Worf accompanies La Forge to Cargo Bay 3 to investigate some anomalous readings, but Worf finds himself sidetracked by a loss against Troi in a game of poker. While he isn't paying attention, a container in the cargo bay leaks, causing another heavy container sitting on it to fall on top of Worf. Worf is immediately sent to sickbay, but the news is not good; Worf sustained a serious injury to his spinal cord, rendering him paralyzed.Dr. Toby Russell, a doctor from the USS Potemkin, accompanies Crusher in trying to find a way to help Worf. Unfortunately, Worf's prognosis is grim; his paralysis appears to be permanent. In cases where a Klingon is rendered disabled such that they may not fight any longer, it is tradition for the invalid Klingon to commit Hegh'bat; ritual suicide. So it is that when Riker visits Worf in sickbay, the injured Klingon requests Riker help him commit Hegh'bat. Riker confides in Picard how troubling such a request was, but Picard explains that for Worf, his life had ended the moment he was injured...Russell has an idea to help Worf recover; using a genetronic replicator to construct a new spinal column for Worf. There is one caveat, however; the procedure had only been performed on holographic test patients up to this point, but never on a live patient. Worf would be the first one to undergo this radical new procedure, and Crusher is uncomfortable about Worf being made into a test experiment. Crusher, instead, suggests to a more traditional treatment for Worf; using medical devices to help stimulate the muscles he couldn't use because of his paralysis. Such a treatment, however, would not return full mobility to Worf, and he emphatically refuses to undertake it. Against Crusher's warnings, Russell suggests the genetronic replicator. Crusher is cross with Russell for playing to Worf's desperation to try and push her experimental procedure on him, especially considering Russell had proposed this procedure to Starfleet multiple times before and was denied each time.As Worf reluctantly sees his son Alexander for a few moments before he sends him away, ashamed of his weakness and disability; colonists who had been attacked by Cardassians come aboard the Enterprise for treatment. While treating the casualties, Crusher learns of another patient Russell had who underwent another experimental and unapproved treatment using a drug called borathium, which resulted in the patient's death. Enraged, Crusher relieves Russell of duty and forbids her from practicing medicine while on the Enterprise.Picard brings Crusher aside to discuss Russell. Crusher is uncomfortable with the idea of an unscrupulous doctor who jeopardizes lives in unethical experiments performing medicine, but Picard believes Russell may be Worf's best chance at living; even if he could live a full life with his paralysis, Worf's Klingon pride would not permit him to suffer such a disability.Meanwhile, Riker is completely opposed to helping Worf kill himself, seeing it as an affront to everyone who had perished in the line of duty, up to and including Tasha Yar. Finally, he tells Worf that he will help him die, but only under one condition; Klingon tradition dictates that the one who ultimately kills a Klingon in Hegh'bat must be a living relative. In Worf's case, that means there is only one person who is permitted to kill him: his son, Alexander. Unwilling to place so great a burden on his son, Worf decides to undergo Russell's procedure.Before going into surgery, Worf asks a favor of Troi; should he not survive, he wants her to raise Alexander. With that, the procedure begins, with Russell and Crusher surgically removing Worf's spinal column and using the genetronic replicator to construct a new one. The procedure hits difficulties when the primary scanner has difficulties recording Worf's spine, but Russell manages to manually scan what the primary scanner cannot. After the new spinal column is replicated, they place it in Worf's body. Suddenly, however, Worf's vitals begin to crash...After the procedure, Crusher delivers the news to Alexander; his father is dead. Alexander demands to see Worf...but when he enters the operating room, he discovers, to everyone's relief, that Worf's vitals have stabilized! Klingons have several redundant organs, including secondary synaptic functions that kicked in after the new spinal column was put into place. Russell is pleased with the outcome, believing that the ends justify the means; but Crusher cannot abide Russell's unscrupulous medical practices.With the procedure being a complete success, Worf begins to undergo physical therapy, with Alexander's help. In time, Worf would regain full mobility and return to his duties.
- Bizarre Alien Biology: Dr. Russell calls the Klingon body "over-designed"—citing such things as 23 ribs, two livers, and an eight-chambered heart. Beverly says that Klingons see it as a contingency—if a given organ fails, a backup immediately kicks in.
- Chekhov's Gun: Early on, it's noted that the Klingons have extra internal organs so that if one fails, there's still another that can take its place. This sets up the Death Is Cheap moment later, where Worf recovers due to a second synaptic system.
- Cloning Body Parts: The treatment proposed by Dr Russell is cloning his spinal column, an untested procedure.
