A power failure cripples Seattle Grace Hospital, trapping Alex and George in an elevator with a gunshot wound victim desperately in need of heart surgery. Alex freezes, but George is able to do what needs to be done. Burke talks George through the operation from outside the elevator's door. Meanwhile Cristina is forced to relieve the pain of a unique patient for whom pain medicine is out of the question. He had been using video porn to relieve his pain (not a perv it really was the only pain management he could take), and now without the power, Cristina has to paint the same pictures with her words.

Meredith and Derek treat a Hmung patient who needs to "find her soul" before they can operate. Izzie deals with a female patient who literally has a broken heart she experiences what appears to be a heart attack every year on the anniversary of an old lover's death. Richard and Meredith say good bye to Ellis, who is checking out of the hospital, and Meredith finally makes a move back to Derek, pleading for him to "pick me, choose me." She goes to the bar across the street to wait for his response.