Patient who needs an extremely difficult surgery comes to Seattle Grace, and it's Richard and Owen who vie for the opportunity to tackle it. But the decision lies in the hands of Derek, who deems that Owen should take on the surgery, leaving Richard bitter. Meanwhile, Bailey deals with her own personal struggles when she nervously prepares for another date with Ben.

When Alex's younger brother, Aaron, shows up at Seattle Grace-Mercy West with a hernia, it's up to Alex to get Bailey's approval for his pro bono surgery. Matters are further complicated when Aaron discloses that his family has not heard from Alex since he arrived in Seattle, and parts of Alex's past long kept secret are revealed to his friends and fellow doctors.