In addition to her photographic memory, Lexie Grey also can read lips.  She is discreetly trying to pass by the room where Chief is speaking to the other attendings about which resident is going to earn the solo surgery.  First she announces the name Karev, then Stevens, but ultimately the honor goes to only on person.  The decision was unanimous that Cristina Yang deserves the first solo surgery, but as fate would have it, she’s been eliminated from the running by the Chief (thanks to Lexie last week).  Richard Webber announces that due to this unfortunate series of events Cristina will be choosing the one to get the solo surgery.  Whomever she chooses can then choose one other resident to assist since the interns are banned from the OR.  As one would only guess, the sucking up and pleading to Cristina begins immediately.  She is so annoyed she can hardly stand it.  What’s more, Chief tells Cristina that Dixon is back for another surgery and he wants her to woo her.  She is to be on Dr. Dixon’s service for cardio today.  After her first awkward meeting with Dr. Dixon, she knows this will not be a great day – at all.

Sadie seeks her good friend, Meredith Grey’s, advice about Alex Karev because she’s his intern.  Meredith reminds her that at work, they are not friends and she is going to have to find out on her own about how to not piss off Karev.  The two walk into the E.R. and join Callie Torres, Alex Karev and Owen Hunt who are assisting two young teenage patients.  Evidently the 16-year-old got in an car accident in her father’s car while texting and driving.  The 15-year-old sister is quick to point all of the blame and spill all the bad news to everyone about her older sister.  The two are very mad and take verbal jabs at each other every second they can, leaving the medical professionals rolling their eyes and trying to work through the fighting.

Outside the clinic, George O’Malley is standing with a lot of patients wondering why it’s not open today.  Izzie Stevens walks up casually (with Denny’s ghost right behind her) and George asks if she forgot to open it or forgot to staff it.  Izzie ho hums, “Both, I’m sorry, I’ll go get the keys.”  As she turns around to go back and get them, she exchanges clever banter with Denny, but George can’t help but notice that she’s talking to herself. 

Meanwhile, Cristina is being hit up every moment she is alone by one resident sucking up or another.  Even George O’Malley is trying to make himself sound more positive and ready for the job.  It doesn’t appear that she will have any moment to herself to think this out.

As the bickering patients continue in their bickering, Callie pulls the curtain between them.  Alex Karev comes to the 16-year-old and suddenly has a major concern.  While Sadie has been giving the patient assurances that her father won’t be as mad as she thinks, she missed the fact that the patient’s eyes are dilated.  Alex knows this means there is a head trauma.  He rushes her off to Derek Shepard to get it checked out.  As the patient is being wheeled out, her younger sister, who is absolutely beside herself about this whole thing, yells out “I hope you die!”

Cristina finally meets up with Dixon in front of the surgical board and Dixon announces that she noticed that there is an empty spot on the board for an amputation.  She expresses interest as she’s not done one since her residency.  At first she tries to dance around the question with awkward response from Dixon about how she stuttered as a child, but with extensive speech therapy she was able to overcome it.  Cristina tells her, “I need to select one of my fellow residents for that slot, it is the first solo surgery of my class.”  “The Chief asked you to choose from your peers?”  Dixon asks.  Even Dixon knows that this will be socially awkward for Cristina.

In looking over the CT scans, Derek Shepard and Alex Karev confirm the worst.  Their patient has  a skull fracture and needs to go into surgery immediately.  They call on Dixon to help with the patients heart while they operate on the brain.  In another room, her sister begins to be nervous about the surgery.  She hopes that her last words to her older sister are not the last words of her life.  In the O.R., Derek lets Alex test his skills, but something is going wrong.  The brain begins changing color, so Derek steps in.  Though Dixon’s end is successful, the girl is left brain dead.  There was nothing more they could have done.

In the mean time, both Alex Karev and Meredith Grey have taken their chances to plead their case with Cristina Yang.  Alex gives her the run down on how he knows he can do it and doesn’t care what she thinks because he deserves it despite her thoughts of him.  He’s done it four times – once on a cadaver and three times on the mechanical dummy.  Meredith takes another approach.  She gives Cristina the confidence that she will make the best decision based on performance.  She knows she’s the best and all emotions aside, Cristina will choose the best candidate.   

George finds Alex in between patients to tell him about Izzie, “Something’s wrong, Alex.  You need to talk to her, she won’t talk to me,” George tells him.  “Don’t talk to me about Izzie again,” is the abrupt response of Alex.  In antoher part of the hospital, however, Izzie is at it again – in an on-call room with Denny.  George pages her, but she ignores it to have a conversation with Denny instead. 

Finally Izzie finds Cristina to plead her case for the surgery – or so you think.  “Have you ever had mind-blowing sex,” Isobel asks, “the kind of sex that makes you want to die.  Just fall on the floor and give up and die?  Cause the sex I’m having, it’s that good.  It’s the best sex I’ve ever had, in fact it’s the best sex anybody’s had.  I don’t know why anybody who’s had this kind of sex would do anything but have more sex.  You’re going to give the solo surgery to Mer which is typical and boring and slightly corrupt, but at least I’m having really really REALLY good sex.  Yah, just thought you should know,” and she takes her leave while Cristina is left with no words.  

