Mrs. Grubman is back for more Plastic Surgery this time she wants Christian to preform it after she has passed on. Sean and Julia have conflicts over Conor's Surgery.
Christian is having a consultation with former patient Mrs. Grubman, who has had a stroke and is now in a wheelchair and is helped by her nurse, Avetta, whom she constantly bickers with. Mrs. Grubman has come back to McNamara/Troy for a reason. She has been in seclusion for two years recovering from the stroke- not seeing anyone, not Christian or her own daughter- but has planned a gala event where she can re-emerge back into Miami society, wanting a few ‘refresher operations’ from Christian before she did. However, plans have to change- Mrs. Grubman has been diagnosed with stage four lung cancer which has metastasized to other parts of her body. Time seems to be of the essence so she wants the operations now. Christian refuses, so Mrs. Grubman moves on to plan B- that the procedures will be done when she is dead and the coming-out party will be the funeral. Christian seems reluctant to do it, but Mrs. Grubman wants him to be the last man to touch her, as her body has been his canvas.
Julia is sitting with Conor at the table when Sawyer comes in. He says he doesn’t want to interrupt but Julia presses him for what he was going to say. He says that she has come far and that motherhood becomes her. When Sean comes in, he leaves for the weekend. Sean has been out late, practicing digital nerve dissections in preparations to do Conor’s surgery. Julia seems a little unnerved that he has been using baby parts, but Sean says that’s why he hasn’t gone into it with her, as he can’t deal with her overreaction. Julia counters this by saying he overreacts whenever she wants to ask questions about the procedure that Conor will go through and that, were it any other surgeon, she would have the opportunity to ask these questions. He says that he is just focused, trying to anticipate any problems that could happen within the surgery for Conor’s sake. Julia agrees, saying that there are many families that don’t have the talent or money to do what they’re doing.
Sean has a flashback to his childhood, where his mother and father are arguing over an operation for him. His father, Tom, says it is a vanity operation that they cannot afford and that he will just have to ‘toughen up’. His mother, Kathleen, says they have five thousand dollars saved and can use that. Tom maintains that that is Sean’s college fund and they will not squander it so he can be a ‘picture perfect pretty-boy’ but without education and prospects. Kathleen is angry and says that other children are tormenting Sean and that she loves him too much to sit by and do nothing. Tom counters this by asking if she suggests he doesn’t love his child. Back in the present day, he tells Julia that he will schedule a sit-down so that she can ask the questions she needs to. He also says he’ll take the kids out for pancakes, so Julia can have some time to herself.
At the diner, Sean goes to put their name down whilst Annie watches Conor. Another child makes fun of Conor’s hands and Sean tells him off, but then goes too far suggesting the child has a ‘pig nose and chubby cheeks’. The boy’s father, Mr. Thompson, suggests that Sean should calm down but Sean erupts, telling Mr. Thompson that he should pay more attention to his son so then his son wouldn’t be such ‘a little asshole’. Mr. Thompson gets angry and suggests that he’ll kick Sean’s ass in front of his kids, so Sean gets in first and punches Mr. Thompson in front of everyone in the diner, including Annie (who’s looking a little scared). With everyone looking, Sean takes Annie and Conor and leaves the restaurant.
Christian calls in to see Mrs. Grubman, as Avetta has asked him too. Mrs. Grubman has stopped eating and Avetta is worried that she will be prosecuted for elder abuse if she dies. Christian maintains that Avetta is probably the only reason Mrs. Grubman is still alive and goes up to her bedroom to see her. Mrs. Grubman is sitting in bed, planning the details of her funeral, sorting out a seating-chart. She says she hasn’t got time to eat because she’s so busy. When Christian suggests that she’s giving up, she tells him that she’s had a wonderful life with only two regrets: that she didn’t sleep with Christian when she had the chance and that she never got to sing at The Rainbow Room. Christian seems surprised at the last regret but Mrs. Grubman gives him her demo CD and tells him she used to be a singer and was very nearly Burt Bacharach’s ‘girl’ (but got passed over in favour of Dionne Warwick). She says he’ll hear all the stories at the funeral but he says that if she doesn’t start eating again, he won’t be going and has no intentions of doing the surgeries if she is just going to starve herself to be a good-looking corpse. Mrs. Grubman gets very upset and says she has been very lonely over the last two years, despite knowing that she has pushed everyone away. Christian makes a deal with her; if she will eat some soup today, he will give her a shot of Botox the next day. She agrees and he feeds it to her. As he does, she tells him ‘I love you, you know’.
