They go into the NICU to see their first patient, a 13-day-old baby whose intestines were born outside her body. Rita is shocked when she realizes the bag suspended above the baby's abdomen -- which looks like one of those vacuum-packed bags of cocktail wieners -- is holding said intestines and Steph explains that they are gradually compressing them each day until they can fit in the body. After doing a brief exam, Alex declares that today is the day they will do it. The baby's mom is so excited that she grabs Alex in a bear hug while shouting thanks. She's a little taken aback when Rita tells them to hold still and starts snapping pictures, then handing over a release for the woman to sign. Everyone except Rita finds this slightly odd and off-putting.

While walking away Alex lectures Rita that these are real people, and sick children, not just her photo op. He warns her that the next patient is a sensitive case so she's not allowed to talk or take any photos. Rita just compliments him on being passionate and protective of his patients, which is the last straw for Alex so he banishes her to the hall. But when they open the door to the room they see the teenage patient and his girlfriend smiling with Jackson next to them shooting finger guns while another dude takes pictures. I love a finger gun more than anyone but this maybe isn't the time, Jackson. The photographer mixes up some pronouns and the patient, Brian, explains good-naturedly that he's a he who was born a she while his girlfriend Jess was born a he. He's not offended at all at the mix-up and says he knows it is confusing. It turns out Jackson is also in the running to be the brand ambassador and this photographer is his own shadow for the day; once Alex hears this he seems offended to learn that someone else is being considered and is suddenly more interested in winning the position if it's a competition. Jackson just leans back over to the patients for more photos, excitedly doing more finger guns in their direction. Did he come straight here from his game of beer pong at the tailgate or something?

Alex pulls Jackson to a corner so they can argue about the photographers; Jackson is fine with it because Brian is fine with it while Alex gripes that Jackson just thinks this patient makes him look good. Jackson counters smoothly with the very-not-untrue, "I always look good." When they walk back over the teens are introducing themselves: Brian is a freshman and Jess is a sophomore at UW. Brian says that Alex introduced them because when Brian was 14 he booked an appointment to find out how old he had to be to start the gender transition process. Alex gave him the info and recommended a transgender support group, which is where the lovebirds met. They are completely adorable and googly-eyed for each other. Brian has been saving up ever since, and today there are there for, as he says, "Chopping off my boobs." Rita coos that Alex changed Brian's life, but Jackson pipes up that he's doing the same thing when he leads the surgery today. Before the pissing match can get too intense, Alex has Stephanie and Princess (who is on Jackson's service) take the photographers out to the hall.