George O’Malley greets Isobel Stevens with a “happy birthday” as they all await their assignments.  Alex Karev gets assigned with Miranda Bailey to help with a surgery and Izzie is responsible to get the clinic budget to Bailey by the end of the day. 

Bailey and Karev are working with a long-time patient of Bailey’s – Jackson.  He is a ten-year-old who has had 12 bowel-resections over the course of his life.  His pediatric specialist, Kinley, calls Bailey  to help on the surgeries every time.  While Jackson begins bargaining with Dr. Kinley for a lollipop, the doctor collapses on the floor.  Karev tells the boy to hit the blue code button behind his bed while he checks the doctor.  Next thing you know, Bailey is having to break the news to Chief Richard Webber that Kinley has just died of a massive heart attack.  The Chief is too stunned to react to her.

Meanwhile, Izzie is in a vacant room looking over her charts and explaining to Denny that she thinks she should tell Alex about him.  Of course, Denny tells her it’s a bad idea and starts trying to talk her out of it.  Izzie reminds him that he’s “dead.  And I’m alive and he’s alive and I’m happy when I’m with him. Don’t you want me to be happy?”  She tells him that she wants both-both Denny and Alex.  She’ll be happy  with both of them.  Denny agrees but warns her that Alex will think she’s a “wack-job.”    She reminds Denny that Alex told her he loves her and that means a lot.

Back in with his young patient, the boy asks Karev to sign his card for the Make-A-Wish Foundation.  Alex refuses.  He explains that that program is for kids that are dying- this kid is not dying, he’s just sick.  Alex tries to ease the child’s disappointment telling him that the prizes are not all they’re  cracked up to be, realizing he maybe could have put it a little more gently.

As Bailey is looking over her patient’s chart, up walks a new young doctor – Arizona Robins, the new pediatric surgeon.  Bailey is caught off guard by this young attractive woman, who clearly can’t be old enough to be a good surgeon. Robins immediately puts in her opinion that she can’t believe Kinley followed this treatment for so long on this boy when it clearly wasn’t working.  She sees Baileys feathers getting ruffled and adds that she doesn’t blame Bailey because it wasn’t her call.  “But I supported the call,” Bailey interjects. She begins to defend the surgery.  Robins agrees to go along with the surgery for now because a lot of older doctors believe in it, but suggests they look at other options for the future.  Bailey  can hardly believe what just happened as she watches the doctor roll away on her “heelys.”       

When Bailey goes to complain to the Chief, she finds him behind a closed door with a sign that reads “DO NOT DISTURB” on the outside.

Izzie meets up with Alex in the hall and after some clever banter, she tells him, “There’s something I need to tell you and it’s going to sound weird. I know it sounds weird, so just don’t freak out.”  “You breakin up with me,” he asks.  “No, not at all.  I see Denny,” she tells him, “around here and at the house.”  “Are you okay,” Alex asks, “because that sounds kinda wack’d.”  She asks him if he ever saw his grandma after she died and he admits to a strange dream  where she told him not to play with his parts.  She first says its kinda like that, but you can see on her face she doesn’t believe herself.  “Alright,” he says.  “That’s it?” Izzie asks.  “I don’t know,” he tells her, “Tell him I said ‘hi’.”  Alex leaves and Denny is still offended that he was compared to the playing with parts dream.

In the surgery with Bailey, Karev and Robins, things arene’t looking as good as they thought.  Dr. Robins is distressed because the boy only has about 10cm left in his intestine.  She says, “It’s a miracle he’s still alive.”  Bailey doesn’t know what to say.  She obviously didn’t know that it was this bad.

Bailey storms into the Chief’s sanctuary and begins, “Kinley was replaced by an infant!” She rants and raves about all of the problems she has with Arizona and the case of the patient.  She’s really distressed.  “You thought Shepard was just a haircut,” Chief tells her, “you didn’t like Hahn. . . you thought Sloan was a ‘hussy.’”  It’s clear that she has had  problems with everyone new.  “I like you work,” she tells him.  He goes on to explain that Arizona Robins is a lot like Bailey was, she’s young, but the top of her class and was a Chief Resident and she’s the best anyone’s seen in a long time.  She is a very good surgeon and she’s all they have, so she’s just going to have to deal with her.    

