Alex is one of the candidates Alana would like to see become a Grand Ambassador for the hospital. He's extremely uncomfortable taking part in a photo shoot. Things are also awkward at home. Jackson and Stephanie are making out on the couch while Cristina and Owen are making love upstairs. Jo helps alleviate things by making loud animal noises. Now everyone else feels uneasy. Jo is a cool lady, but Alex swears there's nothing romantic happening here.
PR folks follow Alex around snapping photos of him as grateful patients hug him for his life-saving work. Jackson is also in the running for the Grand Ambassador gig. The two competing docs team up on a young transgender patient. The patient's father is upset about his daughter's impending operation. It leads to a shoving match with Alex and a heated confrontation with the patient. Nevertheless, the operation is a go.
Pegasus Horizons is the group interested in buying Seattle Grace Mercy West. Callie and Richard check out another hospital they've purchased in the past. They go undercover as the married Calliope and Julio Plantain, with Richard playing the part of a patient. They later use their real names while saying they are reps from Pegasus. They find a lot of unhappy docs who have been forced into toeing the company line.
April joins handsome paramedic Matthew for a drive-along. They pick up a 10-year-old kid who is in critical condition after a hit and run. April knows the boy will die before they make it to the nearest ER. She calls Jackson for help. Since Seattle Grace is no longer a trauma center, Owen and Alana say they'll be liable if anything goes wrong. That's why a team of rogue docs sneak the patient in after prying open the closed ER doors. Unfortunately, all the equipment and medicine has been cleared out of the area.
Jackson, Meredith, Cristina, Alex and a gaggle of interns work to save their patient while keeping all unfriendlies at bay. The paramedics also pitch in by offering equipment from their rig. Without a nurse on hand, Jo is forced to show off her math skills to figure out proper dosages. Derek is wrangled into the mix because his hospital code is needed to access the proper meds. He steers some reps from Pegasus away from the hot zone by offering to show them a real brain. Cool!
Despite Derek's best efforts, he can't keep Alana and the Pegasus folks away from the old ER. Jo screams that they have to move the patient. April is freaking. What if the kid dies?! Alana and the others make their way into the ER. Much to Derek's surprise, the place is empty. All is well until Alana sees a few drops of blood on the floor. She's off in a huff to find out where it came from.
Alana busts in on Alex and Jackson only to find that they are operating on their transgender patient. Frustrated, she heads off to another OR to ultimately find the secret patient. Alana and Owen want the 411 on whoever is on the operating table. That's tough to say, as Meredith claims to have blown away all info due to the problems she been having with the hospital's electronic records system. Oops!
Alex and Jackson come clean about what they did to save a kid's life. Alana realizes that it was Derek who used his code to get meds for the patient. She's trying to help, so she wants him to stop undermining her and get onboard with the program. It looks like Derek is doing just that. His portrait now adorns the inside of the elevator doors. In other news, the Alex and Jackson's transgender patient is going to be fine, but his dad just can't deal with such a big change.
Speaking of change, Meredith thinks Alex should consider getting romantic with Jo. Maybe he will. Matthew the paramedic finally gets the courage to tell April he likes her. They share a long kiss as Jackson walks by with Stephanie. Owen lets Cristina know that she and the other docs are making things rough for him just before they start sucking face. Richard is considering cashing in on his early retirement package. Callie lets Derek, Meredith and Arizona that they can't let Pegasus take over. That's why she thinks they should be the ones to buy the hospital.