Competition heats up as several of the doctors fight to become the new face of Seattle Grace; April brings in an emergency case, and Jackson and Alex work with a transgender teen couple. Meanwhile, the hospital implements new policies which test the patience of the staff.

As the hospital spirals closer to financial ruin, Owen must make some tough decisions, which includes foregoing an expensive surgery that could save the life of a child. Meanwhile, Alex and Jo work together to save the life of an infant, and April asks Jackson for dating advice.