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A generous 25 million donation is offered to Seattle Grace by the parents of Arizonas 10-year-old patient, she finds herself in a conflict of interest when his condition worsens. Cristina tests her boundaries with Owen at the hospital. Alex is left with all of Izzies hospital bills to contend with.

When Isaac has an inoperable tumor wrapped around his spine, he wants Derek to do the impossible. Derek tests the Chief's authority when Richard objects to moving forward with the risky surgery.

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 resident defends their actions in an effort to save their jobs.

The residents of Seattle Grace and Mercy West vie for their careers.

When Meredith and Lexie's father, Thatcher, returns to the hospital with a failed liver, it's up to Meredith to save his life. Meanwhile, Izzie empathizes with a patient riddled with tumors, as Mark, annoyed with Cristina's competitive zeal, tricks her into assisting on an unusual surgery.

Several weeks after her near-death experience, a recovering Izzie returns to work. Meanwhile, nervous that there will be layoffs in the hospital in the wake of an announcement from the Chief, the Seattle Grace residents compete to survive the cuts, including Cristina, who attempts to work alongside Arizona in pediatrics. And Bailey and Alex's patient's already complex case is further complicated by her schizophrenic son.

Everyone is struggling after losing one of their own and are turning to any distraction they can find. Meredith and Derek seem to be consummating their marriage anywhere and everywhere, while Cristina and Owen have been instructed to abstain from sex by Dr. Wyatt. This is the second hour of a 2-hour season primere. A two episode entries have been created. The 10pm EST marker will mark to beginning of this episode.

The hospital staff is left to deal with the aftermath of George's passing. Hitting the staff hard, they all find unique ways to get through the various stages of grief. George's mom returns, faced with the difficult task of deciding what to do with his organs. This is the first hour of a 2-hour season premiere. A two episode entries have been created. The 10pm EST marker will mark to beginning of the second episode.

George gives Bailey news that shocks the entire hospital as everyone awaits for Izzie to recover from surgery. Meanwhile, Bailey is accepted into the pediatric fellowship program; and Seattle Grace comes together to help save a traffic accident victim.

After spending time with a fellow cancer patient, Izzie begins to question whether or not to undergo a risky procedure. Meanwhile, Mark considers taking his relationship with Lexie to the next level; and after helping a patient, Owen begins to rethink his position at Seattle Grace.

As Meredith, Derek and all of their friends prepare for the big wedding, a group of college students, injured in a car crash, are admitted to the ER.

As preparations continue for Meredith and Derek's wedding, Izzie receives a surprise hospital visit from her handful-of-a-mother, Robbie.

Amidst a series of intense treatments, Izzie throws herself into Derek and Meredith's wedding plans, but the stress of her illness takes its toll on Alex - who freezes during surgery just as George begins to excel. Meanwhile: Callie's father arrives at Seattle Grace, but is less than pleased to meet his daughter's girlfriend; Owen seeks help to quell his PTSD outburtsts.

All eyes are on Derek as he is set to perform his first surgery after his breakdown; attention is also set on Izzie, whose medical condition requires her to undergo a difficult surgery; and Owen has another PTSD episode that injures Cristina and traumatizes both of them, throwing the future of their relationship into question.

After his fellow surgeons try and fail to bring Derek back to work, Meredith must summon the strength to convince him. Meanwhile the hospital is abuzz as Mark attempts a rare face transplant surgery. Cristina, at last awarded her first solo surgery, is more focused on the needs of her friends, and Izzie does her best to keep her medical condition a secret.

After learning at a deposition that more of his patients have died than survived, Derek decides to quit, even as Meredith refuses to give up on him. Meanwhile Bailey and the Chief continue to bicker over her peds fellowship -- until Adele steps in to mediate -- and Izzie's interns discover something unsettling on a "patient x," unaware that the charts they're looking at are actually Izzie's.

Derek's confidence is shaken like never before as he faces off with Addison over what course is best for their dying pregnant patient; Cristina calls the abilities of a renown surgeon into question after she botches a standard procedure; and Bailey, who has decided to pursue a fellowship in Pediatrics, is appalled by the Chief's less-than-stellar recommendation letter.

Addison, Naomi and Sam rush the ailing Archer to Seattle Grace and reunite with old friends Derek and Mark to help save his life; meanwhile, Izzie employs her fellow doctors in a medical game designed to help teach the interns, and Owen runs into a significant someone from his past.

