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On Joshua's orders, Frank takes Jamal out to kill him, pointing out that he knew along that Jamal couldn't be trusted. Jamal doesn't believe he'll go through with killing him. In his opinion, Frank is a decent guy with a good heart who cares about his family and friends. In fact, Jamal used to be one of those friends. Frank isn't going to let that influence him now. When Jamal asks what Karen will say when she finds out, Frank threatens him with a stake and orders him to leave her out of this. Jamal thinks that Karen is Frank's conscience.
Not realizing that Lucy is speaking to Karen's spirit, Ian doesn't understand what she is trying to say. Lucy says that she now understands why her friend is there. Although she's not really ready to go, she will go if she has to; she's not afraid. Ian tells her that she's not going anywhere. Karen says that Lucy has so much more love to give and so many more things to do. Lucy doesn't get it. "Aren't you here to take me, Karen?" she asks. Karen tells her that it doesn't have to be that way. Ian puts it together and realizes that Karen is Lucy's angel. He tells his lover that Karen is there to save her, not take her. Karen tells Lucy that it's up to Ian now; he'll know what to do. Ian is again hopeful, confident that this is the cure they've been seeking. Chris doesn't like this; he thinks that he's gone far enough with this. Ian protests that Karen is the angel they were looking for. Chris reminds him that she was his friend, and she just died. He's still trying to deal with all this. Ian points out that she was also his friend. Now maybe she can save Lucy. Chris doesn't know what to think. Ian urges him to do something fast. Otherwise, Lucy won't make it. Ian doesn't know whether or not Chris believes in angels, but he does know that he believed in Karen. She would have done anything for a patient. He urges Chris to let this be her last save. Chris gives in. He and Ian rush out to prepare for the transfusion.
Karen goes to Lucy's bedside to be close to her friend. Lucy is glad she's there to save her, but she doesn't want her to die. Karen tells her that it's already done; her journey is over. Lucy says that she's been sensing her presence for the past few days, but she doesn't understand why her spirit was coming to her. Karen says that their destinies are connected. Their lives are meant to touch; she knows that now. Lucy wants to find another way. Karen tells her not to be sad. Her life's work was healing people, and now she gets to do that one more time. She kisses Lucy's forehead. Ian and Chris return with Karen's body, as well as the necessary medical equipment. Karen goes to look at her body. She smiles at Lucy and then fades away. The doctors go to work, but Chris soon becomes uncomfortable with the way things are going. Lucy's blood pressure drops, and her pulse increases. Chris wants to stop this now. Ian insists on continuing. Chris finally gives in again, knowing it's useless to argue with Ian when it comes to Lucy. Ian urges her to fight for her life. Chris warns that she could die. Ian counters that she could live. It's the only chance she has.
Frank warns Jamal to think of another way to save himself, because playing the sympathy card is a bad move. Jamal says that he doesn't want to die, even if it means living as a vampire. Frank tells him not to make it any harder than it has to be. Jamal is pretty sure that even with fangs, Frank would still help out a friend in trouble. Frank says that all his good deeds never got him anywhere. He was a pushover and a chump! Jamal reminds him that he had the power to change a life. He actually gave Jamal a job and a place to stay when nobody trusted him. He did the right thing. Frank grabs his neck again and accuses Jamal of bringing this on himself. Jamal again asks what Karen would say about this. Frank doesn't see Karen anywhere. Jamal tells him that he has a choice; he doesn't have to murder a friend in cold blood just because Joshua told him to. Frank isn't swayed. His phone rings, and he's annoyed by the interruption. He answers the phone, assuming that it's Joshua. "Don't do it, Frank. Stop," Karen says." She knows him, and she knows that he doesn't want to do this. Frank asks where she is, stating that the connection isn't very clear. His jaw drops as Karen urges him to let Jamal go. She tells Frank that he's a good man, and she believes in him. The connection is gone. Frank tries to call her back, but Ricky answers the phone. Frank is confused. He wants to know where Karen is. Ricky tells him to get to the hospital right now. Frank tries to put him off, saying that he's very busy at the moment, but Ricky insists, stressing that it's bad. Frank hangs up and rushes to the hospital.
