Severe car crash involving an entire family results in an all-hands-on situation in the ER, as the eldest daughter is left to make the toughest decision of her life. Meanwhile Teddy, still in the dark about Henry's death, calls upon Cristina to help with her patient in the O.R., and Lexie finds herself working alongside Mark's new girlfriend, Julia, during an eye surgery.

Richard performs his 10,000th surgery on a pair of bickering sisters who come into the hospital for a liver transplant; Derek and Lexie take on a neuroblastoma case that has been previously deemed inoperable; Teddy and Cristina cross the line when they go against Owen's orders and try to steal a case from Alex and Dr. McQueen; Ellis Grey's shadow looms as Meredith searches for a specialty; meanwhile Adele is brought into the hospital after she is found wandering the streets.