It's finally time for the Boards, and after a couple of brief delays, the residents all head to San Francisco to take the most terrifying exam of their lives. The two that hold things up a bit are Alex and Mere -- Alex, because he's suddenly worried about baby Tommy again and is trying to help with his care on the sly, and Mere, because Zola has come down with the stomach flu. But Arizona, Derek and Callie finally get them out the door, and off they go. When they arrive at the hotel April accidentally sticks her foot in it with a total stranger, because she was offered the job he was hoping to get. But she's not the most distressed; that title goes to Meredith, who comes down with Zola's stomach flu and barfs right in the lobby. Alex isn't really paying attention to either of them because he's still completely distracted with how Tommy is doing and keeps calling Arizona to give her treatment suggestions. When he hears that she's about to do yet another bowel surgery, he declares that he has to go to Seattle, and he actually does leave and fly back even though we haven't seen evidence of his even thinking about Morgan and Tommy since he blew up at her three episodes ago. Whatever.

Back at the hospital, Teddy and Owen have to work together to treat a kid who was in a car accident, and they can't agree on a course of action since he needs a whole lot of things fixed and each of them thinks that their portion of the surgery needs to be done first. Callie bails until it's time for her to step in, leaving Bailey as witness to the horror that is Teddy and Owen (not really) trying to work together. Afterward, Bailey return to fine form as she lectures Teddy that she's being an ass still blaming Owen for Henry's death, and that she's also not actually trying to work with him at all in a professional manner. Teddy seems to start to see that this is true and offers a small olive branch by updating Owen when she hears from Cristina that she's about to go in for her exam and she feels ready.

Mark asks Lexie to help out on a surgery because Jackson isn't there and this gets them talking throughout the day. Mark at one point asks her what it was that broke her and Jackson up but they are interrupted so she doesn't have a chance to answer. When they resume their conversation he decides it's none of his business but tells her that if she still has feeling for Jackson she should tell him, since they were great together. He then tells Lexie that he's missed talking to her. She keeps almost saying something to him about her feelings for him but it never works out and after pulling an all-nighter, she gets home and winds up crying on Derek's shoulder that she is completely miserable and has no idea why she can't actually get the words out to tell Mark how she feels.

When Alex gets back to the hospital he walks right in to Tommy's surgery to see what he can do to help, but once Arizona gets over her shock at seeing him she admits there is nothing else they can do and she has to close Tommy up and tell Morgan it's time to let him go. Morgan can't seem to believe that there's really nothing more to be done until Alex comes up and joins their conversation. Instead of pushing him away, she falls into his arms and sobs. At her request he sits with her while she holds Tommy for the last moments of his life, and then he continues to hold her and try to comfort her once Tommy dies. The next morning Arizona orders him to stop chickening out and to go take his Boards -- he argues that Morgan needs him but at this point it seems pretty obvious that he's trying to sabotage himself, even if it's unconscious on his part. He claims he can't make it back to San Francisco in time but Arizona tells him to try. However, when we see the examiner call his name to take the test, we don't actually see him there.

At the hotel, Cristina manages to get a hold of an IV to help rehydrate Meredith, but as soon as she hooks her up, she leaves the room for fear of catching the flu herself. She comes back later, though, and just sits against Mere's door in the hallway while Mere sits against the door in her room and the two talk. Cristina admits that Owen slept with someone and Mere admits she knew, and then they almost start to argue because Meredith thinks that Cristina has to leave him and that's that. Cristina, on the other hand, is a lot more conflicted about it but admits that she does kind of want to just leave him and Seattle. Eventually, they wind up holding hands under the door (wouldn't that still be germy?) and both fall asleep there. Mere is still totally sick the next morning but Cristina orders her to practice mind over matter. Mere nearly pukes again right before they call her in but Cristina forces her to suck it up and she seems to manage, at least until we see her walk through the door to the exam.

April, who is so nervous she seems about to have a nervous breakdown, goes to dinner with Jackson but while they are at the bar they are confronted by the guy who thinks April stole his job. Jackson stands up for April but ultimately, April actually winds up and punches the dude in the nose. This starts a brawl which is broken up by none other than Richard, who is there to fill in for one of the examiners who also got the stomach flu. Richard orders everyone to leave and go get some rest but when April and Jackson get upstairs, she is so high on punching the guy that she leans in and kisses Jackson. He's really nervous about it knowing she's a virgin, but she assures him that it's okay and she wants to do this, and so they go to the room and do the deed. Afterward he's really sweet and she's elated but then the high seems to fade a little. The next morning, as they wait to be called in to their exams, she finally admits to Jackson that she'd been saving herself because of her religious beliefs (what? This is the first we've heard of this...) and now Jesus hates her for having sex and will probably cause her to fail the Boards. She's then called inside.

One other coupling took place that night, though, and ended much more happily -- Richard runs into Catherine Avery and after everything that happened with Adele, he's much more open to Catherine's advances. He does have a couple of pauses but ultimately, they spend the night together and unlike April and Jackson, both of them seem very, very pleased about it the next morning.