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.
Mark tells Callie that he and Teddy had sex, boasting, "I blew her mind." That's pretty much the same thing Teddy tells Arizona, saying, "He's a legend for a reason. He has skills I never even knew existed!"
Meanwhile, Owen is still in his "dark place," as Cristina calls it, and refusing to talk to her or go see Dr. Wyatt. During a surgery on a cop who survived a shoot-out but still has several "devastator" bullets inside her, Cristina sets one off accidentally and Owen chews her out. Teddy sees how upset Cristina is and advises her, "His triggers may never go away. He won't go to therapy if you tell him to. Don't ever tell him what to do."
As Miranda examines Aaron, he rattles off some surprising information about Alex, including the fact that he was in 17 different foster homes in five years. "My dad wasn't a good guy," Aaron explains, adding that his mom would sometimes forget to buy food, so Alex ended up in juvie when he was 11 because he stole food for the family.
Aaron is shocked to find out, via Arizona, that Alex got married, as none of the Karevs have ever heard of Izzie. "You walk out on us, you walk out on your wife, like father, like son," Aaron says accusingly to Alex before they both start throwing punches. "You hitting people too? You really did turn into dad," he shouts.
We really question Derek's decision to bring April back to Seattle Grace when she flees from an emotional case where a patient has a massive stroke post-surgery. Lexie is having a hard time too, but she does what she has to do, even when it means pulling the plug in keeping with the patient's wishes, despite the husband's protests.
Miranda does the surgery on Aaron, commenting to Meredith about Alex: "Junkie dad, crackpot mom, but somehow Karev still became a doctor. I'm impressed." Meredith assures Alex, "You're nothing like your father." He responds, "You're nothing like your mother. You'd be a good mom."
Callie asks Miranda when the right time to have kids is and Miranda says, "You wait until the perfect time to have kids, you're never going to have kids." Callie tells Arizona they've got to deal with the baby issue, which they've both been avoiding and Arizona agrees to talk about it.
Cristina flinches when Owen loses his temper while making dinner and he asks, "You're scared of me?" "I don't want to be," she says quietly. We're relieved when he decides it's time to go back to therapy."
We're pretty sure Teddy is trying to tell Mark—while they're in bed—that she's still hung up on Owen, but he insists she doesn't need to say anything.
We are so not expecting the doorbell to ring: Or for it to be Sloane, who gasps, "The baby's coming! The baby's coming right now!"