When Anspaugh decides to retire as chief of staff and return to surgery, he appoints Romano as his replacement. Greene expresses reservations about the decision, but Weaver does not support Greene. Romano makes Weaver the new chief of emergency medicine.

A demented patient causes a shootout in the emergency room. After terrorizing people in the ER with a gun, she gets shot by a policeman. She soon dies. Benton later discover her dementia was caused by an aftereffect of his surgery that he and Cleo should have detected. Carter pursues a cute intern.