Meredeth packs up Ziola's clothes and Derek thinks it is a sign that she's losing hope. Meredith assures Derek that it is just because when they get her back, she will be bigger. Derek is not convinced. Avery sends Lexi to meet with his sister, and Lexi realizes it is because his mother's coming into town. She is upset but Meredith reassures her that he is only trying to save her.
Everyone gathers for a lecture by Dr. Avery. She presents a patient without a penis and announces a contest where the winner will get to operate on the first penis transplant ever. The competition comes down to Avery, Meredith, and Karev. Karev is out because he gets an emergency page.
Baily is struggling with her feelings for Ben. Richard tries to convince Baily to let Meredith help with the trial but Bailey refuses. Karev and Arizona discover that Ziola's experienced a seizure. They want to tell Derek and Meredith but can't because of their pending custody. Ziola needs an emergency surgery and Karev pages Cristina who decides they have to tell Meredith. Meredith runs out of her penis implant surgery and finds Derek. They both decide on not going in to see Ziola because of their pending custody. We later see Derek and Owen talking in the staircase and we find out that neither of them have fully forgiven their spouses.
Ziola comes out of surgery and Cristina volunteers to take care of her and give Meredith and Derek updates. Meredith and Derek sing Ziola to sleep over the phone.