There comes a time in the Operation Room when the mare or stallion cannot be saved. Families weep, and the surgeons who were a part of the operation have to live down their sense of guilt as they come back the to the hospital the following day.

For Razor Sharp, eccentric surgical genius, that hasn't happened yet, and he's determined to keep it that way. Known as the best surgeon in Equestria, there has never been a challenge too difficult for him to handle; every single patient that has come out of an operation performed by him has survived, even when by some accounts there was no way they could have.

When Princess Twilight Sparkle shows up in the Hospital one early morning in desperate need of an operation, Doctor Sharp is determined to get her out alive like all the rest of his patients and live up to his personal creed: "Not One Shall Perish"