Grey's Anatomy Universe Wiki
Grey's Anatomy Universe Wiki

To make it - really make it - as a surgeon, it takes major commitment. We have to be willing to pick up that scalpel and make a cut that may or may not do more damage than good. It's all about being committed, because if we're not, we have no business picking up that scalpel in the first place. There are times when even the best of us have trouble with commitment, and we may be surprised at the commitments we're willing to let slip out of our grasp. Commitments are complicated. We may surprise ourselves by the commitments we're willing to make. True commitment takes effort and sacrifice. Which is why sometimes, we have to learn the hard way to choose our commitments very carefully.

Let the Angels Commit is the sixth episode of the third season and the 42nd overall episode of Grey's Anatomy.

Short Summary[]

Derek's sister Nancy comes to visit. Izzie gets used to life as a surgeon again except with restrictions. Cristina goes to more extreme measures to hide Burke's secret.

Full Summary[]

Burke and Cristina are operating. When Burke starts flexing his hand, she takes over. Their team work is going well.

Cristina is directing a nurse as she's filling in the board for Burke. Residents starts sucking up to her, but she tells them all they can't scrub in. She quietly tells the nurse to specifically book OR 2 since that one does not have a gallery. She also needs the instrument tray on Burke's left side. The nurse remarks he has become very specific since his return. Cristina threatens to tattle.

The other interns are watching her. Alex and George thinks she's taking advantage of the situation while Meredith defends her. However, when Cristina takes the marker from the nurse and starts writing on the board, even she looks worried.

As they're preparing to go home, Meredith tells Cristina she hasn't heard from Derek for a week, since she told him about breaking up with Finn. She asks Cristina to get a drink so they can catch up, but Cristina wants to study to prepare for Burke's surgeries tomorrow. George follows Callie and says he'd like to talk, but she only yells his name before walking off. He says that's a good start.

Derek is startled when he comes out of the shower and is greeted by woman on his bed. He asks Nancy if she couldn't have called first as he wraps a towel around his waist. At that moment, Meredith enters the trailer. She takes in the situation. Derek doesn't know what to say. She flees as Derek begs to let him explain. As Meredith drives off, Nancy says she takes that that was the slutty intern. Derek asks why she's here. Nancy says he bailed on Christmas and Thanksgiving, he lives in a trailer, he got divorced, and there's the slutty intern.

George and Meredith are riding an elevator with a nervous Izzie. It's her first day back. George and Meredith aren't paying attention. Izzie gets off for HR. George then tells Meredith he'll be Cristina for her if she'll be Izzie for him. She agrees and he stops the elevator. Meredith tells George about the beautiful woman in Derek's trailer and Derek being naked. George channels Cristina and calls Derek McBastard. Meredith then channels Izzie as George tells her that Callie won't forgive him after dumping him. Meredith tells George he deserved better. He's George. Seriously. George calls that optimism very Izzie. They decide to make a pact not to date anymore and focus on their careers.

Cristina and Burke are meeting their patient and his wife. The wife has read all about Burke. Pruitt has a primary cardiac tumor so they are here for a cardiac autotransplantation. Burke says that's a complicated surgery. They need to take apart his heart, scrape out all the tumor, and put the heart back together. Burke is cautious while Cristina can't hide her enthusiasm. Estelle wants the best for her Pruitt. Cristina has scheduled the surgery for this afternoon. Burke isn't too thrilled.

Bailey is in Richard's office, where Richard tells her that Izzie was assigned to her again. Bailey wants her to succeed and give her a chance with another resident. Richard says some people are questioning Bailey's judgment since the M&M. Bailey asks if he's one of them. He asks if she is. She can't put those concerns to rest by avoiding taking responsibility for Izzie. 

