In this episode of Grey's Anatomy, Derek assumes the role of Chief of Surgery and quickly learns some of the headaches that go along with the job. The cause of his biggest problem: Bailey and Meredith's patient wakes up in the middle of a surgery. Alex works with Arizona on a peds patient who complains of abdominal pain but shows no physical signs of anything wrong. And while Mark and Lexie aren't speaking, Cristina and Owen can't keep their mitts off one another, which leads to problems of both the serious and hilarious variety.
For his first day on the job, Derek wants to look Chiefly, so he wears the blue tie that Meredith suggests. (He later is told he looks like an undertaker, and Bailey simply tells him to take it off.) But he has bigger problems than fashion: He's facing a lawsuit on his very first day. As Bailey was preparing to close her patient's abdomen following a successful tumor removal, the patient's heart rate spikes and Meredith realizes the patient's awake. Naturally, Bailey blames the anesthesiologist, and she gives him an earful.
Ultimately, the anesthesiologist proves that he didn't drop the ball, but that the patient metabolizes anesthetics faster than normal. Even though he's out of hot water, Bailey isn't: The patient refuses to let Bailey touch her, even though they need to go in and patch some things up. In comes Meredith to save the day, and ultimately all is well. Bailey tells Derek that the best way out of a lawsuit is to apologize, something she learned from the Chief and something she has trouble doing with her "gas man" after being called out for the way she treated him. (The real question: When are these two going to get together?)
Derek's other problem on his first day? Tying up the Dr. Weber loose end. The board has presented Richard with two options: early retirement and forfeiture of his medical license, or rehab with the possibility of regaining his job after treatment. Derek is shocked that the Chief is even considering quitting and tells him he's being foolish. Richard accuses Derek of only wanting the job, which he cops to, but he also says he's doing what's right. Meredith tells Richard that her mom would have kicked his ass for thinking of quitting, and Bailey makes him see that going to rehab is not the end of the world. Derek apologizes to Richard, promises his staff not to undo Dr. Weber's legacy (even though he hires back some Mercy Westers), and presumably talks his way out of the lawsuit. Not bad for a first day's work.
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