The residents agonize over their oral boards, reliving every answer they gave during their exams; Arizona's close childhood friend comes to Seattle Grace for medical help; the doctors work on a patient who is missing one third of his skull; and Julia asks Mark to start a family with her. Meanwhile Catherine tells Richard that one of his residents has failed.

The doctors of Seattle Grace are faced with the aftermath of last season's plane crash. As they try to move on with their lives, they must learn to adapt to the changes, cope with their losses and move forward with their relationships and careers.

The survivors from the crash are asked to make an almost impossible decision that will affect the rest of their lives. Meanwhile, tension grows between Jackson and April after they're forced to work together, and Alex tries to restrain himself with one of the interns.

Aware that Derek might never operate again, Meredith stops talking about the surgeries she's performing. Meanwhile, Richard calls on Dr. Catherine Avery to help him perform a complicated procedure, as things continue to heat up between Jackson and April; and Arizona's struggle to accept her fate forces Callie and Alex to face their guilt.

In this Meredith & Cristina-centric episode, the two friends continue to cope with life after the plane crash and their ever-growing responsibilities at their respective hospitals. As Meredith juggles taking care of Zola with a case that hits close to home, Cristina assists Dr. Thomas on a challenging heart surgery.