First off, let’s give a round of applause for Chandra Wilson (clap, clap, clap). Normally, Ms. Wilson directs her interns while in front of the camera as Dr. Miranda Bailey. This time, she guides her underlings from behind the camera as this episode’s director. Whoo hoo, Ms. Wilson!

The seventh episode of the sixth season presents Dr. Derek Shepherd (Patrick Dempsey) in the narrator seat instead of Meredith Grey (Ellen Pompeo). Derek tells the tale of a fellow hospital employee named Isaac (Faran Tahir) that shows a patient’s X-ray photo to him. “McDreamy” is amazed at the photo that depicts an elaborate tumor fused right into the patient’s spine. Derek is drooling with fascination until Isaac reveals that the spine is his and that he wants Derek to perform the difficult surgery even if it means paralyzing or killing him. Word spreads unbelievably quickly amongst the attendings and the interns about the “super tumor” as Derek weighs his decision about the case.

Dr. Alex Karev (Justin Chambers) hasn’t heard a peep from Izzie (Katherine Heigl) and he’s visibly worried that she isn’t going to show up for her cancer treatment. Dr. Reed Adamson (Nora Zehetner) tries to be supportive of her stressed co-worker and offers to take some of his assignments so he can focus on locating Izzie. But Alex reverts back to his caveman self and turns down Reed’s help.

After much thought and encouragement from his friends and even the patient Derek decides to do the surgery. However, Chief Webber (James Pickens, Jr.) is against the surgery and forbids Derek from doing the procedure. That forces Derek and his cohorts to go “rogue” by doing the surgery without the Chief knowing.

A professional competition is held to decide which intern will scrub in on the procedure. Each doctor takes a turn at using what I think was a magnifying machine that would help the doctor see the tiny veins in the spine. The award for the steadiest hand seemed tailor made for Dr. Christina Yang (Sandra Oh) but even she failed to pass the test. The blue ribbon went to Dr. Jackson Avery (Jesse Williams) as Christina looked on in shock and dismay. Derek then appoints Dr. Lexie Grey (Chyler Leigh) to be his “doctor” in the operating room in charge of keeping him hydrated and focused for the surgery.

Before the big event Jackson gets really smug with Lexie bragging that he’s more than ready for the long procedure and that Lexie was given a low level duty as “Derek’s bitch”. Lexie is determined to prove him wrong by using a diaper. Yep, a diaper. In order for Lexie to stay in the surgery she’ll need to stay hydrated and if she’s hydrated she’ll need to pee and peeing in the diaper will allow her to stay in action without having to leave the OR. Christina catches Lexie with the diaper but instead of making fun of her Christina encourages Lexie to wear the diaper and even offers to guard the door while she puts it on.

We finally get to the big event where Derek and his team get Isaac into the OR and prepare to operate on his spine. Everything is going green until Derek gets stumped and is frozen in his tracks for ten straight hours. The Chief gets wind of the medical mischief and is able to talk Derek into quitting and sewing up Isaac’s back. Derek goes home to Meredith and they both talk through the surgery while Derek draws the spine and tumor on the bedroom wall. He even takes the time to color it in.

Round Two of Derek’s bout with the uber-tumor has him doing the procedure in Dr. Owen Hunt’s (Kevin McKidd) OR so the Chief will be none the wiser. Unfortunately, Christina was supposed to take part in Owen’s surgery and now that it’s been axed she is relegated to observing Derek’s tumor surgery while giving Meredith the play-by-play via phone.

The Chief eventually does find out and goes to the OR to stop Derek again but he’s halted by Dr. Arizona Robbins (Jessica Capshaw). This is a big deal because those who know Arizona are aware that she has a problem with standing up to authority figures. Despite her condition Arizona convinces the Chief from interfering while Isaac’s spine is exposed. The Chief huffs, puffs and storms away in the opposite direction while Arizona cries on the shoulder of her girlfriend, Dr. Callie Torres (Sara Ramirez).

In the OR Derek is severing the veins that will free the tumor from Isaac’s spine while trying not to cut the one that will take away Isaac’s legs or his life. Suddenly, Jackson’s hand starts to cramp up due to lack of hydration and he starts fidgeting with his scalpel. Derek orders Lexie to relieve the humbled and embarrassed Jackson and take his position. It all boils down to one last cut and Derek hopes that the vein he cut doesn’t detonate the bomb, if you know what I mean.