The younger sister is brought in with her parents to see her older sister – now in a coma with no chance to come out.  She is unsure of what to do, but before Meredith can offer comfort, Dixon enters and explains in a very brutal manner that the patient will not come out of it.  “Your sisters bodily functions are fine, her brain is dead.  She has no thoughts, no emotions, no senses.  My name is Dr. Dixon, I will be harvesting your sisters organs if your parents agree.”  The parents say they need more time, but Dixon persists – she just doesn’t understand the emotion and relation of it all.  “I’m very sorry for your loss, but her organs are young and vital.  They could save many lives.”  Still the younger sister pleads for her to wake up and Dixon persists that she is dead.  “Get out,” the sister finally yells, “She is not dead and you cannot have her.”  Meredith politely and firmly asks Dixon to leave the room.    “I have offended you but there is no much time.”  The sister gets frantic, trying to wake her ‘sleeping’ older sister.

Cristina is frantically trying to choose an intern for the surgery and all Dixon can say is “It’s not right, people are dying and we’re just sitting here.”  Mistaking her annoyance being aimed at Cristina, Dixon explains it’s about the patient’s organs.  “Leave feelings out of it.  Leave them out of the science.  Leave them out decision-making because people are dying.”  Cristina can see Meredith helping the patient from afar and suddenly she has her answer.  She walks to the OR board with all the residents watching and writes a name.  Karev, A.  No one can believe it and Alex pretends not to care, but he rushes off to find someone – to find Izzie.   Meredith is left behind just staring at the board.

Alex finds Izzie asleep in an on-call room.  While he’s trying to explain that he won the surgery, she’s not quite awake enough to process it all.   When she finally gets it, he tells her, “I love you!”  What?” She asks.  “I love you.  I frickin love you.  I just got the solo surgery and the first thing I did was look for you and you weren’t there.  You’re never there anymore.  I been thinking about it and I think it might be cause you love me, too.”  He continues on, but Izzie just looks uncomfortable and he doesn’t seem to notice much.  “You had that patient that reminded you of Denny and it reminded you of how bad you felt when you laid on that bathroom floor.  I get that.  I get that you’re scared, but you’re not going to have to feel like that again cause I’m not going to die and I’m not going to cheat on you, Izz.  I’m not going to go anywhere.  I think you’re my best shot.  I think with you, you make me better, you make me want to be better, you make me want to be good and I think I can – with you I think I can.”  He tells her that its okay if she wants to be scared, but to be scared with him, in the solo surgery.  “You love me?” she asks unsuredly.  “Shut up!” he smirks and he kisses her.  As he leaves, she turns to Denny on the bed with her and he tells her, “I’m really starting to no like that guy.”

Meredith is in with the sisters.  She encourages her to let out her feelings and tell her older sister what she wants her to hear.  She has to believe that she would forgive her as would be the case if the tables were turned.  The young girl finally is able to apologize and tell her she loves her.  “She loved you, too,” Meredith tells her, “No matter what happened between the two of you.  She loved you, she loves you.”  When she leaves, she finds Derek staring at the surgical board.  “So you’re right,” she tells him, “Cristina and I are fighting.”  He tells her she should go to her. He insists, but she can tell something’s bothering him.  “They don’t tell you when you become a doctor that it’s going to be like this,” he begins, “ They don’t tell you that you’re going to lose more patients than you save.  16?  I’m sick to death.”  “I’m sorry,” she tells him, then they take their separate leaves.    

Chief finds Dr. Dixon to ask her how her day has been at Seattle Grace.  “Dr. Yang, you tortured her today.  Making her choose among her peers, some kind of emotional torture, was that your intention?”  “Yes,” he admits.  “Have your board make me a better offer” and she takes her leave.

Meredith sits next to Cristina in the observation deck.  “We’re fighting and I don’t want to be, so can we put this past us,” she asks Cristina.  She continues to explain how Cristina made this personal with choosing Alex, but assures that they can put it behind them.  “You made it personal!” Cristina tells her. “This right here is you making this personal.  You told me to do what I had to do so I chose Alex.  He was the most prepared. . . because unlike you I can separate my personal life from my job.”  Cristina sits for a moment, then can’t take it, she stands and announces, “None of you said anything.  Those were all our interns.  But I won this.  They picked me.  If I don’t deserve this solo surgery then none of us do.”  She can’t bear to watch anymore and leaves to go cry in the hallway.  George takes this terrible moment to sit with Meredith and say he’s not sure who he’s more worried about – Alex in the surgery or Izzie.  He tries to get Meredith to worry with him about her, but she says that they all have problems and brushes him off because Alex is paging her.  Hunt follows Cristina into the hallway.  “Not here!” Hunt tells her, and he points her into a nearby doorway.

Meredith finds Alex scrubbing up and he’s freaking out. He needs her to scrub in with him, but where is Izzie?  “I’m freaking out,” he tells her, “I told her ‘I love you.’  I told her before the solo surgery.  I can’t believe that.  Who does that?  And now she’s not going to show up and I’m freaking out.”  “Stop freaking out,” she tells him, “If you screw this up and kill this guy, I’m gonna be pissed.  Then I’ll know I should have won it.  You have to kick ass in there, Alex, you have no choice.”  Chief walks in and asks if Alex is ready.  He pauses, but then Izzie comes through the door, “He’s ready,” she says.  He calms down and she starts scrubbing.