Sean and Christian learn that they have to take a test in order to continue practicing. Sean and Megan visit a doctor to learn that there is nothing they can do for her. Mrs. Grubman returns to get an operation on her and her fiancé. Christian passes his test, but Sean walks out. Megan makes a decision Sean objects to. Julia finds out about Sean's affair with Megan.
Christian is busy with reattaching a guy's fingers that were chopped off in a garbage disposal when Liz tells him that he mixed up the middle and index finger. Christian refuses to acknowledge this until she gets Sean, who insists on fixing it himself. Afterwards, the two talk about their upcoming test.(a test that all plastic surgeons have to take every ten years to keep practicing) Christian tells Sean that Sean has always been the better surgeon and that he wouldn't have made it through school if it wasn't for Sean.
Sean and Megan visit a doctor and there he tells them basically, there's nothing he can do for her. Megan decides to go home and rest before their dinner date.
At the office Christian does a consult with Mrs. Grubman and her new fiancé, Sumner Charles. They explain that they want their private parts made to look younger and that they want both operations free. Christian objects until she brings up her lawsuit and demands that Sean be the one to operate on her.
The two go to the test site and fill out their paper work. In the operating room, a group of plastic surgeons, Sean, and Christian learn that their tests will be on cadaver heads. Christian is doubtful and claims the head is too small for his hands, but the test goes on.
Sean has dinner with Megan and learns that she is planning on committing suicide.
The next day, Sean and Christian discuss the test and Christian is still worried that he won't pass. Sean suggests practicing on something. Afterwards, Christian learns from Liz that a Jane Doe was murdered and heads to the morgue. There he bargains with the guard to allow him in, in exchange for plastic surgery on his chin.
Sean goes to see Megan while she's packing her stuff. Sean repeatedly tries to talk her out of it.
The doctors return for the next part of the test. Christian accidentally flings his head a few feet in front of him to the ground. Sean imagines that his head begins to talk to him about Megan, his wife, and everything else.
Sean visits Megan the next day and watches her swallow pills and put a plastic bag on her head. He stays with her until the end. Later, Christian has passed and he is quite pleased with himself. Sean on the other hand continues to talk with his head, this time about Megan's suicide. Eventually Sean can't handle it anymore and runs out of the building with Christian in pursuit. Sean reveals to Christian that he's been having an affair with Megan and that she has just committed suicide.
Julia cleans off Sean's tux and asks if she can go with him. The next day Jim, Megan ex-husband, gives her eulogy. Afterwards, everyone is given a jar with her ashes in them to throw in the ocean, as per her final request. There Julia witnesses how hard it is for Sean to do it.
The married couple returns home and Julia asks him if he had an affair. Sean doesn't deny it and says she also had one with Jude because of the half naked picture in her school book. Julia tells him that although she wanted to, she wanted Sean more. The two then talk about their marriage and Sean cries with his head in her lap repeating "I'm sorry."