This week's Grey's Anatomy is all about the things that haunt us — not actual ghosts this time, but more the psychic wounds that follow us around. For Derek, it's the fear that his medicine is doing more harm than good. For Owen, it's the things he saw in war that make it hard to live a normal life back home. And for Izzie, it's the thing in her brain — a thing that finally gets a name in this episode. Ready to talk about it? Just read more.

The big news of this episode is Patient X's Izzie's diagnosis: stage IV metastatic melanoma, which has spread to her liver and brain, and which comes with a five percent survival rate. It's trendy to rag on Katherine Heigl for her comments about the writing — heck, I've done my share of it — but she does some great work here. Izzie's stern with the interns when they say Patient X is fine; she doesn't want her legacy to be that she didn't teach them anything. She's tender with Alex when he tells her he wants them to take over the hospital together. And with Cristina, standing on that vent and confessing her disease, she's vulnerable. But my favorite scenes were the ones with Lexie, who's actually growing into a good doctor. The way she delivers the news about Patient X, with her speech about odds being meaningless, is exactly what Izzie needs to hear.

Meanwhile, Derek's an even bigger mess than Izzie. He's traumatized by being called a murderer, and moreso after he sees how many patients he's killed. Meredith's urging him to see the big picture — of course he had a lot of deaths, he ran a clinical trial that took a long time to get positive results — but he's a messy-haired, cereal-eating wreck. And he's quitting, or so he says when he's sucking down beers in the woods. Meredith tells him not to run away; Derek thinks that's hilarious coming from the queen of running away. Of course, by that point Meredith knows about the ring. Which the Chief told her about. Which makes no sense. And the ring's just lying there in the grass now anyway. But Meredith's not leaving. Maybe our girl's growing up after all.

Alex also has some great moments in this episode — and one that goes frustratingly unexplored. He, too, is struggling with something from his past: the idea that he's a dumb wrestler who will never be great at anything. But he catches something about his teenage patient that no other doctor has ever caught, and suddenly, he's being touted as the future of Seattle Grace. But why didn't anyone talk about the apparent panic attack he had holding the paddles? We've never seen Alex freeze like that before, and it's odd to just drop it.

Some other thoughts:

  • Owen's suffering is so deep, and it keeps rearing its head in ugly ways these days — like when he wakes up from a nightmare and shoves Cristina so hard she gets hurt. He seems to want to protect her by keeping them far away from each other, but Cristina insists that she'll decide when she's had too much.
  • One of the night's more improbable plotlines is Bailey tattling on the Chief to Adele, but I like the resolution that comes of it: Bailey tells the Chief that she's tired of him getting angry at her because he's afraid of going soft; in fact, maybe being a little softer with his staff is just the thing they need.
  • The story of the siblings with stomach cancer didn't do much on its own for me, though it was a fine reflection of everything else that was going on, but it's worth mentioning who the three were: Michael Rady of Greek; Erin Cahill, who was Ted's baby sister on How I Met Your Mother; and Wendy Hoopes, who was Jane Lane on Daria!
  • Lexie and Mark get about two seconds per episode together, but they make them count: "You think you broke me, Little Grey? You're the one who put me back together."
  • Can you believe we got an honest-to-goodness scene with George and Izzie?

What do you make of Izzie's diagnosis? What will get Derek back in the OR? And do you like Callie and Arizona more than Callie and Erica?

Photos copyright 2009 ABC, Inc.

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