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Dream a Little Dream of Me, Part 1 is the first episode of the fifth season and the 79th overall episode of Grey's Anatomy. Meredith stands on a hill as candles slowly started to blow out, one by one, and she talks about not believing in happy endings. Hahn, Shepherd, Sloan, Yang, Bailey, Karev, Stevens, and Meredith are huddled around a computer for word on the new rankings of teaching hospitals around the country. Bailey arrives inside the ER with Billy, but the Chief steals the patient from her and gets into a trauma room. Betty, one of the women, doesn’t know what’s going on, so Izzie’s gonna order a head CT to make sure it’s nothing more than a concussion. Lexie finds George and wants to talk about the surprising thing she’s heard, but he walks up to Sloan to ask him to suture Sarabeth’s face.
Anna sees Michael, Sarabeth’s husband, in another trauma room and yells he has a pen in his throat. Cristina finds Richard and tells him Hahn wants him to come take a look at the crush injuries.
Outside the room, Derek tells Owen he’d appreciate it he didn’t give his patient and his wife false hope.
Cristina is getting ready to stitch up Owen’s leg, but he takes a stapler and closes the wound himself. Sarabeth is talking to her husband and tells him she called the insurance and credit card company. Alex asks Meredith if she knows anything about patient insurance as he’s trying out to help out a patient.
The shoe fits Cinderella, the frog turns into a prince, sleeping beauty is awakened with a kiss. Sloan hopes Seattle Grace Hospital could bump Johns Hopkins for the top spot after a year at No. He doesn’t know when he’ll get to retake his test with everything that’s hitting the fan, but Lexie says he’ll be ready whenever the test is. Meredith wants to talk about the recurring dream she has of Derek dying, but Cristina is too distracted by the hospital’s position.
Anna says they should have waited for an ambulance, but Sarabeth says they did, until they decided it took too long. Meredith says she wants to be like these women, happy with the men they’ve been with for years. She’s on the phone with dispatch, where the people keep on talking about three men, who’re most likely going to Mercy West as well.
Bailey comes over and she tells the women about another collision, which possibly could have been their husbands.
Meredith and George body block her and she keeps calling Michael sweetheart and says she’s here, but Meredith takes her to see her own husband. He can elevate the bone fragments, but there’s no way to know how much damage has been done. Derek needs an instrument to remove the last skull fragment, but he changes his mind and asks for another. It’s also possible he’s gonna have to have another surgery to take care of his abdominal injuries.
He diagnoses a subdural hematoma, which explains the memory loss, and asks Izzie to book an OR.

Cristina is going to scrub in on Betty’s husband, on whom Richard and Erica are still working. Mark asks if she’s his little cheerleader and sends George out to go check if the OR is ready. George answers one of Lexie’s questions, prompting Mark to say that the fact that he gets to retake the test doesn’t make him the big man on campus. Callie shows him the research and confesses Derek thinks it’s too risky because of his age. She says she was helping him, but he replies talking to an attending like that is not helping at all. Derek moves in with Meredith, while Lexie develops an interest in George but realizes it may be futile.
George asking what it means to be downgraded to a level 2 trauma center doesn’t help either. Richard says not now, because the snow will cause black ice on the roads and thus lots of traumas, but they will go to Mercy West because that’s still a level 1 trauma center. Bailey complains to them about the Chief stealing her case and asks Hahn to look at the patient’s scans. Cristina points out they’re gonna be taken to Mercy West unless the women insist they be brought to this hospital.
Mark says he’s gonna need extra hands in the OR, so Bailey and Richard give him Lexie and George. Anna says she had lunch with Michael when they ran into each other at the mall and here they are, 8 months later.
Derek says that patient was in his 20s and in primary cardiac health, contrary to his patient. Richard thinks the ranking was a mistake and he’ll make calls as soon as he’s out of the OR. They’re going to build a house together on their land, because they’ll be married and she’ll be Dr.
The chief is enraged by his number 12 status in a top hospitals list and begins to make the staff work harder. Next, Meredith rushes into the emergency room where she is told that Derek had an accident trying to avoid hitting a bus. Derek belived they would stay number two, Erica says maybe three but Mark is content with a top-five ranking. Hahn says it’s a hemopericardium and teaches Bailey about this, explaining she’s trying to become a better teacher. Derek says the man has a skull fracture and Erica concludes this man gets an express ticket to the OR. Anna says she’s sorry, but Callie has Meredith take her away and asks for a consult from Shepherd. She does love Phil, but little pieces of you get chipped or taken away from you by another person so that you’ll fit together. Owen appears in the doorway and says they should freeze him if they want him to have a shot at walking again. Meanwhile, Erica and Callie avoid each other but eventually decide to be awkward about being together. As everyone waits impatiently, Bailey is constantly reminded to hit the refresh button, she tells them to stop guessing their positions and speculating but Meredith interrupts to say the list is up.

She names some past mistakes she’s made, including sleeping with George, which surprises Lexie. Bailey says they’re going to take care of that, but she asks if there's another car or insurance policy. She handled the bowel wrong, which she would know if she weren’t allowed to clock so many cardio hours at the expense of her general surgery knowledge. It's the other stories, the ones that begin with dark and stormy nights and end in the unspeakable. Mark comes over and says he teaches like a guru, guiding people on the path to truth and wisdom. After that, they’ll have chatty babies with perfect hair and a chatty husband and they’ll live in the wilderness. She walks off with her interns and Lexie tries to get more info about Meredith and George from her, but Cristina is not answering. Meredith points out they’re just waiting for someone to be so badly injured that they have no choice but to come to Seattle Grace as Mercy West is too far away. Sarabeth refuses to let George stitch up her face, allowing only a plastic surgeon to do it.
Izzie says she sometimes still thinks Denny’s right around the corner and it’s been a while since he died, so she knows it can take a while to get used to it. It makes Meredith wonder about the point of marriage, wondering what makes you committed if 40 years of marriage doesn’t.
Owen walks off to go check on his other patients, but Cristina points out he is the patient now.
She starts talking about moving in with Derek, but Cristina wants her to talk about something else.
Bailey forgot about God and wants to get back inside as a damaged limousine drives into the ambulance bay.
The driver, a bleeding lady in an evening gown, gets out of the limousine and stammers she drove all by herself. The patient crashes before Cristina can answer and Richard says they might need to turn to damage control.
She’s heard it all before and she’s got to listen to every up and down in their relationship every single time. In the back, another dressed up woman is holding Billy and she asks the doctors to help him. Bailey asks for a gurney and Cristina applies pressure to stop a bleeding while Meredith and Izzie take the other women inside. So Cristina asks Meredith to consider the possibility of shutting the hell up, because she can’t listen to it anymore. Cristina says she’s done and wants to walk back into the hospital, but she slips on the ice and falls to the ground. Cristina laughs a little and asks her to help her back up as an icicle breaks off from the roof above her.

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