“Grey’s Anatomy” mini-cap 5.19: “Elevator Love Letter”

Oh, for the old days when Meredith’s one-night stand turned out to be an attending at her hospital, Cristina gleefully ran people over on her way to being better than everyone else, George caught syphilis from a nurse and married a lesbian, McDreamy and McSteamy were merely unshaven man candy, and Izzie’s story — raised in a trailer park, popped out a baby at 16, earned med school money by posing half-naked — only made her seem spunky. Good times.

But now, everything has gone all to hell.

Cristina wakes up to find Owen throttling her during a PTSD nightmare. Izzie prepares herself for brain surgery while enduring her closest friends’ sad, helpless faces, and Meredith and Derek put each other through the ringer for the umpteenth time.

The only one who’s having any fun is Callie.

Grown women dancing around the house. Maybe later, they’ll make popcorn, paint each other’s toenails and crank call boys.

Back at the hospital, Izzie’s oncologist is planning a very toxic course of cancer treatment. Without bothering to ask Izzie – because, really, why would he? – the Chief suggests to Alex that he fertilize Izzie’s eggs before they start to glow in the dark.

There’s the audacity of hope, and then there’s just audacity.

The men look over at Izzie, who lies in her bed, knitting her own death shroud, oblivious to their plans for her unborn children. Alex grabs a little cup and runs off to find a lingerie catalog while the Chief returns to his office to re-write Izzie’s will.

A short time later, the Chief raises meddling to an inconceivable level when he knocks on Alex’s door and asks how things are coming, er, going. The Chief: Nature’s birth control.

The next knock on the door is Meredith, who plops down and offers to chat about Izzie. Alex’s emotions finally surface when he reveals how guilty he feels – he should have seen her illness sooner. Instead, he thought she was just another insane girl who saw ghosts. Women are, in fact, insane, so he’s being very hard on himself.

In patient news, Sloan and the residents are baffled by a family’s apathy toward their dying aunt, who has about 24 hours to live. One man doesn’t want to stick around to say good-bye because he has a board meeting. Another is annoyed about having to switch his flight because he’s too cheap to pay the change fee. Apparently, the old lady’s been dying for three years, and each time they drop everything and jump on a plane, she pops up and proclaims, “I’m not dead yet!”

Arizona and Callie pay a visit to the hospital chapel. Here’s one room in the hospital Callie hasn’t had sex in. That we know of.

Callie confesses she used to wish Izzie dead because she was sleeping with George while they were married. All set with the gay now, and no longer torn up with jealousy, Callie prays for her old rival will live.

Elsewhere, the old lady codes as her family watches nonplussed. Alex charges the paddles to 360. I’ve heard that said from County General to General Hospital and I still don’t know what it means, except it seems to bring things back to life every time. Have a falling out with a friend? Charge the paddles to 360. About to get fired? Charge the paddles to 360. Discover, much to your dismay, that lesbian bed death may actually be real? Charge those paddles, stat!

The old woman stabilizes and opens her eyes just in time to hear Alex banning her family from her room. She’ll have none of that and gives this week’s thinly veiled life lesson.

Wise old lady who won’t die: They’re impatient. It’s been a long time. But they always come. They’re my people. People keep you going. People are better than no people.

People who need people are the luckiest people in the world. People who have well-meaning but skittish people? Izzie. No one’s visited her all day. On the bright side, she had time to finish knitting a scarf.

Meanwhile, Derek prepares to operate on Izzie’s brain but the only grey that matters is Meredith Grey. He tells her he’s not ready to pick up a scalpel — Izzie could die if she doesn’t come back to him. But no pressure or anything.

Callie finds George angrily smashing discarded casts with a hammer. He’s upset because although he asks Izzie what was wrong again and again, she ignored him and turned to Cristina, instead. Nothing hurts more than being shut out while others are asked for help. Callie suggests they go wait for Izzie but George ignores her and smashes another cast.

Callie: George! You were my husband and you slept with her. You are the reason I wished her dead. You owe me this. You can lie to yourself all you want, but I know you. I loved you once and I know that you care if she lives or dies.

Exes and all their accurate insightfulness. How annoying.

While everyone gathers to wait for the outcome, Derek and Bailey open Izzie’s skull and begin. The know-it-all oncologist strolls in and starts second-guessing an already nervous McShakey. Bailey, the glue that holds Seattle Grace together, subtly tells the persnickety doctor to pipe down, while assuring Derek he can do this. And that was all he needed. He digs in.

Bailey emerges from the OR and tells the anxious group all is well. Izzie’s bad brain parts have been removed and she’s in recovery. She also reminds them visiting hours are 8AM to 5PM. Use them!

A superhero’s work is never done, but Bailey takes the rest of the night off from saving the others from themselves and each other. She dons the scarf Izzie knitted for her and disappears into the night, the way superheroes are wont to do.

As much as I love Cristina, I didn’t need the sex scene with her and Owen. So it was a relief when we cut to Meredith getting on an elevator, only to find Derek waiting for her, clean-shaven and surrounded by MRI films.

Each case is a sign post from their journey together: Their first operation, the case that showed him her potential as a surgeon, the one when Bailey kicked her out of the OR, the procedure before their first kiss, the moment he knew he needed her. It’s all there in black and white.

Oh, and look over here. Someone is giving away kittens.

When all is said and done, Derek knows she’s seen pain. But what didn’t kill her, made her stronger.

“You say you’re all dark and twisty. It’s not a flaw. It’s a strength. It makes you who you are,” he says gently.

And that’s all Dark and Twisty needs to hear. She accepts his marriage proposal because he accepts her crazypants. Dr. and Dr. Twisty McDreamy. Monogram that on a towel.

Elsewhere, things are not as accepting and promising. Cristina lies awake next to Owen, afraid to close her eyes. She tells him she’s reached her limit. In the hospital, Alex lies down next to Izzie and tells her he gave her a gift. It’s in a little cup in the fridge.

Whether it’s a break-up, a make-up, or getting knocked up, they’re all screwed up. “Get messed up before you can step up” has now officially replaced, “Check yourself before you wreck yourself.”

Next week: ABC will be airing repeats for the next two weeks. See you in three!