The episode begins, with Owen and the rest of the team are going over the list of residents and trying to figure out who's staying and who's leaving Seattle Grace Mercy West. Derek tells Owen that Meredith is still weighing Boston and Seattle, and Owen tells Derek that if he's going to one of his talented resident and his top neurosurgeon he'd love a decision sooner rather than later. Cristina is getting offers from Stanford and Columbia, but Teddy thinks Seattle is still in the mix. Richard tells Owen he should be proud, and Owen returns the compliment, saying Richard "trained them well." Cut to all the residents partying, including April, who is wasted and rocking out. Cristina gets a call in the middle of the party from the Mayo Clinic, who wants to give her a research lab.
April gets a phone call next. "UVA wants a board-certified surgeon, so they pulled my offer," she reports. Then she wants the music cranked up again. Meanwhile, Cristina goes home to find Owen asleep. She gets into bed with him and when he asks what she's doing she says, "I don't know." She says nothing more, and then leaves. Meanwhile, Ben has made a breakfast for Bailey and is ready to enjoy the day, but finds that she's about to leave for the hospital. They called with a tricky case and she's going to help. Bailey gets to the hospital and meets Jake, the man with the stomach perforation. He's with his wife, whom he's married three times and divorced twice. They just got back from their third honeymoon.
Meanwhile, Callie, Cristina and Teddy tell Arizona's friend, Nick, that he needs a complicated surgery. Arizona is still avoiding him. He asks Callie to tell "Scottsdale" he said goodbye. He doesn't think he's going to get the chance. Meanwhile, Derek asks Meredith about the Boston vs. Seattle. Derek has an offer from Harvard to run its neuro surgery department. Meredith doesn't want to go, but Derek does. Meanwhile, Richard pulls Alex aside and tells him that Keith Colliers, the examiner at the boards who Alex shouted at, wants to offer him a per surgery fellowship at Hopkins. Richard says Hopkins is adding a position just for Alex, who thinks it's a practical joke. Richard vows he isn't pulling anything. Alex waits for his phone to ring. It does and he freezes. Meanwhile, Meredith tells Cristina she's made a decision: Cristina is going to Stanford.
Meredith wants Cristina to be relatively close. Teddy gives Cristina the chance to be the only cardio representative from Seattle Grace Mercy West on a conjoined-twins case in Boise. She's trying to entice Cristina to stay, and when Teddy leaves Meredith gives Cristina a hard time for not having told Teddy she's leaving. Alex comes up and tells Cristina and Meredith that Hopkins wants him. He's fired up. Meanwhile, Bailey is working on the stomach surgery. Meredith finds something odd in the man's stomach, and neither she nor Bailey can figure it out. Ben is there, too, and he's annoyed. Meanwhile, Richard asks Alex how it's going with Hopkins. He urges Alex to negotiate for more money and great benefits from both Hopkins and Seattle Grace. He tells Alex to make sure he tells Owen he knows about his "incidentals and overhead fund."
Meanwhile, Mark tells Derek that he was ready to impregnate Julia, but Lexie told him she loves him. Mark is torn. The elevator doors open and Lexie steps in. There's awkward silence. Callie goes to Arizona and tells her to "get (her) crap together" before Nick leaves so she can talk to him. Meanwhile, Bailey's patient, Jake, is upset that they don't know more about his condition. His wife is scratching a rash. Jake is convinced he picked something up in Thailand on their honeymoon. Meredith and Bailey look at the woman's arm and see a worm crawling just under her skin. Meanwhile, Ben is upset that he has to cancel lunch reservations, but Bailey is excited about this "once-in-a-lifetime worm." He tells her the man is on anti-parasite medication and the worm is going to die.
Meanwhile, Owen is upset with Alex for backing out of his commitment. Alex shows Owen what Hopkins is offering him. Richard is over Owen’s shoulder egging Alex on. Alex plays the "incidentals and overhead fund" card and Owen says he doesn't know what Alex is talking about. At lunch, Meredith is still urging Cristina to go to Stanford. Cristina says all options, including staying, are still on the table. April gets another call and doesn't want to answer. Cristina picks it up and pretends to be April. It's another rejection. The phone rings again and it's yet another rejection, but this time Cristina defends April. Nick is upset with Arizona for not having his back. She asks him to have the surgery and promises she'll be there. He's glad he finally got her attention. Meanwhile, Derek tells Meredith that Harvard is offering him a $10 million endowment and an entire research team.
