After being shot at, Pratt, Jing-Mei and Elgin are trying to get out of their sinking car. Sam took Alex with her while fleeing from Steve. Kovac is considering going after them. Abby wants to go to bed since tomorrow is her first day as a doctor, but is thwarted by Weaver, whose custody battle might take a dramatic turn. A young drug dealer is brought in with "a foreign object" in her tunnel of life.
Neela is still struggling with her decision not to continue becoming a doctor. We discover that Ray is in a band. Kovac and Sam are in love, but where does that leave them? Carter takes Abby to dinner in a restaurant he hired off for the evening.
Carter, Pratt, Kovac and Abby are dealing with a woman and her three children who've jumped from the third floor of an apartment building to escape from the violent husband/father. Meanwhile Dr. Lewis becomes Chief of Emergency Medicine, Howard quits his internship and Dr. Corday is facing dismissal.
Neela starts a new job in the emergency room after working at the convenience store near the hospital. On Neela's first day, Pratt expects the interns, Abby, Ray and Neela, to take on a large patient load during their shifts. Pratt turns processing the patients into a competition, in which Ray is clearly going to be the winner.
From 11:22 to 12:06 we can follow everything that happens to Charlie Metcalf (played by Ray Liotta), a patient who is at death's door. We are shown the minutiae of a treatment which are usually glossed over in the "regular" episodes, interlaced with images from Charlie's delusions which give an insight into the regrets he has about his wasted life.
A wounded police officer's teenage son must make a life or death decision. Abby tries to convince a girl needing appendicitis surgery's parents not to transfer her and do the operation at County, but her father wants her transferred to another hospital due to his own trauma with surgery complications from years before.
When a 16-year-old girl who had received a kidney transplant from her father arrives at the emergency room feeling dizzy, Carter traces the problem to a new drug that the girl was taking to control seizures related to her kidney dysfunction.
While examining a young boy, Pratt finds a suspicious gash across his chest and calls Wendall for a consult. Kovac and Pratt examine a man who was shot when he confronted his boss with a gun. Jake tries to convince Abby to date him despite his being a student.
Morris is named the new chief resident, which makes nobody really happy, except Morris. Meanwhile Luka and Sam are having communication problems, Carter gets a promotion Susan really wanted and Ray finds out a 14-year old who always comes in for free drugs has been raped.
Casualties of a disaster flood the ER, which is short-handed because everyone is at Dr. Carter's going-away party because he's leaving the ER after 11 years. Dr. Pratt looks for the courage to confront his father, Charlie.