This is one of those episodes that starts out by showing us the aftermath and then goes back to show us how it all happened. The doctors are all gathered -- every single regular player including the four main new Mercy Westers -- to each speak to Richard, Jennings, and a hospital attorney as Richard tries to figure out who was responsible for the death of a patient. That night, the ER had been overrun with injuries from a hotel fire. A teen is brought in with massive burns, a firefighter fell three stories from a ladder, a dude tried to run down a flight of stairs with a fire axe and wound up embedding it in his sternum, and a mother comes in with some burns on her chest and leg, along with her little boy who is fine. While Cristina is first to grab the chart, she immediately hands it off and April is the first doctor to see the woman. April and Reed gripe, as they watch all of the "good" patients come in, that the original Seattle Grace docs are hogging all those cases.
After examining her, April hands the woman off to Sloane for her burns and goes to help Bailey. It's the first in a whole series of flashbacks, as each doc tells the small panel what they did that night. They wind up showing that nearly every doctor at some point or another worked on the young mother. When she wound up not able to breathe, each doc sees her at a different point -- first her lung collapses, then her airway constricts completely, and eventually she suffers organ failure, bleeds out and dies. As Richard interviews each person and hears their side of the story, each doctor winds up looking pretty bad for either missing something, not being sure of what they actually did, or for not being with the patient at all when they probably should have been. Ultimately, however, Reed is the one who realizes where it all went wrong, and that's with April at the very beginning, when she got distracted by Axe Guy and forgot to visually check her patient's throat. If she had, she would have realized the woman had smoke inhalation and treated her appropriately, but since she didn't she started in motion what ended in the patient's death. Richard has no choice but to fire her. All of the remaining residents both start to come together in blaming her while still also arguing and pointing out each other's mistakes along the way, until Cristina points out that it's a mistake any of them could have made, and a maybe kinda possible sorta truce could possibly be starting. This is while another showdown appears to be brewing: Derek tells Richard that he's let the hospital dissolve into chaos since the merger, and implies that what happened as much his fault as April's. It's about time, both that there was an actual consequence for this being the most unprofessional workplace in history, and for Richard to be made to actually take some responsibility rather than just saying he's taking it. Of course, I'm not sure he'll actually take that responsibility, but at least it kind of gets the ball rolling in that direction.
It's nighttime, it's raining (in Seattle! Imagine that!), and the thunder rolls and lightning flashes ominously so we know that things aren't good. Mere tells us, "In order to get a good diagnosis, doctors have to constantly change their perspective. We start by getting the patient's point of view, though they often don't have a clue what's going on." Mere, an overnight bag packed, gets her IV taken out by a nurse while she looks anxiously out the door.
"So we look at the patient from every possible angle. We rule things out. We uncover new information, trying to get to what's actually wrong." In one of the trauma rooms, a guy mops up a massive pool of blood. Outside, Alex walks out into the rain while on his cell phone. "We're asked for second opinions. Hoping we'll see something others might have missed." Alex paces a bit, then hurls his phone into the wall, which made all the more dramatic by the sound effect they picked -- not a crunching phone, but the sound of a car crash. No, the accident of the week isn't a car crash, but doesn't it sound scary?
"For the patient, a fresh perspective can mean the difference between living and dying." Inside, Alex is back and he and all of the other regular residents and attendings are gathered in a hallway, looking somber. "For the doctor, it can mean you're picking a fight with everyone that got there before you." Reed comments rather breezily that someone is getting fired, and April tells her, horrified, to stop while Charles gripes that it wasn't his patient. Everyone's tense and cranky, and when Alex asks how long it's going to take, Avery asks pointedly if he needs to leave and make a phone call. When Charles snickers, Alex snaps and lunges at Avery, and a thousand fanfic chapters are begun. I think this is what it must be like for guys watching two hot girls have a pillow fight -- I just had to fan myself! Everyone jumps in to separate the two and Richard comes out of a room at the end of the hall and hollers, "Enough!" He lectures them all that what happened that night was inexcusable, and they'll all be there until he figures out who is responsible. Everyone is to sit and shut up until they are called, and Hunt is the first up. As he walks in Cristina tells him in a low voice that she's not going down for this, but he just tells her that someone is before going inside to face the jury.
It's a good thing there's a big storm because thunder and lightning punctuate just about every dramatic moment tonight, and there are a lot. Hunt sits on one side of a long table, facing Richard, Jennings, and a woman who is their "in-house counsel" but yet is not important enough to have a proper name. As the actress' name is Saundra, let's call her that, shall we? Jennings plays good cop and tells Hunt they, "just need to get in front of this thing," but Richard cuts him off and has Hunt lay out the scene that evening. Hunt explains that the ER was slammed with victims from a hotel fire including burn victims, a "penetrating chest wound," and a firefighter with multiple injuries; there's a flash to each as he lists them. When asked he tells them that Cristina, Lexie, Alex, Reed, "That big kid whose name I don't know" (Charles), April, Avery and Callie were all working that evening. We're also treated to a shot of each of them, all looking worried and/or flustered in the middle of a whole lot of chaos. Jennings asks him who was on the patient who died, and Hunt nearly shrugs as he tells them that everyone was everywhere. Richard asks who then got the chart first, and a roll of thunder precedes his reluctantly admitting that it was Cristina.