Cameras have been installed in various parts of the hospital. It's all part of a plan initiated by Dr. Alana Cahill (guest star Constance Zimmer) to have a remote physician oversee things to improve efficiency. Big Doctor is watching, though Cristina simply refers to him Bob. Alana also brings in an outside doc to teach everyone how to standardize a medical procedure. The man eats, sleeps and breathes hernias. The first doc who completes his procedure 20 times wins a swell Seattle Grace Mercy West sweatshirt. It's the Hunger Games of hernias!
Richard is perfectly happy with his personal hernia procedure, so he's not thrilled about learning a new way. Bailey, on the other hand, is all about toeing the company line if it means keeping her job. Too bad she can't keep up with one of her former charges. Meredith is a hernia hero until she steps away fearing something is wrong with the baby. Bailey lets her know that everything is cool. That fluttering she feels in her belly is just her baby kicking. Whew!
Cristina works on a kid in critical condition after a skateboarding accident. Leah finds an ID tag listing him as a Jehovah's Witness. That means they can't give him any blood. They need to attempt the extremely difficult challenge of saving his life without a transfusion. The family is adamant that the patient is not to receive blood. That's not good enough for Leah. She tries to sneak the patient a pint, but forgets about the cameras. Dr. Bob busts her, but won't rat her out. As for the patient, despite their best efforts, he can't be saved.
Callie and Arizona's argument about dressing their daughter in the morning spills over a patient's case. A 13-year-old girl needs to get up and moving or clots will stop her from ever walking again. The patient used to be a gymnast, so she feels like her life is over. The girl's meanness has both Alex and Callie feeling like they need to be on suicide watch. Arizona is also on the receiving end of a rant, but she deflects it nicely to get the girl walking. Now if she can only get Sofia to get dressed in the morning.
The anxious interns fear they are going to be fired due to budget cuts. Everyone is a little on edge due to the uncomfortable changes that are headed their way. Richard gets into a heated yelling match with the hernia doc who inadvertently blurts out that the patients don't matter. Bailey ends up winning the competition, but lets it be known that her snazzy new sweatshirt is itchy. Love it!
Owen argues with Alana over the ER situation as they head up to the roof to meet the Medivac team. The incoming patient's carotid artery blows. Alana is closest to the problem, so she stops the bleeding with her hand. She offers to stick around for the rest of the surgery. Alana is surprisingly calm and efficient as a surgeon. Owen wonders why she ever gave it up.
Jackson shoots off his mouth about Alana before he realizes she's behind one of the surgical masks. It's nothing she hasn't heard before at all of the other hospitals she's saved. Owen stops Alana from leaving the surgery once their patient is out of the woods. He wants her to see it all the way through to experience the sheer joy felt when others find out that she saved someone's life. It's a nice moment when she meets the patient's grateful family. Owen can't help but smile. Alana, too.
With only one day left before the ER doors are closed for good, Derek and April pull an all-nighter to find ways to cut costs. They present their pitch to all the department heads. April's initial attempt to get everyone onboard goes south fast. Derek steps in to present the more human side of the pitch. He also has to give up his plum parking space. The cuts are a go, but Alana says it still won't save the ER. The reason she's shutting the doors is to make the hospital more attractive to a prospective buyer.