Beautiful Sandhya Ahuja sits with her domineering mother Deepha and her brother Vik as Alex carefully explains the minor laparoscopic surgery she's about to perform to remove a tumor on the wall of Sandhya's bowel. Deepha is concerned Sandhya won't recover in time for her pre-wedding celebration, but Alex claims she should be ready to go home by the end of the day. Alex is scheduled in back-to-back surgeries, so she asks Melanda for a favor: will she look out for a coma arousal therapist named Ashley who's scheduled to work on Charlie? Melanda's on board, but she runs off when she spies Charlie's ex-wife Dawn, who's dropped in for a visit. Dawn is just harassing Alex - why isn't Charlie waking up? - when Ashley arrives, who, counter to Alex's expectations, is a creepy male folk rocker. When Dawn asks whether Alex found Ashley at a clown school, Alex snips that she doesn't have to explain herself to Dawn.
In the ER, Zach and Maggie question heavily tattooed and pierced Karn, who's sporting a couple of subdermal horns on his forehead. He's feverish and woozy, so Zach assumes he's been drinking and drugging, but Maggie's immediately drawn to the horns, which Karn explains are silicone implants. After a consult, Zach tells Maggie to order a blood test and consult with Joel to make sure Karn's skull isn't infected. In the OR, Sandhya has just been anesthetized and starts chatting with Alex about her upcoming wedding to fiance Sanjay.
Alex has just made her first little incision when Sandhya crashes and her temperature skyrockets. Her adverse reaction to the anesthesia has put her into malignant hypothermia with convulsions. The team races to cool her down just as an alarmed Kinney steps in to assess the situation. They quickly manage to get her temperature under control - but were they fast enough? Since they can't wake her up, Kinney orders Alex to bring Shahir in for a consult and tell her family what they know. Alex wants to mention that Sandhya's pupils are reactive - a good sign - but Kinney doesn't want to give false hope. Alex tries to reassure an upset Deepha, promising there's no reason Sandhya won't wake up today, but Kinney pulls her away, reminding, "Less is more."
Before Joel begins his exam, he reminds Karn that his implants are illegal. Tattoo shop owner Karn knows the drill, having performed all his own work for the last five years. Joel and Maggie are upset to discover that Karn inserted his own implants, without anesthesia. Karn clearly has cellulitis, but Joel is concerned that he may have osteomyelitis - a skull infection. Karn is dead set against removing his horns - it took over a year to build them up! Joel explains that if the infection reaches his brain, Karn could be looking at meningitis, brain abscess and possible death. Maggie tries to quell the tension. They have to take things one step at a time, and first they'll need a CT. On the way out, Joel advises Maggie to bring Gavin down for a consult, since he's pretty sure Karn will resist treatment.
Karn is upset when Gavin shows up at his bedside. The hospital staff is succeeding only in treating him like a freak. Surprisingly, he does agree to answer Gavin's questions. For Karn, pain is an attitude, which can be overcome in the face of his goal. He wants to mark his body with his identity. Who cares if he continually operates on his body? Skydiving, smoking, eating fast food - these activities are all dangerous, too. So who's crazy? Gavin wraps up the session, promising he'll tell Joel that Karn is as sane as anyone else. Upstairs, Dawn gives Shahir the third degree, trying to ascertain Charlie's condition. In the end, she wants to know whether it's fair to keep Charlie alive since he appears to be in a persistent vegetative state, a question Shahir refuses to answer.
Charlie is just trying to tell Dawn to stay out of his affairs when a panicked Sandhya rushes into his arms, relieved that somebody can actually see and hear her. Later, Charlie and Sandhya stand by while Alex and Kinney consult with Shahir, who can only say it's a waiting game. Who knows when Sandhya will wake up, especially since they really don't know what's wrong with her. Unsatisfied with this prognosis, Alex refuses to stand by and wait. She huffs off to Charlie's room in the ICU where Ashley sings folksy songs about chi. Melanda advises Alex to fire Ashley, and Alex tells Melanda that Dawn is no longer permitted to visit Charlie.
Sandhya claims she's in no hurry to wake up, mostly because she's in no hurry to get married. Maybe she's not scared because she's Hindu and believes in reincarnation? None of Charlie's science can explain how they're talking to each other... Gavin checks in with Joel to report that Karn is mentally competent, and his body mods are merely an exhibition of his identity. Joel is nonplussed, offering to show Gavin the places where Karn's skull is turning to mashed potatoes. Meanwhile, Kinney has the terrible job of talking to Sandhya's family about her condition. Her adverse reaction to the anesthesia has affected her brain, and she's in a coma and won't wake up. Deepha lays into Alex for promising Sandhya would walk out of the hospital today. How can she live with herself!? Kinney is equally upset - how could Alex have lied? Sandhya isn't Charlie, and Alex has no idea what her family is going through.
