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The theme of this episode is -- as hard as it is to guess -- lying. The lies we tell to friends, to lovers. The lies doctors tell to patients, however good their intentions. Perhaps most intriguingly, the lies we tell ourselves. You name it. No matter who we're observing during the episode, truthfulness is certainly in short supply.
Meredith and Cristina lie about their respective relationships to each other. Meredith says she's over Derek, Cristina says she's content living with Dr. Burke. Both are sketchy on the details and clearly in denial. In particular, Cristina seems unable to express herself as she is continually blindsided by emotions. It's simultaneously painful and funny to watch.
Izzie lies to herself when she pretends to no longer care about Alex. By the end of the episode, she has shown her true colors by helping him pass his medical boards and remain at SGH. Richard lies to Meredith, as well as to himself, about his relationship with Dr. Ellis Grey. Even if his words are not overt lies, he is clearly withholding something big.
On the marriage front, Derek seems sincere when he says he wants to work it out with Addison, but he's clearly hung up on Meredith. In his mind, when he suggests being just friends with her, be probably believes that is his intention -- although the way he looks at her suggests otherwise. Addison, in her own right, lies to herself by saying everything is fine.
The irony, of course, from a fan's perspective, is that these are some of the most honest characters on all of TV.