Lexie drops in with Mark scouting for houses. Being a girl, Lexie says he's only doing that to make her feel bad that he's moving on. He tells her that he's a better woman than her.
Meanwhile, Meredith and Derek are trying to find a way to juggle their busy surgical schedule to make time to go to city hall and get married. Derek wants to reschedule, understandably, but Meredith insists that today is the time. Derek wants to write vows on a piece of paper, and Meredith gives him the post-its from Yang. The two brainstorm about their vows. They came up with the following: (1) To love each other even when we hate each other, (2) To never walk away, and (3) To take care when old, senile, and smelly - "this is forever." The two sign the post-it, and Meredith declares, this is our wedding. A post it. The two kiss, and you can tell it's more real than any big ceremony in some big church.
Izzie complains to Cristina that Alex marched in earlier and told her that being married to him is the worst thing ever. Apparently, this is the only thing that she is able to remember without the help of a note. How weird is that? Maybe Izzie will survive and come back next season? Once again inspired, Cristina rushes out, looks for Owen, and kisses him full on the lips. She tells him yes, and scoots off - still smiling.
The Chief tells Bailey and Callie that George took the day off. Uh oh, I don't like the sound of this.
Meredith and Derek - newly married - tell Owen that they're Ok with spending their honeymoon on the OR, as they prep up for operating faceless guy. Meredith tries to comfort the guy and tell him it's OK. He writes something on her hand - 007 - and Mer yells "Oh God oh God." Oh dear. Faceless guy is George frigging O'Malley.
Meanwhile, Karev is kind of happy that Izzie remembers something, even if it is his outburst of him saying he's considering killing her just to put them out of their misery. The two hug, but she loses consciousness.
Meredith comes running down the hall and yells, "It's George!" And at about the same time that they figure it out, Izzie crashes. Knowing that it's George, everybody - Derek, Owen, and Meredith - tells him to hang in there.
Izzie flatlines and despite signing a DNR, Karev tries to revive her. The Chief goes, "Screw the DNR" and grabs on the defribillator to revive her, too. Everybody goes to work.
Meredith's voice over suddenly comes in - did you say it? That you love this person. Say it. - while a montage appears of the Chief trying to revive Izzie and people working on George. And we know she's going to die because we see her on a dress in the elevator (is that the same dress she wore when Denny died?), and suddenly the elevator opens and it's George, in a sort of army uniform. And the two smile. Meanwhile, Izzie is still not responding to the efforts of everyone. Alex starts sobbing.
"It might all be gone tomorrow," Meredith closes grimly.
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