With the engagement ring taken care of, Derek ponders the perfect way to pop the question to Meredith. Meanwhile, Lexie demands that Mark go public with their relationship; and Bailey, happy with her work with recent patients, considers a new career direction.

Bailey becomes desperate as her patient's condition rapidly worsens, causing everyone to work to find the boy an organ donor before it's too late. Meanwhile, Mark finds himself in a compromising position and Crisitina avoids Owen.

Derek's mother, Carolyn, makes a surprise visit and meets Meredith for the first time. Meanwhile, Mark tries to hide his relationship with Lexie; William, the death row inmate, asks to donate his organs to Bailey's patient; and Owen and Cristina go on their first date.

Bailey teams with Seattle Grace's new pediatric surgeon, Dr. Arizona Robbins, to save the life of a young patient near and dear to her heart, as the admittance of a death row inmate at the hospital stirs anger in Derek and further erodes Meredith and Cristina's friendship. Meanwhile, Callie and Sloan work as a team to fight their respective attractions to Sadie and Lexie, and Izzie tells Alex that she's seeing Denny.

Cristina wins the first solo surgery among the residents, but is forced to give it up and choose who will perform the surgery in her place. Meanwhile, Mark heads up a procedure that will allow his patient to regain their ability to speak. Elsewhere, Callie tries to figure out if Sadie is being friendly to her or hitting on her.

Meredith, Cristina and Bailey come to Lexie and Sadie's rescue when a routine surgery goes horribly wrong, as Owen and Derek treat a man seriously injured while sleepwalking and Mark comforts the sleepwalker's distraught daughter.

Meredith's old friend Sadie (Melissa George) becomes an intern at Seattle Grace, but Meredith's other friends aren't exactly welcoming; new surgeon Virginia Dixon (Mary McDonnell) brings rules and order to the OR; and Lexie leads the interns in secretive, unorthodox surgical-training sessions.

The Chief announces to the residents that a solo surgery will be awarded, and the news sends them into a competitive frenzy. Meanwhile Derek turns to Bailey for advice when he feels Cristina is interfering in his relationship with Meredith, and Erica discovers a shocking connection between one of her surgical residents and a longtime patient.

The Chief gives Bailey new responsibility in order to help her to be one of the best surgeons at Seattle Grace. Meanwhile, Owen Hunt, the new head of trauma, clashes with the current staff's methods and abilities.

Bailey leads a team for a "domino procedure" in which each surgery is dependent on the one before it. Meanwhile, Derek receives sole credit for the study he and Meredith worked on; Lexie tries to get George to see her in a different light; and Sloan gives Callie relationship advice.

Meredith is sent into a state of panic when Derek finds her mother's diary in the house. Meanwhile, Callie stresses while preparing for her first date with Erica. Later, Cristina stumbles across a part of the hospital no one has ever seen before.

When the plumbing springs a leak, chaos breaks out at Seattle Grace as the Chief tries to put in place new teaching methods. Meanwhile, George takes his residency exam; and Derek attempts to get Meredith's roommates to move out, much to their surprise.

While Meredith and Derek continue in their new relationship, Cristina continues to get to know the military doctor as they treat his trauma patient.

As Meredith and Derek begin to find that their "happily ever after" is anything but easy, Cristina develops a crush on a military doctor who brings in a trauma patient. Meanwhile, the Chief and his staff cope with the news that Seattle Grace is no longer considered a top-tier teaching hospital.

In the two-part season finale, Meredith and Derek take another shot at the clinical trial while the others race to free a boy from a hardening block of cement. Meanwhile, Izzie helps Alex care for Rebecca and Lexie learns a secret about George's intern status.

In the two-part season finale, Meredith and Derek take another shot at the clinical trial while the others race to free a boy from a hardening block of cement. Meanwhile, Izzie helps Alex care for Rebecca and Lexie learns a secret about George's intern status.

As Dr. Wyatt refuses to let Meredith give up on her therapy sessons, Alex learns the truth about Rebecca's condition. Chief Webber has Dr. Hahn perform a high-risk surgery on his mentor. Meanwhile, after hearing about Burke, Cristina continues to act unusually, going as far as to clean her ever-messy apartment.

