No one, including Meredith, has heard from Derek. She tells the Chief she won't go back out to talk to him. Miranda bullies Callie and then Owen into talking to Derek, but they both start drinking along with him after dredging up memories of patients they've lost.
Mark is undertaking a rare surgery, a face transplant on a man unkindly nicknamed "blowhole," after losing most of his face to a car accident. The interns all murmur when Mark chooses Lexie to scrub in. Due to the drain on services, Cristina is awarded her first solo surgery, a hernia patient, but is more intent on lining up an appointment with a highly regarded specialist for Izzie.
A patient can't help wondering why one of the interns has a shiner, another is crying, and one has a bleeding arm, but Meredith insists the residents shouldn't get involved. George tells Meredith he's sure something is wrong with Izzie, but she's too preoccupied with the intern drama to follow up. She finally learns the three interns are involved in a love triangle and orders them to never act this irresponsibly at the hospital again. Izzie chews out the interns for being insensitive to the face transplant patient and Mark takes her off his case.
Miranda admits that she sent Owen and Callie to talk to Derek and that now she's lost them all, so Richard drives out and finds them all drinking on Derek's front porch. Derek takes Richard to task for sending Meredith out to see him, expecting a ring. "Why in God's name would you do that? You destroyed me," he says, and goes into the trailer.
Richard follows him inside and says, 'I've destroyed lives before and you're not one of them. I sent the woman who loves you out here to bring you back to your life. If you ruin it with her, that's on you." Richard continues, "I've been where you are. You've been drunk for a few days, I was drunk for years. And I know you're going to need at least one friend when you get out of that hole you're digging."
"I don't think I can get her back," Derek admits. "What am I going to say?" Richard tells him how Adele took him back even after his years-long affair. "You can make your way back from anything," he says.
Cristina is furious when Izzie blows off her appointment, but Izzie insists she doesn't want to be a patient, citing everyone's insensitivity to "blowhole." "I will not be a piece of meat in this hospital while you all argue over who gets to slice me up and then laugh while you do it."
Cristina urges her to talk to Meredith or George, but Izzie refuses to tell anyone else. "If you don't tell anybody, I will," Cristina threatens.
"I don't even know if I want treatment," Izzie says. "Why should I put myself through hell if it's not going to work anyway?"
Cristina demands, "Why did you tell me if you don't want my help?" and Izzie snaps at her to keep her mouth shut.
Cristina pauses before beginning her solo surgery and then tells Alex, who's assisting her, "Izzie has stage four metatastic melanoma that has spread to her brain, liver and skin. She may only have months to live and she's resisting treatment. She needs help." She then asks for the scalpel.
Cristina tells Izzie, "I told Alex and Bailey, and they're telling Meredith and George. I think you came to me for help, and that's what I did. Sometimes we win, Izzie. And I want you to fight." Izzie can only say, "Thank you."
Lexie is tired of all the interns' speculation and decides to kiss Mark in front of them. "They think you're taking advantage of me, they think I'm using you, but they don't know us," she says.
Meredith goes to the trailer after Derek calls. "I love you," he says before asking her "Would you still love me if I weren't a surgeon?" She says, "No," and tells him Izzie has skin cancer that's spread to her brain and Derek is "one of about 20 people in the world who can save her. And I don't know if I could respect somebody who could walk away from a gift like that. So please don't."
She shows him Izzie's scans. "It's pretty bad," she says, and drives away.
Izzie's friends help her into her gown as she goes from being a doctor to being a patient.