On Christmas Eve, an exhausted Hathaway attends to her 6-week-old daughters, Tess and fussy Kate. Hathaway brings them to the er where Kovac examines Kate. Kate has a fever but will be okay. Haleh and Kovac care for the twins while Hathaway gets some rest.

Meanwhile, rapist and murderer Dean Rollins taunts Corday as she administers to him. The police have found evidence linking him to another murder. Corday discovers that Rollins has a blood clot, but he refuses necessary surgery. Even though she doesn't want to help him, Corday convinces him to have the surgery.

Valerie Page (MINDY CRIST), a 24-year-old heart transplant candidate, gets treated by Lucy who updates Valerie's status because she is critical and needs immediate help. Even though no heart is available, Lucy learns that a special procedure can be performed that may save Valerie's life. Unfortunately, Romano is the only doctor at the hospital who can perform it, and he refuses her request because he is off duty. Lucy barges into his home and convinces him to help.

Carter collects gifts from staff members to secretly give to one another. He tends to a wounded gang member, Taylor Sparks (KENTE SCOTT), and confiscates a gun from the youth. Later, Carter gives Taylor one of the gifts in exchange for the gun he took. Other gang members visit the hospital to trade their guns for gifts. Carter's proud of his accomplishment until a child is killed by one of the gang members who got another gun.

Cleo treats a drunken Chad Kattmeier for a fractured ankle suffered during a party his mother hosted. His mother gave him beer, so Cleo contacts the authorities and forces Chad to enter the hospital's alcohol treatment program immediately, missing Christmas day with his mother.