The episode primarily focuses on Izzie Stevens (Katherine Heigl) coping with the unexpected death of her fiancé, Denny Duquette (Jeffrey Dean Morgan), while dealing with the decision to quit the internship program.

Further storylines include Preston Burke (Isaiah Washington) facing the repercussions of his being shot, and Meredith Grey (Ellen Pompeo) dealing with the aftermath of her affair with Derek Shepherd (Patrick Dempsey), which puts a strain in his already troubled marriage to Addison Montgomery (Kate Walsh).

The recurring characters of Adele Webber (Loretta Devine), Finn Dandrige (Chris O'Donnell), Ellis Grey (Kate Burton) and Olivia Harper (Sarah Utterback) were portrayed with guest star billing.

Izzie Stevens (Katherine Heigl) has a mental collapse after the loss of her fiancé, Denny Duquette (Jeffrey Dean Morgan), as she refuses to deal with the repercussions of her decision to leave the internship program, by lying on the bathroom floor.

[5] The episode's soundtrack featured music by notable artists, including The Dixie Chicks ("Lullaby"), Tegan and Sara ("Take Me Anywhere"), Sleeping at Last ("Quicksand"), Emilíana Torrini ("Nothing Brings Me Down"), Gnarls Barkley ("Gone Daddy Gone"), Grant-Lee Phillips ("Under the Milky Way"), and Mat Kearney ("All I Need").

[6] Initially, Rhimes planned to set the timeline three months after the previous season's finale but ultimately chose to continue immediately from where it left off, believing that viewers deserved to see the aftermath of the dramatic events.

[6] Rhimes also emphasized the role of Meredith Grey's underwear in the episode, symbolizing her character's emotional state and unresolved relationship issues, noting that it became a key element in developing her storyline.

While Dahl noted that some scenes were overly dramatic and not reflective of real-life subtlety, he commended the cast's performances, especially calling the dialogue "smartly written" and effective for character development.

He noted that Izzie's storyline provided emotional depth and continuity, especially in the wake of her fiancé Denny Duquette's (Jeffrey Dean Morgan) death, making her more prominent than the series' titular character.

Chao also found Addison Montgomery's (Kate Walsh) reaction to Meredith's misplaced underwear hilarious and described Miranda Bailey's (Chandra Wilson) encounter with a quarantined patient as emotionally resonant.