Izzie finds George sleeping in the on-call room and announces that she's tired of waiting, they're going to have hot sex tonight.
Meredith can't sleep and Cristina diagnoses severe abandonment issues. She wonders if maybe Meredith should stop having "breakup sex" with Derek.
A sky diver miraculously survives a 12,000 feet fall even though his parachute didn't open. It appears all he needs is an appendectomy. The residents watch the video of the accident, during which the diver proclaims that he loves Sally, the instructor.
Meredith wonders why her brush with death didn't inspire her to declare her love for Derek. She dreams that, lying his arms after sex, she tells him how she remembers him saving her when she drowned and how the water washed away all her issues.
Alex finds Lexie doing her charts in a closet and tells her she needs to not be "the runt" of the lot of interns and to come with him.
Two women who were injured competing for the wedding of their dreams refuse to let go of a wedding dress since the last one holding on wins. Mark, who's firmly on Callie's side, decides to make George the proxy for the woman with the injured shoulder, so he has to keep hold of the dress while they work on her. She needs surgery for her shoulder but just wants to get back to holding the dress. Lexie mentions that she hopes that the bride will wear her hair down, to cover her deformed shoulder, and the woman quickly agrees to the surgery.
Cristina tries to trade the skydiving surgery to Izzie for a cardio surgery but Izzie refuses and scrubs in with the new cardio doctor, Erica Hahn. The patient has a severe coronary blockage, but he is allergic to the anesthesia, so they can't perform the necessary surgery. Erica is ready to discharge the patient, but Cristina proposes a solution: A local epidural which would leave the patient awake but remove the need for anesthesia. Izzie reminds the man, a bird watcher, of the rare bird he wants to live to see and he agrees.
Richard, who's staying with Derek, proposes a "gentleman's evening" to cheer them both up. Derek invites Mark and he wants to know whether the evening involves strippers. They tell about Erica about it and when Richard reprimands her for not running the awake surgery past him first, she tells him that he's being sexist and goes off to do her surgery.
Cristina watches the awake surgery from the gallery and marvels how Izzie thought to put a balloon with a drawing of a bird on it in the patient's eye line to keep him focused. Derek confesses that Meredith won't let him take care of her anymore and Cristina says it's okay because she's taking care of Meredith.
The heart patient starts to freak out that everyone is watching his surgery and asks them to stop. Izzie steps in and asks him to pretend that the people in the gallery aren't people, but birds, and to describe what kind of bird each one is and that keeps him sufficiently calm for them to finish the surgery.
George is still holding onto the dress when the second contestant collapses. The bride with the shoulder injury wakes from surgery and only wants to know if she's won the contest. Callie chews her out for not caring that the woman she stood next to for two days nearly died. "You shouldn't fight this hard for a wedding, you should fight this hard for a marriage," Callie tells her and says you have to know when it's time to let go.
Callie passes George in the hallway and asks how his bride is. He says she's okay and Callie hopes that he let go first, because she doesn't want her bride to have won that way. George is surprised that she's able to just talk to him and she tells him, "I'm letting go." George tells the patient who collapsed that he let go first, to catch her, so she's won.
Meredith counsels the sky diver that the feeling he has right now, that he can do anything, will go away. She tells him she saw his video and that he should tell Sally how he feels, right now. He demurs, saying Sally is out of his league, but she says that if he doesn't find out if Sally feels the same way, then that will be his only scar.
Mark and Derek are still trying to guess what Richard has planned for the evening and are disappointed that merely wanted to spend time with just the guys. However, one woman shows up: Erica, who has invited herself along. They end up playing Monopoly.
Lexie and Alex end up leaving the hospital together and she asks his plans for the evening. He tells her all she could hope for is sex from him and "that's never enough for girls like you."
George and Izzie finally get their evening alone and she's too exhausted from the surgery to have sex. He confesses his hand hurts from holding the dress, so he's willing to postpone their "perfect night."
Meredith tells Cristina she can't give up sleeping with Derek, because it's not about the sex, it's about the moment afterwards, when she feels safe in his arms. She asks if that makes her pathetic and Cristina says, "A little bit."
Meredith opens the door of her bedroom to find Lexie and Alex half-naked together in the hallway and Lexie is horrified to realize that Meredith is his roommate.