After a burn victim unexpectedly dies in the midst of a chaotic ER, the Chief and board member Jennings interrogate the residents to find the culprit, as all the Mercy West and Seattle Grace residents defend their actions in an effort to save their jobs.
- Voiceover Meredith started the night by talking about how doctors have to constantly change their perspective in order to get the right diagnosis. All the doctors sat around looking tense -- and the Mercy Westers were now wearing Seattle Grace-issue blue scrubs. They were all waiting for the chief, thinking someone would be fired. Dr. Avery, one of the Mercy Westers, mocked Alex after Alex said something about how long the meeting would take. Avery asked Alex if he needed to make a phone call, and Alex attacked him.
The chief came out and shouted that "what happened to that patient was inexcusable," and that no one would leave until he found out exactly what transpired.
"I'm not going down for this," Cristina told Hunt as he walked into the chief's office.
"Someone is," Hunt said.
Hunt started to tell the chief and Jennings, the board chairman, about the chaotic scene in which "everybody" was on the patient who died. Hunt eventually admitted that Cristina got the chart first. Cristina said she had the patient for two seconds and then was called outside.
Cristina flashed back to when she was sitting in Meredith's hospital room complaining about the Mercy Westers. Cristina was called to the ER and handed two charts off to a pair of the Mercy Westers -- Reed and April. They split up the charts and they talked to each other about how the Seattle Grace doctors hated them. April examined Mrs Becker and Reed was treating Mrs Becker's son. April asked for Sloan's help in treating Mrs Becker's burns then went to help Bailey, who was trying to stop the bleeding on a patient who was bleeding profusely after getting axe removed from his chest.
Charles, the Mercy Wester who was helping Bailey at first, had fainted. He explained to the chief that there was a blood drive that day and he'd been donating. He then flashed back to himself and another Mercy Wester talking about how the Seattle Gracers were "a little douchey" and never wanted to help them.
Charles was giving his side of the story when he flashed back to Bailey asking him to hold the axe and not move a muscle. As he grew weaker, he fainted and pulled the axe completely out as he fell. "In retrospect," he said, "I should've had a cookie." Bailey said it was "stupid, stupid, stupid." Bailey asked Alex to "clean up" Charles' mess, which included a wound he gave himself on the forehead when the axe hit him as he hit the floor.
April said that was the last she saw of the patient, leaving her with Sloan, who she said treated the burn. Lexie corrected that part of the story, saying she treated the burn after Sloan was pulled away by Arizona. Arizona also asked Lexie to help with the new patient, a 16 year old boy. Lexie told Jennings that she didn't rush her treatment of the burns before joining Sloan and Arizona. The other patient was trembling in pain and Lexie turned away. Sloan asked her if she wanted to switch off with Alex or someone else, but she stayed. Then Lexie said Reed stayed with Mrs. Becker, the patient in question.
Reed denied that she was with Mrs. Becker, but that she was with her son before going to help Callie with another patient. Reed left Mrs. Becker alone with her son. Jackson, a Mercy Wester, said that a nurse mentioned Mrs. Becker was in pain. But when he flashed back to the nurse's comment, the nurse asked who was treating Mrs. Becker and no one replied. The nurse placed the chart on a counter between Cristina and Jackson. The chief asked who was in charge: Reed, April, Lexie, Jackson and Cristina all said they weren't responsible. Dr. Avery said Cristina ordered medication and the next time he saw Mrs. Becker, "she was dying."
Cristina said "she wasn't dying, she had some pain." She tried to hand Mrs. Becker off to Alex, saying that his initials, AK, were on the chart (important later). But he was either on the phone or "stitching up 'Nosedive'" -- referring to Charles, the doctor who fainted. Charles said Alex "was supposed to be" helping him. He flashed back to Alex leaving a message for Izzie on the phone. Alex insisted he never saw the patient. Cristina admitted she gave Mrs. Becker morphine. Lexie's name was the next one on the chart.
Lexie said she was "supposed to be" with "the burn kid," but she flashed back to the moment when she was upset to the point of crying about the burn victim's injuries. Lexie left the room and Mrs. Becker's young son came out and told Lexie that his mom couldn't breathe. Lexie went over to her and discovered her lung had collapsed. Mrs. Becker pleaded with Lexie to not let her son see her die. Lexie said she was trying to get a chest tube in the right place and then flashed back to watching Dr. Avery come out of nowhere and jammed something into the woman's chest.
