The fifth-year residents return for the first day of a year that will make or break their careers: Meredith faces the consequences of tampering with Derek's clinical trial and is terminated at the hospital; April tries to step up to the plate as Chief Resident in the wake of a giant sinkhole in the middle of Seattle; and Cristina and Owen are still at odds over their drastically different feelings for their unborn child.

News of Meredith and Derek's unsteady relationship raises a red flag for Zola's adoption counselor; Alex quickly realizes that he has become the outcast of the group after ratting out Meredith; and Cristina makes a tough decision regarding her unexpected pregnancy. Also, Chief Webber brings Henry in for a last minute surgery, alarming Teddy.

This is an historic episode that finally crosses a long-standing barrier.