"Grey's Anatomy" airs Thursdays (Photo courtesy of ABC)

The episode started with the realization that Meredith and Derek would have a meeting in about 36 hours where they would try to convince a judge they are suitable parents for Zola. But Meredith did not have much time to worry about the issue as she was kept busy by Mrs. O’Malley who was in the hospital after complications from another surgery (for you "Grey’s Anatomy" newbies, George O’Malley was a surgeon at Seattle Grace who died in a tragic bus accident). Not wanting another O’Malley dead under her watch, Bailey was a nervous wreck throughout her stay, which didn’t help her and Meredith’s still tense relationship.

Derek was kept busy too with his author patient who refused to have her aneurism removed until she finished her novel. In other McDreamy news, he also went searching for patients who had previously been denied by other surgeons because of inoperable neuro issues and is on a mission to become the ultimate “yes” man. 

Derek told Lexie that she would be able to help him if she convinced his author patient to go through with the surgery. So of course she helped… that is she helped the author finish her book until her aneurism blew and they had to perform emergency surgery. 

But that was the least of Lexie’s problems this week as her relationship with Avery struggled to survive after Lexie’s jealousy about Sloane’s new girlfriend. It got to a point where Avery couldn’t even be around Sloane, causing him to back out of a surgery he had been looking forward to for weeks, causing Sloane to worry that Avery was “breaking up with him” as his teacher. 

Meanwhile, after a donor patient died before receiving his new heart, Teddy and Cristina were left with the heart in a box, the first of its kind. Typically a donor heart is taken out of the body and placed on ice, but this particular heart was placed in a special contraption that allowed it to never stop beating. 

And while that may not sound especially interesting, to the surgeons at Seattle Grace and especially Dr. Webber, the heart in a box was like a mystical and fascinating object. In fact, when Cristina struggled to finish her surgery bucket list, Webber told her that the heart in a box was the answers to her problems and encouraged her to get in touch with her creative side (a difficult feat for Cristina). 

But alas the heart in a box did the trick, as Cristina was able to distinguish the surgeries she really wanted. She would look at the box and if the surgery in question wasn’t half as cool, then it was crossed off the list. 

Webber thought the heart’s magic would work for Avery too, who was stuck sitting in the gallery watching the surgery he should have been performing. 

Meanwhile  Mrs. O’Malley’s stay at the hospital caused some drama as she wanted Meredith to perform her surgery by herself. Cali also grappled with the idea of telling Mrs. O’Malley (her devoutly Christian ex-mother in law) about her relationship status with Arizona. 

By the way, in this week’s episode Arizona was meeting with a prospective fellowship doctor, Polly, much to Karev’s disappointment. But Arizona’s loyalty to Karev seemed to remain constant as towards the end of the episode he overheard Polly on the phone talking about how Arizona wouldn’t stop talking about him. 

At the end of the episode Avery chose Sloane over Lexie, breaking up with her over the obvious “thing” between her and Sloane. Sloane and Avery rekindled their bromance and the “plastics posse” was reunited. 

Cali’s fears about coming clean to Mrs. O’Malley ended up being for nothing, as she was delighted over Cali’s daughter and asked to see pictures.

The episode ended with a nerve-wracking cliffhanger. Teddy and her husband have been living in marital bliss for the last few episodes, completely forgetting about his illness. But tonight in the last few minutes he began to cough up blood, leaving the audience clenching to their seats in anticipation for next week.