The nurses' outcry over McSteamy's frequent trysts leads the hospital to enact a new "date and tell" policy. Meanwhile, news about Burke's career force Cristina to cope with her feelings about the past; Meredith and Derek take in a veteran soldier to participate in their clinical trial; and Callie finds comfort in Sloane when she needs it the most.

Addison makes her return to Seattle Grace in order to perform an operation. As she does so, she is preoccupied by all of the changes in her former co-workers' lives. Meanwhile, Meredith and Derek's clinical trial has its first patient, and Rebecca returns to deliver Alex some shocking news.

Six weeks following Derek and Meredith's break-up, Derek continues to date Rose while Meredith, Alex, Izzie and Cristina compete in a surgical contest. Meanwhile, George and Lexie adjust to their new apartment and Callie finds a new friend in Erica Hahn.

Bailey's family faces a medical trauma, just as her marriage is falling apart, a surprise visit from George's mother comes as a shock to both Izzie and Callie, a faith healer challenges Erica and Alex's beliefs in traditional medicine, and Derek must deal with the aftermath of his kiss with Rose.

In the conclusion to the two-part episode arc, Meredith races to save the life of a paramedic, who is trapped inside an ambulance. Meanwhile, the life of a patient is in Lexie's hands and Derek and a nurse work together to save the life of a patient.

Meredith and the Chief rush to the scene of a devastating ambulance crash in which the lives of the paramedics are at stake. Bailey treats a difficult patient and Ava returns to find Alex with a new girlfriend.

The ER is thrown into a state of chaos following a school bus accident. Meanwhile, Bailey treats her high school crush; Derek goes on a date; and Thatcher comes to Seattle Grace in search of Meredith.

George and Izzie's relationship is tested, as is Derek and Meredith's when Derek wants more than a physical relationship with her. Meanwhile, Mark falls for a surgeon and Callie's position as Chief Resident is put on the line when she gives too many duties to Bailey.

With his marriage once again falling apart, Chief Webber invites the male surgeons out on a "gentleman's evening." Meanwhile, Cristina and Izzie compete for the same surgeries, mainly to impress the doctor performing them; Meredith treats the survivor of a skydiving accident; and two finalists competing in a promotional competition are treated by the doctors.

It's Halloween at Seattle Grace and the day is chock-full of surprises for the doctors. Alex has a surprise visit from a former patient; Meredith thinks her mother's ashes are haunting her; Cristina is snubbed by a top surgeon; and everyone is shocked when Callie reveals George and Izzie's relationship to the public.

Izzie reveals her true feelings for George to one of her and George's friends, and the reaction she receives is not what she expected. Meanwhile, Adele Webber rushes her niece to Seattle Grace; Derek gives Cristina pointers on how to be a better teaching resident; and Norman, the world's oldest intern, misdiagnoses Meredith's patient.

The new interns are in awe of fellow intern George's skill level, and Lexie tries to keep his "repeater" status secret. Meredith comes to Lexie's aide when Lexie is faced with her first emergency situation. The Chief and Sloan have to use a radical surgery to save a woman's vocal ability. Meanwhile, George debates telling Callie about his affair with Izzie.

The interns and residents treat victims of an apartment complex explosion as Alex looks into the cause of the devastating accident. Mama Burke arrives at Seattle Grace to pick up the rest of Burke's personal things while Cristina trades wedding gifts for surgeries. Meanwhile, Lexie tries to talk to Meredith, who is less than willing to do so; Callie deals with the stress of being Chief Resident; and Bailey tries to figure out what to do with her excess leadership skills.

Meredith and Cristina return from Cristina's honeymoon to find that Burke is long gone. Izzie, Alex, Meredith and Cristina start their first day as residents, each with their own set of interns. Among the interns are George, who is repeating his internship after failing the exam, and Lexie, Meredith's half-sister. Meanwhile, Derek begins to look elsewhere after his relationship with Meredith hits an emotional impasse; Bailey grapples with the fact that her former interns now report to Callie, the new Chief Resident; and Richard returns to his position as Chief of Surgery.

A big day arrives for all -- Cristina and Burke's wedding and the interns receive their exam results. Meanwhile, Chief Webber's replacement is named and George and Callie make a decision about their relationship.

