A train crash brings in many patients to Seattle Grace, including Meredith, who is too drunk to work; while the rest of the interns face their own professional crashes as Cristina searches the entire hospital in search of a foot for the Chief; Izzie is unsure how to react around Addison; and Meredith, George, Bailey, Derek, and Burke treat two strangers impaled on a pole. All the while, Meredith awaits Derek's decision.