At the McNamara house, Sean reveals that Mr. Thompson is threatening to sue him for hitting him in the diner but Sean doesn’t care. Julia is worried about how intense Sean is being. Sean explains that on hearing Conor being mocked in front of strangers and in front of Annie, he knew that people like that would torment Conor for the rest of his life and he had to do something. Julia counters with the fact that Sean is doing something: he’s doing Conor’s surgeries. She asks him to talk to Mr. Thompson and apologise to him in the hope that they won’t have to go through a lawsuit. Sean agrees to do that but also says he will contact Dr Mugabe to accelerate the surgeries; they’ll be ready to proceed with them in two weeks’ time. Julia worries that Conor is just so little, but Sean says the sooner he does it, the sooner Conor will be able to develop coordination and hand functions. Julia wonders who Sean is doing this for: him or Conor.
At the baseball diamond, Sean finds Mr. Thompson playing catch with his son. He has another flashback to his childhood, where he plays baseball with Tom. Sean asks Tom if he can join Little League and Tom gets affronted, saying that the other kids will laugh at him and that he won’t get a decent game. Mr. Thompson interrupts Sean and they go to the bleachers to talk. Sean apologises to Mr. Thompson and explains that Conor is about to get an operation. Mr. Thompson says that he was humiliated in front of his son but they’re going through it. Sean says that all he wants for Conor is a moment where he can ‘be normal’. He ends by telling Mr. Thompson to do what he has to with the lawsuit but that he is sorry for what he did and what he said.
At the McNamara/Troy offices, the surgeon- Dr. Mugabe- is going through the procedures that will happen to Conor to reconstruct his hands. Sawyer comes into the meeting late and Julia explains that, because Sawyer will be helping with Conor’s care, she asked him to be there. Sean does not look happy about that. The meeting continues but Sawyer interrupts and asks whether there will be a lot of pain in Conor’s recovery. Dr Mugabe insists there will be minimal pain and they go on to discuss the procedure to extend the thumb. Sawyer asks how they will be measuring Conor’s pain levels, which gets him a sarcastic answer from Christian, but Julia defends it as ‘a reasonable question’. Sawyer says that due to research he’s been reading that the traditional methods of measuring infant pain are not as conclusive as they could be. Sean looks bored and Christian again gives a patronizing comment, but Sawyer stands up for himself saying that he’s doing his job and if that puts anyone’s nose out of joint, he’s sorry. Sean asks him about the research and Sawyer tells them that developmental psychologists have done hypnotherapy on a group of adults who had surgery at an early age and that they all seem to similar problems such as phobias, panic attacks and the like. Julia asks Sean if he knew about this to which Sean replies that this kind of ‘new-age healing’ conversation is fodder for the dinner table not the office. Julia wants this conversation and so says she is heading home to cook dinner. As Julia walks out, Sean glares at Sawyer.
Avetta and Mrs. Grubman arrive at the office for the Botox shot. Mrs. Grubman reveals they have been out for brunch and eaten well. When Avetta mentions that she shouldn’t have had the chocolate milkshake as well as the lobster, Christian offers some liposuction. She sets him straight: she was talking about heartburn and that she neither wants or needs lipo as she loves herself, as she is, ‘every pound of it’. Mrs. Grubman tells her to go and read a magazine, leaving her and Christian alone. Christian turns to get the Botox but when he turns back to her, she has died in the wheelchair.
Julia is reading one of the books that Sawyer has given to her, describing a very traumatic memory of someone who underwent surgery at the age of seven months. After reading this, Julia is adamant that she wants Conor’s surgeries postponed until he is older and won’t sign the consent form. Sawyer tells her that he’s leaving as he feels he has become a disruptive influence in the house. Julia says that he’s her rock and she can’t go through this alone, also admitting that she can’t imagine waking up the next morning and not seeing him. They kiss, and Sawyer admits that his attraction to her is another reason why he has to leave.
