The doctors of Seattle Grace are caught off guard when Dr. Alana Cahill (Constance Zimmer) comes into town. The fiesty physician advisor, recruited by Owen, needs to find efficient ways to cut the hospital's spending in order to remain open. The hospital's financial woes stem from the plane crash victims' severance payments, which the hospital is now responsible for, marked at $15 million each.
After Owen announces Cahill's impending arrival, Meredith pulls Derek into the on call room for an "urgent" matter, which turns out to be sex. Apparently her pregnancy hormones cause her to want sex, all the time, which Derek is a fan of. Before the two even share a few minutes together, Meredith receives a page that she's needed on a consult. She begins to cry but stops when she hears Shane outside, begging Derek to talk to Meredith for him so he can scrub in on Derek's surgery. Meredith bursts open the door, demanding him to do the work up because they have a consult to do. Ah, hormones.
Cahill fails to make a good first impression on the doctors after she is nowhere to be found during Owen's staff meeting, where he planned to introduce her. It turns out she was in the hospital all along - in a busy, crowded ER. Stephanie asks April for help since she's struggling with the ER. April boasts to Stephanie she'll show her how to get things done. April walks over to the bed to find a patient who claimed to be suffering from shortness of breath. Surprise! It's Dr. Cahill. Cahill scolds the pair for her 45 minute ER wait which made her late for her very important meeting. (Oops!)
Meredith and Shane examine a pregnant woman, who's in terrible pain, but not in labor. Shane mixes up the tests, delaying the results. He runs off to get the test he forgot while Meredith stays with the patient. It turns out their patient needs a new liver, fast. Meredith and Shane head off to a nearby hospital to retrieve a donor liver, but Shane botches the extraction, costing them the organ. The two get a second chance when they're offered another donor liver, but there's a catch: it's a plane ride away. Meredith eventually faces her fear head on and flies again.
Arizona continues to struggle with the loss of her leg, resulting in some strange nightmares. She assures Callie she's fine, but she can barely make it through her surgeries. Owen and Cahill walk into the doctor's lounge to find Arizona, who's visibly upset. Owen excuses himself and sits with Arizona, reassuring her she's not "going crazy" because phantom limb is real. He brings over a mirror and puts it next to her other leg to calm her down, explaining that they'll find a solution that works for her. Eventually Owen brings Arizona in for biofeedback therapy, consisting of controlling waves, which she calls "dumb." After some initial hesitation, Arizona finally gives it a real chance due to the fact that she has to operate later that day.
Webber is shocked to learn that Cahill, one of his former students, turns out to be the hospital's physician advisor. He asks Cahill out for coffee multiple times, suggesting the two could catch up, but she quickly denies his invitations, stating she's too busy. Instead, she plans to spend her time observing two big surgeries: Derek's acoustic neuroma and Arizona, Alex and Cristina's pericardial stripping.
April surprisingly takes Stephanie under her wing and teaches her the ins and outs of running the ER. This is shocking, considering April knows that Jackson and Stephanie are sleeping together. (Well, kind of.) Stephanie and Jackson meet in the on call room later that day, but Stephanie can't even focus on sex with Jackson because she's too preoccupied with work. Instead she leaves him and runs off to learn from April in the ER. Later that night, April gets asked out by a cute paramedic as Stephanie happily looks on.
Cahill criticizes Arizona for having what she calls a "panic attack" during surgery. Little does she know Arizona is struggling with her phantom limb syndrome. Owen tells her to leave the situation alone, asking her if there's somewhere else she has to be. Cahill is surprised to learn that she was duped by Jo, who told her Derek's surgery was rescheduled for that afternoon. She rushes to find Derek in surgery but he quickly informs her she's not welcome in his OR.
During their pericardial stripping surgery, a weak Arizona tells Alex to stab her prosthetic in the foot. Cristina and Alex are extremely confused about what's going on with Arizona, but before they get an answer Owen demands that Alex stabs her prosthetic leg. "It's an order!" Arizona finally eases up, allowing her to get back to surgery.
After a close assessment of the hospital, Cahill calls the staff in for a meeting. She starts off by thanking everyone and segways into Alex's Pediatric African Exchange Program. Before she can even begin to compliment the program, Cristina cuts her off, exclaiming "You can't cut that program!" Cristina attempts a heart warming speech, which everyone can see right through. The truth is, the more patients that the program brings in, the happier Cristina will be. "I will never get that that chance. They will never get that chance. They. Precious children." Cahill explains she has no plans to cut the program. It's PR gold and puts the hospital in a positive light. She does recommend to close the ER, spreading chaos throughout the room. "This is ridiculous," says Derek, before he's publicly bashed by Bailey. "Do you have a better idea? Because the way I see it this woman is trying to keep the hospital from closing, in which case there'd be no patients, we'd have no jobs and some of us don't have a few million to fall back on. So unless you have a better idea, why don't you just sit there and listen to what she has to say." Oh, no she didn't!
At the end of the day, Callie is ecstatic that Derek completed his 23 hour surgery, but is noticeably still annoyed with Cahill's request to cut the ER from the hospital. "Do you want to go to the beach with me?" Arizona asks, confusing Callie. Eventually she gives in and joins in Arizona's meditation, confessing it's actually nice. Meanwhile, at Meredith and Derek's, Meredith is still in shock over Bailey's outburst, insisting she had no right to do that in front of everyone. Derek defends Bailey, who he believes was just nervous. "Everyone should be." As the two sit together, Meredith congratulates Derek on his first surgery back and Derek learns Meredith got on her first plane since the tragic crash. Ah, progress. It seems like the Seattle Grace docs are starting to move on, once and for all.