Credit: Randy Holmes/ABC Television Group © 2011 Disney Photo: Alex Karev on Grey's Anatomy May 19, 2011

This penultimate episode of the Grey's Anatomy season was bound to have fewer shocks than this week's finale, but it still packed some dramatic punches (and some freaky-deaky medical cases). Here's a blow-by-blow of this week's twists and turns.

5. Altman Out?

Teddy Altman, we hardly knew ye? Kim Raver, on to bigger and better things? We haven't heard about the character leaving Seattle and the actress leaving Grey's, so we're not entirely convinced that Teddy is gonna go with Perkins to the base in Germany like she announced she would this week. It was a bold statement, however, and we'll be curious to see how it pans out (or, in this case, doesn't pan out).

4. Fir Real?

How the heck does a tree grow inside a lung? It must have been The Little Tree That Could to survive in such a relatively-hostile environment. Well, come to think of it, trees convert carbon dioxide to oxygen, so there are worse things to have inside your lungs. But had to go.

3. A-Very Bad Move

In the words of Sassy Gay Friend (YouTube him if you haven't seen the web videos): Jackson Avery (Jesse Williams), what, what, what are you doing? Quitting the diabetes trial as Owen (Kevin McKidd) was busily rating the Chief Resident candidates seemed like such a bone-headed and irrational decision. But once Owen put the pieces together and realized that Jackson didn't want his name holding the trail back, it all made sense, and we realized that the decision was, in fact, noble.

2. Seriously Ex Utero

We've seen some pretty nasty medical cases and surgeries on Grey's over the years, but this one really makes us blanch: the docs rushed Zola into an emergency C-section only to find that her baby was outside the uterus and enmeshed with her intestines. Oh, and you better believe we saw that face among the entrails; it's an image that will haunt our dreams for years to come.

1. Alex Karev, Whistleblower

We knew he was a ladykiller. A jerkface. A Scrooge. But now we can add "blabbermouth" to Alex (Justin Chambers)'s long list of less-than-flattering descriptors. He totally spilled the beans on Meredith (Ellen Pompeo)'s placebo switcheroo, and worse, he didn't even do it for the right reason. Nay, he didn't lay bare the secret to save the trial and the hospital from scorn; he did it because he was feeling inferior and spiteful toward Mer. Shame on her, but maybe even more shame on him.