Dr. Shaun Murphy and Dr. Claire Browne devise an experimental procedure that can save the leg and life of a young groom, that is if his bride-to-be and parents can learn to work together. Meanwhile, Jared struggles to emotionally connect with his patient whose scars may prove too deep to overcome.
The episode begins with Dr. Shaun Murphy walking down the hallway of the hospital as Dr. Jared Kalu gives Dr. Claire Browne and Dr. Audrey Lim a special blend of of his own coffee; they are working the ER commenting on how quiet it is when a call comes in that there was a massive accident and 2 dozen passengers are on their way in. The interns are told they are all trauma tonight and no one is going home until every patient is cleared. Dr. Lim asks if anyone knows the trauma color codes and Shaun recites them for her as they won't for the entourage of ambulances. Dr. Neil Melendez arrives and tells Dr. Browne to forget about the object embedded in the patient's neck and treat her like any other patient.
He asks her what the first steps are and tells her like any other patient. He asks her what the first steps are and tells her it. Shaun stares at the patients being brought in bay 5 as he stands to stare, Nurse Fryday grabs his arm and he pulls back; everyone observes this but he quickly recoves as he tends to a patient who is bleeding out. He calls out all the medical supplies needed Dr. Aaron Glassman comes in asking what Shaun is doing; he says they don't have one so he is making a REBOA, the nurse has no idea what he is talking about as he envisions what he is doing; he tells the EMS workers to release the pressure and the patient stabilizes. Dr. Marcus Andrews stops Dr. Kalu form misdiagnosing a patient, he quickly cuts her throat to relieve the constricting on her neck from the burnt skin. He tells Kalu to get her up to isolation in the burn unit as quickly as possible. Dr. Glassman doesn't have an ultrasound machine, making Melendez worry he might pierce the man's heart, but he proceeds with he needs and laughs as Melendez says the REBOA could have gone really wrong. Glassman reminds him that is didn't and it's a cowboy move Melendez would have never dreamed of even trying; asking him how long will Shaun have to try to prove himself to him.
As Melendez and Browne prepare for surgery, he understands that this was her first trauma but reminds her she needs to think clearly, quickly and methodically and should think a little more like Shaun. Jared is removing the burnt skin from Celez' neck, apologizing for asking her how she is doing. She is crying but says she is maxed out on morphine and he will wait for a little before continuing. She demands a mirror since he won't even look her in the eye as she wants to know how bad it is. She sobs at the image and talks about how she looks like Freddy Kruger and who would marry her looking like this. Dr. Melendez brings Shaun upstairs to see Marco's family, they are told the doctors cannot fix the leg and their only choice is to amputate. His bride breaks down crying as this was their wedding day; Shaun watches their emotional hugs as Melendez observes him. Back in the ER, Shaun runs past everyone trying to use one of the computers, but all the doctors take them before he can get there. Jessica Preston and Melendez are asked about their plans for their wedding by Dr. Lim and they fend off saying they will have to figure it all out. Jessica suggests they can talk about it later when she prefers a beach wedding and he says his family likes churches better. Aaron listens with concern as Shaun rushes off again after Nurse Fryday asks him if he wants love and he says no.
Shaun begins to visualize any options to save the leg but the leg but agrees there are no other options but before he can dash out the door, Claire wonders if they could replace the entire femur. Melendez watches as they are building a femur out of titanium, sating he needs to think on this as he still has 7 tags to deal with. Claire tells Melendez it was her idea, but he doesn't believe her; he says it's a problem to believe she is brilliant because he has known her for 6 months. Outside, Claire comes to see Jared sitting on the bench, he advises him not to talk but listens to her because she is trapped inside there, alone with her fears and thought and he is her only escape. Melendez and Shaun go to see Marco's family, who are in disbelief about the "fake" femur. Shaun repeatedly corrects them saying it is real - not fake! Shaun says this is the first time he is doing this surgery and admits there is a 10% chance he could die. Marco's mother immediately refuses, but his bride-to-be says Marco would want them to take the chance. Melendez informs her that his parents are the next of kin and they need to decide ; his father tells them to amputate his leg. Melendez quizzes Shaun as they prep for surgery, he asks him why he is marrying Jessica. Melendez says he loves her but Shaun doesn't understand why having someone to love is so important to everyone. Jessica comes in to the room and tells them they can't go forward with the surgery as she filed a injunction to stop it.
Claire talks to her patient about her neck surgery and how lucky she is to be alive. She extubates her and immediately the patient wants to see her wife. Claire check the list and her name isn't on it, so she promises to check the waiting room and to bring her up. Jessica tells Melendez that Judge Singh is en route as Shaun frets about testifying. Melendez reminds Jessica it is Marco's parent's decision, she objects when he says all parents love their children no matter what. She gets defensive, wondering if he would want his parents to make the decision over her. He says there is no need to be bright red lights when it comes to the rules. Shaun tells her they have 3 hours before Marco's leg will die. Jared returns to Celez, he tells her to pick a movie but she says a funny movie won't change this for her. She mocks him, saying he has all the answers for her. Meanwhile, Marco's parents and fiancee meet with the Judge; they both want him to live but if there is a chance to save his leg, they need to do it. His father says Marco can still be happy but with a prosthetic leg. She finally reveals to his parents that they met at rehab.
