Alex Karev starts the day with asking Izzie Stevens to cover for him. He's not going to work, he's going to stay home and watch movies with Ava. Izzie immediately goes to Bailey for advice, but Bailey is too busy trying to "see something." She's trying to see the bigger picture. Despite her attempts to ask others, everyone just seems too busy to help Izzie with her "problem."

Meanwhile, back at home, Alex sits down next to Ava on the couch and asks her to catch him up on what he missed of the movie. She hasn't the faintest idea what has happened and says, "I think I wet my pants." Alex is caught off guard, but says, "It's okay," Ava tells him, "I'll do better, I promise," and they leave to go get her cleaned up. While she's cleaning up in the shower, she huddles down in the bath and curls up in a ball. Realizing something is wrong, Alex gets in (clothes on and all) to get in and help comfort her. She doesn't understand what has happened and how she wasn't pregnant. Alex again tells her, "it's okay" and that she just got confused.

Back at Seattle Grace, Izzie Stevens calls Karev to see how things are going at home with Ava. They were just making sandwiches for lunch and he's yelling at Izzie for being in his business. Then he suddenly leaves the phone to attend to Ava leaving Izzie clueless as to what is happening on the other end. The next thing we know, Alex has Ava in the E.R. She had slit her wrists with a knife he'd left in the kitchen to get the phone. Izzie realizes that things are much worse than she thought. After lying about the injuries and cussing Izzie out of the room, Izzie finally gets a moment with Miranda Bailey. She quickly gives a synopsis of what's going on. Miranda tells her that its no different than other patients, she is the physician, Alex is just the loved one and, " C'mon, you know what to do. It's just hard to do it." Izzie, defeated says, "Okay, I'll try." Bailey tells her, "No, you don't have to try. You're a doctor, trained by me with all the skills God gave you. You have everything you need," and sends her off to take care of it.

Izzie musters the strength and brings the psychiatrist to meet with Ava. She pulls Alex over in private to discuss the matter further. "What did I tell you? " Alex says accusingly. Izzie (thankfully with much more backbone than she's had lately) tells him, "She's my patient. I decide her treatment plan. I am not releasing her without a consult. If you try to take her out of this hospital without my okay, I will call the police and have you arrested." Thinking he's calling her bluff, Alex says "You can't have me arrested," but Izzie's not backing down. "Try me." "Look, Izz, you're worried, I understand, but you're being a little unreasonable. I got this." Izzie explains that he can't handle it. "Are you going to bodily restrain me," Alex asks. "If I have to . . . Are you going to hit a woman?" "If I have to," Alex answers. The tension continues to rise until Alex finally says, "Look, I can take care of her, I've done this before. She's just going through a rough patch alright? I can feed her and I can change her and I can bathe her and I can watch her until the bad patch is over. I can take care of her. Look, I took care of my mom and I can take care of her. . .but I was a kid then and now I'm a man so I'll be better at it. I have done this before." Izzie finally gives in and says, "Stop, you don't have to say anymore."

Alex is forced to face the reality in front of him. He finally calls Ava's husband. He tells Alex that he left Ava 2 months ago and took the baby. She has "underlying borderline personality disorder" and with the accident, the problem is getting worse. He goes to talk to Ava abaout it and tells her, "you need help Rebecca and I can't give it to you." She explains, " I wanted to be better for you. I know how hard it is for you to trust people and I wanted to be there for you. I'm sorry." "It's okay," he tells her, "you tried."

At the end of the day Bailey comes to Izzie to ask how everything went. "Awful." Miranda Bailey hands her the keys to the clinic and Izzie asks why. "I'm not giving you the keys to the clinic, I'm giving you the clinic. I've seen the bigger picture. I love the clinic, I love what it means, I love what it is, but I don't love it as much as I love surgery, I don't love it as much as being chief resident, i don't love it as much as my husband and child. Now I've seen the bigger picture and I can't do everything and have everything so I have to let some pieces go - this piece- this is your piece. I've watched you earn this piece the hard way, the awful way, knowing that I can give the clinic to someone like you. You have grown into a fine doctor, Izzie Stevens." "Thank you," are the only words Izzie can muster. "The Denny Duquette Memorial Clinic is in your hands - Make me proud!"

Back at home Alex is very torn up. Izzie walks to him, "I'm sorry," she says. "Not whatever, I'm sorry about Rebecca (Ava) and your mom. I'm sorry." Alex leans over and starts kissing her and begging, "Please, just this one time, just for this one night, please, please." But Izzie's not sure how to react. She pulls away, kisses him back a little, then pulls away and holds his sobbing head against her chest. What a day it has been for these two.

more from this episode. . .