The episode begins and Meredith and Cristina are checking out the new cameras that have been installed throughout the hospital. Cahill explains that the cameras are in place to minimize mistakes because there are doctors watching on the other side. Derek and April have stayed up all night working out cost-saving measures that they hope will keep the ER open. Cahill introduces another doctor, Dr. Nussbaum, who is showing the surgeons some new procedures. Arizona and Alex have a 13-year-old patient who just underwent hop-replacement surgery.
Hunt in the meantime is refusing Cahill's orders to stop running the ER, saying there's one day left of its operation and he doesn't want her workers getting in the way by starting renovations early. On the way to the roof to get a patient from, they argue about the merits of emergency medicine. The patient gets rolled into the elevator. He's a 40-year-old man who was on the wrong side of a chainsaw accident. The man's carotid artery starts spewing blood and Cahill is on that side of him. She stops the bleeding; telling Hunt she "was closest". In the O.R., Cahill is still holding the artery. Hunt offers to get another surgeon on it, but Cahill wants to stay. Dr. Nussbaum finishes his training, but Webber says he wants to keep doing it his way. Nussbaum proposes a contest, asking the surgeons to perform 20 hernia operation simulations using his method.
Alex's patient on the other hand unloads about how upset she is because of her hips. She was a gymnast and was hoping to take care of her mother with her gymnastics career. In surgery, Cahill is still helping with the operation. She starts humming as she works and Hunt realizes she enjoys surgery. Derek comes in and isn't happy to see her. He notes that if the man's chainsaw accident happened the following day after the ER was closed "he'd be dead already". Cristina in the meantime gets an emergency patient, a teenage boy who was injured slaloming. They're about to start giving the kid blood when a chain falls from his wrist. Leah picks it up and sees that the kid is a Jehovah's Witness. Cristina tells everyone to stop. They can't give him blood. The O.R. is being prepped for a bloodless surgery. A machine will recirculate the patient’s blood instead of using donor blood.
Cristina preps the O.R. and gets started. She's about to cut, but says she can't because he'll lose too much blood. She's going to go in a different way. Meredith on the other hand finishes the first round of the hernia challenge first, and gets high praise from Nussbaum. The friend of the Jehovah's Witness waits and Leah comes out to talk to him. The friend says that the injured boy never talked about being a Jehovah's Witness. Leah sees the boy's family praying in the lobby. Cristina is looking for ways to get the Jehovah's Witness skater to produce more blood on his own. Leah still thinks it's ridiculous that they can't give him blood. Cristina agrees to go talk to the family. Callie tries to get the gymnast to move so the muscles around her hips won't atrophy.
Bailey is getting the hang of the hernia thing and gets giddy about it, but Meredith stands up and takes a deep breath and walks out. Bailey gets serious and follows Meredith out of the room. Meredith thinks something is wrong with the baby. Bailey touches Meredith's stomach and tells her this isn't a bad thing her baby is kicking. Cristina in the meantime is explaining the blood situation to the skater's family, but they refuse to use donor blood. Cristina reiterates that without blood, the boy's organs will fail and they will run out of options. The boy's mother cries but still refuses to accept it. His father says that living with the donor blood would be worse than dying without it. Cristina assures them they will try to do everything they can without giving him blood.
Leah smuggles in a bag of blood and gets ready to attach it, but the doctor on the other side of the camera tells her to stop. Cristina yells at Leah and tells her she knows nothing. Leah says she's trying to save the patient because he's "circling the drain". Cristina says she understands Leah's passion, but kicks her off her service. Leah apologizes and leaves. The doctor behind the camera says he won't get Leah fired because she didn't do anything. Cristina tells the camera doctor that Leah's right about the boy circling the drain, and the camera doctor agrees. Cahill removes the clamps from the carotid she helped repair. She breathes a big sigh of relief. She tries to leave, but Hunt tells her to stay and help finish, and then she can tell the man's family that she saved him, "and then they'll thank you".
Stephanie tries to encourage the interns, saying that if Cahill is planning for the future of the hospital then there will be a future. Callie overhears all this and tells them the future is completely out of their control. Webber finishes a round of the hernia challenge, but Nussbaum isn't pleased that he didn't use the approved method. Webber did his own thing, and goes on a rant to talk about how he doesn't want to work on an assembly line of medicine. Nussbaum gets flustered and says Webber is "missing the point, this isn't about the patients". All the doctors whip their heads around while Nussbaum stammers to correct his phrasing. Cristina's patient is crashing. Leah watches from the doorway as Cristina and others try to save him. Cristina finally calls the time of death.
Leah walks in and tells Cristina that he didn't have to die. Arizona shows up and sees that Callie and Alex weren't able to get the gymnast out of her bed. She walks into the room and tells her to get up. Arizona says she knows how this feels. The girl tells Arizona, "you don't know what I want". Arizona rolls up her pant leg and shows her prosthetic leg. The girl isn't buying it though, mocking Arizona for the fact that they sent "the cripple in to come and tell me how to live my life". Arizona is fed up and starts giving the tough love, telling the girl that she isn't going to let her take other people down with her. She's going to be kind and thoughtful and will get up and walk by the time Arizona counts to three, or she'll drag her out of the bed. The girl gets up and takes some steps. The chainsaw guy's wife in the meantime is shown thanking Hunt, but he tells the woman to thank Cahill.
She hugs Cahill, who smiles. Nussbaum shares an elevator with Webber and Bailey, who say nothing while he tries to be cheery about hernia surgeries. He gets that they don't like him, but tells Bailey the sweatshirt she won looks good on her. "It's itchy" she says, before walking out. Cahill tells Hunt she forgot what a rush it is to save lives. He says they can do it again the next day if they keep the ER. Derek and April bring their budget plan to Cahill and say they can save the ER. She tells them they've misunderstood. She says no amount of budget cutting will save the ER or the hospital. Derek realizes she's getting the hospital ready to be sold. Cahill confirms that a buyer is going to save the hospital; she just has to "make it presentable".
Hunt says she's "staging it, like a house". Cahill confirms this and says "the ER is like the shag carpet it’s got to go". She apologizes and tells Hunt she had a wonderful time that day. Hunt shuts off the lights to the ER and walks away for the night. He walks outside and Cristina is waiting. She asks him what he's going to do. In the short term, he says, he's "going to drink a lot". She offers to buy the first one. That night, Derek feels the baby kicking and laughs. The episode ends at this point.