The mood is tense as Alex and Dawn meet for the consent capacity hearing, presided over by Mr. Stein, who will decide Charlie's fate. Dawn argues that Charlie wouldn't want to suffer and live like a "horizontal corpse," offering an email where he specifically requested not to spend the end of his life on a respirator. He should be allowed to die with dignity. Alex can't disagree more, offering evidence that Charlie is supportive of a full-code status. Dawn thinks Alex is too close to Charlie to make a rational decision, but Alex insists Charlie wouldn't want her to give up. Meanwhile, Maggie tells Joel that her sister and her very colicky baby are coming to visit this weekend - can she crash at his place? When Joel asks if he can think about it because he doesn't have any plans, she tells him his plans suck.
A vital heart has arrived at Hope-Zion Hospital for a sick patient who desperately needs it to survive. As soon as the organ reaches the hospital doors, the guy it belongs to, Bernie, finds Charlie. Bernie watches in disgust as his organs are harvested. Charlie explains that Bernie is giving the gift of life, but Bernie's having none of it. Soon afterwards, we meet young Kyle, who will receive a second chance at life because of Bernie's heart. With his new wife Grace by his side, Kyle is optimistic. Meanwhile, the cop that transported Bernie's heart to the hospital, Officer Jimmy Howard, asks Joel to take a look at his back, which is killing him. Joel doesn't find anything particularly wrong, but Jimmy claims he's in great pain and requests a prescription for painkillers. Rather than just hand over the script, Joel schedules an MRI.
Bernie finds Charlie sitting by himself in the basement morgue, looking morose. He explains his situation - his life or death will be decided today - then asks Bernie how he's facing death. Bernie admits he couldn't prepare for having his skull crushed by a barbell. Suddenly, Charlie's surprised to discover that he's in pain. Could this be a good sign? Unfortunately, it turns out he's got an embolism - not good news. Melanda has Jackson page Alex to the ICU.
Alex begins the heart transplant operation with expectations that Dr. Levine, the surgeon slated to perform the actual transplant, will arrive any minute. Unfortunately, Dr. Levine has contracted food poisoning. Much to Alex's surprise, Dawn steps into the OR to operate in Levine's stead. The operation continues with tension you can cut with a scalpel - especially since Dawn is quite full of herself. As she takes over the surgery, she tells Alex that she was once pregnant with Charlie's baby; in fact, they'd probably still be together if she had carried to term.
When the MRI results come back, Joel tries to assure Jimmy he has nothing more than mechanical back pain. Jimmy doesn't seem to care and immediately asks for a prescription - again. Joel believes Jimmy simply needs to strengthen some of his core muscles, possibly through Pilates. Jimmy scoffs - he's not going to roll around on the floor! When he gets deadly serious, Joel capitulates and hands over the prescription.
After Dawn concludes her part of the transplant operation, Alex notices severe bleeding. A tear in Bernie's heart is causing tremendous blood loss and the patient's blood pressure is beginning to drop. Alex spots the problem. Dawn becomes more and more angry and flustered, and Kyle flatlines. With only one shot at stitching the tear successfully, a very calm Alex takes over the operation. In the end, she's able to stop the bleeding, even earning a compliment from Dawn. Alex steps out of surgery to receive the page from Melanda. She runs to Charlie's bedside, only to learn the embolism has moved from his groin to his chest. Melanda assures Alex they're trying to break up the clot, and Charlie will be fine.
In the doctor's lounge, Maggie grouses about knitting a cap for her nephew and Joel reads a book, when Gavin erupts, upset to discover someone has stolen his lunch out of the refrigerator. When he hears about Maggie's weekend with the colicky baby, he invites her to crash at his place without a second thought. She accepts, then heads out to buy a baby cap at the hospital gift shop. Gavin turns to Joel with a few incisive questions about his relationship with Maggie. Gavin's surprised to hear Joel doesn't intend to hang out with Maggie and her sister over the weekend, and is even more surprised to learn he doesn't believe men and women can be friends.
Spying Dawn in the coffee shop, Alex can't help asking once again, "Why are you doing this?" Dawn doesn't want to talk. "If Charlie was any other patient, you would see it my way," she says. When Alex claims Charlie is "a fighter," Dawn explains that term is one families, not doctors, use. Doctors know that nobody is a fighter, which Alex would know if she had more experience. All Alex knows is that Dawn is saying she wants to kill Charlie, and she will never understand that. Both Alex and Dawn are paged to Kyle's bedside; he's rejecting Bernie's heart. Alex stays positive, while Dawn remains pessimistic, until Grace claims Kyle is a fighter. That's when Dawn smiles with a nod to Alex, having made her point about Charlie.