Ian and Chris wait to see whether the transfusion worked this time. Chris leaves Ian alone with Lucy, saying to call him if there's any change. Ian lays his head down on Lucy's chest. Suddenly, Lucy's hand touches his head. He looks up and sees Lucy smiling at him. She came back to him. Overjoyed by her seeming recovery, they hug each other.
Dressed all in white, Karen is surrounded by white light. She's alone until Casey meets her and extends her hand. Together, they watch events unfold below.
Ian tells Lucy that he'll have to run some tests. Lucy says that she feels so much better, as if whatever was ailing her is now gone. Chris returns, happy to see that his friend and patient is better. Lucy jokes that he can't get rid of her that easily. His face wet with tears, Ricky enters the room just as Lucy relates a dream she had in which Karen healed her. Ian says that Karen did save her. Lucy realizes that Karen is dead. Ian confirms that she was hit by a car. Lucy is stunned. After taking it all in, Ricky announces his presence by saying that it all makes sense now. Chris asks what he's talking about. Ricky explains that Casey had no idea why she was sent to Port Charles, although she though at first that it was to save him. Tonight, he was going to stay home, but he got a sudden urge to see Karen and talk to her about Casey. Then he found her and brought her to the hospital. Casey completed her mission. "Good for you, baby," he says, looking toward heaven. Kevin comes in, followed by Elizabeth. Kevin is glad to see that Lucy is all right. Elizabeth remarks that she made quite a recovery. Lucy credits Karen for this. Having no idea what really happened, Kevin goes on and on about what a good doctor Karen is. Lucy stops him and says that Karen died. Frank, who just arrived, states that it's not true, because he just talked to her on the phone. Chris tells him that it's impossible, since she died over an hour ago. Frank wants to know how he heard her voice. He has to see her!
Casey tells Karen that she touched many lives during her time on earth. Karen says that she had a lot of wonderful friends, and she loved them all. Casey says that she gave them a brand-new start, which is one of life's most precious gifts.
Jamal unties the rope around his feet. "I owe you, Karen," he says, running out of there.
Frank thinks it must be a mistake. He doesn't believe it until he pulls back the sheet and sees Karen's face. He kisses her face and tells her that he will love her forever. White light bathes him, and he looks up. "Let my love guide you and keep you safe, Frank, until we meet again," Karen says from heaven.
Casey takes Karen's hand again to lead her.
Ian lies down with Lucy, saying that he ran all the tests and that the disease is out of her system. Lucy states that it's because she refused to leave him. She kept hoping for a miracle, and then she saw Karen's smiling face. Now everything seems so much better. She's going to use this second chance to the fullest, and she will carry Karen around with her always. Scott bursts into the room, having heard that Karen was in an accident and that he should see them. Throwing her arms around him, Lucy tells him that she's so sorry. Scott has no idea what she means. When Lucy doesn't reply, he seems to understand what happened to his daughter.
Karen doesn't want her father to be sad. Casey assures her that he'll realize that she saved Lucy's life, and that knowledge will bring him comfort. Karen is happy to know that she helped Lucy. Casey tells her that she fulfilled her destiny and that she has earned a place of honor in heaven. Karen comments that she feels such peace. Casey says that although her time on earth is up, her journey is just beginning, and it will be a beautiful one. Karen always wondered whether she would be able to say that she had no regrets. She can. Casey tells her that there's nothing to be afraid of. "Not anymore," Karen agrees. She kisses the palm of her hand and holds it down. Lucy feels it and touches her cheek. "Goodbye, Karen. Thank you, my angel," she says gratefully.
Her work done and her goodbyes said, Karen takes Casey's hand and walks toward her new life.