The episode opens with a
voice-over narration from
Meredith Grey (
Ellen Pompeo) about making tough decisions and taking responsibility for what you're willing to fight for. Meredith
carpools to work with her half-sister,
Maggie Pierce (
Kelly McCreary), and her sister-in-law,
Amelia Shepherd (
Caterina Scorsone), but expresses annoyance over both Amelia's nakedness while changing in the car, stating her children sit in that seat, and Maggie's denial about the wide-eyed expression she makes upon reading a notice for Meredith's promotion to Head of General Surgery following
Miranda Bailey's (
Chandra Wilson) promotion to Chief of Surgery.
Richard Webber (
James Pickens Jr.) overhears
Callie Torres (
Sara Ramirez) inform Meredith that she has been underpaid regarding her new salary as Head of General Surgery. Callie and the sisters urge Meredith to renegotiate her salary as they chat in her house. Maggie expresses apprehension about an invitation to her ex-boyfriend, Ethan Boyd (
Lance Gross)'s wedding, culminating in her kissing
Andrew DeLuca (
Giacomo Gianniotti) at Joe's bar.
Arizona Robbins (
Jessica Capshaw) is consulted on an
OB/GYN case involving a pregnant mother of twins, Laurie Kiefer (Jennifer Marsala).
Alex Karev (
Justin Chambers) pages
Alex Karev (
Justin Chambers), Head of Pediatric Surgery. Laurie delivers fraternal twins, a girl and a boy, but both children are severely jaundiced and need extra care. DeLuca asks why Robbins and Karev are shocked, and Ben Warren (
Jason George) explains that both fraternal twins have tumors, and now they must tell the parents their twins are dying. They reveal the kids need liver transplants, and Alex informs the parents that he will decide which child will receive a donor, based on the strength of the child. In the bathroom, surgical resident
Jo Wilson (
Camilla Luddington) feels sick about something she discovered earlier in the morning.
Stephanie Edwards (
Jerrika Hinton) states that Jo needs to tell Alex. In the hospital elevator, Jo awkwardly asks Alex if he wants kids, much to his confusion. Arizona suggests Jo may be pregnant and is hesitant to tell him. When Alex comes home after staying up all night to make contacts for a donor for the less healthy twin, Jo confronts him with an invoice from the
fertility clinic about his
embryos with
Izzie Stevens (
Katherine Heigl) 7 years prior. She questions her worth in their relationship compared to his previous relationship with Izzie, feeling insecure. The two reconcile, as Alex humorously pulls down his pants to "make a baby" and Jo laughs at the absurdity of the idea, stating she is in the middle of her residency and he is never home. He climbs on the bed on top of her, and they both laugh. Meanwhile,
Jackson Avery (
Jesse Williams) expresses frustrations with
April Kepner (
Sarah Drew), who has returned from the army, stating he is changing the locks and wants a divorce. April urges him not to. The next day, she returns, planning to thank him, only to discover Jackson has moved out and is now living with Ben and Bailey. ==Production==