[1][2][3][4] Vernoff received a nomination for the Primetime Emmy Award for Outstanding Writing for a Drama Series for her work on the episode.
The episode opens with a voice-over narration from Meredith Grey (Ellen Pompeo) about balancing the need for control with embracing uncertainty and hope.
As Meredith Grey (Ellen Pompeo) nervously awaits Derek Shepherd's (Patrick Dempsey) final decision about their relationship, her thoughts are interrupted when a train crash brings several critically injured patients to Seattle Grace Hospital, including Bonnie Crasnoff (Monica Keena) and Tom Maynard (Bruce A.
In the ER, Alex Karev (Justin Chambers) is performing sutures but fails to notice a woman bleeding internally, leading to her death.
Meanwhile, Addison Montgomery (Kate Walsh) sees great potential in Izzie Stevens (Katherine Heigl), who faces a difficult choice—whether to remain loyal to her friend Meredith or seize a professional opportunity.
[8] Due to the positive fan reception, Monica Keena reprised her role as Bonnie Crasnoff, despite her character's death, in Season 3, Episode 17, "Some Kind of Miracle".
Krista Vernoff received a nomination for the Primetime Emmy Award for Outstanding Writing for a Drama Series for her work on the episode.