Meredith and Karev are in an ambulance, trying to keep a newborn infant alive, when the vehicle's engine sputters and dies on a dark, wet road in the middle of nowhere. The ambulance driver leaves on foot to get help while the two doctors work on the infant. A car, not seeing the ambulance in time, smashes into it, scattering the passengers and driver of an entire family across the road. Meredith and Karev are shaken but not seriously hurt, go to help the family. The grandmother of the family dies at the scene while the father is seriously hurt. A teenage daughter, Lily, emerges from the wreckage unscathed, is asked by Meredith to keep the infant's resuscitation bag going while she attends to the other family members.
A fourteen year old male named Michael's legs are trapped under the car. Meredith struggles to pull him out, sees headlights approaching. Waving her arms, she manages to stop the driver of the tractor trailer. The family is transported to the hospital. In one operating room, Altman is working on a female heart patient, not knowing that Henry lies dead elsewhere within the hospital. Avery tells the heart patient's husband how the operation is proceeding. Owen realizes that Altman must be told at the appropriate time, just not yet. He asks wife Christina to do that when the time is right. She argues that she doesn't feel up to the challenge, but Owen says that she must. She agrees, reluctantly. The father of the family in the car crash is still unconscious, is bleeding massively internally.
Daughter Lily is told that the doctors must operate, to which she agrees. Lily watches the doctors working to revive her mother, but the woman dies anyway. Brother Michael is conscious, but complains of severe abdominal pain. The doctors decide he has a tear in his liver and needs an immediate operation. Lily is informed. She is also told that her sister is in an operating room because there is glass in her eye that needs removal if the eye is to be saved. Lily settles down to wait. Dr. Julia Tanner is called in to remove the glass from the young girl's eye. She decides that she will decompress the eye to remove the shards, hoping to save the eye. The operation is touchy but her eye is saved. Young Michael, on the operating table, goes into organ failure and the doctors decide to ice him down, drop his temperature to save him from death.
His heart rate drops, saving the boy's life. Altman is working on the heart patient when she asks that Yang be paged to assist her. A reluctant Christina comes in and helps. Altman chatters away merrily, not realizing that Henry is dead. Yang, feeling guilty when Altman asks about Henry, diverts her attention to a watching Cassie outside the operating room. Yang pokes fun at a sullen Cassie while the doctors work away. They have to remove the patient's heart from her body for a bit while they put her on a heart machine to determine what the next best move might be. Avery informs the heart patient's husband of what is going on and the man responds angrily, but calms down when he realizes that it will do no good to be upset. Lily's father is put on a ventilator.
She sits by his side as he lies comatose, begging him to get better, making wild promises if he will only live. Grey explains that he will not be able to live on his own, that his major organs are failing and that the tubes in his body are draining the fluids that his body is filling up with. She says that each time the doctors have to revive him when his heart goes into defibrillation, that it is extremely hard on the man's body, that he is basically dying and there is nothing they can do. Lily asks Grey to take her father off life support, that she doesn't think he would want to live that way. Grey takes him off the ventilator, explains what is happening as time goes on. She tells the girl that the monitors will go off as his heart rate drops, that his organs will begin to shut down and he will stop breathing.
A grief stricken Lily asks Grey to stay with her, clinging to her as the man slips closer to death. He stops breathing and dies. Lily cries, telling Grey that she, her brother and sister are alone in the world, but that she will look after her younger siblings. Grey holds the girl close as they exit the room. Christina tells Teddy that Henry died on the operating table, that when he was opened up, the tumor had eaten through a main artery, that the doctors had done all they could to save him and failed. A stunned Altman stands silently, tears running down her cheeks, then turns on her heel, flees the room. Christina's eyes well up with tears.
Christina angrily tells husband Owen that she is very upset with him for making her tell Teddy about Henry's death. Teddy spends some time alone with Henry's body, gently combing his hair as she remembers time spent with her husband, cries alone as she gazes on his dead face.
A brave, resolute Lily informs her brother and sister of their parents' deaths, promises that she will be there for them, not to worry. Back at home, the Greys wait tiredly in the kitchen for food she ordered to be delivered, chat amongst themselves when suddenly, the door bell rings. Thinking that it is the food delivery, she trudges to the door, only to scream when she sees who it is! She tells her husband to come see. Together, they see baby Zola, held in the arms of a social worker, standing at the door. They welcome her in and begin to talk.