Dr. Carter, Abby and other staff of the ER are quarantined as the CDC investigate a mysterious, deadly outbreak.

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 doubt his role in surgery is no longer an option.

Carter's day shift and Pratt's night shift (his final shift at County) are intercut. Both men have extremely busy days. Doc Magoo's burns down. Luka calls Carter from the Congo and asks for help. Carter decides to go. Pratt decides to stay at County. In other parts of the hospital, Romano has his now-useless left arm amputated.