Train Wreck victims come to Seattle Grace and all staff gets called in. Everyone deals with really weird cases. Except Addison and Izzie. They work with a woman who is pregnant.

Addison's patient is a Catholic mother of seven. Addison gets in trouble after learning that the patient's husband won't use contraceptives. Derek treats a divorce attorney who asks if Derek is in need of her services. While Izzie and George are talking about their personal lives they "overhear" part of Derek's conversation with the divorce attorney who calls herself one of Seattle's best. Alex gets in trouble with Addison yet again for not being able to keep his mouth shut when other people think he should. A legendary jazz musician refuses to see medical reason. The musician is Burke's musical hero. Finn makes Meredith breakfast.

Cristina meets Burke's parents, the interns try to get Izzie's job back, and Addison takes a day off, a surgical patient may be living her last day. Some of the interns want to know why Bailey won't talk to Izzie. Meredith tries to decide between Derek and Finn and comes to a decision somewhat. Webber finds out that Callie has been living in the hospital and he confronts her about it.

Derek learns one of Addison's secrets. Bailey talks about motherhood and depression to a mother who is set to have cancer surgery and who seems to not care about any decisions concerning the future. A resident is fiercely questioned about the death of a male patient. An ex-couple meet before lunch and get stuck - Meredith and Addison work on their case. Things get awkward when the ex-couple's daughter, Michelle, arrives at the hospital.

George's father has a serious heart problem that requires surgery and George chooses Burke to do the procedure. Burke doubts himself because he knows the pressure this kind of surgery will put on him, but Cristina believes the team can handle it. Derek works with Meredith on being a couple again and tries work with Addison on more civil terms. A patient has had mutiple plastic surgeries so that his girlfriend will like him more. A mom wants her daughter's babysitter fired, after she is brought in with multiple injuries, but the girl likes the babysitter more than her mother.

Izzie and George's new-founded relationship results in them having bad sex. Callie's Chief Resident position is taken away from her, and Bailey is the humble replacement. Meredith can barely handle it with Lexie anymore.