Well, if you think about that title, you might get a basic idea about what goes down on this week's Grey's Anatomy. Derek returns to the hospital to be one link in the giant chain of doctors now trying to save Izzie's life. Meanwhile, Izzie tries adjusting to being a patient instead of a doctor, some disturbing things happen with Owen, and George . . . has a couple of lines. Ready to chat? Just read more.

Let's talk about Derek's Elevator o' Love, wallpapered with brain scans of patients whose lives he and Meredith have saved together. It's his grand gesture, his giant candle house in the woods. And, like the candle house was for Meredith, this is Derek's way of communicating that he's OK. Meredith doesn't have to worry about him wasting his talent on drinking and can batting in the woods; he's going to be fine. And with that, he doesn't need to ask a question; he simply tells her he wants to spend the rest of his life with her. It's not the proposal I was expecting from Derek, but I actually like it better than a room full of roses and candles.

They're engaged, but they're not celebrating — at least not right away — because they both have some work to do helping Owen and Cristina. Speaking of things I wasn't expecting: I knew the writers had been building up to something with Owen's PTSD, but strangling Cristina during a nightmare? That's big. And Cristina wants to pretend it's not. She wants it to be OK, even if that means she's wearing a turtleneck under her scrubs, even if her friends are standing guard to keep Owen away. Owen is terrified he'll really hurt her, but Cristina says again that she'll decide how much she can handle. And later in the episode, she does: After television's longest sex scene (I mean . . . they're good-looking folks, but that was a while), she tells him she's afraid to fall asleep. That's how postengagement Meredith ends up crawling into bed with Cristina; that's why Derek stays at the hospital to get a scan of Owen's brain. It took a while, but Owen finally realizes he needs help.

Meanwhile, Izzie Stevens is still alive — no thanks, as Bailey says, to the friends who didn't bother to visit her. Yeah, Izzie told them to go save lives; sure, she has her knitting. But guys, she's having brain surgery. At least stop by? Bailey won't let Izzie down, though, even quizzing her on surgical skills in between medical procedures — probably the vote of confidence Izzie needed, especially when her new oncologist is so brutally honest (and sometimes downright negative) about the whole endeavor. Callie won't visit because she feels bad about wishing Izzie dead; George won't visit because Izzie didn't tell him first and because he really doesn't want to lose his best friend. But the saddest story of all is Alex's. He's so used to crazy girlfriends that he didn't even contemplate that something could be seriously wrong with Iz. And now he's conceiving lab babies and wondering if he and Izzie have gotten together just in time for her to die. Karev is still Karev, though: His first line post surgery — well, after "I'm here" — is about his cup of "swimmers." Nice.

Some other thoughts:

  • Now every time I see Owen, I'm looking out for helicopter noises. Was there always that "whap-whap-whap" in the room with the hot vent?
  • "People are better than no people" is such a classic Grey's line, and I loved the old woman who just wouldn't die.
  • Also love Karev delivering his cup to the Chief in the middle of lunch. "I'm eating here, Karev." "I washed my hands."
  • How cute was Bailey wearing Izzie's scarf?

So Izzie's through surgery one, but she's got of fighting left to do. So does Owen, if he wants Cristina back. And do you think we'll see a Mer-Der wedding before the end of the season, or can they stretch that out another year?

Photos copyright 2009 ABC, Inc.