Cristina, Izzie and Alex have crammed all night for their boards test and wonder if, with Susan's death, Meredith is ready. First she's going to the hospital, than the funeral, than onto the test. Cristina urges Meredith to ask the Chief to take the test later but she won't hear of it.
Callie is more excited than George that he's been accepted to Mercy West, pointing out that it has fewer interns and "fewer distractions." Izzie pleads with him not to go but he insists he can't keep kissing her in elevators. "I'm a married man," he says and walks away.
With just one day to go until their wedding, Burke is upset to learn his best man can't make it. He pressures Cristina for her vows, but she puts him off because of the test. Burke picks Derek as his new best man and tells him he has to plan his bachelor party now.
Ava notes that her baby has her father's nose and Alex is excited that she's regained a memory. When she shrugs it off, he suspects her memory's already come back. She confesses her memory came back a few days ago. She knows now she was unhappily married to her college sweetheart and yearning for life in the big city. She had gone to Seattle to think when the accident happened. He wants to know why she hasn't called her husband yet and she says she was leaving him. He asks what her name is and she refuses to tell him.
Miranda announces that Richard is making his recommendation tomorrow for Chief of Surgery and Chief Resident. Mark asks her how it feels to be the chosen one for Chief Resident.
Three of four lost climbers on Mount Rainier are brought in with severe frostbite and various broken bones. Derek asks them what happened on the mountain. They blame a sudden storm. They were all tied together when it hit and fell as a group down a 100 foot drop. When they came to, their friend Lonnie was dead and they had no choice but to leave him.
Joe and his partner, Walter, ask Addison to examine their potential birth mother, Rina. She tells Addison she's feeling great, other than terrible heartburn. Addison informs Rina she's carrying twins and Joe passes out at the news.
Meredith is on her way to the funeral when her father shows up to tell her she's "not wanted." He angrily tells Meredith she killed Susan and now he never wants to see or hear from her again. Richard assures her she's not to blame and that her father knows it too. Meredith tells Richard that just because he slept with her mother that does not make him her father and to stop acting like one.
During the exam, George notices that Meredith hasn't written a single thing on her paper. He tries to go after her when the test is over, but Cristina advises him not to. Derek asks her how it went but she doesn't even answer. The other interns wonder how to help Meredith since if she fails, she'll have to repeat her year as intern. But then they're paged and have to leave Meredith brooding alone in the waiting room.
Miranda asks George if he's trying to throw his career away by transferring to Mercy West. She says it's a mistake to leave the best surgical program in the country. Izzie calls after George when he walks away, as Callie looks on.
Izzie asks George what they're going to do about Meredith. Since he's already spoken to her and gotten nowhere, he tells her there's nothing to do. Just then, they overhear the hikers talking about how it was wrong to leave their friend behind. Once again, Izzie begs George not to leave, telling him, yes they made a mistake, but it was just sex and it didn't mean anything and then she goes into the next room and bursts into sobs.
Addison is surprised to see Adele in the ER; she had a fender bender but insists she's fine. She begs her not to tell Richard especially because she's pregnant. Addison examines her and tells her the baby looks fine, but she's spotting a little and wants to keep her overnight. Adele agrees, only if Richard doesn't find out.
Addison gripes to Callie that everyone teenagers, gay men, women in their 50s is having babies but her. Callie tells her that with George getting a fresh start at Mercy West, she wants to try to start a family.
While Burke operates on one of the hikers while Mark has to amputate both of the second hiker's hands. George assists Derek on the third hiker's surgery and when Derek asks him how Meredith did on her test, George is surprised he doesn't know, but assured him he's already talked to the Chief about her.
Mark praises Callie for her impressive work, assisting on four surgeries, saying it looks like Miranda's not a shoo in for Chief Resident after all. Miranda asks Callie if she's also in the running. Callie replies she thinks she has a shot, even though everyone knows that Miranda is the Chief's favorite.
Richard summons Meredith and tells her she's taking the test over again, right now. She tells him he's not her father and he says he knows, but hugs her anyway and she finally starts to cry.
Derek sees Meredith taking the test on his way to Joe's, where he's holding Burke's impromptu bachelor party. Derek asks Burke if Cristina's written her vows and he says he'll find out tomorrow. In turn, he asks how Meredith is and Derek says he has no idea. At Joe's, a pretty woman approaches Derek and asks to buy him a drink but he declines.
Alex chews out Ava for not contacting her family and she says her husband never even came looking for her. He threatens to tell the police and she says it'll be his word against hers. Disgusted, he says she's right: He has absolutely no idea who she is. Later, Alex is tending to Ava's baby and she tells him, "Rebecca Pope. That's my name."
Cristina is still having trouble writing her vows. Callie and Meredith tell her the "love and cherish" part is overrated but Izzie fervently declares that if they couldn't be with the person they loved, they'd feel differently. Callie glares at Izzie, who has to look away. Meredith asks Izzie if she's talking about Denny and Izzie lies and says she is.
Richard spots Adele going into the ladies' room and tells her she doesn't have to hide. He finally barges in and finds her passed out on the floor. Meanwhile, Walter shows up at the bar with Rina, who complains of heartburn and faints dead away.
The fourth climber is brought into the hospital barely alive and with an ax in his head!