Meredith's attempts to cheer up Cristina all fail, so she hands her the sparkly pager, which instantly perks her up as she gets her surgery mojo back.
Derek decides to sell the land on which he'd planned to build a house. Rose tells Meredith about it, saying she knows Derek's doing it because he's lost Meredith, and that the "legend" of Derek and Meredith intimidates her.
Meredith tells Dr. Wyatt that her mother slit her wrists in front of her when she was a child -- and she had to wait until she passed out to call 911.
Callie and Mark are still hot and heavy, only now Mark likes to spice things up by talking dirty about what they'd also be doing with Erica if she were here.
Miranda is told that she needs to spend 15 more hours a week in surgery to sit for her board exams.
A major trauma case comes in that no one knows how to handle: A teenager named Andrew was dared to lay in a bed of quick-drying cement and is now encased in solid layers of the stuff. None of the surgeons can agree on the right way to proceed. Richard orders them to get started because the patient's already been stuck in cement for 4 hours and they'll have only 20 yet before he dies.
Construction workers chip away at the cement as Andrew confesses he did it to impress a girl, but that not only has he not impressed her, but now she'll always remember him as the idiot who died in a block of concrete. The team has to work fast, not just to free him from the concrete, but to stop his organs from shutting down and his leg from swelling dangerously. The O.R. is booked but Miranda realizes they've been giving him water for four hours and his bladder is likely to explode unless they put in a catheter immediately.
Derek and Meredith next two clinical trial patients are two tumor-ridden teens in love, Beth and Jeremy. Her parents oppose the match because they're worried if he dies, Beth won't want to live either. Beth is trying to get her mother to leave her alone with Jeremy when he starts seizing violently.
Richard tells Meredith that since they've had 11 deaths with their clinical trial, the board will be shutting them down at midnight tonight: They have one last chance to save a life. Jeremy is already scheduled and Meredith wants to also get Beth in before the deadline. Beth is determined to get to Jeremy before his surgery, although she can barely walk. Meredith and Derek find her and she asks if she can be alone with Jeremy -- as neither of them have ever had sex. They stand watch outside the door as Jeremy and Beth sleep together for the first time.
It's time for Jeremy's surgery. He won't be conscious before Beth goes in for her operation, so they say their goodbyes, and promise that neither one of the will die. "Do not kill him," she tells Derek as they wheel Jeremy away, but Jeremy dies. Beth is devastated, as are her parents, who were hoping for a miracle for their daughter. Beth's parents want to take her home, but she insists on having the surgery today, saying Jeremy would be mad if she gave up.
George complains to Lexie that even though he's the chief's intern and has access to everyone's files, he has no power and no cases. She sneaks into the Chief's office and takes all the files and reads them, including George's. She tells him he failed the intern exam by one point.
Izzie is concerned about Rebecca's declining health and keeps calling Alex for updates. Alex tells Izzie that Rebecca's fine -- until he finds her in the kitchen with a bloodied knife.
------------- Freedom, Part 2
Andrew asks to see Lola, the girl he was trying to impress, who's goofing around with her friends in the waiting room. Once she's away from her jerky companions, Lola admits she does care about Andrew, but she cares more about what her friends think. "You're going to hate yourself for this," Callie tells her when Lola refuses to see Andrew.
They're about to remove the last bit of cement from Andrew, and Miranda tells him that once they do that, there's a chance that all the toxins will rush to his heart, but that they are ready to deal with that. He crashes and they rush him to surgery.
Derek is furious with Meredith for encouraging Beth to have the experimental surgery because he's convinced they'll kill her too. And when that happens, he says, he doesn't ever want to talk to or see Meredith again.
Dr. Wyatt tells Meredith her mother didn't intend to kill herself but won't explain further, trusting Meredith to reach the conclusion on her own.
George is discouraged, rather than encouraged, to realize he missed passing his exam by one point and tells Lexie that he'd rather not have known that. She points out he had more letters of recommendation than any one else and that she knows he's capable of greatness.
