The next day, Derek tells the staff who are trying out to join him that microsurgery is about precision. He tells them the doctor who can use a pen to dot the nose of George Washington on the dollar bill while a cut out cup is over it will be able to scrub in for the surgery. Several doctors try and fail. Avery is able to successfully complete the task. Cristina is arrogant during the other doctors' attempts, then goes up and hits the cup which eliminates her.

Sloan, Arizona and Callie ask Derek if he is going rogue. Lexie says she is offended since he didn't ask her to try the skills test. Derek explains he needs her to provide him with fluids during the surgery. Lexie tells Avery she is going to be basically Derek's doctor. Avery says it sounds like she is going to be his bi****. Lexie says he is going to need to take breaks, but he says he will prepare.

Cristina finds Lexie while she is examining a diaper. Cristina tells her that she is genius and the decision to wear the garment is hardcore. While wheeling in Isaac to surgery, Webb meets with the board and says they are testing the new computer scheduling system. Webb says the patient Derek is working on is a woman, but Derek says the computer system is incorrect. In the OR, Isaac tells Derek he is a survivor. He tells Derek he is inspired in the face of danger.

The surgery is under way. Derek examines Isaac and sees that he can't cut the tumor without cutting his spinal cord. Meanwhile, Hunt tells Cristina that he is sorry about the skills test. Cristina is jealous of Lexie since she wants to be put in a situation where she has to pee in a diaper. Cristina becomes impatient since Derek hasn't made one cut yet. Lexie tells Derek he should take a break since it has been eight hours. Avery and Lexie get in a fight. Derek tells them to shut up and take a break if they are tired. Bailey walks in the room and tells Derek that Webb is scheduled to operate in the room across the hall.

Reed tells Alex they have to do rounds, but she can do it herself since he has to take care of securing Izzie's cancer treatment appointment. Alex says he will go on the rounds with her.

Webb overhears Callie talking about Derek's surgery. He enters the OR and tries to talk to Derek, but he ignores him. He demands he close Isaac up and relinquish the OR. Derek decides to stop the surgery.

Later, Derek tells Isaac there was no way to operate without cutting his cord. Isaac tells Derek he should try again tomorrow, but Derek says it is inoperable. Isaac suggests he go home and think about it.

Derek goes home and explains to Meredith he just stared at Isaac's spine for more than ten hours. Meredith says she just stayed home and tried to call Izzie, but got her voicemail. Derek realizes Meredith wants to talk about the surgery. He turns her around and draws on the wall to describe Isaac's condition. He talks until morning. Meredith suggests he should cut the cord to save Isaac's life. She says there is a reason why he didn't operate yesterday.