If you didn’t already hate Alex Karev from “Grey’s Anatomy” for his womanizing ways and poor treatment of Izzy, last night’s episode gave you plenty of ammo. As regular viewers of the ABC smash hit know, Alex is the painfully honest intern at Seattle Grace Hospital–as distinct from the painfully earnest Meredith Grey, the show’s namesake; the painfully put-upon George, etc. Alex’s character is drawn as the type of doctor who thinks the term “beside manner” refers to how skillfully one ditches that evening’s one-night stand.

In last night’s show, Addison, a highly regarded OB/GYN surgeon, forces Alex to shadow her as punishment for his mouthing off to her. Addison’s patient is scheduled to have a C-section to deliver her seventh child. Instead of being ecstatically happy about the coming delivery, the woman, Rose (played wonderfully by Jean Louisa Kelly), reels off a list of hospitalizations she has endured for exhaustion and dehydration due to the fact that she is constantly caring for her six children and forgetting to care for herself. She’s happy to have another child, but she wants Addison to tie her tubes so that she can’t have anymore. Nothing unusual there.

But, it turns out, the woman and her husband are Catholics, and while she doesn’t feel the Church would have a problem with her operation, she knows that her extremely devout husband would go ballistic. Her husband is so devout that he stopped receiving the Eucharist for the month she had gone on the pill, so the couple abstained from sex for three years to avoid pregnancy. Rose loves her husband, but wants to be able to make love without all the worry. Now she wants the surgery done, but wants no records of it to exist. She’s even been saving up money so she can pay for it out of pocket. Addison completely understands, but Alex just says that if her husband is so Catholic, he would never divorce her, even if she told him. That, of course, is the woman’s fear, that her husband would never divorce her and she would be stuck in a hate-filled marriage. Addison reminds Alex that their duty is to their patient.

While performing the C-section, Addison says that she sees unexpected bleeding that needs to be taken care of and begins to perform the tubal ligation. Alex responds loudly that he sees no bleeding and doesn’t think anything needs to be done. There is a standoff and Alex eventually backs down. Addison tells the woman that there were complications during the c-section and she won’t be able to have children again—wink, wink. The woman weeps with joy, but her husband is shocked and wonders aloud to Alex about whether it’s a blessing or not. Alex lets slip that maybe he should consult a lawyer, that this complication is, indeed, a “blessing”–a blessing “that will put your seven kids through college.”

The husband consults legal and Addison asks the woman to tell her husband that she requested the tubal ligation. She refuses to do so–a not very Christian thing to do, in my opinion, especially when Addison’s career is on the line. Addison doesn’t let Alex’s impunity go, though: She asks for him to be assigned to her for as long as she sees fit.

There are many reasons to dislike Alex, and he certainly shouldn’t have hinted to the woman’s husband that there may be a lawsuit in all of this. But there have been instances where his brutal honesty has been helpful. Remember the time he told a woman that there was no hope for recovery, to snap out of denial so that she would talk to her daughter about it and have some final quality time with her? Of course, he didn’t put it that nicely, but it is interesting that in the same episode where a prominent, eager-to-offer-advice divorce attorney is also a patient, the outspoken intern gives some of the best marital advice. What he said to Addison’s patient was, in essence, that she shouldn’t blame the pope for not being able to talk to her husband. And if hubby doesn’t understand, there’s always that divorce lawyer in the room next door….