- Continuity Nod: Riker brings up Marla Astor and Tasha Yar in his list of officers who continued to fight even after being critically wounded.
- Death Is Cheap: Worf dies on the table and comes back later due to a backup synaptic system.
- Driven to Suicide: Worf asks Riker for help in a Klingon ritual suicide. Naturally, Riker refuses to help him.
- Riker does note that despite his personal feelings, he would help Worf commit suicide if it was his place. Unfortunately for Worf, the Klingon ritual suicide is pretty specific about who has to help Worf.
- Foreshadowing: Beverly's talk of Klingon's backup systems in their bodies.
- Freudian Excuse: Alexander cites his mother's dismissive view of Klingon honor when objecting to Worf not letting him visit in sickbay.
- Harmful to Minors: Riker correctly anticipates that this is why Worf won't ask Alexander to take part in the ritual.
- Honor Before Reason: Deconstructed with Worf, as he gets a lot of grief for it. He would rather die than live on as paralyzed, but Riker calls him out on what an affect that would have on the people around him. Worf also spends much of the episode being too proud to ask for help, initially refuses to let Alexander see him in his current state, and resists a implant treatment with limited results in favor of a riskier procedure with better results in the long term. In the final scene, though, Worf acknowledges that it'd be better for both himself and Alexander if he swallowed his pride and let him help in his recovery.
- Jerkass Has a Point: Beverly chastises Dr. Russell for broaching her treatment to Worf, despite the dangers. While Beverly is right that she only did so to test a treatment that Starfleet previously rejected, Dr. Russell is right that proposing her treatment is preferable to Worf committing suicide. Picard pointing this out to Dr. Crusher is the reason that she eventually relents, and helps with the procedure.
- Living Is More Than Surviving: Worf says the ritual is for cases when a Klingon can no longer function as a warrior and becomes a burden. Riker is against helping Worf commit suicide—saying he's not suffering. Picard says that's a human perspective and understands the Klingon perspective on it.Picard: You and I could live to learn with a disability like that, but not Worf. His life ended when those containers fell on him. Now, we don't have to agree with him; we don't have to understand it, but we do have to respect his beliefs.
- Loophole Abuse: How Riker gets out of the ritual. He studied up on it and found that it is the place of a family member (such as the oldest son) to carry this out. When Worf says Alexander is just a boy, Riker notes how Klingon males are considered men the moment they can hold a weapon.
- No OSHA Compliance: Worf would probably have been alright if those barrels had been properly secured.
- Noodle Incident: During The Teaser, Geordi discusses a recent poker game in which Troi beat Worf at a hand. Geordi says she successfully bluffed him and that he knows because the deck was transparent to his VISOR.
- Oh, Crap!: The look on Worf's face when Dr. Crusher tells him he's actually not being restrained: his spine is severed and he's now quadriplegic.
- "The Reason You Suck" Speech:
- Dr. Crusher delivers one to Dr. Russell.Crusher: I am delighted that Worf is going to recover. You gambled, he won. Not all of your patients are so lucky. You scare me, Doctor. You risk your patients' lives and justify it in the name of research. Genuine research takes time. Sometimes a lifetime of painstaking, detailed work in order to get any results. Not for you. You take short cuts. Right through living tissue. You put your research ahead of your patients' lives. And as far as I'm concerned, that's a violation of our most sacred trust. I'm sure your work will be hailed as a stunning breakthrough. Enjoy your laurels, Doctor. I'm not sure I could.
- Riker's last scene with Worf is basically this in a tough love sort of way.Riker: Do you remember Sandoval? Hit with a disruptor blast two years ago. She lived for about a week. Fang-lee, Marla Aster, Tasha Yar—how many men and women, how many friends have we watched die? I've lost count. Every one of them, every single one, fought for life until the very end.
Worf: I do not welcome death, Commander!
Riker: Are you sure? Because I get the sense you're feeling pretty noble about this thing. "Look at me. Aren't I courageous? Aren't I an honorable Klingon?" Let me remind you of something: a Klingon does not put his desires about those of his family or his friends. How many people on this ship consider you a friend? How many owe you their lives? Have you ever thought about how you've affected the people around you, how we might feel about your dying?
- Dr. Crusher delivers one to Dr. Russell.
- Sadistic Choice: Riker has to choose between his friendship with Worf and his disgust with him wanting to commit suicide. He concedes he probably would've helped Worf in the ritual if not for finding a loophole.
- Take a Third Option: What Riker does in the end.