Meredith's long wait for "McDreamy" at Joe's bar is ended abruptly by a train wreck, which causes a rush hour in the ER. Cases include a young woman and a middle-aged man impaled---together---on a pole. They had been strangers but they bond quickly. Meanwhile, Cristina can't find an amputee's severed leg; Addison and Izzie try to save a badly burned pregnant woman's baby; and Alex treats a woman with an annoying friend.
Exhibition: Miami at Carolina.
It's Michael's birthday (which he proudly shares with actress Eva Longoria), but nobody in the office seems to care---except for Dwight. Meanwhile, Kevin waits to hear from his doctor about whether or not he has cancer. This upsets the staffers, but none more so than Michael, who sees the medical crisis taking attention away from his special day.
A 28-year-old single mother is found shot to death in her home in what looks like a suicide, but Catherine determines quickly that the victim was murdered. The autopsy reveals that the woman was a virgin, but that she had also given birth. Back at the lab, Grissom is summoned by Ecklie to refute the testimony of an expert entomologist in a murder trial in order to prevent a killer from going free.