On the day of April's wedding, the Grey Sloan Memorial doctors are all preoccupied with their own drama. Meredith and Cristina continue to argue about their research and careers, Bailey comes clean to Ben about her feelings regarding him moving back to Seattle, and Shane puts himself in a risky situation. Meanwhile, Derek gets a phone call that will change his life.

Arizona has a bad day which escalates when she advises one of Callie's patients on a potential double amputation. Derek goes back on a promise to Callie, and Jo and Stephanie come across an abandoned baby outside the hospital. Meanwhile, the doctors deal with the repercussions of the non-fraternization rule, which include meetings with HR and one doctor's suspension.

It's Richard's birthday and Bailey invites him to scrub in on the case of a lifetime. Meredith hires a research assistant to help with her portal vein project. A scorned Callie gives Derek quite the shock. Meanwhile, Shane helps screen candidates for Cristina's clinical trial and meets a young expectant mother who needs his help.