The episode begins and Alex is posing for pictures and Cahill is lobbying for him as a possible "brand ambassador". A PR rep is shadowing Alex and taking pictures of him. Stephanie brings Alex to a new patient, Maya, a 13-week-old girl who was born with her intestines outside of her body. Alex says "today is the day" they're going to be able to close her up. Bryan and Jess talk about how they first met. Bryan was a girl and Jess was a boy. The doctors are removing Bryan's breasts. Jackson mentions that he'll be "taking the lead" on the surgery for the benefit of the PR folks. Bryan's father is yelling at Jess in the hallway about Bryan's gender reassignment when Alex shows up.
Bryan's father then shoves Alex against the wall and shouts "Are you the one who wants to hack my little girl into pieces?" Callie looks up Pegasus Horizons, the company that's looking to buy the hospital and owns apparently half the hospitals in the country including Portland General, which was bought the year before. The website has no information about health care. Arizona tells Callie to cool her heels because "there's nothing we can do about it". Callie tells Webber that she isn't one to cool her heels and he suggests a road trip. Bryan's in the meantime father apologizes, saying he learned about the surgery the night before in an email. He had no idea about any of it.
He talks to Bryan's father about how big of a change a surgery like this can be. Bryan shows up and asks his father what he's doing there. Webber and Callie show up at Portland General and Callie gives a fake name, "Calliope Plantain". Webber takes her lead and says he's her husband, "Julio Plantain." Callie says "Julio" has chest pain. April calls Jackson from the field, where she's with a kid who was in a hit and run. She says the next available ER is an hour away, and the kid will die en route if they go that far. "Are you asking what I think you're asking?" Jackson says. "If I am, will you do it?" April replies. Hunt is now leading the tour for the buyers when Jackson pulls him aside and tells him about the hit-and-run case.
Cahill hears this and says, "absolutely not". Hunt agrees and says the protocol dictates the kid has to go to the closest trauma center. Jackson turns to Jo and Stephanie and asks them both if he can trust them. Back in Portland, Callie and Webber are experiencing the retail-like "customer service"-oriented treatment at Portland General. Callie intentionally tries to challenge the doctor's questioning. The doctor's tablet freezes and he has to start all over. Jackson and Jo roll a gurney into the darkened ER.
He tells her to lock the door and reminds that "no one can know about this no one comes in, do you understand?" Jo is guarding the door and won't let Meredith in. Jackson opens the door and tells her that he paged Meredith. Bryan explains to his father that "this is me," even though the father thinks Bryan is making a huge decision to change his sex. Jess chimes in and says that "Bryan is dying inside" but his father starts shouting again. Bryan tells him to get out. The father leaves. Cristina and more interns are involved in Jackson's secret project now. April rolls up in the ambulance but the doors are locked shut and won't open. Alex shows up and helps pry the door open.
The doctors are all working on the kid. There are supplies missing and everyone scrambles to find the things they need. Shane is standing lookout and shouts, "Incoming". The doctors shut all the lights off and wait for a clear sign from Shane. He gives it and they turn the lights back on. Jackson realizes they don't have meds or access to them because they don't have the codes. Derek shows up and says he has the codes, "tell me what he needs". Callie and Webber in the meantime are wandering around the Portland hospital. They stand near a group of doctors and Webber finally introduces himself with his real name and Callie with hers, but says they're with Pegasus and wanted to see if the doctors have any concerns. "Really?" a couple of the doctors say, smiling.
Derek on the other hand is getting meds when the Pegasus tour group comes around. Derek tells Jo to get over to the ER, and then he distracts the tour group by offering to show them a real brain up close. Jackson notes that Bryan's surgery is happening in 20 minutes and Cahill will know something's amiss if he and Alex don't show. Jo shows up and tells the doctors they have to move the kid because Cahill is on her way there. Alex says, "I'm staying". Cahill tells Derek they're on a tight schedule and need to get down to the hernia clinic immediately. Derek steps into the elevator and offers to go with them. The doctors are scrambling and Jo shouts that they have to move because Cahill is almost there. Derek tries to distract Cahill again at the last second, but she blows right by him.
She opens the door and the doctors and the hit-and-run patient are all gone to Derek's surprise. Back in Portland, the doctor's tell Webber and Callie that they "have no say in anything at all". They're venting about how it seems, at times, "like the walls have ears". Another doctor joins the group and recognizes Callie's name. He's an ortho, too, and knows her work. He's surprised she went to work for Pegasus. In Portland, the ortho tells Callie and Webber about how he's "the face of Portland General" and doesn't get to do much real medicine anymore. He asks them if there's an opening at Seattle Grace. Cahill walks in on Jackson and Alex's surgery and asks who they're operating on. "My transgender patient...why?" Jackson says.
Cahill leaves. Alex and Jackson show up to see all the doctors sitting in a hallway outside the room where Cahill and Hunt are questioning each doctor and the interns individually. Alex decides to barge in. Cahill asks who else was involved and Jackson jumps in to say he, too, was involved. He says it was his call, and he and Alex agree that saving the kid's life was all that mattered. Cahill asks if they're going to be disciplined. Derek shows up asking why he was paged. Cahill says that if she's going to do her job, she can't be dealing with an "uprising" especially when Derek helps them. Cahill basically knows he is involved. Cahill tells Derek this "stunt" would have cost the hospital dearly if the kid had died on their watch. She says she can't help if Derek and others are "undermining" her at every turn.
Jess in the meantime waits for word about Bryan. The surgery went well and Bryan will be in recovery soon. Bryan's father steps out from around the corner and looks tearful but relieved. He apologizes before starting to leave. Jess tells Bryan's father that he talks about him a lot, admires him and wants to grow up and be like him. Jess tells Bryan's father that "it's hard being like us, trying to fit into this mold that doesn't fit". Bryan's father asks if they're ok on rent. He hands over some money and turns to leave. "You don't want to be there when he wakes up?" Jess asks. Bryan's father shakes his head and walks away. Webber and Callie on the other hand sit outside Seattle Grace. Webber says he has an early retirement package waiting and he might take it. Callie says nothing.
Hunt finds Cristina in an on-call room and tells her, "You guys are killing me". She says it was the right thing to do, and Hunt says, "Yeah, but you're still killing me". They start to make out. Callie is on the roof with Meredith, Derek and Arizona. She says they can't just keep their heads down and lay low. They have a responsibility. She proposes that they buy the hospital themselves. The rest of the group is stunned. Inside the hospital, Webber steps into an elevator. When the doors close, he's looking at a massive photo of Derek, who is apparently now the "brand ambassador". The episode ends at this point.