All of the press and hype around tonight's episode has been about either Izzy having to face the consequences of her decision to sneak Denny up on the heart transplant list (the season before last) and the very abrupt departure of Brooke Smith (Erica Hahn) from the show. Not too surprisingly, the two stories were intertwined in tonight's episode.
I'd forgotten that it was Hahn's patient that was supposed to get the heart that ended up going to Denny in season two. Tonight, we meet the patient and he hasn't been doing so well. Erica is determined to help him now after having to let him and his wife down so many times before, most recently with the loss of the heart that Izzie stole. I didn't really completely understand the procedure, but it seems to basically consist of inserting alcohol into the man's ventricles in order to burn off muscle impairing his ability to breathe. Yeah, it didn't make sense to me, either.
Meredith and Izzie are assigned to assist Hahn in the procedure - Izzie specifically for her insane levels of compassion for the patients, since the procedure will be very painful and someone will have to keep the patient calm and breathing so that the alcohol being pumped through him doesn't back up and cause further complications. When she hears the patient's case history, she realizes who he is and begins to freak out, seeing Denny everywhere she turns. Because Izzie's too busy losing her mind, the patient gets too caught up in the pain and forgets to breathe, causing the procedure to be halted.
Okay, let's come back to this once we've touched on everyone else.
Meredith and Yang have started reading through Ellis Grey's diaries like they're "Harry Potter" novels and calling each-other to discuss them at all hours of the night. Derek, sick of being kept up all night by this, asks Sloan to try to seduce Yang so she won't be all up in Meredith's Kool-Aid 24/7. Yang is too caught up in the contest drama (see next paragraph) to even notice and, when she finally does realize, mocks Sloan and Derek mercilessly.
The Chief has decided that the best of the second year residents (conveniently, the majority of our main cast) will get to fly solo on a surgery, presumably having their interns assist. Eager to "win" the surgery, all of the residents spend the day worrying more about advancing themselves than taking care of their patients. Hilarity ensues, except when McBadass rips them new assholes.
Touching back on Izzy's argument against McBadass's use of animals to teach trauma surgery, the chief has brought in a computerized dummy that can simulate pretty much anything a human patient can. Unfortunately, Izzy and Meredith are busy with the guy that Izzy stole the heart from, so she can't play. Yang's pulling more with McBadass in Trauma/ER, so the only residents left are George and Alex. Alex quickly gets bored with the computerized patient and takes off, but not before the dummy taunts him about his fear of learning. George spends the rest of the show trying to "save" the patient while the chief (in another room) causes the dummy to keep developing new problems. There are quite a few scenes of the Chief giggling madly while George has a nervous breakdown and gets sprayed with fake blood and vomit. The Chief is a sick, sick man
Alex doesn't really do much of significance for the rest of the day, other than uncovering the bodies donated to science that Lexie appropriated for the interns to teach themselves (since Yang isn't sharing the knowledge), stealing them for himself and Izzy, and then trading some away to Yang for her patient.
The Chief asks McBadass to give him an opinion on who he thinks should get the solo surgery, since McBadass is too new to have any real bias for or against any of the residents. Through watching the residents and speaking to Torres about them, he becomes gradually more and more irate at the lack of professionalism and respect that the residents (especially Yang) show for their patients until finally ripping into Yang and Alex over their treatment of a man found beaten almost to death under a bridge (the patient that Yang traded to Alex for three cadavers) like a piece of meat, just a body for them to use for their own purposes. He tells the Chief that he's not sure that any of the residents deserve the surgery or if he'll even be staying on with the hospital, though he later relents and says he wants to stay. Yang later tells him privately about how her memories of saving her father on the side of the highway after an auto accident drive her to be the best surgeon, but he doesn't seem any more impressed than I am. Being driven is no excuse to neglect patients to serve your own ends.
In possibly the most heart-breaking storyline since Denny died, Shepherd and Bailey are trying to remove a brain tumor from an elderly woman who has had multiple surgeries. Every time, she signs a DNR, kisses her husband goodbye, goes under the knife, and kisses him hello again when she wakes up. Bailey, who is going through a difficult time in her marriage, and Derek, who has a failed marriage under his belt, express envy at the couple's ability to find "the holy grail of marriage". Derek and Bailey both warn her that this will be the riskiest surgery yet and she could live with the tumor for several more months, but she doesn't want to live another day feeling as bad as she has been, so she signs the paperwork and kisses her husband goodbye.
The surgery doesn't go as well as planned and the woman doesn't wake up right away. Eventually, when her heart stops, the husband begins to second guess the DNR and tries to give her CPR himself. Though he's able to make her heart beat by pumping her chest, it won't beat on its own. The man can't bear the thought of letting his wife die, so he keeps pumping. Bailey takes over for him, intending to take the responsibility onto herself, but she can't do it either. Finally, Derek takes over and finally lets her go. Every time they showed the anguish on the husband's - and on Bailey's - face, I started trying to imagine the day coming when I have to say goodbye to my wife. In the end, I couldn't imagine it and I've decided that I'm going first, no matter what it takes.
...which brings us back to Hahn, Izzy, and the heart patient. Through some investigation and prying, Hahn finds out about Izzy and Denny's relationship (and I'm really surprised that she didn't know about this before - it had to have been pretty big news and wasn't much of a secret) and throws a fit - demanding the Chief fire Izzy, bring her up on charges, burn her at the stake, and scatter the ashes - or something. The Chief refuses, saying that Izzy's been disciplined and has learned her lesson - the case is closed. Hahn seems to accept this and goes back to work, though she refuses to let Izzy of the case. Hahn tells Izzy that - if they can convince the patient to try the procedure again - Izzy will be there to witness each moment of pain that she caused by stealing the heart and, if he dies, she'll be there to see that, too, because it'll be Izzy's fault.
The patient initially refuses to do the procedure again, but Izzy convinces him to give it another try by making a speech about how losing him will be something that his wife will never get over, though it's obvious that she's really talking about herself and Denny. When the patient begins to forget to breathe, Izzy has a momentary zone-out when she "sees" Denny on the other side of the man, but snaps out of it and demands he breathe. Eventually, he coughs and begins breathing again, making it through the rest of the procedure.
In the locker room, Izzy imagines that Denny is with her again and tells him that he has to move on, and so does she, but then Alex appears and asks if she's okay. She tells him that she's fine and she'll catch up with him at the bar. When he goes, she "sees" Denny again and he asks her if she's sure she'll be okay. She tells him that she will and he disappears, maybe for good.
As Callie and Erica are leaving the hospital, Erica begins talking about reporting Izzy to the United Network for Organ Sharing. Callie's appalled that Erica would cause the hospital to lose their transplant accreditation, costing the hospital's patients their transplants and Izzy and the Chief their careers. Hahn is angered that Callie thinks that something like this should be let go when it cost her patient a heart and could have cost him his life and finally storms off, gets in her car, and drives away.
....which is apparently the last we'll see of Erica Hahn. Heart Surgeons just don't last at Seattle Grace.