- While Derek and April try and find a way to save the ER, Cristina and Leah struggle to keep a patient alive while respecting his wishes. Alana is pulled into a surgery with Owen that may change the way she views the hospital's ER.
- Meredith and Cristina are checking out the new cameras that have been installed throughout the hospital. Cahill explains that the cameras are in place to minimize mistakes because there are doctors watching on the other side. The interns aren't in the meeting, but Jo overhears some of it and tells the others that the interns will certainly be fired.
The doctors are also worried about the new developments. Derek and April have stayed up all night working out cost-saving measures that they hope will keep the ER open.
Cahill introduces another doctor, Dr. Nessbaum, who is showing the surgeons some new procedures. Bailey is overly eager to show how excited she is about all the changes, thinking that cost-cutting is going to bring on layoffs and she wants to keep her job.
Arizona and Alex have a 13-year-old patient who just underwent hop-replacement surgery. The patient is "mean," and neither of them wants to work with her. Callie, after some back and forth with Arizona about how Callie is the "bad cop" when it comes to taking care of Sophia, orders Alex to go in and get the girl to move her hips.
Hunt is refusing Cahill's orders to stop running the ER, saying there's one day left of its operation and he doesn't want her workers getting in the way by starting renovations early. On the way to the roof to get a patient from, they argue about the merits of emergency medicine. Hunt explains that the closer you are to the source of an injury, the better chance you have to help. The patient gets rolled into the elevator. He's a 40-year-old man who was on the wrong side of a chainsaw accident. The man's carotid artery starts spewing blood and Cahill is on that side of him. She stops the bleeding, telling Hunt she "was closest."
In the O.R., Cahill is still holding the artery. Hunt offers to get another surgeon on it, but Cahill wants to stay.
Derek and April are going over their presentation on their way to it. Derek gets a page from Hunt and has to go to the O.R. He tells April to go do the presentation without him.
Dr. Nessbaum finishes his training, but Webber says he wants to keep doing it his way. Nessbaum proposes a contest, asking the surgeons to perform 20 hernia operation simulations using his method. The first to finish gets a hoodie.
Alex's patient unloads about how upset she is because of her hips. She was a gymnast and was hoping to take care of her mother with her gymnastics career. She tells Alex he might understand if he'd "ever been great at something." She says her life is over and now she'll just "wait to die."
Leah tells Cristina that "Dr. Richardson" is suggesting a different medication for her patient. Cristina goes into the room and confronts the camera.
April catches Dr. Russell, who doesn't want to hear about her proposals and is upset that funding for TED conference trips is being cut.
In surgery, Cahill is still helping with the operation. She starts humming as she works and Hunt realizes she enjoys surgery. Derek comes in and isn't happy to see her. He notes that if the man's chainsaw accident happened the following day (after the ER was closed) "he'd be dead already."
Cristina gets an emergency patient, a teenage boy who was injured slaloming. They're about to start giving the kid blood when a chain falls from his wrist. Leah picks it up and sees that the kid is a Jehovah's Witness. Cristina tells everyone to stop. They can't give him blood.
The O.R. is being prepped for a bloodless surgery. A machine will recirculate the patients blood instead of using donor blood. Leah can't believe it. Cristina hasn't done an aortic transplant without blood before, but is going to try it.
Callie and Arizona keep going with their good cop, bad cop thing.
Cristina preps the O.R. and gets started. She's about to cut, but says she can't because he'll lose too much blood. She's going to go in a different way.
Meredith finishes the first round of the hernia challenge first, and gets high praise from Nussbaum. Webber flubs it and Nussbaum encourages him to keep trying. Bailey does OK, but uses too many sutures and gets annoyed when Nussbaum tells her to look at Meredith as an example of how to do it correctly. Meredith smiles and offers to help Bailey, who offers to smack Meredith in the mouth.
The friend of the Jehovah's Witness waits and Leah comes out to talk to him. The friend says that the injured boy never talked about being a Jehovah's Witness. Leah sees the boy's family praying in the lobby.
Jackson comes into the chainsaw guy's O.R. and sarcastically talks about the time- and cost-saving measures Cahill is recommending. He then realizes that Cahill is in the surgery, wearing a surgical mask. Jackson leaves and Hunt apologizes to Cahill for Jackson. Cahill tells him "it's easier if there's a bad guy." Cahill says that without her they'd lose the entire hospital.
"So if you need to blame me instead of thank me, I'm fine with that," she tells him. "Because I will know who saved it. I've saved a dozen before just like this one, and nobody thanked me for those, either."
Cristina is looking for ways to get the Jehovah's Witness skater dude to produce more blood on his own. Leah still thinks it's ridiculous that they can't give him blood. Cristina tells her she doesn't get to have an opinion about it. Cristina agrees to go talk to the family.
