As Adele's condition continues to deteriorate, Richard considers altering their living situation; an explosion at a local coffee shop results in a busy day in the ER for the doctors; Callie takes Meredith under her wing by helping her study for her boards; Lexie joins Arizona and Alex in peds, as they continue to care for intern Morgan's premature son; and when Jackson snaps at a patient, Mark encourages him to find ways to relieve his stress. Meanwhile, Cristina lets her suspicions get the best of her.

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.

A patient's condition sparks a conversation between Richard and Maggie about Alzheimer's disease; April and Jackson struggle to return to their normal lives and Arizona is faced with the reality that Callie is moving on. Meanwhile, Meredith reveals her biggest fears about Derek.