Miranda, Burke, Addison and Derek all lose patients in the beginning of the show. Izzie is convinced there will be three more deaths before midnight. George drops something, Meredith hands it back to him and he just walks away. Meredith tells Izzie and Cristina that Derek says she should apologize till he listens, to which Cristina questions why she should listen to Derek’s advice. Meredith says that he’s a friend. Addison hands Miranda a hot cocoa for good juju because of the four deaths. She hands one to Meredith for her help too and then hands one to Derek. She give sit to Meredith in the spirit of friendship. Derek clarifies that Meredith and him are friends, but Addison claries that they are married so by proxy Meredith and her are friends. Meredith throws out her hot cocoa. The ER starts out quiet, but then gets hectic with people walking in and ambulances. One of the patients was unrestrained in a car and his head hit the windshield. Not sure why, but he is counting with his fingers. He’s counting the siren blips, he says they can’t go until it hits 30 blips. Another patient was struck by lightning.
The woman who was struck by lighting, Nikki, says her horoscope said to stay home today. She doesn’t exhibit any wounds from lightning. But she insists it was a sign that she shouldn’t have left the house. Meredith tells her there should be an entry and exit wound from the lightining. Nikki then clarifies that she wasn’t struck struck, a tree was struck and it fell on her. When Meredith questions her, it turns out it was more a big branch. George tells the Chief that there is a Holly Warner waiting for him. George offers to help the Chief but he refuses the help. Izzie and Alex are with Denny. Denny tells them he knows about the deaths this morning and that they are expecting three more. And that he wants to avoid the ER. Meredith and Cristina both get into the same elevators with their patients. Meredith tells Cristina about the hot chocolate and how she didn’t drink it. Meredith is wondering if she is Derek’s friend, is she obligated to be Addison’s friend too. Cristina says maybe. Callie is helping Nikki. George comes to offer to help out but Callie tells him he’s missed the boat. He wants to know she’s talking about this case or… She spells it out for him that when a hot chick gives him her number, you’re supposed to call. George tries to make an excuse but Callie tells him he’s too late. But Nikki tells him he shouldn’t give him if he really likes her. Meredith walks into the room and George rushes out. Callie notices that Nikki is bruised all up her left side and asks if she’s sure that a tree branch did all this. Nikki asks if she thinks her boyfriend did all this. She says he’d never hit a woman, ever. But Callie doesn’t believe it and says it doesn’t look like tree branches. It turns out she climbed up the tree when it was struck by lightning because she wanted to surprise her boyfriend but had to make sure his psycho dog wasn’t around. But the worst part was that her boyfriend wasn’t home. Burke and Cristina talk about the patient he lost today and how he lost it because he didn’t have one of his caps. Cristina points out that that isn’t the reason why his patient died, which he understands, but he still feels he needs one of his caps. Cristina slyly mentions that she has one of his caps in her locker but will hold it hostage until he gets rid of George. Coincidentally George walks out of the elevator because he’s got some free time and asks Burke if he needs some help. Instead of telling George he has to move out, he is asking George to get the cap back for him. Not very manly of him. The Chief goes to check in on Holly. It’s serious and she’s been puking blood. She needs a new liver, I think she is a former alcoholic. He is scared for her. She mentions that she hasn’t seen him in a meeting for awhile and asks how he’s been. He evades the question. He tells her that Ellis Grey’s daughter is working in the hospital and that Ellis is in a nursing home with Alzheimer’s and he tries to see her as much as he can. We find out that Ellis was the one who drove the Chief to his alcoholic bottom. He insists he’s not having an affair. Holly was his sponsor and tells him that he’s making a big big mess even though he hasn’t slipped yet. He’s been sober for 17 years now.
George is rummaging through Cristina’s very messy locker. She walks in and catches him. He asks what does she want for the cap, which is him out of the apartment, but George refuses to leave until Burke tells him to. Meredith and Miranda are looking at Nikki’s spleen. It’s lacerated pretty badly. Miranda wonders how she got that standing under a tree. Meredith tells her she was climbing it and Nikki may be more of a gentle stalker than a kill you with a knife stalker. Denny has a big clot and Burke tells him they’re going to have to open his chest again. Cristina is with her OCD patient and George is peering in. He likes to repeat things three times, or multiple of three times. Meredith and Derek run into each other and Meredith is about to ask him something when Addison appears. They both look awkward and walk away from Addison. The Chief doesn’t have good news for Holly. He has to do something that has only a 50% survival rate. Turns out her daughter was also an alcoholic but she is sober now. She wants to know what other choice she has, and he is silent. She asks if he will perform the procedure, he says he’s done it nine times and has had four patients alive. She says it’s perfect, she can be his five out of ten. Nikki refuses to have her surgery today, even though she has a ruptured spleen. She says they can’t do it until after midnight, but Burke says she doesn’t have enough time to wait that long. Nikki insists it’s more than just her horoscopes, she went out today and had a flat tire, there was a wreck on the freeway and then she was struck by lightning. Meredith insists that she was not struck by lightning. But Nikki insists if they operate on her today, she will die. She knows she will. She asks that Meredith call her boyfriend and tell him she is having an operation at midnight because he will want to be there. Meredith ends up calling a psych instead. Denny is back in her room. Alex is with him. Denny asks him if he is going to die and Alex pretty much tells him it doesn’t look good and that Izzie likes him but she won’t be the one to pull away.