He says he wants to cure Alzheimer's. He tells her she's making the choice to stay in Seattle with Cristina, but he's her husband and she should be making it with him. Meanwhile, Jake can't feel his legs or toes and Bailey asks a nurse to page Derek. The worm is in Jake's spine and there's a chance of paralysis. Derek has to go in quickly. Bailey is fired up and tells Derek and Meredith to "lock and load." Teddy in the meanwhile, is still trying to butter up Cristina and says she has to know, but Cristina doesn't respond. Meanwhile, Jake's wife is worried she's jeopardized her husband's life because she insisted they go to Thailand. She says she's not sure why they keep going back to each other and why she's trying to change him. Mark and Jackson both pay close attention because what she's talking about relates to their personal lives.
In surgery, Bailey and Ben go at it about the crossword puzzle he's wanted to do together all day. Derek and Meredith agree that "this is why you don't work with your girlfriend." She takes the crossword and starts doing it, sarcastically answering all the "easy" questions. She gets to one where the clue is "My question to you." She mocks it then Ben gives her the answer. It's "Will you marry me?" He made up the puzzle himself, it took him two months; Bailey is stunned. Derek, meanwhile, has pulled the worm from Jake's spine. Meanwhile, Cristina and Teddy are operating on Nick while Arizona and Callie watch from the gallery. They run into a deeper tumor than they expected. Cristina tries to come up with options, each of which Teddy says won't work. Callie tries to assure Arizona that they're going to figure something out.
Finally, Cristina and Teddy look at each other and it's clear they have no idea what to do next. Nick wakes up after his surgery and asks Arizona, who's sitting there with him, if he's cancer-free. She explains that the tumor had taken over his heart and they couldn't do anything so they had to close him up. He says he's going to Belize, and then calls himself stupid for not having come to Seattle sooner. He and Arizona both cry and she hugs him. Meanwhile, Owen erases Alex's name from his dry-erase board. Teddy comes in and tells him she thinks they're also going to lose Cristina. She asks him what happened and Owen finally admits he slept with someone else. Richard gets the update from Alex: Hopkins gave him an international rotation and moving expenses, took care of all his loans, and gave him a mortgage allowance.
He says they gave him everything he asked for, but so did Owen. Richard asks Alex why he isn't celebrating. Alex tells him no one's every wanted him like this. Meanwhile, April responds to Owen's page and he tells her he can't hire her next year. He says she doesn't have the money, and she tells him she has nothing left. Seattle Grace was her last option, she says. He tells her she's "not the best candidate for the job anymore." He says he's sorry. Meanwhile, Meredith asks Cristina about Seattle still being in the mix, and she tells Cristina that Owen should be with someone who wants a baby and she should be with someone who wants her. Cristina tells Meredith to stay out of it. Meredith tells Cristina she's her "person," but Cristina tells Meredith that Owen is her person. Meanwhile, Callie finds Arizona crying outside in the rain and Arizona tells Callie "don't ever leave."
Arizona says she can't lose another person she loves. Callie promises she's there and will always be. Meanwhile, Owen asks Christina if it's going to be Columbia, Stanford or Mayo. He tells her she can't go wrong with any of them. Cristina says nothing and kisses him. Meanwhile, Bailey is all dressed up and asks Ben to propose to her again. He wants to talk. He says he got accepted as a surgical intern at UCLA. He says "everything's different now." Cristina and Owen are lying together after doing the deed and he says he's "happy." She tells him she's leaving. Meanwhile, Arizona shouts at Alex about going to Hopkins. Meredith and Cristina watch, and talk about how Alex is showing them all up and going to Hopkins.
Meredith tells Cristina she's going to Boston. Cristina says she's going to Mayo. Meanwhile, April is doing shots alone at the bar and Jackson finds her. He puts his arm around her and she goes to kiss him, but she says he just feels guilty for having had sex with her and her subsequently failing her boards. Nearly everyone is on a private jet headed to Boise: Derek, Meredith, Cristina, Arizona, Mark and Lexie; while Owen is back at the hospital erasing name after name from his dry-erase board. Next, the screen goes black for a moment, next is shown the scene of a plane crash and which then focuses on Meredith's potentially lifeless face. The episode ends at this point.