The episode begins and Meredith and Cristina watch the interns in their locker room looking all happy. Meredith says, "I can't believe we used to be them". Cristina's intern presents their patient, a 3-month-old baby named Samantha who needs a heart transplant. Her mother has waited 77 days. A man eagerly listens and is actually the father of another baby who is at the hospital. They're supporting each other through this. The father's son is named Reese and Cristina tells her she won't need to stay at the hospital to wait for her heart. Alex asks his intern, Jo, to help get a boy to have a bowel movement.
He gives her a bunch of latex gloves, and suggests she take off the fancy watch he's noticed she's wearing. Cristina gets another patient, Mrs. Crossley, who is getting a pacemaker installed. Barring any complications, she'll go home that day. Her husband is deaf in one ear and talks loudly. A hunter comes into the hospital asking for help, saying he and his friend think they've shot "Bigfoot". A man in the back of a truck screams in pain. He's covered in a bunch of shrubbery. Jo is pulled into a room where a 15-year-old girl is suddenly delivering a baby that is suffering with a condition that makes it difficult for the baby to breathe. Jo is shaken and doesn't know what to do when a nurse hands her the newborn, which is not breathing.
Jo decides to incubate while the mother of the 15-year-old yells for updates on how things are going. A nurse walks Jo through what she should be doing. "Bigfoot" turns out to be just a guy who was out hunting in an Army-issued suit. Jackson comes in to report to Callie that he's having trouble finding a nerve long enough to replace the one Derek needs in his hand. Meredith asks her intern, Heather, to call all of Derek's sisters and ask them to donate a nerve. The first one who says yes gets to do it. Callie says Derek made it clear he wanted a cadaver nerve, but Meredith insists. Jo updates Alex on their newborn patient, and he explains what they'll do next. Derek comes into Meredith's O.R. upset that his sisters have been called about donating a nerve for him.
He tells Heather, the intern, to undo what she's done. He leaves and Meredith tells her "don't undo a thing". Alex and Jo work on their tiny patient, who is crashing. Arizona comes in to help, but Alex and Jo handle it together. Relieved, Alex tells Jo that the baby needs to be monitored day and night. Shane pulls back the robe on his next patient, an elderly woman. She has a scab on her behind that makes him nearly vomit. The interns hang out behind the hospital and talks about how things are going. Jo asks if she's "prissy," and the others seem to think she is. Heather gets a page and runs to help with "Bigfoot." When she gets there, she's not needed to help and she's reminded that she answered Meredith's phone.
Heather then engages in answering a series of phone calls on both Meredith's phone and her own, from Derek's sisters responding to the request for a nerve donation and also checking in on holiday travel plans. The final call Heather answers is from a doctor asking if Meredith wants to confirm her ultrasound. Meredith casually tells her, "Hang up... now". Callie notices. Edwards is with the two babies’ parents when she gets a call for Cristina. She runs to report the news to Cristina while the two parents of the two babies wonder what's going on. Edwards comes back to report the latest development. She tells the man that his son, Reese, has gotten worse and that there is a heart available. If it is viable, it will go to Reese, not Samantha.
Leah comes to Edwards and warns her not to even try to get in on the transplant. Edwards is a little emotional after feeling like she'd just stolen Samantha's heart away from her mother. Cristina decides to let Edwards scrub in to help cheer her up. After Cristina leaves, Leah mocks Edwards for using her emotions to get in on the surgery. The 15-year-old mom is more concerned with making it to a friend's party than seeing her baby. April tells Shane to make sure he passes his boards or else he'll be stuck "on lumps and bumps" like her. Heather congratulates Meredith, who tells her to forget she ever heard anything about an 8-week ultrasound and she should "never mention any of this to anyone, ever".
Noah, the father of Reese, goes over to Samantha's mother and she tells him she can keep sitting there watching her daughter die. "It was her heart" she tells Noah. She says she wants to be happy for him, but she can't. Mrs. Crossley's husband calls for help while standing in the hallway holding his wife upside down. He says that if he puts her down "she goes out." He proves this by doing it momentarily. Then he lifts her by her ankles again and she comes back to life. The interns are amazed, but Mr. Crossley tells them to "go get the real doctors". Cristina checks on Mrs. Crossley, who is lying on a bed that's inclined in reverse so she's upside down, and says the pacemaker fell out of place.
They'll need to open her up again and reposition it. All the interns' pagers go off and Callie has them rounded up to offer them a chance at the coolest procedure they'll ever be a part of. They bring Derek in and have each of the interns examine him before moving on to the "skills lab portion of the contest". Jo and Edwards are eliminated quickly. Ross goes up, asks the right questions and reassures Derek using the lessons learned by working with April and tells him that he and Callie and Jackson are going to take good care of him. Callie declares Ross the winner, saying he was the only one who treated the patient like a patient.
Leah and Edwards suddenly race to get the edge on Mrs. Crossley's surgery and they make some kind of mistake getting her prepped that Edwards realizes could have killed the woman. Cristina walks in and Mrs. Crossley tells her the interns were trying to kill her. The 15-year-old mother and her mother are waiting for the elevator when Jo sees them. The young mother says she's not coming back because her baby is "all messed up". Jo physically tries to stop them from leaving. Alex walks up and restrains Jo, telling her to let them go. Later Jo tells Alex that her mother left her at a fire station when she was two weeks old. She was bumped around foster homes until she was 16.
Leah and Edwards get yelled at by Cristina, and Hunt tells them they're banned from the O.R. until further notice. Ross comes back to work with April, who is skeptical about why he's there. She says no one slums it down in "lumps and bumps" when they don't have to. He tells her he's getting in on Derek's surgery because of her. She gave him 27 solo procedures the day before at least one of which saved someone's life. Edwards goes to say goodbye to Samantha's mother, who goes over to Noah and tells him she's happy for him. He's worried his son could still reject the donor heart, and she tells him he won't. Derek and Meredith argue about why Heather was calling Derek's sisters.
Derek spots Heather and asks her whether she shut that whole thing down. Meredith tells Heather not to say anything, and Heather finally lets it all out. She tells Meredith she put her in a bad positions and she was more involved in their lives than she thought she should be. She tells Derek that his sisters told her stories about him and Meredith that she didn't really want to know. She's saying all this when Lizzie, Derek's sister, walks in and guesses that Heather's parents were divorced and always put her in the middle.
Lizzie tells Meredith she'd better have some baby pictures for her to see because she didn't take the red-eye just so her brother could hack her arms into hamburger meat. At the end of the day the interns watch all the action at the hospital unfold. Jo watches the residents do their work and says aloud, "I can't believe they used to be us". The episode ends at this point.