After learning of Richard's drinking problem, Derek confronts him for the sake of his friend and the hospital, Izzie returns, hoping to reconcile with Alex, and tensions run high between Teddy, Cristina and Owen in the aftermath of Cristina's startling confession.

As part of their training, Seattle Grace's residents are put in charge; the attending surgeons compete for a million-dollar grant.

Owen puts the residents through a rigorous trauma certification drill; Cristina is left alone to monitor an ill lung transplant patient.

The residents are on their own with the dreaded night shifts while the attendings go out to play to celebrate Derek's grant for his clinical trial.