Burke has been shot and Izzie has just cut Denny's LVAD wire. George, Meredith, and Cristina all wind up helping Izzie keep Denny alive long enough to get moved up the transplant list and get the heart in question. Addison figures out that Richard's niece's (Camille) cancer has unfortunately returned. Bailey and Derek are attending to Burke and it's Derek who must operate on Burke to help save his surgical skills. Richard and his wife discuss his past affair with Ellis Grey. Meanwhile Alex desperately stalls at Mercy West in order to maintain possession of the donor heart while the rest of the interns struggle with each other in their fear of losing their places in the program as well as Denny, who makes a surprise marriage proposal to Izzie amidst the madness.
After Bailey discovers the interns and Denny's situation, she helps them confirm Denny should receive the heart. Burke decides to have the surgery performed, risking nerve damage. But during his surgery, Derek must perform a wake up test to check for nerve damage, and he asks Cristina for her help. But Cristina, horrified at the sight of Burke in pain on the table, freezes. Alex travels with Dr. Hahn from Mercy West with the heart, scrubbing in with Dr. Bailey for Denny's transplant. However, after the heart has been inserted, it still does not begin to beat and back in Derek's OR, Burke still cannot move his fingers successfully.