Instead of taking the school bus, Jackie and Kevin and their kids take a walk to the streetcar. When Jackie takes a tissue out to clean the face of her daughter Fiona who is eating a donut with chocolate topping, she accidentally spikes Fiona's donut with granules of oxycodone. When Jackie discovers that one of her Percocet tablets opened, she slaps the donut out of Fiona's hand and explains that she saw a bug on it.
At work, Mrs. Akalitus informs Jackie that they are four nurses short because of budget cuts, but she got Jackie a temp for that day. Mrs. Akalitus introduces Jackie to the temp Sam who is unsuccessfully trying to fill out a patient's form for Mrs. Greenfield who had a car accident. Jackie sends Sam away and takes over the case.
Soon later, Jackie tells Zoey that she is on her own that day and needs to act like Jackie and refers to a previous case where Zoey gave a drug addict Percocet for a non-existing broken finger.
Jackie and Dr. Cooper examine Mrs. Greenfield. When Dr. Cooper wants to check for fluid in her abdomen, Mrs. Greenfield is able to convince him that she is fine despite a cut on her forehead. He orders to stitch it and leaves. When Jackie wants Mrs. Greenfield to sit up, she cries in agony and reveals that she feels pain in her abdomen. Her daughter Amy wants to know why she didn't tell Dr. Cooper about it, and Mrs. Greenfield answers she didn't want to disturb him.
In the meantime, Mrs. Akalitus enters her office and it is revealed that the baby that was left at the hospital previously is still with her.
Mrs. Greenfield's other daughter Melissa joins them. Apparently, Mrs. Greenfield is much fonder of her than of Amy and wants her to meet Dr. Cooper.
Meanwhile, the temp Sam is annoying Jackie for not doing his work. When she learns that he hasn't checked for a while on one of his patients, she tells the patient that Sam will pay him 50 dollars when he doesn't get all he needs within the next five minutes. Then Mo-mo approaches her to tell her that Dr. Cooper needs to see Mrs. Greenfield, but he isn't answering his pager.
Zoey, who doesn't want to give out painkillers to a drug addict again, is questioning one of her patients until Mo-mo interrupts and tells her that the guy has a broken leg and is in real pain.
In the hallway, Jackie meets Thor who is ready to go home, but she tells him to stay. When she meets Mrs. Akalitus, she can convince her to jump in so Jackie has half an hour to get something to eat. At last, Dr. Cooper appears. Jackie is angry with him for not responding after being paged repeatedly. To make matters worse, her daughter Grace calls her because she has a panic attack. Jackie tries to calm her daughter down, but Dr. Cooper disturbs the call because he feels mistreated by Jackie. Finally, she tells him to shut up because her kid is on the phone.
When she has ended the phone call, she follows Dr. Cooper and asks him not to tell anyone about her kid. However, soon later, Dr. Cooper tells Eddie about Jackie's kid.
At a restaurant, Jackie meets Dr. O'Hara who has the day off and tells her about what happened that day.
Back at the hospital, Zoey nearly catches Jackie sniffing a line of granules of oxycodone in the ladies' room. Zoey tells Jackie that she thinks the temp is on drugs because he didn't feel it when she accidentally rolled a patient's bed over his foot and his pupils didn't respond to direct flashlight. Jackie promises to take care of the situation.
Finally, Dr. Cooper checks on Mrs. Greenfield and tells her and her daughters that she will need exploratory surgery because the scan showed some spots on her stomach.
Jackie offers Sam two choices, to leave right away or to take a drug test first. Before he leaves, he tells her it "takes one to know one".
Jackie visits Eddie in his infirmary and right he asks how her kid is. She apologizes for not telling him, but he tells her it is ok, and he will wait until she feels ready to tell him about it.
Jackie and her family spends the evening in Kevin's bar. It's karaoke night and when Jackie is called to the stage, she refuses to sing until she learns that Grace put her name in the pitcher. Jackie starts singing "Up On The Roof" and is glad to see her daughter happy, but she hasn't even finished the first verse when Grace stops smiling.