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The two develop a close relationship, and Casey develops romantic feelings for Izzie towards the end of the season–leaving her wondering what it means for her and her boyfriend, Evan.
During a night out with friends, Elsa meets a bartender and begins an affair with him.
Meanwhile, Julia deals with frustrations regarding a lackluster proposal, as well as her pregnancy.
Sam has a session with his therapist Julia, in which he learns that autistic people can date people.
Meanwhile, Sam's sister Casey is suspended for punching Bailey Bennet, a fellow student, who graffitied "ORCA" on another student, Beth Chapin's locker.
Beth makes Casey a chocolate cake out of gratitude, bringing her brother Evan with her.