The interns face one of their biggest challenges yet -- their first-year medical exams. Meanwhile, the interns must tend to three injured mountain climbers. Elsewhere, Callie becomes increasingly suspicious of George and Izzie and Cristina has trouble writing her vows.

In the conclusion to part 1, Addison visits Los Angeles and continues to reconnect with her old medical school friends. In Seattle, Meredith gets closer to her step mother. Cristina deals with the pressures of her pending marriage, and reluctantly plans the wedding with her mother and future mother-in-law. Meanwhile, Derek operates on Ava.

Addison, on leave from Seattle Grace, heads to Los Angeles to reconnect with old friends from med school. Back in Seattle, Meredith continues to bond with Susan, her step-mother, and Cristina, with the help of both her mother and Burke's mother, begins planning her wedding. Meanwhile, Derek performs emergency surgery on Ava (Jane Doe) and Alex continues to stand by her.

As the interns study for and stress over their upcoming exam, the attendings suck up to the chairman of the board in order to become front runner for the Chief's position when he is admitted to the hospital as a patient. Meanwhile, Burke has a difficult time involving Cristina in the planning of their wedding, Addison and Alex get closer, and Derek begins to second guess his relationship with Meredith.

When Izzie has to face her past, she turns to George for support and comfort. As Alex continues to work with Jane Doe, the two become more attached to each other. Meanwhile, Meredith and Derek begin to question their status while Cristina strives to repair her relationship with Burke despite her past history with Dr. Marlow that continues to damage their engagement.

George comes face-to-face with his father-in-law, but the circumstances of their meeting are less than perfect. Alex continues to tend to Jane Doe and helps her choose how the world will see her from here on. Meanwhile, the board interviews Chief of Surgery candidates, and everyone is stunned when Sloan emerges as a top candidate. Elsewhere, Izzie wrestles with the events of her drunken night with George.

The race for Chief of Surgery continues to heat up, especially when a new contender enters the race. Callie reveals a big secret to George, and when George ends up telling Meredith, Callie kicks him out, leaving George with no where to go except to Meredith's. Cristina and Burke's engagement suffers when a secret about one of Cristina's past relationships is revealed. Meanwhile, Derek treats an old friend; Alex and Jane Doe get closer; and Meredith has dinner with her father and step-mother.

While Meredith's life hangs in the balance, the interns each have to grapple with the reality that she may not make it. Derek refuses to give up hope that Meredith will pull through, but as time passes, Derek begins to slowly break down. Cristina takes the possibility of her death the hardest, and refuses to accept that it could happen. As Bailey and Chief Webber work to save Meredith's life, Meredith is visited by figures from her past, including Denny and Dylan Young, both of whom try to convince her not to die. Elsewhere, Addison and Alex continue to work with their pregnant Jane Doe, who has no memory of the ferry boat accident or her life prior it.

As the chaos surrounding the ferry boat accident continues, Derek frantically searches for Meredith, and is devastated when he finds her barely clinging to life. Cristina is also devastated when she learns about Meredith's condition. Meanwhile, emotions run high at Seattle Grace as family of the accident victims demand to know the status of their loved ones. In the midst of the trauma, Alex has trouble dealing with the death surrounding him; George searches for a missing 7 year-old boy; and Izzie is forced to take desperate measures to save the life of the man stuck under a car.

A horrific ferry boat accident challenges the interns, as well as the rest of the hospital staff, both physically and mentally as they all near their breaking point. Chief Webber has to assemble and send out a team to the location of the accident to help save the few lives that were spared. On location, Alex tends to a woman who was crushed by a cement pylon. Meanwhile, Meredith looks out for a lost young girl and George searches frantically for a woman's young son.

With Izzie's inheritance money, Bailey and Izzie open the Seattle Grace free clinic and eagerly wait for their first patient. The lives of the doctors are put at risk when a patient's blood is found to be toxic. Meredith, Cristina and Izzie volunteer to risk their lives to save the woman after Derek and Burke's air-tight suits run out of battery. Meanwhile, Ellis, Meredith's Alzheimer's-stricken mother, has a change in her condition; George and Callie return to the hospital with surprising news; and Cristina gives Burke an answer to his proposal.

