The boards are over. The fifth years are physically and emotionally spent. No one has any idea how they did. Catherine lets Richard know that at least one resident from Seattle Grace Mercy West has failed. The question is... WHO?
We jump back in time to observe some of the sessions. Cristina is beyond fidgety thanks to the plodding pace set by her elderly inquisitor. Meredith is still trying to keep from vomiting thanks to her lingering stomach flu. Jackson is still trying to process the fact that his mom slept with Richard. April is still trying to process the fact that she slept with Jackson. As for Alex, he's still trying to get to an exam that's already started.
Alex finally arrives to learn that he's already failed the first of the three sessions. That means he needs perfect scores in the remaining two. Speaking of being perfect, April demands that she have all the information on a case from her questioners even though it's time to move on. She's sweating up a storm, as evidenced by all the moisture seeping through her shirt. Jackson continues to have mommy issues. As for Cristina and Meredith, one is trying to contain her rage while the other is trying not to lose her lunch.
In random news, Bailey is asked to woo some snooty possible replacement residents just in case they lose anyone after the boards. Derek is told to use metaphors whenever anyone asks him for advice. He takes this approach with Meredith when she calls with fears that she's failing her boards. Believe it or not, his cryptic answer invigorates his wife. Richard and Catherine make plans to meet up at a future medical conference. In one final random tidbit, Julia blurts out that she and Mark should have a baby. Oh boy. Or girl!
Jackson finds April in mid-meltdown as she tries to dry her sweat-soaked shirt in the men's room. He's having his own personal panic attack. They calm down once they start reminiscing about their night of passion. CLICK! That sound you just heard was Jackson locking the men's room door so he and April can have some alone time in the nearest available stall. When they go back into their respective exam rooms, both formerly flustered fifth years are back at the top of their game.
Meredith vomits up a storm upon returning to her exam session, but she forges ahead through upchucks. Cristina continues to be combative with her guy. Her session ends abruptly when the old doc says there's no need to go on. Alex is also very hostile once he realizes he got sucked in by a trick question. He goes off on his examiners who don't seem to be sympathetic to the fact that he was late because of his dedication to a patient.
Arizona's best childhood friend, Nick, is in town from Tibet. He was her rock after her brother died. The guy has cancer, but Callie is optimistic because it's been slow-growing for six months. Nick clarifies that he's actually had cancer for six years. The guy's in a lot of pain. There's a good reason for that. Callie discovers that Nick's cancer has spread. There's very little they can do for him. Needless to say, Arizona is devastated. She's also furious at Nick for not calling her sooner. She couldn't help her brother, but she could have helped him.
Derek, Mark and Lexie treat a man who fell off a roof. They are fixing a bone defect that occurred after the initial operation. They secure a titanium plate onto his skull. During the operation, Derek tries to subtly deliver a message to Lexie about her situation Mark. Later, Lexie repeatedly tells Mark that she loves him during a sweet, rambling speech. It ends abruptly when Julia pops by. As for Mark, he just stands there speechless.
Back in Seattle, the fifth years learn their fate one by one. Jackson is the first to find out he passed his boards. Cristina and Meredith have also made it through. Even though he missed the first session, Alex has passed the boards, too. But we said earlier that one of our favorite docs didn't make the grade. By the devastated look on April's face, we now know who it is.