It's Jackson's first day on the job, and what greets him is a group of colleagues pissed that he's now their overlord, understaffed ORs, an overworked Chief of Surgery, and a mom who still calls him "Sweetheart" in front of the Board. When he and the survivors have their first meeting he is really just a mouthpiece for the Harper Avery Foundation, and the rest of them have no patience for it at all and no respect for him. The last straw for all of them is when he suggests that they might need to start fresh with new leadership, meaning Owen would be fired as Chief. No one else wants to even consider it and they shut down the meeting. Meanwhile, Owen is out of his mind trying to coordinate the surgery schedule considering that they don't have enough nurses to actually have all of the ORs up and running at once. It's extra tricky because there wind up being multiple organs that need transplanting at the same time.
Cristina is done keeping secrets from Owen so she goes to him and tells him that he might be fired. Owen confronts Jackson but while he's screaming at him, Derek comes up and gets in the middle. He and Owen wind up screaming at each other with Derek once again alluding to the crash being Owen's fault so Owen lobs back that Derek didn't have to sue and consequently bankrupt the hospital. That said, he then quits.
Alex is still in an extra-bad mood because he both feels left out and because Princess has a hot new boyfriend and he was too dumb to tell her his feeeeelings. He has a kid who is having a kidney transplant but as he goes through all of the possible side effects of the meds she'll need to take, the girl freaks out and locks herself in the bathroom. Alex finally manages to get her to talk to him and somehow relates her situation to his own mistake of not telling Princess how he feels about her. Because he's a pediatrics god, that somehow gets the girl to agree to the surgery after all.
Cristina has one patient who is getting both a new heart and lungs, and another patient who flies off the handle when he hears that that guy is getting a heart before he is. It turns out the two men have a history -- one's wife left him for the other guy, though a while after that she left him too. Cristina realizes that she can do a domino procedure, giving heart/lungs' old heart to the other guy (yadda yadda lung heart stress medical reasoning yadda) but he refuses to accept it. She manages to talk him into it by convincing him he'll be able to use the new ticker to dance on the other guy's grave one day. (It's actually really cute.)
The last organ-related activity is April's patient, a friend of hers who was a resident with her at Mercy West until he was diagnosed with ALS and couldn't work anymore. He made the decision that he's going to go off his ventilator and let himself die so that his organs can go to others, but April can't bring herself to let him do this and keeps trying to talk him into other options to try and live longer. He finally fires her as his doctor, but she eventually comes to respect his decision and actually helps him convince his mother that this is truly what he wants to do. April takes him and his family to the OR where they'll disconnect him and then once he dies, they'll take the family out and harvest the organs within five minutes.
Jackson, meanwhile, is busy trying to participate in a Board meeting but obvious he's in over his head. Richard is concerned for him and tries to tell Catherine that it's too much. But she's convinced Jackson will figure it out, and finally yells at Richard for overstepping his bounds and acting like a parent. She immediately recants, though, because she realizes that they are awesome together and Richard really did mean the best for Jackson.
All of the organ hoo-ha converges at once, with April and her guy in one OR and Cristina and Alex fighting over the other and trying to shove each of their patients' beds through the door first. Jackson manages to finally take some control and figures out the OR schedule (heart and lungs get priority over kidney) and the others seem to find a bit of respect for him, at least for a moment.
Cristina tells Derek that he has to stop blaming Owen so Derek chases him down with his car and finally admits he doesn't blame him, while Owen admits he blames himself. Derek admits he's just pissed off at the world, and also at Mark, and he and Owen bond and counsel each other on getting over it all.
Finally, Jackson calls a new meeting with the survivors and this time, he's ready to be a leader. He tells them that they will reopen the ER (he'd been waffling about it earlier) and that they are going to hire Owen back, which Owen has already agreed to. Finally, he says that he thinks that they need to remember that they are now a hospital run by doctors and they should be even more awesome because of it. In honor of this, and of a fresh start, and most importantly in honor of the two doctors who died in the crash, he proposes that they rename the hospital Grey Sloan Memorial Hospital. The idea is met with full support by the others, and they realize maybe this crazy harebrained plan of theirs might work after all.
It's the dawn of a new era at Seattle Grace (Mercy West), where the new management board -- the crash survivors -- are getting ready for their first meeting. At the same time, Mere VOs something about transplants and the body trying to fight off what it thinks is an invader -- in this case, they are the body, and Jackson is the offending new organ. The others all talk about just how little faith they have in him while they remind the audience that the Harper Avery Foundation gave $175 Million to the $15 Million each from each of the survivors. Derek adds that as a member of the board as the HAF's representative, Jackson can veto their vote. Meredith is the calmest of everyone and reminds them that they know Jackson and he's not just some unknown corporate suit who is going to take them over, but they are all disgusted at the idea that a Plastics Fellow with a powerful mommy holds so much power and won't really listen to Mere's voice of reason.
Speaking of Mommy, she and Richard are having an argument about, as Richard says, "Anointing your son boy king." Richard is worried that Jackson isn't prepared for this job but Catherine dismisses his every (insightful and well-meaning) worry and insists she knows what Jackson is capable of and he'll be fine. He's also not thrilled that this boy king is now his boss, which makes his girlfriend his boss' boss. Catherine reminds him that she's a very powerful lady in her own right and that the only room in which she takes orders from her boyfriend is not in this hospital. Richard is worried enough that her saucy power flirting doesn't seem to affect him but she just heads into a conference room for her own meeting.
The boy king himself arrives at the board meeting full of apologies, while carrying a giant stack of binders topped off with a box of donuts. They are meant as a peace offering but he realizes this is going to be a long meeting when the others all just give the pastries withering looks. Mere catches him up that they were discussing reopening the ER and the trauma department (which I guess are somehow different) but in reply Jackson tentatively says that he's not sure they are ready to do that just yet since the board wants to look at some numbers and figure out if it's worth it. Basically, he's kicking off the very nightmare that all of the others were afraid of. It gets worse when Cristina mentions getting Owen's opinion, and Jackson admits that the board also thinks a change in leadership could be good for morale. Translation: Owen might get canned. Callie starts to berate Jackson for being his mom's mouthpiece while Cristina declares that there's no way he can fire Owen. Jackson, backed up against a wall, reminds them just how much money the HAF invested in this venture. Mere still continues to be the calmest person in the room and tries to make peace, telling Jackson they didn't expect the Foundation to dictate policy. Jackson shoots back that no one expected all of these guys to sue the hospital into bankruptcy. But instead of blowing up, Mere looks right at him and asks if he's talking about the crash that killed Lexie. The camera zooms in on his troubled face so that we know this point hit home.