In this episode, the doctors of Seattle Grace Mercy West Hospital cope with the physical and emotional reverberations of the aviation accident that took place in the season eight finale, while several surgical residents are promoted.

Further storylines include Cristina Yang (Sandra Oh) relocating to a different hospital, and a group of new interns being intimidated by Meredith Grey (Ellen Pompeo).

The episode opens with a voice-over narration from Meredith Grey (Ellen Pompeo) on how death impacts the living and the lasting memories we leave behind.

The episode begins with Seattle Grace Mercy West Hospital's new interns, Shane Ross (Gaius Charles), Jo Wilson (Camilla Luddington), Heather Brooks (Tina Majorino), and Stephanie Edwards (Jerrika Hinton), expressing fear of Meredith Grey, who is now an attending general surgeon.

In the hospital cafeteria, Meredith Grey announces that Wilson will be given the honor of performing a supervised appendectomy, a procedure historically used as a reward for interns.

Barnett informs Karev that he will not be continuing with the African orphan charity program (a function to treat ill children from Third World countries), something that was initially finalized by the latter and former chief of pediatric surgery, Robbins.

Back in Minnesota, Yang is annoyed by the peppy attitudes of her superiors at Mayo Clinic, Craig Thomas (William Daniels) and Parker (Steven Culp), so she decides to take a trip to Seattle for Sloan's death.

Shortly thereafter, Meredith Grey finds Karev at the airport bar, where he reveals that he will be remaining at Seattle Grace Mercy West Hospital.

[3] George returned to the episode as Warren, while Daniels, Culp, Casnoff, Charles, Luddington, Majorino, and Hinton made their first appearances as Thomas, Parker, Barnett, Ross, Wilson, Brookes, and Edwards, respectively.

[9] After it was announced that Dane would be departing shortly after the commencement of the ninth season,[10] Dempsey uploaded a set picture on Twitter of Sloan in bad condition.

However, she noted that the writing team considered having him move to Los Angeles to be with Addison Montgomery (Kate Walsh) after her departure from Private Practice, but they feared it would have given the impression that his love confession for Lexie Grey was forgotten.

The installment's 4.4 Nielsen rating in the target 18–49 demographic ranked the series first in its time slot and second for the night, trailing only CBS's The Big Bang Theory (5.0).

Online's Kristin dos Santos called the installment "gut-wrenching", saying it was the type of episode that "rips out your heart and feeds it to you with a spoon".

"[29] The International Business Times' Arlene Paredes concluded that the episode "raised the bar for deeply emotional yet again", and noted that it was "one of the most high-anticipated TV [returns] this fall".

[31] Writing for AfterEllen, Bridget McManus threatened to boycott the show if Capshaw's character was killed, but thought the FaceTime calls between Yang and Meredith Grey were humorous.

[33] Zap2it's Carina Adly MacKenzie opined that it "became increasingly clear" that Sloan would die as the episode progressed, and praised Capshaw's performance, noting that it was "brief but truly striking".