The residents of Seattle Grace and Mercy West vie for surgeries and their careers as day one of the hospital merger begins. Meanwhile, Arizona stands by an enraged Callie when her father, Mr. Torres, employs a priest to help convince her to date men, and Izzie experiences the brunt of her new surgical competition.

When Isaac, the hospital lab tech, has an inoperable tumor wrapped around his spine, he turns to Dr. Derek Shepherd to do the impossible, and Derek tests the Chief's authority when Richard objects to moving forward with the risky surgery.