Cristina tells Teddy she didn't mean it when she said she'd give up Owen for her and Teddy suggests they both forget about it.
When Meredith goes to tell Alex that Izzie is coming home, she finds him in bed with Lexie! She orders them to keep their mouths shut. "No one needs to know," Meredith says.
Meredith tries to keep Derek from reporting that Richard is drinking on the job. "McDreamy is being a McAss," she tells him. She thinks he wants the Chief's job for himself, but he says he's simply doing his duty. She calls "Post-it," invoking the "laws" of their marriage, which supersede anything else. "Fine, I won't tell," he promises her. But when he offers Richard help, and Richard instead decides to start operating again, Derek feels he needs to act. Derek gives Meredith a choice: If he goes to the board, he'll end up with Richard's job and then he can give Izzie her job back. After seeing Izzie so happy about her PET scans, she tells Derek he can go to the board.
Cristina asks Alex whether he'd choose surgery over the person he loves. Meredith admits "gun to my head" that she'd choose surgery. Izzie, who's looking for a job in Tacoma so she can stay and patch things up with Alex, tells her, "That's crazy. Surgery is just a job. If you lose your job, you get another one, but if you lose your love, suddenly nothing else matters." We wince when Alex tells Izzie, "Love comes and goes. Surgery doesn't." He admits to Izzie that he's slept with someone else. When he hears that her scans are good, he breaks down and tells her how much he loves her. We think they're getting back together, but instead, he thanks her for convincing him he's a good man—and that because of her, he now knows he deserves better! "I'm happy you're okay and I'm happy about your job and I want you to go and not come back," he tells her, and wow, it's tough to hear!
Teddy summons Owen to Joe's, where she's already been drinking, and confesses what Cristina said: "She was willing to trade you for me." He immediately goes to confront Cristina, telling her, "You don't get to toss me aside. I won't let you." He kisses her angrily and we can see she does love him when she starts to cry.
Mark tells Lexie he slept with Addison, so she tells him she slept with Alex, thinking that makes them even. Instead, Mark is furious.
After all she's done for her, Meredith tries to get Izzie to stay but Izzie insists, "I need to start over."
Meredith and Derek both accuse each other of choosing surgery over love: He, to get the Chief's job, and she, to be able to do a complicated procedure under the Chief's watch. We have a feeling the fallout from this is just beginning.