In the ambulance bay, George brings Addison up to speed about Noelle, who's expecting twins. They are at 32 weeks and one appears to be developing more slowly than the other. They greet Noelle and Greg, her fiancé. They enter the hospital. Addison doesn't understand why Mercy West sent her on an ambulance as she doesn't seem urgent enough for that. Noelle says they said she needs a specialist because of her thing. George then reads in her file that she has two uteruses. That's very rare.

Izzie is finally done with the paperwork. She tells Bailey she's grateful to be back. Bailey reminds her there are rules to her probation. Izzie says legal went through those with her. Mandatory counseling, the extra lab hours, and voluntary work with transplant patients. Bailey has some extra stuff for her. She can't interact with any patients, nor be alone with them. She will be seen, not heard. She will perform no procedures and won't work in pre- or post-op. The OR is off limits. And she has no authority or opinions, nor any say in this. Izzie asks what she can do. Bailey says Izzie needs to earn back the right for any of them to trust her. Until then, she will be shadowing a different doctor each day. Today, she'll be shadowing Meredith. Bailey tells Meredith to only let Izzie observe. None of them are pleased.

Meredith and Izzie walk onto the catwalk while laughing about the situation. Izzie accidentally bumps into a guy that Derek's talking to. Derek wants to talk to Meredith, but Izzie has to stay by her side. Nancy then comes over and comments that Seattle's nice by day. Derek introduces her to Meredith and Izzie. Nancy comments on Meredith making Addison run off, leading to Derek telling her to go home right away. As they walk off, Izzie calls her McBitchy.

Burke is still upset over Cristina scheduling the surgery without talking to him. Cristina thinks they can handle. She studied and they are a well-oiled machine. As Cristina leaves, Bailey approaches Burke and brings up that people are doubting her judgment. He doesn't really listen and brushes her off.

Meredith is seeing a patient with a burned hand. While she has Izzie set her up for debridement, the patient says she was studying and forgot the water she was heating up for tea. The smoke alarm went off and now here she is. She failed the bar before, but she's going to pass now. Izzie says that's great.

Nancy is tailing Derek while asking about the panties on the bulletin board, which Kathleen told her about. He ignores her and says he has a job. Nancy says she is an OB and she a pregnant patient at home, so she'd be glad to leave. But they still need to cover the slutty intern and the divorce. Derek tells her she starts to sound like mom more and more. Nancy tells him to take that back.

George is with Noelle and Greg. Greg tells him he decided he was ham when he saw Noelle. He tells George about his ham or eggs metaphor. A chicken lays eggs and is involved, but a pig needs to be slaughtered in order to get ham so it's really committed. George understands.

Mark asks Alex if he's free. Alex says yes, but then Mark hands him his phone and asks him to sort out a problem with switching his registration and license to Seattle. George comes over and Alex asks him how he likes OB. George tells him about the woman with two uteruses. George drops off the chart and walks off, after which Alex asks the nurse for the chart. Having overheard George, Nancy walks over. Mark then walks by and recognizes her. They hug and Nancy asks why he's here. Mark says Derek is his family and he needed a change of pace. And he slept with his tennis partner's wife and the guy got a gun. Addison then comes over and hugs her. As they talk, they see Derek watching them. Nancy runs after him after Addison invites her to meet her later for the two uteruses.

Greg is talking to Noelle's belly about sports. Alex appears in the doorway and Noelle tells him that Greg calms one of the babies down. Addison comes in and comments Alex is not on her service. He leaves. Addison then tells Noelle and Greg that the fetuses are different in size because they were conceived at different times. The son was conceived six weeks before their daughter. Greg says that's impossible. Addison says the tests are accurate. Greg says they split shortly after finding out about the pregnancy because he wanted to get married and Noelle didn't, so he knows what she's been up to in those few weeks apart. Noelle says it was only one night. Greg can't believe this. He walks out.

Addison joins Bailey and tells her about what happened. Bailey says at least they are not doubting her competence as a surgeon. Richard then comes over and complains that his last clean shirt is missing a button. Adele always handled his buttons. Addison asks if he's called her. He asks if one of them can help him out. Addison uses the two uteruses as an excuse. Bailey says she has other skills to put to use.

