Both Kate Walsh (Addison Montgomery) and Isaiah Washington (Preston Burke) have been removed from the opening credits and are no longer main cast members.

Ratings: 20.5 million viewers

Meredith: (opening voiceover) Change. We don’t like it. We fear it, but we can’t stop it from coming. We either adapt to change or we get left behind. It hurts to grow. Anybody who tells you it doesn’t is lying. But here’s the truth: sometimes the more things change, the more they stay the same. And sometimes, oh, sometimes change is good. Sometimes change ... is everything.

Meredith: (closing voiceover) In the practice of medicine, change is inevitable. New surgical techniques are created, procedures are updated, level of expertise increase. Innovation is everything. Nothing remains the same for long. We either adapt to change or ... we get left behind.

Alex: I'm going over Callie's head to Bailey.
Cristina: Callie is over Bailey's head.
Meredith: Spiritually, Bailey's over everyone's head.

Mark: I really am up for a drink, you know if you need to talk.
Derek: What would I need to talk about?
Mark: Meredith. You were lucky, man. That girl jerked you around.
Derek: You have no idea what you're talking about.
Mark: Hey, I'm just... you seem like you can use a friend right about now.
Derek: Meredith's mother never wanted her and her father was never man enough to hang around. She has a right to be damaged and us, together? It's a big step for her. Her best friend gets left at the altar and all she sees now is things like this, they don't work. She panics. She wants this, but she doesn't know how to have it. And you know what? It's not her fault. So don't ever talk to me about Meredith Grey again because you do not know what you are talking about. And I don't want a friend.

Meredith: Have you seen Burke?
Cristina: No. Have you seen Derek?
Meredith: No.
Izzie: Wait, you haven't seen either of them since the wedding?
Meredith and Cristina: Nope.
Izzie: And you're all fine?
Meredith: Yep.
Cristina: Yep.
Izzie: Wow. You're either incredible healthy or completely messed up.

Izzie: (to her interns) I know you didn’t wake up this morning expecting this was how your first day was going to go. You thought you’d get to reattach an arm or observe brain surgery; instead you helped save the life of a deer. You can bitch and complain about it, or you can adjust your expectations. Because like it or not, you're stuck with me and I’m the kind of doctor who lets little convince her she can do the impossible. Oh! Plus, when I woke up this morning, I thought today was going to go a lot differently too. I thought I was going to get the good interns; instead I get stuck with the duds. So I have to adjust my expectations as well.

Derek: How is Meredith by the way? Is she okay?
Cristina: She's fine.
Derek: She's always fine. That's her problem.
Cristina: We're fine people. We do fine. We're fine.

Episode Title: A Change is Gonna Come

"A Change is Gonna Come" is the title of a song by Sam Cooke.

Cristina: Izzie is playing Doctor Dolittle.

Doctor Dolittle is the main character of a series of books by Hugh Lofting who has the ability to speak to animals. The books were later made into a series of movies starring Eddie Murphy.