Meredith is thrown when Derek suggests it's time to have a baby. She asks Alex's advice, saying, "I had the worst mother in the world. I would be the worst mother in the world."
Alex's brother Aaron—the one no one ever knew he had—shows up unexpectedly, saying that Alex hasn't been home in seven years. Oh, and Aaron has a bizarre growth on his belly button. It's an umbilical hernia and he needs immediate surgery, but he doesn't have any insurance. Fortunately, Alex gets Miranda to do the surgery pro bono.