Charlie sits beside a drowsy Alex in the lecture hall, willing her to see him again. Instead, Alex's eyes close, while on the dais, Kinney reviews a tricky, high-profile surgery. Migrant worker Ysidro Pineda has had both hands amputated at a chicken processing plant, and two teams of surgeons, handpicked by Kinney and led by herself and Joel, will reattach them. The surgery must be completed within the next 12 hours or the hands will die, and Ysidro is en route. Kinney calls out Alex for napping, then goes on to say that a successful double hand replantation has never been achieved in the city of Toronto, so this one's a biggie. After the lecture, Alex apologizes for falling asleep and is somewhat thrown when Kinney sends her home to get some rest. Back at home, Alex finds a note on the fridge, from Charlie on their wedding day. Where are his cufflinks? Now Alex feels even more sad, tired and lonely... is there no rest for the weary?
Feeling connected to Ysidro, Maggie tells Joel that she would do anything to participate in the replantation surgery - which clearly includes sexual favors. Joel promises to see what he can do as his pager goes off, calling him to a meeting with Kinney to pick the two surgical teams. When Kinney fails to mention Alex, Joel goes to bat for her, but Kinney stands firm. Alex is exhausted, even if she is chief surgical resident - which she may not be for too much longer. Meanwhile, Charlie is in the ICU looking at his comatose body when Melanda wheels in elderly Scott Cockburn, who's comatose and has pneumonia. Melanda rues using the bed space for someone she can't help, as a young vibrant Scott materializes next to Charlie to explain Melanda's not wrong; he's been in a coma for nearly 30 years.
Melanda calls Maggie up to the ICU for a surgical consult on a homeless and pneumatic John Doe, who's been beaten and left for dead by a pack of teenagers. Certain she's going to be chosen for the replantation surgery team, Maggie says she doesn't have time for John Doe, but Melanda insists he has a nasty abscess, which needs draining - now. Alex is trying and failing to nap at home when there's a knock on the door. Joel has come to tell Alex she's not part of the surgical team. Alex maintains that she screwed up by falling asleep, but Joel thinks she's giving up. Even if she is scared to death of Kinney, Alex needs to channel it and show why Charlie made her Chief Surgical Resident in the first place... or Reycraft will happily fill her shoes. Alex gets herself together and is back in the hospital for Ysidro's arrival.
Ysidro has also sustained a crush injury to his legs, which Alex knows means gross contamination of all wounds. Noticing that his urine is contaminated with blood, Alex checks his kidneys, while Kinney explains the reason she didn't put Alex on the surgical team: she's a liability. When Ysidro's heartbeat shows arrhythmia, Kinney demands answers. What's going on? After taking a minute to think, Alex concludes the urine is a false-positive. Acute muscle damage has flooded Ysidro's system with myoglobin, making his urine turn red. They have to flush the myoglobin now, or he'll face total renal failure. Despite Alex's good work, Kinney orders her to step out and grab a coffee.
Joel finds Maggie all scrubbed in and ready to join the surgical team. She's not too happy to hear that he was too busy fighting for Alex to get Maggie on the team too, though he claims it's nothing personal. Alex finds Shahir in the doctor's lounge. Having heard she was sent home, Shahir asks if she wants to talk. Alex admits she's exhausted, hallucinating and fighting for her job. What if this is it? Shahir points out that comas can last for decades. What is Alex going to do if Charlie's dies? Meanwhile, Charlie tells Scott that this is week five of coma for him. Scott is the only person Charlie's met who knows something about the in-between state they're in - can Scott offer any help? Scott figures Charlie should lighten up and try to have some fun - which he accomplishes by pushing Charlie off a balcony.
After picking himself up off the floor, an angry Charlie lays into Scott - how can he be so cavalier!? Scott wants to know how Charlie can be so depressed - it's like he's happy about being in a coma. The guy in the coma is the dreamer now; this in-between state is Charlie's life. Scott hasn't given up; he's adapted. Charlie needs to let go of his old life - and he should heed Scott, because Scott has been to hell and back. Their present is a happy place. Zach tells Kinney that Ysidro is too weak to survive surgery, a fact she blithely ignores. When Alex returns with coffee, Kinney decides she can be part of the surgical team. As the surgery gets underway, Maggie checks on her John Doe, whom she decides to call William Darcy. She is alarmed to find his abdomen distended and his urine output low. She's thinking it's ACS (Abdominal Compartment Syndrome), but Melanda doesn't and accuses Maggie of trying to draw attention to herself.
