Before and After

Summary
Addison and Naomi touchdown and arrive at Seattle Grace Hospital with Archer, with Derek and Richard greeting them all in the Ambulance Bay and an ICU bed arranged and ready. While in ICU, Archer has a reaction to his anaesthesia, forcing Derek to take him off - but Addison is at odds with him, setting the tone of their relationship. Derek, after consulting with doctors at the Cedars-Sinai Medical Center and the Mayo Clinic reveals he is unable to surgically navigate the brain without rupturing one of the parasitic cysts - which would do more damage than good. Addison admits to Derek that before, she put him in a box: to make him petty and insignificant, so that she can move on with her life; now, she has to take him out of that box. She needs him to be a God.

Addison, distraught with Derek's opinion, goes to the chapel and prays, having a crowd of Bailey, the Chief, Sam, Naomi and Callie looking on, confused at to what she's doing. Addison admits she's trying to pray, but doesn't know how to (She's a WASP, her family only goes to Church at Christmas). Callie comforts Addison while she breaks down as Addison believes God doesn't know she exists and she really could use a God at this point. Callie gives her an example of prayer, admitting she kissed a peds surgeon and she's a lesbian, then reminds Addison that she saves babies - God knows of her existence.

Sam meets Derek, and after a quick catch up, Sam gives Derek a gentle push into doing the surgery. Derek, now confident he can do the surgery, tells Archer he will, and antagonises him into agreeing to let him be operated on.

Derek takes Archer into surgery, successfully removing seven of the eight cysts, but the eighth cyst ruptures and the parasite begins digging into the third ventricle causing cardiac arrest. Meredith orders the crash cart, but Derek forbids it until he can get the worm. He eventually gets the world and Archer's heart rate begins again.

Addison, Derek, Mark, Naomi and Sam reminisce over their time at medical school at Joe's, trying to remember the love song Derek wrote for Addison, featuring heavily aspects of their medical training (Mark writing the line rhyming 'gross anatomy class' with 'Addison's fine ass').

Cristina and the Chief are treating Michael, who passed out, with his daughter, Beth, by his side, but he insists she goes to work. After she leaves, he quickly admits he has colo-rectal cancer, having five polyps removed in the last three years and radiation therapy. His daughter does not know, and he wants to keep it that way. Richard asks for where he's been previously treatment, when Owen comes in and tells them his past treatment, Michael visibly enraged by Owen's presence and his decision to come after Beth leaves and blurts out that he broke off the engagement with her in a two lined email.

Beth returns later, only to see Owen, hugging him and admitting she's been praying for him to return safely. Owen says nothing, taking her off him and walking away, while Cristina watches.

Michael begins coughing up blood, and Cristina and Owen rush him into surgery. During surgery, Owen reveals parts about his past relationship with him and his daughter. After surgery, Owen talks to Beth, and Beth begins to ask about why he couldn't even break up with him decently, but Owen deflects, informing her of her father's cancer.

Owen confronts Cristina, who's been avoiding him all day, and admits he calls his mother but pretends to be in Iraq. He can't bare to tell his mother that the man he used to be, the son she sent to war, is gone. He feels she would give him the same look at Beth gave him, and Cristina is the only person who really sees him.

Izzie tries to get the interns excited about medicine again and sets up a game for them. Alex thinks it's stupid and the interns are loosers, and naturally, Izzie sets out to prove him wrong. She sets up the game using the attendings and residents with all interns participating. The game uses what they've learnt this year: draping patients appropriately for surgery, diagnosis and basic examinations.

Alex informs Jen that Derek is held up and that her surgery is being pushed back. Jen and Rob dislike the sound of this, begging Alex to get Dr. Shepherd to get the surgery done as soon as possible.

Izzie has Sadie conduct a obstetric exam on Jen to find the baby's heartbeat as part of the game, Jen telling Izzie that they need a prize, only sending Izzie into a panic. She asks the Chief for a prize just before the end of the competition, ending in a three way tie between Lexie, Ryan and Steve, Lexie winning because she correctly diagnoses the disease.

George notices Sadie was not doing as well as the rest of the interns during the game, and offers some help as he remembers what it was like repeating his intern year. She brushes him off, and George continues to question her. She cannot answer him and walks off. George gives her a choice: talk to the Cheif, or he will. She decides to quit, hinting she may have cheated her way into the program.

Jen begs Derek to do her surgery at the end of the day and he complies. Derek complies, but accidentally clips the aneurysm during surgery, but resolves the bleeding. However, post surgery, Jen begins finding it heart to breathe, leaving us with Alex demanding Shepherd be paged now.

Music

 * "Emily" - Keri Noble
 * "Gather to the Chapel" - Liam Finn
 * "Roll It" - Shontelle
 * "Winter Song" - Sara Bareilles & Ingrid Michaelson
 * "Happy Ending" - Slow Runner

This episode's title originated from the song Before & After, originally sung by The Wannadies.

Quotes
"Callie: (to Addison)) You're an amazing doctor, you save babies. God knows who you are."

"Addison: I need you to be a God."

(Regarding the game's prize) Chief: You get to scrub in on Shepherd craniotomy and hold the doomsday sucker Lexie: Yes! What's the doomsday sucker? Izzie: (to the Chief discretely) Doomsday sucker? Chief: It's just a really bad sucker

Cast

 * Ellen Pompeo ... Dr. Meredith Grey
 * Sandra Oh ... Dr. Cristina Yang
 * Katherine Heigl ... Dr. Isobel 'Izzie' Stevens
 * Justin Chambers ... Dr. Alex Karev
 * T.R. Knight ... Dr. George O'Malley
 * Chandra Wilson ... Dr. Miranda Bailey
 * James Pickens Jr. ... Dr. Richard Webber
 * Sara Ramirez ... Dr. Callie Torres
 * Eric Dane ... Dr. Mark Sloan
 * Chyler Leigh ... Dr. Lexie Grey
 * Kevin McKidd ... Dr. Owen Hunt
 * Patrick Dempsey ... Dr. Derek Shepherd

Special Guest Stars

 * Kate Walsh ... Dr. Addison Forbes Montgomery
 * Audra McDonald ... Dr. Naomi Bennett
 * Taye Diggs ... Dr. Sam Bennett

Guest Starring

 * Grant Show ... Dr. Archer Forbes Montgomery
 * Brandon Scott ... Dr. Ryan Spalding
 * Melissa George ... Dr. Sadie Harris

Patients and relatives

 * Jennifer Westfeldt ... Jen
 * Ben Shenkman ... Rob
 * Laura Allen ... Beth
 * Sam Anderson ... Michael
 * Steven W. Bailey ... Joe