A heart-transplant patient returns to the hospital with chest pains and emotional and personality changes that challenge the notion of what really is exchanged in a transplant. Shutt is approached by a direct, self-confident psychiatrist who insists he perform psychosurgery on a 12-year-old boy with an obsessive-compulsive disorder that severely limits the life he can lead.

A friend of Kronk's seeks his advice about a health problem she thinks resulted from her sex-change operation. Austin treats an impressionable teenage boy with a heart condition and a crush on her. Dr. Konstadt, off her medication, acts injudiciously when Shutt seeks permission from a reluctant board to perform surgery on Eric.

Aaron proceeds with Eric Dipretto's psychosurgery while Austin campaigns for the position of chief of surgery and Bix continues to lose control. Kronk is determined to perform a controversial intestinal bypass on Nyland's former boss and good friend, a restauranteur who just wants to enjoy a good meal again.