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As repayment for services rendered by his father, young New Jerseyite Frank Siena (Danny Nucci) is put through medical school in the U.S. and Italy by powerful mafia don Nicola Dellarusso (Paul Sorvino). Upon becoming a doctor, Siena dutifully returns the favor by giving body and soul to the organization, covering up murders, tending to the mob wounded without making police reports, and, in general, relinquishing his soul in the name of gratitude. Although Frank's mafia-princess wife enjoys the perks attending his privileged status, Frank ultimately suffers from pangs of conscience fueled by the pointed words of his envious friend Danny Keegan (Jonathan Scarfe). But when Frank goes to Dellarusso and respectively asks to be let off the hook, he is rather forcibly made to realize that no one retires from the mafia and lives to tell about it.