(Opening Scenes) Meredith does her opening voiceover and rushes into the emergency room where Bailey is trying to save Derek after a car accident. He dies and Meredith starts screaming. Then she wakes up.

Owen staples his leg together while Cristina watches, amazed. She takes over the stapling and Callie interrupts to ask him about a freezing procedure. / Izzie talks to Dr. Shepherd about Betty's cat scans while he operates on Phil. Rose insults Dr. Shepherd. / Izzie, Meredith and Cristina talk about patients (and who they're sleeping with & cheating on) in the hallway. Izzie tells Meredith that Alex has turned into a good man.

Mark humiliates George in front of Lexie, trying to get her to admit she likes him. He calls her a coward. Michael and Vincent start crashing. Dr. Shepherd works on Phil. Sarabeth and Anna comfort Betty, who can't remember anything about where she is or what happened.

Cristina walks away from Meredith and goes outside and Meredith follows her while she whines about how chatty Derek is. She yells at Meredith to stop talking about Derek and their relationship. Cristina tries to go back inside Seattle Grace and as she gets near the door, she falls and a melting icicle breaks off the roof overhang and falls into her stomach. Meredith runs for help, leaving Cristina lying on the cold, wet ground gasping for air.

Sarabeth and Anna sit with Vincent and Anna tries to explain to Sarabeth about the situation with Michael. Sarabeth puts it together and realizes that Anna has been sleeping with him. Vincent begins to crash.

Alex talks to Sarabeth about Michael's surgery. She asks him why men cheat and tells him what Anna said. Alex tells her that Michael is embarrassed by his financial situation and that he probably didn't want her to see him low and weak, less than a man, that he has his pride so he turned away.

Owen removes the icicle from Cristina's stomach and Meredith comes in the room to tell Cristina that Vincent died. The chief and Derek talk about Owen and Phil's surgical procedure. The chief wonders if he's become soft because Meredith works there. She comes in to tell him about Vincent and he loses it, yelling at her about everyone not knowing what they're doing. Derek interrupts his rant and the chief says that they need to try harder, leaving the room.

Lexie reads a note from Michael to Sarabeth and Sarabeth walks out of the room without responding. Sarabeth and Anna check on Betty and Meredith tells them that Vincent died. Meredith apologizes to Izzie for teasing Alex. Cristina asks Owen about trauma surgery as he sews up her wound and gives her a shot. They talk about being the best, making mistakes and learning from them.

Betty's confusion continues as Izzie, Sarabeth and Anna watch the clock to see if her condition has changed. Lexie reassures Michael about making mistakes and making it right. Bailey finds Alex outside to do Michael's procedure and he is frustrated with her because Michael's insurance has expired so he snaps at her.

Izzie tells Betty that her husband is on his way. Sarabeth holds Anna's hand as they go check on their husbands. Bailey tells Alex to set the clock back so that Michael's insurance won't be expired. Owen finishes caring for Cristina's 'battle scar' and tells her that she should ditch Seattle Grace and go for the adventure. The chief comes in the room and offers Owen a job, but he declines. After the chief leaves, Owen closes the blinds and kisses Cristina.

Izzie rides the elevator to Denny to show him her prom dress and they walk off together. Fade back to Izzie watching Alex kiss a girl and then he shuts the door in her face. She turns and walks off in disgust. Lexie quizzes George, they kid around and she sniffs him. Meredith helps Derek pack his things while looking thoughtful.

when lexie humiliates mark and sarabeth, anna, and betty comfort each other