It's another new day, and Alex is filled with determined optimism. In hopes of capitalizing on the movement of Charlie's hand, she's decided to mount her own coma arousal therapy campaign. After spritzing fancy perfume, Alex yanks off her top and climbs on top of Charlie in hopes of literally getting a rise out of him. In spirit form, Charlie is sufficiently aroused, but the flesh and blood Charlie doesn't move. When nurse Jackson pops his head in to suction Charlie's phlegm, Alex scurries off in total embarrassment - it's not long before everyone knows she was in her bra on top of her fiancee. On the way to rounds with Alex, Charlie the spirit muses on the efficacy of hope: he's always told his patients that they have to believe they're not going to die. And today, that's exactly what Alex is going to choose to believe.
After their night of passion, Joel and Maggie enter a cafe to pick up some coffee, still basking in the afterglow of their pleasure, only to run into Gavin. When Gavin asks if they came together, they both step on each other's lame answers. Meanwhile, Alex bumps into Reycraft in the corridor. Would he mind covering for her if she had to take some time off? While Reycraft is perfectly willing to be chief surgical resident while Alex is out, he knows it's Kinney's call. And while he promises he has Alex's back, he isn't promising to give her job back either. Joel comments on the proceedings, quoting Shakespeare, which Alex knows is a sure sign he got laid last night. Joel refuses to kiss and tell. He heard about Charlie's hand movement; it doesn't mean Charlie's going to wake up today. Still optimistic, Alex insists it doesn't mean Charlie's not going to wake up either, and heads off to her consult.
Patient Benjamin Munk is charming Maggie and some nurses, honing his wedding proposal skills. He's intending to fly to San Francisco tomorrow to propose to his beloved, Karen Anne Churley, but right now he's experiencing abdominal pain. Alex discovers several scars on his belly that Benjamin claims are from multiple operations to treat pyloric stenosis, which he's had since he was a baby. His father, a surgeon now working in Africa, knows Charlie. Alex schedules a full battery of tests, then moves off to the ER, where brothers Isaac and Johnny have just arrived after falling 30 feet off a roof. Johnny's leg is completely mangled, but Isaac is in worse shape and has to be rushed off to surgery.
Despite all of Alex, Joel and Victor's hard work, Isaac bleeds out on the operating table as his spirit joins Charlie. Charlie explains that he's in a coma, but Isaac's dead, and he's not sure why Isaac's spirit is hanging around. In his limited experience, usually dead people disappear. Meanwhile, Maggie brings Benjamin the result of his tests - he's simply anemic, and free to go. Maggie steps aside to write him a prescription, only to learn there's a chronic swallower in the ER, and she just swallowed Gavin's phone. Maggie turns around to find Benjamin complaining of dizziness. When he stands up to leave, his legs buckle and he crashes to the floor.
Joel visits Johnny with lots of bad news. Not only is Isaac dead, but Johnny's leg is majorly mangled, and he'll need surgery right away to save it. Joel wants to perform a Van Ness rotation plasty, amputating the lower part of the leg and rotating it 180 degrees so the ankle becomes the knee. This way, Johnny will be able to walk and work. All Johnny will say is, "Whatever. Do what you want. I don't care." Alex meets with Benjamin to ask more questions, just as he starts coughing up blood. Although he was adopted, Benjamin knows a form of colon cancer, Lynch Syndrome, killed his birth mother at age 32. Since it's hereditary, Alex schedules more tests, then assures Benjamin that none of this means he has cancer. She tells him about Charlie and his recent movement - he's getting better, and it's proof that the human body is simply amazing.
Alex proceeds to the endoscopy suite to watch Maggie perform a colonoscopy on a drugged-out Benjamin, who's calling out the name of his fiancee, Karen Anne Churley. When Maggie asks Alex if Joel was a bad boyfriend, Alex assumes the obvious. What's not obvious is why Benjamin's colon is as flawless as the Hope Diamond. Alex is paged to the lab by Dr. Clay Fisher, who's just analyzed Benjamin's stool sample and found it strongly positive for occult blood. Alex walks away, pondering this mystery, when she looks up to see a poster with a photograph of Hope Zion's employee of the month: cafeteria cook Karen Anne Churley!
