Izzie tells Alex he'll be a rock star surgeon in 10 years. She's amused by Meredith and Cristina's bickering. She devotes her time to mushing the interns along in trying to diagnose her case.

When they do their typical intern shoddy job, she's annoyed and hammers them to go back and find what they missed. She gives George pretty much his only actual interaction during the entire episode.

But what is wrong with Izzie?

Finally they come up with an answer: "Patient X" has a metastatic melanoma that has spread to the liver, skin and brain. Her prognosis with chemo and radiation: a few months and a 5 percent chance of survival.

It's affecting watching her hold it together as the diagnosis sinks in, but the best scene is Izzie's conversation with Lexie, as they discuss how to break the news to the patient.

They choose to face the diagnosis head on and fight. Izzie finds herself on the verge of telling Alex when he comes to her excited about his great day, but in the end turns to Cristina.

We close on the two of them in the boiler room where Hunt took Cristina, and Izzie finally letting it all out. So now the fight is on.

Working on a trauma case with Arizona and Hunt, Alex ends up saving the day - and the life of a teenage "band nerd" who has epileptic seizures.

She keeps crashing in the midst of the seizures, making it doubly dangerous to shock her heart because it could kill her.

Alex figures out that the problem is the girl's heart, insisting over Arizona's protests against a cardiac procedure that could kill her if Alex is wrong.

But he turns out to be right, and reaps all kinds of impressed praise from both Hunt and Arizona. It's sweet to see him excitedly react to people actually believing in him.

Bailey's big case this week - because, as the Chief reminds her, there are no kids around for her to babysit - is a set of three siblings who have a 3 in 4 chance of developing the gastric cancer that has killed most of their family. They're there to have their stomachs taken out.

The oldest sister, who clearly saw more of their family, including their mother, suffer, is insisting. The middle sister and younger brother are less sure.

Then they find early-stage cancer in the oldest sister while she's in surgery - she should be fine now - and the middle sister gets the procedure too. The brother is resistant, but the oldest sister promises Meredith that he'll end up getting the surgery.

Which brings us to Derek. He's being sued over the death of Jen, his recent pregnant patient with the aneurysm, and during the deposition the lawyers confront him with the stacks of files on his patients who have died.

That's surely enough to throw anyone, and you can't really blame the guy.

But he takes it a step futher when he threatens to quit operating.

To her credit, Meredith has been understanding and has been trying to give the guy some space. But when the Chief enlists her help to bring Derek, she does.

Meredith finds Derek, drunk and out of control at his trailer. He's moved out of her house, and he's pushing her away, and is saying outrageously nasty things to try to get her to leave him.

In response, our girl calmly and firmly stands her ground and stands up to him - and ultimately tells him she knows about the engagement ring.

Which Derek promptly takes out of his pocket, removes from the box, and swats out of sight.

Elsewhere ...

• The Chief's behavior leaves Bailey struggling with her competing anger and understanding of what's going on, but she stuck to her guns. She does what she has to do - tattle to Adele.
• Shadow Shepherd, a.k.a. Jim Nelson, the interim head of neuro until Derek swooped in, is having a rough go of it.
• Callie seems to be getting a little mojo back when it comes to Arizona.
• Mark and Lexie seem to be doing okay as well.

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