Meredith waits at the bar for Derek, but before he arrives, a train wreck calls all the interns back to the hospital. Alex, still reeling from his embarrassing moment in the elevator, is forced to watch a couple train victims one of whom is in bad shape, the other not. And it's the one who's not the one that no one pays any attention to that winds up dying. Cristina is assigned by Richard to find the severed leg of a victim, which is more difficult than it should be and her boyfriend Burke is of no help. Izzie and Addison treat a pregnant victim who is very badly burned. They are able to deliver the baby, but with her arms badly burned, the only way she can feel her baby is to have the baby held up to face. Meredith, unfortunately, starts off too drunk to do anything.
Bailey keeps her from practicing medicine until she's sober, and which point and she and George are both helping Burke, Bailey and Derek on the giant case of the day: two strangers impaled on the same pole, both fully conscious, and the pole is the only thing keeping them both alive. The removal surgery is so tricky, only one patient is likely to make it out alive, and they have to choose. Meredith finds out that Derek chose Addison as this story unfolds. And Derek is reeling, too so drained from his decision and having to face Meredith, he breaks down in the elevator, with Bailey.