The episode begins and Bailey warns April about a patient named Mr. Linzer, who will pretend to be fine because he wants to leave the hospital. Alex introduces his intern, Jo, to Leftkowitz a young boy who has gastroparisis, which means he can't really digest his food. Alex assures the kid and his parents that he's "got a crack team" taking care of him. Jackson is explaining to Derek's sister, Lizzy, the process of her nerve transplant surgery. Derek wants to make absolutely sure that she's ok with this because she's told him forever that he ruined her life. Hunt tells Cristina that the divorce lawyers sent over paperwork that needs signing.
Cristina seems surprised at how quickly it's going. Meredith doesn't want to tell anyone including Cristina about her pregnancy until she's sure things are going well. The ultrasound allows them to see the baby and hear the heartbeat, but Meredith doesn't smile. She turns away. Alex walks Jo through the steps of what they're going to do in surgery and that he's going to let her take down the adhesion. Meredith starts to tell Cristina, but then stops herself. Jackson goes over a scan and says Lizzy's calves are a little shorter than expected. The solution would be to take some nerve from her other leg, but Derek rejects this and says they need to find another donor. He angrily tells them to cancel the procedure. Lizzy is surprised to learn her calves are too short.
She tells Meredith its fine and Meredith tells her Derek thinks it's too much so if he tries to talk her out of it she has to be forceful. Lizzy tells Meredith she's "got some balls" asking for body parts after not even having a wedding and sending just a couple of pictures of Zola over email. She tells Meredith that they're family, but she basically isn't feeling much of the love. Meredith says her version of family is different than theirs and Lizzy brings up Lexie. Meredith doesn't want to talk about Lexie. Lizzy tells Meredith that she, of all people, should realize "you need spares in a family you need as many as you can get". Meredith tells Lizzy it was "very nice" to talk with her, and leaves. Lizzy tells Derek she's doing the procedure and tells him to "just say thank you".
In surgery, Jo is removing the adhesion and it's going well for a moment, but she accidentally cuts a hole in the boy's stomach and Alex has to move her out of the way. Jo freezes in the O.R. and Alex yells at her to leave. In bed, Meredith asks Derek if he's still mad at her for going to Lizzy. He says he's "medium". She says she just wants him to be better so they can put the whole plane crash behind them. Derek tells her the lawyer called and said they have a strong case, "especially now that Cristina and Owen are getting divorced". Meredith asks what that has to do with anything, and Derek tells her about the conflict of interest if Hunt is married to one of the plaintiffs. Bailey is at work the morning of her wedding and everyone is surprised to see her. Cristina and Hunt get a gunshot wound patient.
Cristina is going to have to work on the man's heart, but Hunt says there's a bullet in the stomach in the abdomen. He says he can do it or he can call someone else. Cristina tells him he can do it. Cristina tells Meredith that she's scrubbing in with Hunt, who wants to sign their divorce papers. Meredith asks her why she didn't tell her that the divorce was because of the plane crash lawsuit. Cristina says she didn't know. Hunt comes over and asks Cristina if she's ready for their surgery and she says nothing. Bailey is a nervous wreck, dropping case files. Webber sees this and she asks him if he was "like this". She says that if it goes well in 10 years, she'll think of this moment as "cold feet". If they're in the midst of a divorce, she'll think she knew it was a mistake the day they got married.
Webber tells her "a little bit of doubt is just a sign of an intelligent adult". Callie preps Derek and tells him to close his eye, enjoy his nap and he's "got nothing to worry about". Meredith, in the meantime, is watching from the gallery and telling Jackson that she's going to be watching. "No mistakes," she says. Jackson knocks over a tray of tools and tells Stephanie to "get that woman out of my gallery." Stephanie doesn't want to, but Jackson tells her, "Now." Meredith says over the intercom that she wouldn't dare, but Stephanie seems to be headed toward Meredith. Jackson brings over 50 centimeters of prime nerve for Derek's hand.
In surgery, Cristina is harsh and cold to the nurse and Hunt. Afterward, Hunt asks Cristina what that was about and she tells him she didn't know they were getting divorced because of the lawsuit. Hunt says he wants her and the others to get the money. They argue about her going to Minnesota and she says he's "hiding behind the lawsuit" but Hunt finally says he picked the airline. He explains that he had to make a budget cut and went with a cheaper airline. Cristina tells him he's not responsible, but Hunt insists that a lot of people made a lot of small decisions that made that plane take off with her and the others in it, and he was one of them.
Meredith gives Derek a kiss. He's in a hospital bed and Meredith tells him Callie said it couldn't have gone better. Before she leaves, Derek pulls her close and says, "It may have worked". They both smile. Meredith checks on Lizzy, who tells her she realizes she's pushy. She tells Meredith that she doesn't "have to want a truckload of Derek's sisters in life". Meredith sits down, warning that she's "not very good at this" but she's willing to try. She makes Lizzy promise "not to blab it to the whole family". She hands over her ultrasound picture. Lizzy is happy. Hunt puts on his coast and Cristina comes to see him. She asks if the lawsuit was the only reason he asked for a divorce. He says, "There were many reasons”.
He says, "You were done a long time ago". "I'm asking about you" she says. Hunt says nothing. "Let me put it another way" she says. "I wanted to try again. I was going to ask you if we could try again, and you said, 'I want a divorce'" Christina adds. They then kiss passionately. Webber and Bailey are in the back of the limo. Webber gets a phone call from the hospital saying Adele just arrived there. The paramedics brought her and she's vomiting blood. Bailey orders the limo driver to turn around and take them to Seattle Grace Hospital. The crowd is gathered at the wedding. Webber catches up to Adele, who is still vomiting blood. Webber wants to work on her himself, but the other doctor orders him to step away. Bailey, in her wedding dress, says she'll do it.
She has the nurses take her dress off and gets everything ready. Back at the wedding, Callie admits to Arizona and Meredith that she may have "by mistake, said that if she had any doubts she should leave". Callie says she was joking and Bailey was nervous. "How nervous?" asks Ben who overhears this. Everyone turns to look at him. "How nervous was she, Callie?" he asks again. No response. Bailey is still working on Adele. Bailey carts Adele toward an O.R. Bailey's dress is on a cart next to the bloody sheets from Adele's emergency hospital bed. The episode ends at this point.