Shane West treats Birdie, the panhandler from last week, who has a low-grade temperature and a cough. Birdie and Rebecca rhapsodize over Chuny's caramel skin, and argue over which old-time movie star she most resembles. Shane tells Birdie that she might have a lung infection, so she needs a chest x-ray. Birdie says that Abby didn't mention that, and Shane checks the chart and sees that they were in last week. Rebecca compares Abby to "a young Patty Duke," which is pretty apt, actually. ["If Abby got hooked on dolls and started ripping people's wigs off, I might actually start watching this stupid show again." -- Wing Chun]

Anspaugh and Kaysen explain the heart surgery to Ruby, using illustrations. Abby walks in and asks angrily if they're definitely going ahead with the surgery. Kaysen and Anspaugh just stare at her. Ruby asks the doctors to confirm that surgery is the only way to go. Kaysen and Anspaugh say that they could try to treat Ruby's condition medically, but that "surgery's the only definitive treatment." Abby jumps in and informs Anspaugh of Ruby's kidney problems. Kaysen ignores her and gives his pre-surgical orders. Abby doesn't take the hint and starts blathering about Ruby's decreased lung capacity. She stops when she notices that everyone is staring at her. She says angrily, "What I mean is, shouldn't we be discussing the risks?" Ruby says that they already discussed them, and Anspaugh cheerily says that they'll continue discussing them. Anspaugh asks to see Abby outside.

In the hallway, Anspaugh curtly says, "I take it you have a problem with Mr. Rubadoux's decision to have the surgery." Abby says that she thinks he hasn't made an informed decision. Anspaugh asks if that's because Abby failed to inform Ruby of the risks, and Abby looks down, kind of busted. Anspaugh asks rhetorically why he would operate on someone who didn't want it, and then tells her that if she has concerns, she should ask the consulting doctor to step outside. He works up to a yell as he concludes, "You do not, in front of a patient, attempt to subtly disagree with a senior cardiologist and the Chief of Surgery!" I feel like I'm supposed to think Anspaugh's being an ass, but he's totally right. Abby may be correct about the surgery, but she went about it all wrong. Abby's dressing-down concludes, and she appears chastened. Anspaugh starts to head back into Ruby's room, and Abby finally pipes up, "I have concerns." He stares at her for a minute, and then goes into the room anyway.