The premiere of Grey's Anatomy's twentieth season kicks off with Owen delivering a grim update on Teddy's condition. He informs the team that after a devastating collapse in the operating room, Teddy has been successfully resuscitated. An echocardiogram revealed bacterial endocarditis, which Owen suspects stemmed from a dental infection. This infection led to severe damage to the aortic valve, forcing Beckman and Schmitt to perform an emergency valve replacement. However, further investigations, including blood and tissue cultures, as well as cardiology consultations, are still pending.
Amelia gently suggests to Owen that he take a moment to rest and spend time with his children. Winston echoes this sentiment and instructs Schmitt to conduct post-operative CT scans.
Elsewhere, Nick confronts the interns, enraged by their absence from their designated posts. He rants, blaming them for the multiple lawsuits plaguing the hospital and himself, indicating that he's on the verge of firing them all. Despite his order to stay, the interns disperse, leaving him alone. Their predicament stems from a rash decision in the previous season, which led to the untimely death of a patient named Sam.
Simone and Lucas rush to aid a crash victim, but their situation quickly escalates when they become trapped in the ambulance itself after a car collides with it. Their efforts to open the door are futile.
Meredith and Miranda arrive on the scene and demand that Simone and Lucas operate on the patient within the ambulance, warning that he will perish otherwise. Link and Blue join them outside. Miranda commands the interns to proceed, but Simone hesitates, haunted by the memory of Sam's fate. Lucas makes the initial incision, and Simone eventually takes charge, stabilizing the patient.
Meanwhile, Jules visits Maxine, delicately confessing that she might be developing feelings for Blue. However, her fears of job insecurity persist. She tries to convince Webber that she was not involved in the tragic incident, but he remains unmoved, pointing out that her name is on the patient's medical chart, making her undeniably implicated.
Upon observing Teddy's leg devoid of blood circulation, Winston urgently requests Schmitt to contact the Interventional Radiology team and prepare for an endovascular embolectomy. The subsequent test reveals a clot has formed within her vessel. Winston seeks Owen's consent, and he promptly responds with a reassuring thumbs-up. Meanwhile, Meredith and Miranda, motivated by the urgency of the ambulance patient's situation, quickly prepare themselves for surgery.
Nick, however, stands visibly distraught, his emotions raw after Simone and Lucas' departure against his wishes. Simone, seeking to leave the Operating Room, is sternly instructed by Meredith to remain, observe, and learn from the ongoing procedure.
The surgery progresses smoothly, and the patient is successfully saved. Winston, having adeptly handled the clot, assures Owen that Teddy is now out of harm's way. Upon waking, Teddy finds herself surrounded by the loving presence of her husband, the beacon of her life.
Nick, in a moment of clarity, gathers the interns and informs them that while they will not be dismissed, he himself is moving on, planning to relocate to Boston. Despite his earlier harsh words, he assures them of his unwavering faith in their abilities. As the episode draws to a close, Nick entrusts the care of his interns to the capable hands of Dr. Miranda.