Mark is examining Gretchen's hand as she talks about burning it while heating up soup. Mark says the burn's extremely deep. She says she held onto the pan a bit before dropping it. She brings up she has a test on Friday, but Mark promises they'll make sure she can take the test. Izzie notices that Gretchen doesn't seem too thrilled.

Privately, she tells Meredith about her suspicions. Meredith fears that Izzie's already bending the rules on her first day back. Izzie says this is about the patient. Meredith says this is her patient. Izzie has to remember that.

As Cristina is reading up, Bailey sees Burke's surgery on the board. Since she has never seen it first hand before, she decides to scrub in and writes her name on the board. She asks Cristina to let Burke know.

George asks Callie to listen to him. They are like ham and eggs. He knows he was the chicken while she put herself out. She was the pig, but now he's committed. She's not the pig anymore because he is. Callie still thinks he's calling her a pig and walks off.

Izzie finally finds the other interns in a patient room. George introduces her to really old guy. He sleeps all the time, so it's quiet and nobody bothers them. Izzie moves some of Cristina's books to sit down and starts talking about her day, but Cristina directs her to another corner of the room. Alex keeps asking George about his case although he pretends not to care. George then says he called Callie a pig. Meredith reminds them of their pact and leaves after winning their card game. Izzie is surprised that she doesn't know about Meredith and George's thing while seeing them every day. Cristina angrily leaves because the quiet is gone. Izzie says everything has changed.

Estelle is yelling at a nurse because her husband hasn't gotten his meds. Cristina comes in and calms her down. Estelle says she's becoming this horrible person who yells at people trying to do their job. Cristina says she's doing everything to protect her husband. That's not horrible, it's smart.

Noticing the empty hallway, Cristina walks up to the board and erases Bailey's name from Burke's surgery.

Noelle is hyperventilating while asking about Greg. One of babies is bradycardic. Noelle always gives Greg a hard time but she cannot do this without him. She screams in pain. Addison and George get her back in the bed. Addison tells her not to push.

Nancy and Derek are having lunch at Joe's. Nancy is asking about Meredith. She heard from Kathleen that Meredith's not even single. Derek says she is, but she's none of her business. Nancy comments he never talked that way about Addison. Derek still hates Addison. Nancy says she should be ashamed over what she did, but Mark is Mark and they've all gone there once or twice. Sleeping with Mark is like a rite of passage. Derek then tells her that Mark and Addison have been together for months. She didn't know that.

Meredith sits down with Cristina and tells her about Derek's sister. Cristina doesn't care because she has bigger things in her life right now. She leaves. Bailey then walks by the board and notices her name has disappeared.

Burke is in the OR with Cristina, about to start operating on Pruitt.

Greg approaches George outside Noelle's room and asks about Noelle. George tells him she's freaking out because she thinks he left. Greg needs some to process that his daughter is not his. Greg needs to know that Noelle is okay. George says she went into early labor so Addison is going to perform an emergency C-section to deliver one baby so that the other one can stay in a little longer. Greg asks which baby they are delivering now. George asks him if he's ham or eggs and goes back into Noelle's room.

Mark finds Alex researching Addison's case. He thought Alex wanted a career in plastics. Alex says what Mark has him do has nothing to do with plastics either. Mark says it does, because it has to do with him and he's the one who can get Alex into plastics. Alex overhears a nurse asking nurse Tyler to get two units of blood for Addison's patient.

Meredith tells Gretchen that the biosynthetic dressing ensures that she won't need skin grafts. Gretchen asks if it'd take long if she needed skin grafts. Meredith says that depends on the severity of the burn. Gretchen takes away that the burn would have to be more severe than this one. Izzie scrapes her throat. Meredith asks how she burned her hand. Gretchen says they have been over this. She has work to do for her test. Izzie bluntly asks her if she burned her hand on purpose. She suspects Gretchen did it to get out of taking her tests. Gretchen says she can't fail that test again. It's all she's known for. She failed five times. It's pathetic. She can't do the test again just to prove to everyone how pathetic she is, while she already feels pathetic as it is. Izzie understands

Burke and Cristina are working on the heart. Cristina has clearly been doing her homework and proves this through asking.

