Dr. Alana Cahill (guest star Constance Zimmer) is a physician adviser who has been hired to help Seattle Grace Mercy West avoid bankruptcy. She was Richard's student a long time ago. Alana is concerned from the get-go when it takes 45 minutes for someone to finally treat her fake ailment in the ER. That's not very efficient. April gives Stephanie a crash course on how to keep things moving in the pit. While this is happening, a handsome paramedic named Matthew observes April from afar until he dials up the courage to ask her out for coffee.
Meredith is having a serious bout of raging pregnancy hormones. She cries constantly, especially when she's angry. This has Shane on edge. He screws up an assignment involving a pregnant woman who goes into liver failure. The patient needs a transplant pronto. Shane tries to chat with Meredith about her pregnancy during their ambulance ride to find a new liver. It doesn't go well. Neither does the donor surgery. Shane makes a mistake that causes the liver to no longer be viable. Meredith is furious. She's also a blubbering mass of tears.
Another liver becomes available in Portland. Meredith still can't get on a plane, so she wants Shane to serve as delivery man. Bailey doesn't want this job left in the hands of an intern, so she goes along for the ride. There's a delay before takeoff. Meredith lets Bailey know that she's ready to fly again. She boots her off the plane. Later, Shane discovers a mass on the new donor liver. Not good. Thankfully, further testing indicates that it's still viable. Back to Seattle they go!
Alex and Cristina treat a young girl from Africa with heart issues. Arizona excuses herself in the middle of the first surgery because she's dealing with phantom limb pain. Owen helps her deal with this. They try a virtual reality exercise where a beach scene serves as a calming agent. She later asks Alex to stab her prosthetic foot with a scalpel when she wavers during the second surgery. Owen orders him to do this. So, Alex stabs Arizona. Calmness sets in. The OR assault did the trick. Alana witnesses the entire oddly-effective scene.
Derek's first comeback surgery with his patched-up hand (Callie claims it's her hand) is for a patient named Jimmy. The guy has been waiting for the only neurosurgeon on the planet that will touch his case to get back in the game. Derek doesn't want any distractions, so Jo deceives Alana about the operation's start time. Derek stimulates Jimmy's facial nerve often during the surgery. All is well if he twitches. Alana tries to observe, but Derek gives her the boot from his OR. A short time later, Jimmy's face stops twitching. Not good.
Now it's time for a bunch of random surgery updates. Meredith, Bailey and Shane transfer the new liver into their pregnant patient without a hitch. Mer weeps before surgery when she sees a baby pass by. Apparently, she cries when she's happy, too. The young girl from Africa is breathing easy with a fixed-up heart. Cristina loves that she got to work on such an unusual case. Finally, when Derek and Jo visit with Jimmy during his recovery, they learn that he has full use of all facial nerves. The surgery was a success. Woo hoo!
At the end of a long day, the docs gather in the conference room for an update from the physician adviser. Cristina makes a speech in support for the African pediatric program so that she can see more fascinating cases. Oh, and it saves the lives of lots of kids, too. Alana has no intention of cutting the program. It's a terrific as far as PR. However, there will have to be some cuts. Alana proposes they close the hospital's ER.
Everyone is aghast at the thought of closing the emergency room. Derek tries to speak his mind, but Bailey cuts him off. She says that some people need their jobs at the hospital, as they don't have a few million bucks to fall back on. Ouch! Later, Richard tries to have a chat with Alana, who can see that he's disappointed in her. Changes are coming whether he likes it or not. Alana lets Richard know that he logged fewer OR hours than anyone else last month. Was that a threat?