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 Adelman Neurological Institute, 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 is, but Picard explains that for Worf, his life had ended the moment he was injured - that getting him to accept life with a disability would require getting him to utterly abandon his Klingon identity.
Russell proposes an experimental treatment that would fully cure Worf: using a genetronic replicator to construct a complete new spinal column. There is one caveat, however; the procedure has only been performed on holographic test patients up to this point (with a 37% success rate), but never on a live patient. Worf would be the first one to undergo this radical new procedure, and Crusher believes it to be an unnecessary risk. Crusher, instead, suggests a more traditional treatment for Worf, using cybernetic implants to bypass his damaged spinal cord and stimulate his leg muscles. That 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 previously requested permission from Starfleet three times to test it on live patients, being denied each time.
Worf reluctantly sees his son Alexander for a few moments before he sends him away, ashamed of his weakness and disability. Meanwhile, colonists who had run afoul of a mine left over from the Cardassian war come aboard the Enterprise for treatment. Dr. Russell assists the Enterprise medical staff with the casualties, but Crusher learns that Russell has performed another experimental and unapproved treatment on one of them 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 visits Crusher's office 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; it may be possible to live a full life with his paralysis by human standards, but 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 has 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 a snag 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 will regain full mobility and return to his duties.
Tropes in this episode include:
- 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.
- Both Sides Have a Point: No one involved is portrayed as entirely right or wrong. It appears that the episode was not meant to send a specific message one way or another, but simply to encourage the viewer to think.
- 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 Aster 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 Healing: Doctor Russell's got to take out Worf's spine (disconnecting it from the brain and putting said brain on temporary life support) in order to install the cloned one. The Federation doesn't know much about the Klingon nervous system, either, but Doctor Russell thinks she shouldn't have any problems figuring it out. Beep...beep...beeeeeeeeeeeeee--
- 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 paralyzed, but Riker calls him out on what an effect 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 an 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 his son help in his recovery.
- Hypocrite: Crusher.
- Refusing to let Worf kill himself is a violation of the Federation's respect for alien cultures, because by Klingon standards, Worf committing suicide is what is expected of him. Crusher is acting as a healer first, sworn to heal and help, not to allow her patient to just kill himself because he believes himself to no longer have worth. Her argument with Picard before allowing the treatment has him indirectly calling her on this one.Picard: This may not be good medicine, but for Worf, it may be his only choice.
- Refusing to let Worf kill himself is a violation of the Federation's respect for alien cultures, because by Klingon standards, Worf committing suicide is what is expected of him. Crusher is acting as a healer first, sworn to heal and help, not to allow her patient to just kill himself because he believes himself to no longer have worth. Her argument with Picard before allowing the treatment has him indirectly calling her on this one.
- As Worf is refusing to see Alexander, Troi tells him to stop lying there thinking about honor and think about his son instead. If only she knew about the Hegh'bat ritual and who's really supposed to be doing it...
- The brak'lul, which are very redundant Klingon organ systems Doctor Russell criticized as "overbuilt", end up being the only thing that keeps Worf from dying as a result of her experimental treatment. (In fact, in the continuity of the novels, genetronics didn't go anywhere for a decade or so specifically because it only worked in this case due to the brak'lul, although another doctor manages to refine the technique).
- It's All About Me: Riker accuses Worf of wanting to make himself look honorable at the expense of the happiness of his friends and family. Dr. Crusher accuses Dr. Toby Russell of this, taking short cuts "right through living tissue" in a "The Reason You Suck" Speech (see below).
- 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.
- Lesser of Two Evils: Either let Worf kill himself, or let him be used as a guinea pig for a super-risky experimental procedure. Crusher also expresses a willingness to forcibly restrain Worf to stop him from killing himself, but in the absence of any real plan to convince him that life is worth living, that option is probably not much better than the other two.
- 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 (preferably the oldest son) to carry this out. When Worf says Alexander is just a boy, Riker notes that Klingon males are considered men the moment they can hold a weapon.
- The Needs of the Many: Doctor Russell feels that her experimental methods will save thousands of lives down the road at the cost of a few experimental test subjects. Doctor Crusher finds this irresponsible.
- 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. Doubles as a case of Comically Missing the Point when Worf acts shocked at Geordi's ability to essentially cheat by looking through the cards. He assures Worf that he only peeks after the hand is over, but this completely misses the point that knowing the hands at all allows Geordi to establish people's tells by comparing their demeanor when bluffing versus when they actually have a strong hand.
- Geordi does mention that Worf should have provided infrared-opaque playing cards, which hints that the more experienced players know how to negate his advantage — it could essentially be a running gag in the poker circle.
- Physical Therapy Plot - Worf has a choice of limited physical mobility and months of physical therapy via cybernetics or a dodgy expermential treatment from Dr. Russell. The episode ends with him receiving physical therapy to help his legs get working with his new spine.
- Oh, Crap!: The look on Worf's face when Dr. Crusher tells him he's actually not being restrained—his spine is crushed and he's now paraplegic.
- "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 above 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.
- Tested on Humans:
- Doctor Russell's procedure has a 37% percent success rate on holographic patients. Starfleet Medical has denied her the right to experiment on living humanoids three times as of this episode. And along comes Worf...
- Doctor Russell also uses a gravely injured accident victim to test a different one of her experimental treatments, killing him. According to her, conventional treatments wouldn't have helped, but Crusher points out that she didn't even try using them first.