The episode begins and "Dying changes everything," says Meredith's voiceover as an unfamiliar face is seen walking through the hospital's halls. This new young doctor has a conversation with another newbie, much the way Meredith and Cristina have for years. But these two doctors stop short when they see Bailey and Meredith. They're scared of one of them; it's Meredith. Meredith barks out orders to the newbie, and Bailey is impressed. Bailey asks about Cristina and Meredith says Cristina "loves" Minnesota. With freezing cold outside her hospital, Cristina is shown talking to her new boss. Derek is sitting alone and Webber tells him "we're all set for tonight".
It isn't clear what they're talking about, but it's going to happen at 5 o'clock. Ben surprises Bailey by showing up from UCLA. They head for an on-call room to fool around, but it's occupied. Alex is in there with someone, talking about how he would like to put off Hopkins to spend more time with her, but he can't. Callie is annoyed with people staring at her. Callie shows Derek some scans of a patient with a spinal cord issue and she's surprised that he's going to perform the surgery with her. He insists it's no big deal. Callie talks to Sloan, who's in a coma, and tells him that Derek is going to operate today with his brand-new hand. She asks Sloan if it's going to work. He obviously doesn't respond. Derek walks in.
They both notice its seven hours until 5 o’clock and it is then revealed what the deadline is about. Derek says Sloan's directive was very clear: If after 30 days there were no signs of recovery, he wanted to be let go. Meredith walks over to the table of interns. They're freaked out by her presence. She announces that one of them will get their first surgery, an appendectomy, for having shown the most promise. She gives it to Dr. Wilson. Derek and Callie are going over scans for their surgery, and Callie looks at Derek's surgically repaired hand. He tells her she did a great job and he's fine. Hunt walks in and introduces the new pediatrics surgeon. The guy tells her he's sorry, that he heard about her wife, and she tells him thank you. He and Hunt leave, Callie asks Derek, not to make a big deal.
Cristina and Meredith have another video chat while Cristina. Cristina tells Meredith that Hunt emailed her and wanted to make sure she had people around her that night. She says she doesn't know why anyone is so worked up about 5 o'clock. Alex meets the new head of pediatrics and boasts about the program where they brought in 32 orphans from five countries for treatment. The new guy says it was impressive work but it doesn't fit his agenda and he's asked UCLA to take over the program. Alex is speechless. Derek enters the O.R. and gets a round of applause from everyone inside. Derek pauses for a moment, takes a breath and says, "It's a beautiful day to save lives".
Meredith is in surgery with her intern doing the work while the others watch from the gallery and talk about Meredith being "Medusa" and "a demon". Meredith doesn't react at first, but glances up and one of them says, "It's like she can hear us". Hunt lets them know that the red light means the intercom is on. In his surgery, Derek drops a clamp. Callie's eyes get wide, but no one says anything. Derek flexes his hand and tells Callie that the standby surgeon should take over. She tells him to just take a moment, but he walks away. Alex tells Callie about the new ped guy's plan to ditch the orphan program. She tells him it's not a good time. She tells him she doesn't really care about his peds program, adding, "Sometimes things die and there's nothing you can do about it".
In her surgery, Dr. Wilson Meredith's intern gets the appendix out successfully, but makes a mistake soon after and the patient starts bleeding out. She freezes and Meredith nudges her aside to fix it. In Minnesota, Cristina stands up to Dr. Thomas and tells him he can't take her surgery. He's welcome to back-seat drive, but he can't take the surgery away. Callie finds Derek and tells him neither of them should have been in surgery, given that they're so emotional. Avery is talking to Sloan and tells him that while he's taught him a lot, he thinks he knows what he's doing now. Avery walks out and Webber, Callie and Derek walk in.
Webber tells them what he's going to do, warning them that their brains can't comprehend what's about to happen but he wants to give them a chance to catch up. In Minnesota, Cristina looks up at the clock and sees its 7, meaning it's 5 in Seattle, which she tells Dr. Thomas. He says it's also 4 a.m. in Moscow and 8 a.m. in Singapore. She says nothing and keeps operating. Webber says Sloan's final request was that, only comfort care be given to him in his final moments". He says once the cord is removed Sloan could only hold for a few moments or several hours. He turns the ventilator off and says Sloan's been sedated with morphine, so he's not feeling any of this.
Webber removes the tube, then leaves to give Derek and Callie some privacy. Meredith and Avery sit next to each other in the hall outside of Sloan's room, saying they tried so hard in the woods thinking they could do something if they could get him back to Seattle alive. She gets up and says she can't stay. She's going to the airport to see Cristina. Hunt runs into Dr. Wilson, who is crying in another hallway. Hunt tells her the surgery was designed for her to fail. She asks him why Meredith is so mean. "Is it that plane crash?" she asks. She says she heard about it, they were stranded in the woods for a week, "people died, or almost died, or something".
He gets kind of upset, and tells her that Meredith isn't mean, she's strong. He tells her that Meredith won't go easy on her because that would be a disservice to her. Cristina visits the boss and he says he's asked Dr. Thomas to help her around. He tells her that on this hospital's yard stick, she's not thriving. He says there are no superstars there, because they work as a team. He tells her to take a few days and see the lakes and visit the Mall of America. He tells her to "soften up those sharp Seattle edges." It's a mandatory "R&R" period, starting immediately. Sloan is still hanging on while more doctors gather around. Bailey is one of them. Meredith sits at the airport and sees Alex. She confronts him about not saying goodbye.
She tells him that Sloan is dying and everyone's leaving, but Alex says he can’t sit around being the guy who should've been on the plane that crashed. He tells her he should've left three months ago, Hopkins won't wait and he can't stay in Seattle just because Meredith doesn't want to be alone. She walks away and Alex gets bumped from behind by someone he doesn't seem to recognize as Hunt, who's racing to catch a flight somewhere. Back in Sloan's room, Callie and Derek are still sitting and watching his monitor. The look at each other as his heart rate starts to drop. It finally goes flat and they both cry. Meredith is next shown on a plane headed to Rochester, Minn. She starts to shake and demands that the flight attendant let her off.
Next Cristina is seen telling Meredith on a video chat that she had the boarding pass in her hand but couldn't get on the plane. Meredith is drinking at the bar and agrees that they'll have to get over this some time. Alex shows up and sits next to Meredith, apologizing for the way he acted earlier. He says he has to stay because the new guy is going to mess everything up. He says he couldn't get on his plane. He tells Cristina on the video chat, "When Hunt lands, tell him I'm staying". Cristina's confused, but Alex says he saw Hunt at the airport and assumed he was headed to see her.
The next morning, Hunt is shown visiting April on a farm. She's literally walking a pig. He tells her Sloan died and he wants her to come back to work at the hospital. He tells her she doesn't belong on a farm; she belongs in Seattle saving lives. Callie in her apartment opens a door where Arizona is laying in bed with her back turned to the door. Callie tells Arizona to get up and "snap out of this; if not for me, then for Sophia because she lost a parent last night and I lost my best friend, and I will be damned if I lose you, too".
Arizona angrily replies, "Snap out of it? Snap out of this?" She reveals her amputated leg, saying, "How the hell am I supposed to snap out of this when you cut off my leg?" Callie says nothing and walks away, slamming the door. A video is shown, of Arizona trying to get a take picture of Callie and Sloan holding baby Sophia, but the camera is on video. Sloan turns the camera around and says, "Oh, I got it". One last picture of Sloan is then shown. The episode ends at this point.