Dr. Greene is still having trouble dealing with cases in the ER and the new Chief of the ER is growing increasingly concerned. Greene also faces a difficult peer review to examine his handling of the Jodi O'Brien case. Dr. Benton takes on the difficult task of telling his mother that she must be placed in a home with full-time care. Susan's very pregnant sister Chloe returns to live with her. Dr. Ross deals with the case of a young girl with a heart condition while Ross and Carter encounter a patient who refuses treatment for tuberculosis. When Benton asks Deb Chen and Carter to submit their procedures book in a few days, Deb feels she has to get a few more procedures under her belt if she's to best her fellow student. Unfortunately, her eagerness leads to near tragedy for a patient.

Dr. Kovac's speeding causes a crash on an icy road. The ER staff treats angry elves and a female hockey player with a head injury.