It's a Sam-centric episode. Actually, it could be a Sam-centric television series as our favorite heart surgeon is the focus of a reality TV pilot. A production crew follows him everywhere documenting his day-to-day activities. Sheldon stiffens up whenever he's on camera and Violet is caught crying in Pete's old office. Cooper is impressed that the producer also shot a documentary about a meningitis epidemic and Charlotte vows to use the camera as a shot put if the crew gets in anyone's way. She's such a natural on TV.
Sam's mom, Dee (guest star Alfre Woodard), is in town with two old family friends. Raymond (guest star Richard Roundtree) is Dee's longtime boss. The guy is having serious heart issues. His wife, Jillian (guest star L. Scott Caldwell of LOST fame), is by his side as Sam lets them know they need to run some more tests. At the hospital, the camera crew catches Dee kissing Raymond in his room. A few moments later, Sam also catches them in the act. It makes for great reality television, but it's not a great reality for Sam.
Sam has it out with his mom during dinner about her longtime secret lover. The conversation does not go well. Sam struggles to control his emotions while watching Dee, Raymond and Jillian laugh it up at a barbecue he hosts. Party guest Addison says Sam's mom never liked her and her steady date Jake wonders why his pal opted to do the reality TV thing. These issues get put on hold when Raymond collapses and is rushed to the hospital.
Raymond is revived and rushed into surgery. Sam later lets the TV crew know that they removed obstructions to Raymond's heart, but the patient isn't out of the woods. Raymond needs a new lung. They need a partial donor transplant until one becomes available. The match would have to be from a family member, but Raymond doesn't have any children. Actually, that's not quite accurate. Jillian drops the bombshell that she knows about her husband's 40-year affair with Dee. She also knows that Sam is actually Raymond's son.
Sam is understandably angry. He has another blowout argument with his mom. He also trashes one of the cameras when the TV crew won't get out of his face. After a heart-to-heart with Addison, Sam has a calmer discussion with his mother. Dee lets him know that Raymond is the one who gave him his first toy stethoscope when he was a kid. Now Sam must decide if he wants to give his dad part of his lung.
The TV crew shoots footage of the vigil for Sarah, the little girl who went missing in "You Don't Know What You've Got Till It's Gone." New ER doc James is shooting Sheldon dirty looks because he knows he's been treating a patient who has urges for young girls. He also lets camera shy Amelia know that she's wrong about the preconceptions she has about him. Speaking of Amelia, she signs a waiver so she can speak on camera to let the world know that Sam's reputation doesn't need to suffer because he was blindsided by all this family drama.
Sam lets Raymond know that he has nothing to do with the man he's become. He has no right to have any pride for that. Sam is a match for the lung donation. He'll give it up if that's what his dad wants because that's the type of man his mother raised. Raymond doesn't want Sam to cut out a piece of his body for him. He's ready to go home to die. He also says no one can take away how proud he is of the man Sam has become even it was in spite of him.
Sam shakes Raymond's hand as he exits the hospital. He also thanks him for the stethoscope he gave him as a kid. Across the way, Sarah's dad speaks about how it is a parent's job to protect their children. Inside, Sam talks to the camera about all the things he hasn't done in life. His identity has always been his family and friends. It's always been enough until now. Sam wants to know what's next. Unfortunately, he doesn't really know what he's looking for.