In the fourth hour of the shift, Dr. Robby extubates Spencer and leads the family through a Hawaiian forgiveness ritual, but the same room triggers a panic attack tied to his mentor Adamson's COVID death. Spencer dies peacefully after the family reaches a hard-won reckoning. Intern Santos nearly kills a festival rigger by putting him on positive-pressure ventilation without authorization, converting a small pneumothorax into a life-threatening tension pneumothorax. Meanwhile, resident Samira coaches Santos on bedside manner and handles a sensitive pediatric diagnosis with quiet skill. Jenna reveals to Nick Bradley's parents that he was picking up pills as a favor, not using them himself. Collins, secretly pregnant, performs a medication abortion for a seventeen-year-old. The hour closes with a seizure in the waiting room.

This episode marks ...