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It's Christmas time and that means stress. Whether you're working at a hospital or anywhere else. A young boy, Justin, needs a heart transplant but doesnâ€™t seem to want it. As a result of his treatment, Dr. Burke and Cristina spar over philosophical differences -- namely whether the boy's desire to live has any impact on the result.
Meanwhile, the interns rally around Alex to help him prepare to re-take his medical boards, after Meredith learns that he failed them. Initially Izzie is furious at them for helping him, but comes around and helps him in the true spirit of the holiday. On a superficial level, she decorates the house so that it closely resembles Santa's workshop. She loves Christmas!
Richard is pressured by his wife to spend more time at home. Miranda is pressured by her unborn son, whose kicking is making her job especially difficult. Derek is feeling depressed in spite of having reconciled with Addison, and confides to her that Meredith wasn't a fling. In the midst of her own internal struggles, Meredith tells Izzie and George how much they mean to her.
In the end, despite the hassles and gripes, the inconveniences and the hurt feelings, the surgeons and interns cling to the ones they love.