There's more than one Dr. Shepherd roaming the halls of Seattle Grace at the moment. That's because Amelia (guest star Caterina Scorsone) left sunny California seeking help from her big brother. Derek won't even consider operating on his sister's friend, Erica, so Amelia calls him a jackass. Lexie can't help but crack at this.
Lexie convinces Derek to let Amelia practice a procedure she needs to complete in 90 seconds if there's any chance of saving Erica. The dry runs don't go well, but a more difficult plan may actually be more efficient. Derek softens a bit once he realizes that Amelia is stronger than he thought. They work together get the procedure down to 86 seconds. That'll work! They'll be operating on Erica in the "You Break My Heart" episode of Private Practice.
The fifth years are busy prepping for the oral boards. Jackson and April are study buddies. Alex is using his intern, Morgan, to quiz him. Meredith should be studying with Cristina, but she's too busy trying to save her marriage in therapy with Owen. After a clandestine meeting with Richard, Callie considers letting Mer in on her secret study method. She must first prove herself worthy by leading the case involving a man who got his arm stuck in a meat grinder.
The patient's buddies work to take apart the meat grinder. They pass out the moment they complete the job. The arm looks like it can't be saved until Meredith remembers reading something about using a patient's toe to repair a thumb. It's the only way to save the entire arm, and it was all Meredith's idea. Her reward is access to Callie's secret study methods.
Carrie Rissler was given six months to live over eight years ago. She's still around thanks to the efforts of Dr. Miranda Bailey. Now this woman is having a lymph node transfer done thanks to a suggestion from Jackson. Bailey had deemed such a procedure too risky months ago. She isn't happy this is happening now. That's why she demands Jackson and Mark read every single line of Carrie's medical history report before operating.
Bailey drives the surgeons crazy during Carrie's operation. It gets to the point where Mark tells his protégé that he needs to remove all distractions from the OR. So Jackson asks Bailey to leave the room. This has to be a first at Seattle Grace. Mark later tells Bailey that the reason she put the kibosh on the surgery initially is because of the potential consequences. The reason they keep residents like Jackson around is to remind them of all the possibilities. Nice.
Morgan quizzes Alex as he works on a patient. The symptoms she describes are actually the ones afflicting her at the moment. That's why she passes out. Morgan is 24 weeks pregnant. Everyone in the hospital knew that. Well, everyone but Alex. He does, however, know that his intern is having a heart attack. Teddy needs to operate right away which means the baby needs to come out now.
Alex is frantic when complications arise for both mother and baby. He's feeling guilty for running Morgan ragged. He had no idea she was pregnant. Heck, he didn't even know her name. Arizona consoles him by revealing that she used to be just like him. Pediatric surgeons are hard core about learning medicine. That's just what it takes to save all those kids on a daily basis. Later, Alex is by Morgan's bedside when she wakes up. He lets her know she has a baby boy.
Owen desperately wants a reason as to why Cristina doesn't want kids. Cristina wants Owen to stop holding a grudge. All of their conversations seem to circle back to the abortion. They also ask to be each other's person. That may not be the easiest request to fulfill. At the end of the therapy session, Cristina and Owen still seem to be very far apart.