The drunk driver who hurt Mia and killed Dell is persona non grata at a lot of places, but he's especially not welcome at Oceanside Wellness. Nevertheless, the man walks through the front door begging forgiveness for the pain he's caused. The guy barely has time get out an apology before Sam is choking the life out of him. Soon the man is going into cardiac arrest. Later, Sam screams, "Some things don't deserve to be forgiven!"
We flashback to Sam's first solo heart surgery many years ago. The patient is a schoolteacher who believes he's going to die. He wants to unburden himself from a secret he's been keeping. The ailing teacher admits to Sam that he's a pedophile moments before being wheeled into the OR.
At the end of a long day, Addison finally musters up the courage to tell Naomi about her relationship with Sam. Naomi has a mini-breakdown but a lot of it has to do with emotions she's feeling after losing William. Addison wants to know what she can do. Naomi says, "I just want you and Sam to back me with this merger." She also tells Addy that she can never talk to her about Sam. Not ever. Sounds like a plan.
Drunk driver guy needs surgery and Sam seems to notice something on the guy's electronic heart readout. But he's not the one doing the surgery, so it's not his problem. Right? In fact, no one will be operating since the patient is refusing treatment. He feels he deserves to die because of what he did. Not many people around Oceanside disagree.
We flashback to Sam's surgery on the pedophile teacher. Complications arise during the operation. Those assisting wonder why Sam isn't taking more aggressive action to save the guy. Later, Sam tells Addison he made a choice. In other words, he chose to let that pedophile die.
Naomi comes clean about how she truly feels about the AddiSam situation. Addy then briefs Naomi about the pedophile case. Addison needs Naomi to talk to Sam, which she does. Sam then visits drunk driver guy. He says, "Have the surgery. Live. And do better next time." He also tells Charlotte to have the operating surgeon look for the hidden aneurysm he noticed on the electronic readout. The guy will die if the doctor misses it.
Amelia returns from a successful trip to Seattle where she made amends with big brother Derek. Now she needs a job. She tells Naomi she should hire her because, as far as neurosurgeons go, she's a total catch. As you may have already guessed, Amelia gets the gig.
Charlotte hates Cooper's loft. She's been seeing realtors behind his back. When Cooper finds out, Charlotte lets him tag along to a place she wants to check out in the Palisades. The place is a death trap. At least, that's what Cooper argues. The elevated ocean view won't be so nice when an earthquake shuttles them into the icy waters below. Dramatic much, Coop?
Charlotte doesn't want to live in a place with so many not-so-pleasant memories for her. The mistakes she's made, the fights they've had...Charlotte finds it hard to move forward with all those memories constantly staring her in the face. Cooper sees the place differently. He only remembers the good times. Aww.
Pete's old war buddy, Gibby, runs a medical clinic out of his house. Shockingly, he also performs surgery in a back room. Violet thinks Gibby has a God complex. Pete believes he's just helping people who are out of options. But the line between helping people and doing the right thing get blurred when a young girl is shot. The patient will die without the proper medical help, so Pete calls 911.
An ambulance takes the wounded girl away. Pete knows Gibby went too far. He promises to call the cops on his old friend if he ever opens another clinic. Still, Pete can't shake that desire to help people who are truly in need. He and Violet agree to find a way for Pete to do some emergency room shifts a few days a week. That'll work.
Naomi knows that the day Sam let that patient die was the beginning of the end for them. They'd never kept secrets before that. But she tells Addison that her relationship with Sam is NOT the beginning of the end for them. Whew!