A woman named Karen is nearly nine-months pregnant and acting as a surrogate mother for her sister Wendy and her husband Phil, but Wendy doubts whether or not she still wants to be a mother. After getting into a car crash, Karen manages to deliver the baby, but she goes into cardiac arrest as a result of internal bleeding. Coming to terms with the likely prospect of her sister's death, Wendy is forced to counsel her young nephew Dylan and finally connects with him. Fortunately, Karen pulls through, and Wendy's interest in raising a child is renewed.
Selena and Nathan walk into work together after getting back together, but Selena wishes to keep their relationship private. Believing that Harry is a great leader for the emergency department, Selena recommmends that Nathan offer Harry the clinical director position back. Nathan, in an attempt to undermine Harry, approaches him about sharing the clinical director role with another person and puts Selena forward as a candidate. However, his plan backfires when Harry and Selena work amicably together.
Alice decides to create a game among the nursing staff where they can earn a certain number of points depending on the first letter of the injury or condition their patients are suffering from. Kelsey treats a woman with a laryngectomy stoma named Rosie and convinces her to pretend that she has xerophthalmia — a condition where the sufferer's eyes cannot produce tears — but she is soon caught out and disqualified. However, after Rosie's stoma clogs up with mucus, Kelsey realises that she has been trying to kill herself. In solidarity, Kelsey decides to quit smoking with Rosie. She is keen to keep the news private in fear of being ridiculed, but she is forced to disclose her decision when Tess nearly finds out about the alphabet game.
Elsewhere in Holby, a drunk worker named Doug falls from scaffolding after spotting a grafitti artist named Niall tagging a nearby building. While helping Doug, Niall agrees to keep his drinking habit a secret, but Alice convinces him to tell the truth. Meanwhile, after Dixie and Cyd continue to work together behind Josh's back, he splits the pair up again, and the two start to get along with their new colleagues.
- Elizabeth Carling as Selena Donovan
- Ben Price as Nathan Spencer
- Simon MacCorkindale as Harry Harper
- Janine Mellor as Kelsey Phillips
- Susan Cookson as Maggie Coldwell
- Sam Grey as Alice Chantrey
- Luke Bailey as Sam Bateman
- Elyes Gabel as Gurpreet "Guppy" Sandhu
- Suzanne Packer as Tess Bateman
- Georgina Bouzova as Ellen Zitek
- Joanne King as Cynthia "Cyd" Pyke
- Jane Hazlegrove as Kathleen "Dixie" Dixon
- Ian Bleasdale as Josh Griffiths
- Kip Gamblin as Greg Fallon
- Lucinda Raikes as Wendy Radcliffe
- Abigail Thaw as Karen Whitear
- Matthew Gravelle as Phil Radcliffe
- Thomas Wall as Dylan Whithear
- Gerard Kelly as Doug Murray
- Daniel Anthony as Niall Gorton
- Chrissie Cotterill as Rosie North
- John Enthoven as driver