While rumors about the chief's retirement begin to fly among the hospital staff, Bailey pushes for the creation of a free clinic at Seattle Grace. George uses sex as a way to cope with the death of his father, which worries both Izzie and Callie. Meanwhile, The interns treat a woman diagnosed with stage 4 cancer who has a complex Puritan past and Callie and Cristina operate on a runner in order to save his legs. Later, one of the doctors receives a surprising proposal.

Mr. O'Malley heads back to surgery in order for the doctors to operate on his cancer. Meredith deals with her emotions while her father is at Seattle Grace to visit his new granddaughter. Meanwhile, a woman has a breakdown at the hospital after having to give up something important to her. Elsewhere, Meredith continues to worry about Derek when he is unable to sleep.

After George's father's heart operation, Mr. O'Malley heads back to the O.R. for another surgery for his cancer. As George continues to worry about his father, Meredith's father visits Seattle Grace in order to see his newborn granddaughter. Meanwhile, Meredith discovers that Derek is having trouble sleeping, which is no fault but her own. Elsewhere, the interns treat an angry 17 year-old girl with severe scoliosis who has a poor attitude towards the doctors due to the several surgeries she has endured during her life.

Burke and Cristina's relationship continues to be strained in the aftermath of Cristina revealing Burke's limitations due to the shooting. Meredith's half-sister, Molly Thompson, is admitted to Seattle Grace forcing Meredith to once again confront her emotions towards her father and sister. Meanwhile, Derek and Mark are forced to work together when two conjoined brothers come to the hospital to be separated.

The ER is taken over by a horrific car accident and the trauma caused by the accident pushes and challenges the interns. Elsewhere, Cristina begins to wonder if she's doing the right thing by helping Burke lie about his hand condition and Izzie pushes the boundaries of her probation.

George's family comes to Seattle Grace when George's father hurts his clavicle, throwing George into a frenzy. However, George's worst fears about his father's hospital visit are realized when the test results come back abnormal. As Meredith strives to have a more positive outlook on life, Derek and Addison work on finding away to have a civil relationship once again. Meanwhile, Richard attempts to work things out between him and Adele.

The Seattle Grace men pack up and head out to the Seattle wilderness for a camping trip. Back at the hospital, Callie and Addison work together on a pregnant patient who slipped and broke her arm in the shower and Meredith helps Dr. Sloan with a unique sex reassignment surgery. Meanwhile, Bailey becomes increasingly suspicious of Cristina and Burke and decides to confront Cristina. Elsewhere, the interns treat a 9 year-old who swallowed Monopoly game pieces.

Cristina gets the once in a lifetime opportunity to scrub in on a rare humpty-dumpty procedure, much to the envy of the other interns. Meanwhile, Alex begins to question his choice of surgical specialty and George and Addison work together to help Noelle, a woman pregnant with twins that are developing at different rates.

Bailey treats a young woman suffering from breast cancer while Derek begins to learn more about Addison and Mark's rekindled relationship. Meanwhile, the interns team up to defend a resident at a staff meeting, and Meredith and Addison stumble into an awkward situation with one another.

As Addison works with Rebecca, a pregnant woman who needs to have a C-section but wants to give birth naturally, she begins to doubt her abilities as a doctor. The interns work with Shawn Sullivan, a car salesman who wants to return to his normal routine after he has surgery. However, when Shawn lights a cigarette that catches his face on fire, Derek and Mark argue over how they should procede with his burn treatment. Meanwhile, Burke continues to rehab his injured hands with the help of Cristina, gradually progressing from operating on chickens to operating on a corpse. Meredith goes into surgery after her appendix bursts and after surgery, she finally makes a decision between Derek and Finn. Elsewhere, Callie and George continue to discuss their relationship and Izzie meets a man who gives her the surprise of her life.

Finn and Derek continue to try to outdo one another in order to win Meredith's heart. Derek woos Meredith with once in a lifetime surgeries while Finn tries his hand at a romantic hospital date, all making it more difficult for Meredith to make a decision. With Burke's hand continuing to tremor, Cristina does her best to help him deal with his injury. As George and Callie's relationship continues to grow, Izzie attempts to visit the hospital for the first time since Denny's death. Meanwhile, Alex tends to a patient with numerous injuries.

