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During her first heart surgery, Meredith (Ellen Pompeo) makes what she regards as a serious error, but is afraid to say anything for fear of losing her internship. Meanwhle, George (T.R. Knight) is saddled with a cranky emphysema victim (Kathryn Joosten) who insists that she has stopped smoking--but the X-rays tell a different story; and Alex (Justin Chambers) deals with a patient who is addicted to prescription pain killers, and will go to any lengths to keep the supply flowing. Finally, a middle-aged man (Jeff Doucette) with obstructed bowels may prove to be equally obstructive to Izzie (Katherine Heigl), who must take time off from planning a lavish party for her boyfriend Hank (Jonathan Scarfe).