The episode begins with Cristina dancing away in Meredith's bedroom, telling Mer to dance away the pain and frustration she feels about life. Meredith is obsessing about what she would do if she didn't have Derek in her life in some form. She wants to tell Derek not to see other people, but isn't sure how to. Izzie, brooding, resents Cristina and Meredith's friendship, especially due to issues with George.

Miranda is at home with her husband and son, Tucker Sr. and Jr. Tucker is upset that she is at the hospital all the time. She asks him to meet her for lunch so they can talk, but then must rush off to Seattle Grace.

Derek asks nurse Rose if they can be friends. He sort of flirts with her, pointing out some licorice stuck in her teeth. Later, Derek notices that she is wearing an engagement ring - around her neck. Clearly Der is making himself comfortable as a friend. Rose tells him that they broke off the engagement because he couldn't give her what she needs. Funny how things like this work out.

Lexie is still mad at Alex but finds herself more attracted to him all the time. She even tells this to her patient (Seth Green), who just had a huge tumor removed from his neck and now only has a thin piece of skin over his artery. This recovering patient flirts with Lexie and tells her that his girlfriend recently broke up with him ... probably because of the tumor.

Then the big stuff happens.

Dr. Hahn receives an emergency patient who has heart problems, but just as he is being rolled into the hospital, an ambulance comes flying around the corner, crashes into another ambulance and puts the lives of everyone on the scene at risk. The driver of the ambulance had a seizure and blacked out, causing her to lose control of the vehicle.

One of the paramedics in the ambulance suffered internal injuries from the crash, and we learn he is a white supremacist when he refuses treatment from both Bailey and the Chief. Cristina Yang gets the honors.

Two medics were in the ambulance that was hit, and Richard says that one of them, Stan, will bleed out and die as soon as he is moved from the upside down position in which he is trapped. His partner, Ray, talks to him to try to keep his spirits up, so that he can stay alive in time for his wife to get there and say goodbye to him at the very least.

Emergency workers pry open the wrecked ambulance to get Stan out. At that point Stan yells to stop because an oxygen regulator is embedded in Ray's back, which caused a tear in his heart. Stan dies as predicted. Richard tells Mer they need to examine Ray with an ultrasound to determine the extent of his injury, so Meredith crawls through the smashed window.

Bailey struggles with treating the white supremacist, who insists on having at least one white doctor in the OR. They get George to complete that part of the surgical team. Bailey calls upon Jesus to give her strength before cutting him open across a huge swastika tattoo. Unfortunately, she misses her lunch date with Tucker. In the other OR, Derek has just drilled a hole in Mary's brain (the paramedic who seized and caused the crash), but as he does so, the imaging computer goes dead. Completely dead.

Dr. Hahn asks Mark for help with her heart patient. Even after she shoots down his offer for drinks after work, Mark agrees to co-operate with her, and lets Alex scrub in with him as well. This works out interestingly for Karev, who encounters Ava at Seattle Grace yet again. She wants to spend time with him so he sneaks her in to watch the surgery from the gallery.

Of course, Ava blows her cover by remarking to Lexie how amazing surgeons are. Ava says she's here to watch Alex, which upsets Lexie. The young Dr. Grey goes back to her patient, Nick, who suggests she go out with him if she is looking for revenge on Alex. They start to laugh about his plan ... but his artery bursts all over Lexie.

To be continued in the conclusion, "Crash Into Me, Part II" ...

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