While Burke continues to recuperate in the hospital, his parents arrive at Seattle Grace to visit and end up meeting Cristina in embarrassing circumstances. The interns, as well as Bailey, lobby for Izzie to be re-admitted to the intern program. Meanwhile, Addison opts to take a day off from the hospital and spends the day at Joe's where she runs into both Izzie and a surprise visitor from her and Derek's past. Elsewhere at the hospital, a patient lives what she believes to be her last day to the fullest.

In the fallout of Izzie's decision to quit the program, the interns try to help Izzie come to terms with the death of her fiancé, Denny. Meredith is forced to decide who will be the man in her future after her fling with Derek during the prom. Meanwhile, Dr. Webber is confronted by his wife after spending the night at the hospital; George asks an unlikely person for relationship advice; and Addison must find out which one of a group of teenaged girls is the mother of a baby found in a trashcan.

After Richard learns who Derek is operating on, he tries to pump Addison for information. Callie and George have a talk about their relationship and George's true feelings. Meanwhile, Meredith and Derek get together to talk about Doc, and later realize that their feelings for each other may not entirely be gone despite Finn being in Meredith's life and Addison being in Derek's.

George and Izzie race to find Denny a heart as his heart gets weaker and weaker by the minute. Derek is faced with the pressure of performing surgery on one of his friends, while Cristina is faced with the pressure of running the O.R. after she is left in charge. Meanwhile, the interns are supervised by Erica, a new attending, who tries her hardest to act like Bailey, but has a tough time doing so.

Finn continues to work with Doc and is able to give his owners, Meredith and Derek, and update on his condition. George is assigned to work with Derek, while Meredith is assigned to work with Callie. Denny still is without a heart donor, leaving Izzie and Burke to continue the hunt for a potential donor. Meanwhile, a 12-week pregnant woman dies in the O.R., and her parents' decision to try to keep the baby alive creates a rift between Addison and Derek.

The interns attend to Marshall, an intern from another hospital with short-term memory loss. Marshall was also the cause of a bad accident involving a family, which leads Derek to let his emotions get in the way of his work. Meanwhile, a woman from the past comes to visit one of the female interns, and Burke and Izzie have an idea relating to Denny's condition.

A strict Catholic mother of seven children comes to the hospital to ask Addison for medical help because her equally religious husband refuses to use condoms. Addison is able to come up with a solution to her problem, but Alex's interference causes problems for both Addison and the mother. Derek rethinks his marriage after treating a divorce attorney for seizures. Izzie hounds George for information about his private life and pressures him to move back into the house. Meanwhile, Meredith agrees to go out with Doc's vet and Burke is faced with considerable pressure when he has to operate on his musical hero.

Derek performs brain surgery on Andrew, a young spelling bee champion who suffered a serious head injury. George, who begins to overstay is welcome at Burke's, has trouble not speaking up when one of his patients constantly lies about her health to her daughter. Bailey begins to worry that the interns will no longer see her as "the Nazi" now that she has a child. Meanwhile, Addison treats a patient with pregnancy issues; Alex gets a lesson in manners; and secrets are revealed about Meredith's father.

The doctors' superstitious sides are brought out after several deaths and strange events take place at Seattle Grace. Derek and Addison talk about a more permanent living situation, Izzie worries about Denny's surgery, and Richard gets reacquainted with an old friend.

Cristina has a hard day on the job when Bailey has her take care of her baby after she gets involved in a case, despite being on maternity leave. Meredith continues to deal with the fact that she slept with George, who begins to bond with Burke much to Cristina's disgust. Addison and Derek have a deep talk about their relationship and Denny continues to get in the way of Alex being closer to Izzie. Meanwhile, the interns must deal with a hockey player who wants an unnecessary amputation and a woman with a fork stuck in her neck.

Meredith and George fight over who gets to treat a patient. Bailey, despite being on maternity leave, treats Addison for a specific feminine problem. Izzie starts spending time with Denny, and Alex becomes jealous. Meanwhile, Burke treats a man who had a heart attack, and the man's fiancée leaves him when she learns about the risky surgery he's decided to have.

When a person from Derek and Addison's past arrives at Seattle Grace, their now stable relationship is shaken up. Meanwhile, after visiting with her mother, Burke is told Cristina's secret; and after a visit with her mother, Meredith digs to find the family's secrets.

