When J.D. and Turk are paid a visit by their college cohort, Spence — who is now leading a life of luxury as an investment banker — they are struck by the daily sacrifices they make as residents leading them to re-evaluate their career choices. Spence’s visit also triggers the reveal of another dirty little secret – Dr. Cox learns the truth about his relationship to Jordan’s baby, but the truth may be more than he can handle. Meanwhile, Elliot’s skills and patience are tested by the unrelenting Dr. Kelso.

The unexpected death of Carla’s mother causes her to second guess her wedding plans with Turk. J.D. turns to Elliot for help when his romance with Jamie begins to fizzle, and Dr. Kelso appoints Dr. Cox to teach a daily seminar on doctor-patient relations as punishment for his inappropriate behavior.

JD finds himself in a tough spot after a romp with Jamie in a funeral home leads him to an accidental sighting of the janitor’s “private” equipment and a language barrier with a patient results in some major miscommunication. Meanwhile, Turk starts having steamy dreams about Elliot making things a bit uncomfortable, especially when Carla finds out and Jordan forces Dr. Cox to watch her still-to-be-named son.

J.D., begins a surgical rotation and in an attempt to lose his nerdy medical resident reputation he reveals a secret about Turk to get “in” with the rest of the surgeons. While his betrayal earns him a place at the surgical table, it may cost him a friendship. Meanwhile a miscommunication between Elliot and Paul leads to confusion about their true feelings for each other and Dr. Cox plays a “deadly” practical joke on Dr. Kelso.

When J.D. starts getting flak from his friends about dating a woman who is visiting her comatose husband, he quickly becomes defensive. Elsewhere, Carla and Turk fight over every little thing since they became engaged, Dr. Cox is jealous of all the attention Jordan gives the newborn baby and Elliot overreacts because she thinks Paul doesn’t trust her.

While J.D. struggles with whether to tell Dr. Cox the truth about the baby’s paternity, he gains some valuable insight into Dr. Cox’ troubled mind and his relationship with Jordan when he meets Dr. Fisher, a former student of Dr. Cox. When Dr. Kelso prevents Turk from playing his pre-surgery basketball game, Turk retaliates by cutting the cord to Kelso’s beloved Ms. Pac Man machine. Meanwhile, Carla worries that she’s lost her sex appeal since she got engaged and Elliot’s lucky streak continues as she makes a new friend in the janitor.

Elliot tries to keep up her perfect persona for her new boyfriend for fear he won’t like her if she tries just being herself. At the hospital, things misfire for Jordan and Dr. Cox when a miserably executed practice run of the baby’s birth turns into the real thing — and in the throes of labor, Jordan reveals the identity of the baby’s father to J.D. Meanwhile, Turk and J.D. can’t handle their guilt when they believe that one of the golf balls they hit off the hospital roof caused a car accident.

At a bar, Carla makes a decision on the right answer to Turk’s proposal while Elliot thinks she has struck gold when she meets Paul, a charming man whom she recognizes from the hospital and assumes is a fellow physician. However, the next day, she learns that he is a nurse, and she is forced to put her ego in check to give the relationship a chance. In the meantime, J.D. enjoys a rare day when everything goes right while Dr. Cox’ world is in chaos as he manages to alienate himself from all of his colleagues at the hospital.

Dr. Kelso assigns J.D. to work on a patient with Dr. Townshend, but things go downhill when Dr. Townshend insists on using his “old school” treatment method which proves to be an alien concept to an inept J.D. While Kelso defends his friend’s technique, Dr. Townshend’s lack of current medical knowledge forces Kelso to admit his mistake. Meanwhile, Carla tells Turk she needs time to consider his proposal because she thinks he is still too immature, prompting Turk to invite his married brother for a visit to show Carla how seriously he is. In addition, Elliot learns the sex of Jordan’s baby, but Dr. Cox and his ex-wife can’t agree if they want to know.

Turk makes plans to propose to Carla, only to watch all his plans fall apart when one thing after the next prevents him from actually popping the question. Meanwhile, J.D. comforts a patient in need of a heart transplant by explaining his theory about the balance between life and death in the hospital. This theory is put to the ultimate test when a husband must choose between saving his unborn child and his wife’s well-being. On another front, Elliot prevents Dr. Kelso from expanding his office space when she launches a campaign demanding that Dr. Kelso build a separate female locker room.