The Harper Avery ceremony is over and Meredith and Owen are headed back to Grey Sloan Memorial Hospital, but Cristina Yang is nowhere to be found. Elsewhere in Seattle, Alex tells Jo that he was officially offered the job at the private practice. And Callie and Arizona are having a hard time getting adjusted to life with April, their new roommate, who is still keeping her distance from Jackson.
Derek's sister Amelia surprises everyone when she shows up unexpectedly at his doorstep. She's newly engaged and wants to see what domestic life is like. Derek is elated. Instant babysitter! Derek decides to celebrate by surprising his wife with a "date" in the OR. He has a rare surgery for her. Ah, the romance is still alive, folks. Meanwhile, Meredith is furious with all-thing Avery. So when Jackson interrupts their surgery, Meredith lashes out at him in defense of her best friend.
Frankie (one of Cristina's sibling heart patients) is going to have her heart transplant. Since Cristina is MIA, Dr. Russell prepares to scrub in with Arizona. But he's not needed, because just as the surgery is about to begin Cristina appears. But despite Cristina's best efforts, things take a turn for the worse in the OR. They are going to need another new heart for Frankie, so Arizona and Alex head off to secure it. While Arizona and Alex are gone, Frankie's sister crashes. She's in desperate need of a heart too. It's every parent's worst nightmare when Cristina tells the girls' parents that despite Frankie being in worse shape, she thinks Ivy may benefit from the heart that's in route to the hospital more. The parents refuse to make the impossible decision and they demand that Cristina do it. Thankfully, Owen is there to help her. Together they decide to give Ivy the new heart and Frankie an artificial heart until another transplant becomes available. Unfortunately, despite Cristina doing everything in her power, Frankie doesn't survive. And the parents blame Cristina for their daughter's death.
Callie, Jo, Owen and April treat a patient who was hit by a pick-up truck while attempting to walk from coast to coast. While in surgery to repair the damage, April runs Jo and Callie out by lamenting about her current situation with Jackson. When she's alone with Owen, April breaks down in tears as the surgery continues. Their patient was almost finished with his journey when he was hit. He made a commitment and he was so close, but failed. Will she be able to make her own commitment with Jackson work? She doesn't know how they'll recover from this. Owen shares some wisdom from his own past relationship with Cristina. He has complete faith that April's relationship will recover, despite their first fight. "This is not your pick-up truck," he assures her.
Richard goes to visit Catherine Avery. She's thrilled to see him, but immediately assumes his visit is to find out why Cristina didn't win the Harper Avery. Richard denies that, but since he's there, he does grill her on what happened. He is shocked when Catherine reveals that Cristina did win. Then what happened? The Harper-Avery Foundation co-owns the very hospital Cristina works out. "She could never win that award," Catherine states. Richard is livid. He then tells Catherine the real reason he surprised her was because he had a romantic weekend planned and was going to ask her to marry him. "That's why I came," he explains. "And now I'm leaving." No proposal occurs.
Bailey's Bubble Boy is getting worse, but his mother refuses anymore treatment. Stephanie asks Bailey what they're supposed to do now. She shrugs and says all they can do is hope the boy gets better. But when Stephanie leaves, Bailey pulls a bag out from the pocket of her coat. It looks like she may be prepared to give her Bubble Boy treatment, despite his parents' wishes.
Meanwhile, Jackson gathers the Board together and announces they may have to cut at least one doctor's research project due to financial reasons. This is understandably met with hostility. As he's making the announcement, Alex walks in and gives his notice. Everyone is shocked, except Arizona, who he had told earlier. (He was pleasantly surprised when she was supportive.)
After a day with her brother's kids, Amelia breaks down in tears when Meredith and Derek return home. She wanted to see if she'd be able to handle life with a family and sobs as she says she doesn't think she can cut it. Speaking of kids, Jackson is surprised when he returns home later that evening and April is there. She's only picking up clothes, but when they get into another argument, April drops a bombshell: She's pregnant!
Back at Grey Sloan, Owen comforts a defeated Cristina over the loss of her patient and then stuns her when he reveals she actually had the votes to win the Harper Avery. (Richard divulged the information to him as soon as possible.) Cristina wordlessly walks out of the hospital... alone.