In another OR, George tells Addison that the baby is moving too much. He can't hold it longer. Addison needs him to keep it still so she can complete the C-section. Nancy is observing and tells George he really needs to get the baby to stop moving. George doesn't know how. Alex comes up and tells George to start talking, but George doesn't know what about. Alex enthusiastically starts talking about a boxing match, which works.

Derek finds Richard sewing on a button in an empty OR. It's not going well. Derek takes care of it for him. Richard heard about his sister. Derek says he has four annoying sisters and Mark was his brother. Derek wanted the divorce to be over so he could move on, but he's in a surprising amount of pain. Derek asks about Adele. Richard says he's sewing on a button for the first time in his life. That should say enough.

Alex leaves the scrub room and finds Mark waiting for him. Mark says he forfeited his future in plastics by going into Addison's surgery. He asks for his phone back. Alex returns it.

Burke and Cristina leave the OR. The patient is fine and Burke tells Cristina he could not have done it without her. Bailey comes up and asks for a moment alone with Burke. She didn't know Burke was one of the doctors who doubted her competence. Burke says he's not, but she tells him he must have been the one who erased her name from the board. Burke looks at Cristina. Bailey wants to know why he didn't want her in that surgery. Burke says he just couldn't use her. Bailey walks off angrily.

Nancy finds Derek and enthusiastically tells her about the two uteruses. Her plane leaves in two hours. He asks what she's reporting back to their mother. She's going to say that he's him, still running circles around all the women in his life. Which is to be expected with four sisters and a dead father. Derek says he's not running around in circles. Nancy points out he's never been single and invites him to take some space from Meredith and Addison so he can figure out what he wants. Derek says Kathleen is the shrink in the family. Nancy says it's time to go. Derek genuinely thanks her for flying out here.

Meredith and Izzie are on the elevator with Gretchen. They arrive on the fifth floor, the psychiatric floor. They need to place her on a 72-hour hold. Gretchen says she's not crazy. She needs to go back home. Izzie knows she's planning on hurting herself again. She needs help, and that's okay. Everyone needs help from time to time. They all need someone to look out for them, to make sure they're ready. Izzie has that now and Gretchen needs it, too. Gretchen says she just didn't want to fail. She takes Izzie's hand.

Noelle wakes up and asks about her babies. Addison tells her she has a healthy baby boy and her daughter is fine. She asks about Greg. Addison says he hasn't come back yet. Noelle is disappointed. Seconds later, she asks what happened. Addison tells her she's still coming off the anesthesia. Noelle asks about Greg again, but Addison again has to disappoint her. Noelle asks it again moments later, but this time, Greg tells her he's here. He enters the room and says he saw their son. He's amazing. Greg asks about their little girl.

Mark finds Callie and says she looks like she could use some cheering up. Callie says not from him. Mark says he remembers he cheered her up three cheerful times. She says it was dirty, not cheerful. She again refuses his offer. Alex has overheard their conversation.

Meredith and Derek run into each other in the stairwell. Meredith says Nancy didn't like her. Derek says she's from the East Coast. He then says he wants them to work, but it's complicated. He needs some more time. Meredith says he can have some space. She understands. They smile.

Richard approaches Izzie and says he read Meredith's evaluation. She had a lot to say. It was a difficult case, but he thinks Izzie handled it perfectly. He welcomes her back. Izzie walks off smiling.

Callie is waiting for George. She apologizes for being rude before. She understands his metaphor now, but she hates that he waited to say all that to her until after they have broken up. Callie's out of her element here. She never gave a crap what other people think about her because she's a happily independent woman. But when George says stuff like that, it makes it too difficult. She asks him not to chase her unless he's ready to catch her.

