Grissom investigates when a sadistic client tries to murder Lady Heather (Melinda Clarke), who makes the probe more difficult when she refuses to name her attacker. Also, Grissom's reunion with Lady Heather makes Sara uneasy.
The interns finally take their first year medical exams, the biggest test of their careers, and one of them is ill-prepared. Callie grows more suspicious of George and Izzie. The doctors treat a patient named Dale. Three mountain climbers are treated. Cristina works on her vows. Adele wants Addison to keep a secret from Richard.
Michael is being considered for a position in corporate, but also plans a day of "Survivor" like competitions while the office workers visit Lake Scranton. Pam is not asked to join in on any of the competitions and is forced to sit and watch Jim and Karen have fun.