Claire learns Jenna hasn't been seen since the bus and suddenly realizes Jenna could still be at the crash site and tells them they need to go back. Marco knows what makes him happy and knows his weaknesses; Marco's mother interrupts her saying he cheated on her with an ex about a month ago, his father confirms. The judge says this matter as his mother reminds her that she isn't his wife yet. Claire rushes off at the accident site, telling everyone to scour the area. Claire finds Jenna lying on the ground in the woods, just off the the side of the road. her pupils are reactive but she needs to get her out of here now. Jared talks to Dr. Andrews about his patient, Celez who is eligible for an experimental burn treatment. He thinks they can do it there and as Andrews attempts to speak he cuts him off again. Jared was hoping Dr. Andrews could expedite the process form 3 months to 2 hours; he tells Jared to keep thinking outside the box as initiative is good. Claire reveals that Jenna's pupul is blown showing she has a subdural hematoma and if she doesn't use the drill to alleviate it now, she won't make i to the hospital alive. Claire arrives at the hospital with Jenna whose sats are in the low 70s Dr. Lim pulls the tube a little higher and told them she's good for the OR. Dr. Glassman follows and tells Claire she made a good call.
Jared returns to the isolation room Celeste is in, informing her the Tilapia skins are on their way to the hospital and should be there within the hour. He tells her that she qualifies for an experimental treatment that might prevent her from needing skin grafts. Dr. Andrews demands to know how this happened and Jared says they are willing to provide the skins as long as they give them the data; he assures Celeste he will do it. Shaun is brought in for questions by Judge Singh; he keeps reminding people that the femur is not fake. He processes what she wants to know as Jessica asks him to focus. Marco’s parents are frustrated with Shaun being so slow but his fiance wants them to give him time. Shaun orders them to be quiet, he says Marcos’ toes are changing color and quickly tells them to page Dr. Melendez, as he is clotting. Melendez wants to know what the decision is, as they are running out of time. Judge Singh says his parents know him as their child while his fiance knows him as a man and agrees with her, ordering Melendez to replace the femur. Shaun follows Melendez into the OR. Dr. Glassman allows Claire to perform the surgery on Jenna with him, saying the first time is a little exciting, a little nauseous and hopefully, no one gets hurt.
Jared begins to lay the Tilapia skins on Celeste as Shaun helps Dr. Melendez with the surgery on Marco. Glassman is very proud of Claire and her performance, he tells her to close up the roof/skull. Dr. Melendez finishes the surgery and asks the nurse to release the clamps, the blood flow is restored to Marco’s toes and his heart rate is normal. Claire and Glassman watch as there is no brain activity on the monitor, she suggests her brain could rewire itself, Glassman says no and she is “gone.” Marco is surrounded by his parents and fiance when he is unable to move his leg. His mother is concerned he will die but Shaun runs a pen along his foot and reveals that he moved, showing them his toes moving. He says the surgery worked as Melendez says it will be a long road to recovery and he thanks them for saving his leg. Marco wants to finish what they started but she tells him to get well first as there is plenty of time for a wedding. Jared tells Celeste she looks good, that she looks like Aquaman. She smiles, saying she looks like sushi but it is only for 6 months, giving her new skin a chance to grow in with minimal scarring. She thanks, Jared, admitting she misjudged him. He assures her that she judged him just right.
Claire is watching her patient sleep when Dr. Glassman comes in realizing she hasn’t told her that Jenna is dead. He takes Claire out of the room, asking her how long before she intubated Jenna and did she check that she was breathing afterward. He shares that the ER doctor informed him that Jenna wasn’t ventilating properly when she got to the hospital because Claire inserted the tube too deep into her injured lung. They had no way of knowing how long she was hypoxic before they gave her the EEG. Claire says she drilled a perfect hole in the middle of nowhere in the dark of night but screwed up her intubation? He agrees it was tough conditions and any one of them could have made the same mistake. They sit down as Aaron tells her about one of his stories of a mother who came into the ER, he sent her home with antibiotics and 6 hours later she was back after having a heart attack that he missed and she died. Claire learns she was his 4th patient who died and tells her she will never forget this, but she needs to find a way to keep going. He tells her to go home and get some rest; he says Claire made a mistake and is not allowed to talk to the family nor anyone else about this. She understands and leaves.
Dr. Andrews joins Jared in the elevator after their shift, he called the other hospital who asked him to pass on their gratitude for his generous donation to their burn unit. He doesn’t begrudge that he comes from a wealthy family but reminds him he cannot open his wallet every time a patient is in need, as the lines can get real blurry, really fast. Jared nods and gets off the elevator. Claire looks in on her patient as Dr. Glassman informs her that Jenna has died. Jessica hands Melendez her health care proxy, saying its good to know nothing will happen. They kiss as they leave the hospital. Outside the hospital, Aaron sits with Shaun on the bench, talking to him about not wanting love. He said he loved his brother and his rabbit, but now he doesn’t because you can’t love people or things that are dead. He reaffirms he doesn’t want love. Aaron says “okay” and asks him if he wants breakfast, Shaun says he wants 4 pancakes instead of 3 and agrees to go.
- The episode title is a reference to Marco's titanium femur. Throughout the episode, several characters refer to it as a "fake" bone, to which Shaun would always retort, "It's not fake."
- Starting with this episode, Glassman is almost-always seen wearing or carrying a hat when not working at the hospital.
- This is the first episode in which a patient dies on screen.
- In the Turkish Mucize Doktor adaptation of this episode, Claire's neck surgery patient (and the female deceased patient's wife) is changed to a male, due to gay marriage being illegal in Turkey.