One of Owen's challenges in this episode was trying to help April Kepner who avoided dealing with the diagnosis of her as yet unborn child via stepping into her surgeon's persona instead. Without expressing details, Jackson Avery told Owen that April wasn't in the best frame of mind to operate. As her supervisor and friend Owen wanted to support April yet had to make the decision to pull her from surgery given the possibility her emotional state could impact the life of the patient on the table. In stepping in to cover for April in the operating room it put Owen in contact with Meredith Grey, another surgeon who was avoiding personal grief through facing work challenges instead.
By being in that OR Owen learned of Derek Shepherd's decision to go to Wasington D.C. to lead the President's brain mapping initiative. As Owen and Meredith settled into surgery they also began to talk about Derek's decision to leave, how messy things felt at home for her and what to do with Derek's patients. This Crowen fan's heart surged when Owen asked if Meredith had talked to Cristina about the situation. Meredith said they usually talk on the telephone once a week but that she had missed the last couple of calls because she wasn't yet ready to talk to her friend about her marriage. Once they'd finished surgery and found a medical explanation for their patient's actions, Owen encouraged Meredith to call Cristina, to reach out to her friend, and even to say hello to her from him.
Elsewhere in the hospital: Arizona Robbins and Amelia Shepherd continued plotting to remove Dr. Herman's supposedly in operable brain tumor while Dr. Herman struggled with pushing away the hope of having another option to survive her cancer; April and Jackson wrestled with the news their child has a rare condition that will severely limit that child's life; Richard Webber was a listening ear for Jackson; the trauma case that brought everyone together was ultimately solved by Meredith who discovered their patient wasn't suicidal but was experiencing symptoms of a previously undiagnosed tumor; while Alex Karev and Jo Wilson worked with Miranda Bailey to treat some irascible pediatric patients.