Richard has completed rehab but he won't get his job back until the board approves. In the meantime, Derek offers him a spot as a "general attending surgeon," and he refuses. But he does take Derek up on his offer to be part of the lecture series.
Miranda starts off the series with a case from 2003. We flashback to when she was an intern with long braided hair and called herself "Mandy!" Her resident couldn't stand her, since Miranda was clearly better at diagnosing. Richard notices the animosity and tells her, "Surgery is a shark tank. Make sure you're a shark too, not a minnow."
After several surgeries fail to turn up a cause for a patient's abdominal pain, Miranda diagnoses her as having porphyria and takes the bold step of canceling her attending's surgery. We cheer when Miranda chews out the attending and, in full earshot of Richard, calls her a "supercilious fool!" Richard summons Miranda to his office, but we smile when, instead of reprimanding her, he tells her, "You're going to make a hell of a surgeon."
Callie presents a case of a a man with severely deformed legs from polio. Alex, who assisted on the surgery after lying that he was the "heart in the elevator guy," helps jog her memory. When she promised the patient she could make him walk, Richard told her, "All right, Dr. Torres. Your career lives and dies on this." The surgeries eventually succeed and the patient is able to walk. And we gasp to see that there was a celebratory Alex/Callie hookup afterward!
Richard presents a case from when he was a resident in 1982 that he worked on with Ellis Gray that he says changed his life. We flashback to Richard and Ellis when they were young and ambitious—and carrying on a hot affair, even though both were married. They land a case they diagnose as GRID, which is what AIDS was known as at the time. The patient is so upset at the diagnosis that he threatens to sue for slander. When the patient returns with visible lesions on his face, he admits, "You were right about everything. Please help me." Their attending tells them the patient is a "lost cause" but they insist on operating on his twisted bowel anyway. "We weren't more noble, just more arrogant. We had more to prove," Richard says of himself and Ellis. The surgery is successful, but we can see how crushed they were when the patient died of pneumonia.
Richard tried to break it off with Ellis, but she says, "We should leave them. You leave Adele and I'll leave Thatcher."
We're so moved when Richard tells the audience, "It changes you, this work. Your patients, your colleagues, you change each other. You never think you'll lose your way." He repeats the physician's oath and we might get a little choked up when he does. He's met with thunderous applause and a standing ovation. Later, Derek tells him the job offer still stands. "We'll see," he says.
And we see that it was Ellis who started Richard drinking. "It's time to act like a grown-up," she says as she orders him a vodka. "It's time to leave her." And so Richard took his first drink.