Previously, the Marquis de Sade took over the show and decided that Meredith hadn't suffered enough. So he killed off her new stepmother Susan and then made Meredith's dad slap her and blame her for Susan's death. Also, Richard's wife left him, George slept with Izzie, Burke and Cristina planned a wedding, Addison learned she couldn't have a baby, and Crush continued to suffer from amnesia.
It's a rainy morning in Seattle. Meredith is getting dressed in her bedroom -- black bra, a simple black dress laid out on the bed. Voiceover: "A surgeon's education never ends. Every patient, every symptom, every operation, is a test. A chance for us to demonstrate how much we know, and how much more we have to learn."
Cristina is in the kitchen with Alex and Izzie. She's quizzing them using Callie's flash cards. Cristina has apparently forced them to study all night long, and Izzie is whining about the lack of sleep and coffee. Alex gets a question right, and Cristina tells him to ask her one. Alex worries that George is missing their study session, but Cristina thinks it's no big deal: "Oh, you're kidding, right? We have Callie's cards, but George has..." Izzie: "George has Callie." Alex asks Cristina for the most frequent cause of diarrhea in hospitalized patients. Cristina snaps out a couple of answers, both of which are wrong. Meredith walks through the kitchen and tells them, "The most frequent cause of diarrhea in hospitalized patients is C. diff., which can lead to toxic mega-colon, perforations, sepsis, and death. That's what killed Susan." While she's talking, she pours some coffee, and then marches out of the room. Izzie asks Cristina if Meredith is okay, and Cristina says that she's fine. Alex: "Dude, she's messed up." They agree that she is, indeed, messed up, since her fake mother died just as Meredith was getting to know her. They also confirm, in case you were in doubt, that the intern exam is that afternoon. Meredith will be going to the funeral and then coming back to take the exam. Cristina also tells us that Meredith has studied for the exam, and "just needs to be left alone." And then, Cristina forces Izzie to answer a medical question before giving her any coffee. I see the Marquis found a worthy pupil during his time with the show.
In their hotel suite, George is answering the question that Cristina just asked Izzie. Callie tells him the question was too easy and then looks through some papers to find him a harder question. Instead of a question, she finds an envelope containing the notice that he was accepted in the Mercy West residency program. She clearly knew he applied, and is thrilled that he was accepted. George is a little more hesitant, noting that his acceptance is contingent on satisfactory results on the intern exam, and also that he hasn't yet told the Chief that he's leaving. But that doesn't stop Callie from doing a little song and dance to celebrate his success. She thinks it's good for him because it's a smaller program that will enable him to get more surgeries, and she think it's good for them, because "when I come home and ask you how your day went, you can actually tell me because I won't already know." She gives him a very happy kiss and hug, and somehow fails to notice the painfully guilty look on his face.