The long-awaited start to Season Four, "A Change is Gonna Come," promised not to disappoint, and it most certainly didn't. Just 17 days have passed since Cristina's wedding that wasn't. Today is the first day of being surgical residents for the fab four. Note that it's now the fab four. George, who must repeat his intern year because he failed his Step 3 exam, is now under the tutelage of Meredith.
Also, in an interesting twist, Lexie Grey, half-sister to Meredith, who memorably flirted with Derek at the bar in last season's finale, is Cristina's intern. It is also Callie's first day as chief resident, and it's pretty much the day from hell as Bailey is upset with the Chief for passing her over for that position, and extends her bitterness to Callie as well.
All hell breaks lose when a car accident sends victims into the hospital. All the residents get their interns together to meet the ambulances, and Lexie picks this hectic moment introduce herself as Mer's sister.
Derek, Meredith and Lexie later have an encounter in the hallway. Derek recognizes the younger Grey as the girl from the bar. The original Grey defiantly responds, “I'm the girl from the bar!”
Alex has a patient named Joey who seems alright, but is so hungry that he swipes cotton balls - and soon, other things - to eat. Alex and Callie are bickering so much that they don't notice this strange behavior, though.
Meredith's patient is a pregnant woman whose right arm was severed below the shoulder, cleanly from the crash. Cristina goes to call the time of death on another victim when he comes back to life. His head is cut off from his spinal cord and is only being held together by skin and muscle. Derek rushes to his aid.
George is having a hard time coming to grips with having to repeat his year as an intern, and there's clearly a lot else on his mind, as well. Callie tells him she might be pregnant and he's disinterested. There's also the matter of his avoiding Izzie, who has confessed her love to him.
Speaking of Izzie, she wasn't getting much love from her interns, who think she's crazy and a loser, at the start, and their impressions of her don't change when she decides to go all out to save a deer that had been hit in the accident. Really. A sad little boy talks her into it, begging Izzie to try to bring the (cute) animal back to life.
After researching everything she can online, Izzie tries to jump start its heart, and lo and behold - it works! She then says to her interns that take it or leave it, they're stuck with her and she is who she is. And maybe it's them who suck (in as many words).
Mark finds Derek and asks him if he wants to have a drink, since Derek is Meredith-less now. Derek defends her to Sloan, saying that she is damaged because her mother didn't want her and her father left her and her best friend was left at the altar, so of course she is wary.
After Alex's patient has eaten almost everything he can get his hands on, including clamps and scissors, Alex finally notices. He tells his interns to page Bailey. That doesn't sit well with Callie. Bailey realizes she's still in charge, no matter what her title says, a fact reinforced by the Chief telling her she belongs in the OR, not setting schedules, and that she'll thank him for this one day.
Mark is in the process of reattaching the pregnant lady's arm when she goes into labor. It happens so fast that there is no time to call an OB-GYN, so George jumps in to deliver the baby. Easily!
Derek's patient is not properly anesthetized and begins to move around on the table. Any movement at all could cause death, so the doctors scramble to increase anesthesia. Cristina tells him that he cannot move, that he told his family that he loves them so he cannot leave them. We know what Cristina is really referring to - missing Dr. Burke, who she learns from Derek is not coming back... ever.
George is outside of the nursery looking at the baby he delivered. Lexie joins him and is impressed to hear he delivered the baby on his first day as an intern. He bitterly tells her it's not is first day.
He goes into a big “What about me?” speech - despite saying he wouldn't do that - but a wise Lexie counters that she didn't want to come to Seattle, but her mom died and her father is a drunk, that Mer doesn't acknowledge her. So she tells George to stop feeling sorry for himself. He tells her she's kind of awesome.
Later, in the locker room, Lexie has spread the word that George delivered a baby on his very first day as an intern. She emphasizes that it was his VERY first day as an intern. He smiles as he tells them about it.
At the end of the day, in a rare moment of weakness for each, Alex and Cristina admit to each other they miss Ava and Burke, respectively. Dr. Bailey sees Callie sulking outside and offers her some cursory words.
Meredith and Derek go to an on-call room and decide that they have to break up. For real this time. Only they immediately share a passionate break up kiss, which leads to break up sex. Hot break up sex. So once again, we have no idea where it will lead!
Lastly, George shows up at Izzie's door and lets outs the three words she has been waiting 17 days to hear ... “I love you.”