Bree confides that she feels guilty because she and Rex were having a fight when he had his heart attack and that now he needs a pacemaker. Lynette's marriage takes a dramatic turn after an upset Tom vows that it is now her turn to go back to work and he'll be staying home with the kids. Carlos finally learns that John and Gabrielle have been lovers for a while, and vows revenge as he is carted off to jail. Mike takes Paul out to a deserted quarry, intending to shoot him.

Lynette tries to put a daycare center in Parcher & Murphy by recruiting employees' children to get the program started. Gabrielle and Sister Mary Bernard face off over Carlos' mission of mercy to Africa. Bree brings Andrew home and tells him about the revelation of George poisoning his father Rex and killing him. Lastly, Susan confronts her biological father's wife after she thinks they are having an affair.

Carlos and Gabrielle decide to adopt, but the process comes to be a lot more difficult than either had expected. Susan finally has her surgery as she finally has medical insurance. Meanwhile, a showdown between Bree and her son Andrew lead to a full out war between mother and son. Also, a dying Noah Taylor learns more about Paul Young and his biological grandson Zach. Lastly, Tom is having more difficulty at the job when having to take orders from his boss and wife Lynette.