Jackie's kitchen the morning after, Kevin arriving to take Grace and Fiona to his place. Grace gives her parents attitude about attending Jackie's sobriety ceremony, saying she has to attend model U.N. for school. She again hints at an affair between Eddie and Jackie, and Jackie agrees that its Grace's decision whether she wants to attend.
Jackie meets Frank outside his precinct to confront him for not returning her calls. She gets across how important her sobriety ceremony is to her, but he is still sore over Kevin's late night visit and Jackie reciprocating his commitment to the relationship. The two argue and leave on a bad note, after Jackie clearly lies about 'loving' the gift that Frank sent to her at the hospital.
At the hospital, Fitch, Thor and Jackie tend to an elderly patient convinced that he is dying. He tells them he is a gay man who managed to live to an old age, something that seems to affect Thor upon hearing. They recognize each other from a piano bar where the man used to sing Cole Porter classics, and the two briefly reminisce. He refuses morphine and other pain killers, revealing that he is a recovering addict.
Meanwhile, Prentiss, and Zoey tend to another patient, Zoey acting coy around the doctor. When he tries to flirt with her, she takes offense and storms off, worried that the hospital staff will learn of their affair. Prentiss thinks that acting uncharacteristically formal around one another is a bigger giveaway than flirtation, and Zoey ultimately relents. At the nurse's station, Jackie finally opens Frank's gift to find... a giant loaf of bread in the shape of a horseshoe. Jackie is puzzled. Zoey is insistent that Jackie apologize to her for her snapping at her the previous day, and the two tear up when Jackie expresses her regret for her behavior.
Roman runs into Fitch to ask about her peer review scheduled for later today. She is a bundle of nerves given her uneven performance at the hospital, which seems to please Fitch. Jackie speaks with Eddie about Grace's bloodwork, showing that she was positive for traces of Adderall. He tells her that he would rather not attend her sobriety ceremony either, as he would like to avoid any more family drama.
Akalitus tells Jackie and Thor that the elderly patient needs to be transferred to hospice care, as they have limited space in the ER. They transfer him to a private room. Jackie again tries to get him to take pain medication for comfort, but he is proud of his 22 year sobriety and won't budge. Thor leaves, and Jackie and the patient discuss religion when he spots her necklace. Jackie lets on that she doesn't attend mass as much as she used to, appearing regretful, and the patient tells her that the individual can leave the church but the church never really leaves the individual.
At Roman's performance review, the doctors and Jackie address her uncertainty and shaky performance. Roman admits to an extreme lack of confidence, that while she knows what she's doing she is simultaneously rattled at the life and death implications of every procedure. Fitch finally stands up for Roman, citing everyone's past issues including his own and even blurting out Jackie's drug addiction, stating that Roman is not the first doctor to make mistakes. Fitch is the sole positive vote, while Jackie, Akalitus, and Prentiss all vote to terminate Roman's residency.
Jackie checks in with the hospice patient, who reveals that he is inexplicably feeling much better. Jackie sees that a morphine drip has been attached to his IV, and confronts Thor about doing so against the patient's repeated wishes.
Dr. Roman talks to Akalitus in her office about her dismissal. Roman claims her termination is unfair since she has been forced to work in a hostile work environment, from Fitch 'groping her breast' to other supervisors treating her badly. An attorney walks in and introduces himself. At the church chapel, Akalitus reveals that Roman issued an ultimatum: keep Roman on or have their dirty laundry aired in court.
Fitch, Thor, and Jackie again check in on the steadily declining hospice patient. He overhears Fitch recommending they 'increase' the morphine, and the patient finally relents and agrees to it. Thor is too emotional, and Jackie administers the dose herself. The patient requests Jackie give him his last rites.
Upon learning that Grace won't be attending Jackie's sobriety ceremony, Zoey heads over to the teenager's school to confront her. Zoey tries to force her to go, but Grace begins to break down, causing Zoey to relent.
Thor and the hospice patient have a moment together, and Thor tells him what an inspiration he is. He has lived through prejudices and hard times, doing so with elegance, and Thor is honored to share his final moments. Jackie administers the last rites, and he passes away right before she finishes. Jackie returns to the church chapel, praying openly about her year of sobriety, but admitting that really nothing ever changes no matter what she does.
As Jackie walks home, Frank pulls up in his police cruiser to talk but she is not in the mood. Frank is shocked to learn about Grace's drug use and, moreover, that Jackie has given up custody of her daughters to Kevin. He apologizes for not returning her calls, saying that he still loves her even though he was angry. Elsewhere, Thor sings a tender love song at the piano bar in tribute to the hospice patient.
At Jackie's house, she and Frank have repaired their rift with makeup sex, and the two snuggle and talk in bed afterward. She asks him what the significance of the giant loaf of bread was, and he reveals that it's a family tradition: when something good happens to his family, they make horseshoe bread. He tells Jackie that he's done some things wrong and some things right in life, and she is what's right. Jackie tells him that she loves him and seems to actually mean it this time. They kiss, and Frank tells her he's proud of her sobriety.
Jackie gets ready for her ceremony. Just before she walks out the door, she doubles back and to look at the pill hidden in her ring box. She quickly takes it. At the ceremony, Grace and Fiona bring up her one-year cake -- despite their earlier reservations about attending, nearly everyone from the hospital is there. Grace even spots Eleanor O'Hara lingering at the back. She tears up during her speech, lying that she has been sober for one year. The episode ends with Jackie blowing out the candle on her cake.