It's Dr. Cox's first day as the new Chief of Medicine. He's determined not to get stuck behind a desk, but despite his best efforts, that's exactly what happens. Every time he turns around there's a new problem with the Board or someone else wants a favor.
J.D.'s elderly patient had a serious case of pneumonia. He's getting better, but he's not quite ready to leave, even though his time at Sacred Heart is up. J.D. thinks he has some pull with the new Chief of Medicine, but when he asks Cox to find a place for his patient, he's shut down. We're talking shut down hard.
J.D. resigns himself to the fact that there's nothing more he can do for his patient. Dr. Kelso tells him that when he was Chief, Cox would never take "no" for an answer. He would always fight for what was most important to him. Now that Perry's the Chief, it's up to J.D. to wage the war. J.D. takes Kelso's advice and goes back to fight for his patient. He gets what he wants, but it now seems like Dr. Cox hates him more than ever. Did you even think that was possible?
Carla is getting the cold shoulder from her fellow nurses because she's so friendly with doctors. She tries to get Dr. Cox to agree to hire some new ones so that the others aren't stuck with so much forced overtime, but Cox says no to her, too.
In her frustration, Carla snaps at Elliot, who realizes that the doctors really do disrespect the nurses. Elliot confronts a group of nurses in the cafeteria and apologizes, suggesting that they use Carla's relationship with doctors to start a dialog that will get them the respect they're after.
Elliot's not sure if the nurses went for it, but at the end of the day, a group of them smile and wave goodbye to her and Carla. Maybe old roles can change after all.