Addison is back with darker hair. As she helpfully points out to everyone, she is just back for a surgery, not back back. See, she can’t be really back as long as they continue that farce known as Private Practice. Sigh. Elsewhere in the hospital, we’re pretty much where we were last week. Meredith is getting ready to start her clinical trial for bear attack tumor guy and Hahn is still refusing to acknowledge Cristina, while Izzie just stands around because the writers have given her absolutely nothing to do.

Speaking of nothing to do, Izzie’s interns are grumbling because she’s taking them down to work in the clinic. Hey, I don’t know why they’re complaining; at least she remembered that she has interns. Meredith’s charges make an appearance too. Still missing? Cristina’s interns, who have no doubt all quit the medical profession and taken up therapeutic macramé.

Whoa. So Alex just broke out the ever-popular Dr. McAsshole character. Dear, sweet, formerly comatose Ava has come for a visit, and he immediately tries to blow her off—so she blurts out that she’s pregnant. Alex takes a beat and then asks her if she’s going to keep it or have an abortion. Before Ava can even wrap her mind around what a tool he is, Alex tells her that he has a big case (he’s working with Addison today) and rushes off, leaving poor Ava behind, with her jaw on the ground.

We finally find out what Addison’s big, special case that brought her back to Seattle Grace is: a fetus with his heart growing on the outside of his body. Now, I know that this is really sad, and since I’m going to have my first baby in a few months I should really be upset by this, but I find this whole scene hilarious. All I can think of is Glen from Raising Arizona: “Healthy white baby? Five years? What else you got? Said they got two Koreans and a negro born with his heart on the outside.” Then Sloan starts talking about skin flaps and I lose all ability to take this scene seriously.

So we go visit with the parents of the kid with his heart on the outside, and Alex succinctly sums up my feelings about the father: “something about that guy makes me just want to punch him out.” The team is explaining this very complicated medical procedure and he’s got this dippy grin on his face the entire time and says things like, “our baby is unique; he’s wearing his heart on his sleeve.” Now, I know that staying positive in a situation like this is important, but when a team of doctors is about to perform a procedure on your unborn child that requires not one, but two ORs? Maybe it’s time to put on our serious face, Mr. Happy.

Speaking of Mr. Happy, bear attack tumor guy can’t stop laughing. Of course, it’s because the giant tumor is pressing down on his brain and making him act all loopy, but whatever. His poor wife has to sit there and listen to him try to fix her up with other guys because she’s “a waitress with no prospects who needs to learn how to use her ass to find a new man.” That’s bad enough, but when the tumor starts pressing down on the optic nerve, causing him to go blind, Meredith and Derek decide to move up the surgery. What that means is that there’s a very real possibility he might die today and his wife’s last memory of him will be of him calling her a piece of ass. Awkward.

Okay, so after the whole bear attack tumor guy tantrum, there is about ten minutes of this episode that is pretty great. First, Ava stands up to Alex, who’s still being a jerk to her. She tells him to get over himself for one minute so they can figure this thing out together. He still runs away, but it seems to sink in and I’m proud of her spunk. Then, Alex is faced with the stupid hippy parents of the kid with the heart on the outside. He freaks out on them and afterwards, when he’s defending himself to Addison and Bailey in the hall, he sputters about how they’re not prepared and they need to be prepared if they’re going to raise a kid successfully. If I had a nickel for every time I’ve heard a similarly insane speech in my house over the past few months, I would have quite the college fund started. Bailey tells him basically that his gross feelings are getting all over her and would he please shove them back in. I’ll have to remember to try that approach next time.

Of course, none of this compares to the scene with Addison and Callie. Addison, who has been watching Callie and Hahn, asks the former Mrs. O’Malley if she’s “speaking the Vagina Monologues.” When Callie realizes that she’s being asked if she and Hahn are in a relationship, she starts giggling like a crazy person and loudly proclaiming that she’s “a Big fan of the penis.” Because if you have to yell it in a public place, it’s definitely true.

Callie follows this up with a little self doubt and asks Meredith and Cristina if anyone has ever mistaken them for a couple. The short answer is uh, no. The long answer, on the other hand, is priceless:

Meredith: No, because we screw boys like whores on tequila.
Cristina: And then we either try to marry them or drown ourselves.

Indeed.

It’s surgery time. Bear attack tumor guy has a nice moment with his wife before he’s wheeled in, so now she has a better potential last memory of him. The baby with the heart on the outside is successfully delivered and looks good so far. The mother, on the other hand, starts to hemorrhage. Addison is dealing with that, so Cristina gets to step up and massage the baby’s heart. Hahn manages to get the heart back inside the baby and Alex gets a little choked up. It’s kind of cute. Bailey manages to save the mom, too! Not cute is how bear attack tumor guy dies on the table.

The episode ends with all kinds of fun personal stuff. Just for old time’s sake, we have the most awkward elevator ride ever: Derek, Meredith, Addison and Rose in a confined space. Sloan just cracks up when he gets on. At Joe’s, Addison is still trying to figure out what is going on with Hahn and Callie. What it looks like is Hahn has it bad for her, and Callie is freaked out. This leads to her dancing rather awkwardly with Sloan and asking him to go home with her--because, you know, BIG fan of the penis. As Addison is leaving, she tells Meredith she wants to kick her ass. Girl fight! Except not at all. She’s just annoyed at Meredith for letting Derek go after three seasons of drama.

Alex finally comes around and looks like he’s having a sweet moment with his babymama Ava, but AVA ISN’T PREGNANT. Dun dun DUN!

I’ve got to say, tonight’s episode more than makes up for last week’s lackluster offering. Seriously—I don’t even remember what happened in that episode. I like Izzie and George together just as friends, I’m glad the whole Derek/Meredith thing is reaching a conclusion, and I love how Ava is faking a pregnancy. I especially love the Callie/Hahn storyline and I only hope they can sustain it while keeping it as funny as it is now.

Next week: Did Meredith take Addison’s advice to heart? It looks like she and Derek could be getting back together.

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