On a busy Halloween night, Carter and Abby are the only staffers in costume when victims of an apartment building fire pack the ER. Corday takes on a new med student for a surgical rotation - Paul Nathan, who suffers from Parkinson's disease and decided to pursue medicine after being diagnosed. Despite a difficult first day, both professionally and medically, Nathan makes a difficult diagnosis. Romano's rehab lags behind his expectations, and he begins to think his role in surgery is no longer an option. In a moment of personal weakness, he tries to express his feelings for Corday. Weaver continues to display erratic behavior, raising staff suspicions about her menopause. Luka's burgeoning sex addiction worsens, as an affair with Chuny is revealed, and tensions rise when he treats a patient with a perpetual erection.

As Carter prepares to open a new facility for the underprivileged, some old friends/colleagues gather. Rachel Greene, Mark Greene's daughter, applies for an internship at County.