Owen and Meredith are on a plane, preparing to return to Seattle after the Harper Avery award ceremony. Meredith calls Derek and vents about Cristina’s loss, though she’s nowhere to be found on the plane.
Just as Derek hangs up the phone with Meredith, there’s a knock on the door. It’s his sister Amelia, who recently got engaged and is freaking out about marriage. She’s hoping that if she spends some time around them, she’ll feel less nervous. Derek agrees and decides to leave Amelia with the kids for the day while he’s at work.
While in bed together, Alex informs Jo that he received an official job offer from the private practice, but he has to let them know his answer by the end of the day. He’s nervous about what to tell Arizona.
Back at the hospital, Frankie is getting prepped for another transplant, while Ivy’s heart is still in rejection. Since Cristina is MIA, a new doctor is called in to do the surgery. However, right before the procedure Cristina steps in and says that she’ll handle the patient. Everyone is surprised to see her back at work so early, especially right after losing the award.
Avery approaches Derek to give him a heads-up that he’ll be following up on all of the projects going on in the hospital since the foundation is thinking of trimming some of its research. However, the one that he has the biggest problem defending is Bailey’s since her HIV gene theory has no results to suggest that it’s even worth pursuing. She assures Avery that the treatments are starting that very day and they’ll be seeing results very soon. She’s sure of it.
Richard goes to see Catherine for a romantic weekend, but the topic of Cristina’s award loss quickly gets brought to the surface. The two start fighting, which leads Catherine to admit that since Harper Avery co-owns Grey Sloan Memorial, there was no way Cristina could ever win the award. Catherine also reveals that Cristina did have the votes. Richard confesses that he was going to propose to her that weekend, but instead he decides to leave the ring on the table and walk out.
After talking with Frankie’s mother, Sabine, Braden’s mother starts questioning if the doctors always know what they’re doing. She decides to change her mind about Bailey’s treatments—fearful it’s only going to make her son worse. But since the mother technically already signed the consent papers, Bailey decides to secretly administer the treatment anyway.
During Frankie’s transplant, it’s discovered that the heart isn’t able to pump on its own due to an injury it received upon being removed from the donor. Luckily, another heart has been found, so Alex and Arizona go to get it. In the meantime, Frankie is put on bypass.
At the same time, Ivy’s heart begins to seriously deteriorate as well, making her immediacy for a new heart greater than ever. Cristina tells the parents that the heart is a perfect match for both girls, so they could easily redirect the heart to Ivy instead of Frankie. But the decision proves to be too hard for them to make, so they leave it up to Cristina.
Alex finally works up the nerve to tell Arizona about his new job offer. She tries to reminisce with him on the plane to retrieve the heart, but he misconstrues it as her way of guilting him into stay. She admits that she will miss him dearly, but is very proud of him no matter what his decision may be.
Cristina decides to give the heart to Ivy. But while her transplant succeeds, Frankie is unable to pull through and she dies. Owen and Cristina go to tell the parents, who are devastated.
During a board meeting that night, Avery presents his findings to everyone and remarks that the solution seems pretty obvious. However, they get interrupted by Alex, who officially gives his notice.
Having spent the entire day in surgery together without the kids to worry about, Meredith and Derek return home only to find the house wrecked and Amelia crying. She doesn’t think she can handle a career, marriage, and kids like they can. Derek goes to try and make her feel better, while Meredith orders takeout.
Avery comes home and finds April there as she’s picking up her iPod. He tries to get her to stay and promises that they can push through their differences, but she’s still worried they’d have problems raising children since they have such polar opposite beliefs. He doesn’t understand why they’re even talking about hypothetical children. But she informs him it isn’t so hypothetical now because she’s pregnant.
After speaking with Richard, Owen manages to track Cristina down and reveal that she actually did win the award. She received the most votes, but politics got in the way. She storms out of the hospital.