J.D. has finally earned the spot as brightest student, but he's got competition: Nick Murdoch, who seems to be nicer, friendlier and has a better butt than him. But even J.D. can't hate the guy, for he is so nice. But he is surprised when he finds Nick sitting in a corner crying because he can't take the pressure of medical internship. Meanwhile, Turk is having problems at the operation table and doesn't tell Carla, who keeps bothering Dr. Cox about it. And Dr. Cox gives Turk a very unique suggestion on how to calm down before surgery.

J.D. has a patient who's rude to him and the nurses and eventually dies from cancer. J.D. feels awful for not giving him his full attention and worries maybe he could have saved the guy if he was nicer to him.

Meanwhile, Elliot is convinced that Dr. Kelso is the one singing a song called "Tuscaloosa Heart" on a tape given to her by a patient who claims he went to college with Bob. And Dr. Cox finds himself trapped in a love square: He's falling in love with Kristen Murphy, his intern, just as his ex-wife reappears demanding sex – and there's also his crush on Carla.

All of the male doctors are euphoric due to the visit of Julie Keaton, the pharmaceutical sales rep, except for Dr. Cox, who still believes in treating patients for their best health, instead of trying to get some attention from the hot Ms. Keaton.

Meanwhile, J.D. and Elliot argue over a risky decision regarding one of Elliot's patients. Turk tries to talk Carla into entering a practitioner nurse course, so she won't be so underestimated by the doctor's staff.

Ever since her father cut her off financially, Elliot's been feeling the weight of the world on her back. While having to find a new affordable place to live, she also has to face the threat of being sued by a patient whom she told he had only eight months to live. Carla and Jordan hit a sore spot when Carla gives her opinion on Jordan and Perry's relationship.

Meanwhile, J.D. has a fight with Dr. Cox and the two dispute over who gets to give the better treatment to two patients with the same prognosis.

J.D. is unsure what to do, when he realizes he made a mistake telling Elliot he loved her.

The Janitor squares off against Dr. Cox after he loses the election of the janitors to Randall.

Carla's brother Marc constantly puts Turk in a tough situation, when Turk forgets to write his wedding vows.

Dr. Kelso dons scrubs to prove a point to Dr. Cox, only to watch it backfire, when an obnoxious patient refuses to listen to him.

J.D. and Turk party, while Carla struggles to find solace in Elliot.