The fresh start those two previous episodes implied was necessary began with Richard's memorable speech to a new crop of interns. Intercut as it was with footage of the show's initial group of interns - including Cristina, George, Alex, and Meredith - the scenes in this episode paid homage to the history of the show and its characters and also reminded us that its longevity relies heavily on the recurring schedule of training surgeons.
While the attending surgeons, once new interns themselves, mouthed the words of Richard's traditional speech along with him, Owen shared a quick check-in glance with a seemingly skittish Amelia before the medical action began. Owen, just returned from a war zone and feeling a bit antsy, was clearly a little annoyed as Arizona began peppering him with questions about when he was resuming his position as Chief. He unceremoniously announced with a shrug that he was stepping down, saying he'd done the job long enough and it was time to try something else. That plot point put Owen in the right place to step into surgery and utilize his trauma surgeon skills as the inevitable Grey's tragedy occurred. A tunnel collapse resulted in mass casualties and several intricate patient cases for our surgeons to use to jump-start teaching their new interns.
Owen's efforts put him in Jackson's path as they worked together to save a critically injured patient. Considering April had left Jackson waiting at home during a lengthy stint serving alongside her mentor Owen in the field, Jackson's reactions to Owen's surgical approach may have been colored by his personal reactions, a tried and true Grey's maneuver. As the two doctors assessed their patient and their rapidly dwindling options, Owen shocked Jackson as he recommended stopping time to give them a better chance at saving his life.
As questions erupted around him from his fellow surgeons, Owen calmly explained they should put the patient on bypass and replace the limited amount of blood still in his system with chilled saline which would support the patient's stressed system long enough to save his life in surgery. (Not quite making a surgical table out of an exploded Humvee, but certainly reminiscent of the medically-induced hypothermia of the Season 5 premiere, an episode which introduced Owen Hunt, army trauma surgeon, to the cast.) The resulting argument between Owen and Jackson had Ben calling in Richard to mediate.
Jackson continued to argue for the safer option of transfusing the patient and rushing him to an operating room, while Owen continued to advocate for the riskier option, calling it a 'Hail Mary,' which might allow them to save their young patient's life. After Alex and Catherine weighed in, Richard grimly gave his Chiefly approval to Owen's surgical option. Even as his efforts continued to be questioned by those working with him, Owen maintained the effort was worthwhile as this option was under development in research trials and would have to be tested with human patients eventually. As much as I admire that flinty look in his eyes over a surgical mask while he's working his trauma magic, I have to admit that I worried for this patient's survival as teaching cases don't always turn out very well on Grey's.
While complications arose, screens flashed, and sensors beeped we waited to see if the surgery Owen and Alex just completed would have a good result. Finally the monitors indicated a heartbeat and their patient slowly returned from the experimental treatment Owen had believed would be their only option. The relief among the surgeons was palpable as they set themselves to the work of transitioning their patient to recovery. Later, Owen apologized to Jackson, which generated some soul-baring from him about how difficult it had been trying to reconnect with April after she returned from her training mission. Owen sympathized with Jackson, saying it can be difficult to step back into your old surroundings when you've had such a life-altering experience and those back home have had a very different experience. He cautioned Jackson to be patient and to give April time.
Elsewhere in the hospital: Richard and Catherine's wedding was foiled by his hospital duties; April, Meredith, Amelia, and Maggie were tested in the field wherein April showed her surgical ingenuity; Stephanie took on guiding a group of new interns; a pregnant patient had Arizona and Callie working together; the same patient introduced us to a new superstar intern Andrew who witnessed the tunnel collapse; Catherine sent what would have been their wedding buffet to the hospital to feed the staff as they worked around the clock; Jo considered her own surgical tour of duty overseas while Alex shared his complete lack of interest in such an endeavor because he's finally found a home and a family at Grey Sloan Memorial; Richard told Miranda he was recommending her for the newly vacated Chief's position; still grieving Amelia trained her scattershot emotional responses on Meredith; Catherine and Richard argued about how the hospital was run; Maggie received a challenging call from home; Meredith - finding herself struggling with the memories of her life with Derek - asked Alex if she and her kids could move in with him; and we were left clear that the final medical case of this episode would carry over into the Season 11 finale.