Cristina gets assigned to a trauma all by herself. Izzie and George wait for Burke to arrives and help Denny get the heart, but they do not realize that Burke has been shot and has to undergo surgery. Meanwhile, the chief's niece Camille has been admitted to the hospital.
We see a series of shots of Doctor Burke lying in his blood after being shot while Bailey is attending to him.
We see heart patient Denny after Izzie cut his LVAD wires.
George and Izzie fight over calling a code because Denny seems to be crashing. Izzie explains that they can't do that because if they do, they will rush him to surgery and he will be stabilized. Izzie says that Denny needs to get worse in order to be first to get a donor heart.
Cristina runs into the chief of surgery, Richard at the ambulance entrance after the shootings (not knowing Burke has been shot). The chief tells Cristina to go run Trauma 2 by herself, which is a big responsibility for an intern. She leaves.
Burke is rolled into the hospital on a stretcher. Bailey updates the chief, he tells her to take Burke to Trauma 1 and to keep the curtain closed as Cristina is working on the floor.
In Trauma 2, Cristina learns that she is working on the shooter, who shot himself in the head.
In Trauma 1, Burke comes to consciousness and seems to think he is alright. Bailey tells him to lay down. Burke seems to have a memory lapse as he asks Bailey, "When did you get here?" Derek is paged.
Derek runs through the halls and enters Trauma 2 where Burke is located. Cristina across the hall sees Burke lying on the bed as Derek enters the room. She has another doctor take over the compressions and goes to Trauma 1 to see Burke.
After some fights the chief, Bailey and Derek leave Cristina alone with Burke. While alone Cristina explains to Burke that she forgives him for not taking her to retrieve the transplant heart and how she is there to support him and do anything he asks. In a sort of comedic moment, Burke then asks Cristina to go check on Denny.
Addison approaches Adele, the wife of the chief of surgery and inquires about what is so important that she was aksed to keep it secret from the chief. We then are introduced to Camille, who is the niece to the chief and who is in the hospital for passing out during her first time having sex after her prom.
George and Izzie are in the room with Denny trying to worsen his condition while still keeping him alive. Meredith runs in after being paged by George. Cristina enters right after. They wonder what has happened. George explains to them what happened and how they are waiting for Burke and how everything will be fine. Cristina tells them Burke has been shot.
Izzie, Cristina, Meredith and George worry about what to do next with Denny at the realization that Burke is not coming, while having an argument about who you love. They decide to stay and help Izzie and Denny out.
The chief runs into his wife Adele and wonders why she is there. He informs her that Burke was shot. He then notices his niece, Camille. Adele explains what has happened. Addison approaches the chief and informs her that Camille has been diagnosed with ovarian cancer. She tells them not to worry until they have to.
Back with Denny, the interns thinks that the only way to get out of the situation is to prove Denny is in a worse condition in order to get the heart. In order to this, however, they must run some labs, which none of them have ever done.
The chief rejoins Derek in Trauma 1 with Burke. They realize the bullet is still inside Burke and that his right arm is becoming numb. Burke's lung collapses.
Meredith calls Alex who is at another hospital protecting the donor heart from Hahn. Meredith informs Alex that Burke has been shot and that they are going to need more time. Alex first refuses to get in the middle of the situation but Meredith asks him to do it for Izzie. He says he will do what he can but he is not making any promises.
Addison examines Camille while she talks to her friends about her first time. She discovers that Camille's cancer has resurfaced and has been for a while. Camille refused to tell people because she wanted to be able to go to her prom.
Addison approaches Adele sitting in the waiting room. They reminisce about their first times. Addison informs Adele that Camille's cancer has resurfaced and that she may not have a chance.
The interns are attempting to perform tests on Denny. Cristina tells Izzie that she should have not have fallen in love wiith Denny. Denny wakes up and mumbles something under his breath.
The interns are with Denny. Denny seems to be flatlining.
Alex informs Hahn that Burke has been shot. She asks if he was alive and says if he was dead he would have made a good donor. She then walks into the operating room and begins to remove the donor's heart.
The chief walks into a hallway where all of Camille's friends have gathered to bring the prom to her. He tells them they have to leave and come back another time in smaller groups.
Derek is with Burke where they realize that the numbness is spreading over his whole right arm. A risky surgery is needed. Burke ask Derek if he is good enough to do the surgery. Derek says he thinks so but he is not sure.
Adele approaches the chief and tells him he was wrong for sending the kids away. She tells him she is tired of his family being second fiddle to his patients. She says she deserves and it and informs him that she has always known about his affair with Ellis and that it is time for them to be put first for once.
Derek and the chief retreat into the doctor's lounge where they both let off some steam. The chief tells Derek about his niece and his affair. Derek worries about being able to do the surgery on Burke. The chief tells him he is good enough to do the surgery.