Callie tries to get the gymnast to move so the muscles around her hips won't atrophy. The girl tells Callie about how she feels completely helpless and like everything is totally out of her control. Callie says nothing.
Bailey is getting the hang of the hernia thing and gets giddy about it, but Meredith stands up and takes a deep breath and walks out. Bailey gets serious and follows Meredith out of the room. Meredith thinks something is wrong with the baby. Bailey touches Meredith's stomach and tells her this isn't a bad thing her baby is kicking.
Cristina is explaining the blood situation to the skater's family, but they refuse to use donor blood. Cristina reiterates that without blood, the boy's organs will fail and they will run out of options. The boy's mother cries but still refuses to accept it. His father says that living with the donor blood would be worse than dying without it. Leah tries to interrupt, but Cristina stops her. Leah stares at the parents for a moment before walking away after Cristina assures them they will try to do everything they can without giving him blood.
April reports back to Derek about how the various doctors have reacted. Derek shows April how it's done by chatting up another doctor while asking him to cut one of his two fellows to save money.
Cristina gripes about her intern and she and Meredith go to get a granola bar. Leah watches Cristina walk away and ducks into the skater's room. She smuggles in a bag of blood and gets ready to attach it, but the doctor on the other side of the camera tells her to stop.
Cristina yells at Leah and tells her she knows nothing. Leah says she's trying to save the patient because he's "circling the drain." Cristina says she understands Leah's passion, but kicks her off her service. Leah apologizes and leaves. The doctor behind the camera says he won't get Leah fired because she didn't do anything. Cristina tells the camera doctor that Leah's right about the boy circling the drain, and the camera doctor agrees.
Cahill removes the clamps from the carotid she helped repair. She breathes a big sigh of relief. She tries to leave, but Hunt tells her to stay and help finish, and then she can tell the man's family that she saved him, "and then they'll thank you."
Stephanie tries to encourage the interns, saying that if Cahill is planning for the future of the hospital then there will be a future. Callie overhears all this and tells them the future is completely out of their control.
Derek comes back to Dr. Russell, who doesn't want to hear anything about cutting the TED conference. Dr. Russell tells Derek that he wants his parking space, which is right next to Derek's. He doesn't want a trade, but he wants to take it over so he can park his car in the middle and not have his doors dinged by Derek. Derek brings up Dr. Russell's sister, whose aneurysm he clipped in the past and Russell said he would owe him a big favor. Russell relents but still wants the parking space.
Webber finishes a round of the hernia challenge, but Nussbaum isn't pleased that he didn't use the approved method. Webber did his own thing, and goes on a rant to talk about how he doesn't want to work on an assembly line of medicine. Nussbaum gets flustered and says Webber is "missing the point, this isn't about the patients." All the doctors whip their heads around while Nussbaum stammers to correct his phrasing.
Cristina's patient is crashing. Leah watches from the doorway as Cristina and others try to save him. Cristina finally calls the time of death. Leah walks in and tells Cristina that he didn't have to die.
Arizona shows up and sees that Callie and Alex weren't able to get the gymnast out of her bed. She walks into the room and tells her to get up. Arizona says she knows how this feels. The girl tells Arizona, "you don't know what I want." Arizona busts out the trump card, rolls up her pant leg and shows her prosthetic leg. The girl isn't buying it, though, mocking Arizona for the fact that they sent "the cripple in to come and tell me how to live my life." Arizona is fed up and starts giving the tough love, telling the girl that she isn't going to let her take other people down with her. She's going to be kind and thoughtful and will get up an walk by the time Arizona counts to three, or she'll drag her out of the bed. The girl gets up and takes some steps.
We next see the chainsaw guy's wife thanking Hunt, but he tells the woman to thank Cahill. She hugs Cahill, who smiles.
Nussbaum shares an elevator with Webber and Bailey, who say nothing while he tries to be cheery about hernia surgeries. He gets that they don't like him, but tells Bailey the sweatshirt she won looks good on her.
"It's itchy," she says, before walking out.
Cahill tells Hunt she forgot what a rush it is to save lives. He says they can do it again the next day if they keep the ER. Derek and April bring their budget plan to Cahill and say they can save the ER. She tells them they've misunderstood. She says no amount of budget cutting will save the ER or the hospital.
Derek realizes she's getting the hospital ready to be sold. Cahill confirms that a buyer is going to save the hospital, she just has to "make it presentable."
Hunt says she's "staging it, like a house."
Cahill confirms this and says "the ER is like the shag carpet it's got to go." She apologizes and tells Hunt she had a wonderful time that day.
Hunt shuts off the lights to the ER and walks away for the night. He walks outside and Cristina is waiting. She asks him what he's going to do. In the short term, he says, he's "going to drink a lot." She offers to buy the first one.
That night, Derek feels the baby kicking and laughs.
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