Jackson, the little boy in desperate need of organs, will die unless new a new liver and small intestine is found for him in the next 24 hours. Dr. Robbins suggests they try an experimental liver dialysis to extend Jackson's life. Miranda breaks down, saying she can't handle it if he dies. Robbins advises her to get some sleep. Richard orders George to check all brain-dead patients to see if they're a match and to ask, but only ask, whether the families will consider organ donation.
William succeeds in knocking himself unconscious after Meredith tells him that injuring his head could lead to brain death. He needs surgery to live, but he's still conscious and refuses to let Meredith page Derek. Miranda advises Meredith to page Derek. "I suggest you do everything you can to keep your patient alive because we're doctors, Grey. We're not executioners."
Derek is in a great mood after getting his mother's approval of Meredith. He shows Cristina the ring his mother gave him to give to Meredith, wanting to know if she thinks Meredith will like it. He urges Cristina to make up with Meredith, saying she'll need someone to freak out to after he proposes to her, but Cristina says he should find someone else.
"I know you think this is wrong. Just let me do this," Meredith begs when Cristina insists on checking on William herself. When William murmurs that he wants to live, Cristina puts in the page. Derek is furious when he finds out that Meredith's kept William's declining condition from him. "He's been manipulating you since he got here. It was a bad decision. It was the wrong decision," Derek insists. He wants Meredith to scrub in to see the results of her actions.
Derek has only begun the surgery when an emotional Miranda enters the OR and insists he stop the operation. "This man is trying to kill himself. God forgive me, I need you to let him," she begs. Derek refuses at first, but then puts the scalpel down. "It's your call: Am I an executioner or am I surgeon?" he wants to know. Miranda finally realizes what's she asking of him and says, "Pick up the scalpel."
"What a waste," Meredith says as Cristina closes. "We saved a life, that's never a waste," Derek replies.
The night after he came to Cristina's apartment drunk, Owen wakes up naked in her bed, where her roommate, Callie, accidentally sees him.
Mark suffers a severe penis injury after having sex with Lexie in the on-call room. She pages Callie, who summons Owen. The rumor quickly spreads through the hospital while everyone tries to guess who the woman was who "broke Sloan's penis." Sadie correctly guesses that it was Lexie, so she lies and tells the other residents that she was the one. She watches the door as Lexie joins a recuperating Mark. "It's not 'Little Grey,' it's Lexie," she insists. "And I'm not going anywhere."
Denny still hasn't left, even though Izzie made it clear she wants him gone. She finally realizes that what Denny's been telling her this whole time -- "I'm here for you" -- means that he's come to bring her to heaven with him. "I'm sick," Izzie realizes, and yells at him for not telling her right away. "I can go now, because you know," Denny says. "But it's your choice. You get to choose." She tells Denny to go, asking what he's waiting for. "This," he says, and kisses her goodbye.
Owen asks Cristina to give him another chance. "You've got some big problems," she says. "Yeah, I do," he admits, and she says, "Yes."
Miranda goes back to Jackson's bedside and tells the mother it's time to let her son go. Richard has succeeded in talking a brain-dead patient's grieving wife into donating her husband's organs -- just as Jackson flatlines. As Miranda and Richard wait to see if Jackson will make it, Miranda admits she crossed a line to try to save Jackson's life and Richard says, "So did I."
When he comes to, William tells Meredith he was playing her. "I wanted to destroy your career. Your boyfriend was right," but she refuses to believe him, saying she would have been scared to die, too. He asks if she'll come to his execution. "It would be good to have a friendly face in the crowd, when they kill me." When William is led into the the execution chamber, Meredith is among the witnesses.
As William flatlines, Jackson wakes up, and asks his mother for some water.
Meredith finds Derek waiting for her outside the prison. "I know you don't understand me. I don't understand me. It was horrible," she sobs, and he hugs her. "It's okay," he says, and drives her to Cristina's. "She's in the car and she won't stop crying," he says, begging Cristina to go comfort her friend, and she does.