In the cafeteria, George and Cristina are giving Alex a strong hint that he should make sure he does something for Izzie’s birthday.  Cristina suggests a party with balloons and bouncy house.  Alex is mad at their suggestions and tells them that he has it covered.   Izzie soon joins him and  he whispers to her and asks, “Is he here?”  She’s a little caught off guard and acts like she doesn’t understand before telling him that he’s not there.  Alex jokes to her, “Good, you can tell him that I can share my girl, but I’m not sharing my sandwich.  I paid four bucks for this thing.”  Izzie’s not quite sure if she should laugh, but takes the joke anyways.      

Derek goes in to talk to the Chief about their patient.  He starts to tell him how he understands why Chief would be having a hard time after losing a colleague like this.  Chief corrects him that he is not sad about Kinley.  “Kinley was a son of a bitch.  Great with children, good with a scalpel, but a terrible colleague. . . ”  “Is this about your mortality?” Derek asks. The Chief laughs at this thought.  “I’m worried about my hospital dying.  I made some calls to replace Kinley and no one wants to come here.”  He goes through a laundry list of all the problems they’ve had over the last few weeks.  They’re number twelve and he thinks he’s failed.  “So I’m going to lay here until I can find a way to walk the halls without cringing,” says the Chief.   He then turns to Derek wondering where his rousing lecture is.  “I’ve got to stitch a serial killer back together today.  I haven’t got a rousing lecture in me.

Finally, Izzie corners Alex again to further explain.  She doesn’t just see Denny, they do things together.  They hang out together, do sex things together.  Alex looks at her and says, “That’s cool.”  She’s put off but he continues that “I’d rather you have fantasies about me or other women, but . . .” and he goes on to explain that he understands that having someone close to you die makes people messed up.  He’s willing to help her through it.  “I’ve been second to that tool for a long time, but now I think I’ve got one up on him,” Alex  tells her.  He procedes to kiss her and asks if Denny can see them.  She tells him that he can, but Alex continues and kisses her lower on her neck. “Can he see this?” he asks.  “Yes, don’t stop, though”  she tells him.  He goes lower and she starts to get a body rush.  They continue and she tells Alex not to stop before telling Denny he’d better leave.  He does and Alex finishes her off. 

Alone with Denny in after Alex has left, Denny tells Izzie, “You know I’m the jealous kind, right?”  She says that she does, but that she can’t choose between them.  “Don’t make me choose.  I’m happy, you want me to be happy, don’t you?” she pleads.  She then asks if he remembered that today was her birthday and if he’s getting her a present.  “I think I just did,” he tells her.     

As Dr. Robins looks over Jackson’s post-op results, she shakes her head.  Bailey questions why.  Robins suggests that they get the boy on the transplant list right away for his intestines and his liver which is now failing.  Bailey suggests they get a second opinion.  Robins gets short with her and hands her the referral to another doctor to review the patient’s case.  Bailey tells her that she doesn’t need to snap at her, “Yeah I do,” says Arizona, “You’ve been second guessing everything from the moment I arrived. . . but I’m not the problem, the patient is, so why don’t you stop focusing on me and focus on the patient.

Bailey after checking the second opinion is left with nothing but to got to he patient and his mother to give them the news about the transplant in their future.  “The good news is you’ve got a cracker-jack new doctor who is going to take good care of you.”  When she gets choked up and has to leave, she asks the mother to come sign some consent forms with her.  Alex stays behind with the boy and signs his Make A Wish card.  It is now clear the boy may not make it.

Bailey goes to the Chief to admit that Robins is alright, though the patient may not make it..  Chief finally gets up from his bed where he’s been laying and goes to help Bailey with her patient.  He takes the sign down and takes the chart from her hands to take a look-finally something worth getting up for.