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In the first part of the two hour season finale, Izzie spends time with a fellow cancer patient and contemplates whether or not to undergo a risky surgery, as Mark is ready to take his relationship with Lexie to the next level and a patient makes Owen reassess his place at Seattle Grace.

In the second part of the two hour season finale, George delivers stunning news to Bailey, sending shockwaves throughout the hospital, and Izzie’s friends anxiously await her recovery from surgery. Meanwhile Bailey is surprisingly displeased after being accepted into the pediatric fellowship program, and the victim of a near-fatal traffic accident brings the talents of Seattle Grace’s doctors together.

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While House tries to cope with his insomnia, he takes on the case of a ballerina whose skin begins to fall off after treatment following the collapse of her lungs during a rehearsal.

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The Michael Scott Paper Company’s low prices continue to bleed business from Dunder Mifflin, but are so low the company can’t attain profitability.

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Gabrielle and Carlos attend a family meeting hosted by Carlos’ aunt Connie (guest star Liz Torres), who reveals an ulterior motive. Bree comes clean to Orson about her true intentions behind stealing and hiding her stuff, and Orson blackmails her into staying married to him. Lynette freaks out when she learns her husband wants to go back to college to study… Chinese. Susan learns just how desperate Katherine is to get Mike to stay with her after Jackson (guest star Gale Harold) tells her he believes Mike was the one who gave him away to the authorities. In the meantime, Roberta Simmons (guest star Lily Tomlin) learns of Dr. Heller’s death, and Dave records a very important tape and starts hallucinating again.

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J.D. challenges an urologist’s assessment on a consult for a patient in need of a risky surgical procedure. He also starts to fall for her. Elliot considers breaking up with Keith, but Carla is showing extreme hormonal changes due to her pregnancy and tries to interfere. The Janitor and Dr. Kelso are having a little tiff of their own about fear.

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