A patient who needs an extremely difficult surgery comes to Seattle Grace, and it's Richard and Owen who vie for the opportunity to tackle it. But the decision lies in the hands of Derek, who deems that Owen should take on the surgery, leaving Richard bitter. Meanwhile, Bailey deals with her own personal struggles when she nervously prepares for another date with Ben.

When famous surgeon Dr. Harper Avery is rushed to Seattle Grace-Mercy West, the staff is surprised to discover that one of their own is related to this legend, and his unorthodox request for his surgery causes tensions t between Derek and Richard. Meanwhile Callie and Arizona try to help Teddy and Sloan move on from their pasts and find greener pastures.

In his new role as Chief, Derek restores the hospital lecture series, and Richard, Bailey and Callie present to the group pivotal surgical cases from their pasts Bailey reflects on her first days as a shy resident, Callie looks back on a polio case, and Richard recalls a case in which he and Ellis worked on a patient diagnosed with GRID, a virus later called AIDS.

It's Valentine's Day, and the doctors must treat dozens of injured people after the roof collapses at a popular romantic restaurant; Derek tries to manage his busy schedule as Chief of Surgery; Meredith wrestles with her new duties as the Chief's wife; and Mark and Callie team up to convince Sloan to do the right thing for her baby.

After being named interim chief, Derek begins to settle into his new position but faces a lawsuit when Bailey and Meredith's patient wakes up during surgery. Meanwhile, Teddy refuses to let Cristina be a part of her service, Alex continues to work with Arizona in pediatrics, and Mark avoids talking to Lexie who is still heartbroken over their break up.