George and Izzie finally have sex -- and it's horrible! Izzie despairs that they don't have chemistry anymore and tries everything, including booze, to get it back.
Mark jokes that Derek is the Chief's girlfriend when he finds out he's running errands like drycleaning for him and spending his evenings having dinner and a movie with the Chief. Mark takes offense when Derek tells him he has no chance with Erica since Mark "has no substance."
Callie pleads with Miranda to take over her scheduling duties because she just wants to do surgeries, which make her happy. Miranda agrees and her advice includes counseling Cristina to find a new specialty when Erica kicks her off the cardio rotation. Cristina scrubs in on a bone surgery with Callie but misses the finesse of heart surgery.
A distraught mother comes in: she dropped her baby in a fall down the stairs and doesn't know if it's breathing. The baby is fine but the mother collapses with broken ribs and a collapsed lung. The father arrives and is too busy focusing on his wife to bother with the baby, whom they had just adopted and hadn't even given a name to yet. He tells Lexie if his wife doesn't make it, he's going to give the baby back since he can't raise her on his own.
Lexie is upset because she'd been making progress in her relationship with Meredith and after finding out about her tryst with Alex, Meredith won't speak to her anymore. Alex says he's up for sex anytime but suggests they not meet at her house, to avoid Meredith. Alex and Meredith are stuck outside their house while Izzie and George try to jumpstart their chemistry, and just then Lexie shows up to ask Alex out for a drink. Meredith chews her out, telling Lexie to get her own friends and her own life. Lexie says she'll wait for Alex at the bar. Alex asks Meredith why any of this matters to her, since she supposedly doesn't care about Lexie at all.
While Erica operates on the woman with the collapsed lung, Lexie asks Meredith if the patient is going to make it, since the fate of the baby rests on the outcome and Meredith points out she's busy. Lexie sits with the husband while they wait for news about his wife. Meredith updates the husband on his wife's progress and then adds, obviously because of Lexie's intervention, that while his wife bonded instantly with the baby, maybe the husband needs a little more time for them to feel like a family. The man admits that he knows five things about the baby, a lot more than he thought he did.
Unfortunately, Erica is unable to save the wife's badly damaged lung and she dies. The husband comes to see the baby and says he's remembered a sixth thing and he's going to name her Keshia, because that's the name her mother had chosen.
Richard gets suspicious that Miranda's really been the one behind all the recent scheduling and advice and she demurs, telling him to ask Callie about it. He catches up with Callie, who says she's busy with surgery, but that she'll "get on" the schedule tomorrow. He tells her there's no need. Richard informs Miranda that he knows she's been doing the job of Chief Resident but getting none of the credit. He tells her she deserves the credit and the job and that he should have given her the job in the first place because she's the one who makes the hospital work. "It's about time you noticed," says says and breaks into tears before hugging him.
Lexie asks Alex to meet her later in the on-call room and he turns her down, saying he doesn't want to get between her and Meredith. Lexie goes to see Meredith and tells her five things about herself, saying she hopes that makes it harder for Meredith to hate her.
At Joe's, Mark offers to buy Erica a drink, telling her how much he admires her technique as a surgeon, and she tells him he's only attracted to her skill, but not to her. And that she's not attracted to him.
Alex tells Meredith he's broken things off with Lexie, who's passed out in her seat at Joe's and Meredith asks Alex to take her sister home. When they get there, Lexie's dad comes out. He's drunk and about to drive to the store for more liquor. Alex offers to run the errand for him and Lexie begs him not to tell Meredith.
George and Izzie bask in the glow of good sex -- until they realize the other one is lying and it's still as bad as ever.