As the hospital spirals closer to financial ruin, Owen must make some tough decisions, which includes foregoing an expensive surgery that could save the life of a child. Meanwhile, Alex and Jo work together to save the life of an infant, and April asks Jackson for dating advice.

The discord and chaos created by the hospital's new management team causes one physician to question his future at Seattle Grace. Meanwhile, the doctors and the interns must juggle several transplant surgeries at once, each coming with its own set of obstacles.