Ginger is rushed to the ER in critical condition after being hit by a car. Rex heads to Statesville in hopes of lending Bo a hand with the hostage situation. Kevin and a distraught Kelly tell Duke how they witnessed Ginger's accident. At Rodi's, Evangeline explains to Michael how his brother and the real Cristian Vega became trapped in the violence at the prison. Meanwhile, Carlo issues new orders to his eager cohorts. Tess tells Nash how much she wants to go back to the happy life they once enjoyed in Napa. Paige is curious about Spencer's apparent connection to Ginger. Out in the waiting room, Duke questions Adriana's motives in coming to the hospital to check on Ginger's condition. Fearing for John's life, Michael comforts an equally frightened Natalie. After Rex is caught trying to sneak into the cellblock, Bo makes it clear to the young man how deeply he cares about his welfare. Hugh offers Evangeline a sympathetic ear and a kindly word to the wise. John and Cris are cornered by two prisoners. Outside the walls, Rex realizes that Haskell may be secretly working for Carlo while Bo argues with the head FBI agent about their next move. Despite Spencer's efforts to save her, Ginger succumbs to her injuries. Afterwards, Adriana bemoans the cruel way she treated Ginger just before she died. Niki bumps into Tess and Nash at a bar. Bo decides to make a solo attempt to rescue his detective. Cris' quick thinking saves John from certain death. Rex trails Bo into the exercise yard and watches in horror as the commissioner takes a bullet to the neck.
Paige watches as Matthew recites the state capitols in front of a still-comatose Nora. Afterwards, Matthew expresses his worry and concern about Bo to Paige. Paige reassures the boy, telling him that the station just heard from Bo a little while ago. Suddenly, Spencer demands to see Paige in the corridor. He tells her that Bo has been shot.
Rex is at Bo's side as he lies bleeding in front of Statesville. Rex refuses to leave the Commissioner until they get to the hospital, where Matthew runs out and spots his father on the stretcher. Paige and Spencer spar over who will operate on Bo, and Paige tearfully yells at Truman that he won't be laying a finger on her beloved. Spencer insists that he is Bo's best hope for survival, and Paige reluctantly agrees to do a dual prep for surgery. Meanwhile, Matthew finally breaks down in the face of both of his parents' conditions, and Rex is unable to stop him from fleeing. Matthew makes his way to Nora's room, where he implores his mother to wake up because Bo needs them. Meanwhile, Paige and Spencer leave the pre-op room and erupt into another argument. Paige claims that she saw what Spencer did to Ginger, but Truman insists that he did everything in his power to save the young girl's life. He swears that he must operate on Bo and tells Paige that she doesn't want to be responsible for leaving little Matthew an orphan. Paige agrees, but decides that she will stand in to observe.
Clint and Antonio are on the hunt for Tess and Niki Smith. They run into Natalie outside of Rodi's, and Clint is immediately concerned that Natalie has encountered Niki. Natalie hasn't seen Jessica or Viki, and she is stunned when her father informs her that Niki Smith is out, and possibly Tess, too. Natalie has gone through so much over the last 24 hours that she is hardly able to absorb this news. Clint takes her inside Rodi's, and Natalie lets her father in on the truth about Cristian's real identity. Clint comforts Natalie, telling her that Cristian must have thought he was doing right by her. He admits that Cris should never have lied, and Natalie tells him that he wasn't the only one; John has also known about Cris for months! Antonio overhears this last part and demands to know what John knew about his brother. Natalie covers, then she, Clint, and Antonio take off in search of Viki and Jessica.
Niki runs into Tess and Nash in a roadside bar and does her best to impersonate Viki. However, Tess sees right her act and sends Nash away for a moment. Tess tells Niki to cut the crap and reveals to her that "you're not the only alter in town." Niki is stunned to learn that Jessica isn't herself, and she claims to have no knowledge that the young Buchanan heiress suffers from DID. Tess tells her that she ought to know, since her very existence is all Niki's fault. Niki says that she will accept blame for a lot of things, but not for Tess's existence. Tess tries to walk away from Niki, but Jessica makes a valiant effort to come out so that they can get to the truth about what happened all those years ago. As Jessica and Tess fight for control, Nash runs to the side of the woman he loves just as Clint, Antonio, and Natalie arrive on the scene. Jessica wakes up in control, and Antonio takes her back to Llanfair. Clint confronts Niki and tells her she can ride peacefully back to Llanfair or else he will have her committed. Niki threatens Clint, telling him that he is in for one hell of a fight. Clint replies, "Been there, done that," but Niki insists that this is going to be far worse than anything they've been through before.
Evangeline and Layla catch up at Capricorn. Van is shocked by all that she witnessed at the prison, and she brings her sister up to speed. It's obvious how much she still cares about John as she worries whether he is alive or dead. Layla demands that Evangeline tell Antonio the truth about his brother, but Van feels too much guilt for how she handled Cristian's situation.