Meredith finds Cristina lost in thought. She tells her that she's here for her, whenever she's ready. Cristina thanks her.

Cristina is filling out the board with Burke watching her. They share an intense look before he walks off. Bailey then walks over and sees Cristina working on the board, and she realizes what happened.


Main Cast[]

Guest Stars[]



Medical Notes[]

Burke's Patient[]

  • Diagnosis:
  • Treatment:
    • Surgery

Burke and Cristina were shown operating on a patient together.

Pruitt Byrd[]

  • Diagnosis:
    • Cardiac sarcoma
  • Treatment:
    • Cardiac auto-transplantation

Pruitt was in the hospital with a cardiac tumor. He needed a cardiac auto-transplantation, a surgery in which his heart would be removed, the tumor would be cut out, and his heart would be re-transplanted into his chest. His surgery went well.

Noelle Lavatte[]

  • Diagnosis:
    • Uterus dicephalus
    • Pregnancy
  • Treatment:
    • C-section delivery

Noelle was pregnant with what she believed to be twins. She was brought in because she was born with two uteruses. It turned out that she was carrying one fetus in each of her uteruses and one was conceived a full six weeks after the other. When she went into labor, she was taken in for a c-section, so they could deliver the larger baby and hopefully stop labor on the other so she could continue gestating and get closer to term. The delivery went well and labor stopped on the other uterus.


  • Diagnosis:
    • Partial thickness burns
  • Treatment:
    • Debridement
    • Dressing
    • 72-hour psych hold

Gretchen burned her hand. When Mark examined it, he determined that the burn was very deep. When the doctors began to suspect that she had burned her hand on purpose, they confronted her about it and then took her upstairs for psychiatric treatment.

Nancy's Patient[]

  • Diagnosis:
    • Twin pregnancy
  • Treatment:

Nancy had a patient who was 35 weeks pregnant with twins.


Song Performer Scene
"Cobrastyle" Teddy Bears
  • Burke and Cristina operate. Cristina steps in when his hand tremors.
  • Cristina dictates Burke's surgical schedule. Other interns bribe her to get in on surgeries.
  • The other interns talk about Cristina and Burke, then see her writing on the OR board herself.
"My Patch" Jim Noir
  • Izzie says she feels good on her first day back. She gets off the elevator.
  • George and Meredith each allow the other to vent.
"Young Folks" Peter Bjorn & John
  • George watches Callie walk away.
  • Izzie finds the others in Really Old Guy's room.
  • The interns all talk about their cases and lives.
  • Cristina leaves, frustrated at the noise.
"Notice" Gomez
  • Cristina and Meredith have a small fight.
  • Bailey sees that her name has been erased.
  • Burke prepares for surgery with Cristina. He starts operating.
  • George talks to Greg about Noelle and asks if he's committed.
"Life is Beautiful" Vega 4
  • Derek thanks Nancy.
  • Izzie and Meredith take Gretchen to Psych and admit her.
  • Noelle wakes up and asks for Greg. He comes back to be with her and claims her daughter as his own.
  • Mark talks to Callie.
"Writings on the Wall" The Album Leaf
  • Richard welcomes Izzie back to the hospital.
  • Callie tells George to stop chasing her unless he's ready to catch her.
  • Cristina sits alone in the locker room.
  • Meredith comes in and tells her she's there for Cristina when she's ready.
  • Bailey sees Cristina writing on the OR board.

Notes and Trivia[]

  • This episode's title originated from the song Let the Angels Commit, originally sung by Danielle Howle and the Tantrums.
  • This episode scored 21.02 million viewers.
  • Goof: Jeremy Rabb played a third-year surgical resident in this episode despite normally playing ER resident Jeremy Bennett. Curiously, Rabb is seen wearing his Jeremy Bennett ID despite not playing that character.


