Bishop Stewart returns, seeking pain medication from Luka, who also has his hands full dealing with the parents of a 16-year-old who does not want another heart transplant. Abby fills in as Carter's date for a Carter family function and sees her ex-husband there. Malucci treats a gay man who wants to contract HIV from his positive partner. Greene continues an abrupt personality change in the wake of his surgery. Weaver makes an appointment for a competency review for Mark.

Carter and Luka are called out to the scene of a major train wreck, where Carter is forced to perform a double leg amputation by himself when Corday begins to experience contractions. Weaver and Legaspi treat a young, suicidal girl who caused the accident. Benton lets prospective med student William White follow him around the ER. Luka wrestles with his faith, revealing that he could have saved his wife by sacrificing his daughter. Bishop Stewart grants him absolution before his death. Also, Carter meets a new pedes intern, Rena Trujillo.