Despite the staff doing all they can, the potentially disastrous situation continues to escalate. Meredith begins to panic about her situation, as does Derek when he's told about her circumstances. Meanwhile, while the hospital is in chaos, Bailey and Webber have to deal with their own health issues.

All morning, Meredith felt like she was in for a bad day. Her fears are realized when a medical case threatens the lives of everyone at Seattle Grace, causing officials to put the hospital on a "code black".

When the nurses at Seattle Grace go on strike, the doctors are forced to work without them. While most of the doctors cross the picket line, George refuses to cross due to his union roots. With Bailey on maternity leave, the interns meet their temporary resident, Dr. Sydney Heron, who is the exact opposite of Dr. Bailey, which Cristina has a hard time adjusting to. Meanwhile, secrets from Izzie's past are revealed as she treats a young, pregnant teen; and Meredith makes a mistake in treating an elderly patient.

Cristina and Meredith hide the truth about their relationships from each other. George is assigned to discharge an elderly patient who refuses to leave; and Alex learns the fate of his career when the results from his medical exams come in.

As the new year unfolds, Izzie vows to let Alex's affair go, and it comes easier when she hits it off with Denny Duquette, a heart transplant patient. George treats Bex, a teen hermaphrodite, with a tumor and Alex treats a man who ate his novel after not being pleased with the results. Meanwhile, Derek talks with Meredith's mom, Addison expresses her disgust with Derek's living arrangements, and the residents, especially Cristina, have a hard time dealing with the new work limit.

Burke and Cristina's differences are shown when a young boy needs a transplant but he refuses to get it. Meanwhile, the interns help Alex prepare for his exams when it's revealed that he failed them. Meredith has to re-instill the Christmas spirit in Izzie and Derek refuses to feel festive.

Cristina finds little sympathy for an inmate who purposely endangers her health to get out of serving her term in solitary confinement. Meanwhile, the interns are put in charge of watching the newborn quintuplets, each with varying health concerns; Izzie's frustrations with Alex's shortcomings hit their end; and Derek teaches Izzie an important, yet painful lesson.

Meredith is horrified when her one-night stand needs treatment after suffering from priapism. Meanwhile, Alex begins to frustrate Izzie and a pregnant woman carrying quintuplets stresses over her high-risk pregnancy.

Thanksgiving proves to be a difficult holiday for both the interns and residents. Izzie plans a big dinner, but it doesn't look like all the invited guests will show up. Meanwhile, George participates in the O'Malley turkey hunting tradition, which abruptly ends after a shooting accident and Meredith treats a comatose patient whose condition might be better than it appears.

Friends of Derek and Addison come to Seattle Grace for preemptive surgery to avoid breast and ovarian cancer. But the arrival of their friends tests Derek and Addison's professional relationship. Meanwhile, George treats a patient who fell five stories and is dissatisfied with his outcome and Cristina and Burke attempt a "normal" date.

The entire staff is in awe when a patient, Shane, comes in with a hysterical pregnancy while Cristina, Izzie and Meredith aggressively work on his unique case. Meanwhile, Alex is encouraged to show his feelings for Izzie after treating a young, sheltered young patient.

Meredith temporarily forgets her worries about Derek's decision when a train crash results in dozens of injuries. Later, Addison sees potential in Izzie, but Izzie is forced to choose between her friendship with Meredith or her career.

Meredith and Derek have to use more than their medical knowledge when a woman's strictly religious father forbids her from having an operation that would save her life. Meanwhile, George and Alex are forced to perform a surgery in scarce conditions, and Derek is forced to decide between Addison and Meredith.

While trying to recover, Cristina proves to be a difficult patient, and matters are made worse when her mother visits. Ellis Grey, Meredith's mother also proves to be a difficult patient when she has the staff running in circles to please her. Derek and Meredith's relationship remains in limbo when Addison's departure is postponed when she becomes involved with the treatment of a cystic fibrosis patient.

Meredith's secrets about the state of her mother, Ellis Grey, are revealed to the staff when Ellis is brought in for surgery. Meanwhile, secrets about Cristina's health are also revealed.

A family arrives at Seattle Grace after a car accident. While treating the members of the family, Alex discovers that their problems are deeper than their injuries. Meanwhile, Mrs. Webber admits her marital worries to Richard as he recovers.

