Christina crawls into bed with Meredith and Derek just as a strange blonde woman knocks on the door, Derek answers, she runs inside and leaps into bed with Meredith, calling her "Death."
Her name is Sadie, Meredith's backpacking partner (in Europe) from before med school. Christina and Derek lament in the kitchen about her sudden and somewhat rude invasion into their lives.
Sadie is at Seattle Grace to start her residency.
Alex tries to get Izzie to talk about the Hahn-Denny thing, but she won't let him in. Inside, she sees Denny's spirit walking about and talking to her.
Intern #3 is sent off to plastics by Cristina because of her scratched-up arms (Cristina suspects her of cutting herself) and Alex tells Christina that he's working on a heart transplant that day.
Dr. Hunt, Callie and Cristina wait for some crash victims to arrive at the ER. The victim is a man they had to fish out of a working garbage truck.
He is impaled on his own femur.
Sadie tries to jump in on the emergency but Christina smacks her down. Dr. Hunt has called in McSteamy to help.
Bailey is charged with showing Dr. Dixon - a new cardiac surgeon - some of the ropes around the hospital. She has Asperger's syndrome and is awkward, albeit brilliant to be there in the first place.
They introduce her to the patient, who had a small heart piggy-backed on his own six years ago but now needs a new heart. He's Navajo and has been seeing visions of the woman who gave him the heart.
With the impaled man, the docs plan to yank out the femur from his chest ... that is until he wakes up screaming in the middle of it.
The patient is homeless and says he can't survive if he can't walk, so they have to save his leg. Dr. Hunt says the surgery is off then. Derek and Mark confront Owen about leaving the patient to die. He storms off, and Der asks Callie if she can figure out a way to build the man some legs.
The transplant patient wants old heart back after the transplant but Dixon won't have it because rules say the heart must go out as medical waste.
Bailey goes to the Chief and asks that they specify in the hospital rules that they respect the beliefs of their patient so that they may give him back his heart. The Chief just declares it a rule then. Win-win.
Cristina introduces herself to Dr. Dixon, who dismisses her, so Cristina goes to Callie to find out what happened to Hahn. Callie says they had a fight and subtly reveals to Christina that Hahn was her girlfriend.
Derek guilts Meredith into talking to Lexie about her problems and Meredith asks if Lexie is cutting herself. Before she can answer, Mark asks "Little Grey" if she wants to scrub in on a surgery. She says yes and runs off.
In the basement, Lexie tells the Secret Intern Society and says they need to keep quiet for awhile because people are getting suspicious of their cutting themselves.
Sadie is there and encourages them to keep at it. She demonstrates by taking off her shirt and cutting her own shoulder with a scapel, then asking who wants to stitch her up. Yeah.
Izzie talks to the heart patient about her Denny-spirit sighting, wondering if he is bringing her heart transplant patients. He asks her not to be in his surgery because he doesn't need any extra ghosts.
Derek and Dr. Hunt talk to the homeless man. They tell him that his refusal to have live-saving surgery is not smart and that they need to operate and figure the rest of the details out later.
In surgery, Bailey tells Dr. Dixon again about respecting the patient's beliefs, stressing that it is now a RULE declared by The Chief. Dixon instructs DKarev to return the heart to the patient after the surgery.
Up in the gallery, Denny talks to Izzie as she tries to ignore it. Izzie admits that before, she would have given anything to be able to see him again, but being able to see him and not touch him is killing her.
Izzie worries that she's somehow sick because he cannot be real. Denny insists that she touch him. She won't.
The patient's heart is beating on its own after they removed the piggy-back heart. As he recovers, they tell the man that if his heart continues to function this way, he won't need a new heart.
The doctors say that his heart had six years to rest and must have repaired itself in that time. He is relieved to no longer be haunted by his piggy-backed heart owner's spirit.
Elsewhere, the homeless man's reconstruction is going very well. Callie is building a leg from titanium and Lexie is out-pulley stitching Derek.
But the man suddenly starts flatlining and they call time of death.
Callie is furious because she built his bones from scratch and all the rest of the team had to do was keep him safe and alive. Cristina gets everyone away while Callie cries, and Mark hugs her.
Izzie gives the piggy-back heart to the Navajo Man, who says they will burn it now because the spirit can cling to any part of it that they don't burn.
Izzie realizes she still has things of Denny's that his spirit can cling to.
Dr. Dixon tells Bailey that she likes the regularity and rules of the human heart, the structure. She then tells Bailey that she has Asberger's Syndrome, a social impairment that she suffers from.
She does point out that she CAN recognize when she is being manipulated, which she knows Dr. Bailey did with the "rules" business.
Derek and Mark have a chat about Lexie where Derek advises him not to let Little Makr anywhere near Little Grey.
Izzie says goodbye to Denny's spirit because she's trying to let him go so his soul can be at peace. He says that he IS at peace, but she says a last goodbye as Alex observes from down the hall.
Cristina confronts the interns about their little circle and tells them to shut it down because practicing on themselves is insane.
At the bar, Callie mopes about Hahn, Cristina watches Owen and Mark gazes at Lexie. Cristina catches up with Owen outside the bar, he yells at her, then they kiss passionately, but she then walks away. Naturally.
Derek asks for a story from Meredith about med school with Sadie and she obliges. Alex finds Izzie holding Denny's sweater and she asks him to burn it for her, which they do in the fire place.
She then sees Denny again in her bedroom and can't believe it. He tells her to touch him and she reaches out... and he's real! She puts her hand on his chest, and they kiss.
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