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A patient who needs an extremely difficult surgery comes to Seattle Grace, and it's Richard and Owen who vie for the opportunity to tackle it. But the decision lies in the hands of Derek, who deems that Owen should take on the surgery, leaving Richard bitter. Meanwhile, Bailey deals with her own personal struggles when she nervously prepares for another date with Ben, and Mark and Teddy go out on a strange date.

Cristina is awarded the first solo surgery among the residents, but she has to relinquish it and choose her replacement; Mark performs a cutting-edge procedure to restore a patient's speech, impressing Lexie in the process; and Callie cannot figure out if Sadie is flirting with her or just being friendly.