Behaving erratically, Jimmy goes on a search for the man receiving the heart he dropped off. Ignoring Melanda, he strides towards Kyle's room in the ICU, telling Jackson he just wants to say hi. Jackson stands firm, insuring Jimmy is out of the room before he tells Melanda Jimmy is high as a kite. Later, Joel finds Jimmy sleeping in an empty hospital room, which is something he full well knows he can't do. Jimmy claims the drugs Joel gave him were heavy duty and starts rambling; clearly, he doesn't want to leave and is looking to engage Joel, who now knows that all is not right with Jimmy. Afterwards, Zack tells Joel that Jimmy always hits up Hope-Zion's new doctors for painkiller prescriptions. A couple of years ago, Jimmy accidentally shot a kid on the job; ever since, he's been little more than a chauffeur. Handing Joel a cooler full of kidneys that need transport, Zach tells him to go find Jimmy.
Bernie and Charlie watch Kyle as his body rejects Bernie's heart. Bernie's convinced his heart is bad, which is why Kyle's rejecting it. Charlie disagrees; there are no bad hearts, only bad life choices. Bernie confesses to murdering two people. Charlie claims this is his chance to do something good. It's time for Bernie to make peace with his heart. Bernie opens up, sitting down for a heart-to-heart with his heart. It's time to let go of all the things his heart had to ignore to survive and make a fresh start. As soon as the words "I'm sorry" are released from Bernie's mouth, Kyle's heart monitor perks up. Bernie thinks he's killed Kyle, but Charlie knows Bernie's heart is finally starting to take to Kyle's body. When Dawn and Alex confirm that this is indeed what's happening, Alex feels her side of the debate over Charlie's life has been demonstrated.
After much consideration, Mr. Stein makes a final decision regarding Charlie's fate. In the eyes of the court, a fiancee and an ex-wife hold equal weight, and Stein thinks Dawn is best able to execute Charlie's wishes.
Joel finds Officer Jimmy sitting in his cruiser in the parking garage with a gun in his lap and a strange look on his face. Jimmy refuses to put down his gun. Five years ago today, he shot the kid. Now no one looks at him as a hero, and they never will. "Things are going to get better," Joel pleads. "You can start to think about your future." Unfortunately, Jimmy can't let go of the past and shoots himself in the head, as Joel watches, helpless. Later, Alex finds Joel in the atrium - what's she going to do about the hearing? Alex hyperventilates, terrified to think Dawn is going to pull Charlie's plug, and there's nothing any of them can do. When it seems Joel is about to tell Alex he still has feelings for her, she begs him to stop talking. Seconds after Joel stalks off, a code blue call comes over the PA system. Realizing Charlie is in trouble, Alex takes off running.
Alex rips off her jacket and jumps onto Charlie's bed to administer CPR as Melanda charges up the paddles. Suddenly Dawn shows up at the door to yell, "Stop!" Alex insists Melanda shock Charlie's heart one more time, which brings back his pulse. Charlie stands by, incredulous to hear Dawn stick to her DNR guns, demanding to know if Alex broke his ribs. It's time to take Charlie off the ventilator. Alex begs Dawn for mercy with everything she's got. Dawn tears up; she understands Alex's heart is breaking - but so is hers. She never stopped loving Charlie, and she's begging Alex to let him die with some dignity. Meanwhile, Joel gets himself into a stupid bar fight over a girl, breaking a guy's nose - and his own hand. He hops in a cab and heads back to the hospital.
That night after work, Maggie tells Gavin that Joel witnessed Jimmy's suicide and just walked away. She insists things are fine between them, but Gavin doesn't buy it. He knows there's always a boy that likes Maggie and always a boy she likes, but they're never the same guy. What would Maggie do if someone really liked her back? Maggie tells Gavin to pipe down, and he agrees, words just won't get his message across, so he leans in for a deep, intense kiss. Afterwards, Maggie realizes she probably shouldn't stay at Gavin's apartment over the weekend and beats a hasty retreat.
Charlie is on hand to support a tearful Alex in her darkest hour, even if she can't hear him. She assures him that there's no way she will ever give up on him. Dawn interrupts. It's time. She's sorry. Charlie urges Alex to hold on tight as Dawn reaches over and shuts off the ventilator...