On a diplomatic mission, Picard and the away team are attacked by a group of radicals. Picard is slightly injured, but the energy blast damages his artificial heart. Picard finds himself in the afterlife, but to his dismay it appears to be the domain of his nemesis Q, who bluntly says "Welcome to the afterlife, Jean-Luc. You're dead."
To prove that Picard is dead, Q introduces him to people that Picard is aware have died, including Picard's father, and the voices of people for whose deaths Picard is responsible. When Picard accuses Q of causing his death, Q reveals that Picard's artificial heart is the cause of his demise.
Picard lost his own heart in a bar brawl with Nausicaans - members of a quick-tempered, bullish race, which resulted in Picard being impaled from the back through his heart. Picard realizes his regret for his "wild youth" and that it has finally caught up with him. It is revealed that the basis of his current disciplined personality and need for privacy in his personal life is rooted in his regret over his earlier life and a wish to keep it secret.
Learning of Picard's regrets, Q offers to let him go back in time to prevent the injury that resulted in him obtaining an artificial heart. Picard is assured by Q that any changes he makes will not affect anyone other than himself. He is whisked back to two days before the injury, meeting with his friends and academy classmates Corey Zweller and Marta Batanides. To his friends and acquaintances, his "newly changed" personality comes as somewhat of an unpleasant surprise, and he alienates his friends - the person they knew as fun loving and quick to anger is now staid, slow to anger, and often unintentionally insulting.
Events proceed as they did with Zweller becoming enraged with a group of Nausicaans who cheat him at dom-jot. Picard short-circuits Zweller's plan to rig the dom-jot table, enraging his best friend in the process. After an intimate encounter with Batanides that was not part of the original timeline, the Nausicaans appear and insult Picard and his friends. Instead of taking on the Nausicaans, Picard throws Zweller out of the way of the fight. The Nausicaans call the ensigns cowards and leave - as do Zweller and Batanides. Picard has destroyed his friendship with them by refusing to stand up for Zweller. Q tells Picard that he has saved his heart, and returns him to the present.
Although Q's promise not to otherwise change the timeline has been kept, Picard finds himself on the Enterprise as a Lieutenant junior grade in the astrophysics department, with Worf as his immediate superior. After meeting with Riker and Troi, he discovers that his career is a list of routine postings and that he has accomplished little of consequence. He is described as competent by his superiors, but he fails to show initiative and is not willing to take the necessary risks in order to have a successful, well-rounded career in Starfleet.
Picard confronts Q, who tells him that although the bout with the Nausicaan nearly cost him his life, it also gave him a sense of his mortality.
Picard realizes that his attempts to suppress and ignore the consequences of his youthful indiscretions have resulted in him losing a part of himself â a part that he does not necessarily like, but a vital part nonetheless.
Q gives Picard the chance to go back again, even though Picard knows that restoring the time line will result in his death. Picard prefers death as the captain of the Enterprise to the routine life he has observed. He goes back to the fight, takes on the Nausicaans and events unfold as they should, with Picard being impaled through the heart and laughing as he collapses to the ground. In the present, Captain Picard awakes having been revived by Dr. Crusher.
On the Enterprise, Picard recovers from his injuries. He wonders if he really did journey into the past or whether it was merely a hallucination or one of Q's tricks. In any case, he observes that he learned an important lesson. Riker expresses some difficulty imagining Picard taking on three Nausicaans. At that point, Picard launches into another story about an encounter with Nausicaans in similar circumstances.