All eyes are on Derek as he is set to perform his first surgery after his breakdown; attention is also set on Izzie, whose medical condition requires her to undergo a difficult surgery; and Owen has another PTSD episode that injures Cristina and traumatizes both of them, throwing the future of their relationship into question.

At Sandover Bridge & Iron Inc., Dean is Dean Smith, the buttoned-down director of Sales & Marketing. Sam is Sam Wesson, a cubicle-dwelling tech support guy. What the heck is going on? Or is it what the Hell?

Michael's relationship with the new vice president becomes increasingly tense, as Michael finds an excuse to goof off even more than usual. Meanwhile, Pam faces the challenge of a new copier and Kelly develops a crush.