In the OR, Reycraft finishes suturing Ysidro's hand back in place before Alex completes hers, but she doesn't cave to the pressure and carefully continues to work. When blood flow is re-established, Alex's hand pinks up and comes back to life, but Reycraft's doesn't. Apparently, he's hooked up the artery, then sewed it shut. Knowing that saving the hands is the most important thing, Kinney replaces Reycraft with Alex. Maggie finds Gavin in the lounge to complain about John Doe - Melanda won't believe he's dying! What should she do? After she explains the whole situation, Gavin asks - is Maggie sure John Doe is dying?
Alex finishes suturing Ysidro's second hand, but it doesn't pink up right away. She suggests tilting the arm - perhaps gravity will help. And it does! Kinney congratulates Alex on a job well done. After the surgery, Victor tells Alex they're all coming to her house at 8:00 - it's Dr. Kinney's new thing. The surgical hero gets to buy everyone dinner as a team-building exercise. If Alex orders Chinese, Kinney will bring the booze. Meanwhile, Scott and Charlie are continuing their conversation in the ICU when Scott is upset by the arrival of his next of kin, his ex-wife Melissa and her husband Robert. Melanda explains that Scott has pneumonia in both lungs and his prognosis isn't good. When Melissa allows that perhaps they shouldn't revive Scott, he tells Charlie that the living always forget about people in comas. Nevertheless, Scott becomes upset that Melissa has lived a full life - without him. Apparently, she divorced him two months after he entered his coma.
Before leaving, Alex stops in to talk to Charlie, telling him that she went home for the first time, and she's going home again - but she'll be back first thing in the morning. After everything Scott has said, Charlie can't help feeling very alone. Later at the party, Kinney tries to make friendly with Alex, insisting she have a beer. Back at the hospital, Scott and Charlie watch as Melanda takes the comatose Scott off life support. Melissa holds Scott's hand as he dies. Scott in spirit form admits he expected something more exciting to happen, but he's not sorry about anything. And before he goes, he cautions Charlie that if he really wants to get back to Alex, he's going to have to try harder to wake up, or he's going to lose her. Melissa starts crying over Scott; she couldn't let him go, and she never stopped loving him. In spirit form, Scott touches Melissa, telling her not to cry. Melissa does seem get his message and a sense of peace.
Back at Alex's, more than a few beers have been consumed, while Kinney, Shahir and Victor swap war stories. Knowing full well Shahir is a germaphobe, Victor drops a wonton on the floor and challenges the group: should he eat the wonton? And after he does, should he kiss Shahir? When Victor does both, the priceless look on Shahir's face makes Alex hysterical, first in laughter, then in tears. Unable to make a recovery, she bolts into the bedroom and Joel follows. What happened? Alex admits she was overcome with guilt, because when she was laughing, she forgot all about Charlie for a moment. She felt free.
Maggie stops into the ICU to find John Doe crashing, and Melanda is nowhere to be found. Making a quick decision, Maggie puts on a gown, grabs a scalpel, cuts John Doe's belly open and spills his guts - relieving the pressure and saving his life. Afterwards, Maggie regales her coworkers about what happened. Saving a life trumps a hand replantation any day. Melanda steps in to say in a clearly disapproving tone that John Doe has stabilized. Maggie can't help telling Melanda that because she didn't listen to Maggie, they almost lost John Doe. Melanda's tone doesn't change. John Doe didn't show the proper signs for ACS, and graveyards are full of people who have died from doctor's mistakes. Neverthless, Maggie tells Gavin she's feeling fine. She feels like a doctor!
Reycraft checks up on Ysidro, who is now awake, hands on the mend and fully attached to his body. Charlie is surprised when a teary Alex returns to his bedside in the ICU. She explains that she had a party and had the chance to experience what it would feel like if life went on without him. What terrified her is that it could. Alex flashes back to the morning when she presented Charlie with her dead father's cufflinks. Back in the present, Charlie sits on his bed as Alex tells him she will never forget about him, and she'll never let him go.