Cristina is thrilled when Teddy assigns her her first solo cardio surgery, a heart-valve replacement. "I am a living, breathing cardio-thoracic surgeon as of now," she boasts. The patient throws Cristina for a loop, however, when she decides against the mechanical valve for one from a pig, which is an entirely different surgery. Cristina preps for the new surgery, and then the patient decides she wants a cow valve instead. Cristina presents her with both valves and forces her to choose. But there's a problem during surgery when the patient starts to bleed out. Cristina is faced with two choices of how to solve the problem and can't decide which to do. We get more than a little alarmed when Teddy refuses to step in, and also dissuades Owen, who's just entered the O.R., to take over. "She's not going to let her die. She's going to save this patient," Teddy insists, and we're relieved to see that she's right. Cristina makes the right call and the patient is fine, but Owen asks Teddy, "So nothing else was going on in that room?"
When an ultrasound reveals that amniotic bands are wrapped around the legs of Sloan's baby, Mark summons Addison to perform the surgery. During surgery, Addison estimates that a complication means there's a 5 percent chance that the procedure can kill Sloan, so Mark orders Addison to stop. Sloan insists that she can't take care of a baby with no legs and Mark tells her he won't let that happen. With a worried-looking Lexie over his shoulder, he tells Sloan to move in with them permanently. We can't blame Lexie for balking at becoming an instant grandmother, but we also understand why Mark chooses his daughter over Lexie. "I think this relationship just ended," Lexie says as she kisses Mark goodbye.
Derek realizes that Richard made an error during a surgery and hasn't operated since. Miranda lies to cover for the chief, and so does Meredith, at least by omission. When Derek presses her to know what's going on, she finally admits, "He's drinking again."
Meredith is appalled when she hears Reed offer "drinks and...you know" to Alex if he'll let her scrub-in on his next surgery. She reminds him he's still married and he tells her, "I'm done worrying about Izzie because she sure as he'll ain't worrying about me. I'm moving on." Meredith calls Izzie to warn her that Alex may be straying. After the "trade" surgery, Alex wants to collect on Reed's offer, but she plays coy. "I don't trade surgery for sex," he tells her. "If you want sex, ask for it. If you want a surgery, kiss up to an attending."
Alex doesn't want to go home to the trailer and Lexie has moved out from Mark's. We totally see it coming when these two heartbroken docs end up in bed together.
Cristina is raving about how alive the surgery made her feel when Owen tells her that Teddy is leaving Seattle. Cristina races after Teddy and begs her to stay. "What do you want?" she asks Teddy. "More money?" Teddy tells her that's not the issue. Cristina begs, "You believe in me more than I do and i need that. I'm going to die here without that." Teddy finally blurts out, "I want Owen" and we're as shocked as she is—and Cristina herself seems to be—when Cristina says, "Fine, take him."