Richard is awake, but not eating. Shane recommends he be fed with a tube. The stubborn patient disagrees. Bailey supports his wish. So Shane calls Meredith, who instructs him to order the tube anyway. This, of course, ticks off Bailey. Richard orders some soup, but he simply can't swallow. Elsewhere, Meredith and Derek are supremely sleep-deprived. That's what happens when you have a new baby. He falls asleep in the car while going out for milk while she nods off on the bathroom floor. Later, after Derek zonks out on the couch, Meredith takes baby Bailey to the hospital so she can deal with the Richard situation.
The interns have been crashing on the floor of Alex's house all week. That's been making it difficult for Jo to get intimate with her new boyfriend. She's wearing sexy underwear all the time waiting and hoping Alex will make a move somewhere, someway. That's not going to happen. Cristina deduces that it's because he wants their first time to be special. She teases him as they treat a 17-year-old boy who had a heart transplant when he was an infant. The family would rather go through a risky repair procedure rather than go on the waiting list for a new heart. Sadly, the surgery is unsuccessful, so the boy will need a transplant.
The recovery rooms are overflowing because of the severe storm damage to the outpatient surgery wing. Owen wants to have a board meeting about the financial issues hitting the hospital, but it's hard to get anyone together, especially the two feuding wives on his staff. In an effort to help move forward, Arizona comes to work sporting a new haircut and a slick, sexy dress. She's hoping Callie will show up for some scheduled couples therapy after their shift.
A woman comes in with piece of a shattered baseball bat jutting out from her chest. She makes Leah promise to tell her husband that she cheated on him with his brother if she dies. Things go south during the woman's surgery. Callie rushes to the OR to stop April from cutting the woman's clavicle. Too late. Callie is furious that she now has to clean up the mess. It seems as though she's subconsciously relating what happened in the OR to the mess that's her personal life. Callie orders Leah to tell the husband about his unfaithful wife, but later changes her mind after realizing no good would come of it.
April is anxiously awaiting the results of her boards. She failed them initially right around the time she lost her virginity to her best friend. It happens. Speaking of Jackson, he's psyched to do a pro bono surgery on a woman to reconstruct her face. Owen says it's not gonna happen because of money issues. Jackson orders him to make it work because, well, he's the boss. Owen thought he was the boss, but he's informed that he's more like traffic cop. He takes his new duties in stride shuffling surgeries so that Jackson is stuck doing fat removal procedures from patient derrières all day. Sounds like interesting work if you can get it.
Jackson is shocked when he sees his pro bono patient sitting in a hospital bed awaiting an early morning surgery. Owen had said he transferred her to another hospital. He lied. It was his way of getting Jackson's attention about the hospital's financial woes. On the bright side, all those butt jobs Jackson did will pay for his patient's procedure. He follows Owen's lead by helping him spin a lie to get the board together to announce plans for the gala fundraiser they need to throw.
In random news, April receives word that she passed her boards. Woo hoo! She leaps up to give Jackson a hug, but all he's offering these days is a high-five. Jo kicks all her interns out of Alex's house so they can finally have sex. As hard as it is, Owen and Cristina are not having sex. They even agree to try to start seeing other people. Callie shows up at the therapy session, but says she isn't going inside. She doesn't think Arizona's affair was a mistake. Callie advises her wife to go to the session alone before walking out the door.
Bailey tells Meredith that she has a plan regarding Richard. She knows that a feeding tube is psychologically damaging. It takes away a man's dignity. The two docs argue about the issue while Shane decides to take action. He tells Richard to stop pretending like this serious situation isn't happening to him before finally getting him to agree to the feeding tube. Shane lets Bailey and Meredith know their patient was starving to death. Someone had to step up and do something. Later, Meredith is by Richard's side when he awakens. She's completely caught off guard when he says he made a mistake choosing her to make his medical decisions.