another post-op exam. Archer got sarcastic when Naomi told him he wasn't alone. "Right," he said, mockingly. "I have you." She thought it was the drugs talking.
Sam told Bailey he went to Seattle to see Archer because he couldn't stand the thought of a college friend dying.
The chief told Bailey to do a post-op exam on Archer and Addison said Derek didn't need to know.
In L.A., Pete and Violet agreed Rachel had post-partum psychosis. Pete was upset that Violet treated him like a babysitter and didn't consult with him like a real doctor. Rachel came out of Pete's office screaming for her daughter, who she said she could hear crying.
Alex talked to Addison about Izzie and said he loved her but kind of wanted to run. "Something's coming and I kind of just want to run," he said. He asked her if she was happy she ran. Addison said she didn't run, she walked -- "there's a difference."
Rachel wanted to hold her baby, who was crying, but Violet wouldn't let her. "I just wanted her to stop crying," Rachel started saying. She said she went to reach for her daughter and she just held her down. She revealed that she was thinking "no one would know until dinner, and I could finally get a couple hours of sleep."
Naomi asked Addison if she was crazy for "jumping in so fast with Archer." Addison realized she was the only person with no one, while everyone else was with someone new. Sam defended himself and said he wasn't having a panic attack.
Derek was upset with Addison for not sharing Jen's test results.
Violet was worried that her baby would have similar problems. "What if mine doesn't sleep?" she asked.
Bailey stonewalled Naomi, who was trying to get information on Archer and Sam, while Bailey was doing the post-op exam on Archer. Sloan and Naomi talked about their new relationships. Sloan told her she and Archer gave him hope.
Addison finally told Derek about the test results for Jen and the baby. At 24 weeks, Addison said they had to get the baby out. It was too early for the baby to survive outside the womb, but Addison said they would risk losing them both if they didn't deliver the baby now.
Jen wanted to wait two more weeks, when the baby might be viable. Addison said it was possible the baby could survive at 24 weeks. In the room, Derek mentioned a risky in-utero blood transfusion that Addison had already explained was too dangerous. Addison felt cornered.
In L.A., Rachel's husband wondered how he let Rachel's psychosis develop. He wondered how Rachel could do it. Pete told Andrew, the dad, that it wasn't his fault. He could only do so much without the mother letting him in -- a pointed reference to Violet, who is trying to make Pete keep some distance from the baby that might be theirs. Cooper came in and said Rachel wanted to see the baby.
Bailey realized she'd given Sam a new inhaler with a corn-based propellant. Sam was allergic to it, and that seemed to cause his problem. He was happy that he was still a man.
Derek was beating himself up over messing up during Jen's brain surgery. Addison tried to tell him it wasn't his fault. "If I hadn't have nicked the aneurysm, she wouldn't have required blood," he said. "It is my fault." He asked Addison to try the in-utereo blood transfusion because he couldn't live with it if the baby died. Addison started the procedure.
Meanwhile, in L.A., Violet was worried about giving the baby back to Rachel. Pete said they couldn't cut Rachel out, and Violet snapped at him, saying it wasn't about him. Cooper talked Violet through it a little and assured her that she understood the hormone issues that a mother could go through. Cooper then gave Violet a hug, which Charlotte saw and didn't seem to like.
Addison was upset with Derek for cornering her, but successfully completed the complicated procedure. "Look who's the hero now," Derek said.
The chief and Naomi brought Archer the results of his post-op exam and before they could say anything to him, he took the X-rays and pointed out what he called persistent parasitic cysts. He still believed he was going to die any minute.
Addison and Derek talked after the surgery and Addison wanted Derek to admit his mother never like her. She wanted to know if she was right, and if that was why Derek's mother didn't give him the special ring she gave him for Meredith. "She hated you," Derek said.
In L.A., Violet and Cooper brought the baby back to Rachel, who cried and said she was sorry as she held her daughter.
Sloan came by Archer's room and Archer told Sloan that he had slept with Sloan's sophomore year girlfriend. Archer decided he was coming clean about everything, so he also told Sam he wrecked his car. "Elsie Jacobs wrecked that car," Sloan said. Then Archer said he slept with her, too, and Sloan wanted to beat him up. Archer was crying and saying he was sorry for everything he'd ever done. That's when Derek walked in, upset about the post-op exam, and pointing out that what Archer thought were cysts was fluid in his brain after surgery that would go away in a few weeks.
"So he isn't going to die?" Naomi asked.
"No, he's going to be an ass like he's always been," Derek said, storming out.
Charlotte came to Cooper and said she got what he was doing for Violet. She said Violet needed him "and I think, at the end of the day, you need her." She said she didn't have it in her to be a part of Cooper's thing with Violet.
Violet and Pete watched Rachel and her baby sleeping. Violet said Cooper gave her support with no string attached, which was what she needed. Pete said she gave a great speech, but she was only thinking about herself.
Jen woke up after her surgery and everyone was happy that it went well. But when she started talking, she wasn't making any sense.