Just 17 seconds separate Denny from the man ahead of him on the heart transplant list. Had Mr. Duquette's information been entered into the system just 17 seconds earlier, he would be first in line.
At first, it's looking like a sure thing, as Mercy West Hospital has a pair of donor hearts ready for both Denny and the other man. But soon after Dr. Burke and Alex arrive at Mercy West to get Denny's donor heart, it becomes unusable.
Burke immediately campaigns for Denny to receive the second heart, even as he is now behind on the priority list. In his fight to get Denny a new heart, he squares off with a no-nonsense Mercy West surgeon intent on getting the heart for her own transplant patient.
The rival surgeon, who also happens to be a former medical school rival of Burke's, wins her case with the people in charge, so Denny is out of luck. Unless, that is, Denny's case worsens and an emergency arises. Aware of this, Izzie phones Burke from SGH and informs him of Denny's deteriorating condition -- a blatant lie. Earlier, Denny signed a "do not resuscitate" form and told Izzie that if this transplant doesn't work out, he was ready to give up the fight. Izzie has other ideas.
Flustered, she buys Burke an hour while she runs tests to prove Denny's worsening state. After Izzie begs, pleads and grovels with her bed-ridden love to go along with her plan -- which effectively involves making his LVAT device stop working so that his heart fails and he gets the transplant -- she calls Burke back and tells him to hurry, but still won't provide concrete test results, as they don't exist. Suspicious, Burke decides to return to SGH himself and verify the situation.
On the Mer/Der front, they're in a full-on lover's quarrel over Meredith dating Finn. Addison confronts Meredith, asking if she is still involved with Derek. When Meredith tells her about Finn, Addison finally snaps and lays into Derek for his apathy, screaming at him on the catwalk as the whole staff stands beneath them, well within earshot. Richard lectures Addison for creating such a spectacle, but at the same time reaches out to her as the good friend and person he is.
In case you haven't noticed, the gigantic chip on Calli's shoulder grows bigger by the day. Her insecurity regarding George's intern friends makes her hard for them to like. When Meredith casually asks her for information regarding bone cancer (because that's what Doc has), Calli bristles and asks why no one respects her field. George is the bigger person, though, and tells Calli to lighten up if she wants to be a part of his "family." After this talk, she sees the error of her ways and reaches out to Meredith as a doctor and friend.
The rest of the staff had been tending to a group of young staffers at a local restaurant who were shot when a former employee came back and went postal. The target of this shooting spree was the restaurant's manager, a condescending jerk who dove through a window to avoid being peppered with bullets -- then taunted his staff in the hospital for not being quicker on their feet. After his constant badgering annoys everyone within earshot, Bailey finally puts him in his place, and he apologizes to his staffers upon being discharged.
Unfortunately, the shooter is waiting for him outside, and Burke -- having just returned to SGH to evaluate Denny -- is the unintended victim this time around. As the screen fades to black, Izzie officially cuts Denny's lifeline (his LVAT) while a wounded Burke lies motionless outside the front entrance.