Inside the prison walls, Cristian and John are still trapped in the stairwell. Suddenly, Hesser's voice comes over the intercom, thanking everybody for their loyalty. Hesser also reveals that he is aware that a transmitter was planted in the briefcase. Hesser has a new demand: he wants a hostage. Hayes is foaming at the mouth with excitement as Hesser sends him to finish off John and Cristian once and for all. But Hayes has no idea who Hesser has in mind as his hostage. Cristian has had it with waiting, and he abandons John in the stairwell. At the same time, two inmates join Hesser to hunt down McBain once and for all. While John waits like a hunted animal, Cristian manages to come up behind Hayes and steal his weapon. Will the good guys escape unharmed?
Dorian and Asa spend time together but Asa refuses to listen to her badmouthing David. They continue to wonder about the scene they witnessed earlier between Ginger and Spencer but when Adriana appears and tells her mother that she won't be able to contact Ginger as planned, they learn of her death. Their curiosity is piqued even further when they hear that Spencer tried to save the girl and think the scenario just too perfect. Adriana wonders why her mother is with someone she hates and doesn't buy her reason. Asa and Dorian decide to head for the hospital for some sleuthing. Duke comes by shortly after their departure, upset over Ginger and apologizing for his rudeness to Adriana.
Rex keeps Matthew company as Spencer operates on Bo under Paige's watchful eye. They are joined by Kevin and Kelly who try to reassure the boy that his dad is in good hands after they learn of his shooting. Dorian and Asa arrive only to learn of the shooting as well. Upset that Spencer is operating, commotion ensues as Asa charges into the OR and orders his enemy to stop or he'll kill him. Paige yells as the old man is warned that he's ruining the sterile environment. Kevin rushes in, grabbing his grandfather and trying to get him to leave. Spencer is his usual snide self as he professes that Bo's death will be on Asa's head. Asa states that if Bo dies, Spencer dies. Kevin is berated for laying his hands on Asa (by Asa) and Rex learns of Ginger. He tries to contact Adriana.
David drops by to see Blair as she leaves Spencer a message to call her. After telling her she looks awful in his own inimitable way, she fills him in on Todd and the latest with Jackie. He's there to discuss Spencer, calling him inhuman except for the fact that he loves Blair. He doesn't want her involved with him because things never turn out right around him, he tells her. He blackmailed David into not marrying Dorian, he continues, but Blair doesn't believe him. Picking up her phone to check for messages, she eagerly listens to the voice mail, assuming that Spencer returned her call. It's not him but Ginger warning her, "he's not who you think he is." David warns her to be careful and as he is being ushered out, Dorian shows up. He admits to missing her every day which touches the hardened on the outside woman. The call from Ginger is mentioned but Dorian has to deliver the news of her death, along with details about the girl's argument with Spencer and his ineffectiveness in surgery causing the death. Blair compares Dorian to David, with both of them trying to pass blame for problems onto the wrong people. Things go downhill for Blair when Dorian feels it necessary to warn her about Spencer, pretty much repeating Ginger's phrasing.
Adriana receives Rex's call and she and Duke learn about Bo. They head for the hospital. Adriana comforts Matthew while Duke spots his family members. Rex admits that Bo has been the closest thing to a father that he's ever had and that he can totally understand how Matthew is feeling. He and Adriana grab hands just as Duke is walking over. Everyone waits for some word as Asa says a prayer though feeling like a hypocrite. In surgery, Bo's blood pressure drops and he flatlines.
Natalie gets her guard to drive her to Statesville; she wants answers. She asks for Bo and learns of his shooting, while the guard tells her that most likely, John and Cris are dead. She asks him about his shooting of the prisoner and the guard shrugs. Why would she care, she's with the cop, he says. Inside, Cris has the gun and the advantage over Hayes while Carlo and his cronies encounter John with a hostage. Since Carlo could care less about the man in custody, he orders his men to take John, which they do. Now the tables are turned but John manages to save himself, temporarily, while reminding Hesser that he's his bargaining chip. Yes, but once he gets what he wants, John is dead, he offers back. John also manages to get Carlo to admit to controlling Cris to kill Tico though unfortunately, Antonio was to be murdered also. Carlo wished to take over the Santi empire and he was betrayed by Antonio so it was all payback. There's a mike hidden under the steps and the confession is either being recorded or heard elsewhere. Carlo demands safe passage or John is dead. Hayes tries to negotiate with Cris while enraging him at the same time with his comments about Natalie. Finally, he takes him by surprise, the men wrestle and the gun goes off.
Much to the relief of all the Buchanans in the waiting room, Spencer came out of the operating room that with news that Bo had made it through surgery. Leading up to that last-minute announcement, there was much drama and many tender moments. Asa (no surprise here) kept barking orders and made sure everyone knew who was a real Buchanan and who was not. Example: Matthew yes, Kelly no. Adriana tried to comfort Duke, but he rejected her only to profess his love for her about 45 minutes later (episode time). Adriana found Rex (who considers Bo his "uncle" though he's by no means a real Buchanan) and they both took Matthew under their wing. Rex and Matthew went to the chapel. Matthew showed Rex how to pray. "Please don't let me live alone," Matthew said. Those scenes were very charming...and this recapper isn't a big fan of the "chapel in hospital scenes."