Episode Stills[]


George: Okay, I'll be Cristina for you, if you'll be Izzie for me.
Meredith: Deal.
Meredith: Derek had a woman in his trailer last night. She was ugly, very ugly, except she was tall and beautiful. And he was naked.
George: Oh. Uh, McDreamy was doing the McNasty with McHottie? That McBastard. How was that?
Meredith: That was good.
George: Cristina enough? Really?
Meredith: Yeah.
George: Yeah?
Meredith: Yeah.
George: Excellent.
Meredith: Channeling Izzie. Go.
George: Okay, uh, Callie... She won't forgive me. She won't talk to me. She dumped me. Which is... I don't care about, you know, at all...
Meredith: Good, because you deserve better. You do. You are George. I mean, seriously. Seriously. Seriously. Was that Izzie optimistic?
George: Yes, it's very Izzie.
Meredith: What the hell has happened to us?
George: We are now the people that the people we want to be with avoid.
Meredith: We have careers to think about. We don't need attention from men with perfect hair.
George: You know, we should make a pact. There's no more dating.
Meredith: No more Derek. No more Callie.
George: Just a hundred percent focused on our work.
Meredith: They're dead to us.
George: They're freakin' corpses to us.

Nancy: What are you doing here, Mark? Are you trying to torture him?
Mark: He's my family, Nancy. Plus I needed a change of pace. Plus I slept with my tennis partner's wife and he went out and bought a gun.
Nancy: There it is.

Nancy: Don't be bitter. Shame on Addison and all that, but he's Mark, Derek. What did you expect? He's just Mark. And who hasn't gone there once or twice?
Derek: What?
Nancy: Everybody sleeps with Mark. It's practically a rite of passage.

Richard: I'm down to my last clean shirt and I'm missing a button. Adele always handled my buttons.
Addison: You called her?
Richard: Adele? Oh, no. I wouldn't want to bother her with something as trivial as a button. I don't suppose either of you would want to?
Addison: I'm sorry. I have two uteruses I have to attend to.
Bailey: I have many skills. Many skills. Surgical skills. Your button ruptures its esophagus, I'm your woman.

Derek: He was like my brother. I had four sisters. Four very annoying sisters. Mark was my brother. It's hard.
Richard: Divorce isn't all it's cracked up to be, huh?
Derek: I just want it to be easy. I want it to be over and move on.
Richard: But you're in a surprising amount of pain.
Derek: You and Adele?
Richard: I'm sewing on a button for the first time in my life. What does that tell you?

Derek: So you going to report back to Mom that?
Nancy: That you're you. Still running in circles around all the women in your life, but that's to be expected with four sisters and a dead dad.
Derek: I'm not running around in circles.
Nancy: Can you even remember the last time you were alone? You've never been single, ever. You're fine, but you're not happy. And you're not going to get happy until you get some space. Just get away from Addie, away from the intern. Just away. Figure out what you want.
Derek: Kathleen's the shrink, Nancy. Not you.
Nancy: I gotta go.
Derek: Nancy. Thanks for flying out here.

Izzie: You need some help, Gretchen. If the idea of taking an exam makes you hold your palm to a burner, you need some help. Everyone needs help from time to time. Someone to look out for them. Make sure they're okay. Make sure they're ready. I have that. And you need that right now.

Callie: I understand what you were trying to say. You're the pig. You are committed. Only we broke up. I've been wanting to hear this from you for how long? And you wait until now to say it to me, after we've broken up? I'm out of my element here. I break bones for a living. I used to live in the basement. Most days, I wear last night's eyeliner. I don't care what people think about me because I am a happily independent, successful woman and I like it that way. Only when you say stuff like this... It just, it makes things too hard, so please don't chase me anymore. Unless you're ready to catch me.

See Also[]

A complete overview of this episode's crew can be found here.

The Grey Matter blog post on this episode can be found here.