A woman who threw her children out a third-floor window to escape their abusive father is discovered to have done it while going through Valium withdrawal. Susan becomes Chief of Emergency Medicine and learns what it's like to be in management. Plagued by his OCD, Howard abruptly quits his internship, leaving a slot open. Susan can't find anybody to fill it, then discovers Neela working across the street at the Jumbo Mart. Corday is in trouble after her illegal organ donation procedure, facing dismissal and the loss of her license to practice medicine. Weaver offers her a non-tenured position as a clinical instructor, and Corday must decide whether to accept the demotion.

The final 44 minutes of alcoholic ex-con Charlie Metcalf's life plays out as Kovac, Pratt and Sam struggle to save his life. Charlie comes to the ER with a stomach ailment that quickly grows more serious. Slowly deteriorating, he confronts a series of doctors and specialists, and the realization that he is dying. As we learn his history, he tries to connect with his estranged son. Meanwhile, Kovac confronts Pratt about his attitude, and we see how each is touched by Charlie's story.