Doug Ross (George Clooney) attends an interview for a new job at a private pediatric practice after he is told his contract at County General will not be renewed.
She is examined by Peter Benton (Eriq La Salle) and his interns John Carter (Noah Wyle) and Harper Tracy (Christine Elise).
Ross returns to the ER for his final shift, greeted by Mark Greene (Anthony Edwards) and Carol Hathaway (Julianna Margulies), but seems strangely annoyed considering his successful interview.
Joey leads Ross to a storm drain where his brother, Ben (Erik von Detten) is trapped, with his leg caught in a gate inside.
Ross goes back to his car to fetch tools to help, telling Ben to keep singing while he is gone in an attempt to stop the youth from losing consciousness in the cold water.
The gate suddenly breaks, and the huge water pressure sends both Ross and Ben flying back into the pool at the end of the drain tunnel.
At the same time, in the other trauma room, Molly has crashed during her CT. Ben is hypothermic and placed on a heart bypass machine while his body is warmed up.
[2] Mike Duffy of the Detroit Free Press gave the episode three out of four stars and called it "one powerful hour of roller coaster television.
"[3] Duffy said "Hell and High Water" does not "quite match the brilliance" of critically acclaimed first-season episode "Love's Labor Lost", but the "intense and affecting hour of ER at least gives George Clooney a prime showcase for proving he's not just another pretty face.
[4] He thought that unlike "Love's Labor Lost", which flowed naturally, "Hell and High Water" "feels like a more blatantly manipulative ratings sweeps stunt.
"[4] He believed viewers would feel "drained" by the end of the intense episode, but Clooney shows that he has a "future to burn on TV's hottest hit.
"[4] Howard Rosenberg of Los Angeles Times praised Clooney, Baer, and Chulack for making the episode "a suspenseful, transfixing blow away—and one that forged an uneasy, fleeting alliance between emergency medicine and local TV news, their clashing agendas in this case belied by a shared reliance on speed.
"[6] John Martin for the Courier News gave the action an "A-plus" and found the secondary storyline of Molly's accident "gives the hour added emotional punch.
"[9] In The Times-Tribune, syndicated reporter Kirk Nicewonger also thought Clooney would garner an Emmy nomination after giving "what may well be the dramatic performance of the season".
"[10] He urged viewers not to miss the "incredibly intense" episode, writing "For 60 minutes, the tension never lets up, and the ending—a catharsis juxtaposing life and death— packs enough power of heart to light up Chicago.
[2] He felt that it "really solidified" Clooney's importance in the show, and "definitively showcased the types of stories that ER could tell, many of which did not have to take place inside a hospital.
[11] When ER was made available to stream on Hulu, Randee Dawn of USA Today, chose "Hell and High Water" as one of eight episodes that would "get your heart racing".
At the Primetime Creative Arts Emmy Awards, Richard Thorpe's work on the episode earned him an Outstanding Individual Achievement in Cinematography for a Series nomination.