After being passed over for ER Chief, Pratt makes plans to leave County and go to a hospital that will appreciate his talents and take him more seriously. A woman comes in with a severely injured ankle and a terrible secret, and Sam finds herself closely identifying with her. A former ER staff member rushes in to be with her son, who was brought in after a fall during gym class. Neela's cousin is in town, and Morris and Harold vie for her attention.

The ortho docs face off in a hockey game against the trauma docs, who have enlisted the aid of a ringer. Bettina wants to take her relationship with Pratt to the next level, but Pratt is hesitant. Gates and Sam disagree over how to treat a young patient. Julia's attempt to provide spiritual guidance to a prison doctor and help ease his conscience leaves her devastated.