Cristina and Meredith are outdoors eating lunch talking about their problem patients. George joins them even though Meredith is there because he wants Burke’s lucky cap. Izzie joins them. She wants to know if the whole three more deaths is ridiculous. She admits that she is worried about Denny because she’s his patient. She insists she’s not worried about Denny because she’s sleeping with Alex. Derek tells Cristina’s patient that he has to remove part of his skull cap. He’s been OCD for three years. The Chief goes by Holly’s room and there are a lot of people there. Her daughter(?) comes out and tells him that Holly says that he needs a meeting. He refuses but he is told that it’s not to protect his anonymity or sobriety. He agrees and walks in slowly looking around him. He participates in their prayer(?). Izzie checks on Denny. Denny asks her to do him a favor, to make sure his will gets into the right hands. He tells her they have to be realistic and calls her Dr. Stevens. She tells him he can’t go into surgery thinking he’s going to die. Cristina goes into the bathroom and George follows her in there. He thinks it’s on her and starts to feel around looking for it as Callie is coming out of a stall. They both notice she is there when she goes to wash her hands. Izzie freaks a little when George tells her that Cristina has one of Burke’s scrub caps. Izzie is a little crazy and kind of manhandles Cristina to try to get it back for Burke (actually for Denny). Izzie threatens her and says she will physically kick Cristina’s ass. Izzie seems to be getting a little unhinged now.
Izzie and Cristina walk up to Burke and Cristina gives him his scrubs cap. He thanks her but she tells him he doesn’t need it. He says he knows that he doesn’t need it and that she is right, but he puts it on anyway when Cristina walks away. Meredith is with Nikki and asks if she may be misreading the signs if two surgeons are telling her she needs the surgery? Nikki asks if Meredith has called her boyfriend and Meredith says she did and he said he hasn’t been her boyfriend in awhile. Nikki looks upset. Izzie confronts Alex and asks him what he said to Denny. Izzie makes it clear to Alex that they’re over and he isn’t good enough for her or anyone. Burke tells him they are not scrubbing in with him and kicks them both out. They are playing The Fray song that was used in Scrubs , “How to Save a Life.” I really love that song, but it kind of makes me sad because of the Scrubs episode. The patient that Derek is operating on is constantly repeating, “Find a penny, pick it up, all day long you’ll have good luck.” He isn’t done with his repetitions but Cristina says they have to start and gives him anesthics before he finishes. Derek is ready to hopefully save a life, as is Burke, the Chief (with Dr. Bailey). Meredith walks in as the Chief is starting to get Dr. Bailey because something is wrong with Nikki. She is bleeding out and they have to get her to the OR right now but she doesn’t want an operation. Meredith tells her that her boyfriend called and says he doesn’t want her to die. She seems happier now but goes into code blue before she can say if they have permission to operate.
Izzie is staring at the board. The Chief is working on Holly. Dr. Bailey is still trying to save Nikki. Derek and Cristina are both still working on the OCD guy. Dr. Burke and George is working on Denny and they are losing him. Two other surgeons walk down confirming that they hit seven tonight. Alex has bets that it is Burke’s guy, while the other two think it’s the Chief’s drunk or the spleen chick. The three make the bet while Izzie watches on holding her cross. Miranda and Meredith come out and confirm that it makes five. Meredith says she heard there is a number six but she doesn’t know who. The Chief comes out and tells the group that she made it. Derek loses the OCD guy. Izzie is crying but Denny wasn’t number seven. It’s past midnight and there was only six. She says she can’t fall for a patient, he wishes her luck with that. She goes to kiss him. George walks into the locker room, Cristina, Meredith and Alex are there. Alex tells him he’s a sad excuse for a man. But George has no idea what he is talking about. It’s because George won’t move on past the Meredith thing. He mopes around the place like a dog who likes to get kicked. I’m glad someone said it, but he didn’t have to be such an ass about it. But he’s Alex. Cristina leaves and Burke runs after her. He says if she feels very strongly about George, he’ll ask George to leave that night, but Cristina tells him not to. She wants him out, but not today. He gives her back the scrub cap. George goes to talk to Callie and says he should have called but she’s walks away from him. So he calls her and she picks up and listens and he tells her he really likes her. Addison brings Meredith a cup of cocoa and apologizes for her patient and then goes to give one to Derek. She takes a sip from it this time.