The episode begins and Arizona is out for a run. Arizona gets to the hospital and her leg shatters to pieces and she falls over. Then she wakes up from her nightmare. At the hospital, Hunt calls a quick staff gathering to explain that because the hospital is facing a financial crisis, there will be a "physician advisor" who will be helping make decisions that will cut some costs. Meredith is checking her pregnant patient, who is experiencing pain, but it isn't labor and the baby appears to be fine. Shane has test results for the patient, but he ordered the wrong tests. He leaves to order the right test.
Alex, Arizona and Cristina are treating a young girl who is there as part of their program to treat kids from Africa. After they leave the room, Cristina tells Alex that the consultant is likely going to cut the program. The pregnant patient is unconscious as Meredith and Bailey try to revive her. Shane walks back into the room, followed by the woman's partner. Bailey says she has liver failure. Bailey explains to the woman's partner that the liver problem seems unrelated to the baby. She should be moved to the top of the donor list because of her situation. Outside the room, Meredith tells Shane not to say anything to her and not to come back to her until he has a liver for their patient.
Derek comes to see his patient, Jimmy, whom he's been meaning to operate on for a while. Jimmy says no other doctors were willing to go near his brain tumor once they heard Derek's hand is better. Outside the room, Derek asks Jo to switch with Ross because he knows what he wants before he asks for it. He tells Jo he won't have time to teach her on this one. Then, Derek is introduced by Hunt to Dr. Cahill. Cahill then tells Derek she'll be seeing him in his surgery. He doesn't seem to like this arrangement and says nothing as he walks away. April gets an emergency patient named Brian Turner, 55, with a "minor head injury". He fell off a ladder in his yard.
Webber spots Cahill and says hello, telling Hunt she was a student of his years back. Webber says they should get coffee, but Cahill says she's booked. In surgery, Cristina is surprised to see the African girl's heart condition, which is something she's only read about. Derek in the meantime comes to see Jimmy, whose tumor has progressed. Derek says he can still operate, but the risks they knew about are even higher now than they were before. Jimmy says he's waited for months for Derek to get better and he can't sit around "waiting for this thing to kill me". Meredith and Shane are in an ambulance on their way to pick up the donor liver. April gets a car crash victim and quizzes Stephanie about which injuries they should be most concerned about. They get to work.
At the other hospital, Shane messes up in the liver removal surgery. Meredith can't believe it. Arizona is in surgery, about to cut into the young patient and writhing in pain with every cut, as if she's feeling it in her leg. She then goes about slicing her leg repeatedly with the scalpel while Cristina and Alex watch. Then Arizona wakes up from her nightmare. Callie finds Arizona locked in the bathroom. Arizona doesn't mention anything, but she has a mirror between her legs so she can see a reflection of the leg she still has, to help her visualize the other leg. Meredith on the other hand tells the partner of her pregnant patient about the surgical complication that meant the donor liver was no longer viable.
They need to buy some more until a new liver becomes available. Shane tries to apologize to Meredith and explain away his "colossal failure," and she yells at him about how he ruined a perfectly good liver and that's all she sees when she looks at him. Webber again asks Cahill to join him for coffee and she says she can't. She says she has to observe more surgeries and Webber says he "alway did expect to see (her) in the O.R." She sighs and says, "well, one way or another, right?" Meredith gets good news: There's a liver in Portland. She tells Shane he has to get on a plane to go get it. She says she can't go on a plane, and nods to Bailey, saying, "You know that". Bailey says she knows Meredith hasn't "been" on a plane since the crash.
Bailey finally gives in and tells Shane that she and he are going to Portland. Derek and Jo are preparing for their surgery. He's giving her orders for what to do moisten the tissue and look for facial twitches. Bailey and Shane are about to take off and the pilot waits a moment. He says he received orders to wait, and Meredith shows up. Bailey leaves, Meredith buckles in and as the plane takes off, Meredith closes her eyes and breathes deeply. At the Portland hospital, Meredith pulls out the liver and puts it in a basin. Shane notices a mass. Meredith, exasperated, says they have to get it biopsied. Cahill is quizzing Hunt about the African orphans program when she sees Arizona stumble a bit and knock something over in the O.R. Hunt gets on the intercom and reminds Arizona to focus on the waves.
Cahill asks Hunt if Arizona should even be in surgery and he tells her to go observe another surgery. He mentions Derek's surgery, which is happening then but Cahill thought it started later because Jo had changed the time on the board because Derek didn't want anyone in the gallery. Back in Seattle, the pregnant woman's partner is worried something is wrong. Bailey tells her about the mass on the liver and the woman. Bailey then gets a call from Meredith the liver is fine. In her surgery, Arizona looks like she's about to faint and tells Alex to stab her in her prosthetic foot. Alex is confused. Hunt orders Alex over the intercom to stab Arizona in the foot. This is when Cahill walks in.
Alex does it and Arizona looks down at the scalpel in her foot, and is relieved. In Jimmy's surgery, Derek has a bleeder. He takes care of it, assuring Jo she didn't do anything wrong. He then asks her to look for Jimmy's facial twitch. There isn't one. Jimmy may have lost the ability to move half of his face. "We won't know until he wakes up" Derek says. Shane and Meredith arrive with the liver. Cristina curiously and excitedly asks the woman who brought the patient from Africa, "What else do you have over there?" She wants to know what other kinds of maladies exist, which could be operated on in Seattle. Alex nudges Cristina and tells the woman that Cristina is just trying to express that she's happy the program is up and running again. Derek checks Jimmy and asks him to wince when Derek touches his cheek.
Jimmy speaks and his sister cries while hugging him. At a big meeting, Cahill says she's happy with what she's seen. She just mentions the Africa program and Cristina jumps up to defend it, saying she can't cut the program. Cahill says she has no intention of cutting it, calling it a PR gem. She says there will be proposed changes. She's proposing closing the ER. She says it doesn't bring in any money. Derek says it's ridiculous. Bailey steps up and asks Derek if he has a better idea to keep the hospital from closing, and losing all their jobs, noting that "some of us don't have a few million to fall back on". Webber catches Cahill on her way out. She still seems bitter about Webber judging her harshly when she was in school.
She recalls him telling her that "medicine is constantly changing; you need to be part of that change or get out". She tells him she'll be making some changes, so he should be proud of her. She gets in the elevator and reminds Webber that he logged fewer O.R. hours than any surgeon on staff the previous month. Later, Callie and Arizona are shown sitting on "the beach". The scene pans back and its seen they're laying in bed, with Callie acknowledging that this whole method kind of works. The episode ends at this point.