We're on a roller-coaster ride this week as Derek and Richard go from BFFs to mortal enemies! Things have been tense between the two ever since the merger, now Richard is so obsessed with cost-cutting that when Derek wants to do a high-risk surgery on Isaac, a fellow doctor with an inoperable tumor, Richard emphatically says no. We know there'll be big trouble when Derek decides to go ahead with it anyway, behind the Chief's back. He's helped by the new computer-generated surgery assignment system. Without the board, Richard has to take it on faith that surgeries are being done as assigned.
Derek spends 10 hours in the OR and doesn't make a single cut! He just can't decide where to begin. Richard discovers the deception and orders him to close. Derek does and tells Isaac that the tumor really is inoperable. Isaac tells him to sleep on it, confidently telling him. "You'll try again tomorrow." Sure enough, that night Derek has a brainstorm and figures out how and where to begin cutting.