While off from work, Meredith and Cristina discuss their mutual man problems and are interrupted when Joe, the bartender, collapses. While Webber recovers from his surgery, he appoints one of the surgeons as interim chief, but has George report to him all the happenings at the hospital. While Meredith learns more about Derek and Addison's past relationship, Cristina tries to decide what to do in her relationship with Burke.

When an STD breaks out, affecting several members of the staff, Webber calls a staff meeting. Later, the chief confides in Derek about his own medical concerns. Izzie and Cristina become stressed when a patient's wife and daughter can't decide on his care. Burke treats an old college friend, Bill, but his diagnosis creates questions about his wife. As Meredith and Derek continue to get closer, their relationship crashes down around them when a person from Derek's past shows up in his life.

The interns treat a patient who, after a series of seizures, thinks he's gained psychic abilities. Meredith becomes dissatisfied with her relationship with Derek when she realizes that she knows nothing about his personal life. Alex treats a patient whose religion interferes with her recovery; Izzie debates whether or not to reconnect with her mother; and Cristina's patient disagrees with her medical advice.

Derek and Meredith try to spend a night together at Meredith's, but their appearance the next morning does more harm than they expected and leads Bailey to tell Meredith to end it. Alex treats a self-mutilation patient, while Izzie's patient literally won't let go of his girlfriend. Meanwhile, George is suspicious that an anesthesiologist is drinking on the job and Cristina fills ill with flu-like symptoms.

The interns are speechless when a woman comes in with a large, record-breaking tumor, but unfortunately for the woman, her outlook isn't good. Derek and Meredith's jobs are at risk now that Bailey knows about their relationship, and Dr. Bailey makes it clear that Derek better not give Meredith special treatment. Meanwhile, Izzie urges George to ask Meredith out, and Cristina and Burke's relationship continues to progress.

Meredith realizes the responsibility of adulthood when her mother has to sign all of her assets over to her. Izzie decides to throw a party for her boyfriend, Hank, and the scale of the party, which Meredith is unaware of, increases throughout the day. After popping a glove during a heart surgery, Meredith fears that she damaged the patient's heart and has to face a meeting with the chief and lawyers who will determine her future as a doctor. Meanwhile, sparks start to fly between Cristina and Burke, and Meredith and Derek's relationship is exposed when Bailey catches them together at the party.

While George begins to feel that he's loosing his masculinity due to Izzie and Meredith treating him like a sister, Izzie's newest patient may loose his masculinity to prostate cancer. Cristina assigns herself to a sick woman, who she believes will need surgery, but ends up learning more from the woman then standing in on a surgery would ever give her. Meredith faces the reality of her mother's Alzheimer's when Derek treats a patient with nails in his brain. Meanwhile, Alex tapes up pictures of Izzie's racy spread all over the locker room.

On the day of a bike race, injured individuals flood into the hospital, including a pedestrian who is left brain dead. Seeing that he has no chance of ever waking up, Cristina and Izzie wish to use his organs for organ donation, but find that the process is an emotional one. George gets assigned to Mack, a good friend of Chief Webber, and constantly flirts with George. Meanwhile, Meredith continues to try to distance herself from Derek and is forced to deal with Alex's big ego, but through the day, Meredith begins to realize the key to winning the battle.

The surgical staff tries to stay positive when a young woman, despite brain surgery, is clinging to life after a brutal attempted rape. Meanwhile, Meredith risks her spot in the intern program when she crosses the line in order to save a newborn suffering from a undiagnosed heart condition. The other interns learn that in order to be a good surgeon and doctor, much more than medial knowledge is needed.

On the morning of her first day as a surgical intern at Seattle Grace Hospital, Meredith Grey is running late as she recovers from a one-night stand and prepares for her first day. Meredith quickly befriends George O'Malley, who's quirky, yet lovable, Cristina Yang, a highly competitive woman, and Izzie Stevens, a model turned surgical intern. Each of the new interns get assigned to Dr. Miranda Bailey, who past interns have dubbed "the Nazi".

Meredith's first patient, a young beauty pageant contestant, recently began having severe, life-threatening seizures and Meredith uncovers that she'll need brain surgery to save her life. However, things take a turn when the neurosurgeon, Dr. Derek Shepard, happens to be Meredith's one-night stand. He wants their brief relationship to progress into something more, but Meredith is firm on her stance - their relationship should remain strictly professional.

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