Seattle Grace is dealt a serious blow when it falls to a twelfth ranking among teaching hospitals. Richard takes the ranking personally and has no time for Erica when she asks for tips to improve her teaching skills.
Now that Meredith and Derek are back together, she keeps dreaming that he's dead. She decides to ask to move in with her and he accepts. His ex, Rose, is now hostile towards him, even in the OR. Derek asks her to transfer to another department but she insists on staying put.
It's snowing, but now that Seattle Grace's ranking has slipped, ambulances are taking accident victims to other hospitals. The residents are just about to give up on patient arrivals when a battered limo drives up: Three women on their way to a formal event have gotten into an accident which seriously wounded their driver. One of the women, Betty, appears to have a concussion since she keeps asking where she is. Sarah Beth and Anna are not seriously hurt, but are concerned about their husbands.
Miranda hears that a limo with three men -- the women's husbands -- is on its way to another hospital, so she informs the women they can ask for the men to be taken to Seattle Grace instead. When the men arrive, they're accompanied by Major Hunt, a military doctor who performed triage on the scene -- including using a pen for a tracheotomy. Hunt is hurt himself, but insists on checking on "his" patients. Cristina is impressed when he suggests a radical freezing technique to save Philip, who will be paralyzed otherwise. She's even more impressed when Hunt staples shut his own wound without any local anesthesia.
Sarah Beth doesn't know what to do when she's told that her husband's insurance expires at midnight and that all his credit cards have been canceled. Anna confesses to Meredith that she's been having an affair with Sarah Beth's husband.
Alex insists he's fineand Izzie tells him she still expects to see Denny around the corner, so it's okay if he needs some time to get over Ava. He regrets having broken down in front of her, however, and orders her to leave him alone.
Lexie scolds Sloan for being mean to George and the surgeon correctly guesses that she has a crush on George. He says he'll stop being cruel to George if she'll confess how she feels, but she refuses. George misunderstands the situation and thinks that Lexie is sleeping with Sloan.
Meredith has been talking Cristina's ear off about her anxieties over having Derek move in and finally Cristina snaps and yells at her to shut up, saying that the whole thing is a terrible idea. Cristina slips on some ice outside and before Meredith can help her up, a sharp icicle falls, stabbing Cristina in the chest.