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Meredith and Cristina are still in a fight, so things are tense when they are both assigned to the pit for a trauma patient with Derek and Owen.
The patient is a PDR (patient, death-row) with major stab wounds.
Richard warns them to keep quiet about the case to everyone else.
It's also Izzie's birthday today.
Lexie sidles up to Mark in the x-ray room to say hi, but he immediately gets jumpy, saying that because of his promise to Derek, their sex – as great as it was – can't happen again.
Alex and Bailey have a little boy patient with severe bowel problems. Bailey has been treating him for the past three years and has grown very fond of him and his single mom.
Dr. Kenley, the attending pediatric surgeon, keels over from a heart attack in the middle of talking to the boy. Alex calls a code blue, but it's too late. Richard doesn't take the news well.
Meanwhile, the boy is busy filling out paperwork to have a wish granted by the "wish people." Dr. Kenley was going to sign the application for him.
The kid asks Alex to do it, but he refuses to because he doesn't think the kid is dying and wants to help keep his spirits up.
George, Callie and Mark have a patient who has had six broken bones in the last year due to a benign tumor near a gland that is leaching calcium from her bones.
Lexie and Sadie ask to be in on the tumor removal with Callie and Mark - their respective objects of lust.
Later, Mark and Callie try making out in an on-call room to try to get their minds off of Lexie and Sadie, but can't stop thinking about their interns.
Callie suggests that they be each other's "sponsors."
Dr. Arizona Robbins is the new pediatric surgeon who will taking over Dr. Kenley's patients, including the boy with the bowel problems.
She, however, doesn't agree with the course of treatment that Kenley have been doing, and wants to try something new, ruffling Bailey's feathers.
Robbins agrees to try operating on the boy one last time to appease Bailey, but in the middle of the surgery, she finds that there's not much they can do.
After the operation, Bailey finds Richard lying alone in the dark to complain to him about Robbins, but Richard tells her to deal with it.
The PDR patient is in a lot of pain. Meredith and Dr. Hunt say that their role here is to save his life as they would save anyone else's life, but Derek and Cristina are unsympathetic.
The x-ray shows that the weapon he was stabbed with (a toothbrush melted down and formed into a sharp point) is still lodged in his spine.
The PDR patient, who is scheduled to be executed in a week, explains that if he is paralyzed (by keeping the object in his spine), he might be able to argue in court for a stay of execution.
Derek doesn't want to let him stay paralyzed because he's pro-death penalty, but Meredith reminds them that they don't know the circumstances of his incarceration and shouldn't judge him.
Izzie discusses at length with Denny that she needs to tell Alex about their weird imaginary relationship. So she finally tells him that she sees dead people. Alex is sweet but doesn't really take her seriously.
The PDR patient notices the interaction between Meredith and Cristina is extremely frosty. He bonds with Meredith, telling her that he got into a fight with a friend who stabbed him in the back with the toothbrush.
The patient wants more morphine because of pain, but Derek refuses to give any more because he doesn't think he deserves to have pain lessened.
Behind Derek's back, Meredith gives him more morphine, and Cristina asks him what he did to get on death row. He slit the throats of five women, just for fun.
Derek seeks out Richard in the dark room where he's been hiding. Richard confesses that he's not moping and shirking work because of Kenley's or anyone else's mortality. He's slacking off because he's worried about the failure of the hospital.
He says bitterly that they can't keep attending surgeons on staff because they're either quitting or dying, and it's no wonder that Seattle Grace is number 12.
Izzie finds Alex and explains just how much she sees Denny, even going so far as to tell him that they even have sex together.
Alex is very understanding about it, and knows that sometimes people do weird things to get over the death of a loved one.
Alex does some naughty things to her to help her forget about him.
Later, Izzie, alone with Denny in the room after doing Alex, tells Denny that she really wants to be with Alex, since he's alive and all.
Arizona Robbins says the kid needs to go on the transplant list as soon as possible, but Bailey wants a second opinion. Robbins goes off, calling her out on the fact that Bailey has been second-guessing her.
After getting the second opinion, Bailey realizes that she's right and tells the boy and his mother about getting a transplant. Bailey chokes back her tears.
The surgery on the PDR patient is awkward, with Cristina and Meredith still competing and fighting with each other. After the operation, Owen finds Cristina looking a bit defeated and offers to talk about it.
She unleashes on him for being nice to her only when it's convenient.
Sadie asks Meredith to get a drink, but she's not in the mood. Sadie reminds Mer about their fight in the past, and warns her that if she doesn't make things right, Cristina will never talk to her again.
The tumor patient's surgery goes well, and afterwards, she says that she'll be moving to Denver as soon as she recovers to track down the man she loves.
This inspires Mark, who is hanging out with Callie at the bar, to get him some more Little Grey. Callie gulps down shot after shot to keep herself from going after Sadie.
Richard decides to come out of his dark, little room. Bailey admits to him that Robbins is a good doctor after all, but their patient might not make it. Richard helps her look through the boy's file.
Derek comes home to tell Meredith that his father died because two guys shot him after he wouldn't give up his watch - a watch that his mother had saved up a long time for.
That is the reason why he is against criminals and doesn't want to treat them like everybody else. Then he turns up the music and invites her to dance to make her feel better. He's a terrible dancer.
Alex presents Izzie with her birthday gift, which is cake with pink frosting that he made himself. Izzie doesn't have a single thing she wants to wish for so Alex advises her to wish that things stay the same.
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