As Christian gets ready to do the postmortem surgeries on Mrs. Grubman, Sean joins him. They talk about Mrs. Grubman and Christian reveals that he is giving her eulogy but is having problems with what to say. Christian feels bad that his influence in her life hasn’t been more positive, likening himself to her drug dealer. As they get ready, Christian asks Sean a delicate question: how would he feel if he wasn’t able to make Conor as close to perfect as possible? Sean overreacts and Christian tells him to go home and make amends with Julia as it would also give him time to figure out what he is going to say at Mrs. Grubman’s funeral. Christian enters the operating room and there is gangsta rap on the stereo. Christian asks Nurse Linda to change the CD and it is Mrs. Grubman’s demo. As he does her surgeries, he imagines her singing ‘This Girl’s In Love With You’, accompanied by Burt Bacharach on the piano.
At the McNamara house, Sean comes in with a box of old belongings, which he looks through, finding his old baseball glove In another flashback, Sean is in the car with his mother in the rain and she is telling him to go on. He’s worried that the other children will laugh at him, but his mother reassures him. He says that his dad is going to be angry but Kathleen says she’ll handle him. Sean gets out of the car. Back in the present, Sean finds an old metal box full of photographs that he starts searching through. He finds one in a frame and is looking at it when Julia interrupts him. She asks if he is alright and he says that they need to talk. Julia tells him that she isn’t ready to sign the consent form for Conor’s surgery. He says he knows and that he’s been obsessive about getting things ready for the surgery but there are things he’s never told her. Julia asks if it’s about the surgeries, but Sean says it’s about him.
Another flashback shows young Sean going into school and signing up for the baseball team. As they are taking the photographs, the photographer asks him to lower his arm slightly as it has been hiding his face. When he does, it is revealed that Sean was born with a cleft palate. He tells Julia he had the corrective surgery done when he was eight and that they used his college money to pay for it; his father never forgave his mother and he walked out on the family a few months later. Julia asks why he’d never told her about it and he said he had left ‘that pathetic kid’ behind him but Julia thinks that his early experience is what made him want to be a surgeon. He was also afraid that if he told her about it, all she would ever see was that child. She tells him that in many ways, that child was who she fell in love with and they embrace.
The turnout for Mrs. Grubman’s funeral is not impressive. It is in fact only Christian and Avetta that turn up, despite Avetta sending out all the invitations. Even her own daughter refused to come because her mother had chosen ‘vanity over family’ and has stopped seeing her after she had had the stroke. Avetta reveals that she only got ‘a few old-lady muu-muus’ in Mrs. Grubman’s will and that she has to get a new job. She says she’ll see him next week. When Christian asks what is happening next week, Avetta says she is coming in for some free lipo as Mrs. Grubman had left Christian all her money, thus setting up The Hetta Grubman Plastic Surgery Fund, for people that ‘need a little work, but don’t want to pay for it’. Undeterred, he begins his eulogy but then stops. He walks away from the lectern but turns towards the coffin and calls Mrs. Grubman ‘a huge pain in the ass’ and saying that her obsession with plastic surgery cost her every relationship in the end. Yet he also notes that she meant well, was funny, honest and stuck up for herself. He concludes that ‘life was more interesting’ with her in it and he will miss her and that he loves her.
At 4:00 in the morning, Julia and Sean get up in order for them to take Conor in for his surgery. As the George Michael song ‘Jesus To A Child’ plays, the surgery begins. Liz is in the operating theatre, ready to assist. Sean looks back at Julia and then draws the blind so she cannot see the operation. Mixed in with scenes of Conor’s surgery are flashbacks to Sean’s own surgery when he was eight, including one of his father coming to see him with a teddy bear, which he leaves on the bed and goes from the room in tears. As Julia waits anxiously, Sawyer comes back to keep her company. After all the surgery is completed, Sean cradles Conor as he bottle-feeds him.