Choi welcomes the new med students. Only one will make it through. Sharon asks Maggie about Vanessa, who comes over and is overexcited and researched Sharon online. Sharon seems to like her.

Dr. Charles asks Dean to come to lunch with him. Dean suggests that Charles just lie to Choi and say they met when they didn't. He wants personal time instead. The ED alarms ring, new patient coming in, which is a convenient reason for Dean to leave.

Some guy who collapsed at the park insists he just has a stomach ache and wants to go home. He seems paranoid and agitated, and has a slight fever. He doesn't want morphine. He says none of this is real, it's just a computer simulation.

Neal thinks it's obvious that everything is a simulation since 1% owns 99% of everything. The game is rigged. All real people are players and have no choice. He doesn't know why the simulation was created. He wonders if Charles is a real person or an NPC. Dean interrupts that Neal is unwell. Neal doesn't agree. Charles says we have to figure out what's causing this pain that is real to you. Nal says he took the red pill and doesn't want them to reverse it. He's sure what he's feeling is just the red pill working.

Dean thinks Neal has appendicits. Charles wants Dean to slow the paperwork so they can keep Neal there longer.

Choi tells the new interns to work fast but smart. Rounds begin. Some guy speaks up before Vanessa can answer the question. Maggie suggests Vanessa assert herself more. Choi calls Vanessa over.

Natalie comes in with Carol who is out of it and slurring her words. Natalie comes running into the room and finds Will examining her mom. He wants to do an EKG. Natalie thinks Will should leave it to Dr. Young. Carol wants Will and is really scared. He asks what meds is she on? Natalie freezes up and he says he is assuming she is on beta blockers. Carol tries to tell him about the new pill she is on. Natalie tries to stop her. She goes to the car and removes the pills from Carol's pill box, putting them in her pocket.

Choi gives the interns their assignments and tells Vanessa she's with him.

Neal is puking and won't accept treatment. Charles tries to talk to him about the butterfly theory. Neal insists he knows what he's doing. Dean starts talking to him about an experience in Afghanistan. He tells him that he saw preventable deaths in Afganistan. Neal claims that wasn't real. He touches Neal and Neal screams with pain.

Dean tells Charles he thinks Neal has appendicitis. He wants a court order to force treatment. Charles says he will make that determination and that Neal is a patient, not a box of loose screws.

Natalie is pouring the pills into a bottle when Marcel comes up and startles her. He is sorry to hear something's wrong with Carol. He hopes the echo brings good news.

Maggie spies on Vanessa and Choi. Doris tells her about the patient. Maggie switches with Doris so she can watch Vanessa. Choi asks Vanessa to insert a center line and prompts Vanessa what to do. Ethan gets called to a budget meeting and Vanessa says she is sure she can handle this on her own. Ethan leaves.

Marcel is up as a guy with a gunshot wound comes in. His wife and baby show up.  Marcel says the man will be okay but he is concerned about the baby. He finds she has been shot too.

Rosa cries she didn't know. Marcel tries to reassure her she didn't do anything wrong and takes the baby to the OR.

Maggie guides Vanessa to insert the line. The guy wakes up and wants to know what's going on.  Vanessa thinks she should tell Choi she might have nicked the lung. Maggie says finish the procedure first.

Charles tries to talk Neal into accepting treatment. Neal insists he's not the one who is delusional.

Dean calls Choi and fills him in. Choi says call Charles. Dean says Charles is dragging his feat. Choi says he can't help, he has butted heads with Charles in the past. Dean snaps at him. Choie tells him to watch it.

Vanessa looks at the scan and sees she was right about the lung. Maggie says she can fix this herself and shouldn't tell Choi. Vanessa doesn't think it's a good idea. Maggie thinks this is the way to win a permanent spot in this ED. Maggie tells Shawn it's nothing serious but they need to put a chest tube in. Shawn asks if it is necessary. Maggie says it is but he will be sedated and won't feel anything.

Dean calls April in to help with Neal. He says Neal is unconscious so they have power of attorney. He demands April tell him if she should intubate or not.

Dr. Young says that Carol's heart is doing super well and the LVAD isn't working effectively. They may need to sew the left ventricle shut temporarily. Dr. Young leaves and Will says must be the fish oil. He insists on looking through Carol's pill box. He accuses Natalie of stealing the meds. Natalie denies it. Will says they don't know how the drug interacts with the LVAD and insists she come clean. Natalie begs him. She was desperate. Will says this is really bad and leaves.

April comes to see Charles. He was trying to get a court order but failed. April tells Charles what Dean did. She thinks maybe he overmedicated Neal to knock him unconscious.

Veroni comes to see Will. He tells her everything is great but he's taking a break. She leaves but he catches up to her and asks her about the LVAD. She says it's a chemical LVAD and would never be prescribed. But if a patient is suffering an adverse reaction it needs to be reported.

The baby is in bad shape but Marcel says to keep giving her more blood.

Choi comes to check Vanessa's work. He sees the chest tube and says that Vanessa acted recklessly by not notifying him. Maggie says she will fix that. She insists to Ethan it's her mistake. Ethan leaves and Sharon asks why Vanessa was assisting Maggie. Maggie says she switched places with Doris.

Charles confronts Dean who says he saved Neal's life. Charles says appendicitis doesn't cause breathing issues. Dean starts yelling that Charles would let a crazy person die. Ethan runs up and makes Dean leave, then asks what's going on.

The baby is on a breathing machine but Marcel has stopped the bleeding. She's alive. Rosa hugs him. Mr. Fuentes looks shocked.

Natalie comes up to Marcel and asks if he's okay. He says he is. Natalie wanted to talk to him but Will calls her to talk about her mom.

Carol is feeling much better and wants to buy a pastry. Will tells Nat he turned the LVAD super low and she seems to be fine. The drug seems to be working. Nat wishes she insisted on the trial in the first place. Who knows what will happen when they find out. Will says maybe they don't need to find out and gives her the pills back. He'll try to get her more drugs for her mom. If they can keep from getting caught Carol may not need a transplant.

Charles goes to talk to Neal. Neal says the red pill was working and then the doctors took that away. Neal says even if he can get another red pill he's stuck here now because of Dr. Archer. He begins crying.

Choi says he's going to talk with Dean.

Marcel comes to see Carol. Nat comes out and tells Marcel the LVAD was causing her problems and that she didn't want Marcel to feel responsible. She says she'll see him tomorrow and goes.

Maggie tells Vanessa she fixed things with Choi. Vanessa feels humiliated. She wants Maggie to leave her alone. Sharon comes along and says she should have known that Vanessa is Maggie's daughter. Maggie insists she will never tell Vanessa.

Choi confronts Dean and tells him he needs to see a psychiatrist if he wants to keep working here.

Dean goes outside. He has some morphine vials in his hand. He throws them away.