He said he was relieving the pressure so that Mrs. Becker wouldn't die before Lexie put the chest tube in. Lexie put the chest tube in the right place. They said they were distracted by Cristina yelling at a toddler. The chief asked why the kid was there in the first place and Reed mentioned "the patient was coding." She was talking about another patient, a firefighter named Roy who was feeling guilty and sobbing because he missed a step on the ladder and fell without reaching the teenager who had been on fire. He coded and Cristina pounded him on the chest, which restarted his heart without paddles. Reed put the paddles down and that's when Mrs. Becker's son picked them up. Cristina turned and yelled at him to put them down, which made the kid cry.
Lexie said she couldn't watch the kid, but when she wasn't able to handle going back to the burn victim's room, she went back to watch the little boy. Arizona yelled at Lexie for leaving the burn victim's room and told her to find someone who could do her job if she couldn't handle it.
Mrs. Becker, meanwhile, stopped breathing and Charles -- who'd been looking for Alex, who hadn't finished Charles' stitches -- went to try to open her airway, but failed. Reed said she, too, couldn't do it because her airway was completely shut. Alex then showed up and performed a tracheotomy. Lexie went back into the burn victim's room and helped him through the pain. Lexie pulled it together after having frozen before. Reed said Alex came over pale, shaky and apparently unstable and "went in blind" on the tracheotomy while muttering something like "hit the carotid."
The chief asked Alex if he gave blood that day. Alex apparently lied and said no. We'd seen him on the table earlier, but when he was paged to the ER, the new flashback showed that he was never stuck with a needle for the blood draw.
Charles said he was calling Alex over for help, but Alex wouldn't get of the phone. He flashed back to Alex getting a call from Izzie. Alex had insisted he hung up the phone. He was talking to Izzie, who sounded as if she wasn't coming back. He hung up on Izzie to come over and do the tracheotomy and what he was actually saying was, "Don't hit the carotid." He said Mrs. Becker was stable, but she suddenly started "sinking fast."
Alex called Dr. Avery over for help and in another part of the hospital. Someone handed April Mrs. Becker's lab results, asking if she were "AK". Her carbon monoxide levels were high. Charles was on the phone with Hunt, who sent Cristina in to help. April said "everything was failing." Cristina said Mrs. Becker was coding when she got into the room. Suddenly, Mercy Westers and Seattle Gracers were all over the patient doing everything they could to save her. As Reed told her part of the story, she stopped and said, "Oh my God. I know why she died."
Mrs. Becker was bleeding out. Derek came into the room and said it was over and asked for someone to call her. He asked whose patient Mrs. Becker was and everyone stood around the bed without saying a word.
Reed walked out of her meeting with the chief and told April, "I'm sorry." April asked Reed what she said, but Reed said nothing.
The chief told April that Reed spent 20 minutes talking about what an excellent doctor she was, then asked her to tell him what caused Mrs. Becker to die. He asked April what Mrs. Becker's throat looked like, and April didn't have an answer. She flashed back to her initial exam and remembered that she was about to look at her throat when the patient with the axe in his chest was wheeled by them. April was distracted and forgot to look back in Mrs. Becker's throat, where she would have seen soot and intubated immediately -- saving the entire ordeal.
April apologized for making one mistake and getting distracted. The chief began to say he understood, but Jennings cleared his throat as a reminder to the chief that something needed to be done.
"You're fired," the chief told April.
Mrs. Becker's son sat in the waiting room and his dad finally arrived, immediately asking, "Where's your mom?"
The chief said Jennings wanted someone fired for legal reasons, but the chief needed to find out who was responsible.
Derek told the chief that maybe the real problem was that there were too many doctors at the hospital who didn't know each other, and that there'd been chaos since the merger. He blamed the chief for that, saying he should think about who was responsible.
Some of the doctors, including Mercy Westers, talked about how stupid April's mistake was and Reed and, surprisingly, Cristina defended her. Cristina suggested it could've happened to anyone and that doctors should be able to cover for each other. It looks like April's loss made for Mercy West Seattle Grace's rediscovery of teamwork.