Susan Lewis' boyfriend Div Cvetic, a psychiatric resident at County General, seems to be under a great deal of stress regularly lashing out at everyone. Doug Ross takes over for Mark Greene who takes a day off to be with his wife. He has a hard time keeping up with all the paperwork. John Carter is increasingly frustrated with Peter Benton who never seems to invite him to participate in surgeries. Benton learns the result of the fellowship he applied for and his mother shows up in the ER with a sprained ankle. Carol Hathaway treats a patient who was raped. A new ER aide, Bob, start work.

The ER staff's slow snow day becomes chaotically hectic when the casualties of a 40 car traffic accident flood in.

It's Christmas-time and the expected range of emotions is to be found among the ER staffers. Susan Lewis treats a middle-aged woman who is overjoyed at finally getting pregnant. Susan is also shocked to hear that her boyfriend Div Cvetic has quit his job and moved out of his apartment. Mark Greene treats a young drowning victim. Doug Ross takes Greene's advice and decides to tell Carol Hathaway that he loves her; unfortunately he chooses to do so at her engagement party. Peter Benton jumps the gun and arranges for transplant teams to harvest an accident victims organs but the man's wife is now refusing to give consent. Susan's sister Chloe announces that she is pregnant.

It's a day of birthdays. Peter Benton's mother is celebrating a birthday and he tries desperately to find someone to cover his shift. He makes a choice however when Dr. Hicks suggests that he's been absent too often and may wish to consider a leave of absence until his mother's situation is resolved. Carter thinks it's Benton birthday and has a surprise for him. Mark Greene's daughter is also having a birthday but he misses that due to an emergency at the hospital. An elderly, solitary man in the final stages of cancer arrives in the ER on his birthday. Carol Hathaway suggests to her fiancé that they adopt little Tatiana, the AIDS patient abandoned in the ER. Ross has to deal with a young child who was kicked out of a window.