Reed has had it with Alex constantly checking his watch and worrying over Izzie so she forces him to go to the cancer treatment floor and wait for his wife in case she does show up. Later, Reed goes to check on Alex and discovers the grouchy intern sitting alone with his eyes filled with tears. Izzie never showed and Alex is deeply concerned that the woman he loves won’t even return to get the treatment that will keep her well. Reed hesitantly walks over to Alex  to offer support. 

Back in Isaac’s room Derek standing over the patient. Isaac is distressed because he can move his toes. He takes this as a sign that Derek gave up again. But au contraire, Isaac, because Derek not only succeeded in getting the tumor out but he managed not to paralyze him either. Isaac profusely thanks Derek while Derek just does that McDreamy smile of his that translates into “Oh shucks, pardner, t'wernt nothing. I was just doin' my duty, pilgrim”.

As Derek heads home he runs into Chief Webber and asks if they can stop this weird feud they’ve been having and reboot their longtime friendship. The Chief responds by telling Derek to clear out his desk because he’s fired. Derek tells The Chief to sleep on it and that he’ll see him in the morning. When Derek gets home to Meredith’s arms she is all set to hear his take of the day’s events until she realizes that her hubby has fallen asleep and won’t be commenting on anything until sunup.

While I enjoyed the episode overall I gotta be honest that the Isaac/Derek thing was a little bit too sappy even for Grey’s Anatomy. Isaac’s soul stirring musings coupled with the strings section accompaniment was like watching an extended Hallmark commercial. I kept looking for a nurse to come in humming “Wind Beneath My Wings”. The writer of this episode (Peter Nowalk) really had an urge to restore Derek’s god status. McDreamy gets all that build up from Isaac and Meredith and the rest and then he ends performing the procedure with flying colors. What a god!

Call me a party pooper but what I was hoping for was a more realistic ending where Isaac either dies or ends up tumor free but paralyzed. I thought maybe the writer pulled a shrewd one by first showing the ideal outcome Derek was wishing for and then we’d get snapped out of the daydream and dunked into the cold and icy waters of harsh reality. But no. It’s all sunshine and lollipops for Derek’s latest tumor surgery.

As for McDreamy’s firing……oh c’mon. Even if The Chief really does boot McDreamy there ain’t no way he’ll be gone from Seattle Grace for good. So all the worry warts out there swearing to abandon the show if Derek gets ousted need to calm down and have a cupcake because McDreamy and his McDreamy hair ain’t going anywhere.

Like I said before in my last recap I am really enjoying the presence of the Mercy Westers. I was very excited to see Jackson get more coverage. I loved seeing more facets of the character. So far he’s been kind of the good soldier but in this episode I got to see his arrogant side as well as his defeated side. I was sorry to see him get schooled in the OR but I also felt elated that Lexie got the last laugh on Jackson in the end.

And Reed. Reed and Alex. Reed and Alex interacting a lot while Izzie is AWOL. I’d be very surprised if nothing substantial came out of it. Alex is emotionally wrecked and one of his favorite healing places is in the arms of an attractive ladyfriend. Reed is already falling for Alex’s "battered bad boy routine" so a few more tears and she might be his new paramour. We’ll be keeping an eye on them.

The diaper gag was cute. Jackson rips on Lexie for wearing one and Lexie fires back by being proud of her diaper and that wearing a diaper makes her a hardcore surgeon. Then Christina gets in on the act and diapers are all the rage at Seattle Grace. At least, for those two. One of the best scenes of the season show Christina & Lexie strutting down the corridor with their diapers bulging out from their scrubs ready to get down and surgical.

What I always admired about Grey’s Anatomy and what I think is one of the show’s greatest strengths is the ensemble factor. Some of the finest moments occur when the characters are all together exchanging dialogue and jokes. This episode has a great scene where one doctor after another gets a hold of the spinal X-ray and gushes over how awesome and deadly it is. First Isaac gives it to Derek and then I think Callie comes in and she “oohs” over it then Lexie comes in and she “aahs” over it and Christina joins the group and is awestruck by the image. I’m glad that Grey’s Anatomy still has that comic flair intact since Season 1.

Couldn’t tell Derek’s fate from the preview but Alex will be working pediatrics again as he helps Arizona with a baby case and Christina’s “scalpel lust” might possibly make her do something really drastic in the OR. I wonder if they’ll use that same rubber baby doll used earlier this season. The one who’s arm almost got cut off, remember? I mean, a little latex to patch up the scar and some makeup to change the skin tone of the infant and bam! New rubber baby for a new episode. Yay!

PS - Alex will be shirtless for a portion of that episode so Justin Chambers fanatics might want to Tivo that for posterity.