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: When twin children, Johan and Anna Liebert, are brought in after a brutal massacre of their foster parents, Tenma prepares to operate on the boy, Johan, who has a critical head wound. Moments before the surgery, the Mayor of Düsseldorf is admitted with a stroke. The Director orders Tenma to abandon the boy to save the high-profile politician. The Climax: Saving a "Monster"

: The episode questions if all lives are truly equal, as Tenma's "moral" choice leads to a darker outcome.

: Tenma’s career is instantly derailed. He is stripped of his promotion, Eva breaks their engagement, and the Director ensures he has no future in medicine. The Twist: A Grim Reward

: The surgery is a success, but the Mayor dies under the care of other surgeons.