Izzie Stevens is cowering in the corner of her bedroom having a conversation with Denny Duquette.  She thinks she’s crazy.  He reminds her that she touched him and kissed him.  She explains that it’s residual.  She had done that when he was alive.  It has to be a memory!  So Denny has an idea.  The only way to test it is to do something that they never got to do in real life.  He pulls her over to him and, standing in front of her, takes off his shirt.  They begin to kiss and Izzie is not holding back, she really wants this.  She rips off her own shirt and pushes him back onto the bed.

Meredith Grey gets paged into the hospital in the middle of the night by Cristina Yang.   She and Sadie, who is also awake, are heading down the hallway and hear Izzie making groans and sex noises in her room.  Moments later Alex Karev steps out of his room, (he was tipped off on the appy, too).  Meredith is shocked that Alex is not in there with her.  She begins to wonder who is in there and calls out to Derek to make sure.  A confused Derek comes out to see what’s going on.   He wonders why Meredith is up and dressed, then hearing the noises asks,  “Who’s making a porno in Izzie’s room?”  “Relax, she’s flying solo. That’s hot,” Alex assures.  He procedes to call her out of the room telling her about the “appy” at the hospital.  She comes to the door out of breath and sweating.  She insists to him that she’s not feeling well and tries to excuse away her symptoms.  He tells her, “It didn’t sound like you were sleeping,”  and offers to help her out.  She quickly refuses saying she doesn’t want to get him sick, too, and shuts the door.  

At the hospital, Alex is assigned to a patient with abdominal pain.   He enters the room and finds the couple bickering.  She’s there because she’s been having diarrhea and the “internet told her it was stomach cancer” according to the husband.  She swears that she is not a hypochondriac, but he says it’s probably just diarrhea.  Alex rules out the appendectomy he was hoping for and takes a stool sample.

Alex comes back to ask the patient for more information about her history.  Evidently his female patient has taken some antibiotics she purchased online because she swore that she had a staph infection.  The husband and her doctor had assured her it was only a zit, but she didn’t believe them.  The tension is high as the couple bicker about it some more.  Alex interjects that she has C-Diff and it’s not going to just go away like the “zit” she had.  He explains that she killed off all of the healthy bacteria so they have to reintroduce more healthy bacteria to help her.  He’ll need a sample from someone she already shares germs with and they’ll insert it in through a tube.  The husband, who’s still upset by her nonsense, says he won’t give it to her unless she admits that it was just a zit.

Back at home,  Izzie is lying in bed holding Denny in her red satin sheets.  She again begins to question the reality of it all.  She decides to keep her eyes closed.  She knows it’s like a dream when you’re half awake and half asleep and wants to stay that way so that it won’t end. 

Alex’s patient is ready to confess to her husband.  All she can say though, is “I believe that you believe it was a pimple.”  It’s not enough for him and they begin to argue again until Alex interrupts.  “Dude, she could lie to you and tell you what you want to hear, but she’s not.  She’s telling you what’s real for her.  Stop walking away.”  The patient goes on to admit to her husband all of the things she fears and tells him, “The world is a scary place.  And there are a thousand things a day that could kill you.  And I don’t know how you don’t see that.”  His face softens.

Izzie wakes up in a frantic rush because she can’t find Denny.  He’s not next to her.  She is startled to find him in the doorway.  “You can’t do that. . . I thought you left me again.”  He tries to calm her down.  “No, you died and you left me here. . . you left me here alone.”  Then she begins to question again why is he there?  She was finally moving on and then he came back , “and now I’m in my room all day probably talking to myself and probably crazy and there’s a real world out there and I’m stuck in here with you.”  He apologizes.  “You don’t get to apologize,” she yells, “You don’t get to apologize because I killed you.”  She rants on and loses it.  She sits down and he sits next to her and says, “I love you.” 

Izzie gets paged to the hospital and asks if he’s going to leave and go tell all his guy friends in heaven about their great last night together.  He assures her that he’ll still be there when she gets back. 

Alex patients make up and she apologizes for her “crazy.”  “It’s alright.  I still love you crazy.” 

In lecturing the interns for their wrongdoings, Alex tells them that they have lost his respect and it won’t be easy to earn back.  An intern snidely whispers, “But he still respects Izzie Stevens.”  When Alex asks him to repeat it, the intern says, “You seem to still respect Izzie Stevens and she killed a man.”  That’s it.  Alex pushes him up against a wall and gets in his face.  “She was trying to save a man’s life.  You almost killed your friend for fun.  It’s different.”  Looking out the door, Izzie was standing right there to hear it.