Die Operation des Präsidenten steht unmittelbar bevor und die Nerven liegen bei allen Beteiligten blank. Doch dann erhält Ellen überraschend Besuch von der First Lady. Diese konfrontiert Ellen damit, dass sie gelogen hat und möchte sofort die Wahrheit über die Hintergründe wissen. In der Zwischenzeit hat Duncan mit Sandrines Hilfe einen Plan geschmiedet, um seine Familie zu befreien.
It’s the day of the President’s surgery and the various plots are in motion. Just before the surgery begins, Ellen is cornered by the First Lady, who finally sees through Ellen’s lies about her husband’s condition and forces her to tell the truth about the assassination plot. Ellen spills the secrets Kincaid has been keeping from his wife and she agrees to help get the bone marrow out of the hospital. Blair’s squad of hired terrorists move into position after passing themselves off as Secret Service agents, and they launch their diversionary attack just after Ellen nicks an artery during surgery. Once Ellen is alone with the President and Logan, she gives Logan a sedative, extracts the bone marrow, and prevents the President from bleeding out on the operating table. Once the terrorist threat is subdued, Ellen takes the bone marrow to Nina, who accepts it and apologizes for everything Duncan did to her family. Meanwhile, Duncan schemes with Vanessa to outwit Blair and free his family. He corners Blair at gunpoint at a fundraising banquet and demands that Blair’s men release Nina and Sawyer. Once they’ve been released, Blair lashes out, forcing Duncan to shoot and kill him. Duncan then confronts Archer, who has captured the rest of the Sanders family and demands payment for his services. The two battle in a brutal fistfight with Archer coming out on top, but Kramer arrives just in time to save Duncan and kill Archer. Duncan then reunites with Nina and Sawyer briefly, saying goodbye before turning himself in to the police for his actions.
Päätähuimaavassa päätösjaksossa presidentti Kincaidin, Ellenin ja Duncanin kohtalot ratkeavat. Juuri ennen h-hetkeä Yhdysvaltain ensimmäinen nainen hiillostaa Elleniä leikkaussuunnitelmasta, jonka epäkohdat eivät lopulta jääkään häneltä huomaamatta. Suostuuko rouva Kincaid leikkaukseen saadessaan vihiä kokonaiskuvasta, ja miten käy Ellenin kylmäpäisyyden, kun salaliittolaiset vaativat häntä päästämään presidentin päiviltä sairaalassa syttyvän kaaoksen keskellä? Vanessa auttaa Duncania nappaamaan Blairin, jotta tämä vapauttaisi Ninan ja Sawyerin.
C'est le grand jour de l'opération du Président; juste avant qu'elle ne commence, la first lady va trouver Ellen et l'oblige à avouer tout ce qu'elle savait au sujet de la santé du Président et la force de dire toute la vérité à propos du complot d'assassinat de son mari...
Duncan ed Archer escogitano un diversivo per fermare Sandrine, dopo aver scoperto il complotto contro di loro. Nel frattempo pero' Blair rapisce Nina e Sawyer, dicendo a Duncan che rivedra' la moglie e la figlia solo dopo l'avvenuto decesso del presidente. Archer riesce a scoprire dove si trova Jake e una volta che Brian e Morgan lo raggiungono, li conduce in un magazzino abbandonato dove minaccia di ucciderli e viene a conoscenza dell'accordo fra Duncan ed Ellen. Ellen, come programmato, tiene in vita il presidente, nonostante un'emorragia durante l'intervento. Poco prima dell'operazione Ellen racconta a Mary la storia di Nina e della sua malattia. La First Lady decide di aiutare la dottoressa e farle avere il campione di midollo osseo passando dalla sicurezza senza essere perquisita. Dopo l'intervento, Mary e Vanessa confessano a Kincaid di conoscere la verita' su Nina e Kate Renner, scioccandolo.
