Meredith tells Cristina that she's going to city hall to get married. She gives Mer her post-it and favorite pen. They think about hugging but readily ditch the idea.

A trauma patient arrives. A woman, who is slightly injured herself, comes in and reveals the unconscious guy jumped in front of a bus to save her life. The face of the man is revealed - and wait there is no face. The woman vomits and is taken out. More doctors are called to the OR.

Mark and Derek talk about their respective relationships. Mark says he's buying a house, Derek says they're going to city hall. The two hug, and Meredith comes in.

Meredith asks Yang if Izzie is doing better. Meredith says she's going to city hall. She quickly points out the parallelism of the things that are happening simultaneously in Seattle Grace - Izzie not knowing Alex is working very hard, faceless guy probably dying and the girl not having the chance to tell him she loves him. She's all, if you love someone, you have to say it, while they can hear you. Meredith tells Cristina she loves her. Cristina tells Meredith that she has changed, in a good way. And the two hug!

Meanwhile, Meredith and Derek are trying to find a way to juggle their busy surgical schedule to make time to go to city hall and get married. Derek wants to reschedule, understandably, but Meredith insists that today is the time. Derek wants to write vows on a piece of paper, and Meredith gives him the post-its from Yang. The two brainstorm about their vows. They came up with the following:
(1) To love each other even when we hate each other,
(2) To never walk away, and
(3) To take care when old, senile, and smelly - "this is forever."
The two sign the post-it, and Meredith declares, this is our wedding. A post it. The two kiss, and you can tell it's more real than any big ceremony in some big church.

Meredith and Derek - newly married - tell Owen that they're OK with spending their honeymoon on the OR, as they prep up for operating faceless guy. Meredith tries to comfort the guy and tell him it's OK. He writes something on her hand - 007 - and Mer yells "Oh God oh God." Faceless guy is George O'Malley!

Meredith comes running down the hall and yells, "It's George!" And at about the same time that they figure it out, Izzie crashes. Knowing that it's George, everybody - Derek, Owen, and Meredith - tells him to hang in there. Meredith's voice over suddenly comes in - "did you say it? That you love this person. Say it." - while a montage appears of the Chief trying to revive Izzie and people working on George.