Well, as we all know, all is not well in MerDer land at the kickoff of Grey's Anatomy's winter premiere, as Derek (Patrick Dempsey) packs up his bag to leave for D.C., and into the trash can goes his and Meredith's (Ellen Pompeo) framed Post-It. Sadface. (Have to say, it's even more cringe-y to watch these scenes given Dempsey's real-life marital problems. Also, did Zola double in size over the course of, like, three episodes or is that just me? Is she starting first grade now?)

In other news, Amelia (Caterina Scorsone), positioned in a DEFCON 5-esque Situation Room within the hospital, can't wait to get her scalpel around Dr. Hermann's (Geena Davis) tumor; and Jackson (Jesse Williams) breaks the news that their baby may have a fatal disease to April (Sarah Drew), who promptly runs out of the room.

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As she adjusts to single motherhood, Meredith finds herself doing a walk-and-talk interview with a potential nanny at the same time the hospital staff is preparing to deal with a trauma case of a woman who has driven off a bridge with her two kids in the car. I really hope this is not foreshadowing for Meredith's upcoming story line, especially when she voices her opinion that the mom's foot may have just slipped. (Is she prepping an alibi???)

The poor husband/father can't comprehend that his wife may have intentionally driven off of a bridge with their kids in the car, in much the same way that many of Meredith's co-workers can't believe that Derek has just up and left for D.C. You're not alone, Grey Sloan employees.

Even though she's worried about winding up in jail for any number of HIPAA violations, Arizona (Jessica Capshaw) realizes she has to tell Dr. Hermann that Amelia wants to operate on her. "I'm too pretty for prison," she tells Amelia - and she's right, although I'm intrigued and temporarily distracted by the thought of a Grey's Anatomy-Orange Is the New Black crossover episode.

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Anyway, it's too late. Dr. Hermann has somehow snuck into Grey-Sloan's SitRoom and is outraged that Arizona has somehow obtained X-rays of her tumor and has shared them with other staff members. But Amelia is confident she can beat the tumor, so now it's just a matter of convincing Dr. Hermann to go under the knife.

Meanwhile, Stephanie (Jerrika Hinton) assumes that Jackson hasn't yet told April about the ultrasound, because if he had there's no way April would be at the hospital, right? But it's actually the opposite. To deal with (or avoid dealing with) her own situation, April has opted to throw herself into work - until Jackson makes Owen (Kevin McKidd) pull her off of a surgery, saying she isn't fit to operate. This doesn't sit well with April, who's clearly on the verge of a breakdown, but it's actually Jackson who starts weeping first, right in front of Webber (James Pickens, Jr.).

After nearly having a panic attack when Maggie (Kelly McCreary) asks some innocent questions about the baby's name, sex, etc., April confronts Stephanie and says she's appalled that Stephanie ("of all people") told Jackson about the baby's problems before telling her. Given the case of the week in tandem with her own situation, she's also at a loss as to how a woman could possibly harm her own children.

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But, it turns out that the mother's erratic behavior is actually the result of a tumor, which Owen and Meredith remove. (A relief, as matricide may have been a little too much, even for Grey's, for this already emotionally taxing episode.)

With Arizona still campaigning on behalf of Amelia, Dr. Hermann finally snaps that she doesn't want the operation because, after numerous disappointments, she's essentially given up all hope of beating the disease. And later, when Jackson wants to talk to Arizona about the baby, Dr. Hermann advises her protégé to be a realist rather than giving them false hope. Needless to say, Arizona and Dr. Hermann have very different philosophies in this regard.

But as it turns out, apparently Arizona is pretty persuasive, and Dr. Hermann agrees that she'll let Amelia operate - but only when the tumor is at the point of no return, so that she can teach Arizona as much as possible in the meantime. (And even with the operation, her chances of survival aren't great.)

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At the end of the day, Meredith has literally forgotten what the potential nanny looks like, but concludes her interview by basically saying that she's looking for a best friend, a nanny, spouse and a therapist all in one. Good luck, Meredith.

And, when April runs out of distractions after treating 25 (!) patients in the ER, she and Jackson finally have a chance to chat. Basically their options are to have a child who will die minutes after being born, or have a child who will endure surgery after surgery after surgery. (Drew crushes this scene, with April's solid-as-a-rock Christian faith crumbling before our eyes.)

Finally, Meredith and Derek have a phone conversation while he's stuck in the airport and she gives him her (real) blessing to go to D.C., before reception cuts out and the call ends. Both are committed to making their marriage work - but will it? At least the Post-It is back in place ...

What did you think of the Grey's winter premiere? What should Jackson and April decide about their baby? How will Meredith and Derek handle a long-distance marriage? And will Amelia be able to save Dr. Hermann's life? Sound off in the comments!

Grey's Anatomy airs Thursdays at 8/7c on ABC.