Growing up poor on the streets of New Jersey, Frank Siena (Danny Nucci) has little hope of realizing his dream of becoming a doctor. But "fate" has a way of intervening. Now a brilliant, successful cardiac surgeon, Frank seems to have it all, except for one terrible secret: Before he swore to save lives and do no harm, Frank took another oath... to mob boss Nicola Delarusso (Paul Sorvino), who paid his way through medical school in exchange for absolute loyalty. And when Delarusso demands payment in full Frank suffers a crisis of conscience that could cost him his job, his wife... and his life!

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