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It's pretty clear from the onset where the boys are. Fishing. If Derek had his way, it would be where he is -- and no one else. But at the last minute he invited Preston, who invited George. And the Chief. And Alex, Joe and his boyfriend, Walter. The whole gang's going!
Tensions rise as Derek wishes he had more space when he set out to get some space, the Chief awkwardly discovers Joe and Walter are more than friends, and Alex and George come to blows. Literally. After George informs Alex that he's inadequately dressed and baiting his hook wrong, Alex counters by revealing that Callie is sleeping with Mark. You know how guys are.
In order to protect his prize investments -- the interns' hands -- Richard insists George and Alex engage in refereed open-hand fighting if they're going to go at it. They do just that, to the entertainment of all. Until they bump into Walter, who smashes his head on a rock. Fortunately, he's not hurt too bad -- but he needs stitches. Enter Dr. Burke.
Earlier, George witnessed his hand tremble while adjusting his fishing line. Now O'Malley watches intently -- and skeptically -- as Preston sews up Joe's man. Burke comes through, but afterwards, chastises O'Malley for his high standards. In a moment of vulnerability, he asks why George attacks when he finds fault in others.
Back at Seattle Grace, Bailey is livid with Cristina for erasing her name from Burke's humpty dumpty surgery. That means no surgery for Dr. Yang. That means sorting through feces for Dr. Yang. To be more specific, when a boy is admitted after swallowing monopoly pieces, the Nazi assigns Cristina to the case after she won't cop to her board-erasing stunt.
Even later on, when the boy experiences an abdominal problem and must be rushed into surgery, Bailey stonewalls Yang. Izzie's doing some serious stonewalling of her own, only she's shielding herself from Sidney, the resident she's assigned to peer counseling with. Sidney, of course, is the effervescent resident tortured by the interns during Dr. Bailey's brief maternity leave.
Her infectious optimism and talkativeness drive Izzie up the wall, and Dr. Stevens snaps when Sidney encourages her to talk about Denny. Izzie comes around after Sidney tells her how she lost a child back in the day, and has learned to cope with the pain even though it never goes away. A melancholy Izzie admits she misses Denny constantly, and is unsure she can succeed as a surgeon again, much as she wants to.
Addison and Callie treat a pregnant woman who slipped in the shower. She refuses pain medication for her broken wrist out of concern for the baby, but Addison soon learns that the damage is already done. The unborn child has died, and Addison must break the news to the woman, who must not only cope with the devastation but birth the baby after.
The only good to come out of that tragedy was Callie and Addison bonding... and admitting they're both through with that slime ball Mark. As for the aforementioned Dr. Sloan, he performs sexual reassignment surgery on a man whose wife somehow sticks by him through his emasculation. Moreover, the man is diagnosed with breast cancer, which is caused by the hormones that aid his transformation. But he goes forward with the surgery anyway.
Meredith assists Mark on the case, and throughout the process, he tries to impress upon her that Derek is damaged goods (taking no issue with the fact that he's the reason behind that fact). He and Meredith flirt at the bar after the surgery, but when Derek returns from the fishing trip, there's no doubt where Meredith's heart is. He's had his space, now he wants to start fresh, and take it slow. Our girl couldn't be happier.
McSteamy is no McDreamy, after all...