It's good to be Chief of Surgery. Because not only are you Chief, but it means that when you admit to messing with a clinical trial, you don't get fired. But while the Board doesn't fire Richard, he does decide to step down as Chief of Surgery and just go back to a regular old garden-variety surgeon so that he can spend more time with Adele. He hands the reins over to Owen, who has some big shoes to fill and a lot of skeptical surgeons to lead. None more so than Bailey, who is furious about the situation and refuses to give Owen an easy time as leader. Because people always want what they don't have, Owen becomes desperate to have her on his side. His chances of this happening, though, so far look about as likely as a snowball's chance in the Sahara. She still thinks that Richard lied just to save Meredith, but Richard tries to convince her that what Meredith did gave him extra time to be with Adele, so he wanted to step down in order to enjoy that time. She's still pissed but concedes that maybe one day, far, far in the future, she might be able to get over being angry at him.

Owen and Cristina are having an awkward day themselves because they now have no idea what to say or how to interact with one another. They are both overly chipper and somehow both awkward and yet formal, and Meredith's theory is that it's because they haven't actually talked to one another about the abortion. She thinks that they will have to talk and clear the air in order to get back to normal, but Cristina has no idea how to go about this. She and Owen wind up ordering Chinese food for an awkward dinner at home but then both come down with food poisoning, and while holding each other on the bathroom floor, the ice is broken and they seem to finally fall back into acting like themselves without having to sit down for A Conversation. Note to self: if I ever have a hard subject to bring up, just have some bad spring rolls instead and everything will work itself out.

In addition to it being Owen's first day as Chief, it's also the first day that the fifth-year residents will have their own surgeries. April still can't control them at all and when she tries to assign them all skills labs to teach, the others turn it into a contest where the person who does the worst at their surgery has to teach all of the labs. Callie finds April having a frustrated moment and they talk about it a little bit; Callie tells her she was an awful Chief Resident but can at least advise her that the best thing she can do is get them on her side and then she'll have a better chance of them listening to her.

For her first surgery, Cristina thinks she's doing a fancy cardio procedure but winds up with an appendectomy. The problem with this is that Teddy is right -- Cristina knows how to do the fancy procedure but the appendectomy not so much. She pretends to quiz the interns so that they'll remind her how it's done but once she's in the OR, she forgets the steps halfway through. Teddy crows that this is exactly why she's trying to teach Cristina the basics but when Cristina does finally ask for guidance, it turns out Teddy also don't remember how to do the procedure. Fortunately for them, the surgical nurse does know and she tells them what to do to finish the job. Jackson is supposed to be repairing a cleft palate on a baby, but Arizona wants Mark to do the job since it's a complicated surgery. Jackson finally convinces her he can do it but once they are in the OR and she starts talking about how this surgery will ultimately determine the course of the boy's life, Jackson finds he's not as confident as he thought and has Arizona call Mark to do the job after all. Alex has a bowel surgery that presumably he thinks will be simple, but as he prepares for it he also forsakes any trace of a bedside manner and April realizes that his bad attitude is because he's kind of terrified. She gives him a pep talk, and when it turns out the patient is beyond help and there's nothing Alex could have done she at least tells him she knows he did all that he could. At the end of the day when they compare notes they decide Alex lost the contest but April helps protect him by calling Jackson out for not even doing a surgery. They all decide that Jackson loses by default and while he's pissed, it's a good first step for April towards figuring out how to work with and lead the others.

The person who turns out to be a rock star is Meredith, who takes on an aneurysm as her first surgery. She tells Derek she thinks he should do it since the two of them aren't acting like a team, and that's a bad idea for her first go at this alone, but he declares that she's ready. Of course once inside the OR, he questions her choices and yells at her a whole lot though she sticks to her guns and does what she thinks is best. It turns out perfectly, which seems to make Derek even angrier, especially when she gets a round of applause from the rest of the surgical team. That night they finally have it out and he admits he can't trust her at all, but points out that he meant what he wrote on the Post-It so he won't leave her. He also grudgingly admits that he knows she did all of the crazy things including messing with the trial and taking Zola because she was trying to help the people she loves, but he's still angry that she's had no real consequences at all. I guess losing Zola doesn't count because it's not just her that's going through that pain? I don't quite know. They finally realize that the biggest problem they have is that he can't trust her at work, and so she says that they will stop working together and that being off of his service will then be her consequence. That seems to work for Derek and while he still seems fairly livid they at least fall asleep on the same bed with their hands nearly touching, so maybe the Post-It will usher them through this mess after all.