Joel stops by Kinney's office to ask her to schedule him a Van Ness rotation plasty on Johnny. Claiming that risky Van Nesses are typically performed on children with tumors, Kinney wants to know why not just do a fusion? Joel explains that Johnny will be a peg leg with a fusion. Joel has performed plenty of Van Nesses and this will give Johnny, who worked as a roofer with his brother Isaac, a shot at full mobility. Kinney thinks the risk of infection - and litigation - is too high, so she declines her permission. If Joel wants to showboat, he should do it someplace else. Joel advises Kinney that if she wants to win respect, she needs to take risks. His triumph will be her glory.
Joel proceeds to the waiting area to apologize to Dalia Wolfe, Johnny's wife. Johnny told Joel he wasn't married! Joel explains that he will be performing the risky Van Ness. A tearful Dalia admits she's scared to see Johnny. They've been fighting and she has to make her peace with him, in case anything happens. But Johnny doesn't want to see or talk to his wife. What can she tell him that Isaac didn't already? Dalia leaves silently as Johnny heads off to surgery.
Alex brings Gavin with her to explore the back of Benjamin's knees - which are riddled with track marks. The doctors explain that not only do they know Benjamin has been lying about his fiancee Karen, but that he bled himself to present as anemic, then drank the blood so it would show up in his stool. Alex orders Benjamin out of the hospital as soon as he's able to stand, then turns to go. Benjamin calls after her - he swallowed an open safety pin, so he probably has a perforated bowel, and will need a CT. Alex thinks Benjamin is a lying con man, but Gavin knows he's a "frequent flyer," and prone to self-harm.
On her way to radiology, Alex bumps into Shahir - has he been to see Charlie? Alex thinks the coma arousal therapy is working - Charlie moved! - and wants Shahir to perform another Glasgow test. He's not happy about it, but in the end, Shahir caves to Alex's pressure. Having learned the safety pin has indeed perforated Benjamin's duodenum, Alex and Maggie prep for surgery alongside Joel, who's feeling anxious. He convinced Kinney to let him do the Van Ness, and now he has to succeed. Alex promises him he won't screw it up. With a full house watching from the observation deck, the pressure really is on. In the waiting room, Isaac mentions Er and Onan, sons of Judah, whom God killed for loving the same woman. Charlie surmises the reason Isaac is still around: unfinished business. Both brothers loved Dalia, and fought over her, and fell off the roof. Isaac tries to apologize to God for creating the love triangle, but he doesn't disappear.
That night, Gavin explains to Alex that Benjamin has Munchausen syndrome. He constantly seeks attention and hospitals make him feel safe. Although he knows this condition will persist, Gavin resolves to keep talking to Benjamin. Alex responds to a page from Kinney, who wants to know what's up. First Alex was stripping in the ICU, then she was slow to catch the Munchausen syndrome, and finally, Reycraft said Alex wants time off. Alex is distracted, and there's no room for anything but Charlie. But Alex is still a doctor, and Kinney needs her head in the game. Alex proceeds to check in on Benjamin. He says he's okay, but Alex knows he's not. He's now a psychiatric patient, and he no longer needs to live his life in denial. Benjamin points out that he's not the only one in denial; what about Alex's belief that Charlie will wake up?
Charlie and Isaac check out Johnny, who's dozing after his surgery. He comes around when Dalia stops by. Now is probably a good time to talk about their problems since he's on a morphine drip. Dalia claims she never wanted to fall in love with Isaac. Johnny admits he knew, but didn't want to see it. He should have fought harder for her or let her go; Isaac died because he couldn't act. Isaac starts yelling at Johnny, hoping to make himself heard. It was no one's fault. Meanwhile, Shahir examines Charlie as Alex looks on. Charlie's condition hasn't changed, and his hand movement was involuntary. When Alex runs off in tears, Charlie gets upset, refusing to believe when Isaac tells him it will be okay.
Having completely lost it, Alex runs to an empty room, flings herself on the bed and cries. She calls out for Charlie, then flashes back to post-coital bliss during their first week together, when Charlie suggested getting married. Joel's gentle knock on the door brings her back to reality. What Alex wants to know is how she could be so emotional? She was convinced Charlie was getting better. Joel reminds her that Charlie moved, and it could well have been a sign of improvement. Alex isn't Charlie's doctor, she's his lifeline. And right now, she's all he's got. Alex pulls herself together and retreats to Charlie's room.