Carter engages in competition with new surgical resident-in-training Dale Edson upon learning that residents will be evaluated and graded; only the top ones advancing to second year. It doesn't help that Dale once had a relationship with Harper. Mark flirts with infomercial director Iris. Peter faces the fallout from his altercation with Doug when surgeons begin dropping him from procedures. Shep begins exhibiting uncontrolled hostility, first to a patient being abusive with Carol, then a pedestrian. Susan and Chloe try to reach an agreement regarding Little Susie.

Susan throws herself into her work to escape her stressful personal life, earning recognition from Kerry and Mark, who begins preliminary discussions on next year's chief resident. Carter needs a pedes rotation, and fast, with Doug to graduate med school. Doug takes up with his father's girlfriend. Shep overreacts and attacks an Asian boy interfering at a scene. Mark and Jenn try to discuss their divorce amicably, with unforeseen results. Benton is named Resident of the Year. Harper leaves for an OB rotation at Parkland in Dallas.

Susan visits a psychiatrist to cope with the loss of Little Susie. Jeanie's estranged husband Al checks in the ER complaining of flu-like symptoms, which turn out to be caused by HIV. Shep expects Carol to back his version of events during an official investigation of his behavior. Loretta takes a turn for the worse. Doug discovers that his father has disappeared with a LOT of Karen's money.

Carol is pushed to the breaking point after another day when politics triumph over health care, and she quits. Dr. Greene "trades his soul" when he agrees to back Weaver for ER attending, in exchange for her support of Susan for chief resident. Jeanie takes an HIV test and informs Peter he should get himself tested as well. Carter invites Benton to his med school graduation, which he himself misses. Shep's refusal to see a psychiatrist risks his relationship with Carol.