Algernon wakes in his seedy room in the Tenderloin district. In line for the bathroom, one of the other tenants admires his shoes, menacingly. Algernon narrowly avoids a confrontation before heading into work.
The surgeons put the hospital's recently installed electricity to use. During surgery, Chickering uses the electronic cauterizer with impressive results - until the circuit shorts and the patient catches fire. Nurse Monk rushes over with a bucket of water to douse the source of the flames and is immediately electrocuted.
Cornelia and Thackery express their anger to Barrow over the poorly installed electrical wiring. Barrow vows to get to the bottom of it and summons the contractor who did the installation. Unknown to everyone else, Barrow had it done on the cheap and pocketed most of the money the first time around. Now, he is forced to pay for the proper installation himself.
Cornelia sees Algernon's dank office basement and is furious. Algernon decides to use the location to its full advantage and sets to work cleaning it up. He spots a black woman who has been turned away from the Knick and tracks her down. After hours, he treats the inflammation in her arm - the first patient of his underground clinic.
Thackery informs Barrow that he needs cadavers to practice on, but increased competition from medical schools has sent the price of bodies skyrocketing. Barrow already has his hands full with representatives of the gangster Bunky Collier demanding he pay the money he owes. When Barrow visits the man himself to renegotiate his debts, Bunky pulls out one of his teeth as collateral.
A patient arrives at the hospital with an aortic aneurysm. Thackery and Gallinger plan to go ahead with surgery, even though the ailment is almost certainly a death sentence. Algernon offers that a galvanic procedure he learned in Europe boasts a 60 percent success rate, but the others won't hear it. After the surgery goes predictably poorly, Thackery expresses an interest in trying the galvanic procedure. Rather than consult Algernon, Gallinger, Bertie, and Cleary break into the office of a doctor who receives the latest European journals. They find the procedure - along with some gruesome photos - but the journal is in French.
Barrow and Cleary settle up for all the patients the ambulance driver brought to the hospital that month-minus one corpse Cleary tried to pass off as living. Spending his earnings at the pub, Cleary takes a break from his drinking and brawling when he spots Sister Harriet outside. He follows her as she makes a house call to a young woman in need of an abortion.
In the Tenderloin, Algernon has another confrontation with his neighbor. This time, Algernon skillfully decks the larger man. He goes into his room and retrieves treatment for the man's injuries.