Dana's former beauty queen patient doesn't think her husband finds her attractive and insists on having extensive plastic surgery. Dana refuses to perform the surgery but when Terri Ann lands in the ER, she begins to doubt her decision. Peter tries to figure out why a transvestal is having side effects of menopause and counsels Marc about one of the stickier issues of adolescence. Lu and Lana try to find an appropriate punishment for two young teenagers who spray graffiti outside the hospital.

As a heat wave hits Philadelphia, Andy & the staff will need to get used to its disaster plan to cope with heat wave. Claire a patient of Dr. Campbell is told she will develop Alzheimer's disease within 10 years, she also wants to have a baby.

Andy & tells her kids about Dr. Morton, her kids question why she can't make time for kids. Clare worries that her kids might have the gene PGD (the gene that leads to finding Alzheimer's early.)

A young girl with Down's Syndrome tells Lu she shot a girl to get in a gang. The mother later tells Lu that she had her 16 year old (with Downs Syndrome) confess to the crime to protect her sister who actually committed the crime.