Maverick neurosurgeon Gabriel Monroe goes head-to-head with this new boss when he elects to operate on a patient with a deadly vascular anomaly. Meanwhile, Jenney Bremner returns to St. Matthew's from maternity leave to find the hospital changed.

As Shepherd and Witney reel from their liaison, Monroe finds himself without purpose after a catastrophic operation. Grave complications mean Bremner's operation on a five-year-old refugee turns into a race against time.