Carter listens to Ruby's lungs. He and Abby walk outside, and Abby asks what that was all about. Carter thinks Ruby is "a very unsatisfied customer." Abby says that she called Kaysen for a consult. Jerry interrupts to tell Abby about a phone call regarding another patient. Abby takes off. Haleh walks out of Ruby's room and tells Carter that Ruby is "more of a handful now than before." Carter is surprised she remembers him, and Haleh says, "Don't worry about it, Carter. It was a long time ago, and you were just a student." Carter stares at Ruby and tries to remember. Or tries not to.
Susan walks through the ER, and everyone tries to talk to her about work, even though she protests that she's off. So don't walk through the ER! Find another route. Jerry yells that the Chief Resident meeting got changed to 3:30. Susan is pissed, because it means she can't go home to sleep and see her family. No one cares.
Carter goes down to records to find Mrs. Ruby's old chart. The clerk says it could be a while until she can pull it, and Carter sits down to wait.
Kaysen does an ultrasound on Ruby's chest as they discuss Ruby's doctor, who was apparently Kaysen's teacher. Kaysen starts spouting medical jargon, and when Abby tries to ask a question, Ruby shushes her, saying that he's listening to the doctor. Kaysen decides that there's only one option. He turns to Ruby and announces that he has "critical aortic stenosis." Abby translates that one of the valves in Ruby's heart is narrowed. Kaysen kind of glances at her, and then continues by saying that they have to operate on the valve. Ruby asks when, and Kaysen says they should do it as soon as possible. Kaysen promises that they can do something about it, and orders Abby to run some labs as he jets on out of there.
Abby helps Ruby get his gown back on. Ruby tells Abby that it's nothing personal, but that he likes doctors with experience. Abby pulls up a stool and asks if Ruby understood everything Kaysen said. Well, that won't make him defensive or anything. Who wants to admit that they don't understand? Ruby says that he knows that he needs a heart operation. Abby asks if he has any questions. Ruby shakes his head. Abby says that heart surgery is a big deal. Ruby says he knows, and asks if she thinks he's an idiot. Abby wisely doesn't answer that, and adds that, at his age, the risks are higher. Ruby asks what risks she's talking about, and Abby answers, "Complications." Well, that clears it right up. Abby says she needs to do some lab work to get more information, but that right now, she doesn't know his systems' status. Ruby tells her to come back when she's less confused. Abby sighs and says that she wants to make sure Ruby knows the surgery is serious, and that they don't know yet if he's a good candidate, and that he should consider all of his options. Ruby tells her, "Listen, doll. Can you fix my heart?" Abby admits that she can't, and Ruby says he's going to listen to the guy who can. He sarcastically adds, "Byyeeee!," and turns onto his side, facing away from Abby. She leaves, and Ruby looks a little worried.