Sheldon and Violet treat a trio of teens who made a pregnancy pact. One of the girls gets yanked from the therapy when her mom realizes Violet is the author of the book she's currently reading. The hits just keep on coming for Violet when she meets Sheldon's new lady love, Marla Phillips. You remember her, right? She's the critic who trashed Violet's book. Awkward!
Violet gives a couple of the pregnant girls a piece of her mind when they start badmouthing her. Then one of the girls starts bleeding. Addison is out of town, but the docs on duty save the baby. The young mother is scared that she's all alone in the world. Sheldon reminds her that her new baby makes that statement utterly untrue. Another one of the teens doesn't know how to talk to her mom, so Violet offers to help her get the ball rolling.
Cooper's patient, Patrick, is a prodigy when it comes to the piano. His grandfather taught him how to play after Patrick's parents died. It's been the only way they've been able to connect over the years. The boy has a tumor in the part of the brain that controls hand function. If Amelia operates, it's likely she'll destroy all function in his right hand. He won't be able to play the piano ever again.
Amelia offers a second option. She can do an awake-craniotomy. By doing this, Patrick could alert Amelia whenever she's nearing an area that affects his hands. The risk of paralysis and other problems are far greater by doing this procedure. Cooper is against it. There's more to life than the piano, as Coop knows since he used to play. He believed his father was only interested in his piano playing because of his brother who passed away, so he quit.
Patrick's grandfather opts for the safe surgery, but the kid wants the awake-craniotomy. Again, he feels the only connection he has with his grandfather is the piano. If he has to lose his legs to keep that going, then so be it. Patrick's grandfather loves him, but Amelia knows the kid needs to hear the words. That's not going to happen. The grandfather can't verbalize his feelings, so he angrily signs off on the risky procedure.
Amelia begins the operation. Patrick's grandfather is a no show at first, but arrives in time to tell his grandson he loves him. There's a complication during the surgery. Amelia works fast to control some bleeding in the brain. Patrick recovers but it's too early to determine if he'll be able to walk. The good news is he can still play the piano. The great news is that Patrick finally knows how his grandfather truly feels about him.
At the end of a long day, Charlotte has a little surprise for Cooper. There's a brand new piano sitting in their living room. She says, "You can't give up on the things you love. Not ever." Of course, Sheldon may have to give up his relationship with Marla. Actually, she's the one who walks out on him because she's tired of his relationship with Violet being more important than the one he has with her.
Pete's mom, Frances (guest star Louise Fletcher) is rushed into the hospital after his brother, Adam, gave her some pills. He did this in order to get her out of prison, but the pills actually acted as a poison to her system. Frances stabilizes, but Pete still wants nothing to do with her.
After a chat with Frances, Violet tries to get her hubby to show some forgiveness. Her words have enough impact to inspire Pete to bring Lucas in to meet his grandmother. Frances doesn't have much time left before she dies. Adam tells his mom there's no need to be scared. He's there. Pete lets Frances know that he's also there. And when Pete eventually breaks down at home, Violet is there for him, too.