In this episode, Meredith volunteers to be in charge of the emergency room in hopes to bump herself up the list for Chief Resident consideration. The race is still on and Meredith has her sights on this coveted position even if it means shifting her focus temporarily away from helping Derek with his Alzheimer's clinical trial. Cristina thinks Meredith is crazy to volunteer for ER duty, and wonders why Meredith is acting rather giddy. Meredith explains that her giddiness must be due to the hormone shots to help her and Derek to get pregnant. This leads Cristina to admit to Meredith that Callie asked her to be her baby's godmother. Meredith doesn't think that would be a good idea.
While in the ER, Meredith finds out how much can happen in one hour--from 6:00 to 7:00 pm. First up for Meredith is Oliver who arrives at the ER complaining of chest pains. Although he is in a rush to take his son to the big college basketball game, Meredith exercises all the necessary precautions and convinces Oliver to stay for tests to rule out any serious heart problems. Unfortunately, the ER is busy that night and tests are taking a while to complete.
Meanwhile, Karev is in a rush too to get to the same basketball game because he has courtside tickets. However, he is delayed when he has to stay at Seattle Grace to finish up his pile of incomplete charts. Dr. Lucy Fields finds out about the tickets and helps Karev finish up his charts in hopes that her assistance will result in an invitation to the game. After some obvious prodding from Lucy, Karev extends an invitation only to be shut down by her because she has to work. It turns out that Lucy was just testing Karev.
Meredith is also juggling her commitments in the ER with a planned date with Derek at 6:30 pm. Derek and Meredith are trying to get pregnant so timing is everything. Derek drags her to the on-call room only to mistakenly interfere with Bailey's rendezvous with Eli. I am so glad that Bailey is getting back into the swing of things! Without anywhere else to go and Meredith desperate to get back to the ER, Derek drags her to the only other place he can think of...the elevator where he gives her a hormone shot.
Back in the ER, another patient who is also in rush to get to the basketball game arrives with a knife sticking out of his head. The drunk patient and his equally drunk friend provide the ER some comical relief as the doctors try to figure out the proper course of action to remove the blade from his skull. As the medical discussion continues in the next room, the patient's friend takes matters in his own hands and pulls out the knife without causing any damage to his friend's brain. In fact, both are ready to go to the game. With some stitches and bandages, the patient is released and both board a taxi cab to the basketball game.
As Meredith waits for Oliver's test results, she notices Nathan, a four-year-old boy with a broken femur that needs surgery. Unfortunately, despite his parent's pleas and Nathan's cries of discomfort, an operating room is not available yet. Meredith pleads with his parents to be patient, but is also side tracked when she notices Adele in the ER suffering from a sprained wrist. Mrs. Webber asks Meredith not to say anything to the Chief. She explains that she was taking Christmas decorations down and slipped and fell. When Meredith comes back at a later time to check on her, she asks Adele again how she hurt her wrist. Adele tells Meredith that she slipped and fell at home after coming from work. Meredith grows suspicious and orders an head scan.
Lexie is also busy in the ER and releases her migraine patient when his scans come out negative. Meredith takes a look at his chart and quickly runs out to the parking lot as the patient is just getting into his car. she asks him to squint and raise both arms straight up. Meredith makes a quick diagnosis that Lexie's patient is having a stroke and rushes him back to the ER where he is given blockers to stop the stroke from progressing further. Meredith pulls Lexie aside and shows the differences in the patient's signature from when he was admitted and released. The barely legible signature at the time of his release should have been a clear indicator for Lexie that her patient was having a stroke, but she was so caught up with the patient with the knife in his head that she missed the signs of this patient. Thanks to Meredith, the patient makes a full recovery.
Meredith is also looking for signs in Adele, but when the Chief finds out that his wife is in the ER, he rushes to her side. Adele's wrist is bandaged and is released before a head scan can be performed. Meredith asks the Chief to keep Adele at the hospital to run a head scan, but the Chief refuses. He doesn't want to hear what Meredith is suspecting, despite her explanations that Adele said she was taking down Christmas ornaments in February or fell down after she got home work even though she is retired. The Chief tells Meredith to stop suspecting everyone is sick just because they are a little shaken up or confused.
Speaking of tests, Oliver is still waiting on the results of his tests as his son keeps calling his cell phone. As Meredith consults with Teddy, Oliver suddenly codes in the ER with a dissecting aorta. Teddy apologetically asks her date to wait while her faux husband Henry keeps her date company in the waiting room causing an awkward situation. Teddy and Meredith rush Oliver to the operating room with no time to spare. Meredith hands bottle of hand sanitizer to Teddy in the elevator because they don't even have time to scrub in. Despite their quick actions, Oliver's aorta is completely shredded and he dies on the table. Meredith is completely crest fallen.
After losing Oliver, Meredith visits the hospital nursery to admire the newborns and wonders when she and Derek will have their own newborn to admire. Remember when Meredith and George used to escape to the nursery to look at the babies to make them feel better after a really rough shift? Meredith tells Cristina that the reason she doesn't want Cristina to be godmother to Callie's baby is because if Christina agrees to be someone else's godmother, it would be like she's saying Meredith will never have a baby of her own. To support Meredith, Cristina agrees not be a godmother for Callie's baby.
In all that has happened in one short hour, Meredith forgets about Nathan and inquires if an operating room is available. Nathan's dad tells her that a doctor stepped up to take care of Nathan--Dr. Karev. Karev is in the operating room with Nathan while Lucy is impressed with Karev's selfless act of giving up his courtside basketball tickets to take care of a young patient. As it turns out, Karev gives his tickets to Avery who invites Lexie to join him. Do I see a romance brewing in the horizon?
However, not everyone will be able to go to the basketball game. Meredith hears Oliver's cell phone ring in the bag of his belongings and answers the call from Oliver's son. After she relays the bad news, Meredith composes herself and goes back seeing patients. It's 7:00 pm.
Next episode, Meredith's vision is compromised by the hormone treatments.
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