Bailey enters the room with a now stable Burke and asks if there is anything she can get him. He asks for ice chips, morphine and Cristina. Bailey then wonders where Cristina is and wonders where all of her interns are and suspects Burke knows something. She pulls the usual can't say no to momma attitude, pulling out all the stops using Burke's full name to get him to tell.
The interns are with Denny trying to figure out what to do next. Denny's heart is beating too fast so they search for a drug that will stop his heart for six seconds. They find it and inject him. He flatlines. His heart starts to beat again. Bailey enters and says they'd better have a good explanation.
Bailey tells the interns to step away from the patient. Izzie performs her that she can't, she needs to pump his heart. Bailey tells Nurse Olivia to take over the pumping for Izzie. Izzie refuses to let go. Bailey tells Olivia to stay and help if Izzie will let her and tells the other inters to follow her outside to the hall.
Bailey scolds the interns for helping Izzie in this situation and tells them not to speak because she doesn't want to have to testify against them in court. She tells Cristina that Burke is requesting her and to go see him. Cristina leaves. She asks the other interns if they have performed labs and tells George to go retrieve the results.
Cristina enters the room where Burke is located. They chit chat, Cristina is uncomfortable and searches his files and realizes that his right arm is numb. Burke explains he can't wait it out to see if the numbness subsides or he can let Derek operate. He expresses his concern about losing the ability to operate again and asks an uncomfortable Cristina to make the decision for him. She doesn't know what to say and says she has to go back to Bailey and she will think about it.
Cristina enters the doctor's sleep room and cries as the rain outside Seattle Grace begins to fall.
Izzie is pumping Denny's heart. Bailey asks Denny how he feels. He lies to her and tells her he cut his own LVAD wires. George brings in the lab results. Izzie ask Bailey is Denny will receive the donor heart. Bailey tells Izzie that she is no longer a dcctor at Seattle Grace, she is now a visitor until she says so and tells Olivia to take over pumping.
Bailey approaches the chief and asks a hypothetical question about the worsening condition of a heart patient whose LVAD wires have been cut. She ask him if hypothetically it would be ethical if the patient were moved up on the donor list and received the heart. The chief angrily asks for more information. Bailey insists on keeping it hypothetical to protect the hospital's status as a transplant site. He informs her that their duty is to the patient so medically he should receive the heart however hypothetically he expects names and there will be severe consequences.
Alex receives the phone call letting him know the heart has been awarded to Denny. Hahn tells Alex that her man is a nice man with kids and has been waiting a long time for the heart. He tells her he understands and he is sorry. He tells her there is a chopper on the roof.
Derek is in the room with Burke having a conversation about how he could take up fishing if he wasn't a surgeon... they have a comforting moment and both agree Burke doesn't fish.
Hahn arrives at Seattle Grace with the heart and is seemingly about to go into surgery with Denny.
Izzie walks by Denny's stretcher as he is being taken into surgery. Bailey then takes over pumping of his heart leads him to the operating room.
Burke is being prepped in the operating room. Derek and the chief are scrubbed in on this surgery. Burke calls out to Derek. Derek responds that he doesn't have to thank him as he is sure Burke would return the favor someday. Burke replies, "I was going to say please try not to kill me." All three share and laugh and continue prepping.
Bailey, Hahn and Alex are operating on Denny. They remove his heart and realize how damaged it was and conclude he would have lived another hour with his old heart.
Derek and the chief have run into a complication while operating on Burke. His arm seems to be paralyzed but Derek is uncertain. He tells the chief that the only person who can tell him what to do for certain is Burke and that they will have to wake him.
The interns are sitting in the hallway talking about how Bailey punished them for the Denny situation. Izzie says that she will take the total fall for what has happened and that she knew she shouldn't have fallen in love with Denny but would rather have fallen in love with him than not.
The chief approaches them and informs Cristina that Derek needs her in surgery for Burke. Cristina says she can't, that she is on time out. The chief says time out is over and Derek needs her. They both leave. Izzie is pondering what Denny said about marrying her and wonders if it really did happen. George and Meredith tell her it did. She leaves to go check on Denny.
The chief, Derek and Cristina are in the operating room with Burke. Derek tells Cristina that they are about to wake Burke up and that he will be in some pain and disorientated. It will be Cristina's job to keep him focused. George and Meredith are in the hallway alone. Meredith thanks George for calling her about Izzie. George says he didn't do her any favors and it didn't mean anything. This creates an awkward situation between them and brings up their past sexual encounter. He tells her he knew she didn't love him but he still let it happen and that Meredith should stop saying that she is sorry because she was depressed and didn't know any better but he did. He then apologizes to her.
Cristina is in the operating room chatting to a silent Burke and tells him to wake up. Burke violently walks up. The doctors try to control him and Cristina goes blank. Derek claims him down eventually and tells him that he needs to move his right fingers. The scene ends with a close up on his hand and the audience not knowing if he is paralyzed or not.
Bailey and Hahn are working on Denny's heart transplant and are attempting to get it to beat on his own. He beings to flatline. The camera shows the heart monitor flatlining and pans to a "?"