Everyone is gawking at an x-ray showing something stuck up someone's private bits. At the time, I thought it looked kind of like a phone cord. It turns out I was very, very wrong, and it was in fact a carnivorous fish. And the privates in which it was lodged belong to the head of the hospital board, a.k.a. the Most Powerful Decider of Who Will Be Chief. It turns out that he wants Richard to remain as Chief, so I can only hope that comes to pass so that we don't lose him from the show. They get the fish out, and he's okay, but by the time it's over, he's dumped by his assistant/secret girlfriend as well as his wife, Mrs. Leery (formerly of Dawson's Creek). Because working with someone you're in love with, who isn't your spouse, will only end badly.

Oh yes, the anvils, they are a-droppin', as George and Izzie are learning this lesson at the very same time. They seem to be getting along fine until Callie seeks out Izzie and actually begs her to let Callie have George back. Izzie turns cold toward George, and between that and his having to attend to his patient's wife and girlfriend, he realises that this isn't going to work and inquires about transferring to Mercy West from Seattle Grace. Not wanting to be left out, Derek and Meredith are having relationship problems, too. She tries to be chipper and pretend nothing is wrong while he broods, and he finally tells her he's not sure if he can be with her after the whole drowning/not swimming incident. He forgets to mention, however, the detail that he might not be appointed Chief if they stay together.

In the midst of all of the couple problems, Burke tries to get Cristina to choose a flavour for their wedding cake, all of the interns are studying for their intern exams, Bailey beats herself up for missing a patient's correct diagnosis, Crush has her baby in an emergency C-section, and Alex and Addison have sex in the on-call room. You might think that would have belonged up with the couple updates, but Alex doesn't, and he rather bluntly breaks it to Addison later that the sex doesn't mean they're a couple. As it turns out, neither are she and Mark, since he saw her stumble out of the on-call room with post-sex hair. So Addison is left kind of confused and adrift, and I wonder if this is going to make her think about possibly leaving for a warmer and drier climate south of Seattle? We'll have to wait and see.