Charlie and Sandhya hang out in the maternity ward checking out babies. She wants to know why Charlie looks sad - is he afraid he won't have kids? He's afraid the people he loves are forgetting who he is, because all they see is a comatose body. Sandhya is just saying that it doesn't take a coma for people to fail to see who you are - like her fiance - when her mind goes blank. Something's wrong. Alex meets Melanda in the hallway, rushing Sandhya's gurney to the OR. Sandhya's foot went white from mid-calf down - it's a blood clot in the femoral artery, and she needs an emergency surgery to remove the clot. In the world in-between, Sandhya's worried, but Charlie insists she's in good hands - Alex knows what she's doing. Alex makes quick work of the clot, but she's not looking forward to telling Deepha that this is actually good news amidst all the bad.
When Sandhya asks about her chances of survival, Charlie thinks they're much better than his own - which are starting to look dicey, now that he's been comatose for over a month and Dawn wants to pull his plug. Sandhya is revolted to see her fiance Sanjay in the corridor and tells Charlie she wants to get as far away from him as possible. Joel is alarmed to learn Zarn refused treatment and checked himself out of the hospital. Joel runs outside to find a feverish and delusional Karn about to get beaten up by a construction worker. Karn refuses to return to the hospital, but when he passes out, he no longer has very much of a choice. It's not long before Joel is in the OR, preparing to remove Karn's horns and scrape out the infected fragments of his skull.
Charlie finds Sandhya sitting dejectedly on a bench, upset that she ran away from Sanjay. Actually, she's upset because she's supposed to marry him this weekend, and she doesn't love him. It's an arranged marriage, and she promised her dearly departed father... Charlie points out that Sandhya shouldn't marry Sanjay if she doesn't want to; he knows because he used to be married to the wrong woman. Sandhya is on the verge of getting happy when she blanks out again. Meanwhile, Joel checks on Karn. The surgery was a success, but Karn can't work on himself anymore. Unless he's in a sterile OR, he's going to get an infection guaranteed. For his part, Karn's not making any promises, even if he does have a family who's depending on him to never get a skull infection again.
Charlie and Sandhya watch while Alex and Shahir run through a few theories as to why Sandhya won't wake up. Of course, Charlie already knows what's wrong and tries to tell Alex that it's more than just a coma; she's missing the symptoms. Alex gets a page from Melanda in the OR. She caught Ashley massaging Sandhya when her family was out of the room. Ashley insists he was merely performing Reiki; he never touched Sandhya, just moved her energy around. Ashley complains that Western doctors focus on the disease so much, they miss the whole. Both Charlie and Sandhya are on their journey back to equilibrium. When the comatose Sandhya smiles, Ashley claims she's trying to communicate, but Alex manages to deduce that she's been smiling every 10 minutes. Alex finally knows what's wrong - repetitive myoclonus - she's having multiple seizures! But Sandhya's not too happy to hear she's about to wake up.
It's not long before Alex and Shahir are explaining their theory to Deepha. They're going to put Sandhya on anticonvulsants, and once stabilized, she should wake up. Sandhya's still nervous though, clearly having second and third thoughts about her upcoming arranged marriage. After all, she's 27 and never been in love! Charlie reminds her that the only way she'll find love is by living. Sandhya starts laughing as the medication starts working. Charlie thinks the science is bringing her back to life, but Sandhya knows that it was Ashley scrubbing her chakras that got the ball rolling. When she asks Charlie to kiss her just once before she goes back, he refuses - he's engaged. Still, Sandhya knows her body is calling her back to life, and she leans in and grabs a kiss from Charlie.
It's not long before Sandhya's feeling like her old self again and apologizing to her family for making them worry. She tells everyone that while she was in the coma, she felt protected, as if someone was looking out for her the whole time, but beyond that she doesn't remember much. When Alex kicks everyone out of the room, Sandhya asks her mother to stay for a few minutes so she can explain the big life decision she's made.
Alex tells Charlie all about her day. She's realized something: just when she thinks she's done everything she can, there's always one more thing to try. She flashes back to an evening when Charlie brought her a photo of a farm for sale, which used to belong to his aunt and uncle. After Charlie's parents died, leaving him an orphan, he spent a few years in foster care before joining his aunt and uncle on the farm. Happy memories. Alex immediately proposes buying it - they can make it work! Back in the present, Dawn appears at the door to Charlie's room, asking to speak to Alex. She's going to appeal to the Consent and Capacity Board. Charlie should be DNR, and there will be a hearing to determine who should make Charlie's end-of-life decisions tomorrow. Alex should get ready...