Clint brought Niki home and almost fell for Niki pretending to be Viki. Niki tried her best to maneuver Clint into bed, but he wasn't interested. "Are you dead or something?" she barked. Clint got a call about Bo so he headed to the hospital and gave Nash the keys to watch over Niki. Niki offered to make a deal with Nash. Maybe they could both work together to both get what they wanted. Nash reminded her that he had made a promise to Jessica. Jessica, Niki reminded him, was now sleeping with Antonio. That struck a nerve, but Nash wasn't changing his mind. Not yet.
Antonio kept Jessica company in Jessica's room, as Jessica tried to explain why they needed to keep Tess and Niki alive to help her. (This is about as confusing to recap as it must be for Antonio and Nash to understand.) Jessica tried to explain to Antonio that locking her up made the Tess side of her stronger. Antonio confessed that if he doesn't watch Jessica, he'll lose her. Antonio was about as confused as Nash was the previous day. Jessica learned that Viki had let Niki out to help her and Jessica worried that they may have lost Viki forever.
The violence continued at Statesville. John escaped from Carlo's clutches and ran into (literally) Cristian who had left Hayes for dead. But Hayes wasn't quite dead when Cris left; in fact he managed to drag himself to the airshaft and set the bomb to go off when Cristian would return. That last act before dying worked. Cristian did trip the wire and a bomb went off, which left Cristian covered in dust and John pinned under lots of cement wall. John urged Cristian to leave while he could. Though unwilling at first, Cris left with the tape of Carlo's confession.
Natalie kept getting in the way at Statesville but then got a message from Rex explaining that Warden Haskell was on Carlo's side. Unfortunately that very warden was watching her when she got the message and he wasn't about to let her out of his sight. Natalie tried to get away, but Haskell said, as he stuck his gun in her side, "Congratulations, Mrs. Vega, you've just graduated from civilian to hostage."
Marcie and Hugh run in to Michael at the police station. Michael is beside himself with worry about John, but Marcie notices that he's almost as concerned about Natalie. When Hugh goes to visit Todd in his cell, Marcie tries to comfort Michael. He appreciates her words, but it's obvious that their connection has suffered. When Hugh returns, Marcie expresses her feelings of uselessness in the face of Michael's pain. When a call comes in to the station, Marcie answers the phone and immediately falls into the duties of her old job as dispatcher. Hugh is impressed with her phone manner and tells her that she's just found a way not to feel useless anymore!
Evangeline visits Todd in his cell to let him know that she's dropping his case. She reminds Todd that he said he would be nothing but honest with her, but the coroner's report has just come back, and it looks like Margaret was already dead when she hit the water. Evangeline insists that not one, but two different coroner's reports cite Margaret's cause of death as strangulation, not drowning. Todd maintains that a mistake has been made, and he seems genuinely confused by these results.
Meanwhile, Blair has dropped by Spencer's and interrupted the doctor in nothing but his towel. Once he is properly dressed, Blair tells him that she received a call from Ginger Foley just before the girl's death; Ginger told her simply that "he isn't what he seems." Blair had thought Ginger might be referring to Todd, but David suggested that she could have been talking about Spencer. Spencer makes up a story and convinces Blair that Ginger was just upset because he told her he wouldn't persuade Blair to give her a good job reference. Blair seems to buy Spencer's story, but before they can discuss things further, Paige drops by. Paige informs Blair that Spencer saved Bo's life, and Spencer tells Blair that every patient's life is of value to him. Once Blair leaves, Paige can't hold back her disgust. She reminds Spencer of the patient that he killed years ago, but Spencer insists that Paige is at fault for that death. As Paige heads out, Spencer tells her that he'll let her know what the price is for saving her boyfriend's life.
Blair heads directly to the jail, where she tells Todd that she still wants to believe in him. He asks her to marry him that night, knowing full well that a wife can't be asked to testify against her husband. When Hugh drops by, the truth comes out about Margaret's cause of death. Faced with the seemingly indisputable facts from the coroner's report, Blair storms off, leaving Todd behind. Has her belief in the man she loves finally reached its breaking point?
Haskell drags Natalie into the depths of the prison, where Carlo is relieved to see that he has a hostage to help aid his quick escape. Meanwhile, John fights to free himself from the debris from the roof cave in, but his strength is running out. Two inmates come upon John and attempt to kill him, but Cristian appears on the scene in time to knock them out and free John from the wreckage. The two men are on their way to the sewer to escape when Carlo comes over the prison intercom to announce that Natalie Vega is his hostage. Cristian and John make a last minute change of plans and head towards the common area where they know Hesser is holed up. They manage to overcome Haskell, but then Carlo appears with a gun to Natalie's head. He forces McBain and Vega to hand their one weapon over to Haskell, and then Natalie tells the men that Hesser only has one bullet. Natalie and Cristian share a meaningful glance, each of them overcome to finally be in the face of their true love. Hesser says that he needs Natalie in order to ensure his escape, but that his remaining bullet needs to be put to good use. He forces Natalie to choose who he should shoot: John or Cristian.