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For the first time in the show's brief history, the story begins with a voiceover by George, not Meredith. It's appropriate, considering the soul searching he is going through.
Following their brief romantic encounter, things are beyond uncomfortable between George and Meredith at work, with everyone immediately sensing that something happened between the two. The tension is palpable, with George seemingly ready to implode at any moment.
In typical cool, collected fashion, Burke admonishes Cristina for prodding into George's personal life, then goes on to save the life of a man whose fiancee leaves him on the eve of heart surgery. If it weren't for the best surgeon in Seattle, this man's broken heart might well have been stopped completely.
Meanwhile, just as things between Alex and Izzie seem to be progressing, their relationship is strained by the reemergence of Denny, whose bad heart (and charm) gained him a place in Izzie's once before. Alex appears more whipped than ever and is noticeably jealous by the attention Izzie pays Denny. At the end of the episode, she breaks plans with Alex to spend time with the patient (whose own affection for Izzie is thinly veiled) in his room.
Although Bailey is on maternity leave, and her husband is discharged, she finds herself stuck in the hospital treating Addison... who catches poison oak in a particularly precarious place after taking the dog out for a walk in the woods and deciding to relieve herself as well. She blames karma for the ironic turn of events and begs Derek's forgiveness once again. He may not have forgiven her, but he responds with sympathy... and no small amount of laughter.
Things go from bad to worse for George when his encounter with Meredith becomes public knowledge and he dislocates his shoulder in a fall down the stairs he was trying to flee down. A flashback clues us in to how awkward and sad the incident was, with Meredith crying out of regret while having sex with George. Bruised mentally and physically, O'Malley reaches his breaking point... and what may become his defining moment.
Despite Meredith's pleas for him to stay, George takes Cristina's advice -- to stop feeling sorry for himself, and to start demanding better. He packs his suitcase and moves out of the house... and onto the couch in Burke's apartment. Cristina may soon regret that pep talk. Meanwhile, Dr. Callie Torres, the resident who treated his shoulder injury, becomes enamored with George and passes along her phone number.