Rebecca has slit her wrists but Alex nixes a psych consult. Izzie says it's her call as Rebecca's her patient but Alex yells, "Will you leave us alone, you stupid bitch?" Izzie goes to Miranda -- who's in the middle of surgery on Andrew -- for advice, and she tells her she already knows what to do. Izzie fetches a psychiatrist and takes Alex aside while he talks to Rebecca. Alex swears he can take care of her, because he took care of his mother when she was going through a "bad patch," and that's all Rebecca is going through.
Andrew flatlines during the surgery and Cristina suggests a controversial heart procedure that she did with Burke. Richard gives her the go-ahead and even overrules Erica when she walks in and tries to take over. He tells Erica that she needs to learn how to be a better teacher if she wants to stay at Seattle Grace. Cristina, meanwhile, is so happy after being able to operate again the she shows Lexie how to do a running stitch on a banana.
Derek is melancholy before the last clinical trial. He tells Rose he's not good enough and that he's "failed her" over and over again. She's sure he means Meredith, although she asks whether he meant to say, "them," meaning the patients.
Beth survives the surgery and Meredith offers to stay with her, but he tells her to go. She goes home to find Rebecca's blood all over the kitchen, which she cleans up, all by herself.
To the Chief's surprise, George has stayed all night to keep watch on Andrew. When Richard tells him, "Good job," George says it's not a good job for him, since they both know he's better than that and that he deserves a second chance, like Izzie and Meredith and Cristina have all gotten. Richard is convinced, and says he can retake the test.
Callie admits to Mark that she was turned on during the surgery, when they worked closely with Erica. He tells her that it's not his dirty talk about Erica that's turning her on, it's who he's been talking about.
Lola is still waiting at the hospital, but won't see Andrew since it would cost her the respect of her friends. She tells a disapproving Callie that she doesn't know how hard it would be if she let Andrew knew she liked him and Callie tells her it's better to be honest.
Alex goes to see Rebecca and tells her he called her husband, who told him that he'd taken the baby and left two months ago, and that she has a borderline personality disorder. He admits that he can't help her and that she'll have to be admitted.
Miranda tells Izzie she's handing over the running of the clinic to her, because she doesn't love it as much as she loves her job, being a surgeon and her husband and child. She tells Izzie that she's grown into a fine doctor, one who makes her proud.
Richard is angry with Meredith for telling Derek that she had the Chief's approval for a second surgery, when she didn't. Instead of apologizing, she tells him that her mother tried to kill herself after he left her, which he didn't know. And she realizes now why her mother didn't mean to kill herself -- as a skilled surgeon, she could have killed herself instantly by cutting her throat instead. Meredith also realizes that when her mother told her to "be extraordinary," she wasn't talking about surgery.
Lola not only comes to see Andrew, but she kisses him for the first time.
Meredith examines Beth's X-rays and sees that her tumor has shrunk -- the trial was a success! She asks Rose to tell Derek, but she says to tell himself. Rose congratulates Meredith on her medical breakthrough, saying, "It's the stuff of legends."
Derek finds Beth's parents sobbing -- he expects the worst but finds her alive and awake. In his frustration, Derek had earlier thrown out the celebratory body of champagne, but now he goes to retrieve it, and to find Meredith.
Meredith shows up at Derek's trailer but he's not there. Instead she finds Richard, who tells her he's not a bad man, even though he knows he's the villain in her story. He goes home to Adele and tells he's not asking her, he's telling her he's come home. "It's about time," she says.
Mark and Callie are leaving the hospital together when they see Erica. He urges her to go with her instead. Callie tries to talk to Erica, but instead just kisses her.
George tells Lexie that because of her, he's retaking his intern exam and kisses her in his enthusiasm.
Izzie tells a broken Alex she's sorry about Rebecca and he kisses her. She tries to tell him no, but he says, "Please, just for this one night."
Derek looks for Meredith everywhere and then finds her on his patch of land. She's set up candles to outline where their house will be. She keeps talking about how she's going to try to trust him and he shuts her up with a passionate kiss. He tells her before they go any farther, he needs to talk to Rose, and he asks her to stay and wait for him.