Picking up right where we left off last season, half of the staff is operating on George while the rest are trying to bring Izzie back to life. While they succeed with the latter, Derek has to admit defeat with George. They leave him on life support as his organs are still viable, but no one knows if he is a donor or not. Mrs. O'Malley arrives and pleads with Callie (who, she insists, is still George's wife in God's eyes) to make the decision about whether or not to donate his organs. Callie, however, realizes that Izzie knew him best and should be the one to make the call. Alex is against telling her but they finally convince him it's the right thing to do and Izzie of course says George would want everything to go to help people. Everyone is mourning in their own way but currently Bailey seems the worst off -- she barely speaks and seems to be going through the motions in an angry, gutted, haze. The one thing that seems to make her feel a little bit better is ordering all of the doctors there for the organs to tell her specifically to whom they are going, so that she can at least visualize all of the people that George will save.

The gang all go to the funeral, and when Izzie runs off with her shoulders shaking, Meredith, Alex and Cristina all run after her to find that she was laughing. Everyone grieves in their own way, obviously, and it wouldn't be Izzie if it weren't super-inappropriate, right?

Things are generally a mess at the hospital even without taking George's death into consideration. The board wants to oust Richard and put Derek in his place. Derek stalls for time and warns the Chief, but Richard would rather pout about it than figure out an actual plan of attack. Callie goes to him to find out about the status of her application to be an Attending and finds out that it's been pushed, so she pitches a royal fit and tells him he's making a huge mistake and storms out, which of course takes place in front of the Chief Richard-Hating Board Member. Arizona is trying to treat a teenage patient with inexplicable crazy spinal pain but when she orders an expensive procedure, Richard blows up at her in an effort to assert his dominance and orders her to cancel it. It's not going to make the kid's mother, Martha Plimpton, very happy as she's been wary of the care at Seattle Grace from the beginning. To top it all off, there's a girl there whose arms and one leg were severed in a boating accident. They reattach her arms and Lexie is ordered to be her friend as she has no one else and refuses to tell her mother in England that she's had the accident. When Lexie tries to tell her that she's lucky to have lived, the girl pitches a fit and begins screaming that they should have let her die; from the looks of things, during her fit she might have pulled some sort of important tube as last we see her she's bleeding through all her many bandages and possibly making her death wish come true.

And finally, it looks like we might have some moves coming up -- when Mark goes to visit and comfort Callie he notices the apartment (condo?) across the way being renovated and looks seriously interested. Back at Meredith's house, Alex and a newly-discharged Izzie walk in on Meredith and Derek having sex on the stairs, and Derek declares that as newlyweds Izzie and Alex should have their own place and gives them his keys to the trailer. With that, we then launch immediately into the second episode of the season...